Perceived control and support during childbirth and their association with postpartum mental health outcomes: a cross-sectional study.

Music performance anxiety (MPA) is defined as persistent, distressing apprehension related to musical performance that impairs functioning or undermines subjective experience (). Prevalence estimates across professional and conservatory-level musicians typically range from 25% to over 70%, depending on the severity threshold and population studied (; ). Despite decades of research, MPA remains substantially undertreated in applied music settings, and the interventions most readily available to practitioners—breathing exercises, positive self-talk, and beta-blocker pharmacology—share a common conceptual foundation: anxiety as a problem, and its reduction as the goal. This framing, while clinically familiar, may be incomplete. The recognition that anxiety, including MPA specifically, may function adaptively rather than purely as pathology is well established in the existing literature (; ; ). The de-pathologizing of MPA as a signal has been articulated directly in the music psychology literature (), and the present article builds on this foundation rather than introducing it. This article argues that the physiological substrate of MPA, which includes sympathetic nervous system activation, heightened arousal, and attentional narrowing, is not inherently maladaptive. These responses evolved as functional preparatory systems; they become problematic primarily when cognitively appraised as evidence of threat rather than readiness. From this perspective, the primary intervention target should not be arousal itself, but the interpretive schema through which performers assign meaning to arousal. The following sections describe the theoretical foundations of this framework and operationalize them through four practitioner-applicable techniques grounded in peer-reviewed science and refined through two decades of clinical and performance coaching practice. The author occupies a dual position—concert-trained pianist and clinical psychologist—that informs the framework’s integration of performer-insider knowledge with psychological science.