The Application of Virtual Reality Exposure Versus Relaxation Training in Music Performance Anxiety

The aim of the study is to investigate the effect of exposure treatment using virtual reality (VR) in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. The prospective, randomized clinical trial will include 46 musicians with musical performance anxiety (MPA). The experimental group will receive four exposure sessions in VR and the control group will receive four progressive muscle relaxation (PMR) sessions. Anxiety symptoms will be measured using a german version of the Performance Anxiety Questionnaire and a behavioral assessment test (BAT) before, after the treatment, and at 6-month follow-up. The cardiovascular reactivity will be assessed measuring the heart rate variability (HRV) throughout the BAT and the blood pressure before and after the BAT. Furthermore, blood and saliva samples will be collected before and after the BAT to assess endocrine stress parameters and epigenetic markers. The following hypotheses are derived: 1) Significant and lasting reduction of subjective MPA symptoms for the experimental group receiving VRET at T1 (post/ shortly after treatment) and T2 (follow-up/ 6 months after treatment) compared to T0 (pre/ before treatment). 2) Significant better reduction of subjective MPA symptoms for the experimental group receiving VRET compared to the control group receiving PMR at T1 (post/shortly after treatment) and T2 (follow-up/ 6 months after treatment) compared to T0 (pre/ before treatment). 3) The postulated effects in hypotheses 1 and 2 go along with a significantly higher HRV representing less cardiac stress during the BAT in case of a successful reduction of anxiety symptoms at T1 (post/ shortly after treatment) and T2 (follow-up/ 6 months after treatment) compared to T0 (pre/ before treatment).

Inclusion Criteria:Music performance anxiety (MPA)Reporting anxiety and/or avoidance of musical performance situationsReporting psychological distress and/or impaired functioning due to the MPASufficient knowledge of the German language (to understand questionnaires and the therapy manual)Compliance with the covid-19-regulations for local study appointmentsWritten informed consentExclusion Criteria:Substance use disorderPhysiological contraindications for an exposure therapy (i.e. epilepsy, serious disorder of the cardiovascular system)Psychological contraindications for an exposure therapy (i.e. psychotic disorder, substance dependence, borderline personality disorder, acute suicidality)Use of sedative medication or tranquilizers (i.e. beta-blockers) for the therapy appointmentsClaustrophobiaBlood-injection-injury type phobiaInstrument not portable, too big or not playable while standing (i.e. piano, drums, harp, double bass)Not able to play the instrument blindfoldCurrent psychotherapy because of the MPARecent (< 6 months ago) psychotherapy because of the MPA