A number of issues have been recognized as being salient for performers in various domains (Hays & Brown, 2004; Hays, 2009, 2012; Murphy, 2012). These include concern for high standards and excellence, competition, the role of emotion, memorization, the role of the audience, consequences to performance, and performance stress. These issues are addressed in the next section in relation to performing artists.

High Standards and Excellence

For performing artists, “the pursuit of flawlessness is legitimatized, encouraged, and even revered” (Hill, Witcher, Gotwals, & Leyland, 2015, p. 237). While recognizing that “perfection,” if it exists, would at best be momentary or fleeting, for many performing artists the affective experience is black and white, all or nothing: Anything less than perfect performance is considered failure. Testing this anticipation of error via a “Russian roulette” method of repeated practice serves only to increase performance anxiety (Provost, 1995).

Even though, moment to moment, one cannot change what has just occurred, performing artists dwell on error. This is perhaps best exemplified in dance, where, in an Orwellian “newspeak,” the highest form of praise is meted out via “corrections” given by one’s dance teacher. In her autobiography, long-time Canadian principal dancer Karen Kain noted her teacher’s technique:

… [She] singled me out, giving me a dozen corrections every class, while everybody else got two or three. Nobody thought for a minute that these frequent corrections meant I was making more mistakes than anyone else; in the elite world of dance, only those who have promise are given these attentions (1994, p. 15).

The double-edged sword of perfectionism is intimately intertwined with artistic performance. On the one hand, everything is driven toward the goal of perfect performance; on the other, the spectre of not being perfect hovers and intensifies, as one comes closer to the actual performance event. Although perfectionism has often been portrayed as a personality disposition, typically with pejorative attribution, aspects of perfectionism are intrinsically involved in the pursuit of excellence (Nordin-Bates, 2012). Research in sport psychology on adaptive versus maladaptive perfectionism has relevance to artistic performance (Mainwaring, 2009). In competitions for young talented musicians, perfectionistic strivings, as compared with perfectionistic concerns, were found to be positively correlated with music awards (Stoeber & Eismann, 2007).

Especially salient in artistic performance is self-oriented perfectionism. Concern over judgments of others, particularly one’s professional peers, as well as a sense of obligation to not let down the ensemble, colors much of a performing artist’s concerns. “Am I in tune with or matching the timbre of the other musicians in my section?” may feel much more important than the judgment of the massed audience watching the performance.

A recent atheoretical, qualitative inquiry involved semistructured interviews with professional athletes, dancers, and musicians who self-identified as perfectionists (Hill et al., 2015). These perfectionist performers noted three overarching themes: drive, accomplishment, and strain. Drive was described as “unwavering commitment to, and focus on, constantly improving her or his performance/work” (p. 242), including obsessiveness, meticulousness, and a continuing commitment to remaining dissatisfied with current levels of performance. Participants saw this drive as critical to their success and accomplishment, while recognizing that drive could strain both intrapsychic and interpersonal relationships (Hill et al., 2015).

Competition

The central role of artistic performance is aesthetic and subjective, involving interpersonal communication. It would seem, then, to differ from sport performance, which is designed for competition, whether against others or some external standard (the clock, specific judgment, or rules of the game). In fact, though, competition permeates various aspects of all performing arts. Competition and its effects can be seen in the hierarchy of roles within the performing arts, for example. The artist may be designated the first chair of a section of an orchestra, a principal dancer, or be given the lead role in a theatrical production (Hays & Brown, 2004). By being unnamed, unacknowledged, and unaddressed, competition may be even more insidious and challenging for performing artists.

Competition begins during initial training and continues throughout one’s professional career. Even once thoroughly trained, actors, many musicians, and some dancers must compete on a regular basis. Many performing artists work independently, with no particular professional trajectory or prospect that one job will lead to the next (Kogan, 2002). Especially for actors, auditioning for roles or positions may be an ongoing fact of life. Even as a member of a performance company, competition may occur for a particular role or change in status.

The Role of Emotion in Performance

As one of the central aspects of human behavior, emotion plays a pivotal role in all areas of performance. How emotion is addressed, however, varies among different domains of performance (Hays, 2012). Further, it is important to differentiate between the experience of emotion and the use of emotion in performance. Three elements deserve attention: the performer’s awareness of emotion, expression of emotion, and regulation of emotion.

The salience of emotion to optimal performance has gained or lost favor at different times within research regarding sports performance. Because cognitive behavioral perspectives have dominated research and the practice of psychological skills training, the primary focus is often on the influence of cognition of negative emotion and its transformation or regulation (Jones, 2012). Designed to increase, minimize, suppress, prolong, or curtail the emotional experience via behavioral or physiological regulation, recommended strategies are intended to assist athletes to increase attentional focus or to allow for cognitive reappraisal while avoiding distraction from attending to their emotions (Martinet, Ledos, Ferrand, Campo, & Nicolas, 2015). As an alternate perspective concerning emotion, the influential work of Yuri Hanin (2000) has suggested that for any individual athlete, a particular set of emotions (which can range from positive to negative) is necessary for optimal arousal and performance.

In some contrast to sports, one of the primary functions of performing arts is the expression of emotion, whether verbally or nonverbally (Nordin-Bates, 2012). Musical expression of emotion has been described as a reflection of the nonverbal aspects of speech, such as tempo, loudness, articulation, or timbre (Juslin, Friberg, Schoonderwaldt, & Karlsson, 2004). Mood in music is evoked by valence (such as happiness or sadness) and arousal (action vs. calmness). To fully engage the auditor, musicians need to balance intensity and variety of emotional expression (McPherson & Schubert, 2004).

In regard to the art of performance, emotional expressivity is often considered mysterious, subjective, ineffable, and logically inexplicable; it should not be demystified. “Technical aspects of playing are often regarded as learnable skills, whereas expressive aspects are regarded as instinctive” (Juslin et al., 2004, p. 251). Yet because emotion is a key component of the performing arts, a more nuanced perspective allows the performer to attend to emotion in a systematic way rather than hope for some unarticulated understanding and expression. For some, the emotion felt by the artist helps the artist understand the composer’s, playwright’s, or choreographer’s intent. Among actors—whose job it is to portray someone other than themselves—various “schools” of teaching and practice have addressed the issue of emotional expression. The most well-known may be “Method” acting, based on Stanislavsy’s Russian system and developed in New York in the mid-20th century. Actors are encouraged to find resonance within their own emotional experience to portray their character most authentically (Ohikura, 2014).

An alternative perspective considers the actor’s own emotion as “noise” that may prevent the audience from the experience of the emotion. In this regard, artists become the conduit rather than direct expressor of their own emotion. Twentieth-century film director Frank Capra summarized this perspective: “I made mistakes in drama. I thought drama was when actors cried. But drama is when the audience cries.”

A mindfulness framework may be especially congruent in regard to the importance and value of emotion to the performing arts. The adaptation of the Acceptance and Commitment Therapy (ACT) (Hayes & Strosahl, 2004) model to sport performance has been proposed for enhancement of performance in any domain (Moore, 2016). The Mindfulness–Acceptance–Commitment (MAC) model (Gardner & Moore, 2007) is designed to support decreased reactivity to internal experiences, whether cognitive or emotional, while increasing task-relevant, present moment attention and increased activation of behaviors congruent with one’s goals and values (Moore, 2016).

Memorization

The need for and expectation of memorization is different for performing artists than for other types of performers and varies depending on the particular art form. The demand for memorization means that the performance itself needs to be known, exactly, before one is “on.” It is expected that the actual performance will occur as rehearsed and memorized; at the same time, the performer needs to be ready to deviate as needed during the actual performance (Hays & Brown, 2004).

The process of memorizing is both a task and a skill; it requires learning within context as well as overlearning (Chaffin, Imreh, & Crawford, 2002; Nordin-Bates, 2012). “The symbol system specific to the particular art form will determine what is remembered—notes for musicians, words for actors, movements for dancers, notes and words for singers” (Kogan, 2002, p. 3). Additionally, the performing artist needs to “metabolize” the memorized material so that it becomes transformed from technical mastery into artistic expression.

Audience

Artistic performance, in its essence, exists in an interpersonal space. It is constituted of both performers and audience. This idea is perhaps most dramatically evident in theatrical production. The “fourth wall” is a long-standing convention that allows actors to perform as if their created world were real. This (invisible) boundary sets off audience from the performers’ “life” on the stage, yet plays directly to the audience.

Even though the presence of an audience is a key element of being a performing artist, some aspiring dancers or musicians, attracted by the precision of movement or the sound of the instrument, may disregard the fact that accomplishing their art will involve presentation before others (Kain, 1994). One psychological element of performing, then, will be the need to figure out how to cope with the necessary presence of audience. For some, it will be a matter of playing to the audience, sharing in the beauty of what is being presented. Others attend to the art form itself, mentally disengaging from the audience.

Performance Consequences

One of the defining features of performance is that there are consequences: What one does matters, it has an effect. Performing artists need to come to terms with the perception, and at times the reality, that they are being judged. In some instances, the actual consequence will be determinative, for example, whether one did or did not win the audition. In others, the consequence will be in the form of critique, whether that be parents, coaches, other performers, critics, or administrators.

Performers also evaluate their own performance. They need to appreciate when and how to do so. Like other performers, self-critique may occur during the performance itself, e.g., focusing on an error that the performer has just made. One of the primary mental skills that performing artists need to have is the capacity to redirect their attention back to the present.

Performing artists are also likely to critique themselves and feel most vulnerable to others’ assessments shortly after a performance. At a physiological level at this time, the performer is flooded with emotion, whether positive or negative (and even if positive, one that can very easily turn negative). Rational attention to one’s performance tends to occur after the physiological reactivity has worn off, yet close enough to the event that the performer retains a clear memory of the various aspects of the performance. Critiquing from a more dispassionate perspective provides the opportunity to learn and build on prior performance.

Performance Stress, Tension, and Anxiety

Stress is variously defined: Depending on the context and the reporter, the term may be used to describe a stressor that disrupts homeostasis. It also can refer to distress, the discomfort experienced in relation to a stressor. Further, stress may refer to the physiological, behavioral, cognitive, and/or affective components of increased arousal (Sataloff, Rosen, & Levy, 1999).

Performance stress and tension in the performing arts is ubiquitous. It is readily recognized, acknowledged, and labeled. The common term “stage fright” is unmatched in any other performance arena. Nervousness or pre-performance jitters may be readily acknowledged, yet performers often receive the message that further practice will resolve any concerns, as if full technical knowledge will solve the cognitive and affective components as well (Patston, 2016; Taborsky, 2007). Anything else is viewed as a sign of weakness or incompetence.

Performance anxiety can be experienced in terms of physiological or somatic (e.g., increased heart rate or sweaty palms), behavioral (e.g., over-rehearsal, or conversely, avoidance), and cognitive aspects (e.g., negative self-talk and catastrophizing), as well as the interaction among those elements. Because of varied definitions, different genres of performing arts, and minimization of the psychological components of performance stress, it is challenging to have a clear understanding of this complex area.

Estimates of performance anxiety among professional musicians have ranged from 16% to 75% (Lederman, 1999; Patston & Osborne, 2016). This startling range—that performance anxiety may affect only 1/6th, or on the other hand, the vast majority of musicians—raises many questions about labeling, diagnosis, and implications for prevention or treatment. If performance anxiety is normative, should it deserve a specific diagnostic category befitting mental ill health? Yet for more than twenty-five years, the term music performance anxiety, or MPA, has been described and measured (Kenny, Davis, & Oates, 2004; Salmon, 1990).

Is performance anxiety the same thing as stage fright? Characterizing stage fright as “self-poisoning by adrenaline,” Acocella described some of the ways that performing artists deal with tension around performing:

Dancers get relief from anxiety just by moving, and to a rhythm, which restores regular breathing. Actors, when the curtain goes up, usually have some narrative matter that they have to communicate to the audience—the dinner guests are coming, the kingdom has to be divided in three, whatever—and this task will help get their minds off their jitters. Furthermore, dancers and actors are usually onstage with others, who cue them for their lines and their steps, and just keep them company. Solo performers of music are up there alone. (Acocella, 2015)

The connection and interaction between music performance anxiety and perfectionism has frequently been noted (Kenny et al., 2004; Patston & Osborne, 2016). Great concern over mistakes may interact negatively with self-criticism, lowering musicians’ estimates of self-efficacy (Patston & Osborne, 2016). Among adolescent musicians, strong correlations between MPA and perfectionism have been noted, with females scoring higher on measures both of music performance anxiety and perfectionism, in particular, concern over mistakes (Patston & Osborne, 2016).

Performing artists’ development occurs within a contextual and developmental framework. This aspect of performing artists’ lives is addressed next, both in relation to the context of the performer’s family and other influential people, as well as the development of skill or expertise.

Family Development

Families are not only centrally important in children’s development, the family itself follows a developmental sequence (Carter & McGoldrick, 1989). Focusing on young elite athletes, Côté (1999) proposed three stages of sport participation in their development: the sampling years (approximately ages 6–13 years), specialization years (ages 13–15 years), and investment years (15+ years), noting the relevant familial developmental tasks at each stage. Although considerable subsequent research has occurred within the sporting realm (e.g., Harwood & Knight, 2016), there is much evidence to suggest that these phases occur across performance domains (Harwood, Douglas, & Minniti, 2012). Fundamental to parental engagement is a balance between integration, such as support and stability, and differentiation that nurtures independence and challenge (Nordin-Bates, 2012).

Because there is a dearth of information concerning performing artists’ psychosocial development, it may be useful to look at parallels among young athletes. Research concerning young athletes has delineated important but varying roles for parents, dependent in part on the age and developmental level of the young athlete. Among elite adolescent athletes, parents influence motivation, perceived competence, and concentration both regarding their sport as well as their entire development (Knight, Little, Harwood, & Goodger, 2016). Adolescents appear to prefer motivational and constructive, rather than instructional, technical, or tactical advice. Practical and logistical support, limiting demands, having a positive and long-term perspective, managing their own anxiety, and appreciating a growth mindset (Dweck, 2007) are all important interactive elements (Knight et al., 2016).

Among young athletes, the opportunity for “sampling,” that is, engaging in a variety of sports in the initial stages of skill development, has been recommended as one way to prevent loss of interest or early burnout (Gould, Udry, Tuffey, & Loehr, 1996). This research finding and recommendation may have general performance applicability, particularly in a cultural context that valorizes early specialization in dance and music as much as in sport.

Musicians often begin taking lessons at an early age. Music pedagogy tends to focus solely on what has been described as an “hereditary nature of teaching practice” (Patston, 2016, p. 417). This “deficit model” of teaching and learning focuses on “technical and musical ability … [a] Darwinian style of training, the survival of those ‘naturally selected’ by and who respond to the teaching model in the system” (p. 417). In contrast, a new model of pedagogy, MIND (Music Instruction Non-Deficit Model), is derived from a combination of Langerian mindfulness, the tripartite MAC (Mindfulness-Acceptance-Commitment) approach to sport (Gardner & Moore, 2007), and the values-based positive psychology focus on signature strengths (Peterson & Seligman, n.d.).

For vocal musicians, the relationship between training and becoming a performer can vary considerably: In the Western tradition, he vocal clarity of boys’ voices has long been prized. With puberty, their voices change and they are no longer so exceptional. Their earlier prominence may have little direct bearing on their success as adult singers, but their early vocal training will stand them in good stead with regard to such elements as vocal technique and music literacy.

At the other end of the age and involvement spectrum, professional actors may begin their professional lives at any point from childhood to adulthood. Formal professional acting training, whether as an academic subject or via free-standing theatre school, is of fairly recent origin. Increasingly, it is a route toward theatrical performance.

Although the nuclear family and its ways and methods of support are critical in child and performer development, over time, the broader community becomes increasingly influential. For athletes, the role of the coach becomes central; the “triangle” of coach, parent, and athlete thus needs to be addressed as well. In the performing arts, the child’s teacher gains similar significance in the child’s performing life. This translation from sport to performing artist is especially relevant to those—dancers and musicians—who begin training early in childhood. Much like athletes, dancers tend to begin training at an early age. Increasingly, their lives become structured around dance training, whether through specialized boarding school or many hours of training that impact body plasticity, friendship patterns, and support systems.

The Development of Expertise

The nature–nurture debate (innate talent vs. life circumstances and practice) around talent development has characterized issues regarding the development of expertise in the performing arts as much as in sports (e.g., Côté & Abernathy, 2012; Harwood et al., 2012; Starkes, Helsen, & Jack, 2001). Wolfgang Amadeus Mozart is perhaps the exemplar of a musician born gifted, yet the expression of his talent was largely dependent on his life circumstances, including the strong influence of his ambitious father (Ericsson & Pool, 2016). Ericsson’s decades-long research concerning the development of expertise in a variety of domains (Ericsson, Krampe, & Tesch-Römer, 1993) is firmly rooted in the “nurture” side of the debate. Popularized (and oversimplified) by Malcolm Gladwell (2008), Ericsson has concluded that expertise in performance can occur as a result of 10,000 hours or 10 years of deliberate practice in that specific area. Of particular importance is that such practice includes present-focused attention and a systematic, intentional, and supported method designed to improve performance. Both quality and quantity of practice are critical (Ericsson & Pool, 2016; Nordin-Bates, 2012).

The development of expertise, thus, is a function not only of whatever intrinsic skills one has but the active engagement of the learner within a planned, structured, and supportive environment. Such concepts as passion, intrinsic motivation, task-oriented goal motivation, and a positive motivational climate, extensively researched with athletes, can readily be applied to performing artists (Murphy, 2012; Nordin-Bates, 2012).

Performing as a musician, dancer, or actor, one is embedded within a variety of occupational challenges. Considered here are issues of self-care, the management of performance demands, and career completion.

Self-Care

Despite the obvious need for appropriate self-care as a basis for learning and practice as well as performance (Hays & Brown, 2004), attention to self-care often appears to be secondary to performers’ focus on their art, per se. Because there are a myriad variables and important distinctions between dance, music, and theatre, no consensus has been reached regarding the specific ways that self-care manifests in the performing arts. The seemingly sedentary process of sitting in an orchestra pit requires considerable stamina; dance involves a marked degree of exertion but is an anaerobic activity (Hamilton, 1997); night-time performance (and after-parties or “merely” winding down) means that performers learn to ignore basic circadian rhythms.

Even among a homogeneous and seemingly obvious group, such as female ballet dancers in relation to anorexia nervosa, prevalence rates concerning disordered eating range from less than 2% to more than 25% (Nordin-Bates, 2012). Described below are some representative samples of relatively recent research regarding self-care:

A survey of thirty-two members of a Norwegian orchestra reviewed both physiological measures of stress and psychological measures of subjective health complaints and coping strategies (Halleland, Harris, Sørnes, Murison, & Ursin, 2009). Compared with a representative sample of Norwegians, they experienced a significantly higher degree of tiredness and mood changes. They were more likely to experience heightened levels of stress, as measured by cortisol levels, specifically on days when they played a concert.

A large-scale review of causes of death for popular musicians between 1950 and 2014 found that, compared to the general population of the United States, popular musicians died earlier and proportionately more often from violent death (accident, suicide, homicide) as well as liver disease (presumably, due to excessive alcohol consumption). Overall mortality was twice as high as that of the comparable general population (Kenny & Asher, 2016).

In a small-scale study of Croatian ballet professionals, more than 1/3 of the male dancers indicated binge drinking; 20% of the female dancers smoked a package of cigarettes daily. Successful ballet performance was perceived as more important than the health consequences that might follow from excessive substance use (Sekulic, Peric, & Rodek, 2010). The authors also pointed to the well-known effect of smoking on basal metabolism, such that cigarette smoking, especially for female dancers, has often been used as an appetite suppressant.

A Canadian study compared female contemporary dancers with age-matched nondancers regarding alcohol and smoking. Dancers’ alcohol use was significantly higher than that for non-dancers and appeared related to the experience of stress and depression. Tobacco use among dancers correlated with disordered eating or unhealthy weight-loss strategies (Tse, 2015).

Via self-report, it appears that the vast majority of dancers use one or more nutritional, medicinal, or performance enhancing substances (Boardley, Allen, Simmons, & Laws, 2016). In particular, dancers in the United Kingdom used multi-vitamin supplements, over-the counter painkillers, and high-energy drinks. Some sex differences were noted, with men who were professional dancers most likely, and women and amateur dancers least likely, to use supplementation (Boardley et al., 2016).

Some performing arts organizations are recognizing and incorporating attention to the whole body of the performing artist. An extensive and ongoing wellness program at New York City Ballet, for example, supports dancers’ cross-training, appropriate nutrition, and stress management (Hamilton, 2015).

Physical Demand, Overuse, and Burnout

Because of its obvious demand on the body, dancing comes closest to sport in terms of physical wear and tear. Ironically, as an anaerobic form of activity, dancers may well need to develop habits of cardiovascular exercise to improve full aerobic strength. Increasingly, both in training and subsequent practice, dancers also turn to Pilates or yoga for cross training (Hamilton, 2015).

For instrumental musicians, the overuse involved in repetitive motion at various points along the arm and hand can lead to repetitive strain syndrome (Chan et al., 2013). Whereas athletes may anticipate the potential for injury and have health care supports available, musicians are unlikely to have the same type of knowledge or accessible support (Stanhope, 2016). Among musicians, injury is often atraumatic, that is, as a result of overuse. It is thus not necessarily visible, in contrast to athletes’ injuries that are more likely to be traumatic and visible. Only gradually is onsite health care available, even in professional orchestras (Stanhope, 2016).

Orchestral musicians may experience stress through gastro-intestinal complaints, fatigue, and mood shift (Halleland et al., 2009). On the one hand, they are highly qualified and perform at a high level of skill. On the other, they experience low control: “they seldom have the authority to decide how to play” (Halleland et al., 2009, p. 58). They also are likely to play a repeated repertoire. The sinecure of a relatively assured job, compared with the stresses of jumping back into the audition pool, may prevent them from stretching their skills. Boredom, characterized by Csikszentmihalyi (2000) as an excess of skill compared to challenge, can result.

More complex than boredom, per se, is burnout. Burnout in the workplace is characterized by three elements: exhaustion, cynicism, and inefficacy (Maslach, 1982). Reworking this concept for its relevance to the sports world, Raedeke and Smith (2001) developed a measure initially tested with swimmers. They translated Maslach’s paradigm, describing the elements as emotional/physical exhaustion, a reduced sense of swimming accomplishment, and swimming devaluation. These factors “correlated positively with stress, trait anxiety, and amotivation, and correlated negatively with coping, social support, enjoyment, commitment, and intrinsic motivation” (p. 281).

Western culture in general undervalues the performing arts; artists may experience very real financial constraints. The potential for burnout, or at the very least, marked questioning about the viability of a career in the performing arts, may thus be even more prevalent among artists. The unemployment rate for actors reportedly hovers around 90%–95% (Kogan, 2002; McMahon, 2012). This issue of employment, while especially dramatic among actors, is not dissimilar for other performers. In Australia, for example, 67% of professional musicians work as freelancers or are self-employed (Stanhope, 2016). Musicians who move from gig to gig will have a different experiences than members of professional orchestras or dancers who are part of a dance company.

To some degree, it is possible that prior knowledge of the likelihood of financial challenge as a performing artist may offset burnout. Additionally, artists may be “immunized” by their own aesthetic pleasure and appreciation of their art form, as well as the sense of having a “gift” that should be shared.

Injury and Career Completion

The length of a performer’s career, even under the best of circumstances, varies markedly between the performing arts. As noted previously, dancers, like athletes, typically start training at a young age and complete their dance careers by their 40s at the latest. Actors may not begin their career until their late teens or thereafter. From a physiological perspective, they would be capable of continuing their theatrical career into late age. (A variety of societal issues makes this unlikely, however, except for a lucky few.) Musicians, somewhere in between, tend to begin training early. In part depending on their instrument, their careers can extend well into late age. Catalan cellist Pablo Casals, who became internationally acclaimed by age 23, continued to play professionally until age 85. Also a composer and conductor, he conducted his final concert at age 96, the year of his death.

Injury is a fact of dancers’ lives (Mainwaring, Krasnow, & Kerr, 2001). Continuing to dance while injured, or coming back too soon, may be a function, in part, of financial constraints. It is also driven by a strong sense of commitment and responsibility to the performance troupe (Hays & Brown, 2004).

Less obvious, perhaps, is the potential for injury among actors. Actors may be placed in situations that are objectively dangerous or ones for which they have not had particular training. In no other performance category do “stunt doubles” exist. Musical theatre, for which one trains as a “triple threat”—singing, dancing, and acting—can be especially hazardous. The interactive complexity within dance or musical theatre demands present-moment attention to not only one’s internal states and verbal or vocal interaction with others, but the physicality of people in motion. “If you are a few seconds out or a few steps off, you can put yourself and other performers/crew in danger (not to mention ruining the show!)” (Tremayne & Morgan, 2016, p. 401). The many issues that plagued Spider-Man Turn off the Dark on Broadway (Setoodeh, 2014) offer a sobering example of the potential for very real danger.

Although it would appear that being a musician is a safer profession than that of dance or theatre, a high proportion of professional musicians actually experience considerable pain (Leaver, Harris, & Palmer, 2011). In a survey of musicians from six professional orchestras, 86% reported pain. One half of these reported “disabling” pain, primarily affecting the upper body but differing by instrument type (Leaver et al., 2011). International surveys indicate that professional orchestral musicians have somewhere between 39% and 87% lifetime prevalence of performance-related musculoskeletal disorders. Current incidence ranges as high as 50% (Chan et al., 2013).

Even though performing artists’ performance careers may well come to a natural end, like athletes, performers often pay little attention to the actual and psychological effects of career completion (Leading Edge After Performance, n.d.). Ballet dancers may be especially poorly equipped to deal with the end of their careers, whether that completion occurs through career-ending injury or age and limits to physical capacity. During their career, dancers themselves, with encouragement from others, focus on their present life and career, rather than being “distracted” by thinking too far into the future. With educational deficits and financial challenges, it can be especially difficult to attend to grieving the ending of one part of their lives along with the necessary energy and attention to the next. Support programs for dancers were created in the 1980s; by the 21st century, they have developed into international consortia addressing a variety of types of services (International Organization for the Transition of Professional Dancers; Artists Health Centre).

Although performing arts practice may involve issues of psychopathology that may confound a purely performance enhancement approach (e.g., depression, eating disorders, motivation), performing artists are most likely to seek consultation for the amelioration of performance anxiety (Nordin-Bates, 2012). From a psychiatric diagnostic framework, performance anxiety has been considered a subtype of social phobia (American Psychiatric Association, 2000) (Lederman, 1999), currently labeled an aspect of social anxiety disorder (American Psychiatric Association, 2013). Diagnostic labeling presents a paradox. As an attribute of the demands of their professional life, performers do indeed have to have social engagement. Given that “virtually all performers have experienced at least some symptoms of anxiety during their performance history, and virtually all fear their reemergence” (Sataloff, Rosen, & Levy, 1999, p. 122), it is reasonable to ask whether this means that all performers have some level of diagnosable illness. Sataloff and colleagues suggest that the common cognitive concern is (the anticipation/expectation of) negative evaluation by judges or audiences. In fact, part of the definition of performing is that one will be evaluated or judged. It seems, rather, that there is a continuum from ubiquitous (and one could argue, necessary) heightened levels of cognitive and physiological arousal in relation to performance, to debilitating and performance-interfering anxiety, colloquially described as stage fright.

These concerns may vary across not only individuals but performance area as well. The majority of research on performance anxiety concerns musicians, with some attention to dancers, but minimal research on performance anxiety among actors (Nordin-Bates, 2012). One comparative study found that instrumental musicians were affected by anxiety most frequently (47% of the time), followed by singers (38%), dancers (35%), and actors (33%) (Wilson & Roland, 2002).

Treatment of Performance Anxiety

Alcohol and other substances are the most common self-medications that performing artists use to deal with performance anxiety (Sataloff et al., 1999). Among some genres, such as pop and jazz music, support for alcohol and street drugs is embedded within the performance atmosphere itself.

Prescribed medication as a treatment for performance anxiety has been common among professional musicians. Originally developed to diminish symptoms of cardiovascular issues, beta-adrenergic blocking medication such as propranolol is commonly prescribed for performance anxiety. An ongoing concern has been the ubiquity, and thus danger, of such medication being shared, without prescription, between musicians (Lederman, 1999).

Although beta-blockers are frequently used among musicians, it has been suggested that they should not be prescribed to singers or wind instrumentalists (Sataloff et al., 1999). It is not clear what mechanism is of concern or whether this stricture should apply to brass players (Taborsky, 2007). The anxiolytic effects of selective serotonin re-uptake inhibitors (SSRIs) may make this class of medication potentially useful for professional musicians.

Even physicians, whose major tool is medication, suggest that first-line treatment should be psychotherapy, including relaxation training such as progressive muscle relaxation (Salatoff et al., 1999). Psychotherapeutic methods run the gamut, including psychodynamic, cognitive behavioral, ACT, and mindfulness methods (Andersen, 2009; Herzog & Hays, 2012; Nordin-Bates, 2012).