Attitudes Towards Virtual Reality Therapy

Abstract

The Attitudes Towards Virtual Reality Therapy (AVRT) Scale, developed by Bergin, Allison, and Hazell in 2024, is a specialized psychometric instrument designed to quantify public attitudes and perceptions regarding Virtual Reality Therapy (VRT). VRT is defined in this context as a psychological treatment modality guided by a virtual coach. Its creation was motivated by the need to explore user acceptance of VRT within the rapidly evolving field of Digital Mental Health Interventions.

The scale development began with an initial pool of 54 items, derived from existing literature concerning VRT perceptions. Participants in the development study were adults located in Ireland and the United Kingdom who had prior experience with VR technology but did not have current personal or professional mental health issues. Following rigorous Exploratory Factor Analysis (EFA), the final instrument was refined to 33 items across four distinct factors, demonstrating strong psychometric properties, particularly in terms of internal consistency.

Keywords

Virtual Reality Therapy, VRT, Attitudes, Perception, Digital Mental Health, Psychological Assessment, Likert Scale, Psychometrics, Health Technology.

Authors

Aislinn D. Gomez Bergin, Aoife M. Allison, Cassie M. Hazell.

Purpose

The primary purpose of the AVRT Scale is to systematically assess public attitudes toward the utilization of Virtual Reality Therapy in psychological treatment settings. The instrument specifically aims to measure nuanced views regarding key aspects of VRT adoption.

These measured aspects include the perceived effectiveness of VRT, the user’s anticipated sense of presence within the virtual environment, and general preferences for VR-based treatments compared to traditional face-to-face therapy. By quantifying these attitudes, the scale provides valuable data for researchers and clinicians developing and implementing future digital mental health solutions.

Construct

The AVRT Scale is a multidimensional instrument designed to measure the complex construct of Attitudes toward Virtual Reality Therapy. The Exploratory Factor Analysis yielded a robust four-factor structure, capturing different facets of public perception:

• Attitudes toward Virtual Reality Therapy (VRT): General acceptance, willingness to try, and comfort with the virtual coach.
• Expectation of Presence during VRT: The degree to which the virtual environment is anticipated to feel real and effective.
• Preference for VRT: Comparative preference for VRT relative to traditional face-to-face therapy options.
• Perception of Cost-effectiveness of VRT: Beliefs regarding the economic utility and long-term cost savings of VRT, particularly in public health systems.

Validity

Specific detailed validity information (such as convergent, discriminant, or criterion validity) was not explicitly provided in the primary development study of the AVRT Scale.

However, the scale’s development process, which involved extensive item generation based on existing VRT literature and subsequent refinement via Exploratory Factor Analysis, supports its initial construct validity by demonstrating a clear, theoretically meaningful four-factor structure that accounts for a substantial proportion of the variance.

Reliability

The AVRT Scale exhibits strong internal consistency, confirming the reliability of its factor structure. Reliability was assessed using Cronbach’s Alpha (α) for all retained factors.

All four derived subscales demonstrated strong internal consistency, with Cronbach’s Alpha coefficients consistently meeting or exceeding the threshold of .82. This robust finding indicates that the items within each factor measure the intended underlying construct cohesively and reliably.

Factor Analysis

The refinement of the AVRT Scale utilized Exploratory Factor Analysis (EFA) to reduce the initial 54 items and identify the latent dimensional structure of public attitudes toward VRT. This statistical procedure was crucial in establishing the final scale structure.

The EFA resulted in the retention of 33 items distributed across a clear four-factor solution. This four-factor model was statistically robust, collectively explaining 58.61% of the total variance observed in the participant data, confirming the multidimensional nature of VRT attitudes.

Instrument

Test Type: Inventory/Questionnaire

Format: 33 items utilizing a 7-point Likert scale, where responses range from 1 (strongly disagree) to 7 (strongly agree). The instrument also includes 16 items that trigger follow-up free-text questions upon strong agreement or disagreement, allowing for qualitative data capture.

Language Available: English (developed and tested in Ireland and the United Kingdom).

Population Group: General public adults with prior experience using Virtual Reality (VR) technology.

Age Group: Adults (18 years and older), spanning young adulthood (18-29 years), thirties (30-39 years), middle age (40-64 years), and elderly (65 years and older).

Population Details: Participants were drawn from Ireland and the United Kingdom. Although they had no history of personal or professional mental health problems, some had supported family members or friends with mental health issues. The administration method was electronic and collected online.

Test Methodology: The methodology involved item generation, followed by participant completion, and subsequent psychometric analysis including internal consistency testing (using Cronbach’s Alpha) and item reduction via Exploratory Factor Analysis.

Keywords

Virtual Coach, VR Experience, Psychometric Scale, Mental Health, Public Perception, Virtual Reality Therapy, Reliability, Cost-effectiveness.

Authors

Author ORCID Identifier: Aislinn D. Gomez Bergin (ORCID); Aoife M. Allison (ORCID); Cassie M. Hazell (ORCID)

Affiliation Email addresses: Not provided in source content.

Correspondence Address: National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, UK (Primary affiliation of lead author).

Permissions & Fee and Test Year

Test Year: 2024

Permissions and Fees: Information regarding specific permissions and licensing fees for clinical or commercial use is not provided in the source documentation. Researchers should consult the corresponding author for usage rights, as the scale was published in an open-access journal.

Reference’s

Bergin, A. D. G., Allison, A. M., & Hazell, C. M. (2024). Understanding public perceptions of virtual reality psychological therapy using the Attitudes Towards Virtual Reality Therapy (AVRT) Scale: Mixed methods development study. JMIR Mental Health, 11, Article e48537. The published article is available online and details the development of the scale.

Items of the Attitudes Towards Virtual Reality Therapy

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The following outlines the items used to assess attitudes towards virtual reality therapy (VRT), categorized by construct. Responses were measured on a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Note that items marked with ‘c’ are reverse-worded.

Attitude toward VRT

• If the virtual coach encouraged me to do something between sessions, I would try to do it.

• I would never be willing to try virtual reality therapy.c

• I would be willing to try virtual reality therapy if I had more information about it.

• I would encourage the people I care about to try virtual reality therapy, if it was offered to them.

• I would discourage the people I care about to try virtual reality therapy, if it was offered to them.c

• I would listen to the virtual coach.

• No amount of practice would make me want to use virtual reality therapy.c

• I cannot imagine virtual reality therapy being useful for someone with mental health problems.

• I am optimistic about virtual reality therapy being used in clinical setting.

• I would feel comfortable interacting with the virtual coach.

• I have a negative attitude toward virtual reality therapy.“

• I think that using technology for therapy is positive.

• I would not trust a virtual coach.

Expectation of presence

• I would feel like I was acting during virtual reality therapy.c

• Virtual reality therapy would not be effective for me because I would be mindful that it is not real life.

• I do not think the virtual environment would feel real.

• I would find that characters in the virtual reality therapy unsettling.c

• Potential side effects of virtual reality therapy would put me off using it.

• I am sceptical about the effectiveness of virtual reality therapy.c

• I think that the virtual reality therapy would make me feel present enough to be effective.

• I would decline virtual reality therapy because I would prefer face-to-face therapy.c

• I think that the virtual reality environment would feel real.

Preference for VRT

• I think virtual reality therapy would be better than face-to-face therapy.

• I would trust a virtual coach more than a real therapist.

• I believe that virtual reality therapy is more effective than face-to-face therapy.

• I believe that virtual reality is equally effective as face-to-face therapy.

• I would trust a virtual coach the same amount as a real therapist.

• I believe that virtual reality therapy is less effective than face-to-face therapy.c

• I would choose face-face therapy over virtual reality therapy.

Cost-effectiveness

• I think that using virtual reality therapy would save the NHSe money in the long term.

• I think virtual reality therapy would be more cost-effective than face-to-face therapy.

• I think that using virtual reality therapy would cost the NHSe more money in the long term.

• I think virtual reality therapy will be worth the cost.

Scale Summary

The following table summarizes the response options for the 7-point Likert scale used in the AVRT instrument.

Scale	Min	Max
Response	1	7