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Moreover, no prior research has demonstrated the feasibility of therapists and clients conducting therapy sessions remotely within a shared (ie, multiuser) VR experience.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The primary objective of this study was to evaluate the feasibility of conducting a randomized controlled efficacy trial (RCT) comparing exposure therapy delivered via Doxy.me VR (Doxy.me Inc)\u2014a multiuser, telehealth-based VR app\u2014to standard TMH in adults with clinically elevated fear of dogs, snakes, or spiders. A secondary objective was to preliminarily examine clinical (ie, specific phobia symptom severity) and treatment-related outcomes (ie, therapeutic alliance, client satisfaction, system usability, presence, cybersickness, and treatment fidelity).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study used a single-site, fully remote, parallel, feasibility RCT design. Participants were randomly assigned using a 1:1 ratio to receive 12 weekly exposure therapy sessions over 3 months, delivered via either standard TMH or Doxy.me VR. Assessments were conducted at baseline, each session, midtreatment, and posttreatment. All therapy sessions were audio recorded, 20% of which were randomly selected and rated for treatment fidelity. Feasibility benchmarks during the 12-month trial included: (1) enrolling 30 participants during Months 1\u20109 of the trial; (2) collecting 70% of midtreatment self-report data; (3) collecting 70% of posttreatment self-report data; (4) collecting 70% of weekly self-report data; and (5) achieving treatment fidelity \u226580%. Between-group differences in clinical treatment-related outcomes also were examined preliminarily.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 54 participants were enrolled between October 25, 2023 and July 26, 2024, and randomly assigned to the Doxy.me VR (n=29) and TMH (n=25) conditions, exceeding our recruitment target by 180%. Among the 30 participants targeted for completion, data were obtained from 29 (96.7%) at midtreatment and 28 (93.3%) at posttreatment. Participants completed 86.5% (180\/208) of weekly self-report assessments. Treatment fidelity was 90% based on ratings of 41 session recordings. There were no significant between-group differences in clinical outcomes (all\n P<\/jats:italic>\n >.05) or most treatment-related outcomes. However, client satisfaction improved significantly more for the Doxy.me VR condition compared to TMH (\n P<\/jats:italic>\n =.04). Power analyses indicated that a sample of 160 participants would ensure adequate power for a fully powered trial.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Telehealth-based, multiuser, synchronous VRET is feasible and shows preliminary evidence of efficacy. These findings are promising, and opportunities to improve procedures identified in this feasibility trial will directly inform the protocol for a fully powered RCT evaluating telehealth-based VR and its potential to improve treatment of mental health disorders.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/84670","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T18:50:09Z","timestamp":1776883809000},"page":"e84670-e84670","source":"Crossref","is-referenced-by-count":1,"title":["Examining the Efficacy of a Telehealth-Based Virtual Reality Clinic in Treating Adults With Specific Phobia: Feasibility Randomized Controlled Trial"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4964-0688","authenticated-orcid":false,"given":"Brian E","family":"Bunnell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7866-7310","authenticated-orcid":false,"given":"Kaitlyn R","family":"Schuler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9531-0559","authenticated-orcid":false,"given":"Jason G","family":"Craggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2214-9282","authenticated-orcid":false,"given":"Brandon M","family":"Welch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2512-2026","authenticated-orcid":false,"given":"Triton","family":"Ong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"issue":"22","key":"R1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17228525","article-title":"Acceptability of telemedicine features to promote its uptake in practice: a survey of community telemental health providers","volume":"17","author":"Bunnell","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"R2","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1089\/tmj.2023.0141","article-title":"Telemedicine from home or the office: perceptions of mental health providers","volume":"30","author":"Wilczewski","journal-title":"Telemed J E Health"},{"key":"R3","unstructured":"Jain S PhD KP Miller A et al. 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