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Performance anxiety can range from an occasional crisis to a reason for changing PERFORMANCE careers. Physicians and sports psychologists—and insightful ANXIETY AND music teachers—have helped artists transcend, harness, or HOW TO BEAT IT just leave the shakes behind. Here’s a psychiatrist’s hen I first met Lisa, have much to do with actual artistic analysis of the syndrome— a talented pianist skill or knowledge. It has hobbled the and a recipe for the cure. in her second year pre-eminent as well as the novice. It is at a prestigious an equal-opportunity anxiety that doesn’t by RICHARD A. conservatory, she discriminate. FRIEDMAN, M.D. sat down in my Vladimir Horowitz, Maria Callas, Sergei officeW and burst into tears. “I knew that Rachmaninoff, and even the great Chopin Bach cold and don’t know what happened were all said to have been plagued by to me.” performance anxiety. The legendary actor At 18, Lisa was no stranger to perfor- Laurence Olivier said in an interview on mance—she’d been playing for audiences, 60 Minutes that well into middle-age, whether friends, family, or perfect when he was at the apogee of his career, strangers since she was six. Over the past he reached a point where he could not several months, she had worked hard on a go out on stage because of paralyzing Beethoven Sonata, the Brahms Handel anxiety. During a run of Othello, he once Variations, and a Bach Partita. “I could asked a fellow actor to stand in the wings have played this in my sleep,” she said. during a soliloquy so that he didn’t feel I was sure she could have, but during so alone on stage. her recital something alarming had hap- What, exactly, are performers with this pened: she felt unaccountably nervous anxiety so fearful of? What danger lurks a few hours before the performance and, in the audience that could provoke such as it drew near, she became aware of a panic and dread? Very little, in reality. sense of dread. She had no idea what she Performance anxiety is fundamentally was anxious about—after all, she could a hard-wired fight-or-flight response play it all flawlessly in the studio—but that we share with virtually all other when she finally walked out on stage animals and that evolved over millions and looked out at the audience, she of years to protect us from life-threat- might as well have come face to face ening dangers. Faced with a potential with a lion. Her heart raced, her mouth predator or feared enemy, we get a surge was cotton-dry and she felt tremulous. of adrenaline and the stress hormone Worst of all, her hands felt rubbery. cortisol. Our heart rate spikes, our mus- Welcome to performance anxiety, a cles are supercharged and we are ready very common anxiety response that has to flee—or fight. It is a marvelous feat afflicted performers of all levels and of evolutionary engineering that saved ages ever since humans invented the our ancestors from saber-toothed tigers ritual of artistic performance. As you and the like. The problem is that we are have already guessed, it doesn’t really still hard-wired for high-risk life in a 95 MUSICIANS’ HEALTH

world that, for most of us, no longer exists. percent of the nearly two thousand musi- are several others. All block the adrenaline Ask people with performance anxiety cians surveyed reported that performance receptors in the body, preventing rapid what they fear and they will tell you that anxiety was a serious problem for them. heart rate, sweaty palms, dry mouth, and they worry they will humiliate or embar- But many smaller studies done in the past tremulousness. These drugs generally do rass themselves in front of other people. It few years show higher rates of performance not make a person feel calmer at baseline, doesn’t take much imagination to see that anxiety among musicians, in the range of but kick in when a person is stressed. Beta- the experience of being intensely scruti- 40 to 50 percent. Not surprisingly, subjects blockers are also used to treat high blood nized is exactly what prey experience— indicated that they were more distressed pressure and cardiac arrhythmias, though just before a predator pounces and makes giving solo performance than when playing at much higher dosages than we use for dinner of them. In other words, people with chamber music. performance anxiety. In low doses, these performance anxiety are reacting as if they Performance anxiety is not a universal drugs rarely have adverse side-effects. But were still living on the savanna facing a experience. As with other anxiety states that doesn’t mean you should take your mortal threat, when they are simply on (such as panic attacks and social phobia), friend’s medication. It should be prescribed stage facing a group of largely harmless genetic factors increase susceptibility. by a physician who knows your medical strangers. Sure, there might be the occa- Some people are temperamentally more history and has examined you to be sure sional critic sharpening his knife in the reactive than others and are hard-wired to that these usually safe drugs do not cause audience, but there is little mortal risk to be more socially anxious. Developmental a problem for you. For example, some peo- performing. This is not to say that the stakes and psychological factors play a role as ple with very low heart rates or low blood aren’t high for musicians in today’s super- well. It is not hard to imagine how overly pressure can still take low-dose beta- competitive environment. Of course they are, critical or perfectionistic parents or teachers blockers, but their blood pressure needs but musicians with performance anxiety might make an individual feel inhibited or to be monitored. experience disabling anxiety at every per- anxious about performing. Contrary to popular intuition, anti-anxiety formance—even when the stakes are low. Curiously, children rarely suffer from medications, such as Valium and It is not that anxiety per se is a bad performance anxiety. Young kids are typically Klonopin—so-called benzodiazepines— thing. In fact, in small doses, it is beneficial. unselfconscious and supremely confident are a very bad idea for performance anxiety. There is a well-known relationship between performers. With the teen years comes peer Sure, they will lower anxiety levels, but anxiety and performance that takes the pressure and much greater self-awareness; they are sedating and can impair reflexes shape of an inverted “U” curve. As anxiety social acceptance by one’s peer group is and motor function. You might feel calm— and arousal rise, performance of all types critically important to teens, and that gen- and give a truly bad performance. Then improves—up to a certain point. Once you erates greater social anxiety, of which you’ll really have something to worry about. reach a critical level of anxiety—and that performance anxiety is just a special type. But there is more to performance anxiety inflection point varies tremendously among What was effortless in childhood is now than just physical symptoms. Perpetuating individuals—there is a steady deterioration filtered through self-doubt. Perhaps the the anxiety is a set of negative thoughts in performance. great pianist Artur Schnabel had this in that people with performance anxiety When you are anxious, your neurons mind when he said that “Mozart is too easy commonly develop about themselves and release norepinephrine (a chemical relative for children and too difficult for artists.” the world: polarized thinking (everything of adrenaline) in your brain and this in turn Much can be done to help people who is all good or all bad); overgeneralizing enhances learning and memory. That is why suffer with performance anxiety. In the (one bad performance is equated with the we learn best when we are a little excited medical world, there are two effective person’s entire capability); catastrophizing or anxious. treatment strategies—biological and psy- (small mistakes seen as disastrous and While we all come equipped with a chological—that target different aspects career-ending); and personalizing (every- fight-or-flight reflex, performance is not of performance anxiety. thing is seen as a reflection of a person’s sufficient to set off this panic alarm in most The class of drugs known as beta-blockers self-worth, with no separation between the people. Still, it is a real problem for many can dramatically blunt the physical symptoms person and the task). This pattern can be musicians. The largest study to date, the brought about by the surge of adrenaline. changed through cognitive therapy. International Conference of Symphony and Propranolol (also called Inderal) is the most In cognitive therapy, the performer and Opera Musicians survey, found that 16 commonly used beta-blocker, though there therapist work together to examine,

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challenge, and correct these dysfunctional thoughts, a process that lowers the stakes of each performance and reduces anxiety MEET DON generally. But that is not all. Performance anxiety is very much like any phobia; people natu- GREENE rally want to avoid things and situations that make them anxious. It is counterin- tuitive, but the most effective treatment for Sports psychology had the time in D.C. and in Illinois as a special phobia is the very thing people want to avoid: jump on other fields in dealing investigator. Next was southern California, more of the feared situation. In other where he went on the strength of an words, exposure and desensitization. with performance anxiety. employment offer—but it fizzled after The more an artist performs—and sees Here’s an alternative to the he’d already moved. Temporarily jobless, there is no catastrophic outcome—the more medical model. he was playing volleyball on the beach comfortable she feels performing. With one day, when his teammate, “an old guy exposure, you become desensitized to the by ELLEN GOLDENSOHN with a PhD in psychic regulation,” started anxiety of performance and come to feel analyzing why some of the other players what you intellectually have always known: he idea that a professional were missing their shots. The man gave him there is no real danger on the stage. musician’s performance a book on the subject of consciousness. Ironically, musicians tend to learn music anxiety is a disorder, or a Fascinated, Greene began immersing in a way that probably increases the phobia like a fear of heights, himself on the subject of mental focus— chance of performance anxiety; they offends performance psy- reading more books and writing down his practice alone and achieve mastery in a chologist Don Greene. “I own thoughts. After stints teaching phys. sound-proof room. This does not prepare Tdon’t work with exceptional people,” he says. ed. to 3rd and 5th graders and working as them for their goal, which is to perform in “There’s nothing wrong with them; they a forensic psychologist for the county front of a crowd. Obviously, if you master are not afflicted. If your heart is racing, District Attorney, Greene decided to enroll a piece during practice and mess up during that’s a normal reaction— normal for elite in the doctoral program at U.S. performance, the problem is not a technical performers facing severe consequences.” International University in San Diego one—it’s emotional. The better approach Greene, who is 64, deals with focus and (“They had the best sports psychologists is to practice performance. Be willing to concentration—and the factors that interfere in the country”). play what you are working on for your friends with them. He has been thinking about As soon as he had his Ph.D., a faculty or class at the drop of a hat. Desensitize the subject on and off ever since high mentor offered him a chance to work with yourself by making performance a common school, when a Bronx chiropractor/trainer Olympic-level divers in Mission Viejo and, and routine part of your life. called Doc Goldenberg used hypnosis to subsequently, in Florida. In the ensuing The goal is not to vanquish anxiety. help him improve his performance as a years—in Florida and then in Vail, Colorado— That is not possible or even desirable; a competitive diver. he developed a clientele that included little anxiety is critical to a good perfor- Greene has written three books on han- such pressured folk as skiers, Grand Prix mance. But there is no good reason to let dling performance-related fears, and explains drivers, and female professional golfers. performance anxiety get in your way. that performance psychology practice Just as he was getting bored and deciding The truth is that performance anxiety is was well established in the sports world he’d already “done it all,” musicians dis- common, painful—and treatable. long before he began adapting its methods covered Greene—and Greene discovered for musicians. music. An amateur golfer he’d helped Richard A. Friedman, MD, is a professor of clinical Educated at West Point in the 1960s, happened to also be the principal bassist psychiatry at Weill Cornell Medical College and Greene spent the Vietnam Era in the military of the Syracuse Symphony. The bassist director of the psychopharmacology clinic at New York–Presbyterian’s Weill Cornell Medical as a Green Beret. After the war he got a wanted Greene to present some classes Center in New York City. He is also a classically master’s in forensic science at George for the orchestra members on “how to trained pianist. Washington University and worked for a quiet their minds.”

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“I didn’t know if I had anything to offer,” that precedes musical performance. “It’s rate to 110 or so. Then, with energy still Greene says, “but I agreed to meet with all about power and focus, about getting high, they come back into the room, pick them. A few came to hear me the first day in touch with their power.” That’s why up their instrument, center themselves I talked, some more on the second day— Greene maintains that beta blockers according to Greene’s technique, and begin and everybody came the third day.” One of aren’t a good idea. “They reduce the heart to play. the attendees, a clarinetist who was tortured rate and try to shoot between speeding “It’s not about playing well in the prac- whenever he had an exposed solo entrance and relaxation. But beta blockers can tice room” says Greene, “it’s about doing or an audition, approached Greene and make you both unpredictable and lethar- well under pressure. Musicians spend too confessed, “My life is dominated by this. gic, like driving a car at 95 miles an hour much time practicing practice. They should I’ve tried everything—alcohol, beta block- with the brake on. I have [the musicians] be practicing performing.” ers, everything.” going with the energy; that’s why sports As you might expect, Greene has kept Greene knew that sports psychology psychology works.” Well-regulated perfor- moving. His success with musicians led to had a solution: “It was a no brainer. It was mance energy, explains Greene, is like work with Wall Street traders, offering 1994, and musicians didn’t have it yet.” As driving well at 70–75 mph; audition ener- counseling after the trauma of 9/11 and he was leaving Syracuse for home, he gy has to be even higher. helping them stay calm when making promised to give some phone sessions to Though action-oriented, the Greene huge financial decisions under pressure. a French horn player with audition problems. method, which can be explored on his Next was Honolulu, where he worked at Back in Florida at around the same time, website (www.dongreene.com), is not the city’s largest private school (President Greene met an opera coach who urged him without introspective aspects. Clients first Obama went there, says Greene), coaching to work with two singers whose anxiety was take his Performance Inventory, a ques- both athletes and musicians. so out of control that “they were considering tionnaire that asks them to identify all the But Greene missed New York and bailing” from an upcoming performance factors that interfere with concentration returned to teach at Juilliard for another of La Bohème. The women quickly on the task at hand, producing a profile that year, during which he wrote Fight Your responded to some basic sports psychology is the basis of future work. A musicians’ Fear and Win. In Phoenix, his next stop, he techniques, says Greene, and word about workbook, 11 Strategies for Audition and “made a ton of money working with pro- his approach began to spread. Meanwhile, Performance Success, is a step-by-step fessional golfers.” Greene didn’t like the he’d fallen in love with opera (an art form guide to Greene’s practical approaches. Arizona heat, though. Now he’s back in he says he’d been avoiding all his life) and The meat of the method is “Centering,” San Diego again and writing a book. This was soon coaching more singers. And the a seven-step strategy that yields con- time it’s his memoirs. Syracuse French hornist he was working scious control over breathing and silences So far there are 714 pages. with by phone aced his audition and won one’s “hypercritical inner voices,” the neg- a job with the Houston Symphony. ative thinking that Greene says emanates All of this led to Greene’s first book, from the brain’s left hemisphere. Most Audition Success. The ultimate mainstream important, the strategies are designed to acceptance came in 1998, when Joseph build qualities most musicians probably W. Polisi, president of The Juilliard School, haven’t acquired: courage, confidence, hired him to give master classes and later, resilience, and toughness. a graduate course. These, according to Greene, are the Greene’s thinking about musicians had character traits that affect performance, been evolving as he went along. “I kept as opposed to the technical mastery that hearing their teachers say, ‘Relax, relax!’ ” affects musicianship. Under his supervision, But he came to believe that the whole musicians simulate the performance situ- notion of relaxing was missing the point, ation—complete with tension-producing even counterproductive. factors. While the piece they are to perform He threw away his notes and adopted a sits on the music stand, they leave the different approach—channeling and con- room and do something vigorous, such as trolling the anxiety-producing energy rush climbing stairs, that will raise their heart

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times. I just did a concert, premiering two sonatas by Robert Capanna. But it went JAZZ, CLASSICAL great because the pianist, Michal Schmidt, and I, did lots of informal house concerts (15 people or more) before the premiere, MUSIC, AND and we focused carefully on releasing our mental and physical tension areas. And I always go back to what I learned ANXIETY from another teacher—David Cerone. He A CONVERSATION WITH DIANE MONROE taught me that no matter what—no mat- ter how many mistakes you might make—you can still do it—communicate Diane Monroe is a Philadelphia- So, in the end, what helped you? the whole work, from A to Z, not worrying based violinist who has had an Some amazing violin teachers got me out about every little thing. That’s the goal, to of all that, especially Karen Tuttle, who was get to Z—with confidence. active career for the past thirty my chamber music coach at Philadelphia years. In her case, great teachers Music Academy and later at Curtis, and Inda How does your classical —not MDs or psychologists— Howland and Rachel Adonaylo, chamber training affect your jazz helped her handle performance music and aural skills coaches. They helped performance? me to get rid of my technical focus. The fears. Recently, crossing over I am about to change course—I have whole point is letting go and focusing on changed course. To date, I feel I haven’t been from classical to jazz created the music. able to improvise as well as I’d like because a new set of challenges. I also played the guitar. When I was of my response to my training. The violin about 18, Karen Tuttle came to hear one of was just learning and learning and learn- How young were you when you my guitar concerts, where I just played ing—not playing. But with the guitar, I first experienced performance and sang songs that I’d written. She saw just played. anxiety? how relaxed I was and said, “You’ve got to Now, with the violin, I am devoting I think from the very beginning—my first play the violin the way you play the gui- myself to listening, closing my eyes and piano recital when I was four years old. My tar.” I thought, “How do I do this?” seeing what’s happening. knees shook and my hands were unsteady. But KT had some tools for getting me to Pieces like David Baker’s Violin Concerto I’d played freely by ear before that, but become aware of what was happening in include improvisation. When I premiered when I had lessons I started worrying that my muscles and my body, and then to let go. it last year, I played from the music. I was I was going to make a mistake. There were also some breathing techniques. under the impression that I could read the Then one day on stage, I actually felt written sections and use my ear for the When did you start violin, and myself transform. I still felt all the nerves— improv sections. This led to a less refined, when did your anxiety peak? but now the point was to allow it all in, less expressive performance in the written I was eight years old when I moved to the instead of pushing it away. I felt all of sections. On stage, my ears naturally want violin. The anxiety was worst when I was those things that made me crazy before— to take control while performing, but I in my 20s. and then I became relaxed. often panic when that instinct kicks in, because I have practiced only in “eye” mode. How did you deal with it? So does that mean you’re totally I am a musician who was trained early on Did you take beta blockers? cured? that to play by ear was inferior to reading In the 1970s and 80s there was a trend to I still get nervous. Lately jazz performance the same notes on a page. beta blockers. I only took them once—I was has been totally dominating what I do, but so curious. It was not for me. It blocked out I also play recitals fairly regularly. And faced my whole emotional sense. I wasn’t able with learning new, different pieces, every to express. muscle in my body can get tense some-

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