This article by Christopher Butler discusses using virtual reality (VR) to assist exposure therapy for music performance anxiety. Performance anxiety affects musicians at all levels, causing physical and psychological symptoms. Exposure therapy, which gradually exposes individuals to feared situations, can help manage anxiety rather than eliminate it. VR technology can simulate realistic performance environments, allowing musicians to practice performing under anxiety-inducing conditions safely. A pilot study at Southern Illinois University is exploring how VR headsets affect musicians’ ability to perform and their anxiety levels, aiming to provide new strategies alongside traditional practice to improve live performance confidence.

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All musicians typically experience performance anxiety. From those in the earliest levels of study to the top artists in our craft, we all experience some level of fear before performing. Physical symptoms can include an elevated heart rate, erratic trembling, and loss of fine motor control. Psychological symptoms can include memory lapses, an inability to focus thoughts, and an erosion of confidence. These common experiences can affect even the most prepared musician.

We know that practice is essential in helping musicians overcome this hurdle. We can all agree that with proper preparation, performing simply becomes easier. We also must acknowledge, however, that performance anxiety can be an absolute roadblock for developing musicians. What if you are one who is more sensitive to the anxiety of live performance? What if you feel like, no matter how much you prepare, there is always a voice in your head just waiting for you to make your first mistake?

This PASIC 2026 session, “Virtual Reality-Assisted Exposure Therapy for Music Performance Anxiety,” will showcase applications of virtual and augmented reality technology to explore how established psychological treatments, such as exposure therapy, can help musicians perform at a higher level. I want to emphasize that this is not intended to replace individual practice, but rather to serve as an informed supplemental approach that may provide musicians with additional strategies to practice performing.

THE METHOD
Exposure therapy is a well-established psychological treatment in which individuals are gradually exposed to feared and anxiety-inducing situations within a controlled environment over time. The goal is not to eliminate anxiety completely, but rather to reduce avoidance by repeatedly confronting these situations and developing new perspectives and responses. Ultimately, we want to provide musicians with additional tools to better understand and manage anxiety — not eliminate it.

Consider this: In an instant, you can transport yourself from a practice room to performing on stage in a packed concert hall. You can hear the hushed sounds of the audience, see their dimly lit faces looking toward the stage, and begin experiencing many of the same feelings you would during a live performance. This isn’t science fiction; this is possible right now with the use of virtual reality headsets.

THE TECHNOLOGY
First, I want to clarify the difference between Virtual Reality (VR) and Augmented Reality (AR). With VR, users enter a completely immersive environment that replaces their physical surroundings. On the other hand, AR combines computer-generated elements with the real world, allowing users to interact with their physical environment while also engaging with virtual content. Virtual windows can be spatially placed throughout your room and resized with a single gesture. In either approach, don’t assume these environments have to look like a video game. Using a 360-degree camera — or even your phone — you can record immersive videos of actual performance spaces and later experience those same environments through a headset.

THE STUDY
In collaboration with Dr. Eric Lee (Associate Professor of Psychology) and Dr. Jessica Butler (Assistant Professor of Low Brass and Music History) at Southern Illinois University, we are leading a pilot program utilizing VR technology with undergraduate and graduate music majors. Among the questions we hope to answer are:

• Is it possible to perform and read music while wearing a VR headset?
• What specific idiomatic challenges do different instrumental areas present when performing with a headset? For example, is it possible to comfortably perform four-mallet marimba literature while wearing a headset?
• How do students rank their performance anxiety before and after repeated VR sessions?
• Does VR-assisted exposure therapy improve live musical performance?

The results will be evaluated through participant self-reflection as well as formal musical performance assessments. For the initial phase of our pilot program, we are utilizing an Apple Vision Pro headset, but we plan to expand to additional devices, including the Meta Quest, in future research.

During my PASIC session, I will share preliminary findings from our pilot study, along with the beta release of our companion iOS app that will continue to be utilized throughout the project. It is our hope that this interdisciplinary approach can contribute to the growing body of research on music performance anxiety and explore how emerging virtual reality technologies can become practical tools that help musicians prepare for the mental demands of live performance.