Psychotherapeutic Treatment of Attachment Trauma in Musicians with Severe Music Performance Anxiety.

The aim of this paper is to contribute to the further development of a coherent theory of music performance anxiety (MPA) and its treatment. I have previously proposed three forms of MPA-focal, MPA with social anxiety, and MPA with panic and/or depression. An attachment disorder was proposed as a possible underlying psychopathology for this third type of MPA. Accordingly, open-ended in-depth assessment interviews of three professional musicians presenting with severe MPA that included panic attacks and depressed mood were analyzed from an attachment theory perspective. Two of these musicians participated in short-term psychodynamic psychotherapy. It was hypothesized that the musical performance setting re-triggers unprocessed feelings related to early attachment trauma, and that performance anxiety can be a manifestation of the emergence into consciousness of these powerful early feelings. As hypothesized, severely anxious musicians suffered both early and current relational trauma that was expressed through symptomatology in their MPA manifestations. The assessment interview of the first musician demonstrated how MPA can arise in the midst of other challenging current life circumstances that re-trigger feelings about early attachment failures and the importance of taking a full life history from severely performance-anxious musicians. Excerpts from the two musicians' short-term psychodynamic psychotherapy demonstrated resolution of their severe MPA. Failure to identify and treat underlying attachment disorders in severely anxious musicians may render other forms of treatment ineffective or short-lived.