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Biological Psychology 33 (1992) 5 l-61

0 1992 Elsevier Science Publishers B.V. All rights reserved

51
0301-051 l/92/$05.00

Psychobiology of stage fright: The effect of public


performance
on neuroendocrine,
cardiovascular
and subjective reactions *
Mats Fredrikson

and Robert

Gunnarsson

Department of Psychology and Psychiatry, Psychology DirGion, Karolinska Institute, Stockholm,


Sweden; Department of Psychology, Stockholm Unicersity, Stockholm, Sweden

Subjective, neuroendocrine
and cardiovascular
functions were studied in high- and low-anxious
musicians performing privately and publicly. Musicians were designated
as high-anxious
if they
reported at least one episode of performance-related
tremor and as low-anxious
if they never
had experienced
tremor while performing
in public. All musicians
performed
privately and
publicly while measurements
of subjective, neuroendocrine
and cardiovascular
functions were
made. Ratings of effort and distress were made prior to performance.
Heart rate was monitored
telemetrically
before, during and after performance.
Urinary epinephrine,
norepinephrine
and
cortisol were sampled after public and private performance,
respectively.
Situational
factors
influenced
most measures.
Epinephrine,
norepinephrine,
cortisol, heart rate and ratings of
distress but not effort increased
from private to public performance.
Heart rate was higher in
high- than in low-anxious
musicians
during public performance
but similar during private
performance.
The increase in neuroendocrine
activation from private to public performance
was
similar in the high- and low-anxious groups. It is concluded that heart rate is a sensitive measure
of both situational
and individual determinants
of performance-related
distress.
Keywords: Public performance,
pinephrine,
cortisol

individual

differences,

heart

rate,

telemetry,

epinephrine,

nore-

1. Introduction
Fear is associated
with behavioral,
cardiovascular
and neuroendocrine
activation,
and it may be influenced
by both individual
and situational
factors. Studies of situational
determinants
of human fear have included
parachute jumping (Ellertsen,
Backer Johnsen, & Ursin, 19781, public speaking (Fredrikson,
Klein, & ohman,
1990), matriculation
examinations
(FranCorrespondence
to: Mats Fredrikson,
Medical Psychology
I, Karolinska
Hospital,
P.O. Box
60500, S-104 01 Stockholm,
Sweden.
* This research
was supported
by grants from the Swedish Council for Research
in the
Humanities
and Social Sciences, Soderstrom-Konigska
Foundation,
the John D. and Catherine T. MacArthur
Foundation
Network on Health and Behavior and from the Karolinska
Institute.

52

h4. Fredrikson and R. Gunnarsson / Psychobiology of stage fright

kenhaeuser,
19831, gravitational
stress (Frankenhaeuser,
Sterky, & Jlrpe,
1962) and electric shock (Frankenhaeuser,
Friiberg, & Mellis, 1965). In normal individuals these situations elicit feelings of fear and are associated with
cardiovascular
and neuroendocrine
activation
(Frankenhaeuser,
1971;
Fredrikson,
1989). Regardless of situational
influences
some individuals
are
more fearful than others, and studies of individual differences in fearfulness
have demonstrated
an interaction
between situational
and individual factors.
Fredrikson
(19811, for example, studied the effect of exposure to phobogenic
material on heart rate and electrodermal
activity in phobics and non-phobics.
In phobics fear-relevant
cues elicited sympathetic
nervous system changes
indicative of the defense reaction, whereas neutral cues elicited a response
pattern indicating that attentional
mechanisms
associated with the orienting
reaction were taxed. In non-phobics
both fear-relevant
and neutral
cues
elicited the orienting reaction. Similar observations
were made by Klorman,
Weissberg,
and Wiesenfeld
(1977) and by Hare (19731. Thus, individual
differences
in fearfulness
interacted
with situational
factors to determine
cardiovascular
reactions.
Heart rate is a well-suited outcome measure to study in situations eliciting
fear, since there is a linear relationship
between fear ratings and heart rate in
fear-provoking
situations
(Lang,
Melamed,
& Hart,
1970; Sartory,
Rachman, & Grey, 1977). Historically, there has also been a great interest in
fear and the patterns
of neuroendocrine
excretion
(Mason et al., 1976;
Frankenhaeuser,
1979; Funkenstein,
1956; Cannon,
1914). For example,
Frankenhaeuser
and coworkers showed that epinephrine
secretion was almost directly proportional
to the amount of fear induced by exposure to
gravitational
stress (Frankenhaeuser
et al., 1962). However, a few studies
have been carried out addressing this question in phobics.
With respect to neuroendocrine
activation
in phobics both individual
(Mathew, Ho, Kralik, Taylo, & Claghorn, 1981) and situational
determinants
have been implicated
(Peronnet
et al., 19861. Curtis and coworkers (Nesse,
Curtis et al., 19851, for example,
observed
increased
epinephrine,
norepinephrine
and cortisol excretion during in vivo flooding in phobics compared to excretion
during
resting
conditions.
Fredrikson,
Sundin,
and
Frankenhaeuser
(1985) reported that phobics had higher cortisol excretion
during exposure to phobic slides compared to neutral 21material.
However,
since both Nesse, Curtis, et al. (1985) and Fredrikson
et al. (1985) lacked
non-fearful
control groups It cannot be determined
whether the increased
neuroendocrine
activation resulted from situational
or individual
influences
or an interaction
between the two.
Exposure to phobogenic material may elicit greater neuroendocrine
activation than neutral material irrespective of whether subjects are phobic or not.
Or phobics may be generally more activated than non-phobics
regardless of
context. Edmondson,
Roscoe, and Vickers (19721, for example, observed

M Fredrikson and R. Gunnarsson / Psychobiology of stage fright

53

increased
epinephrine
excretion in dental phobics during dental treatment
when compared
to controls. However, they lacked a non-threatening
situation, leaving the possibility
that their dental phobics were generally more
reactive. Supporting
this claim, Nesse, Cameron, et al. (1985) observed higher
levels of night-time
epinephrine
and norepinephrine
in patients with panic
anxiety than in controls. Finally, enhanced neuroendocrine
activation may be
elicited only in phobics and only during fear-related
conditions.
The present study compared high- and low-anxious
individuals
in a fearprovoking and a non-provoking
situation.
Fear has been conceptualized
as
activation in three mutually dependent
but partly independent
systems (Lang,
1971). Ideally, studies on the psychobiology
of fear should include concomitant measures
of behavioral,
physiological
and subjective
responses.
However, when dealing with fears and phobias only a few studies have included
measures from all response domains (see Nesse, Curtis, et al., 1985 and &t,
Sterner, & Lindahl, 1984 for exceptions).
The aim of the present research was to evaluate situational
and individual
influences
on behavioral,
cardiovascular,
neuroendocrine
and subjective fear
reactions. We studied string musicians, with and without performance-related
tremor during performance,
in the absence or the presence of an audience.
Physiological
measurements
included heart rate, urinary catecholamine
and
cortisol excretion.
In addition,
quality of performance
was rated by an
attending professor during public performance,
and blindly from tape recordings by another professor who had not been present. It was predicted
that
public as compared to private performance
would increase measures of fear
more in high- than low-anxious subjects.

2. Materials

and methods

2.1. Subjects
Nineteen
subjects from the Musical Academy in Stockholm volunteered
for a study monitoring
psychobiological
changes during performance.
All
subjects were string musicians during their second year of training. The study
was approved by the local ethical committee.
2.1.1. Subject classification
In order to form two experimental
groups all subjects were called to an
interview
with semi-structured
and structured
questions
in order to tap
stage fright. The high-anxious
group comprised
all individuals
that reported at least one episode of tremor that resulted in performance
impairment in front of an audience (n = 12). The low-anxious
group reported that
they never had experienced
tremor during public performance
(n = 7). Stage

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M. Fredrikson and R. Gunnarsson / Psychobiology of stage fright

fright was not due to skill impairment


in any subject. All subjects who
volunteered
were asked to complete
a paper and pencil test, Personal
Report of Confidence
as a Musician (PRCM),
where items from Public
Report of Confidence
as a Speaker (PRCS) (Paul, 1966) were transformed
into situations
and experiences
relevant
to musical performance.
Scores
ranged from 0 to 22, where 0 indicated
no fear and 22 maximum fear of
public performance.
The high-anxious
group was made up by eight females
and four males, and had an average PRCM score (S&V) of 13.8 (2.0) points.
The low-anxious group consisted of six females and one male with an average
PRCM score of 9.3 (3.6) ((F(1, 17) = 4.67, p < 0.05) for the group comparison. The age (SEM) was 20.5 (0.3) and 21.6 (1.0) years in the low- and
high-anxious
group, respectively.
2.2. Procedure

and Recording

Methods

Subjects attended
two sessions on two separate days (1: 00-3: 30 p.m.).
Half of the subjects in each group first performed privately in the absence of
an audience and on another occasion publicly in front of an audience.
For
the remaining
subjects the order was reversed. All participants
were instructed not to exercise, eat, smoke, or drink caffeinated
or alcoholic beverages within 24 h before the experiment.
Subjects voided 1 h before performance and 30 min after the end of their performance.
Urine samples
obtained
after performance
were stored
at - 18C for later analysis.
Epinephrine
and norepinephrine
were analyzed
using the fluorometric
method developed by Euler and Lishajko (1961) as modified by Andersson,
Hovmiiller, Karlsson, and Svensson (1974). Cortisol was analyzed using a kit
manufactured
by New England Nuclear (Ruder, Guy, & Lipsett, 1972). During private performance
without an audience, mean diuresis (SEM) was 1.04
(0.21) and 0.62 (0.08) ml/min
for the high- and low-anxious
group, respectively (F(1, 17) = 3.53, p < 0.10). During performance
in front of an audience, mean diuresis (SEMI was 0.79 (0.16) and 0.66 (0.09) ml/min
for the
high-and low-anxious groups, respectively (F(1, 17) < 1).
Heart rate (HR) was monitored
telemetrically
and recorded on paper in
beats per minute (b.p.m.) using a cardiotachograph
and a Devices polygraph.
The musical pieces were well known and well mastered
by all musicians.
Each musician played the same musical piece both in private and public.
During private performance
no evaluations
of performance
quality or sound
recording were made. Before performance
(both with and without an audience) subjects reported
feelings of effort and distress using a previously
described instrument
(Lundberg
& Frankenhaeuser,
1980). HR was recorded
each minute during three consecutive
minutes before performance
in the
sitting position and 6 min during performance
in the standing position. After
performance
HR was monitored
during 3 min in the sitting position. For the

M. Fredrikson and R. Gunnarsson / Psychobiology of stage fright

55

statistical
analyses HR data were averaged over the three phases: before,
during and after performance.
After completion
of performance
subjects waited 30 min and then voided
urine for storage and later analysis. In the presence
of the audience
all
musicians
were accompanied
by the same pianist.
The audience
varied
between 8 and 10 individuals
and consisted of teachers and students at the
Swedish Musical Academy. Sound recordings were made with a Sony TC-DS
stereo tape recorder
and two Electra-Voice
microphones.
The attending
professor evaluated quality using a 9-point scale, with 9 indicating
excellent
performance
and 1 indicating
inferior performance.
Using the same scale
sound recordings were also evaluated by another professor at the Academy
who was blind to group designations.
Data were analyzed
using analyses of variance
(ANOVA)
with group
serving a between-subjects
variable
and performance
condition
as the
within-subjects
variable. Students t tests were used as follow-up tests.

3. Results
3.1. Neuroendocrine

reactions

Neuroendocrine
activation
individual differences.
Public

200

was influenced
by situational
factors but not by
performance
was more arousing than perform-

Epinephrine

Fig. 1. Public performance


norepinephrine
and cortisol
standard error of the mean.

Norepinephrine

expressed
in percent
in high- and low-anxious

COrtiSOl

of private performance
for epinephrine,
string musicians. Vertical bars denote the

56

IV. Fredrikson and R. Gunnarsson / Psychobiology of stage fright

Table 1
Epinephrine, norepinephrine and cortisol excretion expressed in pmol/min
public performance in high- and low-anxious string musicians
Low-anxious

High-anxious

Epinephrine
Norepinephrine
Cortisol

during private and

Private

Public

Private

Public

41.9
181.7
267.4

60.1
178.7
359.1

47.8
139.0
242.7

104.6
162.7
311.4

ing in private. Averaged over high- and low-anxious subjects public compared
to private performance increased epinephrine (F(1, 17) = 10.63, p < O.Ol>,
norepinephrine (F(1, 17) = 4.84, p < 0.05), and cortisol excretion (F(1, 17) =
4.45, p < 0.05) (see fig. 1). No effect of group designation was observed since
all F ratios involving this factor were less than unity. When excretion was
analyzed in terms of absolute change (pmol/min) epinephrine @Cl, 17) =
8.67, p < 0.01) but not norepinephrine (F(1, 17) = 1.00, n.s.> or cortisol Ml,
17) = 1.10, n.s.) levels were significantly higher in front of an audience than
in its absence (table 1). There were no significant group differences between
high- and low-anxious subjects or interaction between group and performance conditions in epinephrine (Ffl, 17) = 2.92, p = 0.111, norepinephrine
((F(1, 17) < 1) or cortisol @Cl, 17) > 1) excretion.
3.2. Heart rate
Fig. 2 presents mean HR level in high- and low-anxious subjects before,
during and after performing in front of an audience and performing alone.
Analysis of variance revealed that HR was higher during public than private
performance (F(1, 17) = 57.8, p < 0.01). Performance was associated with
higher HR than rest before and after performance (F(2, 34) = 149.61, p <
0.001). In addition, public performance raised HR more than did private
performance (F(2, 34) = 14.99, p < 0.01). A significant Phase X Group interaction (F(2, 34) = 3.39, p = 0.05) reflects higher HR during performance in
high- than low-anxious individuals (t(34) = 4.26, p < 0.01) with similar HR
(ts > 1.5, n.s.> during all other conditions. A trend towards significance for
the Performance condition x Group interaction (F(1, 17) = 4.10, p = 0.059)
reflected a relatively greater difference between anxious than non-anxious
individuals during public as compared to private pe~o~ance
(see fig. 2X
The difference in the average HR increase from private to public performance was significantly greater in high- (39.2 b.p.m.1 than low-anxious
subjects (22.6 b.p.m.) (F(1, 17) = 5.48; p < 0.05). During public performance
maximal HR was significantly higher in high- (153.0 b.p.m.1 than in low-anxious subjects (130.4 b.p.m.1 (F(1, 17) = 4.92, p < 0.05).

M. Fred&son
160-

q
____fi___

E
%
3

and R. Gunnarsson / Psychobiology of stage fright

51

v
Low-anxious Public
____~___ Low-anxious Private

High-anxious Public
High-anxious Private

140 -

120-

3
100 -

ii
8
80 -

60

Before

After

Fig. 2. HR before, during and after private and public performance


in high- and low-anxious
string musicians. Vertical bars denote the standard error of the mean.

3.3. Subjective and behavioral reactions

Ratings of distress and effort are given in table 2. Public compared to


private performance increased ratings of distressW1, 17) = 32.91, p < 0.001)
but not effort (F(1, 17) < 1, n.s.). A significant Group X Performance condition interaction (F(1, 17) = 5.50, p < 0.05) reflected lower ratings of perceived effort in the low- as compared to the high-anxious group during
private performance (t(17) = 2.49, p < 0.051, but similar ratings during public
performance (t(17) < 1, n.s.).
A significant interaction between Group X Rating condition (F(1, 17) =
16.65, p < 0.001) revealed that performance quality was rated as being better
in the low- than in the high-anxious group (t(17) = 4.92, p < 0.001) by the

Table 2
Ratings of distress
string musicians

and effort

awaiting

private

High-anxious

Distress
Effort

and public performance

in high- and low-anxious

Low-anxious

Private

Public

Private

Public

2.0
5.1

3.7
5.9

2.6
6.5

3.6
5.3

M. Fredrikson and R. Gunnarsson / Psychobiology of stage fright

58
Y-

Low-anxious

q High-anxious

Present

Evaluating condition

Absent

Fig. 3. Ratings of musical quality during public performance


in high- and low-anxious
string
musicians by an attending
professor (present) and done blindly from recording by a professor
who had not been present (absent). Vertical bars denote the standard error of the mean.

attending professor. The rater who was blind to group assignment


made the
reverse judgment
(t(17) = 3.08, p < 0.01) (Fig. 3). Raters did not differ in
their evaluation
of the high-anxious
group (t(17) = < 1, n.s.> but only in
ratings of the low-anxious group (t(17) = 8.58, p < 0.001) which was given the
best performance
scores by the attending professor and the worst by the rater
blind to group assignment.

3.4. Interrelationships

between variables

The pattern of correlations


was similar during private and public performance. Neuroendocrine
measures
correlated
significantly
with each other.
Epinephrine,
norepinephrine
and cortisol excretion correlated 0.63 (p < 0.01)
or better with each other during private and public performance,
the only
exception
being between
cortisol and epinephrine,
where only a modest
correlation
of 0.43 (p = 0.07) was observed during public performance.
Mean
and maximum HR level as well as changes in HR were highly correlated
during both public and private performance
(0.89 (p < 0.01) or better).
Correlations
between neuroendocrine
and HR measures were low, not exceeding 0.22 during private or public performance.
Ratings of effort and
distress generally were uncorrelated
with each other (0.44 or lower) and with
neuroendocrine
and HR measures (0.39 or lower).

M. Fredrikson and R. Gunnarsson / Psychobiology of stage fright

59

4. Discussion
String musicians
displayed
greater neuroendocrine,
HR and subjective
activation
during public than private performance.
During performance
in
front of an audience
HR activation
was greater
in musicians
that had
experienced
at least one episode of performance-related
tremor as compared
to those who never had experienced
tremor. HR was similar in both groups
in the absence of an audience.
Epinephrine,
norepinephrine
and cortisol
increased
to a similar extent in high- and low-anxious
individuals
during
public compared
to private performance.
Ratings of perceived distress but
not effort also increased to a similar extent in both groups from private to
public performance.
Thus, situational
factors influenced
subjective, physiological and neuroendocrine
aspects of fear. Differences
in fearfulness
generally did not influence the sympathetic-adrenal
or pituitary-adrenal
systems.
Thus, the greater neuroendocrine
reactions previously observed to fear-relevant as compared to neutral conditions
(Fredrikson
et al., 1985; Nesse et al.,
1985) were not found to result from an interaction
between individual
and
situational
factors, but was obtained both in high- and low-anxious
individuals in the present study. This finding is contrary to HR and subjective ratings.
HR was higher during public compared
to private performance
both in
high- and low-anxious
subjects. In addition,
high-compared
to low-anxious
individuals
evidenced
higher HR levels as well as a greater increase from
private to public performance.
During private performance
HR was similar in
both groups. Thus, HR was sensitive both to situational
factors and individual differences
in fearfulness
since it differentiated
private from public
performance
and high- from low-anxious
musicians
during public performance only. These results provide support for previous findings implicating
an interaction
between individual
and situational
factors in determining
HR
activation
in phobics (Fredrikson,
1981; Hare, 1973; Klorman et al., 1977).
The fact that neuroendocrine
measures did not reflect individual differences
in fear may be due to a relatively greater error variance in neuroendocrine
measures than in HR measures. Thus, stated with caution the absence of an
effect of differences
in anxiety on neuroendocrine
measures may reflect the
disadvantage
of a small group and relatively
greater
error variance
for
neuroendocrine
measures
compared
to HR. When accounting
for the discrepant findings between HR on the one hand and neuroendocrine
variables
on the other in this study, we suggest that HR was shown to be the more
sensitive of the two by virtue of being less influenced
by error.
Quality of performance
rated by an observer present
in the audience
having auditory as well as visual cues was judged to be better in low- than
high-anxious
musicians.
Raters blind to group assignment
who listened to
tape recordings and only had auditory cues made the reverse judgment,
that
is, anxious individuals were judged to perform better than non-anxious
ones.

60

M. Fredrikson and R. Gunnarsson / Psychobiology of stage fright

This indicates that the quality judgment


made by present raters was influenced by factors associated
with visual cues - probably
behaviors
like
self-confidence
and body posture.
Generally,
subjective, physiological
and neuroendocrine
factors associated
with fear were poorly related, underscoring
the necessity to monitor changes
in several systems relating to emotional states and behavior. When evaluating
treatment,
for example, it is important to monitor reactions in several systems
since it may not be possible to generalize
from one class of measures
to
another.
The pattern of results suggests that the experience of performance-related
tremor is associated with less confidence
as a musician, and exaggerated
HR
reactions during public performance
when compared to individuals
with no
experience
of performance-related
tremor. It does not seem to relate to
performance
quality or subjective reactions during actual performance.
The
sample size may be too small to draw any conclusions
on neuroendocrine
measures.

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