Music performance anxiety (MPA) represents a high challenge every vocal performer has to meet. MPA can be defined on a continuum going from a low to a high level. MPA and its phenomena can be considered in terms of four levels: affect, cognition, behaviour, and physiology. A study carried out on seven opera singers and two instrumentalists during performance situations showed highly elevated values for the performers' heart rate and blood pressure. This study, as several others, yielded no clear evidence pointing to a correspondence between the level of anxiety and of physiological arousal. At the end of the article a multimodal approach to the treatment of MPA is illustrated consisting of different psychotherapeutic and body-oriented methods.