Acrophobia

This study examined the effect of computer generated virtual reality graded exposure on the physiological and psychological responses of performing musicians. Three upper division undergraduate saxophonists, two female and one male, performed while immersed in four virtual environments each designed to gradually increase the expected anxiety level of the performer. Heart rates and subjective measurements were taken throughout the exposure period. Results of this study indicated that virtual reality graded exposure did elicit physiological and psychological indications of increased anxiety in musical performance environments designed for that purpose. Findings also corroborated previous research that found gender to be a predictor of heart rate during performance.

Behavioral therapy, including Joseph Wolpe's concept of systematic desensitization and reciprocal intervention, has been successfully employed in music therapy interventions. Appel (1976) found that systematic desensitization training with "in vivo" activities for adult pianist was more effective than music analysis training or no training in reducing solo performance anxiety. Hoelzley (1991) used reciprocal intervention, an extension of systematic desensitization, within the context of music therapy to eliminate fear, anxiety and avoidance in a case study involving a child with pervasive developmental disorder. Use of these behavioral therapies is generally limited to "in vivo" or imagery techniques so that the anxiety provoking stimuli is sufficient enough to produce the anxiety response. If virtual reality is capable of producing adequate levels of anxiety response in music environments, this technique may expand currently available options and be applicable to areas of music therapy in which systematic desensitization or reciprocal intervention treatment can be employed.

Virtual reality is a computer simulation of real or imaginary environments that enables a user to interact with the environment in real time. In many cases a head mounted display, worn by the user, presents visual and audio information about the environment. A tracking device can be added to the head mounted display that allows the video and audio to change naturally with head and body motion.

Virtual reality combined with systematic desensitization has shown promising results in the treatment of different types of social anxiety. Rothbaum et al. (1995a) found that those college students with acrophobia showed significant improvement after 7 weekly 35-45 minute virtual reality sessions as compared to a wait list group that remained unchanged. Pre and posttest measures of a 19-year-old undergraduate student treated for acrophobia using a virtual environment of a working glass elevator revealed that virtual reality graded exposure was successful in reducing this individual's fear of heights (Rothbaum et al., 1995b). Virtual reality exposure therapy has also been shown to be effective in reducing debilitating fear and avoidance of flying (Rothbaum, Hodges, Watson, Kesser, & Opdyke, 1996) and posttraumatic stress syndrome (Rothbaum et al., 1999).

Rothbaum, Hodges, and Kooper (1997) stress that virtual reality must provide a sense of presence where an individual feels present in the environment as opposed to simply viewing a photograph or video of the environment. Hodges, Anderson, Burdea, Hoffman, and Rothbaum (2001) reported that anxious individuals can feel anxious in a virtual environment, virtual environments can generate both interpersonal and physical cues and even low level computer graphics can be effective because individuals seem to add their own experiences to the environment.

Music performance anxiety has been identified as a type of social anxiety that can have positive or negative effects on performance. Negative effects of performance anxiety can cause the musical performance to deteriorate to a level lower than the performer is capable of producing (Wolfe, 1989). Performing condition has been identified as a predictor of the level of performance anxiety experienced (Brotons, 1994, Cox & Kenardy, 1993; Hamann, 1982; LeBlanc, Jin, Oben, & Siivola, 1997; Picard, 1999; Wardle, 1975). LeBlanc (1994) suggested that performers who suffer from the negative effects of performance anxiety should attempt to discern the performing environment and practice under similar conditions. Behavioral-rehearsal or imagery has been found to be effective at reducing performance anxiety (Kendrick, Craig, Lawson, & Davidson, 1982; Wardle, 1975). Physiological measurements of music performance anxiety have included various observational techniques and heart rate measurements (Brotons, 1994; Kendrick, Craig, Lawson, & Davidson, 1982; LeBlanc, Campbell, & Codding, 1993; LeBlanc, Jin, Obert, & Siivola, 1997; Wardle, 1975).

Since performance condition had been shown to influence performance anxiety and virtual reality had been shown to generate environments that can create a sense of presence it seemed reasonable to investigate whether or not this medium can create a sense of presence for performing musicians. This study represents the first known attempt to use virtual reality in a music performance environment with performing musicians. The purpose of this study was to examine the effects of computer generated virtual reality graded exposure on the physiological and psychological responses of performing musicians.

Method

Three upper division undergraduate saxophonists, two female and one male, voluntarily participated in this study. Subject 1, a female, was 49 years old and considered herself a proficient performer on saxophone with 35 years of study and trumpet with 5 years of study. She estimated she had participated in 195 public music performances as a member of a large ensemble and 4 public music performances as a soloist. Subject 2, also a female, was 21 years old and considered herself a proficient performer on saxophone with 9 years of study, clarinet with 2 years of private study and flute with 1 year of private study. She estimated she had participated in 150 public music performances as a member of a large ensemble and 20 public music performances as a soloist. Subject 3, a male, was 22 years old and considered himself a proficient performer on saxophone with 11 years of study, clarinet with 4 years of study, and flute with 4 years of study. He estimated he had participated in 115 public music performances as a member of a large ensemble and 20 public music performances as a soloist.

Both physiological and psychological anxiety measurements were obtained from each subject throughout the study. The physiological measurements were taken from a Polar Vantage S-610 heartrate monitor and T-31 noncoded electrode chest transmitter used to acquire each subject's heart rate at 5-second intervals. Earlier models of this device have been successfully used in previous studies of music performance anxiety (Brotons, 1994; LeBlanc, Campbell, & Codding, 1993; LeBlanc, Jin, Obert, & Siivola, 1997). Electrode gel was also used to aid proper reception and transmission of heart rate readings from the transmitters. Psychological measurements in the form of Subjective Units of Discomfort (SUDs) were elicited from each subject. A SUD is a 0 to 100 self-reported anxiety measure in which 0 indicates no anxiety or discomfort and 100 indicates extreme anxiety. Measurements were taken while subjects were immersed in various virtual environments.

Prior to beginning the study, four virtual environments each designed to be easily identified and recognized by the subjects were created. Each environment was purposely designed to gradually increase the expected anxiety level of the performer. First, the environment designed to create the lowest level of anxiety was an empty room commonly used by the subjects as a practice room. Second, was a room with members of the saxophone studio class seated as an audience. A room with three faculty members from the school of music seated as if listening to and possibly judging a performance constituted the third environment. The fourth environment was a room with the director of bands seated as if listening to and judging an audition for entry and placement in a major performing ensemble. One additional virtual environment that consisted of a nature setting including a forest, waterfall and a stream was used to introduce the subjects to the virtual reality apparatus, obtain a baseline heart rate reading and SUD rating before immersion into the four previously described environments, and to "return" the subject to a baseline heart rate reading and SlJD rating in-between immersion into each of the previously described environments.

Hardware and software used to create the virtual environments consisted of a Canon GL 1 mini digital video camcorder, a Pentium III desktop computer workstation and various digital audio and digital video rendering software packages. Hardware used to experience the virtual environments included a VFX-3D head mounted display with head tracking and stereo audio capabilities.

Two sessions were conducted with each subject. In the first session, the study and proper use of the equipment was explained, informed consent obtained and subjects completed a personal details form recording their age, sex, proficiency level and number of years of study on all instruments, and the number of public performances as part of a group and as a soloist. Subjects were then familiarized with the virtual reality equipment by being immersed into the natural park setting of a forest, waterfall, and stream. Subjects were encouraged to look around the entire environment and physically walk around while immersed in order to help alleviate any self-imposed spatial restrictions that might have existed.

During the second session, each subject was asked to perform his or her major scales as if performing for a jury or audition while immersed in each of the different environments. Subjects remained in each environment for as long as it took to complete the performance of their major scales. Prior to beginning, a 2-minute baseline heart rate and SUD was gathered while the subject was not performing and immersed in the natural park setting of a forest, waterfall and stream. This same baseline reading and immersion took place before immersion into each performance environment where major scales were performed. Immersion into musical performance environments with scale performances were conducted in the following order: empty practice room, room with studio class participants seated as an audience, room with three school of music professors seated as if listening to and possibly judging a performance, and a room with the director of bands seated as if judging a seat audition for entry and placement in a major performing ensemble. Heart rate readings were continuously obtained during immersion and SUDS were elicited immediately following immersion in each environment.

Results

Data from each immersive environment was tabulated to include an average heart rate based upon individual heart rates obtained at 5-second intervals, the maximum heart rate and a SUD rating based upon how the subject felt during the time the heart rate readings were obtained. The average and maximum heart rate for the baseline environment directly preceding each musical performance environment was subtracted from the average and maximum heart rate obtained in the virtual musical performance environment. Results of these calculations show the change in average and maximum heart rate in each graded virtual musical performance environment as compared to the preceding baseline environment. Results indicated that physiological measures of anxiety increased as subjects were immersed in the environments designed to elicit greater anxiety (see Table 1).

Psychological measurements in the form of SUDS demonstrated an increased anxiety level when immersed in the environments designed to elicit greater anxiety for two subjects; however, one subject's SUD levels indicated a relatively stable level of anxiety (see Table 2). For Subject 2, the SUD levels increased and decreased in the same direction as changes in the average heart rate. SUD level and average heart rate for Subject 1 increased from the Empty Practice Room environment to the Studio Class; however, the SUD levels dropped for the other environments while the heart rate increased and maintained a high level. SUD levels for Subject 3 increased with each successive environment, however, heart rate was higher for the empty room than for the studio class environment.

Discussion

Results of this study indicate that virtual reality graded exposure does elicit physiological and psychological indications of increased anxiety in musical performance environments that would most likely educe increased levels of anxiety within the natural world. Interestingly, each subject was acutely aware that what he or she was experiencing was not real. Each subject walked into a room with a computer workstation, put on a head mounted display unit with stereo headphones and proceeded to perform his or her major scales while immersed in different environments. Therefore, they were aware of the non-reality of the event but yet the event was able to evoke physiological and in some cases psychological responses indicative of the real world.

While the different music performance environments did elicit increased levels of anxiety, it was thought at the onset of the study that the different musical performance environments would educe greater levels of anxiety in relation to the order of presentation (i.e., the empty room would elicit the lowest level of anxiety and performing in front of the director of bands would elicit the highest level of anxiety). Results show, however, that anxiety levels for two subjects maintained or dropped slightly when performing in front of the director of bands as compared to performing in front of the three music faculty members. In addition, Subject 2 only showed a slight variation in anxiety levels taken when performing in front of the studio class members, the three music faculty members or the director of bands. These findings may be the result of each subject's current status in his or her degree program. Each subject had completed all juries, major performances, studio lesson and ensemble requirements for his or her degree; therefore, in his or her mind, these environments may very well have been a part of the past. In addition, neither Subject 1 or Subject 2 had ever been a member of the top performing ensemble conducted by the director of bands; therefore, while they were aware of the status of this individual and the audition environment, it may have been an unrealistic environment based upon their past experiences.

Subject 3 elicited much lower differences between baseline and heart rate readings while immersed in the various environments. While his heart rate increased as expected it was not as dramatic of an increase as found in Subjects 1 and 2. This finding supports those by LeBlanc, Jin, Obert and Siivola (1997) in which female performers had higher heart rates during performance and gender was identified as a significant predictor of heart rate. It is curious and unknown why the difference between baseline and performance immersion for this subject was higher in the environment of the empty room as compared to the environment containing the studio class members.

SUD ratings were quite different between subjects. SUD ratings for Subjects 2 and 3 were comparable to the difference scores of the heart rate readings within each environment; however, SUD ratings for Subject 1 were relatively low and consistent across all environments. It is difficult to speculate why this occurred but it may be that for some individuals there is little relation between subjective indications and objective measures of anxiety. Stated another way, for some individuals there may be a large difference between what they feel and what is taking place biologically.

Results from this case study indicate that virtual reality graded exposure does elicit physiological and psychological indications of increased anxiety in musical performance environments designed for that purpose. Therefore, virtual reality may be a viable tool for various types of music therapy intervention. If the sense of presence can be elicited in other environments, it may be possible to immerse subjects into environments that tempt the subject with addictive stimuli without having the serious repercussions that could be associated with someone giving into the addiction in an "in vivo" situation. Since real or imaginary environments are possible, subjects could be immersed into environments that are either not possible or simply not practical for an "in vivo" session. In addition, subjects who find imagery a difficult task may be able to use virtual reality to fully realize a sense of presence. These and other possibilities will need to be pursued in future research. Current research is investigating the effects of repeated graded exposure on the physiological and psychological indicators of music performance anxiety.

References

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Evelyn K. Orman, EdD

Louisiana State University

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