Q&A with Dr. David Juncos

As a clinical psychologist and researcher, Dr. David Juncos is on the cutting edge of developing effective treatment for musicians with Music Performance Anxiety. In this interview I found out more about his approach using Acceptance and Commitment Therapy (ACT), and what exciting developments he has in store for performers and teachers in the future.

Can you tell us a bit about your career path – what got you into psychology and research, and what are you up to now?

I knew from a pretty early age I was interested in a career in psychology. I think there were two main reasons for that. First, both my parents worked in helping professions, so I was bit by that same bug I suppose. My dad is a medical doctor and my mom was a social worker. Secondly, I was always more introverted than my siblings and parents, so growing up surrounded by extraverts forced me to be more introspective, which led to me taking a strong interest in psychology, in particular, theories of personality differences and of clinical psychology.

I was also really into music at an early age. In grade school, I played the piano, clarinet, and I sang in choir. As a teen, I abandoned those instruments and became obsessed with the guitar and started writing music and playing in bands, which was a thing I continued to do into my 20’s and 30’s. I’ve performed with both cover bands and original ones, in fact, I was the singer/guitarist of my own band for several years in Philadelphia. We were good enough to make it in my opinion, but I knew I wanted to be a psychologist eventually, because it was more stable than being in a rock band. So yeah, ever since I was a child, music and psychology were always my main things.

I guess it’s fitting I’ve chosen a career as a psychologist who specializes in working with musicians. It’s funny, I wasn’t too interested in research while at my doctoral program (La Salle University in Philadelphia). It wasn’t until afterwards that I really started to pursue it, because I wanted to continue with the research I’d done for my dissertation that was still very exciting to me, i.e., using Acceptance and Commitment Therapy (ACT) to treat music performance anxiety (MPA).

As a student at La Salle, I was trained in both ACT and Cognitive Behavioural Therapy (CBT) to treat anxiety disorders, and I always found ACT to be more helpful for reasons I’ll share later on. Due to my training in using ACT to treat anxiety, and to my interest in working with musicians, it felt like a natural “coming together” of ideas to start investigating ACT as a treatment for MPA.

I do credit my doctoral program, though, for setting the stage for me to develop my research interests. My professors always supported me. Plus, the former director of my school, Dr. Frank Gardner, was doing pretty groundbreaking research at the time I was there.

He and his wife, Dr. Zella Moore, had developed an ACT-based program to enhance performance with student and professional athletes (the Mindfulness-Acceptance-Commitment approach, aka the MAC), and they were researching its effectiveness. Their research definitely inspired me to want to do the same for musicians.

Currently, I’m a clinical psychologist in private group practice in Philadelphia, PA. I also provide remote lectures and supervision for a school in the UK that offers postgraduate degrees in vocal pedagogy for singing teachers and vocal coaches, called the Voice Workshop.

For those who are not familiar with Acceptance and Commitment Therapy, could you explain what it is and how it differs from other more traditional forms of psychotherapy?

ACT (pronounced as the word “act”) is part of the “third-wave” of behavioural therapies, which means it aims to promote mindfulness and acceptance of unwanted thoughts and emotional distress, rather than a restructuring or replacement of those unwanted thoughts that was more typical of the “second-wave” of behaviour therapies that were popular in the 1980’s and 90’s, i.e., the cognitive-behavioural therapies.

So, whereas a CBT therapist would teach clients struggling with depression or anxiety to identify distortions in their thinking and replace them with more rational thoughts that offer a more balanced perspective of their situation, an ACT therapist would teach clients to mindfully observe their unwanted thoughts with acceptance and willingness, thereby learning to be less entangled with them. This process of disentangling one’s self from their thinking is called cognitive defusion, and it’s one of multiple aims in an ACT therapy.

Those fifth and sixth goals I mentioned are incredibly important in ACT, i.e., identifying the values that bring pleasure and meaning to one’s life, and making a commitment to stay engaged in behaviour that reflects those values in spite of the emotional or mental barriers that may arise. This part of ACT can make the therapy very meaningful for clients, because they learn to define/commit to a set of actions that are personally relevant to them.

Moreover, clients learn to tap into the energy and motivation that are intrinsically generated through engagement in activities of value to them, which becomes reinforcing for them. This self-reinforcing engagement with one’s valued actions correlates with (and predicts) well-being for a wide variety of people, not just therapy patients.

In essence, these two goals in ACT are like a recipe for well-being for anyone who wants to improve their quality of life, and as great a therapy as CBT is, I don’t think it articulates as clear a path for increasing well-being as ACT does. The path is this - when one’s behaviour is guided by values and committed action, they enjoy a better quality of life, and when one’s behaviour is guided by a need to escape emotional distress, they experience increased suffering and struggle with that emotional distress.

You are one of the leading researchers in the world of ACT being used for the treatment of Music Performance Anxiety (MPA). What have you discovered in your research to date?

Thank you for saying that, although I believe it’s more true that I’m the first researcher to draw attention to ACT as a treatment for MPA. There are certainly others in the world who are doing this same work but have not published it yet.

Thus far, I’ve conducted two single-subject experiments (one published and one not), and a pilot study with seven vocal students. Participants in all three studies had clinically elevated levels of MPA, as evidenced by their self-report and scores on a validated measure of MPA. The first participant was a professional rock drummer who received 12 ACT sessions for MPA, as part of my dissertation project. The second participant was an undergraduate violinist and Music Education major who received 10 ACT sessions.

Participants in the pilot study were undergraduate and graduate students at an elite choir college who each received 12 ACT sessions.

Results across the three studies were remarkably similar. All participants showed significant improvements in their ability to “defuse” from their MPA-related thoughts during their performances. In other words, every musician (9 out of 9) improved their ability to disentangle themselves from their unwanted, MPA-related thoughts, so they could experience them more neutrally during performances, without their attention or behaviour becoming overly affected by them.

For example, if they had a troublesome thought like “I am definitely going to mess up that one part” occur during their performance, they learned to experience it from a more distanced perspective, so it no longer ruled over them and affected their behaviour as much. One way they were taught this was to say to themselves, either aloud or silently, “I notice I’m having the thought that [insert thought here],” and then were taught to insert their thought after that phrase. For example, “I notice I’m having the thought that ‘I am definitely going to mess up that one part.” When the participants labeled their thoughts in this manner, it helped them to stay less tangled up with them. This skill of being less fused with one’s thinking is a known mechanism by which ACT therapy enhances overall psychological flexibility.

Other results shared by the majority of the participants were that they became more accepting of their MPA-related physiological symptoms, i.e., increased heart rate, palpitations, shaky voice and hands, coldness and numbness in hands, shortness of breath, etc., and that their performance quality had improved too, according to independent jurors.

When working with the student violinist, I hired a stringed instrumental teacher to blindly rate the quality of her performances before/after therapy. He reported the performance after therapy was superior to the one before therapy. Additionally, when working with the seven vocal students, I hired three judges to rate their performance quality. There was a statistically significant improvement in judges’ ratings of students’ average performance quality, moving from before to after therapy.

These results showed that the majority of participants were not only becoming more accepting of their MPA-related physiological symptoms, but they were also improving the quality of their performances. Such outcomes are actually common in ACT treatments with other types of participants, e.g, with athletes, with college students, with workers, and others. In fact, it’s a common hypothesis among ACT researchers, myself included, that one’s performance quality will improve, regardless of the type of performer they are, when they learn to re-direct attention and behaviour away from attempting to get rid of or control symptoms of emotional distress, and instead onto persisting in behaviour that will reliably add pleasure and vitality to their performances when they do so.

Making this shift appears to engender flexibility and create confidence in the person doing it, and doing it regularly (like any new skill) may help them in a variety of ways, like improving their well-being.

What is the next step in your research, and how can performers and teachers learn more about your work?

I’m excited to share the results of a fourth study that I published in 2020 that is very promising.

In this new study, I worked with a vocal professor at a university in the UK, and our research question was “Can a vocal professor with no training or education in psychology achieve the same results with one of her students with MPA as I was able to achieve (as a clinical psychologist) with the participants in my three studies, when she is trained in ACT coaching (not ACT therapy) by myself?” The answered to that question appears to be yes.

The professor received approximately seven hours of training in ACT coaching by myself via Skype, while she simultaneously provided six ACT coaching sessions (each one hour) to an undergraduate male vocalist with elevated MPA. The student showed the same improvements as the participants I worked with, namely, an improved ability to defuse from MPA-related thoughts, and improved acceptance of physiological MPA symptoms. He also began auditioning for more lead roles in musicals, which is something he’d wanted to do prior to his ACT coaching but often avoided due to MPA.

Although these results only reflect one student’s progress and may not generalise to other students who receive ACT coaching, they certainly have exciting implications for how teachers could potentially get involved in doing effective work to help treat their students’ MPA.

For the longest time, music teachers have deferred to medical or psychological professionals to treat their students’ MPA, understandably so, because they feel it falls outside of their training. However, I hope this study provides an alternative model for MPA treatment that enables teachers to see just how helpful they might be in managing their students’ MPA, even without training or education in medicine or psychology.

In addition to being an efficacious therapy for treating clinical cases of anxiety, ACT is also available as an evidence-based coaching model that has shown to effectively improve psychological flexibility and enhance performance skills within non-clinical populations, i.e., athletes, students, workers, and other professions. I am in the process of further developing an ACT-based training program for music teachers.

Also, in 2022 I will be publishing a self-help book for musicians that I’m co-authoring now with Ms. Elvire de Paiva e Pona, a vocalist and singing teacher based in Vienna, Austria. The book is based in ACT and will offer evidence-based information and exercises that will help musicians to manage a variety of problems, including MPA, pain related to repetitive strain injuries and other physical problems, self-criticism, shame, low motivation for practicing and performing, and other problems. It will also provide guidance on how to enhance performance skills, using techniques from my research studies and those from other ACT-based performance studies. This book will hopefully serve as a valuable resource in providing the ACT-based training for music teachers that would like to work with me in the future.

If anyone is interested in learning more about my work, they can visit my profile on Research Gate, where I’ve uploaded all of my published and un-published works, and where I give regular updates:

https://www.researchgate.net/profile/David_Juncos2

Has performance anxiety or nerves been something that you have had to consciously manage when you perform or speak in public? Or are you just awesome and don’t have any issues because of the work that you do!?

Good question. When I was in graduate school I certainly experienced my share of public speaking anxiety when presenting in class and at conferences, more so than previously in my life. I think it’s a rite of passage when becoming a psychologist to have to prove yourself time and time again to your peers and supervisors (and yourself).

Certainly this is the case with so many other professions too…

For me, whenever it got excessive, I knew I had to just apply what I learned in class to myself and that ultimately it would help, which it did. Luckily, it was never too bad, but obviously I would’ve preferred to not experience it! I think what also helped me get through those stressful years was having the support of my peers and professors, and of my dissertation adviser, as well as the wisdom that using evidence-based techniques like mindfulness and acceptance would eventually work.

It’s funny, now I love presenting and look forward to the opportunity, because I get to focus on things that matter most to me, like talking about research that I’m passionate about.

Regarding MPA, I can’t say I experienced too much of it, but I think it’s because I was lucky and started performing at young age, which really helps. I’ve learned from my research that MPA can happen to so many people, but age of onset of performing appears to be a protective factor. I also never performed music at an elite level.

What advice would you give to performers today in regards to managing their performance anxiety?

This is a question I get asked often, and my go-to answer is somewhat simple: it’s a two-step process.

First, increase your willingness to have MPA by practicing regular mindfulness meditation, and practice defusion techniques like the one discussed earlier ("I notice I’m having the thought that [insert unwanted thought here.]” You know you’re getting better at mindfulness and defusion when you feel more present during your performances or practices, meaning you feel more clear-headed and focused.

You know you’re becoming more willing to experience your MPA when you’re no longer making decisions that revolve around it. For example, when the vocal student who received ACT coaching from my colleague in the UK decided to audition for more lead roles in musicals, he showed an increase in willingness to perform with his MPA present. When you have a lower willingness to be with your MPA, you tend to avoid opportunities like that.

Secondly, once you’ve improved your mindfulness, defusion, and willingness to be with MPA, then identify what valuable things you love most about performing, and start to purposely direct your attention and behaviour onto engaging with those sources of value more regularly during your performances. If you have to feel anxious while doing this, it’s not ideal and takes flexibility, however, the more you stay in contact with those valued things during your performances, the more you can improve confidence, well-being, and possibly your performance quality too.

For example, many of the student vocalists I worked with valued being an emotionally expressive singer, yet they felt stifled by their MPA and held back during performances because of it. By improving their mindfulness, defusion, and willingness to be with their MPA, they then started to make the shift from viewing their MPA as a barrier to be avoided to viewing it as yet another emotion to be expressed. Then, the more they purposely expressed their anxiety during their performances (in ways appropriate to the style of their repertoire, and not in ways that detracted from the performance), the more flexible and confident they became in its presence. In my opinion, that is how they were able to improve their performance quality too.

For more information on David's work, look up his group practice in Philadelphia at www.hptherapy.com

Voice Workshop in the UK at www.voiceworkshop.co.uk

or read all of his research papers at www.researchgate.net/profile/David_Juncos2

If you would like to contact David directly, send an email to drdavidjuncos@gmail.com