Although many musicians perceive music performance anxiety (MPA) as a significant problem, studies about the psychobiological and performance-related concomitants of MPA are limited. Using the biopsychosocial model of challenge and threat as theoretical framework, we aim to investigate whether musicians’ changes in their psychobiological responses and performance quality from a private to a public performance are moderated by their general MPA level. According to the challenge and threat framework, individuals are in a threat state when the perceived demands of a performance situation outweigh the perceived resources, whereas they are in a challenge state when the perceived resources outweigh the perceived demands. The resources-demands differential (resources minus demands) and the cardiovascular challenge-threat index (sum of cardiac output and reverse scored total peripheral resistance) are the main indices of these states. We postulate that the relationship between general MPA level and performance quality is mediated by these challenge and threat measures.

Breaking bad news (BBN; e.g., delivering a cancer diagnosis) is perceived as one of the most demanding communication tasks in the medical field and associated with high levels of stress. Physicians’ increased stress in BBN encounters can negatively impact their communication performance, and in the long term, patient-related health outcomes. Although a growing body of literature acknowledges the stressful nature of BBN, little has been done to address this issue. Therefore, there is a need for appropriate tools to help physicians cope with their stress response, so that they can perform BBN at their best. In the present study, we implement the biopsychosocial model of challenge and threat as theoretical framework. According to this model, the balance between perceived situational demands and perceived coping resources determines whether a stressful performance situation, such as BBN, is experienced as challenge (resources > demands) or threat (resources < demands). Using two interventions, we aim to support medical students in shifting towards challenge-oriented stress responses and improved communication performance: (1) stress arousal reappraisal (SAR), which guides individuals to reinterpret their stress arousal as an adaptive and beneficial response for task performance; (2) worked examples (WE), which demonstrate how to BBN in a step-by-step manner, offering structure and promoting skill acquisition.

Breaking bad news (BBN) is among the most distressing communication tasks in the medical field, wherein physicians disclose serious diagnoses to their patients. Under stress, physicians may resort to maladaptive communication behaviors, potentially affecting patient’s health in the long-term. Therefore, it is essential to support medical professionals in effectively managing their stress responses early in their careers. Using the biopsychosocial model of challenge and threat as theoretical framework, we employed a 2 x 2 study design to examine the effects of stress arousal reappraisal (SAR; i.e., reinterpretation of bodily changes as functional coping resources) and worked example (WE; i.e., step-by-step demonstration of how to BBN) interventions on demand and resource appraisals and cardiovascular responses of 229 medical students engaged in simulated BBN encounters. Participants who prepared with WE reported more coping resources relative to demands after the BBN encounter than participants not preparing with WE. Participants receiving SAR instructions exhibited improved cardiovascular responses during the BBN task, indicated by increased cardiac output and decreased total peripheral resistance, than participants not receiving SAR instructions. These findings align with the notion that both interventions facilitate a shift from a threat to a challenge state, supporting their potential for integration into BBN training.

Breaking bad news (BBN) is among the most distressing communication tasks in the medical field, wherein physicians disclose serious diagnoses to their patients. Under stress, physicians may resort to maladaptive communication behaviors, potentially affecting patient’s health in the long term. Therefore, it is essential to support medical professionals in effectively managing their stress responses early in their careers. Using the biopsychosocial model of challenge and threat as theoretical framework, we employed a 2 × 2 study design to examine the effects of stress arousal reappraisal (SAR; i.e., reinterpretation of bodily changes as functional coping resources) and worked example (WE; i.e., step-by-step demonstration of how to BBN) interventions on demand and resource appraisals and cardiovascular responses of 229 medical students engaged in simulated BBN encounters. Participants who prepared with WE reported more coping resources relative to demands after the BBN encounter than participants not preparing with WE. Participants receiving SAR instructions exhibited improved cardiovascular responses during the BBN task, as indicated by increased cardiac output and decreased total peripheral resistance, than participants not receiving SAR instructions. These findings align with the notion that both interventions facilitate a shift from a threat to a challenge state, supporting their potential for integration into BBN training.

Psychological and physiological responses co-occur during stressful tasks and jointly influence performance. Yet, research on stress–performance links often focuses on single parameters in isolation, overlooking their interrelations. The current study addressed this gap using machine learning—specifically random forest regression—to identify key psychophysiological predictors of communication performance when considered simultaneously. Participants were 229 medical students who engaged in breaking bad news encounters with simulated patients. We assessed neuroendocrine and cardiovascular activity, mood states, emotion regulation strategies and stress appraisals as predictors and communication performance as the outcome. Results revealed suppression of unpleasant feelings as the strongest predictor, with greater suppression linked to poorer performance. Physiologically, better performance was associated with moderate decreases in heart rate variability, increases in cortisol and decreases in stroke volume. Analysis of joint effects indicated that suppression was especially detrimental under high physiological reactivity and among lower-performing individuals, suggesting cognitive overload under these conditions. The findings pinpoint suppression of unpleasant feelings as a maladaptive stress coping strategy, while physiological stress responses within the observed ranges appeared to enhance performance. Ultimately, addressing maladaptive emotion regulation and leveraging assessable physiological indicators—particularly heart rate variability reactivity—could inform training programmes to improve performance under stress.