A multicomponent biofeedback-informed programme reduces music performance anxiety in undergraduate music students a randomized controlled trial

Music performance anxiety (MPA) can affect the physiological, psychological, and behavioral functioning of music students. This randomized controlled trial evaluated a 12-week multicomponent programme integrating physiological monitoring, biofeedback, breathing regulation, virtual-reality exposure, cognitive restructuring, progressive performance practice, and teaching adaptation. A total of 120 undergraduate music students were randomly allocated to an intervention group ( n = 60) or a control group ( n = 60). The prespecified primary analysis used analysis of covariance, with the post-intervention multidimensional total score as the outcome and the corresponding baseline score as a covariate. Adjusted post-intervention means were 69. 82 (SE = 0. 68) in the intervention group and 108. 14 (SE = 0. 68) in the control group; the adjusted between-group difference was − 38. 32 points (95% CI -40. 22 to -36. 42; P < 0. 001). Baseline-adjusted differences also favored the intervention group for the physiological (-17. 71, 95% CI -19. 47 to -15. 95), psychological (-16. 65, 95% CI -17. 92 to -15. 38), and behavioral (-3. 83, 95% CI -4. 40 to -3. 26) dimensions. Exploratory within-group analyses showed progressively higher HRV (SDNN) and lower electromyographic activity and respiratory rate across the three intervention stages (all P < 0. 001). The multicomponent programme was associated with improved outcomes in this sample, but the design cannot isolate the independent effects of biofeedback, virtual reality, additional contact time, or the other programme components. Trial registration : This study was not registered prospectively. It was initiated as an evaluation of a curriculum-embedded educational intervention, and the investigators did not recognize at study commencement that prospective registration is also recommended for non-clinical educational trials. The protocol was approved before recruitment (Approval No. SQYZ-2023-ETH-038; 18 August 2023), and the prespecified outcomes and analysis plan are documented in the approved protocol, which is available from the corresponding author on reasonable request.