Exploring Predictors of Counselors' Acceptance of Virtual Reality Exposure Therapy With Resistance and Job Contexts as Moderators: Cross-Sectional Mixed Methods Study.

Résumé

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 addressing these issues. However, adoption remains limited, with previous studies focusing mainly on hospital settings without considering individual or workplace factors.OBJECTIVE: This study examined factors affecting counselors' VRET acceptance across diverse settings. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) extended with job stress and resistance to change. Open-ended questions provided a deeper understanding of counselors' perspectives on VRET.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, and social influence), resistance to change, and job stress. Stepwise forward selection multiple linear regression with moderation analyses was conducted to identify key predictors and test interaction effects. Open-ended responses (N=257, 290 meaning units) on VRET applicability and improvement suggestions were analyzed using team-based thematic analysis with iterative consensus coding.RESULTS: Performance expectancy (β=.404, 95% CI 0.297-0.512, P