JMIR Publications

ABSTRACT

Background:

Despite the potential of Virtual Reality (VR) for treatment and assessment in mental healthcare, its practical implementation remains limited. Much implementation research explores barriers and facilitators; fewer studies actually evaluate targeted implementation strategies and track how their effects evolve over time in mental healthcare practice.

Objective:

To examine how a structured VR training program functioned as an implementation strategy in routine mental healthcare, and to identify how therapists’ adoption trajectories and implementation needs shifted across stages of the process.

Methods:

Eleven therapists from a Dutch mental healthcare organization completed a six-session VR training. Semi-structured interviews were conducted at three time points: pre-training, immediately post-training, and three months post-training. Data were deductively analyzed using the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to map stage-specific changes in implementation needs relating to VR use.

Results:

The training improved therapists’ perceived knowledge, skills, and confidence in using VR. Nonetheless, actual uptake of VR in clinical routines remained limited. Enduring barriers included workflow misalignment, hierarchical decision-making structures, and the absence of a shared organizational vision and sustained leadership support. The longitudinal design revealed a dynamic pattern: early adoption hinged on individual capability and motivation, whereas maintenance depended on organizational opportunity and communicated support. These stage-specific shifts clarify why training alone does not translate into routine use and which organizational levers are most important when.

Conclusions:

VR training for therapists is a necessary but insufficient implementation strategy in mental healthcare. A longitudinal, theory-informed approach shows that successful implementation requires pairing training with organization-level changes that address opportunity barriers over time. By shifting from static evaluations of whether training works to a process-oriented focus on what support is needed at each stage, this study advances implementation science in digital mental health and offers actionable guidance for embedding VR in routine care.