Table 2.

Summary of key psychological theories explaining MPA’s etiology.

Cognitive theories	Cognitive theories emphasize the centrality of dysfunctional cognitions in the development and maintenance of MPA and their impact on physiology, emotions and behavior (Spahn, 2015).
Behavioral theories	Behavioral models conceptualize MPA as a classically conditioned fear attributed to traumatic learning experiences during performers’ formative years which lead to the development of maladaptive cognitions and behaviors (Clark, 1989; Spahn, 2015; Altenmüller and Ioannou, 2016). Different responses to similar learning experiences can be attributed to genetic/factors (Kenny, 2011).
Cognitive behavioral theories	Cognitive behavioral psychologists attribute MPA to negative cognitions and self-beliefs that undermine preparation and self-confidence (Altenmüller and Ioannou, 2016; Brugués, 2019), particularly catastrophizing and attention binding (Beck and Clark, 1988). The distinction between cognitive theories and cognitive behavioral theories of MPA remains unclear (Kenny, 2011).
Physiological theories	Physiological psychologists primarily attribute MPA to humans’ evolutionary stress response whereby perception of threat triggers a range of physiological reactions known as the fight/flight response. Modern threats include failure, humiliation, exposure and disappointing significant others/peers (Spahn, 2015; Altenmüller and Ioannou, 2016).
Psychoanalytic theory	According to psychoanalytic perspectives (including attachment theory), MPA symptoms arise from individual childhood experiences, including attachment with caregivers, and express conscious or unconscious internal conflicts (Kenny, 2011; Spahn, 2015). In this modality, the audience represents parental figures; fear of negative evaluation reflects feared loss of parental love. Unconscious fears manifest in negative cognitions and fears of losing control (Spahn, 2015). There remains minimal empirical support for this theoretical perspective (Brugués, 2019).
Barlow’s Anxiety Model (2000)	Kenny et al. (2004) adapted Barlow’s (2000) tripartite Anxiety Model to MPA, and this model has underpinned Kenny’s subsequent work on MPA. This adapted theory attributes MPA to the interaction between three dimensions of vulnerability: biological (personality traits), general psychological (early learning experiences) and specific psychological vulnerabilities (learned anxiety in response to specific environmental stimuli) (Barlow, 2000; Kenny, 2011; Gembris and Heye, 2012) Although the most comprehensive of these theories, the distinction between biological and learned traits seems somewhat arbitrary in terms of relevance for musicians seeking to manage MPA. While traits may be relatively stable, research shows their malleability, which problematizes classifying traits as biological.