1

Cannabidiol, Diaphragmatic Breathing Techniques, and Mindfulness-Based

Intervention as Treatment for Music Performance Anxiety

by

William John Floss II

B.M., University of Toledo, 2018

A thesis submitted to the

Faculty of the Graduate School of the

University of Colorado in partial fulfillment

of the requirement for the degree of

Master of Music

Department of Music

4/20/21

Committee Members:

Dr. John Seesholtz

Matthew Chellis
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Floss, William (M.M.., Vocal Performance and Pedagogy)

Cannabidiol, Diaphragmatic Breathing Techniques, and Mindfulness-Based

Intervention as Treatment for Music Performance Anxiety

Thesis directed by Associate Professor Dr. John Seesholtz

According to the Anxiety and Depression Association of America anxiety disorders

are the most prevalent mental illness in the United States and affect 18.1% of the

population. This includes music performance anxiety which often affects music

students and can be debilitating for young musicians. Diaphragmatic and controlled

breathing exercises, mindfulness-based intervention, and cannabidiol have all been

shown to reduce anxiety and stress levels in individuals. This paper compares and

analyzes studies that focus on the use of these practices as treatment for diverse

types of anxiety disorders. It will then cross analyze those findings with breathing

techniques taught from prominent vocal pedagogues. The results will be applicable

techniques and exercises music teachers can use to help their students manage

performance anxiety. These tactics will equip teachers with further understanding

of anxiety symptoms and how to assist students in management.

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CONTENTS

CHAPTER

I. Introduction ........................................................................................................ 3

II. Cannabinoids ..................................................................................................... 6

III. Diaphragmatic Breathing Techniques ….............................................13

IV. Mindfulness Based Intervention ….......................................................20

Bibliography ….....…….……………….…………………………………………25
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Chapter I: Introduction

Anxiety is the most prevalent mental health disorder experienced in the

United States. 18.1% of Americans suffer from an anxiety disorder.1 Performance

anxiety is a medically recognized disorder and is defined as “a physiologic fight or

flight reaction that occurs in an anxious person carrying out an activity in the

public eye.”2 It is quite common that performing musicians experience this disorder

and its unwanted symptoms. A study at Indiana University reported that 97.1% of

music students answered “yes” when asked if they have experienced performance

anxiety before a performance and 86.5% answered “yes” to experiencing

performance anxiety during a performance.3 Performance Anxiety is a crippling

disorder that affects many young musicians. Diaphragmatic breathing exercises

have been shown to reduce physical and psychological symptoms of anxiety

disorders. Voice teachers can and should be equipped to instruct students on

breathing techniques to offset symptoms of performance anxiety Because of the

nature of breathing for singing. There is also evidence that mindfulness-based

intervention practices and use of cannabidiol can also counteract symptoms of

anxiety. With the rising epidemic of anxiety in students the modern music teacher

1 "Managing Stress and Anxiety," Anxiety and Depression Association of America,

ADAA, Accessed December 04, 2020, https://adaa.org/living-with-anxiety/managing-
anxiety.
2 Segen, Joseph. Concise Dictionary of Modern Medicine.
3 Tamborrino, Robert. "An Examination of Performance Anxiety Associated with

Solo Performance of College-Level Music Majors.” (Indiana University, 2001).

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should be equipped with the knowledge and understanding of holistic practices they

can incorporate into their classroom and teaching.

Music Performance Anxiety (MPA) is a disorder that effects all types of

musicians. The symptoms can include sweaty palms, increased heart rate, a feeling

of sickness, tremors, memory lapses, and dry mouth. These are happening because

of a human's natural fight or flight reaction to increased stress levels. Sometimes

added stress can drive performers to better execute their playing, but often, the

stress can lead to a negative sympathetic nervous system response.

The sympathetic nervous system is one of two parts of the automatic nervous

system. This system oversees unconscious bodily actions and is associated with the

“flight or fight” reaction. This system does not always know how to discern

perceived and actual physical threats. This means that in high stress moments,

such as performing, it can cause a sympathetic nervous response that pumps

adrenaline through the body. The adrenaline then causes the physical symptoms to

appear. If a performer does not know how to negotiate this reaction it can

negatively affect their performance.

The other part to the automatic nervous system is the parasympathetic

nervous system. This system oversees automatic bodily functions that usually

happen post eating. These functions can include sexual arousal, crying, and

digestion. This is commonly referred to as the “rest and digest” system.

“Engagement of the parasympathetic nervous system is desired in performance

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situations because it slows down your heart rate and relaxes muscles that are key

for coordination.” 4 This engagement brings down stress levels in the body.

The body will automatically produce some symptoms to alert the person of

potential danger because the nervous system cannot distinguish between perceived

and actual threat. "Performance can be perceived in two diverse ways: positively, in

which the singer copes with the stress and shows little anxiety, or negatively, which

leads to symptoms of anxiety in the performer, thus influencing the performance

badly.”5 Consequently, it is up to the individual to negotiate these symptoms.

Diaphragmatic breathing, mindfulness-based intervention, and cannabidiol have all

been proven to slow, reduce, or stop these symptoms of the sympathetic nervous

system response while in highly stressful environments such as performing.

Chapter II: Cannabinoids

Cannabidiol (CBD) is one of hundreds of cannabinoids commonly found in the

cannabis sativa plant and the hemp plant. Unlike tetrahydrocannabinol (THC),

another cannabinoid found in cannabis sativa, CBD is a non-psychoactive chemical

found in these plants that is being used as treatment for several types of illnesses.

It is a completely save and non-addictive substance. With the rising costs and harsh

side effects of popular pharmaceutical drugs, CBD is an excellent and natural

product to try. The U.S. Government is funding many studies to see the clinical

4 Rosenberger, Amelia. “Take Deep Breaths.” ITA Journal 48, no. 1 (2020),18.
5Emmons, Shirlee. "Voice Pedagogy: Understanding Performance Anxiety." Journal
of Singing - the Official Journal of the National Association of Teachers of Singing
64, no. 4 (2008): 462.
 7

positive effects of CDB on chronic pain, anxiety, inflammation, depression,

autoimmune diseases, neurological conditions, cancer, and skin diseases.

“For example, when cannabinoids inhibit release from excitatory neurons

(indicated by the + sign), the net result is a decreased activity of the target
cell and its protection from excitotoxicity: a word that describes the deadly
over-excitation of neurons in many pathological conditions such as stroke and
epilepsy. This is a key finding, demonstrated by numerous labs looking in
many brain areas, and reveals the endocannabinoids as an innate defense
mechanism of the brain. It also helps explain how cannabinoids could help
lessen the damaging effects of stroke, epilepsy, and perhaps other brain
traumas. When endocannabinoids target certain strategically located
inhibitory neurons (-), the net result is an increased activity in target cells.
This can have complex effects, such as altering synchrony with other neurons
in the network. Such a transient regulation of neuronal firing frequency by
endocannabinoids is likely to be important for many brain activities, ranging
from the regulation of body temperature and stress, to the perception of pain,
fear, space, and time. Although CB2 receptors reside mostly on immune cells
rather than neurons, activation by cannabinoids leads to related cellular
outcomes. Release of inflammatory mediators is decreased and cell migration
is inhibited, which can dampen the painful and sometimes destructive
symptoms of an immune response. This is a simplified description of what
has become a strong scientific rationale to investigate cannabinoids as
therapies for autoimmune diseases, stroke, and a number of serious
neurodegenerative diseases (which often involve years of chronic brain
inflammation)”6

The human body is readily equipped with cannabinoid receptors to process a range

of cannabinoids. The brain uses cannabinoids as a defense mechanism to mitigate

reactions and responses to certain stress induced events. It has especially been

6McPartland, M, Guy G. “The evolution of Cannabis and coevolution with the

cannabinoid receptor - a hypothesis,” in Guy, et al, eds., The Medicinal Uses of
Cannabinoids; and McPartland JM et al. “Evolutionary origins of the
endocannabinoid system,” Gene. 2006; 370:64-74.
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shown to be able to regulate the body’s response to anxiety and help ease symptoms

incurred by anxiety disorders.

There has been a recent explosion of studies and research due to cannabis

legalization in many states within the United States. The Hemp Farming Act of

2018 is a proposed law to remove hemp (cannabis holding less than 0.3% THC) from

being a Schedule I controlled substances federally. This law would make cannabis a

common agricultural product. This act was included in the 2018 United States farm

bill that became law on December 20, 2018. This caused an immediate increase in

the amount and types of CBD products available on the market. In the following

years CBD products have become available anywhere you shop making it a readily

available and easily accessible medicinal product.

In a 2011 study done using CDB to help treat Generalized Social Anxiety

Disorder (SAD), twenty-four subjects with SAD and twelve healthy control subjects

were placed into two groups. The treatment group received six-hundred milligrams

of CDB that had been dissolved in corn oil and put into capsules. The control group

received a placebo capsule that looked identical. This was a completely blind study

and neither group knew what capsule they were receiving.7

Physiological baseline measurements were taken that included skin

conductivity, arterial blood pressure, and heart rate. Eighty minutes after capsule

7Bergamaschi MM, Queiroz RH, Chagas MH, et al. “Cannabidiol reduces the
anxiety induced by simulated public speaking in treatment-naïve social phobia
patients.” Neuropsychopharmacology. 2011 May;36(6):1219–26. doi:
10.1038/npp.2011.6.
 9

consumption pretest measures were taken. Immediately following pretest

measurements, the subjects were told they had two minutes to prepare a four-

minute speech on public transportation in their city. During the speech

physiological signs of anxiety were taken using the Visual Analogue Mood Scale.

The findings of this study showed only slightly less physiological symptoms

in the treatment group. It also found only slightly less psychological symptoms

based off the Visual Analogue Mood Scale analysis that was done. However, there

was one significant finding of this study that could apply to the performing arts and

Music Performance Anxiety. “Another important observation of this study was that

the increase of negative self-evaluation during public speaking was almost

abolished by CBD... In that way, the observed effect of CBD for improving the self-

evaluation during public speaking, which is one of the pivotal aspects of SAD, will

influence the therapy of SAD patients.”8

This finding is extremely significant to the music world because young

musicians are taught to constantly self-evaluate their performances. These self-

evaluations can be quite harsh and even crippling, primarily in students who suffer

from MPA as that can exacerbate mistakes made in a performance and make them

appear or feel more significant than they actually were. These intense and negative

self-evaluations can be extremely harmful to the student musician. CBD could be a

8Bergamaschi MM, Queiroz RH, Chagas MH, et al. “Cannabidiol reduces the
anxiety...”
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way for students dealing with MPA to self-evaluate their performances more fairly

and lead to a more positive relationship with performing.

In a more modern study done in 2019, researchers looked at how THC and

CBD could work together to decrease stress, anxiety, and depression. This is a bit

more controversial in regard to musicians and MPA since THC can have

psychoactive effects, however the findings are significant and important especially

since the use of cannabis is rising and more people are looking for alternative ways

to mitigate symptoms of stress, anxiety, and depression.

In this study an app was used to track medical cannabis users' symptoms. It

analyzed a total of 11, 953 cannabis sessions ((3,151 for depression, 5,085 for

anxiety, and 3,717 for stress). It was a solely self-reporting study and asked users to

also track the percentages of THC and CBD in the cannabis they were consuming.

“Medical cannabis users perceived a 50% reduction in depression and a 58%

reduction in anxiety and stress following cannabis use. Two puffs were sufficient to

reduce ratings of depression and anxiety, while 10+ puffs produced the greatest

perceived reductions in stress.”9 This is an incredibly immediate reduction. This

statistic is important because common anti-anxiety and depression beta blockers

can take months to start working and require constant monitoring, check-ups, and

dosage changes. They can also come with unwanted adverse side effects that can be

debilitating to some users.

9Carrie Cuttler, Alexander Spradlin, Ryan J. McLaughlin, “A naturalistic

examination of the perceived effects of cannabis on negative affect,” Journal of
Affective Disorders, Volume 235, 2018, Pages 198-205, ISSN 0165-0327.
 11

Another significant finding of this study relates to THC verses CBD content

of the cannabis used. In the modern cannabis industry high THC and low CBD

cannabis is sought after by many users. This can actually be more harmful to

cannabis users' long term “continued use may exacerbate baseline symptoms of

depression over time.”10 This information is commonly looked over and lost since

high THC products are pushed at most cannabis dispensaries. Often times a new

cannabis user is not aware of this and since THC is still federally illegal not much is

being done to educate new users on the different types of cannabinoids and how

they work separately and together.

“High CBD (>9.5%)/low THC (<5.5%) cannabis was associated with the

largest changes in depression and anxiety ratings, while high CBD (>11%)/high

THC (>26.5%) cannabis produced the largest perceived changes in stress.”11 High

CDB and low THC products should be used to have the highest effectiveness in

lowering symptoms of anxiety and depression. There was also no perceived change

of the positive effects of cannabis over an extended period of time. Again, high THC

products without CDB can exacerbate the baseline effects of depression but had no

effect on anxiety or stress. High CBD and low THC content cannabis should be used

more commonly to treat anxiety symptoms and this information should be more

readily available to students suffering from MPA.

10 Carrie Cuttler, Alexander Spradlin, Ryan J. McLaughlin, ”A naturalistic

examination...“
11 Carrie Cuttler, Alexander Spradlin, Ryan J. McLaughlin, ”A naturalistic

examination...”
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Safe consumption of cannabis products for musicians should also be

discussed. The primary from of consumption of cannabis is through smoking. This

can be harmful to singers and instrumentalists and have effects on their

performance, lung capacity, and additional damage done to the vocal tract. The

safest way for instrumentalists and singers to consume CBD and THC products is

through oral consumables. Consumable products are also the best way to control the

dosage of THC and CBD since you can track the exact milligram dosage and can be

more consistent and accurate in medicating. The downside to consumable products

is they can often take longer to start working in the body and the perceived

symptom mitigation can take longer.

Dry herb vaporizers are the next safest form of cannabis consumption. There

is still not enough research to fully endorse this method of consumption as safe, but

the positives are the user will feel the perceived effects at once. This is safer than

smoking because vaporizers heat the cannabis to three hundred fifty-six to three

hundred seventy-four degrees Fahrenheit as opposed to six hundred degrees

Fahrenheit when you combust cannabis for smoking purposes. The lower

temperature is both better for the vocal tract then the higher combustion

temperature, but also the lower temperature allows more of the cannabinoids in the

cannabis to be activated giving the user a more efficient experience. Smoking

cannabis is not recommended for singers and instrumentalists as the smoke can

cause significant damage to the vocal tract over extended use. It should also be

noted that dry-herb vaporizing comes with risks and is not fully safe but is a better
 13

alternative to smoking cannabis which can have negative effects on the ability to

breathe and engage in diaphragmatic breathing exercises that can additionally aid

with symptoms of anxiety disorders.

Chapter III: Diaphragmatic Breathing Techniques

Controlled breathing is a skill every student of singing must learn and

develop. Understanding and knowledge of the respiration system and how singers

can use it efficiently is crucial. All teachers of singing should be able to effectively

teach these concepts. “Good breathing is the foundation for all other aspects of

singing. An adequate, exact map of the structures and movement of breathing will

help singers reach their full potential.”12

Active inhalation is the first step of breathing. As the singer inhales, the

diaphragm contracts. The diaphragm pulls down on the lungs and out on the

ribcage. Back muscles also pull the ribcage back. This causes the thoracic cavity to

increase in volume. This also creates negative pressure that causes air to be pulled

into the lungs to equalize the pressure. Exhalation can now occur. After we inhale,

the stretched back and abdominal muscles experience elastic recoil. This recoil

causes the ribs to descend. As they descend, the contraction on the diaphragm is

released. This causes the thoracic volume to decrease and pushes the air out of the

lungs to support pressure balance. Some continued forced exhalation can happen as

Melissa Malde, What Every Singer Needs to Know about the Body. (San Diego,
12

CA: Plural Publishing, 2017), 112.

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well. This is where the singer contracts their diaphragm, back, and abdominal

muscles during exhalation to force any excess air out of the thoracic cavity.

All breathing can be considered diaphragmatic breathing since it is always in

use for respiration, but how to control and coordinate this muscle has long been

discussed among pedagogues. Perhaps the most prominent vocal pedagogue Manuel

Garcia from the 1800’s included the diaphragm in his early teaching. He believed

the breath should be quick with a partially raised chest and lowered diaphragm.

During singing he recommends that the singer have a “continuous and well-

mannered pressure of the diaphragm, and he spoke of the necessity for ‘steady,’

‘moderate,’ and ‘prolonged’ pressure.” 13

Francesco Lamperti is a vocal pedagogue from the 1900’s that expressed the

importance of controlled diaphragmatic breathing as an element in the teaching of

singing. “Let him take the deepest inspiration he can, making use of the diaphragm

and muscles of the belly. Any effort about the chest-ribs in breathing must be

absolutely and entirely avoided. It is here that the evil lies.” 14 Lamperti, along with

most prominent vocal pedagogues, realized the importance of controlled breathing

and the use of the diaphragm and other musculature to effectively and efficiently

breathe for singing.

A 2016 study in China sought out the effectiveness of a diaphragmatic

breathing training (DBR) program on anxiety symptoms. This study used both a

13 James Stark, Bel Canto (Toronto: University of Toronto Press, 2003), 97.
14 James Stark, Bel Canto (Toronto: University of Toronto Press, 2003), 109.
 15

control group and a treatment group. The treatment group were taught a DBR

program while the control group was not. They measured anxiety data in two ways;

they used the Beck Anxiety Inventory self-reporting test on the patients and four

biofeedback tests to measure breathing rate, skin conductivity, heart rate, and

peripheral blood flow. Over a series of eight weeks both groups were tested before

and after performing a breathing exercise. The control group learned a breathing

exercise but not DBR. The experimental group were also instructed to practice their

DBR exercises at home and keep a daily journal.

The study found that after eight weeks there was a significant reduction in

anxiety reported on the Beck Anxiety Inventory by patients in the experimental

group. However, the control group showed no significant reduction in their BAI

scores. Regarding the biofeedback indicators measured there was significant

statistical reduction of the experimental group in breathing rate, heart rate, and

peripheral temperature. No significant difference in skin conductivity was reported

but at the end of week eight the experimental group did have a lower rate of anxiety

per skin conductivity measurement than the control group had. “The present study

provides preliminary evidence for a positive association between DBR and reduced

levels of anxiety. After eight weeks of DBR training, the experimental group made

considerable progress in terms of BAI scores. Furthermore, several physiological

indicators, including skin conductivity, heart rate, and breathing rate, showed
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similarly noteworthy progress. These findings suggest that, when used as a

relaxation technique, DBR is effective in reducing level of anxiety.”15

In another study in China, forty Information Technology professionals took

part to see what the mental and hormonal effects of an eight-week breathing

training program would be. The participants were split into an experimental and a

control group. The experimental group were taught and coached through a fifteen-

minute diaphragmatic breathing exercise. The control group was not taught a

diaphragmatic breathing exercise but were instructed to focus on their breathing.

Two types of self-reporting were used. The PANAS to collect participants perceived

feelings and the NCT to evaluate attention sustainability. Cortisol levels were also

measured in all participants via a saliva cortisol test. Cortisol is a hormone that

increases in the body as stress increases.

The results of this study point towards diaphragmatic breathing being a

successful treatment for anxiety. The respiration rate of the experimental group

was significantly lower than those of the control group. The average respiratory rate

to be four times per min in the diaphragmatic breathing condition and seventeen

times per min in the resting breathing condition.16 The study also found that the

experimental group had an increase in their post diaphragmatic breathing

15 Chen, Yu-Fen, Xuan-Yi Huang, Ching-Hui Chien, and Jui-Fen Cheng. "The
Effectiveness of Diaphragmatic Breathing Relaxation Training for Reducing
Anxiety." Perspectives in Psychiatric Care 53, no. 4 (2017): 329-336.
16 Ma, Xiao, Zi-Qi Yue, Zhu-Qing Gong, Hong Zhang, Nai-Yue Duan, Yu-Tong Shi,

Gao-Xia Wei, and You-Fa Li. “The Effect of Diaphragmatic Breathing on Attention,
Negative Affect and Stress in Healthy Adults.” Frontiers in Psychology 8 (June 6,
2017). 6-7.
 17

intervention NCT score. This means their sustained attention increased with

intervention. Cortisol levels also lowered in the experimental group. Of the four

cortisol tests done over the eight weeks (about two months); the second two had

much lower levels of cortisol than the first two tests. The control group had no

significant variation in cortisol levels in all four tests. This experiment is not fully

conclusive but points to the conclusion that there is “potential for diaphragmatic

breathing practice to improve cognitive performance and reduce negative subjective

and physiological consequences of stress in healthy adults.”17

A study was conducted in 1983 at Ball State University to “address slowed,

paced, diaphragmatic breathing as an adaptive technique for persons in stressful

life circumstances.” 18 It used ninety-six active-duty Army trainers. There were

three groups used in this study: the treatment group, the attention control group,

and the no treatment control group. Each group attended four different sessions

where they were tested before and after their sessions with a State-Trait Anxiety

Inventory and the Mooney Problem Checklist. The treatment group was taught a

ten-minute diaphragmatic breathing exercise cued to a red and green light. The

attention control group were told to count the flashing lights. The no treatment

control group were given just ten-minute breaks between pre- and post-testing.

1717Ma, “Diaphragmatic Breathing on Attention, Negative Affect and Stress in

Healthy Adults,” 4.
18 Mangiardi, Anthony R. "The Effect of Slowed, Paced, Diaphragmatic Breathing on

Self-Reported Anxiety and Perception of Life Problems.” (Ball State University,

1983). 2.
 18

Again, the results showed that diaphragmatic breathing reduced anxiety in

individuals. The experimental group had a significant difference in their pre- and

post-test A-State Anxiety test. The difference showed a decrease in anxiety for the

experimental group. No significant difference was found between the pre- and post-

A-State Anxiety testing for the focus control group and the no treatment control

group. However, it should be noted that both control groups had a slight upward

trend in reported anxiety. No significant difference was found in any of the groups

when it came to their Moony Total scores. This means there was no real perception

changes on their life problems, which is what that test measures. “The results

indicated that training and practice in slowed, paced diaphragmatic breathing can

have significantly beneficial effects under some conditions.” 19

This final study examines the effects that relaxation breathing training can

have on music performance anxiety in young musicians.20 The study included fifty-

nine musicians ranging, in age, from third to sixth grade. The entire group was

taught relaxation breathing training. This training incorporated ideas of slowed

diaphragmatic breathing. A Music Performance Anxiety Inventory for Adolescents

(MPAI-A) test was given four times throughout the study; two months, one month,

thirty minutes, and five minutes prior to the student's jury time. The MPAI-A has

fifteen questions that asks students to name any physical symptoms of music

19Mangiardi.” The Effect of Slowed, Paced, Diaphragmatic Breathing...”. 52.

20Su, Ye-Huei, Jer-Junn Luh, Hsin-I Chen, Chao-Chen Lin, Miin-Jiun Liao, and
Heng-Shuen Chen. 2010. "Effects of using Relaxation Breathing Training to Reduce
Music Performance Anxiety in 3rd to 6th Graders." Medical Problems of Performing
Artists. 82.
 19

performance anxiety that they may be experiencing. However, there was no control

group for this experiment.

The results show that there is an increase in music performance anxiety as

the jury or performance increases up to thirty minutes before. The results of

relaxation breathing training seemed to not affect anxiety rates two months, one

month, and thirty minutes before the jury. The peak anxieties documented were at

thirty minutes before the jury. Interestingly, the music performance anxiety

significantly decreased when the relation breathing was done 5 minutes before the

student’s jury.21 The anxiety levels reported after treatment at two months away

from the jury and after treatment with five minutes until the jury are almost equal

with a sharp increase at thirty minutes until the jury. This points to the conclusion

that diaphragmatic breathing exercises can reduce music performance anxiety prior

to performance. An added comment from this study is that the breathing treatment

seemed to work marginally better on female students than on male students.22

As previously stated, music performance anxiety can manifest itself in both

physical and mental symptoms. There are multiple approaches teachers should take

to help their students to negotiate these different symptoms. The first technique is

known as the four-seven-eight Breath and was developed by Dr. Andrew Weil. This

breath exercise is great because it activates the parasympathetic nervous system by

using slowed diaphragmatic breathing to help with physical symptoms and involves

21 Su. "Effects of using Relaxation Breathing Training...“. pg. 84

22 Su. "Effects of using Relaxation Breathing Training... “. 85.
 20

counting to help focus the mind away from physiological symptoms as well. The

following are instructions to perform the four-seven-eight breath.

“Find a place to stand, sit, or lie down comfortably with a tall posture
in your spine. Prepare for the practice by taking a few deep breaths in
through your nose and out through your mouth. The following steps
should be carried out within one breath cycle. Count at a comfortable
pace and do not force anything. 1. Begin by exhaling completely
through your mouth. 2. Close your mouth and inhale for 4 counts
through your nose. 3. Pause for 7 counts. Hold your breath with ease.
Avoid collapsing your chest and closing your throat. 4. Open your
mouth and exhale evenly for 8 counts. You may find that pursing your
lips will help you control the flow of your exhalation. 5. Pause for a
moment at the end of your exhale. This is not metered.”6. Repeat at
least 4 times.”23

Chapter IV: Mindfulness Based Intervention

Cultivating a sense of mindfulness is also a particularly important

concept when trying to combat symptoms of music performance anxiety.24

Helping lead students in a mindfulness activity can also refocus the brain on

the performance at hand and level out some of the negative thoughts that

arise because of MPA. Have the student's name their negative thoughts

about their upcoming performance and then replace those statements with

positive ones or revised versions of those thoughts/statements. For example, a

student may say “I’m feeling really anxious about bombing this performance,

I don’t think I practiced enough.” Now, frame that into a positive statement

such as “I have prepared for this performance and my audience wants to hear

23Rosenburg. “Take Deep Breaths.” 20.

24Nixon, Wendy. “Helping Singers Manage Music Performance Anxiety.” Choral
Director. March 2013, Vol. 10 Issue 2. 11.
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me succeed.” Altering the state of mindfulness can help combat negative

physiological symptoms of MPA that can appear.

Mindfulness Based Intervention (MBI) is another method to help treat

symptoms of anxiety disorders. “Mindfulness refers to a process that leads to

a mental state characterized by nonjudgmental awareness of the present

moment experience, including one’s sensations, thoughts, bodily states,

consciousness, and the environment, while encouraging openness, curiosity,

and acceptance.”25 There are two main MBI schools of thought. The first

involving the self-regulation of one’s attention. The second involves the

grounding or centering and acceptance of the current moment one is in.

Mindfulness is not the default setting especially in our rapidly changing

society that is constantly demanding of attention and quickly changing where

one’s attention is focused.

A 2015 MBI study sought to see how internet MBI could positively

impact those with anxiety disorders. Ninety-one participants diagnosed with

anxiety disorders were split into two groups. The first group received access

to an internet based MBI program. The second group was a control group and

had access to an internet-based discussion forum. Both groups were told to

engage with their programs six days a week for eight weeks. Participants

filled out a pre- and post- Beck Anxiety Inventory questionnaire. The

25Bishop SR. Mindfulness: A Proposed Operational Definition. Clinical Psychology:

Science and Practice. 2004;11(3):230–241. doi: 10.1093/clipsy/bph077.
 22

participants in the MBI group showed a large degrease in symptoms of

depression, anxiety, and even insomnia. There was little to moderate change

in the control group.26

There is an ever-growing amount of MBI programs available on the

internet and on phone and computer applications. This study points out that

internet based MBI can be just as effective as face-to-face MBI programs.

Access to MBI is at an all-time high and teachers should be recommending

these programs to students with MPA. The practice of mindfulness has

consistently and clinically been proven to mitigate symptoms of anxiety. In

another study individuals in the MBI group demonstrated significantly more

reduction in anxiety symptom severity than the control group that was

measured by self-report measures of anxiety.27

The use of CBD products and other cannabis products with high THC

and CBD have both been shown to reduce perceived symptoms of anxiety

disorders. Consumed safely, these products are readily available to help aid

students dealing with MPA. These products can and should be encouraged as

a frontline assistance to help those students. Knowledge of how the

26 Johanna Boettcher, Viktor Åström, Daniel Påhlsson, Ola Schenström, Gerhard

Andersson, Per Carlbring, Internet-Based Mindfulness Treatment for Anxiety
Disorders: A Randomized Controlled Trial, Behavior Therapy, Volume 45, Issue 2,
2014, Pages 241-253
27 Hoge EA, Bui E, Marques L, Metcalf CA, Morris LK, Robinaugh DJ, Worthington

JJ, Pollack MH, Simon NM. Randomized controlled trial of mindfulness meditation
for generalized anxiety disorder: effects on anxiety and stress reactivity. J Clin
Psychiatry. 2013 Aug;74(8):786-92. doi: 10.4088/JCP.12m08083.
 23

cannabinoids THC and CBD react in the body together and separately is also

crucial for correct usage. Also, the use of CBD has been proven to reduce or

eliminate overly negative self-evaluation which is crucial to creating more

accurate self-evaluation as a musician and creating a more positive

performing experience for students dealing with MPA. This knowledge needs

to be more readily available.

Controlled DBT has also been proven to help reduce and mitigate the

symptoms of anxiety disorders. Teachers of singing and instrumentalists

should both be equipped with this knowledge since controlled breathing is

such a big skill in both mediums. These exercises can easily be taught and

incorporated into the classroom. Which can relate directly into incorporating

MBI into the classroom as well.

Lastly, MBI has again been shown to decrease levels of stress and

symptoms of anxiety and depression. It is crucial that MBI starts to make its

way into the modern classroom. The rise in technology is intensely affecting

attention spans and non-mindful auto-pilot living. Students should be

encouraged to engage in MBI in all aspects of learning, but this practice is

especially crucial in performance-based practice of music as performing

demands our attention to fully be in the experience of performing music.

Anxiety disorders are the most prevalent mental health issue humans

face today. Recent studies confirm that controlled diaphragmatic breathing,

cannabinoid use, and mindfulness-based intervention can reduce or eliminate

 24

symptoms of anxiety. These products are readily available to teachers and

students. There is no reason that the use of these practices should not be

standardized as we face startling high numbers of people being diagnosed

with anxiety disorders. It is even more crucial that music pedagogues equip

their students with knowledge of controlled breathing in the context of both

performing and as an aid to deal with performance anxiety. This research

and practice should extend into any discipline where anxiety symptoms

occur.
 25

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