Table 1 Selected studies (RCTs and CTs) of effectiveness of AT a
From: The Alexander Technique and musicians: a systematic review of controlled trials
Study, type of publication | Design | Participants | Experimental intervention(s) | Control intervention(s) | Outcome measures | Main results |
|---|---|---|---|---|---|---|
Doyle 1984 [24], PhD thesis | RCT | 72 | Short hands-on contact with thought: free neck muscles before playing | Short hands-on contact with thought: tighten neck muscles before playing | Head-neck relationship | 98.6% of subjects showed changes in the head-neck relationship when taking up their instrument to play. |
Violin players | (Defined as the angle between a line going through the sternal notch and the first dorsal vertebra and a vertical line going through the middle of the chair and measured on photographs) | Release in tension in the neck muscles was closely associated with postural changes towards the grid vertical in 71.4% of subjects (p <0.001). When tightening the neck muscles 94.6% moved in a forward direction (p <0.001). | ||||
42 female, 30 male, age 11–19 years (music schools, school orchestras) | ||||||
Dennis 1987 [25], Ed.D. dissertation | RCT | 13 | AT | None | Music performance (posture, movement, breath control, overall performance) judged by 6 expert observers from video-tapes on a 7-point scale | Control group performed better in maximal voluntary ventilation (t-test, p =0.052); no other significant differences between groups occurred. |
Young adult wind instrument players | 20 sessions, 30 min, over 4 months, one-to-one | Respiratory function (standard spirometry, maximal inspiratory and expiratory pressures) | ||||
8 female, 5 male, age 22–33 years | ||||||
Valentine et al. 1995 [26], peer-reviewed | mixed methods: | 25 | AT | None | Height, peak flow, heart rate | AT group showed improvement relative to control group in musical and technical quality, heart rate variance, self-rated anxiety, and positive attitude to performance (ANOVA, p <0.05). |
- RCT | Music students | 15 sessions, one-to-one | Music performance and degree of misuseb rated by 4 blinded expert judges from video-tapes | Effects were mostly restricted to performance in low stress class situations (with the exception of heart rate variance). | ||
-interviews | 21 female, 4 male, age 19–32 years (music department of a university) | Music Performance Anxiety Self-Statement | ||||
Nowlis mood adjective checklists | ||||||
Lorenz 2002 [27], master’s thesis | RCT | 22 | sensory awareness and body alignment exercises based on AT | None | performance anxiety (degree, symptoms) and effects of AT on performance anxiety measured by 4 questionnaires (designed by author) | Inconclusive effect of exercises on performance anxiety. |
Female choral singers, age 13–16 years (high school) | 1 to 4 min exercises, 3 to 4 times weekly, over 13 weeks, group training | |||||
Egner and Gruzelier 2003 [28], peer-reviewed | RCT | 61 | 1. alpha/theta NF | 4. Physical exercise | Assessment by 3 expert judges from video-tape in random order on 10-point scales adapted from a standard set of music performance evaluation criteria (overall quality, perceived instrumental competence, musicality/musical understanding and communication) | Significant improvements in music performance occurred in the alpha/theta NF group (p <0.01 for 3 out of 4 criteria; mean improvement rate 12%), but no post-training performance changes in any other group. |
music students | 2. beta1 NF | 5. Mental skills training | Spielberger’s state-anxiety inventory | Reduction in pre-performance anxiety was observed in all 6 groups (p <0.05). | ||
43 female, 18 male, mean age 23.1 ± 2.21 years (college) | 3. sensorimotor rhythm NF | 6. AT: 15 sessions, 30 min, weekly, over 15 weeks, one-to-one | ||||
10 sessions, 15 min, over 6–8 weeks | ||||||
Valentine and Williamon 2003 [29], conference proceedings | RCT | 18 | AT | alpha/theta NF | Assessment of AT useb by blinded expert on 7-point scale | AT group showed improvement relative to NF group in 7 out of 10 measures of AT use (p <0.05, one-tailed values). |
Music students (college) | 12 sessions, 30 min, weekly, one-to-one | 10 sessions, 15 min, over 6–8 weeks | ||||
Mozeiko 2011 [30], dissertation | mixed methods: | 51 | AT | none | Pain, executive skill function, well-being, awareness | Significant changes were found in awareness and executive skill function in AT group compared to control group (MANOVA, p <0.01). |
- RCT | Female violinists and violists, age 18–34 years | 20 sessions, 30 min, twice a week, over 10 weeks, one-to-one | - Questionnaires (quantitative, questions from author and previous studies, von Korff scale for pain, 10-point Likert scales) | Convergence of quantitative and qualitative data showed also improvement in pain. | ||
-Interviews | Lie down in semi-supine position 10–15 min once or twice a day | - Interviews (qualitative) | ||||
Barlow 1956 [31], peer-reviewed | CT | 74 | AT (“conditioning”) | Verbal instructions, manual adjustment, exercises | Postural faults (according to author’s scoring system) | In the AT group the number of faults decreased from 9 to 4 in women and from 11 to 5 in men. In the control group the number of faults increased from 7.5 to 7.9 in women and from 10.6 to 11.7 in men.c |
44 speech and 30 music students | ||||||
42 female, 32 male (college) | ||||||
Armstrong 1975 [32], master’s thesis | CT | 8 | AT | none | Performance anxiety (author’s questionnaire) | AT group experienced less nervousness and stress after training, while there wasno change in the control group. |
Piano students (music department of a university) | 4-6 sessions, 30 to 45 min, over 6 weeks, one-to-one | Qualitative observations regarding movement | Video-taping revealed less stiffness and increased flexibility in shoulders and neck in the AT group.c | |||
Nielsen 1988 [33], conference proceedings | CT | 39 | 1. AT | 2. exercises | heart rate, BP | Exercise group showed |
Professional musicians in orchestra | 20 sessions, over 8 weeks, one-to-one | 7 km running 3 times a week, over 8 weeks | feedbacks | - significant reduction in heart rate (paired t-test, p <0.05) | ||
3. beta blocker | - increase in general well-being (responses on qualitative questionnaires). | |||||
40 mg Propranolol, 1.5 h before concert | AT group and beta blocker groups showed | |||||
4. placebo tablet | - significant reduction in systolic BP (p <0.02) | |||||
- significant reduction in increases in systolic BP from final rehearsal to concert (p <0.05). | ||||||
Beta blocker group experienced unwanted side effects. | ||||||
Engelhart 1989 [34], PhD thesis | CT | 23 | 1. AT | 2. Progressive muscle relaxation according to Jacobson | Tone quality rated by 3 experts on a 9-point Likert scale | No significant difference was found after interventions among the 3 groups with respect to change in tone quality. |
Beginning singers | 10 sessions, 50 min, over 2 weeks, group training | 3. Standard vocal exercises | Preparatory muscle activity determined by surface EMG | Group-time interaction effects occurred for 6 of 18 EMG variables (ANOVA, p <0.05); no overall pattern indicated differences between the 3 groups. | ||
18 females, 5 males, age 18–29 years (students with no previous vocal training) | 10 sessions, 50 min, over 2 weeks, group training | |||||
Hoberg 2008 [35], master’s thesis | CT | 12 | Selected AT principles included in flute lessons (with author) | flute lessons without AT principles (with other teachers) | Performance anxiety (author’s questionnaire): | AT group had decreased performance anxiety.c |
flute students with performance anxiety | 18 months | 18 months | - degree | |||
age 11–18 years | - symptoms |