Mindfulness- and acceptance-based interventions for music performance anxiety: a three-level meta-analysis of therapeutic effects, mechanisms, and boundary conditions.

Abstract

Music performance anxiety (MPA) can substantially impair musicians' learning, performance, and psychological functioning. Although mindfulness- and acceptance-based interventions (MABIs) have shown promise for MPA, their pooled effects, boundary conditions, and mechanism-related commonalities remain insufficiently understood. Grounded in a dual-path explanatory framework emphasizing decentering and attentional reallocation, this study examined the effects of MABIs on anxiety-related outcomes and positive psychological functioning. A dual-track synthesis combining three-level meta-analysis and qualitative synthesis was conducted. Thirty-two independent studies (N = 1,983) were included in the qualitative synthesis, and 26 studies provided data suitable for quantitative meta-analysis. Three-level meta-analytic models were used to account for dependent effect sizes, and robust variance estimation was applied as a secondary sensitivity approach. Exploratory moderator and outcome-family analyses examined intervention type, intervention dose, and narrower outcome domains. MABIs were associated with a moderate-to-large reduction in music performance-related anxiety outcomes (Hedges' g = 0.732) and a small-to-moderate improvement in positive psychological functioning (g = 0.350). Exploratory analyses showed stronger effects for MPA-specific anxiety than for broader anxiety/stress responses, whereas no clear differential effects emerged within positive psychological functioning. Intervention type and dose did not significantly moderate the main effects. The qualitative synthesis identified four recurring therapeutic components: cognitive defusion, somatic anchoring, acceptance/values clarification, and self-compassion. The findings suggest that MABIs may reduce anxiety and support adaptive psychological functioning among music performers. However, mechanism-related interpretations remain inferential because they are based on theoretical integration and qualitative evidence rather than direct mediation testing. Future research should use longitudinal designs, stronger control conditions, and multimodal physiological assessments to examine dose-response patterns and therapeutic pathways more directly. https://osf.io/7yr5s/overview, identifier osfregistrations-7yr5s-v1.