Accepted for/Published in: JMIR Formative Research
Date Submitted: Oct 7, 2025
Date Accepted: Apr 22, 2026
Examining the Efficacy of a Telehealth-Based Virtual Reality Clinic in Treating Adults with Specific Phobia: A Feasibility Randomized Controlled Trial
ABSTRACT
Background:
Virtual reality (VR) has strong potential to enhance the effectiveness of telemental health care (TMH) by providing accessible, personalized treatment from home. While there is ample research supporting VR for in-person treatment, there is only preliminary data on the efficacy of telemedicine-based VR. Further, most VR applications used in therapy are not designed for mental healthcare. VR has the potential to enhance remotely delivered evidence-based practices if designed for use in clinical settings. This study aimed to address these gaps by piloting a novel, multiuser, telemedicine-based VR application, Doxy.me VR, equipped with animal phobia exposure stimuli.
Objective:
The primary objective of this study was to assess the feasibility of conducting a randomized controlled efficacy trial (RCT) of Doxy.me VR in preparation for a fully powered trial. The secondary objective was to conduct a preliminary examination of clinical (ie, specific phobia symptom severity) and treatment-related outcomes (ie, therapeutic alliance, client satisfaction, system usability, presence, cybersickness, and treatment fidelity).
Methods:
This single-site, fully remote RCT compared exposure therapy via Doxy.me VR versus standard TMH for adults with a clinically elevated fear of dogs, snakes, or spiders. Participants were recruited through online platforms and flyers. All self-report assessments and homework were partially automated using REDCap forms and surveys. Baseline, mid-treatment, and post-treatment assessment of phobia symptoms and exposure intervention were administered by the study therapist. Feasibility of the trial methodology was assessed using enrollment, retention, assessment completion, and treatment protocol fidelity benchmarks. Between-group differences in specific phobia, anxiety, and depression symptoms while co-varying for pre-treatment scores, were conducted using rANOVA along with differences in therapeutic alliance and presence.
Results:
In total, 54 participants were enrolled between October 25th 2023 and July 26th 2024 (Doxy.me VR n=29, TMH n=25). All benchmarks for feasibility were met or exceeded. There were no significant differences between the Doxy.me VR and TMH groups for all clinical outcomes and all but one treatment-related outcome (ie, client satisfaction improved significantly more for the Doxy.me VR group compared to the TMH group).
Conclusions:
This feasibility RCT comparing Doxy.me VR vs. TMH aims to enhance the delivery of evidence-based treatments via telemedicine and reduce barriers to remotely delivered exposure therapy. This feasibility trial will be followed by a fully powered efficacy trial on telemedicine-based VR for animal phobias. Clinical Trial: ClinicalTrials.gov NCT06302868; https://clinicaltrials.gov/study/NCT06302868
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.