Effects of virtual reality training on musical performance-related physiological responses: A mixed-reality physiological study

Music Performance Anxiety (MPA) is a prevalent condition that can impair performance quality and even lead to career abandonment. While virtual reality exposure therapy (VRET) has shown promise in addressing anxiety disorders, its effectiveness for MPA remains unclear. This study explored the feasibility of a mixed-reality VR framework designed to simulate exam performance conditions and assess physiological responses in music students. Fifteen students (10 females; M = 20.73 years, SD = 1.39) were randomly assigned to experimental or control groups. Across three weeks before exams, participants completed two weekly one-hour VR practice sessions. Controls viewed their practice room through VR headsets, while the experimental group trained in a virtual concert hall displaying their teachers in the audience. During exams, heart rate, respiratory rate, and variability measures were collected at rest, baseline, and performance using smart shirts. Data were analyzed with linear mixed-effects modeling. No significant training effects were observed. However, exams reliably triggered physiological stress responses, confirming the anxiety-inducing nature of performance. Instrument type significantly influenced respiratory measures, and gender differences emerged in heart rate variability, with females showing higher variability. Limitations included small sample size, reduced immersion, and suboptimal signal quality. Although no statistically significant group differences were observed, simulation-based sensitivity analyses indicated limited power to detect small physiological effects, whereas moderate to large effects would likely have been detectable with modestly larger sample sizes. Results suggest that our design is capable of inducing and measuring performance-related physiological stress and provide a feasible approach for future adequately powered studies. • VR training used to simulate exam performance during practice in music students. • Mixed-reality concert hall enabled real instrument use with virtual acoustics. • Physiological stress responses measured during exam with wearable smart shirts. • No group differences found, however instrument affected respiration but not HRV. • Results emphasize the need for improved immersion and realism in VR interventions.