Stress is a complex neurobiological response to challenging situations. Musicians are particularly susceptible to both acute and chronic stress, often exhibiting heightened sensitivity to stressors. What are the signs of stress in musicians, and what coping strategies are effective?
Neurobiological Mechanisms of Stress
Stress is a complex neurobiological response to challenging situations. In the brain, the hypothalamus plays a central role by releasing the hormone CRH (Corticotropin-releasing Hormone) in response to stressful situations. This hormone activates the pituitary gland, which, in turn, releases Adrenocorticotropic Hormone (ACTH). ACTH stimulates the adrenal cortex to produce stress hormones like cortisol. Cortisol affects various bodily functions, including metabolism, the immune system, and cognitive function. Under chronic stress, excessive cortisol release can be detrimental and lead to health problems such as cardiovascular diseases, depression, and anxiety.
The limbic system, particularly the amygdala, in interaction with the hippocampus (memory system) and the prefrontal cortex (conscious thinking), plays a role in evaluating stressors and initiating stress responses. These responses can activate the autonomic nervous system, leading to physiological changes like increased heart rate and blood pressure.
Individual stress coping depends on genetic, environmental, and learned or psychological factors. However, the brain's neuroplasticity allows for the improvement of stress coping skills through training and strategies such as mindfulness and stress management (see below).
Psychological Factors & Susceptibility to Stress
Individual stress coping depends on genetic, environmental, and learned factors.
Environmental Factors
Certain professions, such as those in the music industry, are traditionally more susceptible to stress than others. In addition to acute stress (e.g., before or during concerts), chronic stress (e.g., touring and performing, performance pressure, financial worries, and concerns about the future, as well as family and professional conflicts) often plays a significant role. As a result, the prevalence and risk of depression, anxiety, and burnout—conditions that can result from stress—are particularly high among music professionals, especially soloists and lead performers.
Personality & Biological Predisposition: High Sensitivity
High sensitivity refers to an innate or acquired tendency to perceive and process sensory impressions and emotional stimuli more intensely than the average person. People with high sensitivity, also known as Highly Sensitive Persons (HSPs), may react more sensitively both mentally and physically to environmental stimuli, which can affect their susceptibility to stress and bodily functions. High sensitivity can also lead to difficulties in coping with stress, as HSPs tend to have heightened self-reflection and deep emotional processing. This can result in increased susceptibility to stress, especially when they lack effective stress coping strategies.
Learned Factors
The way individuals cope with stressors is influenced both by upbringing and learning from role models within the family and can also be improved later in life through individual experiences, training, and counseling or coaching. Various options are available for this purpose (see below).
Signs and Consequences of Stress in Musicians
Physical Symptoms
Increased heart rate and blood pressure, accelerated or shallow breathing leading to shortness of breath, trembling, dizziness, general discomfort, inner restlessness or difficulties in motivation, digestive problems, and psychosomatic issues are typical signs of stress. Acute and chronic stress can also lead to symptoms such as ringing in the ears, tinnitus, and sudden onset of hearing loss (known as sudden deafness or sudden sensorineural hearing loss). Stress frequently causes muscle and joint problems among musicians during instrument playing.
Rumination (Thought Loop)
Rumination is a process in which we repeatedly dwell on stressful, negative thoughts, and worries. The frontal part of the brain responsible for active thinking and problem-solving becomes overly active, thereby stimulating the limbic system, which amplifies the stress response. Examples of rumination include going over to-do lists repeatedly without taking action (such as prioritizing) or fixating on negative thoughts and worries (e.g., about upcoming concerts or interpersonal issues). Rumination also occurs as a symptom of depression and burnout.
Difficulty Concentrating
Both acute and chronic stress, due to neurobiological activation and the aforementioned psychological effects on emotions and thoughts (e.g., rumination), lead to difficulties in concentration. As a result, tasks at hand are not completed as efficiently as possible, and there is an increased likelihood of making mistakes. Often, affected individuals struggle to differentiate between important and unimportant tasks or urgent and less urgent ones. This, in turn, leads to further time constraints and increased stress.
Memory Problems and Learning Difficulties
The hippocampus is a region in the limbic system of the brain that is crucial for both learning and memory functions as well as stress regulation, and it is closely connected to the amygdala. Consequently, it contains many receptors that respond to stress hormones like cortisol. Scientific studies have shown that stress impairs the hippocampus's ability to encode new learning experiences. Furthermore, stress appears to reduce the formation of new nerve cells in the hippocampus itself. Both of these effects are largely attributed to the overactivity of the amygdala. Additionally, sleep deprivation can also have a negative impact on learning and memory (see below).
Avoidance Behaviour
In addition to difficulty distinguishing between important and unimportant or urgent and less urgent tasks, active avoidance behavior of essential tasks often occurs. Just thinking about the numerous tasks can lead to increased stress because they are perceived as unmanageable.
Aggression or Anxiety
When people are stressed, their reactions can vary widely, but almost all individuals tend to exhibit unfavorable personality traits to a greater extent. Some individuals may become easily irritable or even aggressive in response to what may appear as relatively constructive questions, statements, or behaviors from others (e.g., reactions to criticism in ensemble playing). Others may become particularly anxious and may even develop new fears. They may become overly cautious when faced with new challenges (e.g., traveling for work, separation anxiety) or experience heightened performance anxiety.
Resignation & Hopelessness
Feelings of resignation and hopelessness are warning signs, and I strongly recommend seeking help from a mental health professional when experiencing these symptoms. Typically, resignation and intense feelings of hopelessness are indicators of chronic ongoing stress and the onset or existence of depression or burnout. A mental health professional can assist in breaking free from this cycle in a timely manner.
Sleep problems
Because the sympathetic nervous system, the body's stress response system, as well as the amygdala, are overactive, the organism does not achieve physical and mental rest, which can lead to sleep problems. This is especially true when rumination, such as negative thoughts and worries about the future, comes into play.
Coping Strategies and Why They Work
Relaxation Exercises
People who regularly practice relaxation exercises can better cope with stressful situations. They learn to recognize stress symptoms early and apply targeted techniques to calm themselves. Relaxation exercises such as Autogenic Training, breathing exercises, and Progressive Muscle Relaxation (PMR) can reduce stress in various ways:
Reduction of the Physical Stress Response: These exercises promote muscle relaxation and can slow down the heart rate while improving blood circulation in the muscles and the brain. Targeted breathing techniques activate the parasympathetic nervous system responsible for relaxation, leading to a decrease in stress hormones like cortisol in the body.
Mental Peace: Autogenic Training and breathing exercises allow the mind to calm down and stop the cycle of rumination (thought loop). This promotes mental clarity and the ability to evaluate stressors more rationally.
Improvement in Sleep: Relaxation exercises can alleviate sleep problems often associated with stress by mitigating physiological reactions to stress. Enhanced sleep quality also helps the body better manage stress.
Relaxation exercises offer long-term benefits beyond immediate stress reduction. They can increase resilience to stress over time, enabling individuals to better face future stressful situations.
Regular practice in daily life is crucial to achieve long-term benefits and successfully use relaxation exercises in stressful situations. I highly recommend learning these exercises under the guidance of a mental health professional and customizing them individually, especially when they are intended to cope with chronic stress or anxiety.
Here is an exercise for managing acute and chronic performance stress for musicians - incorporating psychological affirmations, breathing techniques, and elements from Autogenic Training and muscle relaxation.
Distraction
Distractibility can reduce stress on both a neurobiological and psychological level by influencing various mechanisms in the brain:
Reduced Amygdala Activation: The amygdala is a brain region responsible for processing emotions, especially fear and anxiety. When we focus on a stressful situation and engage in rumination (dwelling on negative thoughts), it can further increase amygdala activity. Distraction, such as shifting focus to another task or activity, can reduce the activation of the prefrontal cortex and the amygdala, thereby decreasing emotional distress.
Activation of the Reward System: Distraction can activate the brain's reward system, particularly the nucleus accumbens. When we immerse ourselves in a pleasant or engaging activity, reward neurotransmitters like dopamine are released, leading to positive feelings and a reduction in stress.
Reduced Rumination: Distraction interrupts circular thoughts by redirecting our attention to other things. This allows us to break free from the cycle of stressful thoughts and lower our stress levels.
Relaxation of the Stress Response: Distraction can also help reduce the physical stress response by calming the sympathetic nervous system (part of the autonomic nervous system responsible for the "fight or flight" response) and activating the parasympathetic nervous system (responsible for relaxation). This results in a decrease in heart rate and blood pressure.
Some people find distraction through creative activities such as painting or crafts, while others may distract themselves through physical activity, meditation, or reading a book.
Self-Care & Active Breaks
Taking time for oneself and establishing daily routines, even in the midst of a busy schedule and a long to-do list, can be very helpful in coping with stress. The same goes for actively incorporating breaks. Both practices can reduce unfavorable psychological patterns like rumination and avoidance behavior, while also increasing concentration and efficiency in completing tasks. The types of breaks and routines that are helpful and enjoyable vary from person to person.
Examples of self-care routines and breaks (15-30 minutes):
A daily morning walk
A planned and perhaps even celebrated coffee or tea break
A morning or evening reading routine, perhaps in a favorite chair or on the balcony
Painting or drawing a picture, doing a puzzle
A warm bath (the warmth and optional essential oils can add to relaxation)
Listening to a favorite podcast or reading a newspaper
Writing an emotions or gratitude journal (see also Positive Psychology for Musicians)
Jogging, cycling, yoga, or Pilates
Psychological Counseling
Psychological counseling can be extremely beneficial for musicians, as it provides specific strategies and individualized support to help them navigate the unique stresses and challenges of the music industry. Musicians often face high-pressure situations, whether it's performances, creative blocks, interpersonal conflicts within ensembles and orchestras, family dynamics, societal and personal performance expectations, or an uncertain future. Psychological counseling can assist musicians in identifying their individual stressors, developing coping mechanisms, and learning healthy ways to manage stress—especially for those with high sensitivity.
Moreover, psychological counseling can help individuals address and work through their personal reactions and behavioral patterns (schemas), ultimately promoting long-term mental health, building self-confidence, and improving interpersonal relationships and creative processes. Such counseling also provides a safe space to discuss personal or professional challenges.
Sources and further reading
Kenny, D., & Ackermann, B. (2015). Performance-related musculoskeletal pain, depression and music performance anxiety in professional orchestral musicians: A population study. Psychology of Music, 43(1), 43-60. https://doi.org/10.1177/0305735613493953
Hammen, C. (2005). Stress and depression. Annu. Rev. Clin. Psychol., 1, 293-319.
Kim, J. J., & Diamond, D. M. (2002). The stressed hippocampus, synaptic plasticity and lost memories. Nature Reviews Neuroscience, 3(6), 453-462.
Kähäri, K., Zachau, G., Eklöf, M., & Möller, C. (2004). The influence of music and stress on musicians’ hearing. Journal of sound and vibration, 277(3), 627-631.
Loveday, C., Musgrave, G., & Gross, S.-A. (2023). Predicting anxiety, depression, and wellbeing in professional and nonprofessional musicians. Psychology of Music, 51(2), 508-522. https://doi.org/10.1177/03057356221096506
Pinel, J. P., & Pauli, P. (2007). Biopsychologie (Vol. 12). München: Pearson Studium.
Vaag, J., Bjørngaard, J. H., & Bjerkeset, O. (2016). Symptoms of anxiety and depression among Norwegian musicians compared to the general workforce. Psychology of Music, 44(2), 234-248. https://doi.org/10.1177/0305735614564910
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