Attachments and Strategies: Music Performance Anxiety,Trauma,and Mental Health Distress Within Music Learning Environments

Abstract

This literature review contains a synthesis of research findings at the intersection of music performance anxiety, trauma, and mental health distress. Although these constructs appear dissimilar, each involves a propensity for diminished skills of emotion regulation, particularly during situations of heightened stress. According to attachment theorists, emotion regulation challenges signal a history of suboptimal interactions with adult caregivers during childhood. A search of literature related to attachment theory and the three constructs yielded 65 relevant studies from the fields of music education, general education, special education, psychology, psychiatry, and neuroscience. Included in the review are causes and manifestations of each construct to aid in identifying affected students and associations between suboptimal attachment and emotion regulation challenges for offering insight into related difficulties. The review concludes with suggestions for incorporating self-compassion skills training into music lessons and rehearsals for building emotion regulation skills and enhancing achievement within music learning environments.

Keywords

attachment theory emotion regulation mental health music performance anxiety self-compassion trauma

Introduction

A sizable percentage of music students have likely experienced challenges sufficient to disrupt their learning. For example, 20% of student musicians who abandon their pursuit of a music career cite music performance anxiety (MPA) as the main contributing factor (Gómez-López & Sánchez-Cabrero, 2023). Researchers for the National Child Traumatic Stress Initiative (2022) reported that trauma affects two-thirds of children in the United States by the age of 16. The Centers for Disease Control and Prevention (2021) reported that mental health distress has impacted 29%–42% of U.S. high school students, and Venable and Pietrucha (2022) found that 77% of students enrolled in U.S. colleges and universities have been negatively impacted by issues surrounding mental health. Given that MPA, trauma, and mental health distress are prevalent, it is critical for music educators to understand more about the possible relationships between these causes of distress, as well as how such distress impacts learning.

One way to consider the intersection of performance or learning difficulties related to MPA, trauma, or mental health distress is through the lens of attachment theory (Rusk & Rothbaum, 2010). Some musicians who experience MPA have internalized negative self-talk learned from adult caregivers (Kantor-Martynuska & Kenny, 2018). A history of abuse or neglect by adult caregivers is common among trauma-affected learners, as well as learners exhibiting mental health distress such as anxiety or depression (Romano et al., 2015). A primary concept of attachment theory is that during periods of heightened stress, when situational demands are perceived to outweigh personal competencies, learners who experienced childhood abuse or neglect adopt goals related specifically to safety and security (Rusk & Rothbaum, 2010). Intense fixation on personal safety can allow limited energy, interest, or focus to remain for music learning or achieving.

Individuals affected by inadequate childhood attachment can exhibit poor skills of emotion regulation (Roy, 2015). Music educators can ameliorate poor emotion regulation skills in students by teaching and incorporating self-compassion skills training into music lessons, rehearsals, and classroom instruction. Intentional self-compassion skills training appropriate for music learning environments can include exercises of gratitude, blessings, savoring, mindfulness, or self-compassion writing.

I designed this review of literature to address two purposes. The first was to search research findings to discover connections among attachment theory, MPA, trauma, anxiety, and depression. The second was to identify a pedagogical approach at the intersection of these concerns to support learning and achievement within music learning environments. Three topic areas emerged from the review of the literature: (a) connections among insecure attachment orientations, MPA, trauma, anxiety, and depression; (b) connections among insecure attachment orientations, low levels of emotional regulation, and low levels of self-compassion; and (c) instructional approaches for enhancing self-compassion skills, to ameliorate educational and performance concerns at the intersection of MPA, trauma, anxiety, and depression. The review concludes with implications for practice and recommendations for further research.

Method

For this literature review, I completed an exhaustive search involving over 200 research studies that resulted in 65 applicable peer-reviewed studies related to the keywords “attachment theory,” “music performance anxiety,” “trauma,” “mental health,” “emotion regulation,” and “self-compassion.” Combinations of keyword phrases that yielded applicable results included “music performance anxiety and attachment theory,” “trauma and attachment theory,” “mental health and attachment theory,” “self-compassion and music performance anxiety,” “self-compassion and trauma,” “self-compassion and mental health,” and “self-compassion and mental illness.” The heterogeneity characterizing the constructs required me to undertake a comprehensive search of research studies from the fields of music performance, music education, general education, special education, psychology, psychiatry, and neuroscience. Other than referencing foundational articles by Bowlby (1958) and Ainsworth (1979) presenting attachment theory, I have included only articles published within the past 20 years. My primary search modes were Google Scholar and a university’s library website, but I additionally gathered sources from the reference lists of journal articles, book chapters, and dissertations.

Rationale

A high prevalence of school-aged children experience challenges associated with MPA (O’Brien, 2024), trauma (National Child Traumatic Stress Initiative, 2022), or mental health distresses such as anxiety or depression (Centers for Disease Control and Prevention, 2021). Connections are prevalent among these constructs, for musicians are among the top five vocational groups to report mental health distresses (Matei & Ginsborg, 2017). MPA and social anxiety share identifying features (Goren, 2014). A sizable percentage of musicians diagnosed with severe MPA also receive diagnoses of anxiety or depression (Wiedemann et al., 2020). MPA can be linked with trauma, for unresolved traumatic experiences can interfere with normal stress responses and contribute to the formation of MPA (McGrath et al., 2016). Students who are trauma-affected can exhibit disturbances in mental health (Bauman-Field, 2024). MPA is associated with stress and fear (Stephenson & Quarrier, 2005), as is trauma (Gonzalez & Martinez, 2014), and some mental health distresses including anxiety and depression (Melchior et al., 2007).

MPA (Kenny & Holmes, 2015), trauma (Mikulincer et al., 2015), anxiety (Manning et al., 2017), and depression (Cortes-Garcia et al., 2020) share a connection with attachment theory. Individuals who experienced faulty emotional attachments with earliest adult caregivers experience diminished capacities for emotion regulation (Gold et al., 2023). Enhanced skills of self-compassion can improve poor skills of emotion regulation that lie at the intersection of attachment insecurity (Joeng et al., 2017), MPA (Farley & Kelley, 2023), trauma (Winders et al., 2020), and anxiety and depression (Trompetter et al., 2017). Introducing intentional self-compassion exercises that reinforce student experiences of gratitude, mindfulness, self-kindness, and positive memories can build skills of emotion regulation and mitigate negative educational experiences resulting from insecure attachment and its related concerns.

Attachment Theory

Attachment theory is a psychological framework useful for understanding the evolution of human systems of emotion regulation that contribute to stress sensitivity and coping (Gumley et al., 2014). The primary biological purposes of the attachment system are supporting safety to ensure survival and establishing the essential emotion regulation skills necessary to manage stress during circumstances of heightened threat (Mikulincer et al., 2015). Attachment to others directly impacts individual approaches to emotion regulation (Mikulincer et al., 2003).

Basic Concepts

The concept of attachment theory revolves around the importance of initial social interactions experienced by a child, which play a crucial role in forming a lasting sense of trust in oneself and others. Bowlby (1958) and Ainsworth (1979) posited within attachment theory that infants have an innate attachment behavioral system that stimulates their need for proximity to protective, loving caregivers. Successful early interactions with primary caregivers encourage two positive psychological results for the child. The first is the sense of safe haven, which describes the belief that other people are available and willing to provide comfort, reassurance, and assistance during situations of heightened stress. The second is a sense of secure base, which describes the belief that safety and security are no longer dependent on proximity to the caregiver but are accessible even during unfamiliar or particularly stressful situations or circumstances (Feeney & Thrush, 2010). Early positive social interactions with protective caregivers encourage a child to learn that it is safe to be loved, comforted, and reassured by others, and it is reliable and healthy to provide self-soothing if others are unavailable (Fisher, 2021).

Attachment Orientations

Young children form attachment orientations through repeated patterns of relationship interactions with adult primary caregivers. Secure attachment orientations with caregivers result in optimized emotion regulation skills and a heightened sense of self-worth (Newman-Taylor et al., 2021). Insecure attachment orientations resulting from ongoing unsupportive or hurtful interactions with caregivers prompt children to modify their behaviors to satisfy their emotional and psychological needs (Mikulincer et al., 2015). Modified behaviors can lead to the formation of insecure attachment orientations, which impact the human capacity to cope with stress (Gold et al., 2023). Individuals with avoidant attachment orientations suppress attachment security needs to protect themselves from potential harm and may distrust others, deny their need for human connection, and maintain emotional independence (Ein-Taylor et al., 2010). Individuals with anxious attachment orientations exaggerate perceptions of threat and danger within benign situations, have difficulties extinguishing negative thoughts and feelings, or ruminate on distressing thoughts or experiences (Ein-Taylor et al., 2010).

Connections Between Attachment Theory and MPA

Individuals with anxious or avoidant attachment orientations are more likely to experience severe MPA than individuals with secure attachment orientations (Wiedemann et al., 2020). In one qualitative case study exploring the origin of a 26-year-old pop musician’s severe MPA, researchers found that the stress of musical performance triggered negative emotions resulting from early attachment issues (Kenny & Holmes, 2015). Results from a descriptive design study involving interviews with 10 Australian professional orchestral musicians yielded similar conclusions (Kenny & Holmes, 2018). A quantitative survey study with 100 Australian musicians aged 18 or older, identified as professional, student, amateur, or no longer performing music due to MPA, also indicated a strong association between MPA and early childhood attachment experiences (Kirsner et al., 2023). Individuals with insecure attachment and MPA can lack the ability to manage extreme emotions when under the situational threat of music performance (Kenny & Holmes, 2015).

Connections Between Attachment Theory and Mental Health

Insecure attachment orientations can contribute to mental health distress such as anxiety and depression. In a recent systematic review of literature, researchers reported that 28 of the 30 identified studies confirmed a positive association between social anxiety and attachment insecurity (Manning et al., 2017). Social anxiety and depression frequently coexist, for 37.2% of individuals with a lifetime diagnosis of social phobia also have a lifetime diagnosis of depression (Wright et al., 2010). Results from a recent meta-analysis of 108 studies indicated that depression is also associated with insecure attachment (Cortes-Garcia et al., 2020). Individuals with insecure attachments who experience anxiety or depression can lack the ability to manage extreme emotions when under the situational threat of music learning or performance.

Connections Between Attachment Theory and Trauma

The human attachment system is automatically activated in response to stressful events or situations (Mikulincer et al., 2015). Studies reporting positive associations between trauma experiences and attachment orientations have included participants who self-reported childhood sexual or physical abuse, interpersonal violence, surviving the Holocaust, Israeli Scud missile attacks, or the 9/11 terror attacks, and experiences of security workers, prisoners of war, military recruits in training, and war veterans (Mikulincer et al., 2015). Individuals with insecure attachments who have experienced traumatic events can lack the ability to manage extreme emotional trauma responses when under a moderate situational threat such as music learning or performance.

MPA

MPA is a distinct subtype of anxiety defined by its connection with the act of performing music before an audience (Goren, 2014). MPA is a commonly reported difficulty among musicians of all abilities and experience levels (Kenny, 2011). Although often reported, statistics regarding the prevalence of MPA vary. Fernholz et al. (2019) conducted a systematic review of literature and found that between 16.5% and 60% of professional musicians reported experiences of MPA that negatively impacted performances. Kenny and Halls (2018) reported that as many as 95% of Australian community band and chorus musicians participating in their study experienced anxiety during live performances. Chronic MPA may threaten the health, job satisfaction, and personal gratification of affected musicians (Goren, 2014). Through study findings like these, researchers have suggested that MPA negatively impacts the professional and personal lives of some musicians.

Causes of MPA

MPA lies at the intersection of (a) inherited biological vulnerability; (b) generalized psychological vulnerability caused by faulty childhood attachment that resulted in insecure attachment orientation; and (c) specific psychological vulnerabilities caused by exposure to specific stressors before acquiring appropriate management tools (Kantor-Martynuska & Kenny, 2018). This combination of factors can result in several underlying causes of MPA, including perfectionism, which is defined as the personality trait that causes a musician to hold personal performance standards to a nebulous level of flawlessness (Dobos et al., 2019). Perfectionism can develop as a reluctance to accept mistakes, which can lead to an increased negative evaluation of self (McNeil et al., 2022). A secondary presentation of perfectionism, the need for approval, presents as a striving for a perceived perfection of self or social perfectionism. A need for approval results in impossibly high standards for a self who is reluctant to accept mistakes (Yondem, 2007). Fear of negative evaluation, also related to perfectionism, refers to a need to avoid disapproval by others (Lupiáñez et al., 2022).

A predisposition for shame can influence the development of MPA and is identified by chronic feelings of self-condemnation and self-accusation, including feelings of worthlessness, insignificance, powerlessness, uselessness, and unusual sensitivity to the opinions of others (Coşkun Şentürk & Cirakoglu, 2018). Pervasive feelings of helplessness can also influence MPA development. Helplessness can be caused by a particular sensitivity to reward and punishment and can develop when an individual becomes certain they cannot prevent a negative situation or outcome despite their best efforts (Orejudo et al., 2017).

Thought processes that involve catastrophizing, or exaggerating real or imagined threats, can impact the development of MPA (Bugos & Lee, 2015). Catastrophizing thoughts during performance are usually focused specifically on difficult technical passages or possible memory slips. These focuses contrast sharply with the more positive mindsets of those individuals who understand the inevitability of minor mistakes, the accepting and appreciative nature of most audiences, and the musician’s primary task of expressing the overall message of the music (Liston et al., 2003).

Recognizing MPA in the Classroom

Music educators may be cognizant of MPA manifestations through personal experience, but recognizing symptoms can be important for complete educator understanding and perception. McGrath et al. (2016) codified manifestations of MPA into four separate categories, including physiological, cognitive, psychological or emotional, and behavioral symptoms. Physiological issues of MPA can include increased heart rate, shortness of breath, sweating, muscle tension, shaking, upset stomach, headache, dizziness, or nausea. Cognitive impediments may include loss of confidence, unmistakable memory lapses, or a lack of concentration caused by interfering thoughts or concerns. Psychological or emotional issues may be more difficult to observe outwardly but can include feelings of intensified apprehension, fear of failure, irritability, or panic. Finally, behavioral changes may include counterproductive actions such as backing out of performance commitments (McGrath et al. 2016).

Mental Health

Mental health is a condition of wellness wherein individuals can cope successfully with stressors, work productively, experience positive emotions, and realize their potential (Zhang et al., 2022). A positive state of mental health implies a lack of negative benchmarks such as anxiety or depression, as well as the presence of positive criteria such as optimistic self-concept and positive emotions (Zhang et al., 2022). The self-assessment instrument most often used to identify MPA, the Kenny Music Performance Anxiety Inventory (K-MPAI), consists of 40 self-assessment questions including 33 questions specifically identifying anxiety or depression (Kenny, 2023). Included are eight questions identifying social anxiety, three questions identifying generalized anxious apprehension, 11 questions identifying situation-specific performance anxiety, three questions identifying a generational transmission of anxiety, and eight questions identifying depression (Kenny, 2023). The K-MPAI highlights connections between MPA and anxiety or depression.

Recognizing Mental Health Distress in the Classroom

Educators are in a unique position to identify and support students who experience mental health stressors such as anxiety and depression. However, educators are more likely to identify mental health concerns that include behavioral issues and are less likely to identify students with internalizing mental health distresses such as anxiety and depression (von der Embse et al., 2018). Internalizing symptoms of anxiety or depression can include seeming anxious, fearful, sad, or distracted for protracted periods of time; crying or exploding in ways that seem situationally inappropriate; having difficulties concentrating; engaging in negative self-talk; withdrawing; or avoiding previously enjoyed tasks or people (von der Embse et al., 2018).

Trauma

According to the National Child Traumatic Stress Initiative (2022), at least one of every seven children in the United States experiences abuse or neglect annually, and 54% of families in the United States have reported experiencing a traumatic disaster. Extreme stressors leading to trauma and post-traumatic stress disorder (PTSD) can vary in magnitude, frequency, duration, complexity, predictability, and controllability (Weathers & Keane, 2007). Understandably, trauma exposure can affect classroom learning and achievement.

Causes of Trauma

Primary causes of trauma include experiencing physical or emotional abuse or neglect during early childhood (Erozkan, 2016). Other causes of trauma include experiencing or witnessing psychological, physical, or sexual abuse or domestic violence. Trauma can also result following the sudden or violent loss of a loved one, serious accidents, life-threatening illnesses, community or school violence, refugee or war experiences, national or international terrorism, or natural disasters (National Child Traumatic Stress Initiative, 2022).

Recognizing Trauma-Affected Students in the Classroom

Like MPA, trauma may manifest through symptoms that are physical, behavioral, emotional, or cognitive. According to Bell et al. (2013), physical symptoms of trauma can include hypervigilance, an intensified startle reaction, sleep disorders, weight changes, or recurring physical complaints prompted by an unvaried circumstance. Behavioral symptoms can include social isolation, risk-taking or attention-seeking behaviors, increased aggression, regressions, and changes in play. Emotional symptoms can include difficulty regulating emotions, distrust, a lack of self-confidence, or intensified fears or phobias. Cognitive symptoms can include an inability to focus, dissociation or trauma flashbacks, poor skill development or learning disabilities, or noticeably changed beliefs regarding the self, other people, or the future (Bell et al., 2013).

Emotion Regulation

Difficulties with emotion regulation are associated with MPA (Wiedemann et al., 2020), trauma (Mikulincer et al., 2015), mental health distresses such as anxiety or depression (Kerns & Brumariu, 2014), and insecure attachment (Roy, 2015). Emotion regulation describes the ability to modulate positive or negative emotional experiences to achieve personal goals (Kraiss et al., 2020). According to Gross and Jazaieri (2014), problems of emotion regulation could exist if (a) an individual fails to regulate emotional intensity, resulting in disproportionate emotional responses; (b) emotional responses are consistently very long or very short in duration; (c) exaggerated emotional responses occur frequently; or (d) individuals lack awareness of their emotions or regularly exhibit an emotion type that is inappropriate or incongruous with circumstances (Gross & Jazaieri, 2014). Individuals experiencing difficulties with emotion regulation can enhance their skills by learning, developing, expanding, or emphasizing skills of self-compassion (Joeng et al., 2017).

Self-Compassion

A principal purpose of this literature review was to identify effective pedagogical practices for moderating learning and achievement difficulties at the intersection of attachment theory, MPA, trauma, anxiety, and depression. Although numerous effective MPA interventions and trauma-informed classroom practices already exist, the single pedagogical practice that emerged from my research capable of addressing all constructs was the concept of self-compassion.

Self-compassion is the practice of treating oneself with kindness and non-judgment when facing difficulties such as defeat, blunder, adversity, or misfortune (Brophy et al., 2020). Self-compassion encompasses components of (a) self-kindness during taxing circumstances; (b) recognizing the common nature of human suffering rather than experiencing distress in isolation or disconnection; and (c) practicing mindfulness to observe experiences congruently and objectively (Hwang et al., 2016). According to tenets of attachment theory, self-compassion effectively stimulates self-soothing behaviors while simultaneously abating threats (Neff & Dahm, 2015).

Musicians with a capacity for self-compassion experience diminished perfectionism, self-judgment, and fear of failure, resulting in minimized experiences of MPA (Farley & Kelley, 2023). Victims of trauma can reduce tendencies toward self-criticism, shame, and avoidance of emotional distress through increased skills of self-compassion (Winders et al., 2020). Self-compassion skills can mitigate experiences of anxiety or depression and self-stigmatizing tendencies in individuals experiencing mental health distress (Yang & Mak, 2017).

Embracing components of compassion can be fully compatible with simultaneously embracing the pursuit of musical perfectionism typically required for musical excellence (Oosthuizen, 2024). Musicians and music educators with enhanced self-compassion skills can recognize that temporary failures or setbacks are inevitable, so they can cultivate constructive and supportive responses to unavoidable mistakes made by ensembles, individuals, or the self (Oosthuizen, 2024). Music educators who model compassion can diminish the consequences of extreme performance stress for their students. They can also offer opportunities within lessons, rehearsals, and classroom instruction for students to strengthen skills of self-compassion through exercises of gratitude, mindfulness, and self-compassion writing.

Self-Compassion Exercises for Music Learning Environments

Music educators will likely encounter students with insecure attachments, MPA, trauma exposure, or mental health challenges such as anxiety or depression within learning environments. Knowledge and awareness of the behaviors of students with these challenges can be helpful for educators as they seek to better understand individual learners, provide safe learning environments, and promote best educational practices. Educators can inspire a higher level of success for all students by incorporating compassionate strategies that avoid aggravating or intensifying existing problems and encourage the well-being of all students (Korinek, 2021).

Establishing compassionate learning environments and modeling compassion toward students is a first step in teaching self-compassion skills to remedy poor emotion regulation abilities. Educators can also help students build skills of emotion regulation through intentional classroom or homework exercises meant to build skills of self-compassion. Intentional self-compassion exercises can include incorporating blessing, gratitude, or savoring exercises; mindfulness exercises; and focused self-compassion moments into music lessons, rehearsals, pre-performance practices, and classroom instruction (Lloyd-Hazlett & Maestri, 2013).

Gratitude exercises, effective in building self-compassion and emotion regulation skills, can include activities such as classwork or homework in which students describe three events that have gone well in their day, including possible reasons for those successes (Lloyd-Hazlett & Maestri, 2013). Gratitude exercises could also include asking students to write a letter to a friend or family member expressing thanks for a specific helpful act. A savoring exercise could include asking students to write a short memoir describing in detail a specific treasured memory. Regularly expressing gratitude or savoring memories of positive experiences enhances skills of self-kindness and mindfulness, and in one study involving seventh and eighth graders, keeping a journal list of blessings measurably influenced academic gains (Lloyd-Hazlett & Maestri, 2013).

Compassionate writing exercises, in which students write empathetic paragraphs to themselves and speak as they would to a distressed friend, can encourage sympathy, understanding, and forgiveness for personal misjudgments, faults, oversights, or blunders (Dreisoerner et al., 2021). Mindfulness, which describes curious and accepting reactions to present-moment experiences, encourages kindness and self-compassion regardless of defeats and disappointments (Diaz, 2023). Music educators can teach mindfulness effectively and succinctly by practicing with students the mnemonic device STOP, which asks students to Stop what they are doing, Take deep breaths, Observe with curiosity, and Proceed with intention (Diaz, 2023).

Music educators can purposefully develop compassionate and caring learning environments, model compassion toward students, and encourage students to further develop skills of self-compassion through intentional exercises of gratitude, savoring, compassionate writing, and mindfulness. Incorporating self-compassion skill instruction into conventional music lessons, rehearsals, and classroom instruction can increase students’ ability to regulate emotional states, which can mitigate concerns of diminished musical and academic achievement associated with insecure attachment, MPA, trauma, anxiety, or depression.

Study Limitations and Recommendations for Further Research

Within this literature review, I have suggested conclusions drawn from isolated, unrelated studies of MPA, trauma, and mental health, intersecting those constructs with attachment insecurity, emotion regulation, and self-compassion. Future researchers may aim to directly investigate the effectiveness of self-compassion skills for improving learning and performance in students with MPA, trauma exposure, or mental health distresses such as anxiety or depression. Future researchers may also consider introducing or further testing alternative interventions intended to reduce the impact of MPA, trauma, and mental health distress within music learning environments.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Lydia Schoonover

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