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 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<.001) and social influence (β=.387, 95% CI 0.280-0.494, P<.001) significantly predicted VRET adoption intentions (R2=0.494). Moderation analysis revealed that routine seeking weakened performance expectancy impact (β=-.160, 95% CI -0.277 to -0.043, P<.01), low job control strengthened it (β=.162, 95% CI 0.280-0.494, P<.005), and high job demands reduced social influence effects (β=-.150, 95% CI -0.263 to -0.036, P=.01). The narrow confidence intervals indicate precise estimation of these moderation effects. Younger counselors were more sensitive to contextual moderators, while older counselors prioritized performance expectancy. Thematic analysis identified 3 themes: counselor evaluation criteria for VRET, emphasizing content diversity and scientific validation; considerations for promoting and introducing VRET to counselors, addressing implementation challenges; and areas requiring continuous improvement for VRET field implementation, emphasizing professional competence and system reliability. CONCLUSIONS: This study advances VRET acceptance research by examining certified counselors across diverse nonhospital settings-unlike prior hospital-focused physician studies-and extending UTAUT with profession-specific moderators. Performance expectancy and social influence emerged as primary predictors, with routine seeking and job context significantly moderating these effects across age groups. Thematic analysis revealed that counselors evaluate VRET as a supplementary tool requiring scientific validation, diverse content, and structured training rather than technological usability alone. Findings inform practical strategies as follows: disseminating effectiveness evidence, leveraging professional networks, addressing work environment barriers for high-demand contexts, and developing age-appropriate approaches. Insights guide content developers, policymakers, and researchers implementing VRET beyond hospital settings.