Clark D B, Agras W S
Department of Psychiatry, Stanford University Medical Center, Calif.
Am J Psychiatry. 1991 May;148(5):598-605. doi: 10.1176/ajp.148.5.598.
Performance anxiety in musicians may be severe enough to require intervention but has been the subject of relatively little clinical research. The authors' objectives were to describe the results of a comprehensive clinical and laboratory assessment and to perform a double-blind, placebo-controlled study comparing buspirone, cognitive-behavior therapy, and the combination of these treatments for performance anxiety.
Ninety-four subjects were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were 1) questionnaires for all 94 subjects, 2) diagnostic interview of 50 subjects, and 3) laboratory performance of 34 subjects. Treatment conditions were 1) 6 weeks of buspirone, 2) 6 weeks of placebo, 3) a five-session, group cognitive-behavior therapy program with buspirone, or 4) the cognitive-behavior therapy program with placebo. Treatment outcome measures included subjective anxiety ratings and heart rate measures during a laboratory performance, a questionnaire measure of performance confidence, and a blind rating of musical performance quality.
All subjects fulfilled criteria for DSM-III-R social phobia. Of the 15 full-time professional musicians, ten had tried propranolol and three had stopped performing. Most of the subjects had substantial anxiety and heart rate increases during laboratory speech and musical performances. Cognitive-behavior therapy resulted in statistically significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence. Buspirone was not an effective treatment.
Cognitive-behavior therapy is a viable treatment approach for performance anxiety in musicians.
音乐家的表演焦虑可能严重到需要干预，但相对而言一直是较少临床研究的主题。作者的目的是描述全面临床和实验室评估的结果，并进行一项双盲、安慰剂对照研究，比较丁螺环酮、认知行为疗法以及这些治疗方法联合使用对表演焦虑的疗效。
通过大众媒体公告招募了94名受试者，并在一所大学的门诊精神科诊所对他们进行检查。评估包括：1）对所有94名受试者进行问卷调查；2）对50名受试者进行诊断性访谈；3）对34名受试者进行实验室表演测试。治疗条件包括：1）服用6周丁螺环酮；2）服用6周安慰剂；3）结合丁螺环酮进行为期五节的团体认知行为治疗课程；4）结合安慰剂进行认知行为治疗课程。治疗结果测量包括实验室表演期间的主观焦虑评分和心率测量、表演信心的问卷调查测量以及对音乐表演质量的盲评。
所有受试者均符合《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中社交恐惧症的标准。在15名全职职业音乐家中，10人曾尝试使用普萘洛尔，3人已停止表演。大多数受试者在实验室演讲和音乐表演期间出现明显的焦虑和心率增加。认知行为疗法在统计学上显著降低了主观焦虑，提高了音乐表演质量和表演信心。丁螺环酮不是一种有效的治疗方法。
认知行为疗法是治疗音乐家表演焦虑的一种可行方法。
