Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

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Beta-Blockers, Performance Anxiety, and the Results of the Musicians' Health Survey with John Beder

In the last year, John Beder has not only interviewed many classical musicians about their experiences with performance anxiety and beta-blockers, but also drafted his search into a cohesive survey for ICSOM (The International Conference for Symphony Orchestra Musicians), which has not addressed musicians and performance anxiety in almost 30 years.  On Wednesday, almost a year after initially launching his Musicians' Health Survey and reviewing the data, John shared his findings at the 2016 ICSOM conference in Washington D.C.  

K: With those who were comfortable discussing their beta blocker usage, how did they impact their performances, auditions, or other circumstances?

J: Throughout the project many of the musicians we talked to about beta-blockers heard about them as the “easiest" and “quickest" way to address performance anxiety. Fast and easy of course sounds perfect when so much time is already consumed by all the other demands of the profession. While we spoke with many people who had positive things to say about the use of beta blockers, many of the musicians we spoke to about beta blockers had a nuanced view of their application. They spoke about them as complimenting a diversity of methods for addressing performance anxiety, rather than using beta blockers to get around more traditional methods of performance preparation.

Many had spent a significant amount of time studying how to perform more confidently on stage, beyond the technical and musical demands of performing. Ultimately, beta blockers are not for everyone, and are certainly not a replacement for preparation or some sort of panacea for performance anxiety. This, I think, is the most important take away from any discussion around beta-blockers: that they are a part of a larger conversation about performance skills which is missing from many of our music education programs.

K: For those who don't use them, how do they manage their performance anxiety?

J: Many of the musicians we spoke to who had not tried beta blockers also invested a significant amount of time figuring out how to address performance anxiety. Many used mindfulness techniques and meditation, while others borrowed from sports psychology with things like heart monitors, biofeedback machines, and breathing exercises. We try to talk about as many of these as possible in the film in addition to beta blockers but with the impressive quantity of approaches we only had time to focus on a few of the most practiced. It’s interesting to note as well that the conversations never started with “I don’t get nervous” since every single person we talked to expressed experiences and instances of performance anxiety. 

K: Tell me about the Musicians' Health Survey that you launched a year ago and your findings since then.

J:  It’s been a year now since we distributed the study (2015 Musicians’ Health Survey) to ICSOM and it has been wonderful to see participation from orchestras around the country. A total of 447 musicians responded and some of the results are being shared at this year’s ICSOM conference in Washington DC. Professor Williamon with the Royal College of Music in London is still working on the formal analysis but much of what we learned will be discussed and presented at this year’s conference. 

Some interesting initial data I can share about the survey is that in 1987 women made up 34% of the respondents whereas our study reported 48% women to 52% men. Today’s classical musician also reported better than average health and there was major increase in physical exercise as a method to address performance anxiety. In 1987 61% of musicians reported regular exercise and in 2015, 68% reported regular exercise. As a means for addressing performance anxiety, however, exercise was used by 17% in 1987 and 74% in 2015, a striking increase. 

With regard to beta-blockers, the study shows that 72% of ICSOM musicians have tried using beta blockers for performance anxiety. Out of that group, 90% said they would consider using them for auditions, 74% would consider them for solo or featured performances, and 36% would consider them for orchestra performances. By comparison, in 1987 a reported 27% of ICSOM musicians had tried beta-blockers, representing a significant uptick (45%) over the last 28 years. Also in 1987 of those who’d tried beta-blockers 72% said they would use them for auditions while only 4% would use them for orchestra performances compared to today’s 36%.

Some other popular methods musicians reported trying included more experience (87%), eating bananas (54%), meditation (49%), and performance psychology (44%).

K: How do the survey and your findings factor into your work with the documentary and your work in Musicians' performance health?

J: The 2015 Musicians’ Health Survey is really just the start of a bigger conversation we hope to have with our film Composed. We can’t encourage musicians enough to explore performance skills outside of the notes on the page. Musicians are too often left feeling isolated in their struggle with performance anxiety despite the fact that 98% of ICSOM musicians report having experienced it at some point. The statistics here and ones to follow will likely prompt conversations about the beta blockers alone but our goal is not to adjudicate on the use of beta blockers, rather to promote an environment where talking about performance anxiety is accepted and encouraged as part of what it means to be a performer.

*In Fishbein et al. (1987) Senza Sordino

K: Thanks- I look forward to hearing more about this survey and new findings as the documentary moves towards completion!

Composed will begin a US tour starting October 2016. For more information please visit or email

A Culture of Audition Perfection and the Stigma of Beta-blockers

I recently had one of my posts about Beta-Blockers featured on, and I ended the post with this passage:

I leave the decisions with you, but notice if beta blockers become a crutch. Do you need them for every performance opportunity? Do you find yourself using them for rehearsals as opposed to concerts or auditions? (And if you're not a BB user, that's great too.)

I am neither for nor against beta-blockers.  I just think our culture of perfection is affecting musicians profoundly, and causing a new level of performance anxiety.  Choosing to take beta-blockers should be done with an awareness of side affects and contraindications, as well as an awareness that it will only affect physiological symptoms, and do little to change your mental state of performance or auditioning.

I am neither for nor against beta-blockers.  I just think our culture of perfection is affecting musicians profoundly, and causing a new level of performance anxiety.  Choosing to take beta-blockers should be done with an awareness of side affects and contraindications, as well as an awareness that it will only affect physiological symptoms, and do little to change your mental state of performance or auditioning.

One of the comments was interesting, "Implying that taking Drugs is great??????? Shocking ending to the article."  It made me think, "Performers used to drink before performances and auditions- yet taking beta-blockers is stigmatized?"  Here's some of my thoughts on the issue, and how my perspective has changed over the years.

Modern day classical music has moved to a place of elite virtuosity and a an emphasis on technical perfection and complete 100% accuracy.  Anyone who is in the current orchestral auditioning circuit knows this to be true, and often musical intent and sound quality are ranked lower by committees to pure execution of technical passages.  (Is this true for every orchestra and festival?  Not necessarily, but it is a prominent priority).  This is also true in competitions, and sometimes even collegiate auditions.  There's a very high emphasis on playing with perfect pitch, rhythm, accuracy, etc., which is absolutely important, but can sometimes go to the wayside under pressure (AKA. sympathetic response).  Anyone who has performed or auditioned (without the use of Beta-blockers) knows that things get shaky, breathing can be tricky, and accuracy can be compromised.  When committees and conductors are looking for perfection under pressure, performers are left wondering what to do.

Some people are lucky to not feel strong nerves under pressure, and other people have debilitating nerves.  When a performer spends months preparing for a competition or audition, in addition to spending money on flights and hotels, the stakes get even higher.  When our diminishing job pool couples with more qualified musicians, we have a serious problem of too much supply and decreasing (often poor orchestra management too!) demand.  The pressure on auditioning classical musicians these days is incredible, and I don't think our art form has ever seen anything like it.  Committees have become more and more picky, looking for perfect performance under pressure that often results in no-hires and perpetual vacancies, and many musicians stay on perpetual sub lists because they are deemed worthy to play with the orchestra regularly, but not worthy enough to be given a contract.  I find the whole system to be distressing, and I completely understand why people use beta-blockers, to give themselves a better chance at employment. 

Although most of us play behind a screen, there's definitely a sense of people with clipboards judging every move we make...

Although most of us play behind a screen, there's definitely a sense of people with clipboards judging every move we make...

Classical music is not always the most forgiving art form.  Many students go to expensive private music schools for either undergrad or grad school, take out loans, and then reach a point where they need to take out another loan for an instrument.  If one chooses to take auditions (ensemble, quartet, solo competitions), each audition will cost anywhere from $500-$1000 domestic, and a few thousand if international.  Let's assume that many students have $50,000 in debt, and are somewhat unemployed after graduate studies.  Students might work a day job (administrative, educational, or retail) to start to pay back loans, and then still try to take auditions in between.  The financial pressure alone is intense, and when it combines with a high volume of auditioners and a higher expectation of perfection, there's a volatile and very intense environment.  If you put in a lot of time and money to an audition of 7 minutes duration, and you slightly speed something up or play a little sharp from sympathetic response, that's rarely forgiven by a panel.  It's the unfortunate reality of our world.

I used to be that person who judged others for using beta-blockers.  I thought that real musicians could control their nerves and keep calm under pressure (not a fair perspective at all!).  There's a view that if one is well-prepared, then one won't be nervous, which is rarely true.  I then saw how hard many of my colleagues were working, and how stressed they were, and I started to understand their view.   I did not use beta-blockers for auditioning and performing throughout my studies, and I do believe that school is a crucial incubator for learning performance skills (in a relatively low risk environment).  I also realize that some people have debilitating performance anxiety, either on a physical response level or a mental level, and I will never know what that's like.  I'd love for everyone to eat bananas and meditate and breathe their stress response away, but I honestly know that everyone is different and that every body responds differently to stress.  When we're looking at audition stress and performance under pressure, we're not just looking at isolated anxiety, but often a whole host of issues: lack of job, huge financial pressures, need for stability for spouse/children/ etc.  If I (as a single lady of 28 with only a dog as a dependent) judge whether someone needs beta-blockers in auditions, I'm perpetuating this idea that people must have something wrong with them if they can't perform perfectly under pressure, and that's not fair to the true host of stresses of our career. 

The solution?  I'd love to see orchestra auditions change entirely.  I don't necessarily think that playing 7 minutes of orchestral excerpts is a good indicator of how one plays in a section (especially for strings), and I think hearing solo repertoire is often more telling that standard excerpts.  (I'd also love for student loan situations to change in the US, especially in the arts).  As classical music loses funding and audience, maybe it's time to rethink our harsh perfection oriented standards, and instead ask 'what makes a thoughtful musician?'  The stress is not only for auditioners, but also for many symphonic musicians who play under intense conductors in high pressure ensembles.  I'd love for a shot at an even audition playing field in which no one uses beta-blockers and there's a mindset of forgiveness for any initial shakiness.  Until then, it might be time to check that harsh judgment of beta-blocker users at the door and look at the big picture issues.

The Importance of De-stressing, De-caffeinating, and Resting

I've been in a movement challenge through the Liberated Body, and I've been thinking about the importance of resting in the course of the day.  In the west (and in classical music) we tend to just go-go-go, and every time we feel tired, overworked, and exhausted, we refuel with caffeine.  There's an expectation in music especially that we just have to keep practicing, keep auditioning, and keep stressing out all the time, and as you know from previous writings, that starts to affect the physiological function of your cells, internal organs, etc., courtesy of your sympathetic nervous system. 

How many musicians do you know that drink a teensy bit too much caffeine in an effort to just do more?

How many musicians do you know that drink a teensy bit too much caffeine in an effort to just do more?

Think about how most Americans work out/exercise:  they don't move much all day (we live in cars, sit at desks,etc.) and then do the MOST INSANE WORKOUT EVER for 45 minutes or an hour.  And then go sit again.  What kind of yoga do most studios offer?  HOT SWEATY (intense) flow and go.  What's the problem with this?  Our bodies need time to do the opposite-to decaffeinate, to stop moving so intensely (if that's our problem), to relax, and allow cellular renewal.  Now I don't necessarily mean that you need to quit your caffeine altogether- I just want you to notice how much coffee/tea/etc. you drink, and if that's your first reaction when you're fading in energy level. 

Simple drawing of Alexander Technique's Constructive Rest position. 

Simple drawing of Alexander Technique's Constructive Rest position. 

How do we help out this cellular renewal and parasympathetic response?  Simply put, constructive rest (which is similar to a yoga savasana).  Constructive rest is an opportunity to lie down (floor, bed, couch, yoga mat) with the knees bent, eyes closed, and arms relaxed.  Some folks prefer their hands on the belly or I prefer hands along side the torso.  Constructive Rest shows up as a concept in many different movement modalities- yoga, Alexander Technique, physical therapy, and massage therapy, to name a few. 

Why do this? 

-This triggers parasympathetic response, which can help with anxiety, stress, insomnia, etc.

- This gives the body the opportunity for a natural spinal curve, which may be difficult to maintain in sitting and standing

- Your psoas (AKA. your own personal filet mignon) has the opportunity to release.  That doesn't have to mean anything right now, but just trust me, it's a good thing.

- Your mind has the opportunity to slow down, and start noticing thoughts slow down.  Combining breath awareness with deregulating action gives you a conduit to thought awareness. 

Here's a beautiful quote from restorative yoga teacher Judith Lasater (from this interview) on the importance of restoring and lying down:

There is something spiritually profound about being still and watching your mind.Most of our unhappiness is not created by what happens to us but by what we tell ourselves about it. With Restorative you create a space to watch the rising and falling of thoughts. And then the most important thing we can do can happen- we can dis-identify with our thoughts, “I am having a thought of anger, a thought of sadness, but it’s not who I am.” We distract ourselves with entertainment. We pay people in our culture the most amount of money who can distract us the best. 20 minutes a day to notice the thoughts that never end. The chatter that never ceases. And slowly over time we have space between our thoughts and our reaction or the words we choose.
— Judith Hanson Lasater

Let me make this clear- this is not a nap, at least not intentionally.  This is active rest.  When should you do this?  Whenever you have time/space to do so, and you're energy is flagging.  Maybe you're preparing nonstop for a recital, competition, or audition-make sure you're restoring every day!  Maybe you have difficulties with stress and sleep-try this.  SO many things in the body are benefited by taking time out to rest and de-stress every day, and in adding this to my self-care repertoire, I have more energy and sleep better. 

Want a detailed video on exactly how to do this?  Brooke (from the liberated body) gives an awesome youtube video setup.

What does a Beta-Blocker Do?

So in the last few weeks, I've been busy (and stressed, too!), but I've been thinking about stage fright, sympathetic response of the nervous system, and why things happen to us when we're nervous.  Most musicians will at some point run into beta blockers as an antidote to stage fright- whether a colleague uses them or even a teacher, by adulthood, we have encountered someone who uses them for something not related to its initial prescriptive purpose.  (Musicians are certainly not the only folks who use these-actors, presenters, etc., have been known to use them as well).

Whether or not you take them, it's useful to know what the heck is going on if one does take them. 

First of all, a beta blocker is typically prescribed for folks with heart issues, arrythmia, and who need to lower their standing heart rate.  It tackles the beta-receptors of the smooth muscles of the heart, kidneys, and sympathetic nervous system to prevent norepinephrine and epinephrine (adrenaline) from attaching to beta receptors, which ultimately encourages blood flow (as opposed to restricting vessels) and reduces overall heart rate.  If that language didn't make things clear, let me simplify.  Beta Blockers reduce overall heart rate and prevent adrenaline from playing its role in sympathetic response, AKA fight or flight.  That means it reduces the physiological symptoms of sympathetic system, which affects breathing, fine muscle control, tremors, etc. 

While this may sound like a wonder-drug, there are a few things to consider. 

This is one of the most common BB's: propranolol.

This is one of the most common BB's: propranolol.

-There are side affects, like all mysterious chemical concoctions, and they're fairly standard: nausea, vomiting, headaches, as well as more complex effects if one already has heart problems.  (And of course, there's a warning about sexual dysfunction, so don't forget about that.)

-Beta blockers are banned in the Olympics, but not in auditions.  What would it be like if they were banned in auditions?  It's a question I've pondered, because I think performance under pressure differs so widely person to person.  It would even the playing field, whether that's a good thing or bad thing.

-Beta Blockers only target the symptoms of panic, but don't address any of the psychological/somatic issues.  If your anxiety is based in a constant fear of being good enough, or prepared, or talented, then BB's will only help so much. 

-Some people (audition committees/teachers/etc.) feel that BB's limit expressivity, spontaneity, and in the moment performing creativity, which is something to consider.  If you regularly take them for performances and auditions, it might be worth wondering if you always need them. 

-The sympathetic response does have some benefits when you are in a stressful situation.  Your response time is quickened, your brain is particularly focused, heart rate/blood sugars increase to fuel the body, and muscles tense up to provide speed and power.  The whole point of sympathetic response is to support the body under dangerous conditions, so the changes that occur are meant to support.  I realize that performance is not life or death, but it is an interesting physiological response to notice.

I leave the decisions with you, but notice if beta blockers become a crutch.  Do you need them for every performance opportunity?  Do you find yourself using them for rehearsals as opposed to concerts or auditions?  (And if you're not a BB user, that's great too.)

Read more:

Musicians use Beta Blockers as Performance Enabling Drugs

3 Reasons Why Beta Blockers Could Be Holding You Back

Addiction in the Orchestra

Better Playing Through Chemistry

Stage Fright, Your Sneaky Hypothalamus...And Breathing

As part of my previous post, I talked a little about the nervous system, and how our body creates this "fight or flight" response in reaction to external stresses.  The next question then, is how to keep homeostasis between our stress response and our relaxed cellular repair parasympathetic system?  Last time, I talked a bit about conscious breathing, but let's go back to stage fright first.  I love this Ted Ed video about stage fright, because it tells us things we already know (from performing) but goes in a bit more detail about the hypothalamus, which is a regulator in your autonomic nervous system and a player in "fight or flight."

We've all seen the posters and images that say "just breathe" and whatnot, but there is a touch of truth to that.  Connecting to the quality of your breath is a great way to get control of your autonomic nervous system, which ultimately works independently. 

We've all seen the posters and images that say "just breathe" and whatnot, but there is a touch of truth to that.  Connecting to the quality of your breath is a great way to get control of your autonomic nervous system, which ultimately works independently. 

So this video pointed out some obvious things: preparation is essential, everyone's experience is unique, and your mental state affects your reaction.  Notice how the video ended?  By focusing on the breath.

Bringing mindfulness (of the breath and body) into the music space is an amazing way to start to

a) Become more aware of your breath quality/duration/depth

b) Become more aware of when your body freaks out

c) Start to gain a bit more control of the stress response.

While yoga and meditation practices can be a great way of gaining this experience, the simplest thing to do though is to start noticing how you breathe (short, shallow breaths?  Deep diaphragmatic breaths?  Belly Breaths?)  in day to day life.  Many traditions (Buddhist and non-sectarian) use the breath as a beginning point of awareness, and as a musician who is often under stress daily, this can be helpful. 

If you're in an orchestra and you're a soloist (wind player, section leader, conductor), take the few seconds before rehearsal or during tuning to check into your breath and your contact with the chair.  See if you can settle your energy downwards into your ischial tuberosities (sit bones)  while feeling into your ribs and belly as you inhale.   If you're preparing to speak (either to a class or committee) and you're nervous, do the same thing: begin with your quality of breath as a way of focusing your scattered mind and feel your feet rooted into the earth solidly.  Shallow breath means that less oxygen is in your body, and therefore less oxygen to your brain (and a less focused brain too!).  Another thing- to upregulate and energize, we lengthen our inhalation, if we want to calm the body, we lengthen the exhalation.  Want to learn more about breathing works?  This is also a great Ted Ed video to get started with!  In the upcoming weeks, we'll learn a bit more about meditation and how that practice can help musicians.

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