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. 2024;28(2):73.
doi: 10.1007/s10055-024-00956-7. Epub 2024 Mar 8.

Therapist perspectives on telehealth-based virtual reality exposure therapy

Triton Ong  1 , Julia Ivanova  1 , Hiral Soni  1 , Hattie Wilczewski  1 , Janelle Barrera  1   2 , Mollie Cummins  1   3 , Brandon M Welch  1   4 , Brian E Bunnell  1   2
Affiliations

Therapist perspectives on telehealth-based virtual reality exposure therapy

Triton Ong et al. Virtual Real. 2024.

Abstract

Virtual reality (VR) can enhance mental health care. In particular, the effectiveness of VR-based exposure therapy (VRET) has been well-demonstrated for treatment of anxiety disorders. However, most applications of VRET remain localized to clinic spaces. We aimed to explore mental health therapists' perceptions of telehealth-based VRET (tele-VRET) by conducting semi-structured, qualitative interviews with 18 telemental health therapists between October and December 2022. Interview topics included telehealth experiences, exposure therapy over telehealth, previous experiences with VR, and perspectives on tele-VRET. Therapists described how telehealth reduced barriers (88.9%, 16/18), enhanced therapy (61.1%, 11/18), and improved access to clients (38.9%, 7/18), but entailed problems with technology (61.1%, 11/18), uncontrolled settings (55.6%, 10/18), and communication difficulties (50%, 9/18). Therapists adapted exposure therapy to telehealth by using online resources (66.7%, 12/18), preparing client expectations (55.6%, 10/18), and adjusting workflows (27.8%, 5/18). Most therapists had used VR before (72.2%, 13/18) and had positive impressions of VR (55.6%, 10/18), but none had used VR clinically. In response to tele-VRET, therapists requested interactive session activities (77.8%, 14/18) and customizable interventions components (55.6%, 10/18). Concerns about tele-VRET included risks with certain clients (77.8%, 14/18), costs (50%, 9/18), side effects and privacy (22.2%, 4/18), and inappropriateness for specific forms of exposure therapy (16.7%, 3/18). These results reveal how combining telehealth and VRET may expand therapeutic options for mental healthcare providers and can help inform collaborative development of immersive health technologies.

Keywords: Clinical practice; Exposure therapy; Mental health; Telehealth; Virtual reality.

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Conflict of interest statement

Competing interests Dr. Welch is a shareholder, and all other authors are employees of Doxy.me Inc., a commercial telemedicine company. The authors declare no other conflicts of interest.

Figures

Fig. 1
Fig. 1
Screenshots from the tele-VRET video. Therapist showing a client how to use VR during a telehealth call (top left). Therapist and client talking and gesturing remotely in VR (top right). Therapist and client drawing spiders in VR (lower left). Therapist and client interacting with a simulated spider in VR (lower right)
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