Musicians and performance anxiety
Before we get too exercised about musicians calming themselves with beta blockers, let's acknowledge that physicians have been known to take these meds themselves before stressful occasions. (I have one friend whose propranolol wore off about 30 minutes before his board exam, much to his dismay...) Athletes and public speakers have been known to use them as well.
Both Medpundit and bookofjoe have weighed in on this topic. It seems obvious that self-medication is hazardous, that a level playing field is desirable in competitions, and that performance anxiety should be addressed as part of musical training. This article from "American Music Teacher" seems to have a sensible approach. The author, Anne Petrovich, is a violinist and psychologist. She has this to say:
"What differentiates musicians who thrive on performance from those who dread it and suffer the disabling effects of severe performance anxiety? Contrary to commonly held, and often comforting, beliefs, the amount of technical practice and preparation, the degree of talent and the excellence of professional training with the "right teacher" are not factors that differentiate the confident from the terrified performer. "Preparation, preparation, preparation," or "practice, practice, practice," though important and necessary conditions for an effective performance, are insufficient mechanisms for coping with the anxiety involved in severe stage fright. What the exceedingly nervous performer needs is not only musical preparation, but also a way to manage the anxiety engendered by the performing situation.
"...anxious students will interpret almost any physiological signs of anxiety as harbingers of an impaired performance. Moderate physiological arousal enhances performance, if interpreted by the student as alertness or preparedness. Too much arousal, such as shaking hands, pounding heart, profuse sweating, lightheadedness or other elements of the fight-or-flight response, impairs performance. Self-efficacy is strengthened whenever a musician can reduce the degree of physiological arousal to a manageable level...
"...There are three important points for teachers to remember when discussing with students the use of medication to control anxiety: first, medications should be dispensed only by physicians and not "shared or borrowed" from other sources; second, students whose anxiety is so severe that medication is needed should never be shamed or made to feel inferior or guilty about using a drug; and third, care should be taken not to describe the medication as all-powerful, because the performer may then attribute a successful performance only to the drug, thus reducing his own sense of self-efficacy for managing anxiety. Medical interventions are best used, if at all, as part of a range of coping techniques incorporating all the self-efficacy sources. When considering physiological/emotional arousal, the overall goal should be to help the student learn to control the amount of arousal experienced and to interpret arousal as enhanced preparedness." She also describes behavioral techniques to help manage the anxiety.
Was the music teacher cited in the NYT article fired for having the sort of discussion that Dr. Petrovich describes? Teachers and prescribers could probably find a way to work together on this. But with some caution, of course; these meds are not entirely benign, as Dr. Rangel says:
"**Medstudent and Resident Alert - Beta blockers may not kill off your social life but they can still cause the following: Worse CHF during an exacerbation, heart block (especially if used with other negative chronotropic agents), bronchospasm (even if selective agents are used), worsening peripheral vascular disease, and they may impair the ability to recover from exogenous insulin induced hypoglycemia and mask symptoms of hypoglycemia in diabetics."
Both Medpundit and bookofjoe have weighed in on this topic. It seems obvious that self-medication is hazardous, that a level playing field is desirable in competitions, and that performance anxiety should be addressed as part of musical training. This article from "American Music Teacher" seems to have a sensible approach. The author, Anne Petrovich, is a violinist and psychologist. She has this to say:
"What differentiates musicians who thrive on performance from those who dread it and suffer the disabling effects of severe performance anxiety? Contrary to commonly held, and often comforting, beliefs, the amount of technical practice and preparation, the degree of talent and the excellence of professional training with the "right teacher" are not factors that differentiate the confident from the terrified performer. "Preparation, preparation, preparation," or "practice, practice, practice," though important and necessary conditions for an effective performance, are insufficient mechanisms for coping with the anxiety involved in severe stage fright. What the exceedingly nervous performer needs is not only musical preparation, but also a way to manage the anxiety engendered by the performing situation.
"...anxious students will interpret almost any physiological signs of anxiety as harbingers of an impaired performance. Moderate physiological arousal enhances performance, if interpreted by the student as alertness or preparedness. Too much arousal, such as shaking hands, pounding heart, profuse sweating, lightheadedness or other elements of the fight-or-flight response, impairs performance. Self-efficacy is strengthened whenever a musician can reduce the degree of physiological arousal to a manageable level...
"...There are three important points for teachers to remember when discussing with students the use of medication to control anxiety: first, medications should be dispensed only by physicians and not "shared or borrowed" from other sources; second, students whose anxiety is so severe that medication is needed should never be shamed or made to feel inferior or guilty about using a drug; and third, care should be taken not to describe the medication as all-powerful, because the performer may then attribute a successful performance only to the drug, thus reducing his own sense of self-efficacy for managing anxiety. Medical interventions are best used, if at all, as part of a range of coping techniques incorporating all the self-efficacy sources. When considering physiological/emotional arousal, the overall goal should be to help the student learn to control the amount of arousal experienced and to interpret arousal as enhanced preparedness." She also describes behavioral techniques to help manage the anxiety.
Was the music teacher cited in the NYT article fired for having the sort of discussion that Dr. Petrovich describes? Teachers and prescribers could probably find a way to work together on this. But with some caution, of course; these meds are not entirely benign, as Dr. Rangel says:
"**Medstudent and Resident Alert - Beta blockers may not kill off your social life but they can still cause the following: Worse CHF during an exacerbation, heart block (especially if used with other negative chronotropic agents), bronchospasm (even if selective agents are used), worsening peripheral vascular disease, and they may impair the ability to recover from exogenous insulin induced hypoglycemia and mask symptoms of hypoglycemia in diabetics."
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