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<p>Virtual Reality Exposure Therapy (VRET) demonstrates efficacy comparable to gold-standard <i>in vivo</i> Exposure Therapy (ET) for anxiety disorders, yet clinical adoption remains limited. We propose co-located Multi-User Mixed Reality (MU-MR) for ET, enabling therapists and patients to share virtual environments while physically co-located, preserving natural interpersonal cues through selective video-passthrough without requiring avatars. The system enables flexible transitions between Mixed Reality (MR), where virtual stimuli are coherently embedded in the real world, and fully virtual environments. Through a provider-first development approach, we conducted two studies with practicing psychotherapists. Study 1 (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(n=45\)</EquationSource> </InlineEquation>) demonstrated Single-User Virtual Reality (SU-VR) and MU-MR experiences, identifying five priority features for MU-MR: shared exposure scenarios, collaborative scenario design, precise stimulus control, biofeedback integration, and gaze/attention visualization. Study 2 evaluated these implemented features in a hands-on workshop (<InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(n=10\)</EquationSource> </InlineEquation>). Participants rated all features as useful, attractive, and relevant, with collaborative design and stimulus control receiving highest relevance ratings. While practical implementation barriers remain, findings suggest co-located MU-MR particularly addresses the perceived barrier between therapist and patient present in current SU-VR systems. By combining the interpersonal authenticity of <i>in vivo</i> exposure with the control and flexibility of virtual interventions, co-located MU-MR offers a promising extension of contemporary SU-VR, and a path toward improving VRET adoption in clinical practice.</p>

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Towards co-located multi-user mixed reality exposure therapy for anxiety disorders

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月25日

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  • Florian Schier,
  • Daniel Badeja,
  • Jürgen Hoyer,
  • Matthew McGinity

摘要

Virtual Reality Exposure Therapy (VRET) demonstrates efficacy comparable to gold-standard in vivo Exposure Therapy (ET) for anxiety disorders, yet clinical adoption remains limited. We propose co-located Multi-User Mixed Reality (MU-MR) for ET, enabling therapists and patients to share virtual environments while physically co-located, preserving natural interpersonal cues through selective video-passthrough without requiring avatars. The system enables flexible transitions between Mixed Reality (MR), where virtual stimuli are coherently embedded in the real world, and fully virtual environments. Through a provider-first development approach, we conducted two studies with practicing psychotherapists. Study 1 ( \(n=45\) ) demonstrated Single-User Virtual Reality (SU-VR) and MU-MR experiences, identifying five priority features for MU-MR: shared exposure scenarios, collaborative scenario design, precise stimulus control, biofeedback integration, and gaze/attention visualization. Study 2 evaluated these implemented features in a hands-on workshop ( \(n=10\) ). Participants rated all features as useful, attractive, and relevant, with collaborative design and stimulus control receiving highest relevance ratings. While practical implementation barriers remain, findings suggest co-located MU-MR particularly addresses the perceived barrier between therapist and patient present in current SU-VR systems. By combining the interpersonal authenticity of in vivo exposure with the control and flexibility of virtual interventions, co-located MU-MR offers a promising extension of contemporary SU-VR, and a path toward improving VRET adoption in clinical practice.