Background Existing Virtual Reality Exposure Therapy (VRET) tools are predominantly solo-user platforms that lack real-time clinical interaction, creating structural and psychological barriers to the therapeutic alliance. Objective The aim of this study was to assess the feasibility and patient-side usability of SafeSpaceVR, an open-source, asymmetric VRET architecture designed to bridge the gap between patient immersion and real-time clinician control. Methods Utilizing a four-phase User-Centered Design (UCD) framework, we conducted formative research through a public survey (N = 33) and semi-structured clinician interviews (N = 3) to define technical requirements. These insights informed the development of a functional prototype, which was subsequently evaluated in a summative playtesting phase (N = 11) to assess usability, clarity, and perceived therapeutic relevance. Results Formative data emphasized the critical need for emotional doorways, such as a virtual clinician's office, and granular clinician-side control over social density. Summative testing revealed high usability and strong perceived relevance for social anxiety treatment. Conclusions This study demonstrates the initial feasibility of open-source, clinician-centered VR tools. As a proof of concept, SafeSpaceVR provides a foundational roadmap for remote, collaborative, and asymmetric digital mental health interventions.
Hofbauer et al. (2026) studied this question.