VIRTUAL REALITY EXPOSURE THERAPY FOR MUSIC PERFORMANCE ANXIETY: EVIDENCE, ADVANTAGES, AND FUTURE DIRECTIONS
DOI:
https://doi.org/10.24191/jca.v3i1.10591Keywords:
music performance anxiety, virtual reality exposure therapy, exposure-based interventions, performance psychology, music educationAbstract
This study examines the use of Virtual Reality Exposure Therapy (VRET) as a novel intervention approach for addressing Music Performance Anxiety (MPA), a form of anxiety experienced by musicians during performance. MPA is a widespread phenomenon across levels of expertise, genres, and cultural backgrounds, and it negatively affects psychological well-being and musical performance quality. Although traditional interventions like cognitive-behavioral therapy (CBT), relaxation training, and in vivo exposure have proven effective, these methods often face constraints in terms of exposure intensity control, accessibility, standardization, and acceptability among highly anxious musicians. Findings indicate that VRET offers significant advantages, including immersive environments, adjustable and customizable exposure levels, repeatable performance scenarios, and improved access to treatment. The empirical studies reviewed suggest that VRET is effective in reducing performance anxiety, improving physiological responses such as heart rate variability, and enhancing overall music performance quality. However, the article also emphasizes that VRET should not be considered a complete replacement for traditional methods. Live performance continues to play a crucial role in artistic development, social communication, and stage sensitivity. Therefore, a more effective approach may lie in an integrative model that combines VRET with conventional interventions within a comprehensive therapeutic and music training framework. In conclusion, VRET holds substantial potential as a supportive tool in managing music performance anxiety, particularly in terms of flexibility, safety, and therapeutic effectiveness. Nevertheless, further research employing longitudinal designs, standardized protocols, and interdisciplinary collaboration is required to optimize its application and ensure sustainable long-term benefits for musicians’ psychological well-being and artistic development.
References
Anderson, P. L., & Molloy, A. (2020). Maximizing the impact of virtual reality exposure therapy for anxiety disorders. Current Opinion in Psychology, 36, 153–157. https://doi.org/10.1016/j.copsyc.2020.10.001
Barros, S., Marinho, H., Borges, N., & Pereira, A. (2022). Characteristics of music performance anxiety among undergraduate music students: A systematic review. Psychology of Music, 50(6), 2021–2043. https://doi.org/10.1177/03057356211066967
Bellinger, D., Wehrmann, K., Rohde, A., Schuppert, M., Störk, S., Flohr-Jost, M., Gall, D., Pauli, P., Deckert, J., Herrmann, M. J., & Erhardt-Lehmann, A. (2023). The application of virtual reality exposure versus relaxation training in music performance anxiety: a randomized controlled study. BMC Psychiatry, 23(1), 555. https://doi.org/10.1186/s12888-023-05040-z
Bissonnette, J., Dubé, F., Provencher, M. D., & Moreno Sala, M. T. (2016). Evolution of music performance anxiety and quality of performance during virtual reality exposure training. Virtual Reality, 20(1), 71–81. https://doi.org/10.1007/s10055-016-0283-y
Boeldt, D., McMahon, E., McFaul, M., & Greenleaf, W. (2019). Using virtual reality exposure therapy to enhance treatment of anxiety disorders: Identifying areas of clinical adoption and potential obstacles. Frontiers in Psychiatry, 10, 773. https://doi.org/10.3389/fpsyt.2019.00773
Boyle, D., Morrin, N., Scargill, J., Mulvey, F., Heavin, C., Flanagan, E., McMahon, B., & O’Connell, H. (2024). Co-designing a virtual reality exposure therapy with students experiencing school anxiety: a proof-of-concept study. Irish Journal of Psychological Medicine, 1–9. https://doi.org/10.1017/ipm.2024.22
Bruce, M., & Regenbrecht, H. (2009). A virtual reality claustrophobia therapy system - implementation and test. 2009 IEEE Virtual Reality Conference.
Cho, S.-E., Ma, H., & Kang, S.-G. (2023). Virtual reality exposure therapy for panic disorder. European Psychiatry: The Journal of the Association of European Psychiatrists, 66(S1), S452–S452. https://doi.org/10.1192/j.eurpsy.2023.972
Faur, A. L., Pintea, S., Vaida, S., & Opre, A. N. (2023). The efficacy of cognitive and behavioral interventions upon music performance anxiety: A meta-analysis. Psychology of Music, 51(2), 357–372. https://doi.org/10.1177/03057356221115461
Fernholz, I., Mumm, J. L. M., Plag, J., Noeres, K., Rotter, G., Willich, S. N., Ströhle, A., Berghöfer, A., & Schmidt, A. (2019). Performance anxiety in professional musicians: a systematic review on prevalence, risk factors and clinical treatment effects. Psychological Medicine, 49(14), 2287–2306. https://doi.org/10.1017/S0033291719001910
Freitas, J. R. S., Velosa, V. H. S., Abreu, L. T. N., Jardim, R. L., Santos, J. A. V., Peres, B., & Campos, P. F. (2021). Virtual Reality Exposure Treatment in phobias: A systematic review. The Psychiatric Quarterly, 92(4), 1685–1710. https://doi.org/10.1007/s11126-021-09935-6
Gao, S., Su, P., Wang, A., & Tao, Y. (2025). A bibliometric study of the evidence about applying virtual reality in mental health care. Journal of Multidisciplinary Healthcare, 18, 5213–5225. https://doi.org/10.2147/JMDH.S536946
Gerardi, M., Cukor, J., Difede, J., Rizzo, A., & Rothbaum, B. O. (2010). Virtual reality exposure therapy for post-traumatic stress disorder and other anxiety disorders. Current Psychiatry Reports, 12(4), 298–305. https://doi.org/10.1007/s11920-010-0128-4
Guo, M., Chen, Y., Xie, Y., Zhang, Y., Xu, A., Zhang, G., Kong, J., Zhong, Y., & Wang, C. (2025). How does virtual reality exposure treatment change the brain function of acrophobia patients? A randomized controlled trial. Depression and Anxiety, 2025, 7823251. https://doi.org/10.1155/da/7823251
Halouani, N., Boussaid, N., Turki, M., Barkallah, M., Ellouze, S., & Aloulou, J. (2024). Virtual Reality as exposure therapy in the treatment of blood-injection-injury phobias. European Psychiatry: The Journal of the Association of European Psychiatrists, 67(S1), S707–S707. https://doi.org/10.1192/j.eurpsy.2024.1472
Hartanto, D., Kampmann, I. L., Morina, N., Emmelkamp, P. G. M., Neerincx, M. A., & Brinkman, W.-P. (2014). Controlling social stress in virtual reality environments. PloS One, 9(3), e92804. https://doi.org/10.1371/journal.pone.0092804
Juncos, D. G., & Markman, E. J. (2016). Acceptance and Commitment Therapy for the treatment of music performance anxiety: A single subject design with a university student. Psychology of Music, 44(5), 935–952. https://doi.org/10.1177/0305735615596236
Kenny, D. T. (2005). A systematic review of treatments for music performance anxiety. Anxiety, Stress, and Coping, 18(3), 183–208. https://doi.org/10.1080/10615800500167258
Lindner, P., Miloff, A., Hamilton, W., Reuterskiöld, L., Andersson, G., Powers, M. B., & Carlbring, P. (2017). Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions. Cognitive Behaviour Therapy, 46(5), 404–420. https://doi.org/10.1080/16506073.2017.1280843
Lognoul, M., Nasello, J., & Triffaux, J.-M. (2020). La thérapie par exposition en réalité virtuelle pour les états de stress post-traumatiques, les troubles obsessionnels compulsifs et les troubles anxieux : indications, plus-value et limites. L’Encephale, 46(4), 293–300. https://doi.org/10.1016/j.encep.2020.01.005
Maples-Keller, J. L., Sherrill, A., Reddi, P., Norrholm, S. D., & Rothbaum, B. O. (2023). Extinction-based exposure therapies using virtual reality. Current Topics in Behavioral Neurosciences, 64, 335–352. https://doi.org/10.1007/7854_2023_437
McLay, R. N., Baird, A., Webb-Murphy, J., Deal, W., Tran, L., Anson, H., Klam, W., & Johnston, S. (2017). A randomized, head-to-head study of virtual reality exposure therapy for posttraumatic stress disorder. Cyberpsychology, Behavior and Social Networking, 20(4), 218–224. https://doi.org/10.1089/cyber.2016.0554
Nicholson, D. R., Cody, M. W., & Beck, J. G. (2015). Anxiety in musicians: On and off stage. Psychology of Music, 43(3), 438–449. https://doi.org/10.1177/0305735614540018
Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012). Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis: Virtual Reality Exposure Therapy. Depression and Anxiety, 29(2), 85–93. https://doi.org/10.1002/da.20910
Orman, E. K. (2004). Effect of virtual reality graded exposure on anxiety levels of performing musicians: a case study. Journal of Music Therapy, 41(1), 70–78. https://doi.org/10.1093/jmt/41.1.70
Papageorgi, I., Hallam, S., & Welch, G. F. (2007). A conceptual framework for understanding musical performance anxiety. Research Studies in Music Education, 28(1), 83–107. https://doi.org/10.1177/1321103x070280010207
Planert, J., Hildebrand, A. S., Machulska, A., Roesmann, K., Neubert, M., & Klucken, T. (2025). Efficacy of a blended, mobile-based intervention with integrated virtual reality exposure therapy for panic disorder and agoraphobia: a pilot randomized controlled trial. Cognitive Behaviour Therapy, 1–14. https://doi.org/10.1080/16506073.2025.2550427
Pull, C. B. (2005). Current status of virtual reality exposure therapy in anxiety disorders: editorial review. Current Opinion in Psychiatry, 18(1), 7–14.
Scheveneels, S., Engelhard, I., & Meyerbröker, K. (2025). Opening the black box: The underlying working mechanisms in virtual-reality exposure therapy for anxiety disorders. Clinical Psychological Science, 13(2), 207–221. https://doi.org/10.1177/21677026241267945
Seinfeld, S., & Montesano, A. (2025). Virtual reality in psychotherapy: A commentary on strategies, interventions, and perspectives from five clinical reports. Journal of Clinical Psychology, 81(9), 888–894. https://doi.org/10.1002/jclp.23813
Standen, B., Anderson, J., Sumich, A., & Heym, N. (2023). Effects of system- and media-driven immersive capabilities on presence and affective experience. Virtual Reality, 27(1), 371–384. https://doi.org/10.1007/s10055-021-00579-2
Strickland, D., Hodges, L., North, M., & Weghorst, S. (1997). Overcoming phobias by virtual exposure. Communications of the ACM, 40(8), 34–39. https://doi.org/10.1145/257874.257881
ThompSon, N., Pan, X., & Ruiz, M. H. (2025). Setting the stage: Using Virtual Reality to assess the effects of music Performance Anxiety in pianists. IEEE Transactions on Visualization and Computer Graphics, 31(5), 2504–2514. https://doi.org/10.1109/TVCG.2025.3549843
Wray, T. B., Kemp, J. J., & Larsen, M. A. (2023). Virtual reality (VR) treatments for anxiety disorders are unambiguously successful, so why are so few therapists using it? Barriers to adoption and potential solutions. Cognitive Behaviour Therapy, 52(6), 603–624. https://doi.org/10.1080/16506073.2023.2229017
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ting Wang, Hao Yi Ho
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
