Many musicians experience debilitating music performance anxiety (MPA). Outside music performance, imagery-based interventions have been incorporated into treatment protocols to help individuals, including athletes and those with social anxiety, manage heightened levels of anxiety in order to excel in performance-based domains. Despite the frequent use of mental imagery in MPA interventions and its importance as a mental rehearsal technique for musicians, no existing reviews have examined the literature on imagery-based interventions for MPA. The primary aim of this review was to analyze the existing MPA literature in order to summarize what is known about the efficacy and mechanisms of pre-performance mental imagery exercises. A literature search yielded eight studies that used imagery-based interventions for MPA, in both student and professional musicians, which included three dissertations and five peer-reviewed journal articles. In extant MPA treatment research, pre-performance imagery is often used in conjunction with other techniques in order to alleviate anxiety. Arousal imagery refers to imagining one's state of arousal during performance and has been incorporated into MPA interventions in various ways that guide musicians to anticipate the heightened arousal that accompanies performance, predominantly through imagery-based relaxation techniques. However, methodological limitations make it impossible to determine whether imagery is itself an active ingredient of treatment that underlies symptom changes, or whether relaxation imagery is the most effective use of pre-performance imagery for all musicians. There is much need for future well-controlled studies to examine whether and how imagery affects MPA independent of the other therapy components and techniques with which it is commonly combined.