Effects of biofeedback on musicians' mental health and performance: a systematic review

Background. Music performance anxiety is a common and debilitating problem among musicians. Biofeedback interventions have been increasingly investigated as non-pharmacological approaches to reduce anxiety and enhance musical performance; however, evidence regarding their effectiveness, training characteristics, and outcome specificity remains fragmented. Aim. This systematic review aimed to synthesize evidence on the effects of biofeedback techniques on musician's mental health and performance. Methods. A systematic literature search was conducted across Scopus, PsycINFO, and PubMed. Studies investigating biofeedback interventions targeting anxiety, performance, or physiological outcomes in musicians were included. Study selection followed PRISMA 2020 guidelines. Results. Eleven studies met the inclusion criteria. Interventions included electroencephalography (EEG) - based neurofeedback, autonomic biofeedback, and multimodal biofeedback approaches, with durations ranging from single-session protocols to multi-week and multi-month training programs. Anxiety-related outcomes were most consistently improved by autonomic and multimodal biofeedback, whereas EEG neurofeedback more frequently yielded improvements in expert-rated musical performance. Physiological modulation, including changes in EEG activity, reductions in muscle tension, and improvements in heart rate variability, was observed across intervention types. Conclusions. Biofeedback interventions represent a promising non-pharmacological approach for reducing performance anxiety in musicians. Future studies should standardize outcome measures, define optimal intervention dosage, and directly compare different biofeedback modalities to inform evidence-based implementation in musical performance contexts.