The musical practice is an extremely complex activity that involves a series of cognitive abilities and functions, among them are hearing, memory, motor coordination, attention, affection, mathematical calculation, and the association of all of these concomitantly, including situations of public exposure. Because of this, musical performance is particularly susceptive to anxiety symptoms. Musical performance anxiety (MPA) is defined as an experience of persistent and distressing apprehension and/or real prejudice of the performance abilities in a public context in an unjustifiable degree given the individual musical aptitude and preparation level. It prevails more commonly on the female gender in a 3:1 proportion and affects about 20% of the professional musicians. In the present chapter, its main etiologies and psychic mechanisms, evaluation instruments, as well as the current therapeutic strategies available will be presented.