Background <p>While music performance anxiety is traditionally analyzed through individual psychological traits, there is a scarcity of research adopting holistic frameworks that integrate person, environment, and occupation dimensions. This study utilizes a qualitative approach to examine the multi-dimensional catalysts of performance anxiety among undergraduate music students within the Person–Environment–Occupation (PEO) framework.</p> Methods <p>Semi-structured face-to-face interviews were conducted with 26 conservatory students. Data were transcribed verbatim and analyzed using a content analysis approach within the PEO framework. Findings were organized into a hierarchical structure of categories and subcategories.</p> Results <p>Results indicate that performance anxiety is a multifaceted phenomenon. At the person level, anxiety is driven by perfectionist tendencies and cognitive distortions (fear of negative evaluation). The environmental dimension highlights the impact of suboptimal acoustics, pedagogical attitudes, and competitive institutional climates. The occupation dimension identifies insufficient preparation and the high-stakes nature of solo debuts as primary stressors.</p> Conclusion <p>Musical performance anxiety emerges from the synergistic interaction of personal, environmental and occupation-related factors. These findings highlight the importance of adopting more holistic and context-sensitive approaches for understanding music performance anxiety in music education.</p> Graphical abstract <p></p>