Treating Music Performance Anxiety by Healing Attachment Trauma

Introduction

Kenny et al (2014) present a case study of a typical professional musician suffering from music performance anxiety: a 55-year-old senior strings player in a leading Australian orchestra, named Kurt[1]. During musical performances he typically reported overwhelming anxiety, distracting physical sensations and thoughts, inability to control his arms, and striated muscle tension. This significantly detracted from both his performance and his personal enjoyment of his career[2].

Music performance anxiety is a serious problem for many professional musicians[3]. Typical symptoms while performing include overwhelming anxiety, profuse sweating, dry mouth, muscle tension, inability to focus, loss of self, loss of flow, paralysis and catastrophic performance failure. General traits common to sufferers include perfectionism, dependence on drugs and alcohol, fear of exposure, fear of failure, catastrophizing and extreme emotional distress. Such traits have consequences beyond the performance realm including poor mental and physical health. Many sufferers abandon their career in music altogether while others soldier on despite having a miserable experience[4].

The Problem

Kurt had tried several strategies for dealing with his music performance anxiety including meditation, visualization, self-affirmations, over preparing, and beta-blockers. While these had all been of some benefit, none of them had eliminated his anxiety to his satisfaction. In addition to feeling anxious while performing, Kurt also experienced social anxiety and negative self-talk. He generally acted passive, helpless and detached; rationalized his feelings; and internalized his anger. At the time of the case study, he had recently failed to win a promotion in his orchestra despite having previously acted in the role for some time and attributed this failure to performance anxiety during the audition[5].

According to Attachment Theory, the inability to form a secure emotional bond with parents in early childhood causes attachment trauma that leads to emotional problems in adulthood[6]. Kenny shows that attachment trauma can be triggered unconsciously in performance situations, leading to music performance anxiety, and that this can be cured with an appropriate emotionally focused therapy[7].

Kurt’s mother had been mentally ill, and his father was violent. This left him emotionally abandoned as a young child with no safe outlet for his rage. Kurt became socially anxious and withdrawn as an adult. He was afraid of his own anger and projected his unconscious rage towards his parents onto his audience[8]. He had a strong fear of negative evaluation that triggered when he felt that he was being judged by other people. This led to music performance anxiety whenever he played in front of an audience who he feared may evaluate both his performance and himself negatively[9].

Music performance anxiety is a special case of fear of negative evaluation which can result from early life attachment trauma.

The Solution

Kenny proposed that Kurt’s music performance anxiety was an unconscious manifestation of unresolved childhood attachment trauma and could therefore be resolved by addressing this in therapy. To do so, Kurt had ten sessions of an emotionally focused therapy named Intensive Short-Term Dynamic Psychotherapy (ISTDP) [10].

In ISTDP, an involved therapist utilities empathy, challenge and transference to access genuine feelings about the past which the client has repressed and dissociated from. Using the attachment model, the therapist systematically challenged Kurt’s defenses and helped him overcome his fear of intimacy to access unconscious feelings of intense guilt and rage towards both his parents for emotionally abandoning him as a child.

A major breakthrough came while recalling a specific incident of being beaten by his father. Kurt’s repressed rage emerged, initially projected onto the therapist, and then his father. This was coupled with intense feelings of guilt and anger towards his mother for failing to protect him. Expressing his true feelings of anger, grief and pain towards the therapist, his father, his mother and his wife ultimately gave Kurt access to feelings of love towards himself. He stopped unconsciously self-sabotaging with performance anxiety and began enjoying the experience of performing on front of other people.

Conclusion

Unresolved emotional pain from the past can be triggered by present circumstances, leading to feelings that are out of proportion with our current experience. Traumatic childhood experiences can create patterns of emotional suppression and avoidance which go on to run much of our adult lives.

Music performance anxiety can be caused by unresolved attachment trauma being triggered unconsciously by the evaluative presence of the audience. Traditional cognitive strategies for dealing with performance anxiety don’t go deep enough into the unconscious to deal with trauma. Emotionally focused therapies such as ISTDP can access and release the stored emotions. Once the painful memories from the past have been healed, they no longer get triggered unconsciously when in front of an audience, thus alleviating the resulting music performance anxiety.

Kenny elaborates further on Kurt’s case and gives more details on how healing unresolved childhood attachment trauma can cure music performance anxiety in a subsequent paper[11]. It explores in more detail how a child’s rage at their parents for abandoning them emotionally must be suppressed in order to survive, and how this creates intense feelings of inner conflict and guilt for experiencing rage towards the very parents they both love and rely on for their survival. However, music performance anxiety may also have other causes[12]. Further systematic research is required to determine how often music performance anxiety is related to attachment trauma and can therefore be treated effectively with therapies like ISTDP.

Bibliography

Bowlby, John. Attachment and Loss: Separation, Anxiety and Anger, vol 2. London: Hogarth, 1973.

Davanloo, Habib. “Intensive short-term dynamic psychotherapy: extended major direct access to the unconscious.” European Psychotherapy 2, no. 2 (2001): 25-70.

Kenny, Dianna T. The Psychology of Music Performance Anxiety. Oxford: Oxford University Press, 2011.

Kenny, Dianna T.; Arthey, Stephen; Abbass, Allan. “Intensive Short-Term Dynamic Psychotherapy for Severe Music Performance Anxiety: Assessment, Process, and Outcome of Psychotherapy with a Professional Orchestral Musician.” Medical Problems of Performing Artists March (2014): 3-7. https://doi.org/10.21091/mppa.2014.1002

Kenny, Dianna T.; Arthey, Stephen; Abbass, Allan. “Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP)”. SpringerPlus, 5(1) (2016). https://doi.org/10.1186/s40064-016-3268-0

Footnotes

[1] Dianna T. Kenny, Stephen Arthey, Allan Abbass, “Intensive Short-Term Dynamic Psychotherapy for Severe Music Performance Anxiety: Assessment, Process, and Outcome of Psychotherapy with a Professional Orchestral Musician,” Medical Problems of Performing Artists, March (2014): 3-7. https://doi.org/10.21091/mppa.2014.1002

[2] Ibid 5.

[3] Dianna T. Kenny, The Psychology of Music Performance Anxiety (Oxford: Oxford University Press, 2011), 2-5.

[4] Ibid 1-13.

[5] Kenny et al, “Intensive Short-Term Dynamic Psychotherapy for Severe Music Performance Anxiety”, 5.

[6] John Bowlby, Attachment and Loss: Separation, Anxiety and Anger, vol 2 (London: Hogarth, 1973), cited by Kenny et al, “Intensive Short-Term Dynamic Psychotherapy for Severe Music Performance Anxiety”.

[7] Kenny et al, “Intensive Short-Term Dynamic Psychotherapy for Severe Music Performance Anxiety”, 4.

[8] Ibid, 6.

[9] Ibid, 7.

[10] Habib Davanloo, “Intensive short-term dynamic psychotherapy: extended major direct access to the unconscious.” European Psychotherapy 2, no. 2 (2001): 25-70, cited by Kenny et al, “Intensive Short-Term Dynamic Psychotherapy for Severe Music Performance Anxiety”.

[11] Dianna T. Kenny, Stephen Arthey, Allan Abbass, “Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP)”. SpringerPlus, 5(1) (2016). https://doi.org/10.1186/s40064-016-3268-0

[12] Kenny, The Psychology of Music Performance Anxiety. p83-107