Skip to main content
Log in

Effects of Exposure in Computer-Assisted Virtual Environments on Vocalists’ Performance Anxiety: A Quasi-Experimental Study

Journal of Rational-Emotive & Cognitive-Behavior Therapy Aims and scope Submit manuscript

Abstract

As the use of virtual reality exposure training in treating various anxiety disorders including music performance anxiety increases, it is becoming more important to understand what components of virtual reality programs affect the effectiveness of the training. Thus, this study examines how various attributes of an exposure training program in a computer-assisted virtual environment affect vocalists’ music performance anxiety. This study also explores how different attributes of virtual reality programs affect five experiential dimensions of vocalists’ music performance anxiety. A quasi-experimental (pre- and post-exposure) design study exposes eighteen adult professional vocalists and those training to become professional vocalists with previous public performance experience to virtual performance situations with varying attributes. The results demonstrate that exposure training in the virtual environment significantly reduces the participants’ music performance anxiety. The results also demonstrate that different attributes of the programs affect the sensory, affective, cognitive, behavioral, and relational dimensions of the participants’ music performance anxiety differently. The insights the findings provide for the development of virtual reality exposure training programs and digital therapeutic applications for music performance anxiety and other types of anxiety and disorders are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Data Availability

The data that support the findings of this study are available from the corresponding author upon request.

References

  • Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423.

    Article  Google Scholar 

  • Aufegger, L., Perkins, R., Wasley, D., & Williamon, A. (2017). Musicians’ perceptions and experiences of using simulation training to develop performance skills. Psychology of Music, 45(3), 417–431.

    Article  Google Scholar 

  • Baños, R. M., Botella, C., Alcañiz, M., Liaño, V., Guerrero, B., & Rey, B. (2004). Immersion and emotion: Their impact on the sense of presence. Cyberpsychology & Behavior, 7(6), 734–741. https://doi.org/10.1089/cpb.2004.7.734

    Article  Google Scholar 

  • 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), 1–18.

    Article  Google Scholar 

  • Bissonnette, J., Dubé, F., Provencher, M. D., & Moreno Sala, M. T. (2015). Virtual reality exposure training for musicians: Its effect on performance anxiety and quality. Medical Problems of Performing Artists, 30(3), 169–177. https://doi.org/10.21091/mppa.2015.3032

    Article  PubMed  Google Scholar 

  • 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, 71–81.

    Article  Google Scholar 

  • Caponnetto, P., Triscari, S., Maglia, M., & Quattropani, M. C. (2021). The simulation game—virtual reality therapy for the treatment of social anxiety disorder: A systematic review. International Journal of Environmental Research and Public Health, 18(24), https://doi.org/10.3390/ijerph182413209. Article 13209.

  • Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., Asmundson, G. J. G., Carlbring, P., & Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of Anxiety Disorders, 61, 27–36.

    Article  PubMed  Google Scholar 

  • Craske, M. G., & Mystkowski, J. L. (2006). Exposure Therapy and Extinction: Clinical Studies. In M. G. Craske, D. Hermans, & D. Vansteenwegen (Eds.), Fear and learning: From basic processes to clinical implications (pp. 217–233). American Psychological Association. https://doi.org/10.1037/11474-011

  • Crawford, C. R. (2011). Effects of exposure to virtual audience environments on performing musicians (Doctoral dissertation, McGill University Library).

  • Derryberry, D., & Reed, M. A. (2002). Anxiety-related attentional biases and their regulation by attentional control. Journal of Abnormal Psychology, 111(2), 225–236. https://doi.org/10.1037/0021-843X.111.2.225

    Article  PubMed  Google Scholar 

  • Dewey, J. (1934). The supreme intellectual obligation. Science, 79(2046), 240–243.

    Article  PubMed  Google Scholar 

  • Diemer, J., Pauli, P., & Mühlberger, A. (2015). Virtual reality in psychotherapy. In J. D. Wright (Ed.), International Encyclopedia of the social and behavioral sciences (2nd ed., pp. 138–146). Elsevier. https://doi.org/10.1016/B978-0-08-097086-8.21070-2

  • Fanger, Y., Pfeuffer, K., Helmbrecht, U., & Alt, F. (2020). PIANX–A platform for piano players to alleviate music performance anxiety using mixed reality. In Proceedings of the 19th International Conference on Mobile and Ubiquitous Multimedia, 267–276.

  • Fernholz, I., Mumm, J. L., 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.

    Article  PubMed  Google Scholar 

  • 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. Psychiatric Quarterly, 92(4), 1685–1710. https://doi.org/10.1007/s11126-021-09935-6

    Article  PubMed  Google Scholar 

  • Gorini, A., & Riva, G. (2008). Virtual reality in anxiety disorders: The past and the future. Expert Review of Neurotherapeutics, 8(2), 215–233. https://doi.org/10.1586/14737175.8.2.215

    Article  PubMed  Google Scholar 

  • Horigome, T., Kurokawa, S., Sawada, K., Kudo, S., Shiga, K., Mimura, M., & Kishimoto, T. (2020). Virtual reality exposure therapy for social anxiety disorder: A systematic review and meta-analysis. Psychological Medicine, 50(15), 2487–2497.

    Article  PubMed  Google Scholar 

  • Jung, S. Y., & Lee, H. N. (2019). Experiential marketing case analysis of online shopping mall using VR, AR. Journal of the Korean Society Design Culture, 25(3), 393–402.

    Article  Google Scholar 

  • Kampmann, I. L., Emmelkamp, P. M., Hartanto, D., Brinkman, W. P., Zijlstra, B. J., & Morina, N. (2016). Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial. Behaviour Research and Therapy, 77, 147–156.

    Article  PubMed  Google Scholar 

  • Kenny, D. T. (2009). The factor structure of the revised Kenny Music Performance Anxiety Inventory. In International Symposium on Performance Science (pp. 37–41). Utrecht, The Netherlands: Association Européenne des Conservatoires.

  • Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I., & Nugues, P. (2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: A preliminary controlled study. Cyberpsychology & Behavior, 8(1), 76–88.

    Article  Google Scholar 

  • Korea Ministry of Food and Drug Safety (2022). Digital treatment device license and evaluation guidelines. https://www.mfds.go.kr/brd/m_210/view.do?seq=14596

  • Krijn, M., Emmelkamp, P. M., Olafsson, R. P., & Biemond, R. (2004). Virtual reality exposure therapy of anxiety disorders: A review. Clinical Psychology Review, 24(3), 259–281. https://doi.org/10.1016/j.cpr.2004.04.001

    Article  PubMed  Google Scholar 

  • Lindner, P., Dagöö, J., Hamilton, W., Miloff, A., Andersson, G., Schill, A., & Carlbring, P. (2021). Virtual reality exposure therapy for public speaking anxiety in routine care: A single-subject effectiveness trial. Cognitive Behaviour Therapy, 50(1), 67–87. https://doi.org/10.1080/16506073.2020.1795240

    Article  PubMed  Google Scholar 

  • Maples-Keller, J. L., Bunnell, B. E., Kim, S. J., & Rothbaum, B. O. (2017). The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harvard Review of Psychiatry, 25(3), 103–113.

    Article  PubMed  PubMed Central  Google Scholar 

  • McGinnis, A. M., & Milling, L. S. (2005). Psychological treatment of musical performance anxiety: Current status and future directions. Psychotherapy: Theory Research Practice Training, 42(3), 357–373. https://doi.org/10.1037/0033-3204.42.3.357

    Article  Google Scholar 

  • Mumm, J., Fernholz, I., Ströhle, A., Plag, J., & Schmidt, A. (2020). Performance anxiety among musicians - current state of research on causes, treatment options, and prevention. Z für Neuropsychologie, 31(2), 76–80.

    Article  Google Scholar 

  • Nagel, J. J., Himle, D. P., & Papsdorf, J. D. (1989). Cognitive-behavioural treatment of musical performance anxiety. Psychology of Music, 17(1), 12–21.

    Article  Google Scholar 

  • Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics, 33(3), 557–577. https://doi.org/10.1016/j.psc.2010.04.002

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Osborne, M. S., & Kenny, D. T. (2008). The role of sensitizing experiences in music performance anxiety in adolescent musicians. Psychology of Music, 36(4), 447–462. https://doi.org/10.1177/0305735607086051

    Article  Google Scholar 

  • Owens, M. E., & Beidel, D. C. (2015). Can virtual reality effectively elicit distress associated with social anxiety disorder? Journal of Psychopathology and Behavioral Assessment, 37, 296–305. https://doi.org/10.1007/s10862-014-9454-x

    Article  Google Scholar 

  • Park, M. C., Jung, H. C., & Hur, H. L. (2020). Analysis and suggestions of the regulatory environment for Digital Therapeutics (DTx) from the perspective of addiction treatment. Korean Association of Addiction Crime Review, 10(2), 33–47.

    Article  Google Scholar 

  • Powers, M. B., & Emmelkamp, P. M. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders, 22(3), 561–569. https://doi.org/10.1016/j.janxdis.2007.04.006

    Article  PubMed  Google Scholar 

  • Rahim, M. A., & Magner, N. R. (1995). Confirmatory factor analysis of the styles of handling interpersonal conflict: First-order factor model and its invariance across groups. Journal of Applied Psychology, 80(1), 122–132. https://doi.org/10.1037/0021-9010.80.1.122

    Article  PubMed  Google Scholar 

  • Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24(1), 1–8. https://doi.org/10.1016/0005-7967(86)90143-9

    Article  PubMed  Google Scholar 

  • Riva, G., Bacchetta, M., Cesa, G., Conti, S., & Molinari, E. (2001). Virtual reality and telemedicine based experiential cognitive therapy: Rationale and clinical protocol. In G. Riva, & C. Galimberti (Eds.), Towards CyberPsychology: Mind, cognition, and Society in the internet age Amsterdam (pp. 273–309). IOS Press.

  • Salmon, P. G. (1990). A psychological perspective on musical performance anxiety: A review of the literature. Medical Problems of Performing Artists, 5(1), 2–11.

    Google Scholar 

  • Schmitt, B. (1999). Experiential marketing. Journal of Marketing Management, 15(1–3), 53–67. https://doi.org/10.1362/026725799784870496

    Article  Google Scholar 

  • Shiban, Y., Schelhorn, I., Pauli, P., & Mühlberger, A. (2015). Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: A randomized clinical trial in virtual reality. Behaviour Research and Therapy, 71, 45–53. https://doi.org/10.1016/j.brat.2015.05.014

    Article  PubMed  Google Scholar 

  • Spahn, C., Krampe, F., & Nusseck, M. (2021). Classifying different types of music performance anxiety. Frontiers in Psychology, 12, Article 538535. https://doi.org/10.3389/fpsyg.2021.538535

  • Taborsky, C. (2007). Musical performance anxiety: A review of literature. Update: Applications of Research in Music Education, 26(1), 15–25.

    Google Scholar 

  • Van Kemenade, J. F., Van Son, M. J., & Van Heesch, N. C. (1995). Performance anxiety among professional musicians in symphonic orchestras: A self-report study. Psychological Reports, 77(2), 555–562. https://doi.org/10.2466/pr0.1995.77.2.555

    Article  PubMed  Google Scholar 

  • Van Zyl, M. (2020). The effects of virtual reality on music performance anxiety among university-level music majors. Visions of Research in Music Education, 35(1), Article 15. https://opencommons.uconn.edu/vrme/vol35/iss1/15

    Google Scholar 

  • Watson, D. & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33(4), 448–457.

  • Wechsler, T. F., Kümpers, F., & Mühlberger, A. (2019). Inferiority or even superiority of virtual reality exposure therapy in phobias? - a systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in agoraphobia, specific phobia, and social phobia. Frontiers in Psychology, 10, 1758.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wiederhold, B. K., & Wiederhold, M. D. (2005). Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment. American Psychological Association. https://doi.org/10.1037/10858-000

  • Williamon, A., Aufegger, L., & Eiholzer, H. (2014). Simulating and stimulating performance: Introducing distributed simulation to enhance musical learning and performance. Frontiers in Psychology, 5, 25. https://doi.org/10.3389/fpsyg.2014.00025

    Article  PubMed  PubMed Central  Google Scholar 

  • Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and psychopathology. Psychological Bulletin, 120(1), 3–24. https://doi.org/10.1037/0033-2909.120.1.3

    Article  PubMed  Google Scholar 

  • Witmer, B. G., & Singer, M. J. (1998). Measuring presence in virtual environments: A presence questionnaire. Presence Teleoperators and Virtual Environments, 7(3), 225–240. https://doi.org/10.1162/105474698565686

    Article  Google Scholar 

  • Woo, K., Baik, S., & Kim, S. T. (2020). Application of digital software as a medical device in dental clinics. Journal of Dental Rehabilitation and Applied Science, 36(4), 203–210. https://doi.org/10.14368/jdras.2020.36.4.203

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank People Insight Lab whose assistance with participant recruitment and data collection was critical in completing this study.

Funding

This study was conducted as a part of the Product Service Technology Development Project funded by the Korea Technology & Information Promotion Agency (TIPA) for Small and Medium Enterprises (Grant number: S2614433; Grant amount: 220,000,000KRW).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Junyong Kim.

Ethics declarations

Research Involving Human Participants

The study reported in this article involved human participants, and the IRB at People Insight Lab who was responsible for data collection reviewed and approved the study (IRB-201904-001).

Informed Consent

The participants consented to participate in the study after receiving detailed information about the tasks and the procedure they were to be exposed.

Competing Interests

ECI Co. Ltd., the first author’s company, has the license for all tangible and intangible outcomes produced based on the data and technology generated from the above-mentioned project, and the authors have no other conflict of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, S., Kim, J. & Kim, S. Effects of Exposure in Computer-Assisted Virtual Environments on Vocalists’ Performance Anxiety: A Quasi-Experimental Study. J Rat-Emo Cognitive-Behav Ther (2023). https://doi.org/10.1007/s10942-023-00533-y

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10942-023-00533-y

Keywords

Navigation