Psychological wellbeing in professional orchestral musicians in Australia

International Symposium on Performance Science ISBN 978-2-9601378-0-4 The Author 2013, Published by the AEC All rights reserved Psychological wellbeing in professional orchestral musicians in Australia Dianna T. Kenny 1, Tim Driscoll 2, and Bronwen Ackermann 2 1 Faculty of Arts and Social Sciences, University of Sydney, Australia 2 Sydney Medical School, University of Sydney, Australia We report the major findings from the psychosocial questionnaire component of a cross-sectional population survey of the musicians in Australia s eight full-time professional symphonic and pit orchestras. The response rate was 70% (n=377). Female musicians reported significantly more trait anxiety, music performance anxiety (MPA), social anxiety, and other forms of anxiety and depression than male musicians. The youngest musicians (<30 years) were significantly more anxious compared with the oldest musicians (51+). The youngest female musicians were most affected by MPA. Music performance anxiety was lowest for the older musicians (51+ years). Thirty-three percent (33%) of musicians may meet criteria for a diagnosis of social phobia. Twenty-two percent (22%) answered in the affirmative to a question screening for post-traumatic stress disorder. Thirty-two percent (32%) returned a positive depression screen; this subgroup had higher scores on the anxiety measures. Linear regression analysis identified STAI-T, SPIN, ADD, and age as independent predictors of music performance anxiety severity. Significant numbers of musicians (14%) drank alcohol in a manner outside the NHMRC alcohol guidelines (2009); only 6% were current smokers. This study has identified a significant pattern of anxiety, depression, and health behaviors that require attention in occupational health and safety policies and programs for this workforce. Keywords: professional orchestral musicians; psychosocial well-being; music performance anxiety; depression; anxiety The act of playing music professionally is a complex undertaking, similar to many elite sports, requiring a high level of physical and psychological skill to

166 WWW.PERFORMANCESCIENCE.ORG succeed; yet there have been few health or psychological services to support this population, in great contrast to the sporting population (Tubiana 2000). The mental health of professional musicians is not well understood; hence, their mental health needs are often poorly managed (Kenny 2010). Psychosocial health including health behaviors, such as substance and alcohol use, have not been systematically studied and this needs to occur in order that health prevention programs target the appropriate health behaviors for the appropriate subgroups if these are identified. In 2005, a comprehensive review was conducted of the Orchestras of Australia. This review noted soaring insurance premiums related to health issues and, inter alia, issued a key recommendation to study and develop specific occupational guidelines for orchestral musicians (Strong 2005). In a unique research effort, a national collaborative team was funded to address these major health concerns in this population. The team includes researchers from the University of Sydney (the authors) and the eight major symphony and pit orchestras of Australia with funding support from two Australian government agencies: The Australia Council for the Arts and the Australia Research Council. The first major phase of the study was a cross-sectional survey of the musicians. The survey involved a detailed questionnaire and administration of standardized psychological tests. This paper reports on the major findings from the psychological component of the questionnaire, including psychological tests. We assessed the prevalence and reported causes of music performance anxiety within this population, identified comorbidity profiles, and provide some normative data on a range of psychological screening tests for professional musicians. Participants METHOD Participants were musicians (184 males [49%] and 192 females [51%]) from the eight state orchestras of Australia (n=377, 70% response rate). The mean age of the musicians was 42.1 years (SD=10.3; range=18-68 years). Materials The inventories used were the: Kenny Music Performance Anxiety Inventory (revised) (K-MPAI; Kenny 2011); Trait questionnaire of the State-Trait Anxiety Inventory (STAI-T; Spielberger 1983); Anxiety Sensitivity Index (ASI; Reiss et al. 2008); Social Phobia Inventory (SPIN; Connor et al. 2000);

INTERNATIONAL SYMPOSIUM ON PERFORMANCE SCIENCE 167 PRIME-MD Patient Health Questionnaire; Anxiety and Depression Detector (ADD; Means-Christensen et al. 2006); Core Self-Evaluations (CSE; Judge et al. 2003); and the Alcohol Use Disorders Identification Kit (AUDIT; Babor et al. 2001). Descriptive measures designed by the first author for the study were the performance anxiety in different performance settings rating scale, perceived causes of music performance anxiety checklist, and self-management of music performance anxiety rating scale (for details of measure construction, see Kenny et al. 2011). Procedure All musician members from the eight orchestras were invited to participate. Those who agreed to participate (n=377) completed a self-report survey containing a demographic questionnaire and all of the above measures. RESULTS K-MPAI, SPIN, ASI, STAI-T, and ADD were highly inter-correlated and significantly negatively correlated with CSE, indicating that low CSE predicted higher scores on the anxiety measures (SPIN r=-0.53; STAI-T r=-0.75; K- MPAI r=-0.71; ADD r=-0.50). Female musicians reported significantly higher trait anxiety (F=8.46, p=0.004), music performance anxiety, social anxiety, and depression than males. The youngest musicians (<30 years) were significantly more anxious than the oldest musicians (51+; F=2.87, p=0.04). For K- MPAI, the sex by age interaction was significant (F=2.94, p=0.033). For K- MPAI, male musicians scores remained stable across the four age categories, but female scores did not. The youngest female musicians were most affected by music performance anxiety (mean=104.5), followed by females in the 41-50 year age group (mean=99.7). Music performance anxiety was lowest for the older musicians (>51 years) for both males (mean=78.6) and females (mean=78.3). There were no significant differences in K-MPAI, STAI-T, SPIN, or ADD by instrument group. Eighty-four (n=84; 22%) musicians answered in the affirmative to the question on PTSD in ADD. Musicians were asked to review and then select from a list of 22 items those which they identified as causal factors in their music performance anxiety. From their self-generated list, musicians were then asked to rank order the item in terms of its importance as a factor causing their music performance anxiety. Results are presented in Table 1. Table 2 presents musician ratings of the degree to which they experienced performance anxiety in a variety of musical performance and other situations (such as making an oral presentation or sitting an examination). The non-

168 WWW.PERFORMANCESCIENCE.ORG musical situations were used as benchmark comparisons for the level of anxiety reported in musical settings. Ratings were made on a scale from 0 to 10 where 0=not at all anxious and 10=extremely anxious. Significant percentages of musicians engaged in adaptive strategies to manage MPA such as increasing their practice time before stressful concerts and practicing relaxation techniques. Musicians also used medications to manage their MPA, most commonly beta blockers (31%), but also alcohol (12%), anxiolytics (5%), and antidepressants (4%). Table 1. Numbers, percentages and first ranked causes among 22 causes of music performance anxiety in orchestral musicians (n=377). All ranked causes of music performance anxiety N % % Rank 1 Pressure from self 320 88.6 28.8 Excessive physical arousal prior to, or during 278 78.3 24.4 performance Inadequate preparation for performance 220 63.0 18.8 Health issues 159 45.0 16.8 Tendency to be anxious in general, not just in 131 37.3 15.3 performance Negative thoughts/worry about performing 270 76.3 13.6 Not knowing how to manage physical arousal 165 48.1 13.6 Lack of confidence in yourself as a musician 175 51.5 11.8 Attempting repertoire that is too difficult 216 61.4 9.8 Inadequate support from people close to you 92 27.3 9.7 Concern about audience reaction/fear of negative 243 67.5 9.6 evaluation Bad performance experience 277 78.0 9.6 Concern about reliability of memory 202 57.5 9.0 Generally low self-esteem 122 36.0 8.7 Pressure from conductor or section leader 151 43.4 8.5 Pressure from/competing with peers, other musicians 212 60.7 8.2 Technical flaws that cause uncertainty 255 72.2 8.1 General lack of self-confidence 192 59.1 8.0 Not knowing how to manage negative thoughts/worry 161 47.4 7.6 about performing Pressure from parents 41 12.2 6.3 Generally high level of self-consciousness 191 55.5 4.4 Negative performance feedback 113 33.6 3.3

INTERNATIONAL SYMPOSIUM ON PERFORMANCE SCIENCE 169 Table 2. Mean ratings (0-10) of degree of MPA in different musical settings. Severity of MPA Impact of MPA Performance setting N Mean SD Mean SD Audition 334 8.44 2.07-1.73 2.89 Solo performance 333 7.30 2.31-0.53 2.86 Oral presentation 328 5.82 3.03-1.16 2.35 Chamber music performance 335 5.82 3.03-1.16 2.35 Orchestral concert performance 366 4.85 2.80-0.12 1.93 Lesson or master class 297 4.30 2.94-0.49 1.94 Written exam 290 3.63 2.85-0.12 1.93 Orchestral rehearsal 366 3.01 2.32 0.01 1.98 Practicing alone 365 0.62 1.21 0.12 1.71 Using the SPIN cutoff score of 19 to diagnose social anxiety disorder, 128 (34%) orchestral musicians in this sample (Males=56 [30.4%]; females=72 [36.9%]) may meet criteria for a diagnosis. There were no sex or age group differences. 32% (n=118) of musicians responded in the affirmative to either the first (12.8%) or second (1.9%) question only or to both questions on the PRIME- MD (n=64, 17.4%), indicating that further screening for depression should occur. Univariate ANOVAs indicated that more severe depression was associated with more severe MPA (F=40.84, p=0.001), trait (F=74.02, p=0.001), and social (F=21.03, p=0.001) anxiety. K-MPAI was predicted by STAI-T, SPIN, ADD, and age (F4,343=155.73, p<0.001) in regression analyses; the model explained 65% of MPA variance. DISCUSSION The K-MPAI was sensitive to the age and sex differences observed in most measures of anxiety. Significant correlations with each of the anxiety measures used in this study provide early evidence for the convergent validity of K-MPAI, STAI-T, SPIN, and ADD, which contributed unique variance to the prediction of K-MPAI scores, in addition to age. The results suggest that tests of PTSD and depression need to be included in assessments of musicians presenting with problematic MPA; assessments of medication use are also warranted, given the high usage in this population. This paper has cast a bright light on the extent of underlying psychological difficulties, which must

170 WWW.PERFORMANCESCIENCE.ORG be addressed as a needed first step in enhancing the psychological well-being of this valued profession. Acknowledgments This study was funded by the Australia Research Council (LP0989486), the Arts Council of Australia, and the eight state orchestras of Australia. We thank James Strong for the Strong Review of Orchestras (2005) that motivated this study. Address for correspondence Dianna T. Kenny, Australian Centre for Applied Research in Music Performance, Faculty of Arts and Social Sciences, University of Sydney, Sydney, New South Wales 2006, Australia; Email: dianna.kenny@sydney.edu.au References Babor T. F., Higgins-Biddle J. C., Saunders J. B. et al. (2001). AUDIT - Alcohol Use Disorders Identification Kit. Geneva: World Health Organization. Connor K. M., Davidson J. R., Churchill L. E. et al. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. British Journal of Psychiatry, 176, pp. 379-386. Judge T. A., Erez A., Bono J. E. et al. (2003). The core self-evaluations scale: Development of a measure. Personnel Psychology, 56, pp. 303-331. Kenny D. T. (2010). Negative emotions in music making: Performance anxiety. In P. Juslin and J. Sloboda (eds.), Handbook of Music and Emotion. Oxford: Oxford University Press. Kenny D. T. (2011). The Psychology of Music Performance Anxiety. Oxford: Oxford University Press. Kenny D. T., Fortune J., and Ackermann B. (2011). Predictors of music performance anxiety in skilled tertiary level flute players. Psychology of Music, 41, pp. 304-326. Means-Chrisensen A. J., Sherbourne C. D., Roy-Byrne P. P. et al. (2006). Diagnostic accuracy of the anxiety and depression detector. Gen Hospital Psych, 28, pp. 108-118. Reiss S., Peterson R., Taylor S. et al. (2008). Anxiety sensitivity index consolidated user manual: ASI, ASI-3, and CASI. Worthington, Ohio, USA: IDS Publishing. Spielberger C. D. (1983). State-Trait Anxiety Inventory STAI (Form Y). Palo Alto, California, USA: Consulting Psychologists Press. Strong J. (2005). A New Era: Report of the Orchestras Review. Canberra: Australian Government. Tubiana R. (2000). Functional anatomy. In R. Tubiana and P. Amadio (eds.), Medical Problems of the Instrumentalist Musician. London: Martin Dunitz.