PLOS ONERESEARCH ARTICLE

Factors of choking under pressure inmusicians
Shinichi Furuya ID1,2☯*, Reiko Ishimaru3☯, Noriko Nagata3
1 Sony Computer Science Laboratories Inc. (Sony CSL), Tokyo, Japan, 2 Sophia University, Tokyo, Japan,
3 School of Science and Technology, Kwansei Gakuin University, Sanda, Japan☯ These authors contributed equally to this work.
* furuya@csl.sony.co.jp

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OPEN ACCESS
Citation: Furuya S, Ishimaru R, Nagata N (2021)
Factors of choking under pressure in musicians.
PLoS ONE 16(1): e0244082. https://doi.org/
10.1371/journal.pone.0244082
Editor: Stephan Doering, Medical University of
Vienna, AUSTRIA
Received: March 2, 2020
Accepted: December 3, 2020
Published: January 6, 2021
Copyright: © 2021 Furuya et al. This is an open
access article distributed under the terms of theCreative Commons Attribution License, which
permits unrestricted use, distribution, andreproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: The questionnaire
items are available in the Supplementary Material inboth original language (Japanese) and English(translated). The responded data are ethically
restricted by the ethical committee and therefore
cannot be shared publicly. The contact information
for a data access institutional body to which data
requests may be sent by qualifying readers is Ms.
Keiko Kitagawa, a head administrator of Kwansei
Gakuin Institute of Kansei Value Creation(keikita@kwansei.ac.jp).
Funding: The present study was financially
supported by Centre of Innovation Program

Abstract
Under pressure, motor actions, such as those required in public speech, surgery, or musicalperformance, can be compromised, even when these have been well-trained. The latter isoften referred to as ’choking’ under pressure. Although multifaceted problems mediate such
performance failure in anxiogenic situations, such as compromised motor dexterity and cognitive disruption, the fundamental set of abnormalities characterizing choking under pressureand how these abnormalities are related have not been elucidated. Here, we attempted, first,
to classify behavioural, psychological, and physiological abnormalities associated with choking under pressure in musicians and, second, to identify their relationship based on datasets
derived from a questionnaire with 258 pianist respondents. Explorative factor analysis demonstrated eight functional abnormalities related to the musicians’ choking, such as attention
to the audience, erroneous motor actions, perceptual confusion, and failure of memory recall,which however did not include exaggerated attention to the performance. This suggests distraction of attention away from skill execution, which may underlie the spoiled performance
under pressure. A structural equation analysis further inferred causal relationships among
them. For instance, while failure of memory recall was influenced by passive behaviours
manifesting under pressure, erroneous motor actions during performance were influenced byfeeling rushed and a loss of body control. In addition, some specific personal traits, such asneuroticism, public self-consciousness, and a lack of confidence, were associated with theextent to which pressure brought about these abnormalities. These findings suggest that distinct psycho-behavioural abnormalities and personal traits underlie the detrimental effects ofpressure on musical performance.

Introduction
The performance of highly trained skilled behaviours in public sometimes goes worse than it
does during practice due to psychological stress, and this phenomenon is called choking underpressure [1]. Choking under pressure triggered by such stress accompanies heterogeneous
abnormalities in motor, sensory, and cognitive skills and brings about abnormal ways of thinking and malfunctions in the autonomic nervous system. These malfunctions include but are

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PLOS ONEprovided by the Japan Society and Technology
Agency (JST) to NN, and Sony Computer Science
Laboratories Inc. to SF. Sony Computer Science
Laboratories Inc. provided support in the form ofsalaries for an author (SF), but did not have any
additional role in the study design, data collection
and analysis, decision to publish, or preparation of
the manuscript.
Competing interests: RI and NN have no conflictsof financial and/or non-financial interest to declare.
Sony Computer Science Laboratories Inc. provided
support in the form of salaries for an author (SF),but did not have any additional role in the study
design, data collection and analysis, decision to
publish, or preparation of the manuscript. This
commercial affiliation does not alter our adherence
to all PLOS ONE policies on sharing data andmaterials.

Stage fright in pianists

not limited to failure of memory recall [2], loss of motor dexterity [3–6], atypical attentional
control [7], aberrant elevation in heart rate [8–10], and muscular stiffness [5]. However, thefundamental set of psychological, physiological, and behavioural abnormalities characterizing
choking under pressure and their relationship have not been elucidated. It also remains
unknown in what manner detrimental effects of choking under pressure on the skilful behaviours are related to the innate personal traits of the individual. Resolving these issues would be
useful for performers such as, for instance, musicians, athletes, surgeons and politicians. In
addition, examining the underpinning of choking would shed more light on the neuropsychological mechanisms behind poor or suboptimal performance.
Several theories have been proposed to account for choking under pressure [11–13]. Distraction theory and explicit monitoring theory propose abnormal attention during movements[2, 13, 14]. The distraction theory proposes that psychological pressure causes attentional shiftsof performers away from skill execution toward task-irrelevant cues [7, 15]. Because thisabnormal attentional shift has detrimental effects on working memory [16], choking underpressure often causes failure of memory recall [2, 6]. Neuroimaging studies also demonstrated
abnormal functional connectivity between the dorsolateral prefrontal cortex [15] and inferiorparietal cortex [17, 18], which are regions responsible for cognitive functions such as working
memory and attention, and the motor cortex, which plays a role in the precision of skilled
movements. Furthermore, the successful recall of procedural memory relies on sensory feedback that matches produced motor actions [19–21], which implicates the significance of perception in preventing failure of memory recall. In addition, the distraction-related choking
can be associated with excessive arousal and motivation induced by incentives such as monetary reward and social evaluation [22, 23]. Reward neural circuits mediate contrasting effectsof low and high incentives on performance [22, 23], which explains an inverted-U-shaped relationship between the arousal level and performance [24]. An increased sensitivity to incentives
under pressure can also affect decision making processes, such as whether performers take or
avoid risks. The explicit monitoring theory posits that after an appraisal of performance pressure, attention shifts exaggeratedly toward the procedural process of motor performance,
which eventually collapses skilful performance [1, 2, 14]. Particularly in trained individuals
such as sports athletes and musicians, unnecessarily excessive attention drawn to skill execution disrupts the procedural process that normally runs automatically, which results in loss offine motor control [14, 25]. The loss of fine motor control involves the spatiotemporal imprecision of skilled actions, such as speeding up one’s movement tempo unintentionally. A recent
study demonstrated that an abnormally increased tempo during a piano performance underpressure was associated not with an abnormally elevated heart rate but instead with a lack of
coordinated movement between the fingers [6]. The abnormally increased co-activation of anantagonistic pair of muscles due to psychological stress can reflect a strategy to compensate forthis motor imprecision [5, 26], which also has potential risks of affecting recall of proceduarized memories via the feedback control [27]. Finally, a schema theory can be also associatedwith choking under pressure, in a way that recalling motor memories that were encoded in a
specific situation (e.g. practice room) can be disrupted in an unfamiliar situation such as a concert hall [28]. Importantly, this theory and the others are not necessarily exclusive, because for
instance, the disruption of memory recall can elicit abnormal attentional shift. Together,although previous studies demonstrated the complexity of factors of choking under pressure,
we postulated that candidate factors are abnormalities of attentional control, fine motor control, perception, memory recall, and decision making.
The present study aimed to identify a fundamental set of factors characterizing choking
under pressure in musicians and to understand their relationship. Musicians are individuals
who commonly suffer from choking under pressure [29–33]. A recent meta-analysis based on

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PLOS ONEStage fright in pianists

case reports, intervention, cross-sectional, and cohort studies reported that the prevalence ofmusic performance anxiety ranged from 17% to 60% [30]. Nevertheless, factors of choking
under pressure in musicians and a relationship between the factors have been not yet fully elucidated [34]. Specifically, we attempted to understand whether the distraction theory or explicit
monitoring theory explains the musicians’ choking. Also, there are individual differences in the
problems linked to choking under pressure that could be related to personal traits. For example,
musicians’ anxiety is known to be associated with neuroticism [32], which can be linked to theculture of music (e.g. teaching and learning). Some of the candidate factors of choking underpressure are related to personal traits such as between attentional control and neuroticism [35,36], which let us postulate a relation between personal traits and choking under pressure inmusicians. To shed light on traits particularly related to individual psychological, behavioural,and physiological abnormalities under pressure is needed to prevent music performance anxiety
in a client-tailored manner and to optimize interventions for it, such as cognitive behaviouraltherapy, coaching, and specialized training designed for musicians. In addition to defining factors characterizing choking under pressure in musicians, the present study, thus, also attempts
to address personal traits associated with choking under pressure in musicians.

Methods
Participants
We administered an online questionnaire to 300 pianists who were receiving or had received aprofessional education in playing the piano at a musical conservatory and/or privately (= aninclusion criteria) without any histories of being diagnosed as psychiatric disorders (= an exclusion criteria), and 258 of them completely responded to all questions (218 women and 40 men,
all aged over 18 years old) in a complete manner (i.e. respondents who did not respond to allquestions were excluded from the subsequent analyses) within a period of 6 months (from the
beginning of July to the end of December in 2017). This sample can be considered representative of a larger population because of no biased distribution of the questionnaire. The pianists
were identified based on the history of their past piano education and performance, which were
described in the online questionnaire. The return rate was 86%. All respondents were adult Japanese pianists with an average age of 27.6 ± 11.2 years old (mean ± SD). The mean duration of
piano playing was 20.8 ± 9.6 years. Among respondents, 231 were receiving or had received professional education in piano playing at musical conservatories, 179 have received prizes at somedomestic piano competitions, and 32 have won prizes at international piano competitions.
Although none of the respondents used medications for psychiatric disorders, we included
musicians diagnosed with previous anxiety-stress-depression states (n = 6). On the questionnaire, pianists received information guaranteeing that all data were collected anonymously andconfidentially (i.e., no personal data was included that would enable the identification of the
pianists). Prior to starting the questionnaire, an informed consent was obtained from each
respondent. In accordance with the Declaration of Helsinki, the study procedures wereexplained to all participants prior to responding to the questionnaire. The whole experiment
protocol was approved by the ethics committee of Sophia University (2017–69).

Questionnaire
The present questionnaire consisted of a total of 93 questions that were classified into 2 categories according to their contents (S1 File). The first category (64 items) asked about physical,
mental, and emotional experiences specifically when playing challenging pieces that were wellpracticed and prepared on stage in front of audience (i.e., concert, audition, and competition)(i.e., “choking under pressure experiences”). The question items were created based on a

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PLOS ONEStage fright in pianists

questionnaire designed for assessing choking under pressure in athletes [37, 38]. These questions included physical sensation; physiological responses; memory; attention; awareness; selfconsciousness; confusion of sensory, motor, and cognitive skills; fatigue; behavioural strategies; and feelings of physical and mental imperfection. We adopted questionnaire items thatwere used to assess choking under pressure in athletes because our target was detrimental
effects of psychological stress on sensory, motor, and cognitive functions subserving skilfulmusical performance. We also carefully selected the questionnaire items so that they can test
the hypotheses raised based on previous studies. We pretested the questionnaire with anotherforty pianists and ensured that the questionnaire items covered their experience of choking
under pressure by confirming reliability of the answers through a test-retest evaluation with aninterval of one month. At this pre-test, all of the questionnaire items were provided, and theorder was randomized between the test and retest. The respondents were also asked to rate theseverity of their choking under pressure, which was defined as failure of the execution of awell-learned, proceduralized skill under high pressure when the desire for superior performance is maximal and yields poorer outcomes than would otherwise be expected [1]. The second category (29 items) asked about personal traits, particularly concerning neuroticism andextroversion, on the basis of previous reports that these traits are associated with choking
under pressure in athletes [1, 37] (i.e., “personal traits”). Again, the question items were created based on a questionnaire designed for assessing choking under pressure in athletes [37,38]. The questions included neuroticism, inter-personal positiveness, introversion, public selfconsciousness, and lack of confidence. All questions were rated on a five-point Likert-type
scale. The question items are summarized in the S1 File.

Data analysis and statistics
Using the rating results of the choking under pressure experiences, an exploratory factor analysis (maximum likelihood method, promax rotation) was performed to classify physical, mental,
and emotional experiences. Question items were eliminated from further analysis when the factor loading value was lower than 0.35 and when the factor was not retained again the rotation[39]. To develop a structural analytical model describing the relationship between the factors
quantitatively, a covariance structure analysis was performed. In this analysis, paths between thefactors were drawn based on the following criteria. First, observed and latent variables in themodel were question items and factors identified by the factor analysis, respectively. Here, thequestion items used as the observed variables were all of those not excluded by the factor analysis. Second, a path between the factors in which the correlation coefficient was significantly
higher than 0.4 was used. Third, because both erroneous motor actions and failure of memory
recall are problems that the present study particularly focused on, we assumed these factors had
influences on but no outputs to the other factors. Finally, cause-and-effect relationships were
postulated based on previous studies on choking under pressure [2, 6, 37, 40]. The fitting accuracy was evaluated according to the SRMR (standardized root mean square residual), CFI (comparative fit index), and RMSEA (root mean squared error of approximation). The statisticalsignificance level was set to 0.05. Factor analysis and covariance structure analysis were performed using SPSS (ver. 24, IBM Inc.) and Amos (ver. 24.0, SPSS), respectively. Similarly, factor
analysis was also performed to classify the items regarding personal traits.

Results
Characteristics of music performance anxiety
Exploratory factor analysis. Among the 64 items addressing choking under pressure
experiences of musicians (i.e. music performance anxiety), factor analysis identified 37 items

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PLOS ONEStage fright in pianists

and 8 factors based on the exclusion criteria. Table 1 summarizes the question items classified
into each of the 8 factors and their factor loading values. Based on the items within the individual factors, each of the 8 factors was labelled as follows: “attention to the audience” (F1),“abnormal physical sensations” (F2), “erroneous motor actions during performance” (F3),“vicious cycle of choking under pressure” (F4), “perceptual confusion” (F5), “feeling rushed
Table 1. Results of an exploratory factorial analysis of choking under pressure in musicians.
factoritem

F1
attention to the audience

F2
abnormal physical sensations

F3
erroneous motor actions
during performance

F4
vicious cycles
of choking under pressure

F5
perceptual confusion

F6
feeling rushed andout of body control

F7
memory slip
F8passive behaviours

F1

F2

F3

F4

F5

F6

F7

F8

attention to being evaluated by the others

0.88

-0.01

0.07

-0.12

0.04

-0.04

-0.06

0.00

awareness of being in front of acquaintances

0.79

-0.05

0.00

0.08

0.02

-0.17

0.10

0.01

awareness to be in front of a lot of audiences

0.77

-0.04

-0.05

0.00

0.04

0.00

-0.03

0.06

feeling of psychological pressure from audiences

0.55

0.03

0.09

0.01

-0.08

0.34

-0.06

-0.11

sensation that all audiences focus only on oneself

0.51

0.05

-0.14

0.07

0.16

0.12

0.00

0.05

sensation of abnormal breathing

-0.06

0.79

0.04

0.09

0.06

-0.16

-0.06

0.03

sensation of choking

-0.08

0.74

0.06

0.09

0.04

-0.16

-0.11

0.05

sensation of muscular weakness

-0.04

0.64

-0.06

-0.05

0.35

0.07

-0.04

-0.04

physical sensation of shaking

0.11

0.45

-0.01

-0.11

0.03

0.23

0.10

0.03

being thirsty

0.08

0.41

0.05

-0.13

-0.07

0.16

-0.02

-0.01

loss of tactile sensation of the hand

0.04

0.40

-0.03

-0.08

0.37

0.18

0.09

-0.13

insufficient quality of performance

0.00

0.02

0.79

0.17

-0.06

-0.05

-0.12

0.06

a gap between the ideal and real performance

0.06

0.06

0.77

0.04

-0.03

-0.03

0.06

0.07

a loss of precision in performance

-0.07

0.02

0.71

-0.05

0.10

0.05

0.11

0.01

anxiety of making pitch errors

0.14

0.03

0.36

0.09

-0.16

0.32

0.07

0.07

augmentation of the anxiety due to a failure to cope with it

-0.01

0.04

0.14

0.78

0.02

-0.04

-0.04

0.04

failure to calm down

0.01

0.12

0.08

0.73

0.08

0.07

-0.10

-0.11

promotion of the anxiety due to failures to make desired performance

0.02

-0.01

0.06

0.63

0.20

0.09

-0.09

0.05

promotion of the anxiety following making erroneous actions

0.02

-0.20

-0.08

0.63

0.09

0.15

-0.03

0.29

difficulty in feeling the weight of the piano keys

0.01

0.07

-0.01

0.04

0.68

-0.12

-0.04

0.08
-0.15

abnormal visual sensations

0.10

0.07

-0.04

0.09

0.55

0.06

0.06

unstable feeling in the hands

-0.11

0.15

0.02

-0.18

0.45

0.32

0.05

0.12

sensation that the environment hinders the performance

0.14

0.14

0.05

0.17

0.44

-0.23

0.11

-0.06

abnormal weight percetion of piano keys

0.06

-0.04

-0.06

0.25

0.40

0.07

-0.04

0.09

failure to predict upcoming sensations

-0.03

-0.15

0.20

0.23

0.39

0.17

0.10

-0.25

feeling rushed

-0.10

0.07

-0.08

0.44

-0.18

0.70

0.11

-0.12

feeling nervousness

0.06

0.23

-0.11

0.22

-0.29

0.67

0.01

0.00

sensations of exaggerated muscular tension

0.03

-0.11

0.06

-0.11

0.16

0.64

-0.14

0.22

an incapability of relaxing the muscles

-0.04

-0.10

0.07

-0.09

0.29

0.59

-0.15

0.19

a loss of intended control of body movements

-0.12

0.07

0.27

0.06

0.15

0.49

-0.05

0.01

a lack of temporal precision of movements

-0.02

-0.23

0.07

0.21

0.13

0.46

0.10

-0.11

forgetting a memorized performance

0.02

-0.15

0.07

-0.19

0.02

-0.02

1.02

0.05

failure to recall a memorized performance

-0.04

0.06

-0.05

0.08

0.05

-0.04

0.80

0.03

avoidance of risk-taking during performance

0.04

-0.04

0.06

0.05

-0.02

0.05

-0.03

0.73

inexpressive performance

-0.02

0.16

0.20

-0.10

-0.11

0.09

0.11

0.47

delayed reaction to unexpected actions when playing

-0.04

-0.01

-0.10

0.29

0.13

-0.01

0.24

0.39

failure to make quick decisions when playing

0.08

0.28

-0.04

0.19

-0.05

0.00

0.11

0.37

The number indicates a factor score.
The bolded number indicates a factor score larger than 0.30.
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and out of body control” (F6), “failure of memory recall” (F7), and “passive behaviours” (F8).
The cumulative contribution ratio for the 8 factors was 57.0%. Items that were excluded due toa low factor loading score involved paying too much attention to the performance itself, which
included focusing too much on self-motion/posture during playing, feeling concern about apassage that is difficult to play, and paying too much attention to where to look while playing.
F1 (attention to the audience) consisted of 5 items, which were attention to being evaluatedby others, awareness of being in front of acquaintances, and the sensation that all audiences
focus only on oneself. F2 (abnormal physical sensations) had 6 items, which included sensations of abnormal breathing, shaking, choking, muscular weakness, and being thirsty. F3 (erroneous motor actions during performance) consisted of 4 items, which were insufficient qualityof musical performance, a gap between the ideal and real performance, and a loss of precisionin performance. F4 (vicious cycle of choking under pressure) had 4 items, which were the augmentation of the anxiety due to a failure to cope with it, failure to calm down, and the promotion of the anxiety following making erroneous actions. F5 (perceptual confusion) consisted of
6 items, which included difficulty in feeling the weight of the piano keys, abnormal visual sensations, unstable feeling in the hands, and failure to predict upcoming sensations. F6 (feelingrushed and out of body control) had 6 items, including feeling impatience and nervousness,sensations of exaggerated muscular tension and an incapability of relaxing the muscles, and aloss of intended control of body movements. F7 (failure of memory recall) included 2 items
that consisted of forgetting and failure to recall a memorized performance. F8 (passive behaviours) consisted of 4 items, such as the avoidance of risk-taking during performance, inexpressive performance, delayed reaction to unexpected actions when playing, and failure to makequick decisions when playing.
Covariance structure analysis. Fig 1 illustrates the results of a covariance structure analysis that was performed based on the results of the exploratory factor analysis. The SRMA,

Fig 1. A schematic drawing of the results of a covariance structure analysis depicting inferred causal relationships between eight factors
characterizing behavioural, physiological, and psychological abnormalities due to music performance anxiety. The number indicates a pathcoefficient between factors.
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RMSEA, and CFI scores of the developed model were 0.07, 0.06, and 0.90, respectively. In thismodel inferring a causal relationship between the factors, F3 and F7 were factors without any
output paths, whereas F1 and F2 were factors without any input paths. F3 had strong and weak
input paths originating from F6 and F8, respectively. F7 had an input path only from F8. F8
had input paths from both F4 and F5. F4 had input paths from F1, F5, and F6, whereas F5 had
input paths from F2 and F6. F6 had input paths from F1 and F2. Finally, there was a pathbridging between F1 and F2.

Personal traits
Factor analysis classified 28 of 29 question items regarding personal traits into 5 factors, which
accounted for 53.0% of the total variance. Table 2 summarizes the results of the factor analysis.
Each of these factors was labelled as follows: neuroticism (C1), inter-personal positiveness(C2), introversion (C3), public self-consciousness (C4), and lack of confidence (C5). C1 (neuroticism) consisted of 14 items, which included traits such as nervousness, oversensitivity,
Table 2. Results of an exploratory factor analysis of the personal traits.
factoritem
C1
neuroticism

C2
inter-personal positivenessC3
introversion

C4
public self-consciousness

C5
lack of confidence

C1

C2

C3

C4

C5

anxious about many issues

0.78

0.13

0.04

0.04

0.08

nervousness

0.75

-0.06

0.03

-0.04

-0.24

oversensitiveness

0.74

0.06

0.05

-0.04

0.13

persistent on trivial issues

0.72

-0.03

0.02

0.09

-0.08

negative thinking

0.72

0.14

0.11

-0.06

0.23

serious thinking

0.71

0.06

0.14

-0.06

0.03

mental fragility

0.70

0.06

0.01

0.18

-0.09

anxious about unnecessary issues

0.69

0.14

0.00

-0.03

0.14

mental instability

0.62

-0.04

0.04

0.08

-0.09

easily gets tired

0.61

-0.30

-0.14

-0.10

-0.02

tense

0.52

-0.03

-0.03

0.00

0.23

easy to be distressed

0.49

-0.03

-0.23

-0.02

0.39

easy to get irritated

0.48

-0.15

-0.08

-0.03

-0.05

readiness of feeling guilty

0.42

0.00

0.00

0.20

0.18

communicative

-0.07

0.80

0.10

0.03

-0.04

friendliness

-0.01

0.75

-0.03

0.04

-0.02

active

0.16

0.52

-0.15

0.00

-0.25

openness towards strangers

-0.28

0.40

-0.12

-0.23

0.17

gentle

0.02

0.12

0.93

-0.02

0.03

quiet

0.03

-0.11

0.72

-0.02

-0.11

taciturn

-0.08

0.27

-0.59

0.12

0.05

concerning about external evaluation

0.07

0.05

-0.01

0.80

-0.05

concerning about rumor

0.03

0.10

-0.03

0.73

0.07

concerning about in public

0.00

-0.14

-0.07

0.67

0.09

self-unconfidence

0.16

-0.04

-0.08

0.05

0.64

active speaking

0.27

0.28

-0.21

-0.17

-0.41

positive

-0.29

0.27

0.05

0.11

-0.39

passive traits

0.01

-0.19

0.29

0.06

0.36

The number indicates a factor score.
The bolded number indicates a factor score larger than 0.30.
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persistence on trivial issues, mental instability, likelihood/tendency to fatigue/experienceguild, tension and anxiety about many issues. C2 (inter-personal positiveness) had 4 items:
communication ability, activity level, friendliness, and openness towards strangers. C3 (introversion) included 3 items: gentleness, quiet, and taciturnity. C4 (public self-consciousness)consisted of 3 items: concerning about external evaluation, rumour, and public. C5 (lack ofconfidence) had 4 items: self-confidence, active speaking, positiveness, and passive traits.
To define a relationship between performance deterioration due to music performanceanxiety (i.e., F3 and F7, which were factors without output paths in Fig 1) and personal
traits, all respondents were divided into two groups according to whether the factor score
for these two factors (F3 and F7) was higher or lower than 0 (note that the mean factor score
was 0). Table 3 summarizes the mean factor score of each of the 5 trait factors for the twogroups segregated according to the F3 and F7 factor scores. For each of the F3 (erroneous
motor actions) and F7 (failure of memory recall) scores, two-sample t-tests with Bonferroni
corrections for five comparisons (p = 0.01) demonstrated a significant group difference inthe factor scores for C1, C4, and C5. This result indicates that respondents whose factor
scores for F3 and F7 were higher exhibited higher tendencies of neuroticism, public selfconsciousness, and lack of confidence.

Discussion
The present study demonstrated eight fundamental factors characterizing the choking underpressure in musicians. Overall, these factors can be classified into three categories: psychological (i.e., F1, F4, F6, F8), physiological (i.e., F2), and behavioural (i.e., F3, F5, F7) abnormalities.
A relationship between these factors indicates that two problems that particularly lead tospoiled skilled performance (i.e., failure of memory recall and erroneous motor actions) weremediated by both shared and distinct factors. Failure of memory recall was influenced by passive behaviours manifesting under pressure, whereas erroneous motor actions during performance were influenced by feeling rushed and a loss of body control. Furthermore, personal
traits such as neuroticism, public self-consciousness, and a lack of confidence were likely to belinked to these performance failures, which indicates that the extent to which the choking
under pressure negatively impairs skilled musical performance depends, in part, on personal
traits. While factors associated with choking under pressure in sports athletes have been
Table 3. Results of two-sample t-tests of the personal-traits factor scores between two groups classified according to a score of each of the music-performance-anxiety factors.

F3: erroneous motor
actions

F7: memory slip

C1:
neuroticism

C2: interpersonal
positivenessC3:
introversion

C4: public selfconsciousness

C5: lack ofconfidence

factor score (highgroup)

0.22280.01090.01050.17150.1552

factor score (lowgroup)-0.49200.0672-0.2373-0.4574-0.6784t value-5.47�

0.59

-1.55

-4.79�

-7.41�

factor score (highgroup)

0.12300.0265-0.05540.1491-0.0375

factor score (lowgroup)-0.28930.0431-0.1342-0.3474-0.3622t value-3.01�

0.21

-0.48

-3.88�

-2.73�

The factor score indicates one of the personal trait factors.
�
indicates p < 0.01 (with Bonferroni corrections for 5 comparisons).
https://doi.org/10.1371/journal.pone.0244082.t003

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PLOS ONEStage fright in pianists

investigated previously [11, 37, 38, 40, 41], to the best of our knowledge, this is the first study
that identified eight specific factors related to choking under pressure in musicians, as well as
their relationship.
Among various theories of choking under pressure, there are at least two theories accounting for the detrimental effects of pressure on performance according to abnormal attentional
control. Psychological stress can either distract attention away from skill execution due to ashift in attentional focus towards task-irrelevant cues (i.e., distraction theory) [7, 15] or augment the explicit monitoring of skill execution, thereby disrupting its automated processes(i.e., explicit monitoring theory) [1, 2, 14]. Our results may support the former theory because
attention to the audience (i.e. F1), but not too much attention to the performance itself (i.e. afactor discarded by the analysis), was identified as a factor characterizing music performanceanxiety. Our observation is compatible with a finding that choking under pressure diminishes
a functional connectivity between the motor cortex and prefrontal cortex responsible for the
performance monitoring, which supports the distraction theory [15]. However, several studies
reported that skill levels of performers are related to the pressure effects on attentional control[11, 25], which can confound the present results originating from pianists with different skill
levels.
Our covariance structure analysis further exhibited a putative link between passive behaviours (F8) and both erroneous motor actions during performance (F3) and failure of memory
recall (F7), which had no output path in this model. Passive behaviours included delayed reaction to unexpected actions when playing, inexpressive performance, and the avoidance of risktaking during performance, which suggests abnormal decision making such as a risk avoidance
behaviour. Interestingly, vicious cycles of choking under pressure (F4), which were characterized mainly by failure to cope with the pressure, were related to passive behaviours, which
implies that the destabilizing effect of a loss of attentional and emotional control in performance underlies passive behaviour under pressure. In addition, perceptual confusion was also
linked to passive behaviour, which is compatible with previous reports that the successful recallof procedural memory relies on sensory feedback that matches the produced motor actions[19–21].
Erroneous motor actions during performance under pressure (F3) were also linked to feeling rushed and out of body control (F6) in the present model. First, it is reasonable that feelingrushed resulted in out-of-tempo control, which is a typical behavioural abnormality experienced under pressure [6]. This can be also compatible with the polyvagal theory that proposesa relation between malfunctions of the autonomic nervous and choking under pressure [42].
Second, a loss of neuromuscular control, such as failure to relax the muscles, can elevate theviscoelasticity of the finger muscles, which increases biomechanical constraints on movement
independence between the fingers due to anatomical connections across multiple fingers [43,44]. Our recent study also demonstrated an association between reduced movement independence between the fingers and a loss of tempo control in piano performance under pressure[6]. Furthermore, movement independence between the fingers is responsible for the accuracyof force control in piano performance [45]. It is therefore plausible that choking under pressure degrades the control of independent movements between the fingers due to elevated muscular stiffness and, thereby, lowers the spatiotemporal precision of the performance. However,it should be emphasized that psychological pressure does not necessarily deteriorate the performance, as known by an inverted-U-shaped relationship between pressure and performance[24] or a phenomenon of flow [46]. In this respect, the present choking under pressure inmusicians specifically argues detrimental effects of pressure on the performance.
Our factor analysis classified personal traits of the present pianists into five categories.
Three among these five traits, which were neuroticism (C1), public self-consciousness (C4),

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PLOS ONEStage fright in pianists

and a lack of confidence (C5), were identified as factors accounting for the detrimental
effects of music performance anxiety. Namely, pianists who were less anxious, nervous, andnegative with higher self-confidence and less concern about external evaluation experienced
failure of memory recall and erroneous motor actions in performance to a smaller extent.
Both self-consciousness and a lack of confidence implicate traits concerning external evaluation, which indicates increased attention to task-irrelevant cues during the anxiogenic situation and, therefore, provides further supports for the distraction theory. A previous study
also reported that neuroticism was a trait related to choking under pressure in musicians[32], which implies a relationship between some but not all trait anxieties and state anxiety
of musicians.
There are some implications of the present observations for preventing the detrimental
effects of choking under pressure on musical performance. First, psychological intervention,such as cognitive behavioural therapy [30] and writing about worries prior to a stressful evaluation situation [47], may aid in reducing the worries of the performers because some personal
traits were related to music performance anxiety. However, such an intervention effect may
depend on person and situation, which requires client tailored approaches to optimize interventions according to each performer’s goal. For it, in addition to the therapeutic approaches,coaching and mental training can be helpful as ways of providing strategies to cope with thepressure. Second, the acquisition of skills to reduce muscular tension in musical performance
may lower the risk of performing erroneous motor actions when performing under pressure.
For example, practising a sequence of movements with a variety of rhythms can reduce unnecessary muscular activities during piano playing [48], whereas excessive attention to temporal
precision during piano practising prevents the reduction of such unnecessary muscular tension [49]. Third, a link of passive behaviours that include inexpressive performance to the performance failures concerns potential risks of taking medication that supresses the sympathetic
nerve activities (e.g. beta blocker) in order to cope with choking under pressure in music performance, because it can further suppress expressive performance and thereby increase risks
of making the performance failure.
Several limitations of the present study should be addressed because this is not an empirical study that investigated behavioural, physiological, and psychological responses to pressure. First, it is necessary to perform intervention studies to identify causal relationships
between the abnormalities emerging under pressure, because the present statistical analysis
merely inferred the causality under several prerequisites. Second, the present results are
based not on a phenomenon that occurred under pressure but on subjective reports withrespect to what pianists felt and remembered about their music performance anxiety. Third,
the present conclusions are based on the results of skilled pianists, and so a future study
should investigate music performance anxiety of unskilled players and other musicians.
Fourth, the present study cannot rule out a sampling bias from a specific population (e.g.
self-report ability, willingness to take part in the study) due to difficulty of controlling theparticipants (e.g. gender, level of expertise of participants). Fifth, the questionnaire items
used in the present study were designed based on the questionnaire investigating choking
under pressure in sports athletes, which limits the understanding of the whole aspects ofchoking under pressure in musicians (e.g. aesthetics expression under pressure). Sixth,
although the questionnaire items were evaluated a priori through the pre-test with a small
number of pianists, more precise evaluation of validity and reliability of the questionnaire
items and scales should be performed. Finally, the present questionnaire could not control
pieces related to occurrence of the choking, which however can be related to some factors of
the choking, such as failure of memory recall that should matter when playing pieces relying
heavily on working memory.

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Supporting information
S1 File.
(DOCX)
S2 File.
(DOCX)

Author Contributions
Conceptualization: Shinichi Furuya, Reiko Ishimaru, Noriko Nagata.
Data curation: Shinichi Furuya, Reiko Ishimaru.
Formal analysis: Reiko Ishimaru.
Investigation: Reiko Ishimaru.
Methodology: Shinichi Furuya, Reiko Ishimaru.
Project administration: Shinichi Furuya, Noriko Nagata.
Supervision: Shinichi Furuya.
Validation: Shinichi Furuya, Noriko Nagata.
Writing – original draft: Shinichi Furuya.
Writing – review & editing: Shinichi Furuya, Reiko Ishimaru, Noriko Nagata.

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