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University of Southern California Dissertations and Theses

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High school string orchestra students’ perceptions of wellness and its implications on musical performance

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High school string orchestra students’ perceptions of wellness and its implications on musical performance

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Content HIGH SCHOOL STRING ORCHESTRA STUDENTS’ PERCEPTIONS OF
WELLNESS AND ITS IMPLICATIONS ON MUSICAL PERFORMANCE

by

Diana Kay McConnell

A Dissertation Presented to the
FACULTY OF THE USC THORNTON SCHOOL OF MUSIC
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF MUSICAL ARTS
(MUSIC EDUCATION)

May 2012

Copyright 2012 Diana Kay McConnell

ii
Acknowledgements
I would like to thank many people for their guidance and support during this endeavor. I
am thankful to all the orchestra directors who took time out of their busy rehearsal
schedules to allow me into their classrooms to conduct my research. Also, I greatly
appreciate the time, attention, and candor given by all the students who completed the
survey. Without their assistance, this dissertation would never have come to fruition.
I am also very grateful to my school principal, Mr. Enrique Gonzalez, for his help
in completing my dissertation. He graciously allowed me to take time off from work to
visit school sites to conduct my research. Without his encouragement for my educational
pursuits, I might not have been able to complete my study in such a timely manner.
Lastly, I am indebted to my dissertation committee, Dr. Beatriz Ilari and
Alexander Suleiman, for their support and guidance while preparing this dissertation. I
am privileged to have received such knowledgeable guidance from such an esteemed
committee. Extra special thanks to my faculty advisor and committee chairperson, Dr.
Sheila Woodward, whose consistent guidance, encouragement, and pursuit of academic
excellence has been an asset on this long, and sometimes troublesome, journey.

iii
Table of Contents
Acknowledgements ii

List of Tables vi

Abstract viii

Chapter 1: Introduction 1
Purpose of Study 5
Research Questions 5
Validity and Limitations 5
Study Design 6
Definitions 6

Chapter 2: Review of Related Literature 8
Introduction 8
Sleep 8
Stress 10
Performance Anxiety 13
Food/Fluid Intake 17
Pain 20
Conclusion 26

Chapter 3: Methodology 27
Introduction 27
Research Design 27
Study Population 27
Inclusion Criteria 28
Exclusion Criteria 28
Recruitment of Subjects 28
Research Instrument 29
Methods 29
Data Collection and Analysis Procedures 30
Narrative Description of Results 30

Chapter 4: Results 31
Introduction 31
Item One - Sleep on a Weeknight 33
Item Two - Sleep on a Weekend Night 34
Item Three - Amount of Sleep Before a Performance 35
Item Four - Perceptions of Sleep and Musical Performance 39
Item Five - Physical Preparations Before Playing Instrument 43
Practicing a Home 43

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In Orchestra Class 46
For a Public Performance 48
Item Six - Mental Preparations Before Playing Instrument 50
Practicing at Home 50
In Orchestra Class 52
For a Public Performance 54
Item Seven - Perceptions of Music and Stress 57
Item Eight - Peformance Anxiety Symptoms and Remedies 60
Item Nine - Perceptions of Food/Fluid Intake and Musical Performance 64
Item Ten - Consciously Using or Avoiding Food/Fluids Before a
Performance 66
Consciously Use Foods/Fluids Before a Performance 67
Consciously Avoid Foods/Fluids Before a Performance 68
Item Eleven - Perceptions of Pain When Playing Instrument 70
Practicing at Home 70
In Orchestra Class 72
For a Public Performance 74
Item Twelve - Inclusion of Health and Wellness Information in
Orchestra Class 75
Item Thirteen - Additional Health-Related Issues Impacting
Musical Performance 79
Summary of Results 82

Chapter 5: Discussion 83
Summary 83
Discussion of Outcomes 86
Sleep 86
Perceptions of Music and Stress 92
Performance Anxiety, Remedies, and Mental Preparations 94
Perceptions of Food/Fluid Intake and Musical Performance 101
Perceptions of Pain and Physical Preparations 107
Inclusion of Health and Wellness Information into Orchestra Class 113
Additional Health-Related Issues Impacting Musical Performance 116
Implications for Music Education 119
Recommendations for Future Research 121

Conclusion 123

References 125

Appendices 130
Appendix A: Research Site Permission Letter 130
Appendix B: Parental Information Sheet 131
Appendix C: Student Information Sheet 134

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Appendix D: Participant Recruitment Script 136
Appendix E: Participants Survey 137

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List of Tables
Table 1: Item One - Sleep on a Weeknight 33

Table 2: Item Two - Sleep on a Weekend Night 35

Table 3: Item Three - Amount of Sleep Before a Performance 36

Table 4: Item Four - Perceptions of Sleep and Musical Performance 40

Table 5: Item Five - Physical Preparations Before Playing Instrument:
Practicing at Home 45

Table 6: Item Five - Physical Preparations Before Playing Instrument:
In Orchestra Class 47

Table 7: Item Five - Physcial Preparations Before Playing Instrument:
For a Pubic Performance 49

Table 8: Item Six - Mental Preparations Before Playing Instrument:
Practicing at Home 52

Table 9: Item Six - Mental Preparations Before Playing Instrument:
In Orchestra Class 54

Table 10: Item Six - Mental Preparations Before Playing Instrument:
For a Public Performance 56

Table 11: Item Seven - Perceptions of Music and Stress 57

Table 12: Item Eight - Performance Anxiety Symptoms and Remedies 61

Table 13: Item Nine - Perceptions of Food/Fluid Intake and
Musical Performance 64

Table 14: Item Ten - Consciously Using or Avoiding Foods/Fluids Before a
Performance: Consciously Use 68

Table 15: Item Ten - Consciously Using or Avoiding Foods/Fluids Before a
Performance: Consciously Avoid 69

Table 16: Item Eleven - Perceptions of Pain When Playing Instrument:
Practicing at Home 71

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Table 17: Item Eleven - Perceptions of Pain When Playing Instrument:
In Orchestra Class 73

Table 18: Item Eleven - Perceptions of Pain When Playing Instrument:
For a Public Performance 75

Table 19: Item Twelve - Inclusions of Health and Wellness Information in
Orchestra Class 76

Table 20: Item Thirteen - Additional Health-Related Issues Impacting
Musical Performance 79

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Abstract
The objective of this study was to assess high school string orchestra students’
perceptions of their health and wellness and how this impacts their performance as
musicians. This exploratory study used a written survey with mostly open-ended
questions, which was completed by students during a session of their regular orchestra
class. Students were recruited from two school districts in California for participation in
this study. Participants were 344 high school string orchestra members ages 13 - 20.
Responses were analyzed, highlighting disparities and trends, with indication of a high
level of awareness amongst students of the need to live healthy lifestyles and some
awareness of how this might impact musical performance. There was a positive
indication that students would value education in this area being included in their
orchestra class. It is anticipated that the dissemination of the results will provide valuable
information to the profession regarding the importance of high school musicians’ health
and well-being.

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Chapter 1: Introduction
The health and wellness of high school string orchestra students and how this
impacts their musical performance is the field of study. This population may not be as
knowledgeable and/or conscious as they should be about their own health and wellness as
it pertains to their musical performance. By investigating this area, the researcher aims to
promote awareness of health and wellness in order to support the achievement of optimal
musical performance. High school string orchestra students’ awareness of their health
and wellness is critical to their musical growth and optimal musical performance
(International Musician, 2008; Palac 2008). The following literature review will describe
current issues musicians face in several health and wellness areas – sleep, stress,
performance anxiety, food/drink intake, and pain.
Health and wellness are of vital concern to musicians as our lives are becoming
more complex and demanding. With the advent of growing technological developments,
increased responsibilities on all fronts, and even modern conveniences such as fast food
and soft drinks, our lives are becoming progressively more complicated and exposed to
negative influences which potentially impact our health, wellness, and musical
performance. High percentages of professional musicians, as many as 50 to 75%,
experience health issues of various types which may cause temporary and even
permanent impact on their performing careers (Brody, 1989; Engquist, Orback, &
Jakobsson, 2004; Horvath, 2001; Lederman, 2003). More public effort is being made to
promote health and wellness lifestyles and activities to counteract the effects of numerous
negative impacts on our health.

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High school students are no different from adults in their fight for increased
health and wellness. Due to the changes and advances in the world today, students'
educational requirements and challenges are growing every year. “Educators should be
aware that 10 percent to 15 percent of students experience chronic debilitating stress
caused by poverty, family problems, fear of poor performance in school, or feeling
unloved. For other students, stress can be caused by anything from a quiz to accepting a
new parent” (Amen & Reglin, 1992, p. 27). The average student is struggling to balance
more schoolwork, extracurricular activities, homework, family obligations, and even
employment. “Given the increased competition for college placement, many high school
students are taking more Advanced Placement classes, increasing their extracurricular
activities, and taking part in team sports and volunteer activities to beef up their resumes”
(Sternbach, 2008, p.43). All these challenges have the potential to affect their health and
wellness in terms of stress, sleep, anxiety, pain and more. Also, as teenagers are attaining
more autonomy as they mature, they often find themselves having to make more lifestyle
choices, like what foods to eat, on a daily basis. “Poor nutritional habits are one of the
most significant risk behaviors that pose a threat to the health of adolescents” (Petrillo &
Meyers, 2002, p. 293). Unfortunately, many of the food/drink intake choices adolescents
are making are unsound and have the potential to contribute to health and wellness issues.
Adverse medical effects of poor dietary habits in adolescents can include obesity, high
blood pressure, heart disease, diabetes, high cholesterol, bone and joint problems, and
even cancer (Center for Disease Control and Prevention, 2000). As the negative
consequences of stressful lifestyles and lifestyle choices are arising, schools are

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becoming more aware of the need for health and wellness education to assist students in
creating healthier lifestyles for their longevity.
One wellness issue that can have a negative impact on adolescents’ health is
sleep. The amount and quality of sleep teenagers get every night can greatly impact their
daily lives in a variety of ways. “…Sleep is essential for good health, and health, in turn,
affects sleep” (Buysee, 2005, p. 3). Not getting enough quality sleep can have significant
adverse effects on teenagers’ performance in school. Different kinds of learning can be
either improved by quality sleep or weakened by lack of sleep (Stickgold, 2000).
Cognitive, motor, and even immune functions can be negatively affected by not getting
quality sleep (Harvey & Saxon, 2003). Buysse (2005) goes on to describe the types of
issues children suffer from due to sleep loss; “Cognitive complaints include difficulties in
concentrating, completing tasks, and performing complex, abstract, or creative tasks”
(p.30). When teenagers sleep patterns are restricted their school performance and
behavior can suffer to a great extent (Leger and Pandi-Perumal, 2007). Many teenagers
suffer from some form of sleep deprivation, meaning they are not getting the adequate
amount of sleep a night either due to self-imposed sleep restrictions or other factors that
restrict their nightly sleep patterns. In fact, the majority of adolescents are getting less
than the optimal nine hours of sleep per night, with the disparity in sleep duration against
optimization seeming to increase with age (National Sleep Foundation, 2006). The
National Center on Sleep Disorders Research states that 44% of young adults are
suffering debilitating effects from sleepiness at least a few days a month (National Center
on Sleep Disorders Research, 2003).

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Professional musicians are increasing aware of their bodies and how their
lifestyles impact their musical performance. From dealing with performance-related
pain, ways to increase performance energy and stamina, and dealing with bouts of
performance anxiety and stress, professional musicians need to be ever vigilant in their
lifestyle choices to better maximize wellness and musical performance (Engquist et al.,
2004). In fact, studies show that musicians have almost as many physical problems as
athletes, but most musicians continue to work even through the problems (Palac, 2008).
High school musicians have similar challenges to their musical performance, including
stress, performance anxiety, and pain. “Because musicians often commence their careers
at a very early age, it is important to understand the prevalence and development of these
problems in children” (Ranelli et al., 2008, p. 178). Understanding the potential health
and wellness issues that can plague musicians early in their musical studies can possibly
lead to the development of healthy habits and procedures that may impact the rest of the
musical careers. Since most professional musicians begin learning their craft as children
or adolescents, the realizations of the potential risks and preparations for healthy
performance career need to begin early. Often, however, this health and wellness
information is not provided to musicians as part of their musical studies. “General health
as an important component of good musicianship is rarely addressed at all in the
ensemble or the studio” (Frederickson, 2002, p. 38). Learning whether these musicians
are cognizant of these challenges and if they are making lifestyle decisions with their
health, wellness, and musical performance in mind is vital to making advances in these
students’ current and future wellness as individuals and musicians.

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Purpose of the Study
The purpose of this exploratory study was to investigate high school string
orchestra students’ perceptions of their wellness as this relates to their musical
performance. Wellness in this study covered sleep, food/fluid intake, stress, performance
anxiety, and performance-related pain. In addition, this study was seeking to learn if
these students make conscious decisions about their health as it influences their own
musical performance in their daily home, practice, class rehearsals and performance
events.
Research Questions
This study aimed to answer the following four research questions:
1. Are high school string orchestra students aware of links between physical and
mental wellness and musical performance?
2. Do these students believe it important to include health and wellness
information/practices in their string orchestra curricula?
3. Do these students experience pain when playing their instruments or have they
done so in the past?
4. Does gender impact any of the above results?
Validity and Limitations
This study is limited to a small population of string orchestral high school
students from two school districts in California. The results are not generalizable to the
broader high school population. However, together with future similar studies of high
school orchestra students in other areas, it may provide an indication of health awareness

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in students and how music educators might address these issues with their students,
particularly in regards to musical performance. The assumption was made that students
understood English and answered the questions on the survey honestly. Before
administering the survey, the researcher made a strong point of stressing the importance
of students sharing their thoughts accurately, as this information would potentially be
valuable in our helping students be more successful performers.
Study Design
This is an exploratory, descriptive study that aims to determine the perceptions of
high school string orchestra students on health and wellness issues and how these impact
their musical performance. A written survey was administered that allowed students to
provide details on their perceptions in a specified range of health areas. The results were
analyzed by categorizing answers and determining the number of responses in those
categories. The results and conclusions were written in narrative style.
Definitions
Terms are used in this report that might have broad or limited meaning in
different circumstances. Clarification is provided here on the how these words are
intended to be understood.
Health. In this document, the word "health" is used in the sense provided by the
World Health Organization (1946): "A state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity."

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Mental preparations. Any mental activity, other than musical activities,
performed before picking up any instrument to play. These may include, but are not
limited to: Positive self-talk, goal setting, visualizations, etc.
Performance anxiety. A state of nervousness, fear, or apprehension related to a
musical performance, which may cause physical, mental, and behavioral symptoms for
the musicians.
Physical preparations. Any physical activity, other than musical activities,
performed before picking an instrument to play. These may include, but are not limited
to: stretching, exercise, massage, eating/drinking, etc.
School Night. A night preceding a regular public school day, specifically Sunday
through Thursday nights.
Weekend Night. A night preceding a regular weekend day, specifically Friday
and Saturday nights.
Wellness. In this document, the word “wellness is used in the sense provided by
the National Wellness Institute (2012): “Wellness is a conscious, self-directed and
evolving process of achieving full potential.”

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Chapter 2: Review of Related Literature
Introduction
In the literature, there are numerous studies that address college music students
and professionals regarding their overall wellness and its relation to musical performance,
but less pertain particularly to high school students. This review examines research
regarding wellness amongst musicians as well as some additional documents that pertain
to health in general. The scope is restricted to areas of sleep, food intake, pain, stress,
and performance anxiety.
Sleep
Several articles can be found advocating the importance of sleep in impacting
musical performance. It is suggested that sleep allows the body and mind to get the kind
of rest it needs for optimal musical performance (International Musician, 2005; LaPine,
2008; Meyer, 1998). The National Sleep Foundation also states that females are more
likely to have sleep problems than males (Harvey & Saxon, 2003). It has been further
warned that lack of sleep creates problems that might interfere with performance:
“chronic sleep problems have potentially serious consequences, including negative
effects on the immune system” (International Musician, 2005, p. 8).
In a study of 36 nonmusicians, the effects of rest and sleep were examined in
terms of the performance accuracy of a piano melody (Cash, 2009). All participants were
trained on a five-element sequence to be played with their left hand. The subjects were
asked to play the sequence as quickly and accurately as possible in twelve 30-second
practice blocks. The subjects were placed into three groups: one group who received an

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early intervention of a five minute rest period, one group who received a late intervention
of a five minute rest period, and one control group. After a 12-hour period where the
subjects were allowed to sleep, they were retested. The subjects provided the amounts of
sleep they received both the night before the training and for the 12-hour period between
testing, which averaged between six to seven hours for both nights. For both groups who
received five minute rest breaks as part of their training and testing, they had marked
improvements. Sleep did not have a significant effect on the improvement of piano skills
for this study.
One study of musicians and sleep investigated 56 professional classical vocalists
about their sleep habits, problems, and their perceptions of the impact sleep had on their
musical performance (Harvey & Saxon, 2003). The majority of responders, 96%, fell
within the mean sleep duration of six hours during rehearsals and performances while
during non rehearsal/performance times they averaged about seven hours of sleep. For
sleep problems, 86% mentioned concentration and focus being an issue, as well as 37%
reported irritability. Although 62% of the subjects had high scores for pathological
sleepiness, many of them believed their sleep was adequate.
Only one study was found to specifically investigate sleep impacting musical
performance. Simmons & Duke (2006) tested college level music majors who were
nonpianists, determining the effects of sleep on the performance of a 12-note keyboard
melody. The subjects were trained for 12 minutes, either between 8-10am or between 8-
10pm. Once trained, they were immediately tested. Subjects were then retested 12 hours
later, either later in the day (with no sleep in between tests) or the next day (with sleep in

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between tests). The researchers hypothesized that subjects who were allowed to sleep
before being retested would perform better in terms of speed, accuracy, and evenness of
motor skills than those subjects who did not sleep. The researchers found that there were
improvements in accuracy and speed in the subjects between the intervals that included
sleep, but not in the intervals that did not include sleep. While this study provides useful
information about the short-term effects of sleep on musical performance, it would be
valuable to also have studies that explore effects of sleep over the longer term.
Stress
It is well-known that stress can cause a variety of negative effects on the body,
including harmful effects to the autonomic nervous system, increased cortisol levels that
can suppress the immune system, and lowered production of cytokines which can lead to
depression and altered cognitive function (Kemeny, 2003). Presumably, each of these
physical outcomes might indirectly affect a musician's performance, as might mental
stresses directly interfere with performance. Today's high school musicians might face
stresses originating from a wide range of sources, including family, school, friends, work,
etc., which can be compounded by the stressors of their musical education. “There is
increasing recognition today that professional musicians aren’t the only ones vulnerable
to performance-related injuries and high levels of stress. College-age music students and
even students in middle and high school are experiences many of the same types of
overuse syndromes and similar levels of performance anxiety” (Sternbach, 2008, p.42).
Ensemble musicians can be stressful because they may have little to no control over the
music decision-making process (Steptoe, 1989). In the medical community, it is

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acknowledged that stress can be a contributing factor in many, if not all, illnesses and
medical conditions in people of all ages in the United States today (Sternbach, 2008).
While stress appears to an unavoidable fact of contemporary life, much
information is available to the general public on the positive effects of stress-
management. Claar & Blumenthal's (2003) review of multiple studies highlighted stress-
management techniques in patients who had suffered from coronary heart disease and
cancer. These included relaxation, cognitive behavioral therapy, and coping strategies,
which were found to result in reducing stress, depression, anxiety, and increasing quality
of life and coping behaviors. There were further indications of a reduction in the levels
of cortisol, which impacts the immune system.
In a study of 63 first-year conservatory students who had attended a seminar on
health and wellness for music, the researcher used a questionnaire to inquire about
several areas of health and wellness (Williamon & Thompson, 2006). One area included
was the subjects’ perceptions of stress, including day-to day stress and the demands of
their musical profession. Using a 7-point scale, the subjects responded to the perceptions
of day-to-day stress, with a mean score of 3.85. Researchers found that several of the
subjects were aware of their stress levels and found their day-to-day stress to be serious
in nature.
The health complaints and coping techniques related to stress were investigated in
a study of 35 professional orchestra musicians (Halleland, Harris, Sørnes, Musicon, &
Ursin, 2009). Using a Likert-type scale, a questionnaire asked the subjects about their
subjective health complaints and coping strategies they use. The subjects’ cortisol levels

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were also tested three times within two days of a performance. The majority of the
subjects, 81%, complained of musculoskeletal problems, 69% gastrointestinal problems,
and 91% “pseudoneurological” problems like having mood changes. There were
significantly higher levels of cortisol recorded on the day of the performance than on the
other testing days. In addition, several with higher cortisol levels also complained of
gastrointestinal issues and also scored high on emotion-focused coping, which included
seeking social support and distractions or avoidance of the problem. This study’s results
showed a connection between elevated cortisol stress levels and subjective health
problems in the subjects.
The source of stress was examined in a study of 95 high school seniors in North
Carolina (Amen & Reglin, 1992). The subjects were asked to report five different
sources of stress in their lives based on their personal experiences. Almost all of the
responders, 94 of 95, gave school performance as a source of stress, which included
pressure to achieve good grades, pressures from teachers and graduating. Other common
sources of stress were family, employment, and even getting into the right college.
Another investigation of the sources of stress was particularly focused on the
undergraduate music conservatory student. This explored their perceptions of internal
and external stress during their first three years of musical study and their subsequent
school performance (Butler, 1995). External stressors were identified as broad issues like
family socioeconomic status, education and career goals, while internal stressors were
identified as music specific issues like parental attitude towards their musical choices and
changing music teachers. Results found that those subjects with poor music school

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performance reported suffering from both external and internal stresses. On the other
hand, those subjects with good music school performance reported suffering from only
one or the other, if they mentioned any stress at all. Whether these students genuinely
experienced more sources of stress, or whether they were just less capable of managing
stress, is impossible to judge. Further studies that examine stress in the high school
musician would be valuable.
Some studies about stress are two-fold: incorporating both stress and performance
anxiety within its investigation. One such study examined both professional and music
students to learn about their pleasure, stress, performance anxiety, and coping
mechanisms used by these subjects (Steptoe, 1989). The researchers used a questionnaire
to learn about what aspects of the musicians’ career the subjects find stressful. The
largest areas of stress for the subjects were found in the uncertainty of their employment,
the competition between their musical peers, and perceived “back-stabbing” among their
colleagues. High responses for appealing experiences were for the pleasure of being in
orchestra, variety of their work, travel, and excitement about performances. In terms of
coping strategies for stress and performance anxiety, several subjects tried to distract
themselves, use deep breathing, positive self-talk, muscle relaxation, and drug/alcohol
use. This study found that career stress and stage fright are not independent of one
another for this population.
Performance Anxiety
Performance anxiety is an issue that plagues many musicians of all ages.
Symptoms of performance anxiety can be both physical, including changes in heart rate,

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muscle tension, trembling, and emotional, such as worrying about their performance and
pleasing the audience (Steptoe, 1982; Steptoe, 1989). Many studies examining stress in
musicians focus on performance anxiety. Most of performance anxiety students deal
with the adult musician, while fewer specifically target children. In one example
involving children, a study of junior high and high school musicians found that 55.5% of
the subjects, whose average age was 14.1 years, experience stress from performance
anxiety that negatively impacted their ability to play their instrument in a performance
(Shoup, 1995). The researcher found that 47.3% of these students do nothing to try to
prevent or mitigate their performance anxiety. It would be interesting to learn whether
these students were simply ignorant of measures that might be taken and whether
education on preventing performance anxiety might result in improved performance.
In the Williamon & Thompson (2006) study that addressed several different areas
of health and music for conservatory students, the researcher sought to learn the subjects’
levels of performance anxiety. Based on a seven-point scale, the mean score for
experiencing performance anxiety was 4.55. Performance anxiety scores were higher
than those reported for everyday stress. The researchers also found a correlation between
the reports of performance anxiety and that of everyday stress.
A cross-sectional study was conducted of 97 musicians, aged 9-15, from youth
orchestras in the Midwest to learn about the prevalence of several different performance-
related health problems, including performance anxiety (Britsch, 2005). The subjects
were asked if they experienced nervousness or not in either a group setting or when
playing a solo. In total, 75% of the subjects reported they do experience performance

15
anxiety in some form when performing. It was also noted that older subjects seemed to
experience more performance anxiety than the younger subjects in this population.
Another study examined 26 sixth-grade piano students preparing for a recital
performance (Ryan, 1998). The subjects were hooked up to heart rate monitors that
would measure their heart rate during a regular lesson, as they were sitting backstage
waiting their turn to perform, and during the performance. The researchers also used the
State-Trait Anxiety Inventory for Children, Coopersmith Self-Esteem Inventory, and
Children’s Performance Anxiety Questionnaire to record performance anxiety. The
recital performances were videotaped and evaluated by expert pianists for their precision
of musical elements. The results showed that there are 12-year old children who suffer
from performance anxiety. Large increases in heart rate were seen to occur during the
recital. Based on the results of the inventories, many of the subjects not only had physical
symptoms, they also perceived they were experiencing performance anxiety. The
majority of the subjects reported feeling nervous before the performance. This
nervousness worsened from the morning of the performance until the time when they
were performing.
Looking specifically at elementary children, research was conducted to learn if
there were changes in levels of performance anxiety on regular schools days and
performance days for 190 young student musicians, age 5 to13 years (Ryan, 2005). The
subjects were given both state and trait anxiety tests on a regular school day in December,
and another state anxiety test on the day of performance. Across the board, the level of
trait anxiety results corresponded with the levels of state anxiety for the subjects, i.e.

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those with high trait anxiety scores also had high scores for state anxiety. Results showed
that subjects in elementary school did report experiencing performance anxiety symptoms
in preparation for a performance. Gender differences were found, but only among those
subjects in fifth grade or above. Sixth grade girls were found to have higher levels of
anxiety than boys. The researchers noted that surprisingly fifth and seventh grade boys
reported higher levels of anxiety than girls in this population.
Another study investigated high school adolescent musicians about the
relationship between performance anxiety symptoms they have experienced, their
perception of these stressful musical situations, as well as open-ended descriptions of
their worst musical experiences (Obsorne & Kenny, 2008). Some of the somatic
symptoms of performance anxiety reported were sweaty palms, shaking, rapid heart rate,
flushing, and breathing issues. The subjects reporting descriptions of the worst
experiences were older than those who did not report. Those who reported worst
experiences scored higher for both performance anxiety and trait anxiety. Females also
scored higher for performance anxiety and trait anxiety than males.
One study looked into if the use of relaxation breathing techniques in reducing
performance anxiety in 3rd to 6th grade piano and violin students in Taiwan (Su, Chen,
Lin, Liao, & Chen, 2010). The subjects were taught relaxation breathing in a series of
training sessions that lasted two months. The relaxation breathing was tested at different
intervals from two months to five minutes prior to performance. After the performance,
the subjects responded to 15 questions to rate their physical responses to performance
anxiety. The results showed that using relaxation breathing within 30 minutes of the

17
performance was helpful in reducing performance anxiety symptoms in the short term;
however, its use prior to the 30-minute mark did not show any effect on the performance
anxiety. Further studies on different age groups would be valuable in informing us of the
prevalence of performance anxiety and the usefulness of prevention techniques amongst
young musicians.
Food/Fluid Intake
It is commonly known that the quantity and quality of food and fluid intake have
a profound effect on physical health in both the short and long term (Center for Disease
Control and Prevention, 2003; Cox, 2006; Croll et al., 2001). Although eating a healthy
breakfast is known to have positive effects on the body, particularly in growing children
and adolescents (Croll et al., 2001; International Musician, 2008), it has been shown that
“…one in five students aged 15 to 18 regularly skips breakfast” (Petrillo & Meyers, 2002,
p. 294). Food, since it fuels our body, brain and muscles, contributes to our musical
performance. One of the consequences of poor nutritional choices is obesity, which is an
increasingly prevalent problem, not only amongst adults, but also in children in the
United States. “Obesity now overshadows all other chronic illness in adolescents” (Viner
& Booy, 2005, p. 413). Obesity can not only cause medical concerns, it can also create
issues related to cognitive function, learning potential, and further earnings (Crosnoe,
2007).
A study of adolescent girls investigated links to lower rates of educational
achievement, enrollment in college, and other psychosocial issues (Crosnoe, 2007). The
study found that obese girls were more likely engage in self-rejection behaviors, such as

18
drug and alcohol use, truancy in school, and class failure. In fact, these girls had a 24%
higher rate of class failure than girls who were not obese. Also, obese girls were less
likely to enter college after high school than girls who were not obese. Many studies
investigating dietary choices in adolescents involve the general teenage population and
not specifically musicians.
Focusing more specifically on one population, a study of literature was carried out
to learn what research had been conducted dealing with fluids and hydration for athletes
(Duvillard, Braun, Markofski, Beneke, & Leithäuser, 2004). The numerous studies
showed how through exercise or physical exertion, sodium levels, potassium levels,
plasma volume, and energy levels would drop and possible dehydration would occur
from depletion of fluids. Cardiovascular, cerebral, organ, and hormone changes were
also reported in some research. Concern for the medical effects of dehydration and also
hyperhydration were noted. Although the reports often had differing results, the
consensus is that hydration is important to replenish the fluids and nutrients lost during
physical activity, particularly if this activity occurs in a hot environment. It is
recommended by the researcher that all athletes or those who engage in strenuous
physical activity make attempts to rehydrate their bodies because it not only helps the
body fight the physical effects of fluid loss during exercise, but can potentially give the
athlete a performance advantage.
There are numerous studies of food intake and health; however, very little
research has been done with regard to food intake and musicians. One qualitative study
of 105 choral singers investigated whether singing became more difficult after eating a

19
meal (Edgar, 2007). The singers were surveyed to find out if they perceived it to be more
difficult to sing after eating. The study found that 75 of the responders did find it to be
more difficult to sing after eating a meal. The most common reason for this effect,
reported by 52% of responders, was due to a perceived decrease in breath support. The
study also found that the time they allowed between a meal and a performance was
generally longer than the time between a meal and a rehearsal. Many of the responders
purposely avoided eating for a certain amount of time before a performance while others
would purposely eat a smaller meal before a performance, citing the need for energy.
This study is informative, because it shows that food might well have a direct effect on
musical performance. It also shows how cognizant these singers are of the effects of food
on their performance and how they make conscious food intake decisions based on these
effects. Similar studies on instrumentalists would be valuable in determining other
effects of nutrition on music performance.
In another study of singers, a case study was conducted on three professional
vocalists to examine their eating habits as it related to obesity in the singing world
(Slover & Dwyer, 1995). The researchers believe that obesity is prevalent in many
professional singers because of the “Diva Syndrome”, which deals with the unusual work
hours, specific food rituals, and job stress of their careers. Also, the researchers state that
many singers fast before a performance, which can lead to overeating after a
performance. Some of the specific food rituals deal with beliefs that foods/fluids can
have positive or negative effects on their voices. In the three case studies, two of them

20
fast before a performance and all of them have specific foods/fluids they use or avoid
before performances.
Pain
Many musicians suffer from music-related pain and physical issues (Horvath,
2001; Lederman, 2003). Many studies have examined musculoskeletal and neurological
injuries in professional and college musicians, however few pertain to adolescents.
In the Williamon & Thompson (2006) study of first-year conservatory students,
the researchers inquired about any physical discomfort, and the locations of the
discomfort, the subjects’ experienced from performing music. The most commonly
reported areas of pain and discomfort were in the upper extremities: neck, shoulders,
back, arms, wrist, and fingers, with the pain commonly being perceived as an issue with
posture or poor technique. Although minimal, hearing and eyesight problems were also
reported. Another inquiry in the study was to the subjects’ awareness and perceptions of
medical related issues in music. The researchers found that the subjects did believe that
musicians were more prone to medical and health problems than the general public due to
the nature of their participation in music. An awareness of the potential physical and
mental issues of performing music seemed apparent by the results.
Also looking at college musicians, a study of 97 instrumentalists, age 17 to 27,
investigated the subjects’ experiences with performance-related pain using two separate
surveys (Barton et al., 2008). One survey looked into musculoskeletal problems when
engaging in regular daily activities (DASH survey), while the other specifically addressed
music performance-related issues. The highest averages of scores on the DASH survey

21
were of upper-extremity pain and stiffness, specifically in the arm, shoulder, and hand.
Similarly, 64.9% of the subjects reported pain/discomfort on the descriptive survey as
well. The researchers noted 80% of females reported pain, which was far more than
males in this population.
One example investigated primary and secondary instrumental students in Perth,
Western Australia, the large sample of 731 children, aged 7 to 17, were surveyed on
performance-related musculoskeletal symptoms and disorders (Ranelli et al., 2008). The
frequency of symptoms and medical interventions were addressed. Of the responses,
67% specified experiencing performance-related musculoskeletal symptoms at some
point. Of these, 30% reported not being able to play their instrument normally as a result.
A 20% increase in performance-related musculoskeletal disorders was noted for in each
increasing year of age amongst participants. Gender differences were also found with
regard to performance-related musculoskeletal symptom and disorders, the overall
prevalence being 69.6% for females and 61.2% in males. It would be important to
determine why musculoskeletal injuries increase in children with age and how these
might be prevented.
In another Australian study, secondary school orchestra musicians, aged 13 to 18
were investigated for the prevalence of music-related overuse injuries. From two
different schools, 49 subjects completed a questionnaire along with a control group of
non-music subjects from the same schools (Fry et al., 1988). The questionnaire included
practice times, descriptions of both past and present music-related pain and its duration,
and if the pain impacted their musical performance or other areas of their lives. More

22
than half of the music subjects, 50 to 60%, reported having hand pain, which was
markedly higher than the 12 to 14% reported from the non-music control group. The
majority of the affected music subjects believed that their pain was music related. More
than 50% of female musicians in this population reported current persistent pain, which
was higher than both male musicians and the control population. Further studies of this
age group in different geographical regions might confirm whether music students might
be at more potential risk for overuse pain and injuries than the general population and
whether females may be more susceptible to music-related overuse pain than males.
A study of American students attending the High School for the Performing and
Visual Arts in Houston and others participating in the Houston Youth Symphony,
examined their experience of performance-related pain (Lockwood, 1988). The 131 high
school aged musicians described pain they felt while playing their instruments the scale
of the pain was reported on a range from experiencing no pain at all, to such severe pain
that inhibited their ability to perform any kind of activity, including music. Participants
were asked to report on how much time the subjects practiced per week, as well if they
played through any pain using a “no pain, no gain” attitude. A high prevalence of these
musicians reportedly experienced pain when playing: 32% specified mild problems while
17% experienced more severe problems. The researchers reported these results being
similar to those in studies of professional orchestra musicians. Cellists and bassists were
found to experience more problems than other instrumentalists. In addition, females
reported more pain than males. The majority of the subjects (79%) agreed that it was
acceptable to continue to practice when experiencing pain, in an attempt to overcome the

23
problem. This study shows a concerning prevalence of pain in young musicians, but does
not specifically determine whether students believed this to be performance related or
not.
Another study surveyed 425 junior high and high school band and orchestra
musicians, investigating the prevalence of performance-related problems (Shoup, 1995).
The questions dealt with past performance-related injuries and issues, how much time
students spent practicing, practice habits, and their feelings about playing when they have
pain. Details were solicited regarding the symptoms, location, severity, and duration of
pain. Of the responses, 33.2% of subjects reported having previously experienced
musculoskeletal problems with 51.9% of them having problems at the time of study. Of
those subjects experiencing pain, 39.8% reported using no treatment to help with their
pain while 42.4% reported only resting to deal with their symptoms. Amongst remaining
students who experienced pain, a range of medical or formal interventions were specified,
such as physical therapy, prescription medication, braces, etc. These figures correspond
with other studies indicating pain being experienced in young musicians.
A survey of string players ranging in age from 11 to 18, from 6 youth symphonies
in the American Northwest investigated pain issues (Brown, 1997). The 36 subjects were
asked about the location, severity and duration of any performance-related pain. Of the
subjects, 66% reported experiencing shoulder pain, 25% mentioned wrist pain and 33%
specified finger pain. Although the researcher tried to find a correlation between the
instrument played and location of pain, the results were inconclusive. The study does

24
show that more than half of string participants experienced some kind of musculoskeletal
pain.
In the Britsch (2005) cross-sectional study, the researcher looked into the
prevalence of pain in young musicians, aged 9 to 18 years. The subjects were asked a
variety of pain related questions, from if they experienced discomfort when playing, the
severity of the pain, if they believed in playing through the pain, and about specific
practice habits they employ. For all subjects, 46% reported they did feel pain at least
once while playing. The most frequently reported locations for the pain was in the neck,
shoulders, wrists, low back, fingers, and thumbs. Severity of pain was low in general,
only in the 0 to3 range out of a 5-point scale. The subjects’ seems to make a correlation
in the incidence of pain and the length of time they spend practicing. Only 15% reported
they participated in some form of stretching before they played. In terms of playing
through the pain, only 35% believed this was acceptable. The researcher noted there was
a spike in severity reported between the ages of 14 and 15 in females.
One study went further and not only looked at incidence of pain and discomfort,
but also investigated the effectiveness of a health and wellness promotion program
provided to music majors (Barton & Feinberg, 2008). The subjects, 26 freshman music
majors, took an eight–session health promotion course and took three evaluations at
various times before and after the course. These evaluations investigated their acquired
knowledge about medical issues, risk factors, intervention strategies, and their own self-
use of health promotion strategies. Both post tests showed increases in mean scores
showing an increase in both knowledge of medical issues and intervention strategies and

25
self-use of health promotion strategies. In the pre-test, 42% of the subjects reported they
rarely get eight hours of sleep or stretch before practicing music, while this percentage
decreased in both post-test assessments.
Even more in-depth, a study of 273 college music students examined the subjects’
physical problems from performing and their perceptions of how these problems affect
their musical performance (Kreutz, Ginsborg, & Williamon, 2008). Also, the study also
examined their healthy behaviors and if they perceive these behaviors having an effect of
their musical performance. Using a Likert-type scale, the subjects reported the severity
of their musculoskeletal and psychosomatic problems, as well as the frequency they
participate in health-promoting behaviors. Over 90% of population reported their current
health status at the middle of the five-point scale, between “poor” and “good”. In
general, the subjects reported they engaged in health-promoting behaviors on at least an
occasional basis, including physical activity, stress management, and nutrition.
Approximately 50% of the population reported having at least one musculoskeletal and
one nonmusculoskeletal problem. Far more females (62.5%) reported having these issues
than males (37.8%). Fewer subjects (34.6%) reported having an injury that affected their
practice than those who did not report such injuries (64.2%). The results showed that
although there was a high level of health problems reported, the subjects did not perceive
them impacting musical performance to the extent the researchers’ expected. The
researchers’ concluded that because the population rated their healthy lifestyles as high,
this might have reduced the perception that a healthy lifestyle impacts musical

26
performance. They commented much higher degree of healthy lifestyle might be
required to effect perceptions about health and musical performance.
Conclusion
The literature reviewed here focused only a few specific areas of wellness: sleep,
food/drink intake, stress, performance anxiety, and pain. The literature indicates that
each of these areas is important in the health and wellness of the individual. While
research pertaining specifically to musicians is more prevalent in the areas of
performance anxiety and pain, there is even less literature that specifically focuses on
children in these areas. This indicates the need for studies that target specific age groups
amongst young musicians and determines their awareness how health issues might
impact their musical performance. In conducting this study, the researcher aims to
contribute significantly to the literature, and in turn, open more pathways for additional
research.

27
Chapter 3: Methodology
Introduction
This chapter discusses the methodology for this exploratory, descriptive study. It
includes description of the study population, specifically addressing the inclusion and
exclusion criteria and the process for the recruitment of subjects. Next, the research
instrument is discussed, as well as the specific methods used for study administration.
Finally, all data collection and analysis procedures are addressed.
Research Design
An exploratory design was chosen to meet the needs of this study. Since the
exploration of this population group is relatively new within the literature, the researcher
determined a preliminary inquiry would be suitable to begin investigation within this
population (Babbie, 2009; Stebbins, 2001). The researcher investigated an area of music
medicine that is little understood, using constructivist principles to develop an
understanding and description of the experiences of the health and wellness of the
participants (Creswell, 2011). The use of both closed, and mostly, open-ended questions
within the research instrument also fell with the guise of exploratory research (Denzin &
Lincoln, 2011). The construction of this research instrument used a similar structure as
Young’s inquiry into the musical experience of infants and toddlers (2008).
Study Population
This study involved a population of convenience including high school string
orchestra students from two neighboring school districts within close geographical
proximity to the investigator in the state of California, USA.

28
Inclusion Criteria
Only school campuses providing site permission and permission from the
orchestra director were used in the study. All subjects were voluntary participants, age
13 to 20, in grades 9 through 12 who were enrolled in string orchestra programs in high
schools within a close geographic proximity to the researcher.
Exclusion Criteria
Participants who did not play standard string orchestra instruments (violin, viola,
cello, string bass) were excluded. Surveys with less than half of the items answered, or
with more than half of the responses being off-topic were excluded.
Recruitment of Subjects
The researcher began by calling all 20 high schools within five school districts in
order to determine if they had string orchestra programs. Of all 20 high schools, 13 of
them did have string orchestra programs. Next, the researcher contacted the Fine Arts
supervisors of all five districts for permission to conduct research within their district.
Three of the district supervisors provided permission while two district supervisors did
not give their permission. Of the three districts that gave permission, the researcher
contacted all the high school administrators of the six schools with string orchestra
programs to receive site permission to conduct research. Four high school administrators
did give site permission and two administrators did not give permission, thus excluding
one of the three districts. Next, the researcher contacted the four orchestra directors to
receive their permission to enter the classroom and conduct research. Having obtained
permission from each of these four, a mutually agreed time and date were set for the

29
researcher to visit each classroom to conduct the research. The researcher visited the
prospective subjects’ orchestra classes at the scheduled times. The researcher used a
script to address the students, describing the purpose of the study, describing the survey,
and all other information about their participation. Students were informed that, by
completing the survey, they were giving their permission to be included in the study.
Research Instrument
The instrument for this study was a written survey consisting of open-ended
questions dealing with students' perceptions on their wellness and relevant effects on
their musical performance. The researcher crafted the questions for the research
instrument based on her years of experience as a public school string orchestra instructor
and the concerns of health and wellness and musical performance she observed from her
students. The researcher also consulted with her peers and colleagues in music education
for feedback on appropriate terminology, layout, and format of the questions within the
research instrument.
Methods
The participants answered the written survey anonymously and voluntarily.
Although the participants were allowed all the time they needed to complete the study, it
took approximately twenty-five minutes for each group to complete. All participants
were given the same introductory speech prior to survey administration, which contained
all the information they needed to understand and complete the survey accurately.
Students were also given the opportunity to ask questions. The researcher passed out
surveys, pens, and study information sheet to all students in the classroom. They were

30
then instructed to begin the survey. Once all the surveys were completed, the researcher
collected them, along with the pens, and left the classroom. The participants’ orchestra
directors were present in the room during the entire research process to help maintain
order; however, they were required to keep a reasonable distance, so as not to be able to
view the responses of students.
Data Collection and Analysis Procedures
After completion, the researcher collected the surveys and left the classroom.
Surveys were stored in a locked filing cabinet in the home office of the researcher. The
researcher transcribed all survey responses into a digital format using an Excel sheet.
These data were stored on a password-protected computer. After transcription, the
researcher analyzed the data looking for trends and disparities. Categories of responses
were created, some being obvious groupings, with most categories emerging directly
from participant responses. The researcher supplied any funding required to complete
this study. The study took approximately two months to complete, commencing in late
September 2011.
Narrative description of Results
This was an exploratory, descriptive study by design. The results and conclusions
were written in a narrative style, including descriptions any trends and disparities that
were found in the results. Tables were used to better illustrate the narration. Where
appropriate, participants' responses were placed into categories to facilitate analysis. In
some cases, specific quotes of responses are presented.

31
Chapter 4: Results
Introduction
The purpose of this study was to investigate high school string orchestra students’
perceptions of their wellness as this relates to their musical performance. 344 students
from four high schools within a close geographic proximity to the researcher completed
surveys. This chapter describes in narrative style the results of the analyses for this
exploratory study. This study aimed to explore the following research questions:
1. Are high school string orchestra students aware of links between physical and
mental wellness and musical performance?
2. Do these students believe it important to include health and wellness
information/practices in their string orchestra curricula?
3. Do these students experience pain when playing their instruments or have they
done so in the past?
4. Does gender impact any of the above results?
The survey of thirteen items aimed to answer the above research questions.
The student responses for each individual question were placed into categories and were
analyzed for possible trends in responses. The first 10 items on the survey aimed to
answer the first research question - Are high school string orchestra students aware of
links between physical and mental wellness and musical performance? Item 11 on the
survey was asked to try to answer the third research question - Do these students
experience pain when playing their instruments or have they done so in the past? Item 12
on the survey was asked seeking to answer the second research question - Do these

32
students believe it important to include health and wellness information/practices in their
string orchestra curricula? Item 13 was not asked to answer any specific research
question, but as a guide to further topics for future research. Gender was part of the
demographic information asked at the beginning of the survey.
The researcher received 352 completed participant surveys. The researcher chose
to exclude eight surveys for various reasons, resulting in the total number of participants
being 344. One survey was excluded because the participant was younger than age 13.
Four surveys were excluded because the participants did not play standard string
orchestra instruments: three participants played piano and one participant played harp.
One survey was excluded because the participant only answered three items on the
survey before withdrawing. Finally, two surveys were excluded because more than half
of the responses on the surveys were off topic. Four surveys did not indicate gender.
While these four surveys were included in the general analysis of results, they were not
included in gender analysis. This gender analysis was conducted in a manner that
excluded non-responses. In other words, only the actual responses in any category were
analyzed in terms of male or female gender. Where appropriate, quotes from student
responses are included Chapter four. Numerous spelling and grammatical errors exist in
these quotations. Rather than use the word “sic” in each instance, the researcher points
out that all such errors should be considered recorded verbatim. The following sections
of this chapter include the description of the analysis of participant responses for all
thirteen items included in the participant survey.

33
Item One – Sleep on a Weeknight
Item one on the survey asked, “How many hours of sleep do you normally get on
a school night?” The researcher divided the responses into six categories: 0-2 hours, 3-5
hours, 6-8 hours, 9-10 hours, 11+ hours, and Miscellaneous responses (The percentages
of these values are presented in Table 1). All 344 participants responded, with a few
giving multiple answers that fit into multiple categories. By a large margin, the most
common response, 248, was within 6-8 hour range. The second most common response,
73, fell into the 3 -5 hour range. There were relatively few responses in the 9-10 hour
range, 22, and only one participant stated he/she slept only between 0-2 hours on a school
night. No participants reported sleeping 11+ hours, while three participants gave
miscellaneous responses whose sleep time frames were too wide to be conveniently
placed into any of the above categories: “irregular but ranges 5-9”, “varies 4-8 hours”,
and “8-11”.
Table 1
Item One – Sleep on a Weeknight
Item One 0-2
Hours
3-5
Hours
6-8
Hours
9-10
Hours
11+
Hours
Misc.
Total
Participants
<1%

(100%
male)
21%

(45%
male;
55%
female)
72%

(52%
male;
48%
female)
6%

(59%
male;
41%
female)
-- <1%

(100%
female)

In terms of gender, all of the participants in the 0-2 hour category were male. For
the 73 participants who sleep 3-5 hours on school nights, 33 were male while 40 were

34
female. In the 6-8 hour sleep range, 127 of the 248 participants were male and 117 were
female. Of the 22 participants who sleep 9-10 hours a night regularly, 13 participants
were male while nine were female. All of the three participants who gave miscellaneous
answers were male.
Item Two – Sleep on a Weekend Night
Item two asked the participants, “How many hours of sleep do you normally get
on a weekend night?” The researcher divided the responses into six categories: 0-2
hours, 3-5 hours, 6-8 hours, 9-10 hours, 11+ hours, and Miscellaneous were used (The
percentages of these values are presented in Table 2). A total of 344 participants
answered this question, with one participant providing an answer that fit into multiple
categories. The most common sleep time frame, 159 responses, fell between 9-10 hours.
A similar, yet fewer, amount of participants, 139, answered they received 6-8 hours of
sleep on a weekend night. A smaller number, 36, stated they sleep for 11+ hours a
weekend night. A very small number, five participants, responded they only get 3-5
hours of sleep, while no participants responded they received 0-2 hours of sleep on a
weekend night. Six participants gave miscellaneous responses, where the time frame was
far too wide to fit neatly into any of the established categories: “6-12 hours”, “6-10”, “sat
7-9 sun 4-5 (hours)”, “6-11”, “0-10”, and “varies 2-11”.

35
Table 2
Item Two - Sleep on a Weekend Night
Item Two 0-2
Hours
3-5
Hours
6-8
Hours
9-10
Hours
11+
Hours
Misc.
Total
Participants
-- 1%

(80%
male;
20%
female)
40%

(53%
male;
47%
female)
46%

(47%
male;
53%
female)
11%

(50%
male;
50%
female)
2%

(67%
male;
33%
female)

When looking at gender, of the five participants who responded they sleep 3-5
hours nightly on weekend nights, four were male while only one participant was female.
For the 6-8 hour range, 72 of the 139 participants were male and 65 were female. For the
9-10 hour range, 74 of the 159 participants were male and 83 were female. Of the 36
participants who sleep 11+ hours nightly, gender was evenly divided between male and
female: 18 each. For the six who gave miscellaneous responses, four were male and only
two were female.
Item Three – Amount of Sleep Before a Performance
Item three asked the participants, “How much sleep do you typically get before a
performance? More, Less, or your usual amount? Why?” The researcher divided the
responses into the following five categories: More sleep, Less sleep, Usual amount of
sleep, Miscellaneous, and Did not answer (The percentages of these values are presented
in Table 3).

36
Table 3
Item Three - Amount of Sleep Before A Performance

Item Three

More
Sleep

Less
Sleep
Usual
Amount
of sleep

Misc.

Did Not
Answer
Total
Participants
8%

(58%
male;
42%
female)
12%

(35%
male;
65%
female)
77%

(52%
male;
48%
female)
3%

(44%
male;
56%
female)
1%

(100%
male)

Of the 344 participants, only a few, 26 participants, replied they get more sleep
before a performance. From those 26, nine stated they get more sleep because of their
desire to be well-rested and/or to have more energy for the performance. Playing better
and/or making fewer mistakes in the performance are the reasons given by five for
getting more sleep. Only three answered they sleep more in order to be in the best
condition for the performance. One participant responded he/she sleeps more in order to
be prepared for the performance. Another participant stated it was a habit for him/her to
sleep more before a performance, while another participant replied they sleep more in
order to relieve stress. One participant answered he/she feels more warmed up when they
sleep more before a performance. Yet another participant stated sleeping more helps
him/her to listen to others better at a performance. Lastly, three responded that they did
get more sleep before a performance, but did not state a specific reason as to why they do
so.
In an opposing view, 41 participants stated they sleep less than usual before a
performance. Of those who responded they sleep less, 17 participants gave homework as

37
the reason for sleeping less, while 12 gave performance anxiety and nervousness as their
reason. Six participants stated they practice more than usual the day before a
performance, which affected their length of sleep. One participant responded he/she
sleeps less due to extra effort to organize their next day’s events. Another participant
stated he/she may get less sleep, but it depends on what his/her schedule is the next day.
Yet another participant gave stress as the reason for why he/she would get less sleep the
night before a performance. Finally, three participants stated they get less sleep, but they
did not provide a specific reason for their reduction in sleep.
The majority of participants, 268, answered they get their usual amount of sleep
before a performance. Of those participants, 55 gave homework and other school-related
activities for why their sleep patterns do not change. One 16-year old male stated, “The
usual amount, around 6 hours, because of school work that prevents me from sleeping
earlier.” Completing homework prevents many of them from getting additional sleep
before a performance. Almost an equal number of participants, 52, stated that the day of
a concert was a normal day so they do not sleep a special amount. A 17-year old male
commented, “Usual amount, since performances normally occur on a school night.”
Several participants, 22, replied they do not feel the need to change their sleep patterns
for a concert, 19 participants described how performances do not affect their sleep
patterns. Still more, 14 participants stated they have habitual sleep habits in which
concert days are included. Furthermore, 13 participants replied they do not practice
extra, or practice at all, before a performance so practice does not interfere in their sleep
time. Along those same lines, 12 participants commented they have their music

38
memorized, which allows them to sleep their usual amount before a concert. Having no
performance anxiety to affect their sleep was the reason given by 12 participants, while
another 12 stated they do not stress about performances so it does not cause any loss of
sleep. Still more, nine participants, reported not needing a lot of sleep so they did not
sleep more than usual, while an additional nine participants commented on how they
believe that sleep does not affect their performance, which prompted them to maintain
their usual sleep patterns before a concert. For instance, one female participant clarified,
“My usual amount. Sleep doesn't really affect my playing if I'm not playing a solo.”
Five participants stated that they sleep their usual amount in order to be focused for a
performance. Four participants reported that they sleep their usual amount in order to be
more rested and relaxed at a performance. Two participants reported they do try to sleep
more, but fail in the attempt, so they get their usual amount of sleep. Another two
participants do not care about performances so they do not sleep more in preparation.
One participant remarked, “Usual amt [amount]; school performances aren't that
important.” Still another two participants replied they had no time to sleep more as being
their reason for receiving their usual amount of sleep before a performance. Sleeping
their usual amount was given as a remedy to mitigate performance anxiety by one
participant. No specific reason was given by 23 participants as to why they receive their
usual amount of sleep before a performance. Additionally, 10 participants gave
miscellaneous responses, which included responses that did not answer the question
being asked, responses that were indecipherable, and responses that were off the topic.
Of the 10 miscellaneous responses, seven responses mentioned their sleep time was

39
variable based on the amount of homework they have before a performance. Two
participants did not answer this question.
There were some gender differences in the responses. From the responses that
stated they get the usual amount of sleep the night before a public performance, 139 were
males while 127 were females. In one of the smaller response categories, of the subjects
who replied they get less sleep before a performance, 14 were male and 26 were female.
For those subjects who answered they get more sleep before a performance, 15 subjects
were male while 11 subjects were female.
Item Four – Perceptions of Sleep and Musical Performance
Item four asked, “How do you think getting enough sleep on a daily basis affects
you playing music? Please give examples.” The researcher divided the responses into the
following five categories: Positive effects of adequate sleep, Negative effects due to lack
of sleep, Neutral/no effects of sleep, Miscellaneous, and Did not answer (The percentages
of these values are present in Table 4). Several participants gave responses that fit into
more than one category, as well as many participants who gave multiple examples of
these effects. The responses were broken down into these numbers: 164 participants
sighting positive effects, 120 participants sighting negative effects, 43 participants
responding neutral/no effects, 20 participants giving miscellaneous responses, and one
participant who did not answer.

40
Table 4
Item Four - Perceptions of Sleep and Musical Performance

Item Four
Positive
Effects
of Adequate
Sleep
Negative
Effects
of Lack
of Sleep

Neutral/
No Effect
Of Sleep

Misc.

Did Not
Answer
Total
Participants
47%

(50%
male;
50%
female)
35%

(38%
male;
62%
female)
13%

(70%
male;
30%
female)
6%

(65%
male;
35%
female)
<1%

(100%
male)

Of the 164 participants reporting positive effects of adequate sleep responses, the
largest reason given was being able to concentrate and/or focus better when playing
which comprised 80 of the responses. The next largest positive effect response, 47, was
the ability to be more alert, attentive, and/or have more energy when practicing or
performing. One 13-year old stated, “I feel that when I get enough sleep I tend to play
music better. I feel more attentive & focused when I get enough sleep.” Along those
same lines, 18 participants specifically mentioned how getting adequate sleep helps them
to not be tired or even fall asleep when practicing in orchestra class or at a performance.
A 15-year old female explained, “(sleep) helps me stay awake rehearsals/ If I don't get
enough sleep, at school, I get tired and can't focus as much.” Moreover, 11 participants
replied that regular sleep helps them feel more well-rested and/or relaxed when
performing. In addition, 36 participants mentioned getting adequate sleep allowed them
to play better and/or faster when performing. Sleeping an adequate amount regularly
helps 12 participants play more musically, while four reported it helps them follow the

41
conductor better. For example, an 18-year old male commented, “Getting enough sleep
help me to wake up in the school, which really influences me when I play. Ex) good
condition = better articulation. (cause & effect).” Sleeping well regularly puts nine
participants in a better mood, while three participants believe it increases their
willingness to practice. Eight participants think getting an adequate amount of sleep
allows them to learn and/or retain more when they practice, and two of the participants
replied that their brain functions better when they sleep well regularly. A 16-year old
male noted, “It (sleep) helps me retain what I practiced the night before. It helps me be
more musical & think about phrasing.” Regular sleep gives three participants more
physical endurance and allowed two participants to have better posture. For instance, a
15-year old female indicated, “Getting enough sleep gives one the ability to concentrate
more and be more aware of musicality & technical aspects of what they are playing; also
provides ability/strength to play an instrument for longer time.” One participant believed
getting enough sleep regularly helps his/her eyesight, yet another participant believed it
reduces his/her stress. Two participants commented they believe getting enough sleep
has positive effects on their musicianship, but did not give a specific reason in their
response. Of the 164 participants who responded getting enough sleep has a positive
effect, 80 participants were male while 80 participants were female.
Of the 120 participants who responded with examples of negative effects due to
lack of sleep, 51 replied that they suffer from lack of energy, zone out, and/or fall asleep
when playing. Along similar lines, 47 participants stated they could concentrate and
focus less with lack of regular sleep. Some participants, 28, reported playing suffers and

42
they make more mistakes, while four participants reported they play with less agility. In
addition, 15 participants felt that lack of regular sleep leads to a reduction in their muscle
and motor skills response. For example, a 17-year old male stated, “Sleep helps
attentiveness to music. Also if I’m tired from exercise or lack of sleep my fingers feel
more sluggish.” Moreover, 19 participants found themselves unmotivated to play, while
one participant reported reduces his/her practice time when he/she lacks adequate sleep.
Similarly, five participants found their practice to be less productive when they lack
adequate sleep. Musically speaking, another five participants replied having trouble
reading music, four participants found their general cognitive response slower when
playing, and five participants answered they do not play as musically. Still, four
participants found themselves not emotionally engaged in music, a two participants
responded paying less attention to the conductor, and lastly, two participants find a
reduction in their practice memory retention. A 13-year old female remarked, “I think
when I get more sleep I play better and am able to play fast parts well but when I don't
get a lot of sleep I am not able to play the fast parts, or play dynamics as well because I
am tired.” Lack of enough sleep gave six participants headaches and/or dizziness. One
participant stated a lack of sleep causes stress; another participant found it causes body
aches and pains, one participant commented it reduces their practice duration, and yet
another replied it is harder to hold their instrument. Finally, bad grades were the
consequence of lacking sleep for one participant, while another participant found it might
contribute to possible truancies. Of the 120 participants who answered that a lack of
sleep had negative effects, 46 participants were male while 74 participants were female.

43
Besides the positive effects to adequate sleep and the negative effects due to lack
of sleep, 43 participants believed that regular sleep does not affect them playing music.
Several participants, 20, gave miscellaneous answers that were either indecipherable,
were off topic, or it was unclear of the participants’ viewpoint. Eight participants were
not sure of the effects of regular, adequate sleep on their musical performance. Six
participants had specifically mentioned they had never thought about the relationship
between sleep and musical performance, while one participant did not answer this
question. In terms of gender, of the 43 participants who responded they did not believe
sleep had an effect on musical performance, 30 of them were male while 13 where
female. For those providing miscellaneous responses, 13 participants were male and
seven participants were female.
Item Five – Physical Preparations Before Playing Instrument
Item five asked, “Describe any physical preparations [like stretching] you do
before you pick up your instrument.” On the survey, this item was divided into three
time frames: Practicing at home, In orchestra class, and For a public performance. The
participants responded to this question for each of the three time frames. For each of the
time frames, the researcher divided the responses into the following five categories: Does
participate, Does not participate, Musical preparations, Miscellaneous, and Did not
answer. The participants who responded they did participate in physical preparations
often responded with multiples examples in each time frame.
Practicing at home. When asking about whether the participants participated in
physical preparations for the Practicing at home time frame, 117 participants answered

44
they do participate in such preparations (The percentages of these values are presented in
Table 5). Of those participants, five reported doing some form of deep breathing as a
physical preparation. Many participants replied they engage in some form of stretching
as a physical preparation. Some participants, 15, mentioned general stretching, while
others identify a specific body part. Moving down the body, 14 reported stretching
and/or moving the neck, 10 stretching/moving the shoulders, 31 stretching/moving the
arms, two stretching/moving the elbows, 15 stretching/moving the wrists, 14
stretching/moving the hands, 38 stretching/moving the fingers, 11 stretching/moving the
back, one stretching/moving the legs, and lastly, one stretching/moving the ankles.
Cracking joints, including the fingers, wrists, and neck, was used by eight participants.
For example, one 14-year old female mentioned, “Crack my knuckles”. Warming up the
hands and/or fingers was a physical preparation for 13 participants. Two participants
answered that they massage the hands and/or fingers while one participant replied
rubbing their arms before they play their instrument. One participant chooses running as
a physical activity before playing his/her instrument. Yawning and/or blinking are the
physical preparations for two participants while one participant tried relaxing his/her
muscles. Before picking up their instrument, three participants answered they eat or
drink something, one participant replied drying his/her hands, and lastly, one participant
mentioned using the restroom. Of the 117 participants who responded they do participate
in physical preparations, 52 of the participants were males, 64 participants were females,
and one participant did not give his/her gender on the survey.

45
Table 5
Item Five - Physical Preparations Before Playing Instrument: Practicing at home
Item Five –
Practicing at home
Does
Participate
Does not
Participate
Musical
Preparations

Misc.
Did Not
Answer
Total
Participants
34%

(45%
male;
55%
female)
51%

(55%
male;
45%
female)
9%

(52%
male;
48%
female)
4%

(53%
male;
46%
female)
1%

(100%
female)

The majority of the participants, 177 reported they do not participate in any
physical preparations before picking up their instrument. Of those 177 participants, 12
participants responded they do not feel they need to participate in any physical
preparations, while six participants stated they had never thought about engaging in
physical preparations before taking the survey. For example, one 18-year old male
explained, “None, haven't seen the need to.” Another 16-year old female commented,
“None I have never thought about stretching before practicing before.” Of those
participants who responded they do not participate in physical preparations, 97
participants were male and 78 participants were female. Musical warm-ups/preparations
were given by 32 of the participants. For example, one 15-year old male mentioned,
“Rosin the bow. Tune violin.” Additionally, 15 participants gave miscellaneous
responses, which were either indecipherable, gave responses that were off topic, or it was
unclear of the participants’ viewpoint. Of those 15 miscellaneous responses, the reason
for nine of them was they do not practice at home, with four of the participants
volunteering the reason being they do not have a bass at home. Lastly, three participants

46
did not answer the question, including one participant who specifically responded,
“Choose not to answer”.
In Orchestra Class. Of the 344 total participants, 84 participants reported they
do participate in some form of physical preparation in orchestra class before they pick up
their instrument (The percentages of these values are presented in Table 6). Deep
breathing was the physical preparation for one participant. In terms of stretching, seven
participants performed general body stretching, while others identified specific body
parts where they focus their physical preparations. Moving down the body, 10 reported
stretching and/or moving the neck, seven stretching/moving the shoulders, 20
stretching/moving the arms, one stretching/moving the elbows, 12 stretching/moving the
hands, 13 stretching/moving the wrists, 27 stretching/moving the fingers, five
stretching/moving the back, one stretching/moving the legs, and lastly, one
stretching/moving the ankles. Cracking the joints, i.e. fingers, wrists, and/or neck, was
used as a physical preparation for six participants. For example, a 14-year old female
commented, “Crack my fingers/wrist. Roll my neck.” Warming up the hands and/or
fingers was a regular physical preparation for 14 participants, while two participants
commented they walk and/or run as a physical preparation before playing. Still two
participants mentioned they relax their muscles, while three participants reported
yawning/blinking. Eating or drinking something before playing was a physical
preparation for two participants, and lastly, one participant reported drying his/her hands
before picking up their instrument. Of the 84 participants who answered they do
participate in physical preparations in orchestra class, 41 were male and 41 were female.

47
Table 6
Item Five – Physical Preparations Before Playing Instrument: In Orchestra Class

Item Five –
In Orchestra Class
Does
Participate
Does not
Participate
Musical
Preparations

Misc.
Did Not
Answer
Total
Participants
24%

(50%
male;
50%
female)
62%

(51%
male;
49%
female)
10%

(61%
male;
39%
female)
2%

(25%
male;
75%
female)
1%

(25%
male;
75%
female)

A large majority of the participants, 212, answered they do not participate in any
physical preparations in orchestra class before they pick up their instruments to play. For
example, a 17-year old female stated, “None. I have club activities so I rush to orchestra
all the time,” while one 16-year old commented, “None. I would look weird.” Of these
212 participants, 14 participants stated they do not feel the need to do any physical
preparations, while seven participants replied they had never thought about engaging in
physical preparations before playing their instrument. For instance, a 16-year old female
responded, “None; never thought about it.” Several participants, 36, mentioned some
form of musical warm-ups/preparations, such as one 16-year old male stated he plays
“scales.” Eight participants replied with a miscellaneous response, which was either
indecipherable, gave responses were off topic, or it was unclear of the participants’
viewpoint. Of those eight miscellaneous responses, three of them considered talking to
friends or fellow musicians as a physical preparation. Four participants did not answer
the question; with one participant specifically responding they “choose not to answer”.
In terms of gender, 107 participants were male and 104 were female of those who

48
responded they do not participate in any physical preparations before picking up their
instrument in orchestra class.
For a public performance. Of the 344 participants, 151 participants answered
they do participate in some form of physical preparation before they pick up their
instrument to play for a public performance (The percentages of these values are
presented in Table 7). Deep breathing was a reported physical preparation by 27
participants. One 16-year old male stated, “breathing deeply, stretching sometimes.”
The majority of the participants replied they participate in some form of stretching as a
physical preparation. Of them, 26 participants answered general stretching, while many
others identified stretching specific body parts. Moving down the body, 12 reported
stretching and/or moving the neck, 13 stretching/moving the shoulders, 22
stretching/moving the arms, one stretching/moving the elbows, 12 stretching/moving the
hands, 11 stretching/moving the wrists, 42 stretching/moving the fingers, 10
stretching/moving the back, four stretching/moving the legs, and lastly, one
stretching/moving the ankles. For example, a 15-year old female explained, “Definitely I
stretch my hands/arms/ shoulders/back.” Cracking the joints, i.e. fingers, wrists, and/or
neck, are the physical preparations for 11 participants. Making sure their fingers/hands
are warmed up before playing is a reported preparation for 20 participants. A 17-year old
male explained, “Deep breathing to calm down, moving my fingers, making sure my
fingers are warm. Stretching.” One participant reported massaging his/her fingers/hands,
while eight participants replied they relax their muscles before playing. A few
participants engage in physical exercise before playing: one reported running, two

49
reported jumping up and down/fidgeting, and one reported pacing around. Two
participants answered yawning and/or blinking before picking up their instrument. Three
participants reported dry their hands, while two participants made sure they ate or drank
something before playing. Lastly, one participant stated he/she does engage in physical
preparations before a public performance but did not name any specific preparations. Of
the 151 participants who do participate in physical preparations before a public
performance, 72 were male and 77 were female.
Table 7
Item Five – Physical Preparations Before Playing Instrument: For a Public Performance

Item Five –
For a Public
Performance

Does
Participate

Does not
Participate

Musical
Preparations

Misc.

Did Not
Answer
Total
Participants
44%

(48%
male;
52%
female)
42%

(55%
male;
45%
female)
9%

(55%
male;
45%
female)
5%

(50%
male;
50%
female)
1%

(100%
female)

On the other hand, 144 participants responded they do not participate in any
physical preparations before they pick up their instrument to play in a public
performance. Of those participants, seven participants stated they do not feel the need to
engage in these types of preparations while another seven participants stated they had
never thought about participating in any physical preparations before playing in a
concert. For example, one 14-year old female remarked, “I don't do any because I don't
see how it will help me.” Musical warm-ups were given as a physical preparation by 31
of the participants. Moreover, 15 participants answered miscellaneous responses, where

50
their responses were indecipherable, responses were off topic, or it was unclear of the
participants’ viewpoint. Of these miscellaneous responses, two participants commented
they have never participated in an orchestra performance before. Finally, two
participants did not answer the question, with one of the participants replying, “choose
not to answer”. When looking specifically at the genders of the 144 participants who
answered they do not participate in physical preparations before a public performance, 78
participants were male while 64 participants were female.
Item Six – Mental Preparations Before Playing Instrument
Item six asked, “Describe any mental preparations [like positive thinking] you do
before you pick up your instrument.” On the survey, this item was divided into three
time frames: Practicing at home, In orchestra class, and For a public performance. The
participants responded to this question for each of the three time frames. For each of the
time frames, the researcher divided the responses into the following four categories: Does
participate, Does not participate, Miscellaneous, and Did not answer. The participants
who responded they did participate in physical preparations often responded with
multiples examples in each time frame.
Practicing at home. Of the 344 survey participants, 152 participants replied they
do participate in some form of mental preparations before the pick their instrument to
practice at home (The percentages of these values are presented in Table 8). Many of the
participants do mental preparations related to the practice they will be doing. Thinking
about their practice was reported as a mental preparation for 38 participants. Other
participants, 25, responded they participate in setting goals for their practice session

51
before picking up their instrument. For example, one 15-year old female stated, “Focus,
set goals for practice.” Nine participants reported mentally studying their music, while
11 participants mentioned they hear the music they will be practicing in their minds. In
addition, seven participants reported trying to remember their teacher’s instructions, six
participants stated trying to remember past rehearsals, and two participants commented
thinking about instrumental technique before practicing. For instance, a 17-year old
female commented, “No prep really, I just think of what we worked on & what we're
gonna work on next rehearsal.” In addition, 18 participants reported trying to mentally
focus; four participants described visualizing their music/performance, while two
participants reported talking to themselves about their practice before actually engaging
in practice time. Selected participants engage in performance anxiety mitigation: 24
participants reported engaging in positive thinking and/or positive self-talk, six
participants reported trying to calm down, while another participant answered meditating
before practicing. Self-motivation is the mental preparation for eight participants, while
five participants reported listening to music. Finally, two participants reported engaging
in mentally scolding themselves before they practice. When looking at gender, of the 152
participants who responded that they do participate in mental preparations before picking
up their instrument to practice at home, 66 participants were male and 83 participants
were female.

52
Table eight
Item Six – Mental Preparations Before Playing Instrument: Practicing at Home

Item Six –
Practicing at Home
Does
Participate
Does not
Participate
Musical
Preparations

Misc.
Did Not
Answer
Total
Participants
44%

(44%
male;
56%
female)
48%

(55%
male;
45%
female
1%

(40%
male;
60%
female)
5%

(67%
male;
33%
female)
1%

(20%
male;
80%
female)

Conversely, 164 participants replied they do not participate in any form of mental
preparations before picking up their instrument to practice at home. Of those 164
participants, five participants commented that they do not believe they needed to
participate in mental preparations while a four mentioned they had never thought about
engaging in any mental preparations. For example, a 16-year old male explained, “I
don’t prepare mentally because there is no pressure on me to play well. Five participants
described the musical warm-ups/preparations they employ before practicing. In addition,
18 participants gave miscellaneous responses, where their responses were indecipherable,
responses were off topic, or it was unclear of the participants’ viewpoint. Of these
miscellaneous responses, six participants mentioned they do not practice at home, with
two participants volunteering the reason being they do not have a bass at home. Lastly,
five participants did not answer the question, one participant replying “Choose not to
answer.” In terms of gender, 90 of the 164 participants were male, while 73 were female.
In Orchestra Class. Of the 346 participants (a few participants giving answers
that fit into more than one response category), 115 participants answered they do

53
participate in some form of mental preparations before picking up their instrument in
orchestra class (The percentages of these values are presented in Table 9). Thinking
about their practice was the mental preparation for 21 participants, while three
participants responded on thinking about setting practice goals. Four participants
reported mentally studying their music while 10 participants stated that they hear the
music in their minds before picking up their instrument. Moreover, six participants
mentioned thinking about their instrumental technique. For example, one 15-year old
female mentioned, “I trying to think of ways to improve how I play my instrument, like
fingering.” Six participants described trying to remember past rehearsals, 10 participants
commented on thinking about the teachers’ instructions, while another four participants
reported thinking about general rehearsal readiness and improvement before playing their
instruments. A 17-year old female remarked, “Review what we talked about last class.
Look at the music and see if we made any changes.” An additional group of 26
participants described how they try to mental focus at the same time as three participants
answered talking to themselves about practice. Positive thinking/positive self-talk was
the mental preparation for 22 participants, and three participants reported trying self-
motivation before orchestra class. Furthermore, five participants reported trying to calm
down before playing in orchestra class. One participant stated that he/she listens to music
while two participants described engaging in mental scolding before picking up his/her
instrument. Of the 115 participants who do participate in mental preparations, their
genders were 57 males and 57 females.

54
Table Nine

Item Six – Mental Preparations Before Playing Instrument: In Orchestra Class

Item Six –
In Orchestra Class
Does
Participate
Does not
Participate
Musical
Preparations

Misc.
Did Not
Answer
Total
Participants
33%

(50%
male;
50%
female)
53%

(51%
male;
49%
female)
4%

(53%
male;
47%
female)
7%

(43%
male;
57%
female)
3%

(56%
male;
44%
female)

Oppositely, 182 participants stated that they do not participate in any mental
preparations before they pick up their instruments in orchestra class. Of those 182
participants, five participants commented on not feeling the need to engage in such
preparations, while two participants mentioned that they had never thought about such
preparations. For example, one 16-year old female remarked, “None I don’t feel stress or
uneasy during orchestra class.” Musical warm-ups and preparations were reported by 15
of the participants. Other participants, 25, gave miscellaneous answers, where their
responses were indecipherable, the responses were off topic, or it was unclear of the
participants’ viewpoint. Lastly, nine participants did not answer the question, with one
participant replying, “Choose not to answer.” For those participants who do not
participate in mental preparations, 93 of the 182 participants were male and 88
participants were female.
For a public performance. For a public performance, 256 participants stated
engaging in some form of mental preparation before picking up their instrument (The
percentages of these values are presented in Table 10). The most popular mental

55
preparation, given by 110 participants, was visualizing the music/performance. Before a
performance, 19 participants reported engaging in practice goal setting, while one
participant stated thinking about his/her practice. Other participants, 17, answered
regarding studying their music; four participants replied that they hear the music in their
mind, while 10 participants responded that they think about instrumental technique before
a public performance. Remembering past rehearsals is a reported mental preparation for
22 participants and eight participants stated that they remember their teachers’
instructions before a performance. Nine participants answered trying to mentally focus
whereas 23 participants commented talking to oneself about practice. Several
participants described engaging in mental preparations that deal with performance
anxiety. Self-motivation was the mental preparation for 54 participants, while two
participants reported engaging in positive thinking/positive self-talk. For instance, a 14-
year old female stated, “Take a deep breathe. Drink water. Says ‘It's okay you are going
to do fine.’ in my head. (all before I go on stage).” Three participants reported
meditating, six participants stated that they avoid thinking about the performance and/or
audience, and six participants answered that they pray and/or read the bible. Curiously,
one participant reported worrying to help relieve performance anxiety before a
performance. Listening to music was a mental preparation for three participants and four
participants mentally scold themselves before a performance. For example, a 17-year old
male says “Do not mess up,” to himself before a performance. Lastly, one participant
stated he/she does participate in mental preparations, but did not identify any specific
preparations. Of the 256 participants who do participate in mental preparations before

56
picking up their instrument for a public performance, 117 participants were male while
138 participants were female.
Table 10

Item Six – Mental Preparations Before Playing Instrument: For a Public Performance

Item Six –
For a Public
Performance

Does
Participate

Does not
Participate

Musical
Preparations

Misc.

Did Not
Answer
Total
Participants
74%

(46%
male;
54%
female)
16%

(74%
male;
26%
female)
<1%

(100%
female)
8%

(48%
male;
52%
female)
1%

(60%
male;
40%
female)

Contrary to those participants who participate in mental preparations, 56
participants reported not participating in any mental preparations before they pick up
their instrument for a public performance. Of those 56 participants, three stated that they
did not see the need to engage in such preparations. Musical warm-ups and preparations
is the response reported by a one participant. An additional 26 participants gave
miscellaneous responses, where their response was indecipherable, the responses were off
topic, or it was unclear of the participants’ viewpoint. Of these miscellaneous, three
commented that they have never participated in an orchestra performance before. Lastly,
five participants did not answer the question, with one participant stating, “Choose not to
answer.” Of the 56 participants who do not participate in mental preparations, 40
participants were male and 14 participants were female.

57
Item Seven – Perceptions of Music and Stress
Item seven asked, “Explain how playing your instrument relieves or increases
your everyday stress. Please give examples.” The researcher divided the responses into
six categories: Relieves stress, Increases stress, Both relieves and increases stress,
Neutral opinion, Miscellaneous, and Did not answer (The percentages of these values are
presented in Table 11). Of those who responded that music does affect their stress levels,
several participants gave multiple examples of how music either relieves or increases
their stress.
Table 11

Item Seven – Perceptions of Music and Stress

Item Seven

Relieves
Stress

Increases
Stress
Both
Relieves and
Increases
Stress

Neutral
Opinion

Misc.

Did Not
Answer
Total
Participants
47%

(50%
male;
50%
female)
10%

(49%
male;
51%
female)
29%

(46%
male;
54%
female)
6%

(61%
male;
38%
female)
5%

(61%
male;
39%
female)
2%

(100%
male)

Of the 344 participants, 163 participants replied that music relieves their everyday
stress. When adding those participants who believe music both relieves and increases
stress, the total number of participants who believe music relieves stress is 274.
Approximately half of the participants, 81, stated that playing music helped them get
their mind off of school and their other responsibilities. Similarly, 29 participants
described how music making has a relaxing/calming effect on them, while three

58
participants feel relieved after they play music. For example, a 16-year old male
commented, “Playing music helps me think less about the stuff going on in my life. It's a
way to relax, especially if I have many tests or if I'm stressed with my amount of
workload.” Expressing emotions through music was the reason for 21 participants to
state music relieves stress nine participants described getting lost in the music. A 15-year
old female explained, “I have been a musician since I was 4 years old - naturally, music
calms me down because I have been exposed to it for so long. It relieves my stress,
expecially if I have a test or a basketball game or a swim meet later, because it allows me
to get lost in something I truly love, and think about nothing but what I am doing or
listening to in that moment.” Moreover, playing is reportedly fun/entertaining for eight
participants and three participants find music lifts their spirits. For instance, a 16-year
old female stated,
Playing the violin definitely relieves stress because playing involves the use of
your muscles, your mind, & your brain. You are physically, mentally and
emotionally occuppied when playing, because it's hard to think of anything else
such as bad grades or family issues while trying to perfect inntonation and playing
style. I usually play when I am depressed to get my mind off the issues. Also
music lifts my spirits.

When they play well, eight participants stated that music boosts their confidence whereas
four participants responded feeling they can play freely and/or the music flows through
them. Liking music was the reason for six participants to feel music relieves stress, eight
participants find playing music fun/entertaining, two participants find orchestra easy and
say it does not matter, and yet another two participants think music is easy and state that
they do not have to think to participate. One participant answered he/she believes music
refreshes the brain and another participant feels more awake afterwards. Four

59
participants gave no specific reason other than it relieves their everyday stress. Of the
163 total participants who stated that playing music relieves their everyday stress, 80
were males and 80 were females.
In an opposing viewpoint, 35 participants stated playing music increases their
everyday stress. When adding the participants who feel music both relieves and increases
stress, the total participants who believe music increases stress is 136. Playing music was
time consuming and/or caused time management issues for 17 participants. For example
a 15-year old female commented, “It (music) increases my stress because on top of all the
homework, projects, & sports events, I also have to practice playing my instrument.”
When they are struggling or playing poorly increases the everyday stress of 12
participants. Moreover, four participants stated disliking orchestra and/or disliking their
orchestra teacher, while three do not feel musically prepared. Preparing for music exams,
competitions, and/or auditions increased the stress of four participants, whereas one
participant described finding the competitive nature of his/her orchestra class stressful.
When looking at gender, of the 35 participants who feel that music increases their
everyday stress, 17 participants were male while 18 participants were female.
Several participants, 101, stated that they believe music both relieves and
increases their everyday stress. A 17-year old male clarified, “Playing violin relieves
stress by allowing my mind to take a break from academics or as entertainment to keep
me busy. I also feel very accomplished after practicing. Instruments can increase stress
especially during competitions as I race to solidify the challenging technical passages.”
Gender-wise, there were 46 males and 54 females who feel that playing music both

60
relieves and increases their everyday stress. In an opposite viewpoint, 21 participants
commented on having a neutral opinion of playing music – that it neither relieves nor
increases their everyday stress. Of those 21 participants, 13 were male while eight were
females. In addition, 18 participants gave a miscellaneous answer, where the responses
were indecipherable, the responses were off topic, or it was unclear the participants’
viewpoint. Of these miscellaneous responses, five participants commented how music
does relieve (one stated both relieves and increases) everyday stress, but attributed these
effects when playing a non-standard string orchestra instrument, such as piano, guitar,
etc. Lastly, six participants did not answer the question.
Item Eight – Performance Anxiety Symptoms and Remedies
Item eight asked, “If you experience performance anxiety [being nervous] before
a public performance, please explain the symptoms [like shaking]. If you do anything
[like pacing or positive self-talk] to avoid this experience, please also explain what you
do.” The researcher divided the responses into the following six categories: Does
experience symptoms, Does not experience symptoms, Does employ remedies, Does not
employ remedies, Miscellaneous, and Did not answer (The percentages of these values
are presented in Table 12). Several participants responded in such a way that their
responses fell into more than one category.

61
Table 12

Item Eight – Performance Anxiety Symptoms and Remedies

Item Eight

Does
Experience
Symptoms

Does Not
Experience
Symptoms

Does
Employ
Remedies

Does Not
Employ
Remedies

Misc.

Did Not
Answer
Total
Participants
72%

(45%
male;
55%
female)
25%

(60%
male;
40%
female)
87%

(46%
male;
54%
female)
9%

(48%
male;
54%
female)
2%

(100%
male)
2%

(67%
male;
33%
female)

For performance anxiety, 232 participants reported experiencing symptoms of
performance anxiety before a public performance. More than half, 137 participants,
replied that they experience shaking/trembling symptoms. Other common symptoms
included 53 participants reported having sweaty/clammy hands and/or palms, 32
participants reporting hearts beating stronger and/or faster, and 38 participants reported
their hands getting cold and/or stiff. Butterflies/upset stomach accounted for 22
participant responses, one participant described his/her face flushes, and two participants
explained having to use the restroom. Tapping feet/toes was a symptom for a five
participants; certain four participants reported pacing, and eight participants commented
they get jittery and anxious. Quickening of the breath was reported as a performance
anxiety symptom by seven participants; three reported body temperature rises, two
reported teeth chatting, four reported getting forgetful, four reported feeling dizzy and/or
get headaches, and one reported getting goose bumps. Moreover, two participants
described experiencing dry mouth and/or get thirsty, three participants reported having

62
trouble controlling their fingers, and one participant answered about rushing his/her
music. Furthermore, six participants responded about having thoughts of failure, one
participant reported feeling self-conscious, one participant described getting emotional,
one participant specified eyes tearing up, and one participant reported a loss of appetite.
Lastly, 20 participants mentioned they do experience performance anxiety but did not
identify any specific symptoms. In terms of gender, of the 232 participants who do
experience symptoms of performance anxiety, 104 participants were male, 126
participants were female, and two participants did not provide their gender on the survey.
Conversely, 81 participants replied that they do not experience any performance anxiety
symptoms before a public performance. Of those 81 participants, 48 participants were
male and 32 participants were female.
Although not all participants did, 209 participants answered they do employ
remedies to try to help mitigate their performance anxiety symptoms. The most common
remedy given by 71 participants was deep breathing. Relaxing and/or calming down
were used by 19 participants; 13 participants replied practicing or studying their music,
12 participants described focusing on playing, and two participants mentioned they just
play. Moreover, six participants reported pacing, a five participants answered tapping
their feet, three participants described using some form of visualization, and two
participants replied about trying to ignore the audience. A 15-year old female reported,
“To try and calm myself, I try not to look out in the audience and scare myself even
more.” Talking and/or laughing with others was a reported remedy for 23 participants;
10 participants described just avoiding thinking about their performance anxiety

63
symptoms, while three participants stated they worry or even mess up to help with their
symptoms. For example, on 16-year old female explained, “To fix this I can try to
distract myself by talking with friends or thinking about something else,” while a 15-year
old male remarked, “I think about failing so I could think about the performance as a
second chance.” Several participants mentioned some form of eating/drinking to assist
with performance anxiety: 10 reported eating a banana, four reported drinking water, and
one reported taking natural medicine. This 15-year old male stated, “I drink medicine to
calm myself down. Completely safe medicine sold in ordinary Korean market.” In
addition, five participants explained participating in a physical activity with others
identifying a specific activity, including four reported stretching, one reported cracking
his/her knuckles, four reported yawning, two reported closing their eyes, six reported
smiling, and one reported going to the restroom. Similarly, two participants responded
they rub/warm their body and/or hands, two participants stated trying to stay warm; one
participant described washing his/her hands, even as one participant explained he/she
dries their hands. Furthermore, two participants stated they do everything fast, one
participant responded about fluttering his/her lips, one participant reported he/she
screams, one participant described chewing gum, while one participant described
performing more. Finally, seven participants mentioned that they pray/meditate. Of the
total 209 participants who stated they do employ remedies, 95 participants were male
while 111 participants were female.
On the other hand, 21 participants stated not participating in any performance
anxiety prevention techniques, of which 10 participants were male and 11 participants

64
were female. For example, one 16-year old female explained, “I don't do much besides
worry, sit down and dwell over my nervousness.” Five participants gave miscellaneous
answers, where the responses were indecipherable, responses were off topic, or it was
unclear of the participants’ viewpoint. Of these miscellaneous responses, one participant
stated that he/she has not participated in an orchestra performance before, while two
participants commented on experiencing performance anxiety, but while participating in
other types of performances, such as piano and dance recitals. Lastly, six participants did
not answer the question.
Item Nine – Perceptions of Food/Fluid Intake and Musical Performance
Item nine asked, “How do you think healthy eating/drinking on a daily basis
affects you playing music? Please give examples.” The researcher divided the responses
into the following five categories: Does affect music, Does not affect music, Neutral
opinion, Miscellaneous, and Did not answer (The percentages of these values are
presented in Table 13). For those participants who responded healthy eating/drinking
does affect music, several participants gave multiple examples for how it affects music.
Table 13

Item Nine – Perceptions of Food/Drink Intake Habits and Musical Performance

Item Nine

Does
Affect

Does Not
Affect

Neutral
Opinion

Misc.

Did Not
Answer
Total
Participants
57%

(46%
male;
54%
female)
28%

(58%
male;
42%
female)
8%

(54%
male;
46%
female)
5%

(63%
male;
37%
female)
2%

(57%
male;
43%
female)

65
Of the 344 survey participants, 197 participants answered that healthy
eating/drinking on a daily basis does affect them when playing music. A large number,
76 participants, commented that healthy eating/drinking gives them energy, while 55
participants stated that it helps them with focus and concentration. One 16-year old
female commented, “Having enough energy and being hydrated is important. If one is
hungry or thirsty, concentration suffers, and so does performance,” while another 15-year
old female described how “Healthy eating/drinking provides energy to play music
w/more strength and for a longer time. Playing w/little energy results in a loss of
musicality.” Healthy eating/drinking wards off hunger and thirst for 31 participants,
whereas 17 participants believe it helps with strength and endurance, 14 participants
replied that it helps them feel better, and another 14 participants stated that it helps them
be more active and/or move faster. Eating/drinking healthy regularly made 11
participants happier, helped seven participants be more productive, and helped motivate
five participants to play. For instance, one 15-year old female stated, “I think healthy
eating/drinking will help us perform better so we have more energy & are enthusiastic to
play.” In addition, six participants mentioned it helping prevent dizziness and headaches,
while three participants described it improving cognitive function. Better posture was a
consequence for one participant, at the same time as six participants find it easier to play.
Three participants believe it helps reduce stress while six believes it makes it easier to
play. Finally, five participants responded that healthy eating/drinking does affect music
but were either not sure of its effects or gave no specific examples of such effects. Of the

66
total 197 participants who believe eating/drinking does affect playing music, 89
participants were male and 105 participants were female.
Conversely, 97 participants stated healthy eating/drinking on a daily basis does
not affect music, of which 56 were male and 41 were female. For example one 17-year
old male stated, “I don't think it affects anything. I ate healthy one time and ate junk food
other time and played, no difference,” while one 15-year old male explained, “It doesn't -
having a healthy meal will not affect your performance - practice does.” Also, 27
participants had a neutral opinion about whether eating/drinking affects music either
because they had no opinion about it, had never thought about it, or they were not sure it
affects music. Of those 27 participants, 14 participants were male and 12 participants
were female. Furthermore, 16 participants gave a miscellaneous answer, where the
responses were indecipherable, off-topic, or unclear of the participants’ viewpoint.
Finally, seven participants did not answer the question with one participant replied,
“Choose not to answer” and another participant replied “Cannot answer, ‘healthy’ is
subjective.”
Item Ten – Consciously Using or Avoiding Foods/Fluids Before a Performance
Item ten asked, “Describe any fluids/foods that you consciously use or avoid
before a performance in order to play better.” The question was divided into to two
areas: Consciously Use, and Consciously Avoid. The researcher divided the responses
into the following four categories: Does consciously use/avoid, Does not consciously
use/avoid, Miscellaneous, and Did not answer. Some participants’ responses fit into
more than one category.

67
Consciously Use Foods/Fluids Before a Performance. Of all of the 344 survey
participants, 201 reported that they do consciously use foods/fluids before a performance
(The percentages of these values are presented in Table 14). Not providing a specific
food or fluid, 44 participants stated that they do consciously eat a snack or meal before a
performance. Some participants mentioned choosing to use specific food groups: 24
reported carbohydrates, 12 reported meats/proteins, and nine reported dairy products.
The large majority, 152 participants, answered that they consciously use water before a
performance. For example, one 16-year old male responded, “Water so I am not
dehydrated,” while a 18-year old female stated, “Drinking water!! But not too much that
you have to go to the restroom too often.” Moreover, 21 participants reported
consciously eating fruit, with 14 participants stated specifically using bananas before a
performance. One 16-year old female noted, “healthy foods, foods that calm you nerves
such as bananas.” Furthermore some participants mentioned using other specific foods:
11 reported using vegetables, five reported chocolate, two reported eggs, four reported
sugary foods, and one reported soup. For example, one 16-year old male commented,
“Chocolate sometimes to relieve anxiety.” Other participants reported consciously using
fluids: five use soda, four use tea, one uses smoothies, one uses Gatorade, and lastly, one
uses coffee. When looking at gender specifics, of the 201 participants who do
consciously use specific foods/fluids, 97 participants were male and 101 participants
were female.

68
Table 14

Item Ten – Consciously Using Foods/Fluids Before a Performance

Item Ten –
Consciously Use

Does
Consciously
Use
Does Not
Consciously
Use

Misc.

Did Not
Answer
Total
Participants
58%

(49%
male;
51%
female)
38%

(53%
male;
47%
female)
1%

(25%
male;
75%
female)
3%

(50%
male;
50%
female)

On the other hand, 131 participants stated not consciously using any type of
food/fluid before a performance, of which 70 were male and 61 were female. Of these
participants, two do not believe there is a need to consciously use any food/fluids, while
four participants mentioned they had never thought about use specific foods/fluids before
a performance. Four participants gave a miscellaneous response, which were
indecipherable, off-topic, or unclear of the participants’ viewpoint. Finally, a ten
participants did not answer the question, with one participant replying, “Choose not
answer.”
Consciously Avoid Foods/Fluids Before a Performance. Of the 344 survey
participants, 175 participants reported consciously avoiding certain foods/fluids before a
performance (The percentages of these values are presented in Table 15). The most
frequently answered response, given by 47 participants, was soda. Several participants
reported consciously avoiding other fluids: 10 avoid energy and/or sugary drinks, 17
avoid coffee and/or caffeine, five avoid juice, and 17 avoid water. Other participants
commented consciously avoiding specific food types: 20 avoid greasy/fried/fatty foods,

69
12 avoid spicy/salty foods, 15 avoid fast food, 16 avoid junk/processed foods, 28 avoid
candy/sugary foods, 14 avoid heavy foods, 3 avoid frozen foods, 2 avoid new/weird
foods, five avoid messy foods, and one avoids smelly foods. For instance, one 14-year
old female commented, juice/soda, pizza/hamburgers, junk, processed food,
honey/syrup.” Specifically looking at food groups, two participants avoid meat/protein,
two avoid carbohydrates, 12 avoid dairy products, and one avoids vegetables. Some
participants reported consciously avoiding specific foods, including three avoid soup,
three avoid chocolate, one avoids garlic, 10 avoid chips, one avoids beans, six avoid
pizza, one avoids popcorn, and one avoids burritos. A 16-year old female mentioned
avoiding “Pizza/junk food b/c (because) it might cause you stomach ache.” In addition,
four participants avoid alcohol/drugs, and three participants avoided gum. Lastly, 21
participants did not identify a specific food/fluid, but rather avoided too much of
anything. When looking at gender, of the 175 participants who do consciously avoid
specific foods/fluids, 77 participants were male and 95 participants were female.
Table 15

Item Ten – Consciously Avoid Foods/Fluids Before a Performance

Item Ten –
Consciously Avoid
Does
Consciously
Avoid
Does Not
Consciously
Avoid

Misc.

Did Not
Answer
Total
Participants
51%

(45%
male;
55%
female)
44%

(56%
male;
44%
female)
3%

(64%
male;
36%
female)
2%

(67%
male;
33%
female)

70
Conversely, 152 participants stated not consciously avoiding any foods/fluids
before a performance, of which 84 participants were male and 67 participants were
female. Of those 152 participants, two participants mentioned not seeing the need to
avoid any specific foods/fluids, while four others replied that they never think about
avoiding any specific foods/fluids. For example, one 13-year old male explained, “I don't
really pay attention to foods I do eat to play better,” while a 15-year old female remarked,
None…Never really thought that there was special food/drinks that can enhance or
worsen my playing.” Moreover, 11 participants gave miscellaneous answers, stating they
are unsure of the relationship between food/fluids and music, their responses were off
topic, or it was unclear of the participants’ viewpoint. Of these miscellaneous responses,
one participant stated, “…why would I avoid something to play better??” Finally, six
participants did not answer the question.
Item Eleven – Perceptions of Pain When Playing Instrument
Item eleven asked, “Describe any pain you experience or have experienced when
playing your instrument.” On the survey, the item was divided into three time frames:
Practicing at home, In orchestra class, and For a public performance. The researcher
divided the responses into four categories: Does experience pain, Does not experience
pain, Miscellaneous, and Did not answer. Several participants who responded they did
experience pain provided multiple, specific examples and locations of pain they have
experienced.
Practicing at home. Of the 344 survey participants, 214 stated they do
experience or have experienced pain when playing their instrument when practicing at

71
home (The percentages of these values are presented in Table 16). Most participants,
108, reported experiencing pain/soreness in the fingers. Several participants reported
experiencing/having experienced pain in other areas of the body, including 44 in the
arm/forearm, 36 the shoulder, 33 the wrists, 30 the hands, 30 the back, 27 the neck, eight
the elbows, four the knees, four the legs, and three the feet. For example, a 16-year old
female reported, “Hand cramps and my fingers next after a while, also my neck starts to
cramp up as well after extensive practice.” Around the face and head, three participants
reported experiencing/having experienced pain in the chin, two in the eyes, two head
pain, one collarbone, and one ear. In addition, three participants reported general joint
and/or body pain while seven participants replied they suffered from emotional pain.
One 15-year old male mentioned, “frustration of not getting music.” Lastly, five
participants stated they do experience pain, but did not identify any specific areas where
the pain occurs. Of those 214 participants who do currently experience or have
experienced pain, 90 participants were male and 122 participants were female.
Table 16

Item Eleven – Perceptions of Pain When Playing Instrument: Practicing at Home

Item Eleven –
Practicing at Home

Does
Experience
Pain
Does Not
Experience
Pain

Misc.

Did Not
Answer
Total
Participants
62%

(42%
male;
58%
female)
32%

(64%
male;
36%
female)
4%

(72%
male;
29%
female)
2%

(57%
male;
43%
female)

72
While some participants reported they do experience pain, 109 participants
reported they do not experience or have not experienced pain while playing their
instrument, of which 68 participants were male and 39 participants were female. Also,
14 participants gave miscellaneous answers, where the responses were indecipherable,
the responses were off topic, or it was unclear of the participants’ viewpoint. Of these
miscellaneous responses, three participants mentioned they do not practice at home
because they do not have an instrument at home, and one participant commented he/she
does experience/have experienced pain while playing piano. Finally, seven participants
did not answer the question.
In Orchestra Class. Of the 344 survey participants, 176 participants replied they
do experience or have experienced pain when playing their instrument in orchestra class
(The percentages of these values are presented in Table 17). The three most common
locations for pain reported were in the arm/forearm, back, and fingers, which affected 42,
40, and 39 participants, respectively. Several participants reported experiencing/having
experienced pain in the upper extremities, including 33 reporting pain in the shoulder 21
in the wrists, 21 in the elbows, and 19 in the fingers. For example, one 15-year old
female stated, “Sore arm after playing for a long time.” Likewise participants mentioned
experiencing/having experienced pain in the lower body, including pain one in the
buttocks, two the knees, two the legs, and three in the feet. Also, a few participants
commented experiencing/having experienced pain around the face and head, such as
three reporting pain in the eyes, two with pain in the head/face, three with pain in the
collarbone, and two with pain in the ears. In addition, eight participants described

73
experiencing/having experienced general joint/body pain, one participant described
experiencing pain in the side, and six participants answered that they experience
emotional pain while playing their instrument in orchestra class. One 15-year old male
responded, “pain from mistakes I make while playing.” Lastly, four participants stated
that they do experience or have experienced pain, but did not identify any specific areas
where this pain occurred. Of the total 176 participants who reported currently
experiencing or having experienced pain in orchestra class, 75 participants were male and
99 participants were female.
On the contrary, 147 participants replied they do not experience or have not
experienced any pain while playing their instrument in orchestra class, with 84
participants were male and 61 participants were female. Furthermore, 11 participants
gave miscellaneous answers, where the responses were indecipherable, responses were
off topic, or where it was unclear of the participants’ viewpoint. Finally, 10 participants
did not answer the question.
Table 17

Item Eleven – Perceptions of Pain When Playing Instrument: In Orchestra Class

Item Eleven –
In Orchestra Class

Does
Experience
Pain
Does Not
Experience
Pain

Misc.

Did Not
Answer
Total
Participants
51%

(43%
male;
57%
female)
43%

(58%
male;
42%
female)
3%

(72%
male;
27%
female)
3%

(60%
male;
40%
female)

74
For a public performance. Of the 344 survey takers, 106 participants responded
they do experience of have experienced pain when playing their instrument for a public
performance (The percentages of these values are presented in Table 18). The most
common location of pain reported by 28 participants was in the arm/forearm. Similarly,
in the rest of the upper extremities, 23 participants stated they experience/have
experienced pain in their fingers, 11 in the hands, 16 in the wrists, two in the elbows, and
16 in the shoulders. Several participants reported they experience/have experienced pain
in the lower extremities, including 19 in the back, one in the buttocks, two in the knees,
six in the legs, and two in the feet. In additional, several participants commented they
experience/have experienced pain around the face and head, including 18 with pain in the
neck, two in the collarbone, three in the head/face, two in the eyes, and one in the ear.
Moreover, five participants reported general joint/body pain, three participants reported
experiencing stomach pain, and nine participants stated they experience emotional pain.
Lastly, two participants replied they do experience or have experienced pain while
playing their instrument for a public performance, but did not identify any specific areas
where this pain occurs. Of the total 106 participants who responded they do currently
experience or experienced pain during a public performance, 45 participants were male
and 59 participants were female.

75
Table 18

Item Eleven – Perceptions of Pain When Playing Instrument: For a Public Performance

Item Eleven –
For a Public
Performance
Does
Experience
Pain
Does Not
Experience
Pain

Misc.

Did Not
Answer
Total
Participants
31%

(43%
male;
57%
female)
61%

(54%
male;
46%
female)
5%

(56%
male;
44%
female)
4%

(62%
male;
38%
female)

Oppositely, 207 participants responded that they do not experience or have not
experienced pain while playing their instrument for a public performance, of which 110
were male while 95 were female. In addition, 18 participants gave miscellaneous
answers, where the responses were indecipherable, were off topic, or where it was
unclear of the participants’ viewpoint. Of these miscellaneous responses, four
participants made comments about nervousness or performance anxiety, while two
participants mentioned they have not participated in an orchestra performance before.
Finally, 13 participants did not answer the question.
Item Twelve – Inclusion of Health and Wellness Information In Orchestra Class
Item twelve asked, “Describe what you think about including health and wellness
information/practices into your orchestra class.” The researcher divided the responses
into the following five categories: Positive opinion, Negative opinion, Neutral opinion,
Healthy Statements, Miscellaneous, and Did not answer (The percentages of the values

76
are presented in Table 19). Within their response, several participants gave multiple
reasons for their opinion.
Table 19

Item Twelve – Inclusion of Health and Wellness Information in Orchestra Class

Item Twelve Positive
Opinion
Negative
Opinion
Neutral
Opinion
Healthy
Statements

Misc.
Did Not
Answer
Total
Participants
37%

(47%
male;
53%
female)
24%

(48%
male;
52%
female)
17%

(47%
male;
53%
female)
11%

(64%
male;
36%
female)
7%

(58%
male;
42%
female)
4%

(60%
male;
40%
female)

Of the 344 survey participants, 128 answered they have a positive opinion about
including health and wellness information/practices into their orchestra class. The most
common reason for their positive opinion, given by 44 participants, was that the
information would be beneficial for their general health. One 16-year old female
expressed, “I think it is a good idea to show what can happen to you if you don't take care
of your body,” while another 16-year old female noted, “I think it would be very useful
because most high school students don't eat healthy foods, exercise, or sleep a sufficient
amount of time.” Another 25 participants replied that the addition of this information
would be helpful for improved musical performance. For example, a 16-year old male
stated, “I think it is a good idea so that we can maximize our performance potential.”
Moreover, 14 participants responded it would help them be more focused and/or have a
clearer mind, four participants believe it would raise awareness of health issues, and four
participants feel this information/practices would help affect their mood and/or attitude.

77
Some of the participants specifically addressed some of the areas of the survey, including
eight participants responding that it would help with better eating/drinking habits, four
reported help with sleep habits, one reported help relieve stress, and 23 reported help with
pain/injury prevention. One 15-year old female suggested, “Maybe adding some
stretches to avoid cramps and just move every once in a while instead of staying seated
the whole time.” Lastly, 15 participants have a positive, but conditional opinion of the
inclusion of health and wellness information/practices. For example, one 17-year old
expressed, “It can be helpful, but it should not take up too much time that could be spent
rehearsing,” while another 17-year old female stated, “I think it might be useful for music
teachers to inform their students about how to stretch, eat, drink, and sleep before their
concerts, practices at home, or class rehearsals. However, too much time shouldn't be
devoted to this subject.” Of the total 128 participants who answered they had a positive
opinion of including health and wellness information/practices into their orchestra class,
59 participants were male and 67 participants were female.
In an opposing viewpoint, 81 participants answered they have a negative opinion
of including health and wellness information/practicing in their orchestra class. The
majority, 56 participants, stated that the inclusion of such information is not important,
necessary, and/or relevant to the class. For instance, one 17-year old female explained,
“Not needed. We can learn these things in health class. We're here to play music.”
Likewise, eight participants believed that it would waste time and/or take away from
rehearsal time. Another 10 participants replied that students already know this
information while nine participants responded the information will not make a difference.

78
Six participants stated music class should only be for learning music; while three
participants answered the only thing that will help them play better in orchestra class is
practice. The negative opinion of five participants is due to the fact that no one in their
orchestra class currently has any health/wellness problems, whereas one participant
believes music is not a strenuous activity so this information is not necessary. For
instance, one 17-year old male described, “I don't think it is necessary at all. Orchestra
doesn't need you to be extremely healthy as long as you aren't sick or anything, you are
fine.” Lastly, one participant stated he/she has a negative opinion of the inclusion of this
information, but did not give any specific reasoning for his/her opinion. Of the 81
participants who responded they have a negative opinion, 39 of them were male, while
the other 42 were female.
Besides the participants with positive and negative opinions, 59 participants
responded they have neutral opinions about including health and wellness
information/practices, of which 28 were male and 31 were female. For example, one 17-
year old male explained, “I have not noticed a connection between health and orchestra,”
while a 15-year old female violinist expressed, “I guess it’s good…? Not really sure b/c
(because) I’ve never really thought about the relationship between them.” Of those 59
participants, 29 of them are not sure or have no opinion, while eight replied they do not
believe this information will affect music. One participant stated that adding this
information would not make a difference. Moreover, 26 participants reported having a
neutral opinion because they have never thought about adding this information into their
orchestra class before. Rather than providing their opinion about the inclusion of

79
health/wellness information and practices into their orchestra class, 37 participants gave
general statements about health and wellness as their responses. In addition, 19
participants gave miscellaneous answers, where the responses were indecipherable, the
responses were off topic, or where it was unclear of the participants’ viewpoint. Of these
miscellaneous responses, five participants responded they did not understand the
question. Finally, 15 participants did not answer the question, with one participant
replying “Choose not to answer.”
Item Thirteen – Additional Health-Related Issues Impacting Musical Performance

Item thirteen asked, “Describe anything else health-related that you think might
be impacting your musical performance.” The researcher divided the responses into the
following six categories: Physical, Mental, Social/Emotional, Neutral, Miscellaneous,
and Did not answer (The percentages of these values is presented in Table 20). Several
participants gave either multiple examples or responses that fit into more than one
category and/or multiple examples.
Table 20
Item Thirteen – Additional Health-Related Issues Impacting Musical Performance

Item Thirteen

Physical
Issues

Mental
Issues
Social/
Emotional
Issues

Neutral

Misc.

Did Not
Answer
Total
Participants
37%

(53%
male;
47%
female)
7%

(54%
male;
46%
female)
4%

(67%
male;
33%
female)
45%

(49%
male;
51%
female)
3%

(30%
male;
70%
female)
5%

(59%
male;
41%
female)

80
Several, 133 participants, gave responses of physical health-related issues. Some
participants mentioned several different specific physical issues, including 26 reporting
illnesses/diseases, 16 reporting injuries and/or body weaknesses, and 13 reporting muscle
soreness, fatigue, and/or pain, 10 reporting eyesight issues, two reporting hearing
problems, and eight reporting allergies. For example, a 16-year old female expressed,
“Sports, I get injured (my knees) and it affects the position in which I hold my bass.”
Moreover, one participant identified alcohol/tobacco use, two identified environment of
the performance location, and two identified schoolwork and activities might affect their
musical performance. Exercise is the physical health-related reason given by eight
participants; while one participant answered left-handedness, six participants replied
bodily issues/shortcomings, and one participant responded with musical technique issues.
Lastly, 47 participants responded with physical issues (sleep, food intake, pain, stress,
performance anxiety) already addressed in the survey. For example, a 14-year old male
stated, “getting enough sleep,” and a 17-year old male remarked, “not eating properly.”
From the total 133 participants who gave physical responses, 70 of them were male and
62 of them were female.
In another vein, 24 participants gave examples of mental issues that might impact
their musical performance. These participants gave a variety of mental issues, including
four stating nervousness/anxiety, five stating mental disability, and 12 stating
troubled/stressed mind might affect musical performance. For instance, a 16-year old
male stated, “other stress from other classes, boredom,” while a 14-year old female
explained, “Any outside stress is always in the back of my mind while I'm playing which

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is rather distracting.” In addition, two participants answered confidence, while three
participants answered mental issues but did not provide any specific examples. Of the
total 24 participants who answered mental issues, 13 of them were male, while the other
11 were female. An even smaller group, 13 participants, identified social/emotional
issues. These responses were divided into different areas, such as five mentioning social
issues, two mentioning emotional issues, and six mentioning familial issues. For
example, one 16-year old male replied, “The person you sit next to,” while a 16-year old
female who mentioned, “Embarrassment.” Also, one participant stated a dislike of music
and/or performing, which impacts their musical performance. Of the 13 participants who
answered social/emotional issues, eight participants were male and four participants were
female.
The largest group, 163 participants, gave a neutral response, of which 80 were
male and 82 were female. The majority of the neutral participants, 152, reported being
either unsure of any other health-related issues or they have no answer. For example, one
14-year old male stated, “I don't know any else health-related things that could impact
musical performance, because I never thought it would.” Other participants, 11, gave
miscellaneous answers, where the responses were either indecipherable, off topic, or it
was unclear of the participants’ viewpoint. One participant who gave a miscellaneous
response stated he/she did not understand the question. Finally, 17 participants did not
answer this question.

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Summary of Results
This study investigated high school string orchestra musicians’ perceptions of
their health and wellness as it impacts their musical performance. This chapter illustrates
the participants’ responses for five areas of health and wellness: sleep, stress,
performance anxiety, food/drink intake, and pain. The thirteen survey items attempted to
discover the participants’ viewpoints on the relation between their health and
musicianship, their opinion of the importance of the inclusion of health and wellness
information into their orchestra class, their perception of pain when playing their
instrument, and if their gender has any impact on their responses. All survey item
responses have been analyzed for categories and trends within the responses.

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Chapter 5: Summary, Discussion and Conclusion
Summary
This study investigated the cognizance in high school string orchestra musicians
of health and wellness related to their musical performance. The five health and wellness
areas of sleep, stress, performance anxiety, eating/drinking habits, and pain were
addressed. In addition, the study determined whether the participants would be receptive
to the introduction of health and wellness information and practices within their orchestra
classes. Finally, it examined response in terms of gender differences.
In looking specifically at sleep, the study found that vast majority of participants
have below the minimum 9+ hours of sleep recommended for teenagers by the National
Sleep Foundation, (2006). It is interesting to note that participants tend to have more
sleep over weekends, which makes sense with them not having school and presumably
less immediate deadlines. However, there was still a large amount receiving below the
recommended amount of sleep even on weekends. The majority of participants appear to
have their usual amount of sleep before a performance. They reported schoolwork and
other school/familial responsibilities taking precedence over their preparation for a public
performance. The vast majority also believes that sleep does have an affect on their
musical performance while a very small population perceives that the amount of regular
sleep they receive has little to no measurable effect on their musical performance.
Participants reported on physical and mental preparations before picking up their
instruments to play. While the majority of participants do no physical preparation before
home practicing or class, more did so at home than in orchestra class. However, before a

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public performance, the majority does participate in physical preparations. Overall,
mental preparations are done more than physical; in particular, mental preparation when
practicing at home was more prevalent than in orchestra class. However, the highest
amount of mental preparation was conducted before a performance. Participants largely
specified that this was in order to avoid or mitigate performance anxiety symptoms.
When looking specifically at stress, far more participants perceived that music
relieved their everyday stress than increased it. Still more participants feel that playing
their instrument both relieved and increased their everyday stress. While this indicates a
strong awareness of the stress-relieving properties of music it was also specified that
when preparing for music exams, concerts, and auditions, these musical activities
increased their stress. A majority of the participants do experience performance anxiety
symptoms before a public performance, with only some reporting no performance
anxiety. Likewise, more participants reported employing remedies in attempting to
ameliorate their performance anxiety symptoms before a public performance. Only a
handful of participants reported they do not participate in any remedies.
For eating/drinking habits, the bulk of participants do believe their regular
food/fluid intake impacts their musical performance. More participants consciously use
foods/fluids than those who consciously avoid certain foods/fluids. This indicates that
most participants appear to be cognizant of how foods and fluids can potentially have
both a positive and negative effects on their musical performance.
In terms of pain, more participants reported experiencing pain when practicing at
home and in orchestra class than those who do not. Only for performances do fewer

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participants report experiencing pain than those who do. This makes some sense, since
students are more likely to play their instrument for longer periods of time at home or in
orchestra class than at a performance.
In terms of including health and wellness into orchestra class, although not a
majority, the largest group of participants reported having a positive opinion of its
inclusion. Some of these participants, however, have a positive, but conditional, opinion,
provided that it does not interfere too greatly with orchestra class or their status therein.
Interestingly, only a few participants have a negative or neutral opinion, showing concern
that it would be either a waste of rehearsal time or it would make no difference in musical
outcomes. Lastly, when asked if they had any other health-related issues they felt
impacted their musical performance, most of the participants responded physical issues,
followed by mental and social/emotional issues. The largest number of responses was
neutral, mainly because did not know or could not think of anything else not already
discussed in the survey.
When looking specifically at gender, throughout about two thirds of the questions
there were very slight gender differences in the responses. In fact, a couple of question
response categories had an exact 50/50 split between males and females. Many of the
response categories for the questions had small differences in gender, where span of
difference between results was less than 10% between the genders. Of the 56 different
question response categories, only 19 (about one third) have a greater than 10% gender
difference in responses. Of those 19 question response categories, five of them have a
response population with fewer than 25 participants, so the minimal quantity in the

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responses may have contributed to the appearance of greater gender percentage
differences. All in all, the genders were fairly evenly matched throughout the survey.
Discussion of Outcomes
Sleep. With the National Sleep Foundation’s sleep recommendations (2006) for
teenagers being nine+ hours per night, the fact that the vast majority of participants
expressed receiving one to three hours less than optimization on a weeknight is rather
troubling. The amount of sleep reported here is consist with the six to seven hour sleep
times reported in Cash’s (2009) and Harvey & Saxon’s (2003) studies. Even more
disconcerting is the number of the participants reported getting three to five hours sleep
in the week (four or more hours less than recommended). Since school nights encompass
five out of the seven nights a week that teenagers sleep, the results indicate that
participants are not getting enough sleep the bulk of the time. Far more participants
expressed receiving the recommended nine+ hours of sleep on weekends than on school
nights. One likely explanation for this change in sleep habits is that weekends may have
less academic and other pressing demands on the participants, which may allow them to
sleep more. Even with this possibility, quite a number of participants still mention they
receive one to three hours less than recommended minimum on weekends. It is
disturbing to note that between a third and a half of the participants are reporting they are
receiving less than optimal levels of sleep on a daily basis, including weeknight and
weekends, which corresponds to the 42% of responding they rarely receive the
recommended eight hours of sleep in Barton & Feinberg’s study (2008). Having already
reviewed research indicating that lack of quality sleep can potentially cause cognitive

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and/or motor skill impairment, it may be assumed that many of the participants may be
experiencing these negative effects on a regular basis (Buysee, 2005; Simmons & Duke,
2006; Stickgold et al., 2000). What is even more of a concern for educators is that this
lack of sleep may be compounded in students already suffering from learning and
behavior impairment (Leger & Pandi-Perumal, 2007). By not sleeping at optimal levels
most of the week, these participants may be inadvertently harming their success in school
and also in orchestra. Furthermore, because the complex cognitive and physical demands
of playing a string instrument, this suggests these musicians may not be performing at
their finest much of the time. Although they may not recognize the damage, the
participants’ lack of sleep on a regular basis may be having negative effects on their
musicianship.
A large amount of the participants did not change their sleep habits in
preparations for a performance, for a variety of reasons. This would seem to be contrary
to the advice of being well-rested before an important event, like an exam or
performance. For some, they sleep their usual amount because their academic
responsibilities seem to be more of a concern than the performance. Clearly, academic
success is far more a concern to some participants in the study and they plan their sleep
patterns with academic concerns in mind, rather than their musicianship. Another reason
is the participants’ desire to maintain their regular sleep routines. Along those same
lines, without mentioning the school night issue, several participants do not feel they
should change their sleep schedule for a performance. It would appear that some of the
participants in this study find it more necessary to stick to their well-established routines

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than to alter them in preparation for a performance. Additionally, another reason that
several participants gave was because they did not feel performances are very important.
It is noteworthy that some participants feel that orchestra performances are not significant
or vital enough in their lives to make special arrangements and preparations for them.
While some of the responses specifically mention that music performance is not a
priority, for others the possibility might be that performing is a very natural part of their
normal experience.
Surprisingly, a few participants stated they get their usual amount of sleep
intentionally because it gives them the focus and energy they need to perform well. It is
interesting to note that although many participants in this study are getting less, or even
far less, than the recommended amount of daily sleep, they perceive their usual amount of
sleep is sufficient to provide adequate energy and mental concentration. These results
seem to confirm the results of Harvey and Saxon’s (2003) study of vocalists, who also
feel they receive adequate sleep although their test results suggest they suffer from
pathological sleepiness. A possible repercussion may be that their performance levels are
not optimal and more education may be needed to change their understanding about how
much sleep they need to function at optimal levels. There was one even more concerning
impact of performance on sleep stated by a participant, who brought up the point that
performances may interfere with a student’s regular homework, employment, and/or
other responsibilities. Concerts and other performances may interfere with participants’
ability to complete their homework, study for exams, prepare projects, etc., so they may

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have to stay up even later to finish their next day’s work. This was a question that the
researcher had not specifically addressed and this report came was a revelation.
Overall, the gender differences were fairly evenly matched in terms of sleep.
More females appear to be receiving fewer hours of sleep on weeknights than males, and
vice versa on weekends, although these gender differences were slight. This is a
discrepancy that would be interesting to explore further if one could link this to
performance achievement, which was not evaluated in this study. There were, however,
some noteworthy gender differences. More females than males expressed sleeping less,
while more males than females sleep more before a performance, although the reason for
this disparity is not clear. The fact that females seem to be getting slightly less sleep in
general than males seems to also confirm the National Sleep Foundation’s indication that
females are more likely to have disturbed sleep (Harvey & Saxon, 2003). It might
conceivably be related to conscientiousness of one gender over another, to an issue like
performance anxiety, or to differing perceptions of performance importance or of health
awareness.
The indications of these previous results are somewhat contradictory to those of
the next question, which addressed participant awareness of the importance of getting
enough sleep on a regular basis in affecting their music playing. When looking at the
effects on sleep, some of the participants gave examples of how sleep affects them
playing music, whether directly or indirectly. The fact that so many of the participants
have provided examples of how sleep has affected them playing their instrument
demonstrates they are personally aware of how sleep affects their musical performance.

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The concern, however, is that some of the students are perceiving as little as 6 hours of
sleep as being sufficient, which may be the real issue that requires attention. The most
frequent response on both the positive and negative sides dealt with concentration, focus,
and energy levels. In fact, some responses appeared to show their awareness that lacking
sleep can cause trouble with cognitive functioning. These statements, along with other
similar accounts, indicate a strong cognizance of sleep affecting their musical
performance. Furthermore, this result adds more credence to research indicating that
sleep affects cognitive function (Buysse, 2005; Stickgold et al., 2000). Taking this
stream of thought further, several participants mentioned how energy levels,
concentration, and focus affect their technical abilities to play music. Some participants
notice a change in their motor skills based on the amount of sleep they receive. One
participant in particular even described how his sleep has a cause and effect relationship
with his technique. These statements demonstrate how a lack of sleep can disrupt proper
motor skill functions (Stickgold et al., 2000), and that these participants seem to be
acutely aware of this connection. Furthermore, according to some participants, phrasing
and musicality are also affected by sleep. These responses also indicate how a lack of
sleep affects creativity, which has already been cited in research (Buysse, 2005). It is
clear that several of the participants in this study seem to be keenly aware of the
relationship between the amount of sleep they get and the quality of music they produce.
Another facet that arose was how sleep was reported to affect mood and motivation in
playing their instruments. Although being in a bad mood or being unmotivated to
practice due to lack of sleep may not directly diminish their performance, it presents the

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potential to indirectly affect a students’ ability to learn, retain, and/or make complex
musical decisions which could lower the quality of their performance (Leger & Pandi-
Perumal, 2007). One participant even added that sleep affects his enjoyment of music,
which was an aspect of sleep that the researcher had not specifically anticipated. The
researcher had considered the effects on technical aspects of playing music but had not
fully embraced the possible relation with the emotional side of musical performance.
Sleep, for some in this study, affects not only their mood but also their enjoyment of
making music, which can definitely have an effect on quality of their musical
performance. The opinions expressed above give a clear picture that many of the
participants in this study are well aware of the relationship between sleep and their ability
to play their instrument effectively. It is very important to note there seems to be a
dichotomy between the participants’ perceptions of knowledge about sleep and their
actions. They seem to be aware of how sleep enough can have positive effects on their
musical performance, and yet they sleep less than the National Sleep Foundation’s
recommendations (2006). It may be possible that many of the participants believe they
are getting enough sleep on a regular basis, even though by the National standards they
are not.
In terms of gender, although the majority of response categories were very close
between genders, there were some intriguing gender differences. For example, far more
females than males responded that a lack of sleep causes negative effects on their musical
performances. A possible explanation could be the link to the results indicating that
female participants sleep less than males and therefore have more likely experienced

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these effects. Another reason might be that the females in this study are more acutely in
tune with their bodies' sleep patterns and their subsequent musical performance.
Oppositely, far more males than females felt that sleep has no bearing on their musical
performance. Perhaps, in sleeping more than the female participants, they have
experienced these effects less often or have simply not noticed any changes in their
musical performance as a result of the sleep they get. Overall, it seems more males do
not feel sleep is related to musical performance than females in this study.
Perceptions of Music and Stress. More participants perceived music to be
helping relieve their everyday stress than increase it; however, quite a few report thinking
it does both. Even when adding into the mix those participants who find that music is a
double-edged sword as related to stress, far more see music as a stress reliever than a
stress elevator in their lives. One of the most popular reasons the participants gave for
music relieving stress was that music allows them to take their mind off of their stressors
and responsibilities, including school work, exams, extra-curricular activities, and
familial obligations. Interestingly, it seems several participants use music as a tool to
relax and step away from the other stresses in their lives. In fact, a few participants even
mentioned choosing to practice their instrument when they need to take a break from
their homework, projects, or studying for tests. Music seems to be a tool being used by
some participants to break up their stressful homework and/or activities schedule. These
responses show how several of the participants in this study may be putting music in an
entirely different category than the rest of the academic coursework, and as such, music
has a different effect on their stress levels. This seems to reiterate the responses in

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Steptoes’ (1989) research showing some musicians find playing in orchestra a pleasure in
their lives. Some even find music less intellectually taxing than their other high school
classes so they find music to help them release the tension created by their more
demanding school responsibilities.
Confirming Steptoe’s (1989) research, some participants believe music increases
their daily stress, mentioning several interesting reasons. One common response for
music increasing their stress is that music adds an additional layer to their already busy
schedules. By adding practice time into their daily schedule, they find it much more
taxing to juggle their responsibilities and successfully control their time management
issues. Moreover, another reason for increasing everyday stress shows how for many
participants there seems to be a disparity in the importance of different aspects of their
musicianship. For several participants, they find playing music in day-to-day situations
does relieve their stress, but being in performance or competitive music situations
increases their stress. These sentiments demonstrate that some participants place a much
higher level of importance on auditions and solo performances than they do for their
performances in orchestra class, which in turn creates more opportunities for solo and
competitive situations to add further stress to their daily life. Some participants even
described how playing in orchestra is a daily stress reliever, but when faced with
competitions, auditions and solo performances, they find their stress level increased.
This seems to verify current research that shows that musicians find being in orchestra a
pleasurable experience, but the competition among their peers causes stress (Steptoe,
1989).

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When looking specifically at gender, gender was exactly even for those who
reported music relieving their stress. Slightly more females reported music increasing
stress and both relieving and increasing stress. A larger difference in gender is noted in
the reports from more males than females who expressed not finding music to affect their
stress levels. This may possibly be because fewer males are keenly aware of how music
affects their stress levels than females, or it may indicate that they genuinely experience
fewer effects.
Performance Anxiety Symptoms, Remedies, and Mental Preparations. When
investigating performance anxiety, quite a large number of the participants testified they
do endure performance anxiety symptoms before a public performance. This seems to
correspond to the literature, which shows it is not just professional musicians who suffer
from performance anxiety (Ryan, 1998; Shoup, 1995; Sternbach, 2008; Su et al., 2010).
Over half of the responses referred to shaking or trembling as a symptom of their
performance anxiety. This, along with many of the symptom responses, appears to be
aligned with commonly reported symptoms of performance anxiety (Osborne & Kenny,
2008; Steptoe, 1982). In fact, the number of participants who responded suffering from
shaking/trembling was more than double any other performance anxiety symptom
reported. It is possible that shaking/trembling is a very common performance anxiety
symptom among the all the participants in this study, but there may be another
explanation. Foreseeing that some high school students might have trouble with the term
“performance anxiety” and/or have trouble identifying symptoms associated with
performance anxiety, the researcher provided guidance within the survey question. For

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performance anxiety, the terms “being nervous” and “shaking” were given as examples
of symptoms, and “like pacing or positive self-talk” was added to help students
understand the term "prevention techniques." In an effort to ensure the participants fully
understood the question, this guidance may have influenced the responses of the study
participants. The participants may have been more inclined to answer "shaking" because
they saw “like shaking” within the question. Although there is no way to confirm this, by
attempting to ensure the participants fully understood the survey question, the researcher
may have unintentionally influenced the responses offered by the study population.
However, shaking is a common symptom of performance anxiety and the responses are,
therefore noteworthy.
When trying to deal with their performance anxiety, the participants used a
variety of different and interesting methods to alleviate their symptoms. The two largest
responses were deep breathing and positive self-talk/thoughts, which seems to confirm
the current literature on stress and performance anxiety coping strategies (Steptoe, 1989).
As described above, it is possible that the high number of participants identifying
participation in positive self-talk may have been prompted by the guidance provided,
“like pacing or positive self-talk” in the question. On the other hand, positive self-talk
may indeed be a popular remedy among this population due to the fact that only a few
participants reported they use pacing as a remedy even with “like pacing” having been
provided as an example in the question. Likewise, deep breathing was the most popular
response by the participants who answered they do participate in performance anxiety
remedies even though deep breathing was not provided as a guidance example in the

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question. This suggests that deep breathing, and even positive self-talk are indeed
popular remedies used by the participants in this study and may not have been influenced
by the survey question itself.
Avoidance techniques were reported being used by a few of the participants to
alleviate their performance anxiety symptoms. Some participants try to avoid thinking
about the performance as a way to calm their nerves and other symptoms. Likewise, a
few participants try to ignore the audience before a public performance to help mitigate
their symptoms. This seems to coincide with the stress emotional-coping strategies of
distraction and avoidance described in the literature (Halleland et al., 2009). It is not
clear in the responses whether these avoidance techniques were successful, but it is clear
that some participants do report using these methods before a public performance to try to
alleviate their performance anxiety symptoms.
Surprisingly, only one participant mentioned using some form of medicinal
remedy. Although the medicine mentioned was not doctor-prescribed pharmaceuticals, it
does pose the question if there were more participants who also use some medicinal
remedy to help with their performance anxiety. More participants may be using herbal
remedies, like herbal teas, without realizing these might be helping with their
performance anxiety and thus did not describe them in their survey response. Another
possibility is that this study population is unaware of any medicinal remedies, and that,
indeed, only one participant actually uses any form of medicine to help with his
performance anxiety. On the other hand, it is possible that some of the participants feel
that eating bananas are medicinal, because a handful of participants specifically

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mentioned eating bananas for the potassium to help with their performance anxiety. One
remedy, used by a few participants, seems quite counter-intuitive. These participants
practice being worried or purposefully make mistakes during preparation to help them
prepare for possible later performance anxiety. Although it is unclear why these
participants use this counter-intuitive remedy or if these remedies even work, a few
participants seem to intentionally participate in these remedies to help alleviate their
performance anxiety. One participant described how he thinks about failing, explaining
that this helps him overcome his performance anxiety. The thought of triumphing over
failure at a performance may potentially be a motivator that may make this participant
feel more confident, which may relieve performance anxiety. It is intriguing, though, to
realize how some participants are engaging in negative remedies to help solve their
performance anxiety problems.
The researcher had not expected students to mention spiritual approaches to
addressing performance anxiety, particularly with the separation of church and state in
America and the infrequent addressing of spiritual matters in schools. A handful of
participants mentioned they read the bible and/or pray before a performance to help them
deal with their nervousness symptoms. These participants’ responses opened a door to an
unexplored area within this study: the spiritual nature of students. This study investigated
the physical, mental, and touched on the social and emotional realms, but had not
specifically aimed to include the spiritual.
In considering gender, most of the responses were similar been males and
females. Only in the group of participants who stated they do not experience

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performance anxiety do we find a more than slight gender difference: 60% male and 40%
female. These numbers seem to correspond to both Osborne & Kenny’s (2008) and
Ryan’s (2005) results showing more females suffering from performance anxiety than
males. One possibility for the higher percentage of males not having symptoms is simply
the fact that more males in this population truly do not experience performance anxiety.
Another possible explanation is that the males in this study either do experience
symptoms but may be disregarding them totally or they are attributing their symptoms to
other issues. These males might also be merely unwilling to admit in this survey that
they suffer from symptoms of performance anxiety. Whatever the reason, several more
males than females in this study reported they do not have performance anxiety. In all
the other response categories, males and females were fairly evenly matched.
Although not specifically focusing on performance anxiety, the researcher wanted
to find out if the participants do any mental preparations before playing their instruments.
Fewer participants commented that they participate in preparations before orchestra class
than when practicing at home. The bulk of the participants, however, did participate in
mental preparations before a performance. There is a very intriguing difference between
the types of mental preparations being used in the three different time frames. When
practicing at home, the majority of the responses dealt with pragmatic, practice
organization-related issues, including goal setting, practice time management, thinking
about practice necessities, remembering past rehearsals and instructions, etc. Similarly in
orchestra class, more than half of the participant responses deal with the same
organizational and musical performance-related issues. These pragmatic mental

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preparations demonstrate these participants are concerned with their musical performance
and not as concerned possible with performance anxiety issues. By using these types of
mental preparations, many of the participants in this study are showing their awareness of
their mental state as it relates to their musical performance.
There is, however, a stark difference in the types of mental preparations used by
the participants before a public performance. Although there were several participants
who continued to participate in organizational techniques, far more engaged in techniques
to help with motivation and performance anxiety, including positive motivation,
visualization techniques, and nervousness reducers. Their comments demonstrate that
these participants appear to be concerned enough with performance anxiety that they feel
the need to participate in preventative mental preparation techniques. Some very young
participants mentioned using these techniques, indicating that even young teens may be
experiencing performance anxiety symptoms before they perform. This reiterates the
results of several other studies (Ryan, 1998; Ryan, 2005; Su et al., 2010). The large
number of participants shifting their mental preparations to performance anxiety remedies
and motivational techniques seems to suggest that many of teens in this study do suffer or
have suffered from performance anxiety when they perform. In fact, the number of
participants doing mental preparations before a public performance was the setting with
the highest number of all the mental and physical preparation responses. This suggests
that quite a large number of the participants may be experiencing performance anxiety,
even at very early ages. By participating in mental preparations that try to mitigate
performance anxiety, these participants are illustrating an understanding of how their

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mental state can have an effect on their musical performance, either in both positive and
negative ways.
Even though just over half the participants in this study report participating in
mental preparations, there are also many participants who specifically reported not doing
so. What is particularly interesting is how some of the latter specify there being no need
because they do not find performing in the class to cause anxiety. These statements
illustrate that some participants perceive they are not subject to performance anxiety and
stress when they play their instrument so there is no need for them to do any mental
preparation. Their acknowledgement, however, of performance anxiety in their response
demonstrates this is a subject of which they may be acutely aware. Moreover, some
participants do not find music very mentally challenging, so they do not perceive a need
to prepare mentally for the activity.
It is noteworthy to look at the ways in which a few of the participants motivate
themselves or alleviate their performance anxiety. A few participants mentally scold
themselves as a way to motivate them to play well. It is not clear if these mental
preparations are effective in improving their musical performance, but it is troublesome
to realize that some participants are using negative self-talk before they pick up their
instrument. Along those same negative lines, some participants appear to diminish their
own contribution to the performance in order to mitigate their performance anxiety. It is
disturbing that some participants mentally minimize their own contribution and value in
the performance in order to make them feel less performance anxiety before they play.
Although these techniques may help them with their performance anxiety in the short

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term, they may potentially create larger performance-image and personal self-image
issues in the long term.
When considering gender and mental preparations, there are opposing results.
Most of the response categories were fairly even between males and females. In general,
more females reported participating in mental preparations than males, but the differences
are slight. The largest disparity occurred for those who stated not participating in mental
preparations. Far more males than females reported not participating in mental
preparations. In general, more females in this study tend to participate in mental
preparations than males and, conversely, more males in this study tend not to participate
in these preparations. While causes are unknown, it might be possible that more females
than males are more mentally conscientious, and as such, participate in more mental
preparations. Alternatively, it might simply be that more females may have performance
anxiety than males.
Perceptions of Food/Fluid Intake and Musical Performance. The majority of
the participants do believe that healthy food/fluid intake has an effect on musical
performance. The two largest reasons given were that healthy eating/drinking gives you
energy and it helps with focus and concentration. Some participants discuss food/fluid
intake and its effects on general health. These participants seem well aware of how
healthy eating and drinking affects their overall health and well-being. Moreover, a few
discuss how more energy and focus can specifically affect musicianship. The responses
show how some participants appear to understand how energy and concentration are key
facets in the music making process, and without them, musicianship suffers. By their

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responses, many of the participants in this study appear to show cognizance of how
eating and drinking affect them as musicians. Surprisingly, some participants also seem
aware of how healthy eating and drinking can affect their emotional health. A few
participants responded that eating and drinking healthily makes them happier and/or
increases their motivation to play their instruments. One participant in particular
explained in great detail how eating and drinking can influence mood and attitude.
Despite this participant’s young age, it demonstrates how even younger participants in
this study seem to realize how their eating habits can influence their mood.
On the other hand, some participants reported that their eating habits do not affect
their music abilities. They do not, or at least have not yet, noticed any differences in their
bodies and/or musical performance depending on what they eat. One participant based
this belief on her personal experience. These responses also discussed eating/drinking in
the short term, which may not show any acute affects whereas the question was looking
for broader long-term effects of regular food/fluid intake. It is possible that because of
the study population’s young age and the general healthy resilience attributed to youth,
they may not be seeing the effects of their eating/drinking habits as readily as a musician
of more advanced age. However, it may also be that these participants have never really
thought about or made any connections between the two areas as of yet. The Kreutz et
al.’s study (2008) found similarly that many musicians did not perceive their healthy
lifestyles having an impact on musical performance. These researchers suggested a much
higher level of healthy lifestyle may be needed before significant correlations can be
made between lifestyle and musical performance. If this is a valid rationalization, it may

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explain the lack of awareness of links between food/liquid intake and musical
performance in this study’s results.
Some participants do not consider music a physical activity, like sports, so they
do not believe what they eat/drink will affect it. They feel music is primarily a mental
function so their eating habits will have little to no effect on their musical performance.
Also, some participants expressed a belief that only practice has an effect on their
musical performance and not what they eat or drink. They see the only way to improve
their performance being through rehearsal and practice, so what they eat and drink does
not have any measurable effect on their musical performance. These participants may not
be as knowledgeable and aware as they could, and possibly should, be about the
connection between their health and their musical performance. At the very least, they
may not have experienced any changes in their musical performance based on what they
consume.
When looking specifically at gender, the differences very slight, more males than
females feel that eating/drinking habits either do not affect music or have a neutral
opinion, where the largest span for does not affect music. While reasons are not
indicated, it is suggested that this may be because the females in this study are more in
tune with their physical bodies, either due to heightened awareness or increased societal
pressure on female physical appearance, and may take more interest in educating
themselves on how food contributes to their overall health.
In terms of using or avoiding specific foods/fluids, more than half of the
participants reported to both consciously using certain foods and consciously avoiding

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other foods and/or fluids before a performance, with only slightly more participants in the
Consciously Use category. What is noteworthy is that, although fewer participants
reported consciously avoiding certain foods/fluids, they provided almost twice as many
examples of types of foods and fluids they avoid than those participants who reported
they consciously use specific foods/fluids. This may be because they possibly perceive
negative effects as being more consequential than positive effects items. The negative
effects may have been more obvious and so this awareness is understandable.
Of those participants who do consciously use specific foods/fluids before a
performance, the majority stated they consciously drink water. A few went on to
describe how they use water for the purposes of hydration. These participants, and
possibly several more, use water for its very pragmatic, physiological necessity. One
participant described how she uses water for mental reasons. Although using water for
mental purposes seems counter-intuitive, this participant perceives that drinking water
helps her mentally focus on the performance at hand. Not surprising, a few participants
make it clear that their use of water is conditional – too much water can be a negative.
These sentiments seem to match those of several other participants who stated that they
consciously avoid water before performances. Water appears to have both positive and
negative effects on the musical performances of several participants in this study, which
seems to correspond to the research of Duvillard et al. (2004) about the concerns and
recommendations of the intake of fluids during physical activity. While it can be very
useful in keeping participants hydrated and focused on the performance, it can also be a
distraction if used to excess.

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Some foods/fluids were reported to being used for performance anxiety issues.
As previously discussed, some participants eat bananas to help alleviate their
performance anxiety. Although there is no definitive proof of its effectiveness, it is a
common “old wives’ tale” that bananas can help calm the nerves and can assist with
performance anxiety symptoms. These participants, and possibly more participants who
merely stated they consciously use “fruits,” may be using bananas to try to ameliorate
any performance anxiety symptoms they may be experiencing before a performance.
Another food possibly being used for performance anxiety is chocolate. Although the
participants did not state they used it specifically for performance anxiety, they did
mention how it helped them be in a better mood. A few participants perceive chocolate
to be helping them feel better, which conceivably might as a result be helping them with
their performance anxiety and thus improving their performance.
A few participants reported consciously chewing gum before a performance.
Oppositely, a couple of participants stated that they consciously avoid chewing gum.
One participant clarified their chewing of gum in order to relieve stress while one other
explained avoiding gum because their teacher does not approve of gum chewing. Despite
of the reasons for its use or avoidance, it is questionable whether gum should actually be
considered a food. However, several of the participants in this study appear to regard it
as such.
For those participants who do consciously avoid specific foods/fluids before a
performance, many of the foods they describe are those easily accessible in the American
diet. Several named greasy, fatty, fried, sugary, and processed foods common in junk

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and fast food, some specifically discussing the digestive distress they cause. Soda and
caffeinated, energy drinks were also avoided by several participants. These examples
demonstrate how many participants realize that much of the food that is readily available
to high school students is not as healthy as it could be and can have negative effects on
the health and wellness, which in turn can negatively impact their musical performance.
Many of the foods/fluids avoided here, like caffeinated drinks, dairy, and sugary foods,
are similar to those avoided by professional singers in both Edgar’s (2007) and Slover &
Dwyer’s (1995) research. In fact, some of the participants mentioned purposely not
eating before performances to avoid any problems that may occur, which also reiterates
the sentiments of the participants in Slover & Dwyer’s research.
Although many participants admitted consciously using or avoiding certain foods
and fluids before a public performance, the number specifically reporting not doing either
was, nevertheless, quite a large percentage of the group. Some of the latter specifically
stated that they do not consider whether what they eat or drink has any affect on their
musical performance. Not correlating a healthy lifestyle (i.e. healthy food/fluid intake)
with musical performance seems to correspond to Kreutz et al.’s study (2008) who noted
far fewer respondents making these connections than expected. Some participants even
went so far as to describe how they do not care about what they eat before they play and
even how they do not think food will have any affect on their musical performance. It is
clear that there are quite a few participants who are either not as knowledgeable or aware
about their eating habits and their musical performance as they could be or they do not
perceive, or even care about, any links between the two. Even with the variety of reasons

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for the different food/fluids being used and avoided, it is clear that many participants,
although not all, seem well aware of how food and drink can have both positive and
negative effects on the body and, in turn, their musical performance. By using and
avoiding specific foods/fluids, these participants are demonstrating cognizance of the
relationship between food/fluids and their musical performance and appear to be making
deliberate efforts to create positive effects on their performance. Yet, there are still a
large number of participants that feel the opposite and do not appear to make a
correlation between what they eat/drink and their musical performance.
Perceptions of Pain and Physical Preparations. Several participants expressed
experiencing or having experienced pain when playing their instruments. This result
corresponds with other research on high school students that also found large numbers of
school-aged music students experiencing pain (Britsch, 2005; Brown, 1997; Fry et al.,
1988; Lockwood, 1988; Ranelli et al., 2008; Shoup, 1995). More of the participants
reported experiencing this pain when practicing at home than in orchestra class, and even
less reported feeling pain during a performance. Interestingly, more participants actually
commented that they do not experience pain at a performance than those who do. A
possible reason for this is the shorter time span that might be involved in a performance.
Musicians play their music one time through at a performance, whereas in orchestra
class, and when practicing at home, musicians often rehearse musical works multiple
times for longer spans of time. This same rationale also explains why more participants
may be experiencing pain when they practice at home, because this is often more focused
practice in which the individual is the only one rehearsing and may be doing so for

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extended periods of time, with few or no breaks. This may account for why more
musicians reported experiencing fatigue and pain when practicing at home, which would
be consistent with the results of Britsch’s (2005) study where the participants found they
had more pain and discomfort after longer periods of musical practice. Furthermore,
students might not all have a good chair and music stand, resulting in bad posture (e.g.
sitting on a bed) and resultant tension. Only some specifically reported never having
experienced pain when playing their instruments. These results correspond with other
reports that many high school musicians experience pain, as do professional musicians
(Britsch, 2005; Brown, 1997; Fry et al., 1988; Lockwood, 1988; Ranelli et al., 2008;
Shoup, 1995).
The participants mostly reported experiencing pain in the upper extremities,
further supporting reports of more musculoskeletal issues in musicians occurring in the
upper extremities (Barton et al., 2008; Britsch, 2005; Brown, 1995; Enquist et al., 2004;
Horvath, 2001; Lederman, 2003; Williamon & Thompson, 2006). One of the most
common pain responses in all of the time frames was in the fingers. For most
participants, they expressed experiencing fatigue and soreness rather than more
debilitating conditions. These sentiments were echoed by many of the participants who
reported experiencing pain when practicing at home, in orchestra class, and for
performances. Delving deeper, some participants even went so far as to explain that this
pain is contingent on the length of time they practice, which corresponds with the
perceptions of the participants in Britsch’s (2005) study. Although the survey did not
question the duration of the pain after its onset, it is possible that the soreness and fatigue

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is short-lived and quickly resolved after the participants stop playing. Whether its
duration is short or long, a large number of the participants in this study appear to be
experiencing or to have experienced soreness, fatigue, and pain in their fingers and upper
extremities from playing their instrument, consistent with current literature.
A small handful of participants reported experiencing emotional pain when they
play their instrument. The survey did not specify only physical pain, but the vast
majority of participants referred to physical pain. Of the few that did mention emotional
pain, some described this being associated with making mistakes or struggling to perform
well. Still others described how they feel emotional pain and discomfort when they feel
pressure or receive scolding from their family and/or orchestra director. Why so few
participants specify emotional pain responses is interesting to consider. It is possible
that, indeed, few participants actually do experience emotional pain due to playing their
instrument. However, perhaps most of the students simply did not consider emotional
pain as being included in this question and therefore this result may not be representative
of the study population.
Some participants reported participating in physical preparations before they
begin to play their instruments. The least number of participants reported doing these
preparations in orchestra class, with more doing so at home and the largest number doing
so for performances. There may be several facets to reasons why the participants do less
pain prevention activities in orchestra class than for performances. In the rush to get to
class, set up for orchestra, and do some sort of musical warm-up, many participants in
this study may feel they do not have enough time to complete a physical preparation

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before class starts. Other possible reasons for not participating in physical preparations
before class may be social and/or emotional reasons. Some participants, even those who
might participate in physical preparations at home, might not want to engage in these
activities around their friends and peers, out of fear of embarrassment or possible
alienation. This is also an indication that the teachers do not seem to be implementing
warm-up exercises at the start of class. These participants may be more apt to stretch or
do other physical preparations before they practice at home because they have time to do
so without anyone seeing them do so, and also perhaps because of any previous negative
experiences when practicing at home. These past experiences of pain, fatigue or tension
at home might be a motivator for preventing such occurrences in the future. Moreover,
participants may feel more inclined to implement injury prevention techniques before
public performances because they take these more seriously than daily home practice and
orchestra class. The physical preparations may also be primarily exercised as a way to
combat any tension, stress, or performance anxiety they may be feeling prior to the
performance.
A few of the physical preparations the participants described are noteworthy. For
example, several participants described that they crack their joints, particularly the
fingers, wrists, and neck. This was not a physical preparation the researcher had
originally considered as a possibility. The concern with cracking the joints is the social
stigma attached to them. Although there are varying beliefs about cracking joints, many
view it as something that can have negative effects on the body. The researcher did not
ask the participants why they chose to participate in the physical preparations they use,

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but it would be very interesting to find out why they crack their joints, why they consider
this a physical preparation, and if they believe it has positive effects on their musical
performance. Another noteworthy physical preparation of several participants was deep
breathing, which was also a common mental preparation response for performance
anxiety. Some of the participants did not give reasons for why they choose to engage in
deep breathing, so it is not clear if they use it solely as a way to be more physically ready
to play their instruments or if this was more consciously being use to alleviate
performance anxiety.
On the other side, there were many participants who reported not engaging in any
physical preparations before they pick up their instrument. The rate of not participating
in physical preparations like stretching seems to be correspond, and even exceed, the
42% non-participation in Barton & Feinberg’s study (2008). In fact, with the exception
of preparing for a public performance, more of the participants in this study expressed not
participating in any physical preparations than those who do. Although the researcher did
not ask for any reasons why they do not participate, a few participants volunteered they
do not feel it is necessary to engage in these activities. It calls to question if it is possible
that more of the participants quietly second this sentiment. A few other participants who
do not participate acknowledged they had never thought about participating in any
physical preparations before taking this survey. These statements demonstrates that
some, if not many of the participants in the study, appear to have not consciously
contemplated stretching or any other form of physical preparations before they pick up
their instrument. In fact, the mere fact that so many of the participants report they do not

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engage in these activities may show how many participants are not as knowledgeable or
cognizant of the relationship between their physical bodies and their musical performance
outside of musical technique as they could be.
Interestingly, the term “physical preparation” may have been troublesome for a
few of the participants because they gave responses that contained musical
preparations/warm-ups. This possible misunderstanding was a concern for the
researcher, so to avoid this confusion she added the words “like stretching” and “before
you pick up your instrument” to the question of physical preparations do help
differentiate physical activities from musical and technical warm-ups in the minds of the
participants. Even with this assistance, several participants still responded with musical
preparations and/or musical warm-ups that are often done with instrument in hand. In
addition, although the researcher also explained to the participants they may ask for
survey question clarification at any time during the survey administration, no one asked
for assistance so they may have felt they fully understood the question. They may also
have not wanted to endure any possible social discomfort by asking for question
clarification in front of their peers. Unintentionally, it is possible that by adding the
words “like stretching” might have unduly influenced the responses. Although many
participants gave several, varied forms of physical preparations in their responses, a large
amount of the response dealt with some form of stretching, which relates to the
participants who reported stretching in the studies of Abreu-Ramos (2007) and Britsch
(2005). On the other hand, the responses about stretching were much higher than the pre-
test scores reported in Barton & Feinberg’s (2008) study. While the researcher’s format

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of questioning may have inadvertently influenced the type of responses provided by the
participants, stretching is likely the most commonly known type of warm-up because of
its use in sports and exercise.
In terms of gender with respect to pain, across the board more females reported
experiencing or having experienced pain than males. In fact, the level reported by
females versus males was quite similar to the levels between females and males in the
current literature (Abreu-Ramos, 2007; Barton et al., 2008; Enquist et al., 2004; Fry et al.,
1988; Kreutz et al., 2008; Ranelli et al., 2008; Shoup, 1995). On the other hand, the
genders are fairly evenly matched with respect to doing physical preparations before
playing their instruments.
Inclusion of Health and Wellness Information in Orchestra Class. More
participants stated having a positive opinion of including health and wellness information
and practices into orchestra than those with an opposing viewpoint. Of those participants
with positive opinions, the largest reasoning for their opinion was that this information
would be beneficial for general health. Some of the participants went further and
described how learning about health and wellness would not only improve their general
health, but would also assist in improved musical performance. The comment of one
participant showed an astute understanding of the teenage experience - how teenagers do
not eat, exercise, or sleep in a healthy enough way most of the time. Several of these
participants seem to realize that high school students do not always make the healthiest
choices and could benefit from more helpful information and practices pertaining to
health and wellness. A few participants described in more detail how this inclusion of

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information and practices might be helpful, such as avoiding pain and physical injuries.
These participants appear to realize that pain and tension might be prevented through
learning specific techniques. Similarly, stress and performance anxiety were concerns for
some participants. These participants expressed beliefs that adding health and wellness
information and practices into their orchestra class might assist in reducing these issues,
and by extension, possibly improve their musical performance.
Some of the positive responses were conditional based on the nature of the
inclusion. The concern of several participants was that this inclusion should not interfere
too severely with the main focus of orchestra: learning and rehearsing music. Several
participants express concern that spending too much time on health and wellness
instruction will become problematic since the reason they are in orchestra class is to
actually make music. Another concern of some participants is that this instruction might
be incorporated into assessment and thus affect their grades. These statements
demonstrate that many participants in this study would find the inclusion of health and
wellness information and practices valuable. Knowing some participants show
apprehension about the nature of the inclusion suggests educators should aim to construct
meaningful inclusion plans that are effective in increasing healthy awareness and
practices in orchestra students while remaining sensitive to their concerns about grades
and time-management.
Although several participants have positive opinions about the inclusion of health
and wellness into their orchestra class, several more participants reported having negative
and neutral opinions about its inclusion. Of those with negative opinions, some feel that

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it will be unnecessary because they believed this information is already readily available
to students. Not only have these participants expressed their belief that health and
wellness information is available and is or can be learned from other sources, they have
expressed an opinion that orchestra class should be restricted to for learning and
rehearsing music. Several considered learning health and wellness information in
orchestra class to be a waste of time and irrelevant, because they do not see or have not
seen high school musicians having these issues. Some participants feel that unless there
are drastic extremes being experienced in their health, no prevention measured need to be
addressed or practiced. The other point, possibly even more noteworthy, is the belief that
health has nothing to do with music. Some participants feel that music is not a strenuous
or physical activity so their health does not have any effect on them as musicians. Many
music medicine writings show how health is an important factor in the success of
musicians, so having participants who do not believe there is a correlation demonstrates a
concern about the potential lack of awareness in some of the population in this study
(Frederickson; 2002; Meyer, 1998; Palac, 2008). Along those same lines, there were
several participants who had neutral opinions about including health and wellness
information and practices because they also did not feel their health affected them in
making music. More specifically, a few participants reported having never thought about
correlation between health and music so it had never occurred to them to add health and
wellness discussions in their orchestra class. It seems that several participants in this
study have either negative or neutral opinions because of a lack of awareness in the
implications of their health and wellness on their musicianship. When looking at gender

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differences, the responses were very evenly matched in all categories, with only slightly
more responses from females in each category. The reasons are unclear, but it might be
possible that more females are vocal about their opinions than males in this study.
Some responses given were noteworthy because they call into question whether
the participants completely understood the question. Several participants provided
general statements about health and music rather than expressing their opinion about the
inclusion of health and wellness information and practices into their orchestra class.
Although these statements appear to show they have a positive opinion of having a
healthy lifestyle, it is not clear if they would like to include health and wellness
information into their orchestra class. It is possible that these participants did not
completely understand the question being asked. In fact, a few participants did
specifically respond that they did not understand the question. The researcher did
verbalize in the preliminary speech to the participants before completing the survey they
could ask for clarification on any question. Even with this direction, a few participants
may not have felt comfortable asking for clarification while taking the survey so they
chose to write they did not understand in their response. It is also plausible that several
more participants also did not completely understand the question but rather than ask for
clarification they simply provided a general response. This might explain the large
number of responses that did not express an opinion but rather gave general statements
about health.
Additional Health-related Issues Affecting Musical Performance. The
purpose of the final item on the survey was to open a dialog about other health areas that

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had not been addressed in this survey and possibly not even considered by the researcher,
which in turn might become subjects for future research. The largest category of
responses fell into the category of physical issues. Several responses dealt with areas of
physical injury, fatigue, and soreness that might affect musical performance, which
expressed the possibility that other extra-curricular activities, like sports, might be
impacting their musical performance. Other physical issues like eyesight, hearing,
illnesses, and allergies were responses provided by several participants. A very small
number of participants provided a response in the mental category. Half of these
responses dealt with having a troubled and/or stressed mind. Stress, particularly from
schoolwork or other outside sources, seems to be a concern for some participants and can
even be a distraction and affect their musical performance. Nervousness and anxiety
were also mentioned as possible factors in musical performance. Although the
participants did not specifically mention performance anxiety, they may have been
attributing this nervousness to performance anxiety. It is unclear if this nervousness is
due to outside forces, like schoolwork or personal issues, or if it is, indeed, due to
performance anxiety concerns. If it is not performance anxiety-related, it brings another
facet to the mental concerns high school students may have that could be factors in their
musical performance.
Notably, one participant brought up an issue the researcher had not considered.
He mentioned how a mental disability might impact musical performance. This
participant, and a few others, discussed how a mental disability or some type of mental
medical condition could affect a musician’s musical performance. It had not been

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considered that any of the orchestra students would typically have mental disabilities
might be a factor in this study. A very small number mentioned social/emotional issues
in their responses. The social dynamic of stand partners, whole musical sections, or even
the entire orchestra had also not been considered. It would be very interesting to look
into how complex the social dynamics are between stand partners and how this aspect
might impact an individual’s musical performance. A few participants noted family
issues, and how family and friends can potential impact musical performance. Of course,
there may be more participants who feel that social/emotional issues play a role in their
musical performance, but only a few actually verbalized these thoughts. Approximately
half of the total participants gave a neutral response indicating no other health-related
issues pertaining to musical performance. Several participants stated that they simply
could not think of additional aspects of health and wellness impacting musical
performance. This seems to correspond to Kreutz et al.’s (2008) results where there was
a relatively low perception of health impacting musical performance. It may be that the
survey had exhausted the extent of their awareness, that they do not consciously
experience further issues, or that they did not see a link between health issues and
performance. Some were unsure because they had not thought about health and music,
which appears that quite a few of the participants in this study may not have fully
considered all the aspects of life that impact their musical performance, particularly those
in terms of health and wellness. One participant responded that they did not understand
the question. Although the researcher made every attempt to make the participants feel
comfortable to ask for clarification if necessary, this participant, and possibly more, did

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not understand the question nor did they ask for any help. Still others provided answers
in areas that were already tackled within the survey. In fact, sleep and eating accounted
for almost all of the survey-related responses in the physical category. This may be
because the survey covered all the issues considered by the participants, or because it
drew their attention in specific areas and they were unable to think beyond the scope of
those.
In terms of gender, most of the responses categories were fairly well matched
between males and females. The only area exhibiting a large gender difference involved
responses identifying social/emotional issues impacting music performance. It is
possible that more males than females believe that social/emotional issues affect their
musical performance. However, the researcher found this surprising as it is commonly
thought that females, particularly teenage females, tend to be more socially and
emotionally focused than males. However, this was a category in which the responses
were few, so this might account for the discrepancy.
Implications for Music Education
Considering that musicians' health and wellness potentially affect musical
performance, music educators might consider the important role they can play in
incorporating health and wellness education into their music classrooms. Based on the
responses of some participants in this study, there appears to be a strong interest amongst
music students to learn more about health and wellness impacting musical performance,
however, others may need to be further educated in order to see this importance.
Teachers might also consider including injury prevention techniques in their training, like

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setting realistic practice goals, stretching, and taking frequent breaks, can potentially help
our students to make their practice times more effective while also promoting their health
and wellness. Furthermore, music educators might consider how students, even the very
young, may be experiencing performance anxiety symptoms. They might consider
encouraging an open dialog about performance anxiety with their students and
incorporate suggestions and tips for mitigating and preventing performance anxiety.
Teachers might also consider the importance of including information on food/fluid
intake and implications for musical performance. They can play an important role in
raising awareness about eating habits and helping students make healthier choices. Other
areas that teachers might consider covering with their students are the importance of
sleep, stress relief and injury prevention. Music educators might strive to ensure that
these lessons are being implemented on a consistent basis for maximum effectiveness as
occasional exposure to these matters might have little lasting effect. Teachers might
consider implementing warm-up routines on a daily basis in the classroom and encourage
this in home practice. Furthermore, regular discussions (however short) on health and
wellness issues would keep this awareness in the minds of students and help to develop
healthy lifestyle habits. Teachers might also consider sending information sheets on the
topic home to parents.
Students (as shown in this study) might be reticent to lose rehearsal time for these
activities, as would many teachers. However, music educators should consider
incorporating these practices into their daily lesson plans in a way that is useful, practical,
and efficient. While this may appear to be a sacrifice of time, this may, in fact, result in

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optimal musical achievement and prove worthwhile. Teachers might also ensure that
such practices are fun and motivating so the students will enjoy participating in them, and
consider not incorporating them into formal assessment practices.
Recommendations for Further Research
This study intentionally focused on several specific areas of health and wellness
in order to keep the survey at a manageable length. Of course, there are other areas
within the field that might be investigated. Extending the population base geographically
would allow the results of this study to be seen in a broader context. Specifically
repeating this survey in locations with students from different levels of socioeconomic
status might provide additional insights showing possible differences based on income
levels in families. Also, expanding this survey to investigate other instrumental and
vocal ensembles would help to determine if these perceptions confined to string orchestra
students or are they shared with other musicians of similar age groups. Moreover, using
this survey to learn if even younger age groups have similar or differing opinions would
also be informative.
In-depth interviews on smaller population groups might investigate the reasons
behind some of the responses provided here. For example, questions still remain about
the role of homework in preventing needed sleep before a performance or being seen as
more important than preparation for orchestra class. In addition, more investigation if
they perceive the amount of sleep they are receiving is sufficient for their daily
responsibilities, including musical responsibilities, would be very intriguing. Interviews
might also explore in more depth the nature of injury prevention techniques, such as

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warm-ups, and the reasons behind these being used before a performance or before daily
practice. Questions arose about how performances might be impacting the participants’
ability to complete their daily academic work in a timely manner, and thus affecting their
sleep patterns. Looking into this side of performance and sleep might be an intriguing
endeavor for the future.
Questions also arose in this study about performance anxiety prevention and more
in-depth study of practices or lack thereof in the high school music population would be
valuable. The spiritual realm emerged as a facet impacting performance anxiety
prevention practices. It would useful to look into spiritual aspects further to discern just
how prevalent this is in the musical lives of teenagers. Furthermore, this study did not
delve into medicinal remedies, but it would be very useful to explore this in a future
study.
Hearing is obviously critical in the field of music, and research on avoiding
damage to hearing is particularly warranted in ensembles that include percussion and
brass. It is important to determine whether we should be providing students in schools
with noise reduction equipment.
Much more information might be obtained through oral interviews on the
experience of pain in high school musicians. The frequency, severity and duration of
pain were not investigated here and these are areas that deserve attention. Further details
on the practice or lack of injury prevention techniques are also of interest. Finally,
interviews might solicit more input from students on the types of education they desire on
health and wellness issues.

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Conclusion
This study indicates that many of the high school string orchestra participants
appear to be cognizant of the impact their health and wellness has on their musical
performance. They not only realize that sleep, eating/drinking habits, stress, performance
anxiety, and pain can impact their musical performance, they are making conscious
decisions in these areas to optimize their achievements. However, the study also
indicates that there are some students who are oblivious of links between health and
music. Furthermore, there are many students who find that circumstances, such as
demands of homework and other activities, prevent them from living the healthy
lifestyles they might like. The number of students reporting the experience of pain when
performing is a warning of the need to address this matter with some urgency. Clearly,
many of the students see the need for including health and wellness information and
practices in orchestra classes and teachers would do well to consider the importance of
implementing these consistently. No doubt, the benefits to students and their level of
musical performance would make such efforts fully worthwhile. The study indicated
very slight differences in responses between genders. This emphasizes that health and
wellness are issues that impact all the students, not more specifically one or other gender.
While these results cannot be generalized to a broader population, they do
indicate a fair level of awareness of health issues related to music performance amongst
this population and a need for including health education in their music classes. The
challenge to teachers is to create pragmatic solutions in implementing education that will

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lead to healthy lifestyles and music performance practices. We should be striving not
only to develop superior musicians, but life-long healthy musicians as well.

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References
Amen, J. & Reglin, G. (1992). High school seniors tell why they are “stressed out”. The
Clearing House, 66(1), 27-29.

Babbie, E. (2009). The basics of social research (5th Ed.) Belmont, CA: Wadsworth,
Cengage Learning.

Barton, R., & Feinberg, J.R. (2008). Effectiveness of an educational program in health
promotion and injury prevention for freshman music majors. Medical problems of
performing artists, 23(2), 47- 53.

Barton, R., Killian, C., Bushee, M., Callen, J., Cupp, T., Ochs, B. Sharp, M., & Tetrault,
K. (2008). Occupational performance issues and predictors of dysfunction in college
instrumentalists. Medical problems of performing artists, 23(2), 72-78.

Britsch, L. (2005). Investigating performance-related problems of young musicians.
Medical problems of performing artists, 20(1), 40-47.

Brody, J.E. (1989, Oct. 17). For artists and musicians, creativity can mean illness and
injury. New York Times, pp. C1-C2, C12.

Brown, A.N. (1997). Musculoskeletal misuse among youth symphony string players.
Medical Problems of Performing Artists 12(1), 15-18.

Butler, C. (1995). Investigating the effects of stress on the success and failure of music
conservatory students. Medical Problems of Performing Artists 10 (1), 24- 31.

Buysse, D. J., Ed. (2005). Sleep disorders and Psychiatry. Portland, OR: Book News,
Inc.

Cash, C.D. (2009). Effects of early and late rest intervals on performance and overnight
consolidation of a keyboard sequence. Journal of Research in Music Education, 57(3),
252-266.

Center for Disease Control and Prevention (2003). Making it Happen! Retrieved on
February 22, 2011 from http://www.cdc.gov/search.do?queryText=poor+dietary+
habits+in+teens&searchButton.x=0&searchButton.y=0&actioN = search

Claar, R.L. & Blumenthal, J.A. (2003). The value of stress-management interventions in
life-threatening medical conditions. Current Directions in Psychological Science, 12(4),
133-137.

126
Cox, R.H. (2006). To your health: A holistic approach to performance preparation.
International Musician 104(9), 12.

Croll, J.K, Neumark-Sztainer, D., & Story, M. (2001). Health eating: What does it mean
to adolescents? Journal of Nutrition Education and Behavior 33, 193-198.

Creswell, J.W., & Plano Clark, V.L. (2011). Designing and Conducting Mixed Methods
Research (2nd Ed). Thousand Oaks, CA: Sage Publications.

Crosnoe, R. (2007). Gender, obesity, and education. Sociology of Education, 80(3), 241-
260.

Definition of “Health”. World Health Organization. Retrieved February 6, 2012 from
https://apps.who.int/aboutwho/en/definition.html

Definition of “Wellness”. National Wellness Institute. Retrieved February 6, 2012 from
http://www.nationalwellness.org/index.php?id_tier=2&id_c=26

Denzin, N.K., & Lincoln, Y.S. (2011). The Sage Handbook of Qualitative Research.
Thousand Oaks, CA: Sage Publications.

Duvillard, S.P, Braun, W.A., Markofski, M., Beneke, R., & Leithäser, R. (2004). Fluids
and hydrations in prolonged endurance performance. Nutrition 20, 651-656.

Engquist, K., Ørback, P., & Jakobson, K. (2004). Musculoskeletal pain and impact on
performance in orchestra musicians and actors. Medical Problems of Performing Artists
19(2), 55-61.

Frederickson, K. B. (2002). Fit to play: Musicians’ health tips. Music Educators Journal,
88(6), 38-44.

Fry, H.J.H., Ross, P., & Rutherford, M. (1988). Music-related overuse in secondary
schools. Medical Problems of Performance Artists 3(4), 133-134.

Halleland, H.B., Harris, A., Sørnes, S., Murison, R., & Ursin, H. (2009). Subjective
health complaints, stress, and coping in orchestra musicians. Medical Problems of
Performing Artists, 24(2), 58-62.

Harvey, P., & Saxon, K.G. (2003). Care of the professional voice: Sleep and the singer,
Part 1. Journal of Singing, 60(1), 61-66.

Harvey, P., & Saxon, K.G. (2003). Care of the professional voice: Sleep and the singer,
Part 2. Journal of Singing, 60(2), 165-171.

127
Horvath, J. (2001). An orchestra musician’s perspective on 20 years of performing arts
medicine. Medical Problems of Performing Artists 16(3), 102-108.

Kemeny, M.E. (2003). The psychobiology of stress. Current Directions in Psychological
Science, 12(4), 124-129.

Kreutz, G., Ginsborg, J., & Williamon, A. (2008). Music students’ health problems and
health-promoting behaviours. Medical Problems of Performing Artists, 23(1), 3-11.

LaPine, P.R. (2008). The relationship between the physical aspects of voice production
and optimal vocal health. Music Educators Journal 94(3), 24-29.

Lederman, R. J. (2003). Neuromuscular and musculoskeletal problems in instrumental
musicians. Muscle & Nerve 27, 549-561.

Leger, D., & Pandi-Perumal, SR., Eds. (2007). Sleep disorders: Their impact on public
health. Boca Raton: Taylor & Francis.

Lockwood, A.H. (1988). Medical problems in secondary school-aged musicians.
Medical Problems of Performing Artists. 3(4), 129-132.

Meyer, C. (1998). Preventing music medicine problems. American String Teacher 48(2),
98-99.

National Sleep Foundation: 2006 Sleep in America Poll. Retrieved February 22, 2011
from http://www.sleepfoundation.org/article/sleep-america-polls/2006-teens-and-sleep

Normal sleep, sleep restriction and health consequences. (2003). National Center on
Sleep Disorder Research (NCSDR). Bethesda, MD, Department of Health and Human
Services. NIH public no 03-5209. Retrieved March 20, 2012 from
http;//www.nhlib.nih.gov/health/prof/sleep/res_plan/section4/section4.html.

Osborne, M.S., & Kenny, D.T. (2008). The role of sensitizing experiences in music
performance anxiety in adolescent musicians. Psychology of Music, 36(4), 447-462.

Palac, J. (2008). Promoting musical health, enhancing musical performance: Wellness for
music students. Music Educators Journal, 94(3), 18-22.

Petrillo, J.A., & Meyers, P.F. (2002). Adolescent dietary practices: A consumer health
perspective. The Clearing House, 75(6), 293-296.

Ranelli, S., Straker, L, & Smith, A. (2008). Prevalence of playing-related musculoskeletal
symptoms and disorders in children learning instrumental music. Medical Problems of
Performing Artists, 23(4), 178-185.

128

Ryan, C. (2005). Experience of musical performance anxiety in elementary school children.
International Journal of Stress Management, 12(4), 331-342.

Ryan, C. (1998). Exploring musical performance anxiety in children. Medical
Problems of Performing Artists, 13(3), 83-88.

Shoup, D. (1995). Survey of performance-related problems among high school and junior
high school musicians. Medical Problems of Performing Artists. 10(3), 100-105.

Simmons, A.I., & Duke, R.A. (2006). Effects of sleep on performance of a keyboard
melody. Journal of Research in Music Education, 54(3). 257-269.

Slover, A.N., & Dwyer, J.T. (1995). Professional singers with obesity or eating-related
problems: The diva syndrome. Nutrition Today, 30(3), 123-127.

Stebbins, R.A. (2001). Exploratory research in the social sciences. Thousand Oaks, CA:
Sage Publications.

Steptoe, A. (1982). Performance anxiety: Recent developments in its analysis and
management. The Musical Times, 123(1674), 537-541.

Steptoe, A. (1989). Stress, coping and stage fruit in professional musicians. Psychology
of Music, 17, 3-11.

Sternbach, D.J. (2008). Stress in the lives of music students. Music Educators Journal,
94(3), 42-48.

Stickgold, R., Whidbee, D., Schirmer, B., Patel, V., & Hobson, J.A. (2000). Visual
discrimination task improvement: A multi-step process occurring during sleep. Journal
of Cognitive Neuroscience, 12(2), 246-254.

Su, Y., Luh, J., Chen, H., Lin, C., Liao, M., & Chen, H. (2010). Effects of using
relaxation breathing training to reduce music performance anxiety in 3
rd
to 6
th
graders.
Medical Problems of Performing Artists, 25(2), 82-86.

To your health: Good sleep is essential for hardworking musicians. (2005). International
Musician 103(8), 8.

To your health: Visit the pyramid: Finding good nutrition on the road. (2008).
International Musician 106(4), 12.

Viner, R., & Booy, R. (2005). ABC of adolescence: Epidemiology of health and illness.
British Medical Journal, 330(7488), 411-414.

129

Williamon, A., & Thompson, S. (2006). Awareness and incidence of health problems
among conservatoire students. Psychology of Music, 34(4), 411-430.

Young, S. (2008). Lullaby light shows: everyday musical experience among under-two-
year-olds. International Journal of Music Education, 26(1), 33-46.

130
Appendix A: Site Permission Letter

[PRINTED ON RESEARCH SITE’S LETTERHEAD]

[DATE]

University Park Institutional Review Board (UPIRB)
837 Downey Way, STO 224a
Los Angeles, CA 90089-1695

RE: Diana McConnell
High school string orchestra students’ perceptions of wellness
and its implications on musical performance

To UPIRB:

This letter is to convey that I/we have reviewed the proposed research study being
conducted by Diana McConnell intended to recruit subjects and conduct research at
[INSERT NAME OF SITE/LOCATION] and find High school string orchestra students’
perceptions of wellness and its implications on musical performance acceptable. I/we
give permission for the above investigators to conduct research at this site. If you have
any questions regarding site permission, please contact: [INSERT TELEPHONE
NUMBER OR CONTACT INFORMATION].

Sincerely,

[INSERT AUTHORIZED AGENT’S NAME (E.G., SCHOOL PRINCIPAL,
DIRECTOR, ETC.]
[INSERT TITLE]

131
Appendix B: Parental Information Sheet

University of Southern California
Thornton School of Music
Los Angeles, CA 90089-0851

INFORMATION SHEET FOR NON-MEDICAL RESEARCH

********************************************************************
High school string orchestra students’ perceptions of wellness
and its implications on musical performance

Your child is invited to participate in a research study conducted by Diana McConnell,
DMA candidate, and Dr. Sheila Woodward, PhD, at the University of Southern
California, because he/she is a high school string orchestra student. Your child’s
participation is voluntary. You should read the information below, and ask questions
about anything you do not understand, before deciding whether to participate. Please
take as much time as you need to read the information sheet. You may also decide to
discuss participation with your family or friends. You will be given a copy of this form.

PURPOSE OF THE STUDY
The purpose of this study is to investigate high school string orchestra students’
perceptions of their wellness as this relates to their musical performance. “Wellness” in
this study will cover sleep, stress, performance anxiety, food/fluid intake, and
performance-related pain. In addition, this study is seeking to learn if these students
make conscious decisions about their wellness as it influences their own musical
performance in their daily practice/rehearsal, in orchestra class, and in preparation for
concert performances.

Completion and return of the survey will constitute consent to participate in this
research project.

STUDY PROCEDURES
If your child volunteers to participate in this study, he/she will be asked to complete a
short 13-question survey providing his/her thoughts on different areas of health, wellness,
and musical performance.

POTENTIAL RISKS AND DISCOMFORTS
There are no anticipated risks, discomforts, and/or inconveniences to your child because
of participating in the research.

132
POTENTIAL BENEFITS TO PARTICIPANTS AND/OR TO SOCIETY
There are no anticipated direct benefits to your child because of participating in the
research. The anticipated benefits to society are increased knowledge in this field of
research as well as a deeper awareness of health and wellness in the musical community.

PAYMENT/COMPENSATION FOR PARTICIPATION
Your child will not be paid for participating in this research study.

CONFIDENTIALITY
Any identifiable information obtained in connection with this study will remain
confidential and will be disclosed only with your permission or as required by law. The
members of the research team and the University of Southern California’s Human
Subjects Protection Program (HSPP) may access the data. The HSPP reviews and
monitors research studies to protect the rights and welfare of research subjects. Only the
Principal Investigator and Faculty Sponsor will have access to the data associated with
this study. The hardcopy data will be stored in a locked filing cabinet, and digital data on
a desktop and laptop computer in the Principal Investigator’s office. No personal
identification information for any subjects will be acquired. The data will be kept for five
years after the completion of the study. When the results of the research are published or
discussed in conferences, no identifiable information will be used.

PARTICIPATION AND WITHDRAWAL
Your child’s participation is voluntary. Your child’s refusal to participate will involve no
penalty or loss of benefits to which he/she is otherwise entitled. You or your child may
withdraw your consent at any time and discontinue participation without penalty. Your
child is not waiving any legal claims, rights or remedies because of his/her participation
in this research study.

ALTERNATIVES TO PARTICIPATION
If he/she chooses not to participate in the study, your child will read through his/her
music scores that they are currently studying in the orchestra class during the study
administration.

INVESTIGATOR’S CONTACT INFORMATION
If you have any questions or concerns about the research, please feel free to contact
Principal Investigator Diana McConnell at 323-727-6551 or dkmcconn@usc.edu, or
contact Faculty Sponsor Dr. Sheila Woodward, PhD, at the Thornton School of Music
University of Southern California 840 W. 34
th
St. MUS 301 Los Angeles, CA 90089-
0851, 213-740-3011 or swoodwar@usc.edu.

RIGHTS OF RESEARCH PARTICIPANT – IRB CONTACT INFORMATION
If you have questions, concerns, or complaints about your rights as a research participant
you may contact the IRB directly at the information provided below. If you have
questions about the research and are unable to contact the research team, or if you want to

133
talk to someone independent of the research team, please contact the University Park IRB
(UPIRB), Office of the Vice Provost for Research Advancement, Stonier Hall, Room
224a, Los Angeles, CA 90089-1146, (213) 821-5272 or upirb@usc.edu.

134
Appendix C: Student Information Sheet

University of Southern California
Thornton School of Music
Los Angeles, CA 90089-0851

ASSENT FOR NON-MEDICAL RESEARCH
FOR YOUTH (AGES 12-17)

High school string orchestra students’ perceptions of wellness
and its implications on musical performance

You are invited to participate in a research study conducted by Diana McConnell, DMA
candidate, and Dr. Sheila Woodward, PhD, the University of Southern California,
because you are high school string orchestra student. Your participation is voluntary.
You should read the information below, and ask questions about anything you do not
understand, before deciding whether to participate. Your parents’ permission will be
sought; however, the final decision is yours. Even if your parents agree to your
participation, you do not have to participate if you do not want to. Please take as much
time as you need to read this form. You may also decide to discuss it with your family or
friends. You will be given a copy of this form.

PURPOSE OF THE STUDY
The purpose of this study is to investigate high school string orchestra students’
perceptions of their wellness as this relates to their musical performance. “Wellness” in
this study will cover sleep, stress, performance anxiety, food/fluid intake, and
performance-related pain. In addition, this study is seeking to learn if these students
make conscious decisions about their wellness as it influences their own musical
performance in their daily practice/rehearsal, in orchestra class, and in preparation for
musical performances.

Completion and return of the survey will constitute consent to participate in this
research project.

STUDY PROCEDURES
If you volunteer to participate in this study, you will be asked to complete a short 13-
question survey providing your thoughts on different areas of health, wellness, and
musical performance.

POTENTIAL RISKS AND DISCOMFORTS
There are no anticipated risks, discomforts, and/or inconveniences because of
participating in the research.

135
POTENTIAL BENEFITS TO PARTICIPANTS AND/OR TO SOCIETY
There are no anticipated direct benefits you because of participating in the research. The
anticipated benefits to society are increased knowledge in this field of research as well as
a deeper awareness of health and wellness in the musical community.

PAYMENT/COMPENSATION FOR PARTICIPATION
You will not be paid or compensated for participating in this research study.

CONFIDENTIALITY
Any identifiable information obtained in connection with this study will remain
confidential and will be disclosed only with your permission or as required by law. The
members of the research team and the University of Southern California’s Human
Subjects Protection Program (HSPP) may access the data. The HSPP reviews and
monitors research studies to protect the rights and welfare of research subjects. Only the
Principal Investigator and Faculty Sponsor will have access to the data associated with
this study. The hardcopy data will be stored in a locked filing cabinet, and digital data on
a desktop and laptop computer in the Principal Investigator’s office. No personal
identification information for any subjects will be acquired. The data will be kept for five
years after the completion of the study. When the results of the research are published or
discussed in conferences, no identifiable information will be used.

PARTICIPATION AND WITHDRAWAL
You can choose to be in this study or not. If you volunteer to be in the study, you may
withdraw at any time without any consequences. You may also refuse to answer any
questions you do not want to answer and still remain in the study.

ALTERNATIVES TO PARTICIPATION
If you choose not to participate in the study, you will read through the music that you are
currently studying in the orchestra class during the study administration.

INVESTIGATOR’S CONTACT INFORMATION
If you have any questions or concerns about the research, please feel free to contact
Principal Investigator Diana McConnell at 323-727-6551 or at dkmcconn@usc.edu or
contact Faculty Sponsor Dr. Sheila Woodward, PhD, at the Thornton School of Music
University of Southern California 840 W. 34
th
St. MUS 301 Los Angeles, CA 90089-
0851, 213-740-3011, or at swoodwar@usc.edu.

RIGHTS OF RESEARCH PARTICIPANT – IRB CONTACT INFORMATION
If you have questions, concerns, or complaints about your rights as a research participant
you may contact the IRB directly at the information provided below. If you have
questions about the research and are unable to contact the research team, or if you want to
talk to someone independent of the research team, please contact the University Park IRB
(UPIRB), Office of the Vice Provost for Research Advancement, Stonier Hall, Room
224a, Los Angeles, CA 90089-1146, (213) 821-5272 or upirb@usc.edu.

136
Appendix D: Participant Recruitment Script

University of Southern California
Department of Music Education, Thornton School of Music

Information Script for Recruiting Participants

Good Morning/Afternoon, My name is Diana McConnell. I am a doctoral student
at USC. I am here because I need YOUR help. I am doing a study to find out your
thoughts on different areas of your life and how it affects you as a musician.

In a few moments, I will pass out a survey and I would like you to fill it out. The
survey is COMPLETELY VOLUNTARY. The survey is also COMPLETELY
ANONYMOUS, so no one will know who you are. Your participation in this study
will not affect your grade or status in orchestra.

Please write the only the instrument you play in the space provided at the top of the
survey….DO NOT WRITE YOUR NAME. Please answer the questions as honestly
as you can. There are no wrong answers on this survey. I want to know your
honest thoughts, whatever those thoughts may be. Also, be as descriptive and
elaborate as you can. The more descriptive your answer, the better I can
understand your thoughts and feelings. If you do not understand a question, please
raise your hand and I will help you.

When you have completed the survey, please turn your survey over and wait until I
come to collect it from you. If you choose not to participate, just hold on to the
survey and turn it in blank. Please keep the room silent until everyone is finished
and the surveys are all picked up. Also, do not use any electronic devices while the
surveys are out please.

Do you have any questions before we begin?

THANK YOU ALL FOR YOUR TIME AND EFFORT!!!!

137
Appendix E: Participant Survey (Scanned and Reduced)

138

Abstract (if available)

Abstract The objective of this study was to assess high school string orchestra students’ perceptions of their health and wellness and how this impacts their performance as musicians. This exploratory study used a written survey with mostly open-ended questions, which was completed by students during a session of their regular orchestra class. Students were recruited from two school districts in California for participation in this study. Participants were 344 high school string orchestra members ages 13 - 20. Responses were analyzed, highlighting disparities and trends, with indication of a high level of awareness amongst students of the need to live healthy lifestyles and some awareness of how this might impact musical performance. There was a positive indication that students would value education in this area being included in their orchestra class. It is anticipated that the dissemination of the results will provide valuable information to the profession regarding the importance of high school musicians’ health and well-being.

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