JMIR Publications

ABSTRACT

Background:

Exposure therapy effectively treats anxiety disorders but faces implementation barriers including cost, time constraints, and reluctance from therapists and clients. Virtual reality exposure therapy (VRET) offers a controlled digital alternative that addresses these issues while maintaining effectiveness and affordability. However, adoption remains limited, with previous studies focusing mainly on hospital settings without considering individual or workplace factors affecting technology acceptance.

Objective:

This study looked at what affects counselors' willingness to use VRET in their practice, focusing on certified Korean counselors working in different settings. 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 performance expectancy impact (β = –.160, P < .01), low job control strengthened it (β = .162, P < .005), and high job demands reduced social influence effects (β = –.150, P = .01). Younger counselors were more sensitive to contextual moderators, while older counselors prioritized performance expectancy. Thematic analysis identified three themes: (1) Ambivalence toward VRET as treatment versus supplementary tool; (2) Barriers including technological unfamiliarity and facilitators like promotional needs; (3) Control and professionalism needs including intuitive interfaces and structured training.

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