JMIR Publications

ABSTRACT

Background:

Exposure therapy is known to be one of the most effective ways to treat anxiety disorders, but it’s not often used in actual counseling settings. This is partly because of time and cost constraints, and partly because both therapists and clients can feel reluctant to engage in real-life exposures. Virtual reality exposure therapy (VRET) offers an alternative that could help address these issues. It allows clients to confront fears in a safe and controlled digital environment. While research has shown VRET to be effective and more affordable than it used to be, many counselors still aren’t using it. Most previous studies on VRET adoption have focused on hospital settings and haven’t paid much attention to individual or workplace factors that might affect whether therapists are open to using new technologies.

Objective:

This study looked at what affects counselors’ willingness to use VRET in their practice. We focused on certified Korean counselors working in different settings, such as universities, public centers, and private practices. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) as a base model, but added extra factors related to job stress and resistance to change. We also asked open-ended questions to understand what counselors thought about VRET more deeply.

Methods:

A cross-sectional mixed-methods study was conducted with 258 certified counselors across various settings, including universities, public institutions, and private clinics. Participants watched a 4-minute VRET introduction video and completed a survey measuring UTAUT variables (performance expectancy, effort expectancy, facilitating conditions, social influence), resistance to change, and job stress. Stepwise multiple linear regression and moderation analyses were performed. Open-ended responses on VRET applicability and improvement suggestions were analyzed thematically.

Results:

Performance expectancy (β = .404, P < .001) and social influence (β = .387, P < .001) significantly predicted VRET adoption intentions (R² = .494). Moderation analysis revealed that routine seeking weakened the impact of performance expectancy (β = –.160, P < .01), low job control strengthened it (β = .162, P < .005), and high job demands reduced the influence of social influence (β = –.150, P = .01). Age-stratified analyses showed that younger counselors were more sensitive to contextual moderators, whereas older counselors prioritized performance expectancy. Thematic analysis (N = 258) identified three primary themes: (1) Ambivalence toward VRET—some viewed it as a treatment in itself, while others as a supplementary tool; (2) Barriers and facilitators—including technological unfamiliarity, but also the need for promotional efforts and content diversification; and (3) Control and professionalism—highlighting the need for intuitive interfaces, structured training, and customizable content.

Conclusions:

Counselors showed generally positive attitudes toward VRET, with adoption driven primarily by perceived effectiveness and social support. However, resistance to change and work-related stressors significantly moderated these effects, especially among younger counselors. Importantly, counselors preferred to use VRET as an adjunct to traditional therapy rather than a replacement. Successful implementation in routine practice requires not only addressing technological usability but also providing structured training, diverse scenario content, and institutional support. These findings suggest tailored dissemination strategies are needed, targeting different age groups and professional contexts to increase VRET acceptance and uptake. Clinical Trial: Clinical Research Information Service (CRIS) KCT0010742; https://cris.nih.go.kr/cris/search/detailSearch.do?search_lang=E&focus=reset_12&search_page=M&pageSize=10&page=undefined&seq=30452&status=5&seq_group=30452