Performance anxiety: Can we really treat it?
Performance anxiety is a common experience for many people, but particularly prevalent amongst performing artists and athletes. It can manifest as a range of physical and cognitive symptoms, impacting performance and wellbeing. This blog post explores the findings of a 2023 review article by Niering et al., which investigated the effectiveness of psychological interventions on performance anxiety. The authors carried out a systematic review and meta-analysis, including 20 controlled trials that employed psychological interventions to address performance anxiety in performing artists and athletes.
The Scope of Performance Anxiety
Anxiety-related mental health problems are some of the most prevalent mental health disorders globally. Among professional sportspeople and performing artists, the prevalence of anxiety-related disorders is estimated to be between 19.5% and 34%.
Performance anxiety is understood to be a response to a perceived threat, which triggers a 'pre-encounter defence' mechanism involving activation of the prefrontal cortex. While fear is typically linked to specific objects or situations, the cause of performance anxiety is less clearly defined. Individuals may experience a range of physical symptoms, including increased heart rate, trembling, and sweating, as well as cognitive symptoms such as worry, overthinking, and attentional disruption. These symptoms can significantly affect both quality of life and performance.
State vs. Trait Anxiety
It's important to distinguish between two types of performance anxiety: state anxiety and trait anxiety.
State anxiety is a temporary response to a perceived threat, such as an upcoming performance or competition.
Trait anxiety, on the other hand, reflects a more stable, inherent predisposition towards anxiety.
Both state and trait anxiety can impact performance, but interventions may be more effective in addressing state anxiety.
The Need for Intervention
In their review, Niering et al. highlight the limited evidence-based knowledge regarding effective psychological interventions for performance anxiety in athletes and performing artists. This gap in research is particularly concerning given the high prevalence of performance anxiety in these populations and the potential impact on their careers and wellbeing.
The review examined a variety of psychological interventions, including:
Relaxation techniques
Slow breathing
Bio- and neurofeedback
Self-talk
Cognitive restructuring
Mindfulness
Acceptance and Commitment Therapy (ACT)
Virtual reality exposure
Hypnotherapy
Somatic techniques
These techniques aim to reduce sympathetic activation, change the way individuals perceive anxiety symptoms, and help them restructure negative thoughts that may affect performance.
What Did the Research Find?
The meta-analysis by Niering et al. yielded encouraging results, with psychological interventions demonstrating a large effect on state performance anxiety, particularly in studies that utilised scales with subscales (e.g., the Competitive State Anxiety Inventory-2 Revised or CSAI-2R). Interventions that specifically focused on motivational self-talk or imagery consistently showed the most promising results. The authors suggest that these positive outcomes may be due to participants' familiarity with these cognitive strategies, leading to better emotion regulation and executive function under pressure.
The results for trait anxiety, however, were less conclusive. While the review found a small effect in favour of psychological interventions, this effect was not statistically significant. Studies that examined performance-oriented but not elite athletes tended to show stronger improvements. The authors suggest that elite athletes may have already developed effective coping mechanisms, or may be less receptive to stress reduction interventions than recreational athletes.
Limitations and Future Directions
The review by Niering et al. highlights some key limitations in the existing research:
Heterogeneity in Interventions: The studies included in the review varied significantly in terms of the types of interventions used, the number and duration of sessions, and the overall length of the intervention. This makes it challenging to directly compare interventions and draw firm conclusions about their effectiveness.
Baseline Differences: Some studies included in the meta-analysis had significant differences in baseline anxiety levels between the intervention and control groups, raising concerns about potential bias and impacting the validity of the results.
Limited Generalisability: The majority of studies on performing artists focused on musicians, making it difficult to generalise findings to other artistic disciplines.
Future research should address these limitations by:
Conducting more rigorous studies with larger sample sizes
Standardising interventions to allow for better comparisons
Exploring the effectiveness of different interventions in specific populations
Investigating the long-term effects of interventions
Examining the relationship between visual skills and performance anxiety, given the proposed role of working memory overload in performance anxiety and the importance of visual skills for athletic performance.
Conclusion
Despite these limitations, the findings of Niering et al. offer a glimmer of hope for those who struggle with performance anxiety. Psychological interventions, particularly those that focus on cognitive strategies like self-talk and imagery, appear to hold promise for reducing state anxiety and improving performance. More research is needed to determine the most effective approaches for addressing trait anxiety. It is crucial for performers and athletes to be aware of the available resources and seek professional support when needed.
