Esther van Fenema,  Ludwike van Kalmthout, Carmen van Geel

Perhaps you’ve experienced it yourself: performing in front of an audience can be exciting, but can be frightening as well. A musician’s lifestyle can be accompanied by a lot of stress, due to high expectations from the audience and family, irregular working hours, intense competition, as well as a low income. According to these remarks, it’s no surprise musicians being vulnerable to stress-related disorders such as stage fright (also known as performance anxiety) and other mental problems.
It is obviously undesirable for conservatory students to suffer from a high level of performance anxiety. Unfortunately this does happen, although exact numbers are not known. In the research described below, we wanted to get an overall impression of the psychological functioning among music students. We asked ourselves the following question: ‘What is the occurrence of performance anxiety and perhaps other existing mental problems among first year conservatory students?’

To determine if conservatory students in particular are at risk for mental problems, we compared them with medical students. Both student groups are known to have a stressful profession in their future. We chose to study these student groups at an early stage of their career, that is, in their first year of study.

In October 2012, we sent out 4 questionnaires (see below) to all 170 of the first year conservatory students at the Conservatorium van Amsterdam and 2 of these questionnaires (the SAPAS(1) and the SQ48 (2)) to all first year medical students (n=333) from Leiden University Medical Center to evaluate the signs of psychological problems on behalf of the ‘Muziekpoli’ – a part of the department of psychiatry at the Leiden University Medical Center (LUMC) and the first outpatient psychiatric clinic for mental problems among performing artists (professional musicians, dancers and actors). The Muziekpoli was established in 2008 by psychiatrist and professional violinist Esther van Fenema. You might have seen her at her lecture on the psychological factors that influence musical performances. The video can be found on youtube:

We received responses from 37 conservatory students, of which 34 were completed fully. A total of 60 medical students responded, with a total of 43 completed questionnaires. Due to the low response rate, it is hard to generalize our findings. Yet, we can make the following remarks:

* In both student groups, there was an indication for over 23% of the students to get further examination on the possibility of having a personality disorder. Most students had high scores on the personality trait ‘perfectionism’. A possible explanation for this finding is that certain personality traits come with the choice for one of both studies. They both require a certain amount of perfectionism, and particularly for conservatory students, an expressive temperament is even essential.

* Some music students suffer from social phobia, meaning that they are experiencing intense fear while acting in social situations, like a musical performance.

* The K-MPAI questionnaire (3) proved that music students are likely to suffer from performance anxiety, as indicated by the high mean score. In most cases we found that the students who suffer from severe performance anxiety, were also likely to experience other mental problems, such as general anxiety, depression and/or social phobia.
 
Conclusion and future research
We concluded that both conservatory and medical students experience more psychological problems than the general population. Our research also shows that certain mental problems, like performance anxiety, exist among young music students. These problems can eventually compromise professional functioning, sometimes leading to students dropping out or experiencing severe mental problems later in life.

In order to eventually prevent these mental problems, we would like to continue our research, to study whether psychological problems can be detected early in the education of conservatory students, so prevention or treatment can be offered.

Endnotes
(1) The Standardised Assessment of Personality - Abbreviated Scale - Self Report (SAPAS-SR) contains 8 questions and it can be used as a brief and simple screening for personality disorders. In case of total score over 3 it is advised to interview this person with a detailed structured assessment of personality.

(2) The 48-item Symptom Questionnaire (SQ48) is a psychological distress instrument, which contains 48 questions about symptoms of depression, Anxiety, Somatisation, Agoraphobia, Aggression, Cognitive problems, Social Phobia, Work functioning and Vitality. The questionnaire can be used as a screening tool in clinical settings, as a benchmark tool, or for research purposes.

(3) The Kenny Music Performance Anxiety Inventory (K-MPAI) is a test that researches the presence of performance anxiety by asking questions like: ‘during a gig I’m always worried if I will manage’.
The range of total score varies from -78 to 78. The Social Phobia Scale (SFS) was used to map the presence of social phobia. Questions like ‘I’m nervous when people are looking at me in an elevator’ were asked.

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