yoga reduces performance anxiety in

7/21/2019 Yoga Reduces Performance Anxiety In

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ORIGINAL RESEARCHYoga Reduces Performance Anxiety in

Adolescent MusiciansSat Bir S. Khalsa, PhD; Bethany Butzer, PhD; Stephanie M. Shorter,PhD;Kristen M. Reinhardt, BM;Steph en Co pe, MSW STR CTContext Professional musicians often experience highlevels of stress, music performance anxiety (MPA), andperformance-related musculoskeletal disorders (PRMDs).Given the fact that most professional musicians begintheir musical training before the age of 12, it is importantto identify interventions that will address these issuesfrom an early age.Objective This study intended to replicate and expandupon adult research in this area by evaluating the effectsofa yoga intervention on MPA and PRMDs inapopulationof adolescent musicians. The present study was the first toexamine these effects.Design The research team assigned participants,adolescent musicians, into two groups. The interventiongroup (n 84) took part in a 6-wk yoga program, and thecontrol group (n = 51) received no treatment. The teamevaluated the effects of the yoga intervent ion by com paringthe scores of the intervention group to those of the controlgroup on a number of questionnaires related to MPA andPRMDs.SettingThe study was conducted at the Boston UniversityTanglewood Institute (BU TI). BUTI is a training academyfor advanced adolescent musicians, located in Lenox,Massachusetts.

Participants Participants were adolescent, residentiamusic students (mean age = 16 y) in a 6-wk summerprogram at the BUTI in 2007 and 2008.Intervention Participants in the yoga interventiongroup were requested to attend three, 60-min, Kripalu-style yoga classes each wk for 6 wk.Outcome Measures MPA was measured using thePerformance Anxiety Questionnaire (PAQ) and the MusicPerformance Anxiety Inventory for A dolescents (MPA I-A)PRMDs were measured using the Performance-RelatedMusculoskeletal Disorders Questionnaire (PRMD-Q).Results Yoga partic ipan ts showed statistically significanreductions in MPA from baseline to the end of theprogram compared to the control group, as measured byseveral subscales of the PAQ and MPAI-A; however, theresults for PRM Ds were inconsistent.Conclusion Tlie findings suggest that yoga may be apromising way for adolescents to reduce MPA and perhapseven prevent it in the future. These findings also suggest anovel treatment modality that potentially might alleviateMPA and prevent the early disruption and termination ofmusical careers. [Altern Ther Health Med.2013;19(2):3445.)

Sat Bir S. Khalsa, PhD,isassistant professor of medicineinthe Department of Medicine at Brigham and Women sHospital, Harvard Medical School, Boston, Massachusetts;and research director at the Kripalu Center for Yoga andHealth in Lenox, Massachusetts. Bethany Butzer, PhD,is apostdoctoral research fellow at Brigham and Women sHospital, Harvard Medical School, Boston, Massachusetts.Stephanie M Shorter,PhD,Founder,M ind-Body Collective,Austin, Texas. Kristen M. Reinhardt, BM, is a doctoralstudent intheDepartment ofPsychologyat the Universityof Oregon in Eugene, Oregon. Stephen Cope, MSW, isdirector of the Institute for Extraordinary Living andSeniorScholar inResidence at the Kripalu Center for Yogaand Health in Lenox, Massachusetts.

Correspondingauthor:BethanyButzer PhD

P rofessional musicians face many career Stressors, suas music performance anxiety (MPA), the unpredicability of schedules for work and travel, and perfomance-related musculoskeletal disorders (PRMDs) resultifrom demanding hours of training and practice.' Survstudies estimate that as many as 69% of musicians are negtively impacted by MPA-' and as many as 87% of musiciaexperience PRMDs.^'^ Considering that most professionmusicians begin their training before the age of 12,' it woube advantageous to develop preventive interventions fMPA and PRMDs for young musicians. Early implemention of such interventions might support longer as well more productive and satisfying musical careers. Based recent research on the effectiveness of yoga and meditatifor MPA in adults,^ the present study examines whethyoga would be a valuable preventive measure for adolescemusicians, particularly for MPA and PRMDs.


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Music Performance Anxiety MPA)MPA can involve both cognitive and physical symptom s,including catastrophic and self-defeating thought patterns,obsessive behaviors to counteract anxiety, and intense aro us-al of the autonomie nervous system leading to variousphysical discomforts, such as chest pain and profuseswe ating .' The deleteriou s effects of persis tent atixiety canextend beyond perceived discomfort and can compromisethe quality of performance and/or stage presence, potentiallyresulting in missed professional opportunities. Ultimately,MPA may become so overwhelm ing that it eclipses the m oti-vation to continue performing and leads to careerAnxiety can be crippling to the lives and development ofadolescents. In their recent review of adolescent anxiety dis-orders, Beesdo, Knappe, and P ine reported that 15% to 20%of the adolescent population suffers from an anxiety disor-der. Am ong the many anxiety disorders that plague adoles-

cents, ranging from generalized anxiety disorder to panicdisorder, MPA is most similar to social anxiety. In 2005,Kenny suggested that the perceived social evaluation ofmusic performance by teachers and audience members mayaccount for the similarity between social anxiety and MPA.MPA's symptoms in the adolescent population are identicalto those seen in adults.Existing treatments for MPA consist of psychological,behavioral, an d/or pharmaco logical appro aches.' '^'Psychological and behavioral approaches include cognitivebehavioral therapy, systematic desensitization, hypnosis,psychotherapy, and a variety of mind-body techniques,

including biofeedback, the Alexander techn ique, progressivemuscle relaxation, breath regulation, and meditation.' '^-'Generally speaking, these approaches successfully alleviateMPA in the majority ofcases.'''^ Pharmacological treatment,however, has not proven to be a viable option for manymusicians' *''' because many anxiolytic drugs disrupt finemotor control, interfering with the very skills necessary toplay an instrum ent.Performance-related Musculoskeletal DisordersPRMDs)Musicians also commonly experience performance-re-lated musculoskeletal disorders (PRMDs) that diminishtheir ability to perform. G omm on PRMDs include pain fromoveruse and repetitive movements, peripheral nerve disor-ders (eg, carpal tunnel syndrome), muscle cramping, andinvoluntary contractions. Not surprisingly, some evidencesuggests that musculoskeletal discomfort and MPA exacer-bate one another.'^^''^^ Despite their youth, adolescent musi-cians can also suffer from PRM Ds, with as man y as 17% ofmusic students in secondary schools reporting moderate tosevere PRMDs.'^ Treatments to prevent or heal PRMDsinclude rest, modifications to the playing technique oradjustments to posture, physical or occupational therapy,exercise, pharmacological agents, and in extreme cases.Due to the stigma that surrounds PRMDs

within the realm of professional music, however, few musi-cians seek treatment before their problem s become debilitat-ing.The Beneficial Effects of Yoga

Yoga, a holistic min d-bod y practice, is ideal for preven t-ing or counteracting the psychological and physical Stressorsthat professional musicians face. While physical postures andmovements most commonly characterize yoga for the gen-eral public, other key elements of yoga are meditation, con-trol of attention, breathing, and deep-relaxation exercises.Research documenting the therapeutic benefits of yoga hasgrown steadily over the past 4 decades and now includescontrolled clinical trials on psychiatric conditions such asdepression and anxiety, breathing disorders such as asthma,cardiovascular disorders such as hypertension, endocrinedisorders such as diabetes, and a variety of musculoskeletaland neurological conditions.** Yoga and meditation tech-niques have been shown to (1) improve mood-'*'^'; (2)increase resiliency from both acute and chronic stress'^';and (3) improve performance on a variety of cognitive,^^-psychomotor, - * and physicaP* '^ tasks.

Evidence on the psychophysiological benefits of long-term yoga practice supports its use as a therapeutic treat-me nt for many med ical conditions. ^' * Yoga therapy tai-loring a custom yoga regimen to treat a client's specific psy-chological or physical health concernsis increasing inpopularity and acceptance. The widespread benefits of yogahave led to a rapid increase in yoga practice among the gen-eral population. A recent survey by the Genters for DiseaseGontrol and Prevention^' revealed that yoga was among thetop 10, most-us ed com plementary and alternative m edicine(GAM) practices as well as among the four GAM modalitiesthat dem onstrated the greatest increase in prevalence between2002 and 2007. The survey also found that6.1%of adults inthe United States (approximately 13 million people) and2.1% of children and adolescents (aged 0-17) had practicedyoga in the past 12 months.^

Two recent review papers have detailed the growingbody of research on the benefits of yoga for children andadolescents. In 2008, Galantino, Galbavy, and Ouinn^'reviewed 24 studies that evaluated the neuromuscular, car-diopulmonary, and musculoskeletal effects of yoga in chil-dren and adolescents aged 4 to 17 whereas in 2009 Birdee etal * reviewed 34 studies on the clinical applications of yogafor both physical health and psychological disorders in thepdiatrie population (aged 0-21). Of particular relevance tothe present study, Birdee et al outlined a 1992 study byPlatania-Solazzo et aP' in which a relaxation-therapy inter-vention (30 minutes of yoga, 2-3 m inutes of massage, and 30minutes of progressive relaxation techniques) was imple-mented for children in a psychiatric facility. The childrenparticipated in the intervention for one 60-minute session.In self-reported and observer-rated anxiety scores obtainedbefore and after the intervention, Platania-Solazzo et alfound greater declines for the yoga group as opposed to the


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control group. Both Galantino et al and Birdee et al con-cluded that yoga has beneficial physical and psychologicaleffects for children and adolescents but cautioned that moreresearch is needed due to methodological constraints of thereviewed studies.Yoga as an Intervention for MPA and PRMDsMany papers have suggested that maintaining a regularyoga and/or meditation practice prevents or alleviates thepsychological and physical problems encountered bymusicians,'-'-'^'''^' '' ''^ ''* A handful of studies have also exam-ined the effects of isolated components ofayoga practice onMPA and musculoskeletal conditions. These studies havesuggested tha t relaxa tion techniques, '' ' * regula tion ofbreathing,^''^'''' or meditation/guided imagery*' can amelio-rate MPA and PRMDs, Only two studies, however, haveexamined the effects of yoga as an intervention for MPA and

In a preliminary controlled study on the effects of an8-week yoga program for MPA and PRMDs, young adultmusicians in an intensive, mu sic-training cu rriculum showeda significant reduction in solo MPA relative to a no -treatm entcontrol group,' More recently, in 2009 Khalsa et aF extendedthese findings using additional outcome measures and alarger sample of adult musicians attending the same music-training program. The researchers assigned participants toone of three groups: (1) a yoga lifestyle group, (2) a yoga-and-meditation-only group, or (3) a no-treatment controlgroup. Relative to the control group, both yoga groupsshowed a trend toward decreased levels of MPA and signifi-cant decreases in general anxiety/tension, depression, andanger at the end of the program.Purpose of the Present StudyThe purpose of the present study is to replicate andexpand upon adult research on yoga by evaluating the effectsof a yoga intervention on MPA and PRM Ds in an adolescentpopulation. Demonstrating the efficacy of yoga for adoles-cent musicians can provide a novel treatment modality toalleviate MPA and PRMDs and potentially prevent the earlydisruption and termination of musical careers.METHODParticipantsParticipants were residential music students of aprestigious, 6-week sum mer program of the Boston UniversityTanglewood Institute (BUTI) in 2007 and 2008, BUTI is atraining academy for advanced adolescent musicians, locatedin Lenox, Massachusetts, An affiliate of the TanglewoodMusic Center and the Boston Symphony Orchestra, BUTIhosts many internationally renow ned, master-level m usiciansto instruct its students,

BUTI sstudents (N=107 in 2007; N=204 in 2008) wereinvited through e-mail announcements to participate inKripalu yoga classes on BUTIs campus at no cost. All stu-dents who responded to this initial invitation were assigned

to the yoga group (in 2007, n =3 or 28,9% of BUTIstostudent pop ulation; in 2008, n= 53or 25,9%), Following texperimental group assignment, a second e-mail announcment recruited control participants (in 2007, n= 25or 23,4of BUTIs total student population; in 2008, n=26 or 12,7from BUTI sremaining population of students. The researteam's relationship with BUTIs administration was focuseon the benefits of providing the yoga program to the stdents, and it was determined that BUTI's administratiowould not respond favorably to a random assignment students to a no-treatment control group. Therefore, all stdents interested in participating in the yoga interventiowere placed in the yoga group within the logistical limittions of the available space for yoga practice and of the timing during the summer music program. C ontrol participanwere recruited separately from students in BUTI's same summer music program who had not volunteered to participain the yoga intervention but who were willing to complethe study's questionnaires in return for a modest remunertion.

The research component of the program was approveby the institutional review board of Brigham and WomenHospital, and all participants and guardians signed informeconsent forms before the study. Control participants weremunerated with $25 gift certificates to a local shop after tstudy.Procedure

Yoga Protocol The 8-week yoga curriculum used Khalsa et al's 2009 study* was modified to a 6-week prog rafor the present study, mainly to fit into the shorter p eriod BUTI's summer schedule. The summer schedule spanneonly 6 weeks, as opposed to the 8 weeks of time available the Tanglewood Music Center, which was the site of Khalet al's 2009 study. The current research team modified th2009 curriculum to fit a younger population, accomplishechiefly (1) through the use of different language, such as thuse of English words only to describe yoga postures opposed to the 2009 curriculum's use of Sanskrit names fpostures with an older population, and (2) the inclusion oyoga games and fun time, such as partnered yoga poses anthe playing of popular music, provided by yoga students, some of the classes to engage a sense of fun and to make thyoga practice accessible to a younger population,

Kripalu yoga is a comprehensive set of yoga practicthat includes classical yoga postures, breathing techniqueand meditation. The hallmark of this style of yoga, considered a meditation in motion, is an emphasis on an introspective focus as breath and body movements are coordinated,All yoga classes for both years of the study were led by thsame instructor (author Kristen Reinhardt), who was skillein teaching Kripalu yoga and also trained as a classical muscian. The use ofoneinstructor allowed for the elimination potential variability in the results that could have arisen fromthe use of multiple instructors.


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participan ts performed a sequence of yoga postures followedby 5 minutes of supine rest on the floor, with a final briefmeditation. The yoga curriculum was roughly divided intothree 2-week segments. All yoga poses were selected to sup-port and potentially alleviate pain in the main areas ofPRMDs (shoulders, wrists, spine, and hips). The first seg-ment of the 6-week curriculum included an emphasis ondeep breathing (three-part breath or Dirgha Pranayam),joint-opening exercises, and supine postures, such as theFigure Four pose to stretch the hips and low back and supinespinal twists to relieve tension in the low back and hips. Thefirst segment also included basic standing postures such asDownward Facing Dog pose Adho Mukha Svanasana)an dWarrior I and II poses{VirabhadrasanaI andTI).The second segm ent included longer holds of previouslytaught standing poses as well as more challenging balancingpostures, such as the Eagle pose Garudasana) and theDancer pose {Natarajasana).Du ring the second segment,

alternate nostril breathing {Nadi Shodhana)was introducedas a stress-relieving bre athing practice.Meditation Vipassanastyle, focusing o n awareness ofthe breath without any Buddhist philosophy or references)was introduced in the third segment of the 6-week citrricu-lum. The justification for this late inclusion of meditation isthat yoga poses in most yoga philosophies are meant to pre-pare the body to be still for meditation. This final segmentincluded longer holds ofallpreviously taug ht po ses as well aslonger hip-ope ning poses, such as the Half Pigeon pose{Eka

Pada Rajakapotasana) and the Bound Angle pose[BaddhaKonasana)as well as more intermed iate back-be nding poses,such as the Wheel pose{UrdhvaDhanurasana).In the finalsegment of the program, the instructor also incorporated adiscussion abo ut optima l performance techniques (ie, flowstate).^'O ver time, the in structor was able to develop a famil-iarity and rapport with the students, which allowed her tocreate an e nvironm ent in which the students felt at ease.

The research protocol w as identical for stud ents attend-ing both the 2007 and 2008 sessions of BUTI's training pro -gram. Yoga participants were requested to attend threeKripalu yoga classes each week (out ofapossible five weeklyclasses offered during the 2007 summer session and out ofapossible six weekly classes offered dur ing th e 2008 session).Control Protocol.The control group did not participatein the yoga intervention but was recruited from the samepopulation of BUTI's summer students, and the group com-pleted the same outcome measures.

OUTCOM E ME SURESYoga and control participants completed each of the fol-lowing self-report questionnaires just prior to the start of theyoga intervention and abo ut 3 days before its end:The Performance Anxiety Questionnaire PAQ). Onthis 60-item questionnaire, participants were asked to rate

the frequency with which they experienced 20 common,cognitive and somatic, performance anxiety symptoms inthree contexts: (1) practice, (2) group performance, and (3)

solo perfor man ce. Sample items included: I feel that I lackconfidence and I find that I shake. Particip ants rated eachitem on a 5-point scale (1 = never; 5 = always), with higherscores indicating greater performance anxiety. This ques-tionnaire displays excellent construct validity, and a growingliterature exists on the use ofthism easure.-' -'^'The Music Performance Anxiety Inventory for

Adolescents MPAI-A). This 15-item questionnaire assessesthree com ponents of performance anxiety in adolescents: (1)somative and cognitive symptoms, such as Before I per-form, I get butterflies in my stomach, (2) perform ance con-text preference, such as I try to avoid playing on my own ata school concert, and (3) perform ance evalu ation anxiety,such as I worry that my parents or teacher might not like myperformance. Participants rated each item on a 7-point scale(0=not at all;6 =all of the time), with h igher scores indicat-ing greater music performance anxiety. This questionnairewas created specifically for and normalized on adolescentsand displays high reliability as well as strong construct anddivergent validity.^''

Ih e State-Trait Anxiety Inventory STAI).This 40-itemquestionnaire is made up of two 20-item subscales, one thatmeasures temporary feelings of anxiety (ie, state anxiety) andanother that measures more general, long-standing anxiety(ie,trait anxiety). To measure state anxiety, participants w ereasked to consider each item in terms of how they were feelingright now., at this moment.To measure trait anxiety, partici-pants considered each item in terms of how theygenerallyfeel. Sample items include I am tense and I am worried.Participants rate each item on a 4-point scale 1 =not at all; 4=very much so). The STAI displays excellent test-retest reli-ability and internal consistency.^^

The Performance-related Musculoskeletal DisordersQuestionnaire PRMD-Q). This questionnaire, created byAckermann and Adams in 2004,'' consists of two separatecomponents with questions evaluating (1) detailed timereporting of daily frequency, intensity, and duration of prac-tice and performance; (2) two 100-mm, linear, visual ana-logue scales to assess the frequency (0 never; 100 = con-stantly) and severity (0 = none; 100 = maximally severe) ofPRMDs; and (3) a numerical Borg scale for perceived exer-tion during musical practice (from 6 = no effort; 20 = maxi-mum effort). The PRMD-Q displays high reliability andvalidity in musicians across a range ofages,experience levels,and performance contexts.** The full instrument has no over-all composite score. All three components are scored sepa-rately, and therefore, can be applied separately (Ackermann,e-mail). The current research team employed only the visualanalogue scales and the Borg scale of this instrument toincrease simplicity and reduce participants' burdens.

Evaluation of the Yoga Program.All yoga participantsevaluated the program at its completion by filling out an Evaluation of the Yoga Program questionnaire that wasspecifically created for the purposes of the present study.Seven of the questions were rated on a 10-cm, visual ana-logue scale with extremes of 0 = not at all to 10 = very


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Table 1.Summary of Demographic D ataYoga(n=84)

16.40.930:54

63:11:5:3:1:1

Control(n=51)16.51.5

29:2236:9:5:1:0:0

Age,y mean SDjGender, n male:female)Race, n Caucasian:Asian:black:Hispanic:American Indian/Alaskan Nativetother)

Instrument, nStringsWoodwindBrassPercussionVoiceBlank

42864222

2366313

Musical training,y meanSD) 7.7+3.3Note: Percussion includes classical percussion, harp, and piano.

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much so, while the eighth question was open-en ded.Through the quantitative items, participants were asked (1)about the perceived benefit of yoga and/or meditation ingeneral and as a musician; (2) about the impact of the prac-tice on overall musical performance as well as on the techni-cal and creative elements of musical performance; (3) abouttheir willingness to recommend yoga to other students atTanglewood; and (4) about their intent to continue practic-ing yoga and/or meditation. The qualitative item asked par-ticipants to comm ent on their experience of the program andon anything else they wished to share. No questions regard-ing the instructorsquality or inclusion/exclusion of particu-lar elements of yoga practice were included.Data Analysis

To examine whether end-of-program scores differedsignificantly between participants in the yoga and controlgroups, a series of 12 multiple regression analyses were per-formed on the subscales of the four outcome variables: 1 )PAQ (three subscales), (2) MPAI-A (four subscales), (3)STAI (two subscales), and (4) PR MD -Q (three subscales). Ineach analysis, baseline score and experimental condition(coded as yoga group=1, control group = -1) served as pre-dictors of the scores at the end of the program. For example,in one of the multiple regressions, the participant's baselinesomative/cognitive subscale scores on the MPAI-A and hisor her condition were used to predict the participant's som a-tive/cognitive subscale scores on the MPAI-A at the end ofthe program. All of the other multiple regression analyses

were conducted in the same fashion, with baseline scores ancondition predicting scores at the end of the programincluding baseline scores as a predictor controlled for paticipants' baseline scores on each measure and the potentfor regression to the mean.R SU TSAmalgamation of the 2007 and 2008 Samples

As described previously, the study protocol w as identicfor both the 2007 and 2008 samples. When the multipregression analyses (described above) were conducted seprately for each year, only three instances of differencoccurred between the results for the 2007 and 2008 samplthat were related to the effect of the experimental conditio(ie,yoga group vs control grou p). These results suggest ththe yoga intervention had largely the same effect in boyears.The three instances involved (1) the PAQ group suscale, (2) the STAI trait anxiety subscale, and (3) thPRMD-Q severity subscale. Thus, to increase statisticpower, the data from both years were combined into onsample for all of the study's variables except the PAQ grousubscale, STAI trait anxiety, and PRMD-Q severity. To binclusive, however, the results for the separate analyses aalso included in the results section below.

Baseline scores for the yoga and control participants the combined sample were compared using independesamples tests to ensure that participants were statisticalequivalent on all of the study's measures at baseline, whic


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Table 2.Means and Standard Deviations on Anxiety Measures and PRMD-QYoga

for Comb ined 2007 and 2008 SamplesControl

PAQPracticeGroupSolo

MPAI ASomative/CognitivePerformance ContextPerformance EvaluationTotal

STAIState AnxietyTrait Anxiety 2007Trait Anxiety 2008

PRMD-QFrequencySeverity 2007Severity2008Exertion

BaselineMeanSD

n=84

36.01 10 .2745.04 12.2160.79 14.37

28.70 11.398.264.5110.404.88

47.3618.06

38.16 10.5347.66 11.6642.11 9.67

23.55 2 8.2319.5826.9224.89 24.60

13.02 2 .09

End of ProgramM e a n l S D

n=75

33.659.4940.98 10 .5553.92 12.72

24.46 9.897.44 4.338.76 4.0 2

40.6615.99

35.58 10.3138.11 9.3639.518.51

21.6722.6124.5822.0118.1618.6312.48 2.0 6

BaselineMeanSD

n=5

38.21 12.1846.41 11.8659.00 14.06

27.40 9 .597.94 4.1 310.023.70

45.3614.41

37.81 11.9647.32 11.3542.04 10.04

20.51 24.1217.33 17.7617.15 24.2213.332.08

End of ProgramMean SD

n=44

35.07 8.8946.09 12.4 157.39 1 4.85

27.91 1 1.257.41 4.2310.394.05

45.70 1 6.27

37.76 11.4941.56 10.8841.12 9.07

22.8425.2022.96 18.7018.5824.3112.452.77

Note: All descriptive statistics are reporte d as meansstandard deviations for the combined 2007/2008 sample unless oth-erwise noted by .Abbreviations: PAQ=Performance Anxiety Questionnaire; MPAI-A=Music Performance Anxiety Inventory forAdolescents; STAI=State-Trait Anxiety Inventory; PRM D-Q=Performance-Related Musculoskeletal DisordersQuestionnaire. Due to the significant differences between the 2007 and 2008 samples on trait anxiety and PRMD-Q-severity differencescores, these descriptive statistics are presented separately for each sample. For the 2007 sample, yoga n = 31and control n=25.For the 2008 sample, yoga n= 53and control n=26.

Dem ographic D ata and Descriptive StatisticsTable 1 presents a demographic summ ary of the com-bined sample. At baseline, the combined sample for the 2years consisted of 84 participants in the yoga group (54female and 30 male) and51participants in the con trol group(22 female and 29 male). The mean age of the yoga partici-pan ts was 16.4 0.9 years, and th e m ean age of the controlparticipants was 16.5 1. 5 years. The mean years of musicaltraining for yoga participants were 7.7 3.3 years, and themean years of musical training for control participants were7.02.9years.The m ajority of the participants were Caucasian(73% of the total sample). Seventy-five of the yoga group(89%) and 44 of the control group (86%) completed the

questionnaires both at basehne and at the end of the pro-gram. The yoga participants attended an average of17classesin total over the6 weekperiod.Regression Analyses

Table 2 shows the means and stan dard deviations for theyoga and control groups in the combined sample (2007 and2008 participants) on thePAQ,MPAI-A, STAI, and PR MD -Qat baseline and at the end of the program. Figure 1 showsmean baseline and end-of-program scores for the yoga andcontrol groups in the combined sample on the practice,group, and solo subscales ofthePAQ as well as scores for theMPAI-A Somative/Cognitive Performance Anxiety subscale.


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Figu re 1. Mean Baseline and End-of-program ScoresShows the mean baseline and end-of-program scores for participants in the yoga and control groups in the combin2007/2008 sample on the Practice, Group, and Solo subscales of the Performance Anxiety Questionnaire (PAQ) as well scores for the Somative/Gognitive Performance Anxiety subscale, scores for the Performance Evaluation Anxiety subscaland the total score on the Music Performance Anxiety Inventory for Adolescents (MPAI-A). Superscript a { ) indicates ththe differences between the yoga and control groups for the change in scores from baseline to end of program are statisticalsignificant. Error bars represent the standard error ofthe mean.

PracticeMusic Performance AnxietyH I 1 I I I hGroup

Music Performace Anxiet

504846444240 .

Baseline End ProgramMPAI-A TotalI1 1I11 1h

Baseline End Prog ramMPAI-A Somative/Gognitive

SoloMusic Performance Anxiet

Baseline End Prog ramMPAI-A Performance Evaluation

30 .

28

2 6

2 4

f 1 1 1 1 1 1Gontrol j

Yoga11

10

9

Baseline End Program Baseline End Program Baseline End Prog ram

scores for the MPAI-A Performance Evaluation Anxiety sub-scale, and total scores on the MPAI-A. Table 3 presents asum ma ry of the regression results for all of the study s vari-ables. All effects are reported as unstandardized regressioncoefficients.

PAQ. Wh en baseline PAQ scores and the participant scondition (yoga vs control) served as predictors ofend ofprogram PAQ scores for the combined sample, participantsin the yoga group showed significantly lower performanceanxiety, M = 40.98 10.55, in group-perform ance contextsthan control participants,M = 46.09 12.41 (b = -2.12,i[118]= -2.36, P< .05). Yoga participants also showed significantlylower, end-of-program performance anxiety in solo-perfor-mance contexts, M = 53.92 12.72, than control participa nts,M = 57.39 14.85 (b =-2.68, f[l 18] = -3.13, P .01). No sig-nificant differences emerged, however, between the yoga andcontrol participants on end-of-program performance anxi-ety in practice contexts (b = -.22, f[118] = -.32, ns).When the regression analyses were run separately for

the PAQ on the 2007 and 2008 samples, the effects werelargely the same, except for the PAQ group subscale (data notshown in tables or figures). Yoga participants in the 2008

sample showed significantly lower end-o f-prog ram perfomance anxiety in group perform ance contexts, M = 40.4110.19, than control participants, M = 46.12 13.50 (b = -3.3i[62] = -2.80, P .01). No significant differences emerghowever between the yoga and control participants on enof-program performance anxiety in group contexts for th2007 sample (b = -1.15, i[55] =-.83, ns). Similar to the amagamated sam ple, both the 2007 and 2008 samples showed nsignificant differences between the yoga and control particpants on end-of-program performance anxiety in practicontexts (2007: b = .51, t[55] = .53, ns; 2008: b = -.48, i[62] -.50, ns). In addition, bo th the 2007 and 2008 participants the yoga group showed significantly lower end-of-prograperformance anxiety in solo-performance contexts than paticipants in the control group (2007: b = -2.46, i[55] = -2.0P< .05; 2008: b = -2.82, i[62] = -2.19, P< .05).

MPAI-A. When baseline MPAI-A scores and conditioserved as predictors of end-of-program MPAI-A scores the com bined sample, yoga participants showed significantlower end-of-program somative/cognitive performance aniety, M = 24.46 9.89, than control p articipants, M = 27.91 11.25 (b = -2.40, f[118] = -3.79,P < .001). Yoga participan


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Table3. Regression Analysis Results for Combined 2007 and 2008 SamplesScores at End of Program

PAQ at end of programas predicted by base-line PAQYoga vs control

MPAI-A at end of pro-gram as predicted bybaseline MPAI-AYoga vs cont rol

PAQ PracticeSubscale,52 0,06''

-,22 0.69

MPAI-A Somative/Cognitive Subscale

.740,06''

-2,400,63**

PAQ GroupSubscale.52 0.07''

-2,12 0,90 ''

MPAI-APerformance

Context Subscale730.06''

-.21 0,2 7

PAQ SoloSubscale7 0,06

-2.680.86'

MPAI-APerformanceEvaluation

Subscale.590.06''

-1,07 0,29''

MPAI-ATotal Score740,06''

-3 770,96' '

STAI State STAI Trait AnxietyAnx iety Subscale Subscale

STAIat end of pro-gramaspredicted bybaseline STAIYoga vs contr ol

,21 0,0 8' '

2,25 1,g

PRMD-QFrequency Subscale

PRMD-QSeverity Subscale PRMD-QExertion Subscale

End-of-programPRMD-Q predicted bybaseline PRMD-QYoga vs contr ol

530.06''

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Note: All effects are reported asunstandardized regression coefficients standard errors. Con dition is coded as yoga group= 1, control g roup= - 1Abbreviations: PAQ =Performance Anxiety Questionnaire; MPAI-A=Music Performance Anxiety Inventory forAdolescents; STAI=State-Trait Anxiety Inve ntory; PRM D-Q=Performance-Related Musculoskeletal DisordersQuestionnaire, Due to the significant differences between the 2007 and 2008 samples on trait anxiety and PRMD-Q severity differencescores, these regression results are presented separately for each sample in the Results section,' 'P


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also showed significantly lower end-of-p rogram perform anceevaluation anxiety, M = 8.76 4.02, than control participants,M = 10.39 4.05 (b = -1.07, i[118] = -3.67, .001). Yogaparticipants also showed significantly lower end-of-program,total MPAI-A scores, M = 40.66 15.99, than control partici-pants,M = 45.70 16.27 (b = -3.77, i[118] =-3.93, .001).No significant differences emerged, however, between theyoga and control participants on end-of-program, perfor-mance context preference (b =-.21,i[118] = -.79, ns).

When the regression analyses were run separately for theMPAI-A on the 2007 and 2008 samples, the effects were thesame as for the amalgamated sample (data not shown intables or figures). For both the 2007 and 2008 samples, nosignificant differences emerged between the yoga and controlparticipants on end-of-program, performance context prefer-ence (2007: b = -.29, i[55] = -.60, ns; 2008: b = -.07, f[62] =-.19, ns). In addition, both the 2007 and 2008 yoga partici-pants showed significantly lower end-of-program scores thancontrol participants on somative/cognitive performance anx-iety (2007: b = -2.31,f[55] = -2.67, P < .05; 2008: b = -2.54,f[62] =-2.61, .05), performance evaluation anxiety (2007:b = -1.20, i[55] =-2.88, .01;2008: b = -.94, i[62] =-2.18, .05) and total MPAI-A scores (2007: b = -3.86, i[55] =-2.83, .01;2008: b =-3.71, i[62] =-2.58,P


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meaningful reductions in performance anxiety.The MPAI-A results confirmed those found with the

PAQ, with the yoga group showing significantly lower, end-of-program, somative/cognitive performance anxiety, per-formance evaluation anxiety, and total performance anxietythan the control group. These findings suggest that yogamight b e an effective intervention to deal with both the cog-nitive and somatic symptoms of MPA, such as trembling,increased heart rate, and fear of failure. It is also possible thatyoga might help reduce the fears that adolescent musiciansmay have about negative performance evaluations by author-ity figures such as teachers and pa rents. On the M PAI-A, theyoga participants did not show significantly different perfor-mance-context preferences at the end of the program com-pared to control participants. Perhaps the relatively shortintervention used in the present study simply did not allowenough time to fundamentally change preferences for per-forming in a group versus a solo context.State and Trait nxietyYoga participants did not show significantly lower end-of-program state anxiety compared to control participants.Yoga participants, however, showed a numerical drop in stateanxiety from baseline to the end of the program, whereascontrol participants showed no such drop. The drop in stateanxiety for yoga participants might have reached statisticalsignificance with a larger sample or a longer intervention.Future research should exam ine this possibility.

Yoga participants in the 2007 sample showed signifi-cantly lower trait anxiety at the end of the program com-pared to control participants. This finding is consistent withprevious studies that have found positive correlationsbetween trait anxiety and MPA, '^ * as well as the 2009 find-ings of Khalsa et al* in which an 8-week yoga interventionwas related to decreases in tension and anxiety in adult m usi-cians as measured by the Profile of Mood States question-naire. Yoga and meditation may not only be effective inter-ventions for MPA but also for general, long-standing traitanxiety. These results are also consistent with previousresearch highlighting the anxiety-reducing effects of yoga inchildren and adolescents' and add further credence to thegrowing yoga-therapy movement

The fact that yoga participants in the 2008 sample didnot show significantly lower trait anxiety at the end of theprogram compared to control participants was unexpectedand is difficult to explain. It will be important for futureresearch to examine the effectiveness of tailored yoga inter-ventions for trait anxiety as well as specific anxiety and mooddisorders.PRMDsYoga participants in the combined sample did notchange from baseline to the end of the program in the fre-quency or severity of PRMDs or in the effort required tocomplete a daily music practice routine. Yoga participants inthe 2008 sample, but not the 2007 sample, showed signifi-

cantly less severe PRMDs at the end of the program com-pared to control participants. Six weeks may not be a longenough time for a yoga intervention to bring about consis-tent neurom uscular changes. All of the m ean frequency a ndseverity scores for PRMD were below 25 (possible range0-100), and all of the mean exertion scores were below 14(possible range 6-20), suggesting that the present sample wascomposed of young, healthy musicians. Thus, participants'low baseline scores may have produced a fioor effect thatprecluded meaningful reductions in PRM Ds. Future researchis needed using a larger sample with higher levels of PRMDsas well as a longer yoga intervention to assess the degree andconsistency with which yoga can benefit musicians' muscu-loskeletal discomfort. Interestingly, PRMD severity scoresincreased from baseline to the end of the program in the2007 yoga sample. While this effect was not statistically sig-nificant, it also warrants further research.

YogaProgram EvaluationParticipants responded positively to the yoga programin a number ofways.Regarding questions assessing w hetherparticipants found the yoga program beneficial to themselvesas musicians, would recommend it to other musicians, andplanned to con tinue with yoga as a result oftheprogram, theresponse pattern suggests that yoga may represent a usefuland enjoyable way for adolescent musicians to reduce MPA.Other feedback on the postprogram evaluation suggestedthat yoga did not have as much of nimpact on the technicaland creative aspects of musical performance as it did onpotentially alleviating MPA.LimitationsThe present study should be considered with severalcaveats in mind. First, participants were involved in anintense music fellowship program that became more chal-lenging over time, and thu s it was somewhat different fromwhat would normally be encountered by musicians undermore typical working circumstances. Future studies shouldexamine the effects of yoga and meditation on adolescentmusicians in more naturalistic settings. Second, participantswere not randomized into the control condition, and yogaparticipants self-selected to participate in the yoga interven-tion. Thus, although the results were in the expected direc-tion and are consistent with a positive effect of the yogaintervention, one m ust exercise caution in drawing firm con-clusions from this study. Other factors, such as expectationeffects, attention effects, demand characteristics, or othernonspecific effects of involvem ent in an active yoga interv en-tion could account for the findings. One strength of the cur-rent study is that the control participants were drawn fromthe same population of adolescent music students, and thegroups did not differ on any ofthem easures at baseline, sug-gesting that the groups were very similar to each other. Thelimitations of nonrandom assignment, however, should beaddressed in future randomized controlled studies.

In ad dition, a greater num ber of females (n = 76 for the


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combined sample) participated in the yoga intervention thanmales (n=60). This finding is especially important in light ofthe fact that by age 6, females are already twice as likely tohave experienced an anxiety disorder as males.^*^ Thus, it ispossible that the results of the present study may have dif-fered if a more equal proportion of males and females hadparticipated in the yoga intervention. Future research shouldexamine this possibility.

Finally, only one instructor was used for all of the yoga-intervention classes. While this practice eliminated potentialvariability in teaching meth ods, it could also be the case thatsome of the participants might have experienced differentresults if different teachers were used. Future research shouldexamine this possibility by using multiple yoga instructorsand testing for possible instructor effects.ON LUSIONS

Taken as a whole, the present study both replicates andexpands upon previous research by suggesting that a rela-tively short (6-week) yoga intervention may reduce MPA inadolescent musicians. Thus, it is possible that starting a yogapractice early and continuing to practice may help musiciansprolong their musical careers and take increased pleasure intheir craft throughout their lives. These findings also raisethe question of whether yoga may be a beneficial interven-tion for other types of performance anxiety, such as speak-ing, sports-related, or sexual anxiety as well as other anxietydisorders like social anxiety. Future research sh ould examinethese possibilities.

KNOWLEDGEMENTSThe research team gratefully acknowledges the Kripalu Center for Yoga and Health andthe Boston University Tanglewood Institute for supporting this research.

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