The article discusses how psychological defenses, developed in early childhood to protect us from disrupted attachments with caregivers, are rendered completely useless during the vulnerable process of performing in front of an audience. As a result, anxiety becomes the manifestation of the body and brain's perception of a threat. As we have seen in past blog entries, such threats can be external i.e. "if I don't do well I will not get the gig and will not make money/will not succeed" or internal i.e. "being judged or evaluated is shameful and an inherently negative experience."
I was glad to see that the article made references to the concept of attacking the self, a process in which one directs aggression to the self in order to avoid directing it towards the external source. As seen in the article's description of a 10 week ISTDP treatment, the goals of treatment were to help the patient become aware of the aggression and develop transference with the therapist, resulting in the effective resolution of previously misdirected emotions. Now, what does all this have to do with performance anxiety? For one thing, performers who experience severe anxiety often go through some form of self-attack when they experience thoughts such as "I'm not good enough", "I will fail", "they will laugh at me" etc. In addition, the relationship between performer and audience may be one that symbolizes pivotal relationships in one's past, particularly during childhood. Unresolved feelings, such as anger, neglect, embarrassment etc, which are primarily dealt with by repressing, pushing and turning inwards, may become triggered by entering a relationship where one is assessed, evaluated and judged. The goal is to become both intellectually and emotionally aware of such emotions in order to resolve them through the process of transference in the therapy room. By safely expressing negative emotions in the presence of an external agent and by redirecting them effectively externally rather than internally, the performer will be able to diminish the powerful impact of dropping the defenses - since there will not be such a need for these defenses in the first place.
In the study described, all this took place within 10 sessions. In my experience, these complex stages tend to take a lot longer; but nevertheless, I am pleased to read about the success of ISTDP in this particular case.
You can read the full article here.