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Avatar-Mediated Telepsychotherapy in a Metaverse-Informed Virtual Environment: Qualitative Study of User Experiences and Design Requirements.

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Τίτλος: Avatar-Mediated Telepsychotherapy in a Metaverse-Informed Virtual Environment: Qualitative Study of User Experiences and Design Requirements.
Συγγραφείς: Lee H; Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, United States., Hwang JH; Department of Smart Experience Design, Kookmin University, Seoul, Republic of Korea., Cho CH; Department of Psychiatry, Biomedical Informatics, and Medical Education, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 2 920 5505., Heo J; Department of Smart Experience Design, Kookmin University, Seoul, Republic of Korea.
Πηγή: Journal of medical Internet research [J Med Internet Res] 2026 Aug 06; Vol. 28, pp. e85281. Date of Electronic Publication: 2026 Aug 06.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: JMIR Publications Country of Publication: Canada NLM ID: 100959882 Publication Model: Electronic Cited Medium: Internet ISSN: 1438-8871 (Electronic) Linking ISSN: 14388871 NLM ISO Abbreviation: J Med Internet Res Subsets: MEDLINE
Imprint Name(s): Publication: <2011- > : Toronto : JMIR Publications
Original Publication: [Pittsburgh, PA? : s.n., 1999-
Ιατρικοί όροι (MeSH): Psychotherapy*/methods , Avatar* , User-Computer Interface*, Mental Disorders/therapy ; Humans ; Male ; Adult ; Female ; Middle Aged ; Mental Health Teletherapy ; Qualitative Research ; Aged ; Young Adult ; Telemedicine ; Videoconferencing
Περίληψη: Background: Face-to-face psychotherapy remains the gold standard for mental health treatment; however, it faces accessibility barriers, including geographical constraints, costs, and stigma. Although videoconferencing psychotherapy addresses some limitations, challenges with engagement and therapeutic alliance persist. Avatar-mediated telepsychotherapy (AMT) in a metaverse-informed virtual environment has been proposed as a possible extension of digitally delivered mental health care, combining digital accessibility with enhanced presence through anonymous avatar-mediated communication.
Objective: This exploratory qualitative study examined how participants experienced avatar-mediated psychotherapy within a virtual environment, with particular attention to perceived design features that may facilitate psychological engagement, self-disclosure, and sustained participation.
Methods: We conducted a qualitative study using a minimum viable product platform among adults aged 19-70 years who self-reported psychological health management needs but had not been diagnosed with a major mental disorder, recruited from Korea University Anam Hospital and Korea University (n=60). The participants attended 4 weekly sessions (50 minutes each) using anonymous avatars reflecting real-time facial expressions and nonverbal cues. After completion, 30 participants (16 women and 14 men; 15 hospital employees and 15 university students) were purposively selected for semistructured interviews (30-50 minutes). Data were analyzed by 4 researchers using thematic analysis with ATLAS.ti software (Lumivero).
Results: From 508 initial codes, 4 main themes emerged through iterative analysis. (1) Balancing anonymity and self-disclosure through avatars: anonymous avatars appeared to facilitate greater self-expression, with a sense of psychological safety throughout therapy sessions while maintaining emotional connection with therapists through synchronized nonverbal expressions. The synchronization of nonverbal expressions appeared to contribute to self-identification. (2) The holistic role of metaverse spaces in psychotherapy: pretherapy spaces were perceived as a psychological transitional area, alleviating tension and anticipatory anxiety. Therapy spaces required focused design that accommodated user preferences regarding the visibility of their own avatars. Posttherapy spaces were perceived as supporting self-reflection and anonymous community connection. (3) Consideration for meta-connection: participants described a need for cyclic feedback mechanisms that could help connect session experiences with everyday reflection and intended behavior. Metaverse settings demanded distinct therapist protocols to confirm therapists' attentiveness through avatar-mediated verbal and nonverbal communication to maintain therapeutic alliance. (4) Consideration for metaverse-informed psychotherapy space design: avatar customization may serve not only as a means of self-expression but also as a source of social connection or a sense of community. Technical stability, cross-platform accessibility, and user guidance were identified as key design considerations for developing psychologically engaging and technically reliable avatar-mediated psychotherapy environments.
Conclusions: This study yields a set of qualitative design requirements for AMT, including anonymous avatars with behavioral realism rather than visual similarity, multistage spaces supporting the therapeutic journey, cyclic feedback mechanisms connecting virtual and real-world experiences, and integrated therapist competency development. These findings provide preliminary design implications for accessible and engaging AMT environments.
(© Hyeri Lee, Ji-Hyun Hwang, Chul-Hyun Cho, Jeongyun Heo. Originally published in the Journal of Medical Internet Research (https://www.jmir.org).)
References: J Med Internet Res. 2018 Dec 18;20(12):e11007. (PMID: 30563817)
J Affect Disord. 2020 Mar 15;265:120-131. (PMID: 32090733)
Fam Med Community Health. 2022 Mar;10(1):. (PMID: 35304431)
World J Clin Cases. 2025 Feb 6;13(4):97813. (PMID: 39917577)
Cyberpsychol Behav. 2009 Dec;12(6):761-5. (PMID: 19788381)
Front Psychiatry. 2016 Nov 18;7:186. (PMID: 27917128)
JMIR Ment Health. 2017 Apr 03;4(2):e10. (PMID: 28373153)
Aust Health Rev. 2021 Dec;45(6):675-682. (PMID: 34743787)
Indian J Psychol Med. 2025 Oct 15;:02537176251379999. (PMID: 41113807)
J Med Ethics. 2022 Jan;48(1):22-30. (PMID: 34610979)
JMIR Ment Health. 2022 May 2;9(5):e36775. (PMID: 35499910)
BMC Psychiatry. 2014 Apr 11;14:109. (PMID: 24725765)
Telemed J E Health. 2013 Jun;19(6):444-54. (PMID: 23697504)
Front Psychol. 2021 Feb 19;12:589536. (PMID: 33679513)
J Telemed Telecare. 2024 Dec;30(10):1521-1531. (PMID: 36974478)
Cyberpsychol Behav. 2004 Jun;7(3):321-6. (PMID: 15257832)
Front Public Health. 2025 Apr 10;13:1463494. (PMID: 40276352)
J Med Internet Res. 2012 Nov 14;14(6):e152. (PMID: 23151820)
Behav Ther. 2016 Sep;47(5):669-674. (PMID: 27816079)
Curr Psychiatry Rep. 2024 Jun;26(6):294-303. (PMID: 38602624)
JMIR Hum Factors. 2025 Feb 05;12:e66158. (PMID: 39924261)
JMIR Ment Health. 2022 Mar 11;9(3):e31780. (PMID: 35275081)
Br J Psychiatry. 2005 Jan;186:11-7. (PMID: 15630118)
J Telemed Telecare. 2024 Feb;30(2):250-261. (PMID: 34860613)
Cyberpsychol Behav Soc Netw. 2017 Aug;20(8):501-507. (PMID: 28806125)
Curr Treat Options Psychiatry. 2020;7(2):198-202. (PMID: 32292687)
Adv Exp Med Biol. 2024;1456:333-356. (PMID: 39261437)
JMIR Ment Health. 2018 Dec 10;5(4):e11290. (PMID: 30530460)
Gen Psychiatr. 2022 Jul 22;35(4):e100825. (PMID: 36189180)
Contributed Indexing: Keywords: digital mental health; qualitative research; telehealth; telepsychotherapy; user experience
Entry Date(s): Date Created: 20260806 Date Completed: 20260806 Latest Revision: 20260813
Update Code: 20260814
PubMed Central ID: PMC13446797
DOI: 10.2196/85281
PMID: 42561426
Βάση Δεδομένων: MEDLINE
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  Data: Avatar-Mediated Telepsychotherapy in a Metaverse-Informed Virtual Environment: Qualitative Study of User Experiences and Design Requirements.
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  Data: Background: Face-to-face psychotherapy remains the gold standard for mental health treatment; however, it faces accessibility barriers, including geographical constraints, costs, and stigma. Although videoconferencing psychotherapy addresses some limitations, challenges with engagement and therapeutic alliance persist. Avatar-mediated telepsychotherapy (AMT) in a metaverse-informed virtual environment has been proposed as a possible extension of digitally delivered mental health care, combining digital accessibility with enhanced presence through anonymous avatar-mediated communication.&lt;br /&gt;Objective: This exploratory qualitative study examined how participants experienced avatar-mediated psychotherapy within a virtual environment, with particular attention to perceived design features that may facilitate psychological engagement, self-disclosure, and sustained participation.&lt;br /&gt;Methods: We conducted a qualitative study using a minimum viable product platform among adults aged 19-70 years who self-reported psychological health management needs but had not been diagnosed with a major mental disorder, recruited from Korea University Anam Hospital and Korea University (n=60). The participants attended 4 weekly sessions (50 minutes each) using anonymous avatars reflecting real-time facial expressions and nonverbal cues. After completion, 30 participants (16 women and 14 men; 15 hospital employees and 15 university students) were purposively selected for semistructured interviews (30-50 minutes). Data were analyzed by 4 researchers using thematic analysis with ATLAS.ti software (Lumivero).&lt;br /&gt;Results: From 508 initial codes, 4 main themes emerged through iterative analysis. (1) Balancing anonymity and self-disclosure through avatars: anonymous avatars appeared to facilitate greater self-expression, with a sense of psychological safety throughout therapy sessions while maintaining emotional connection with therapists through synchronized nonverbal expressions. The synchronization of nonverbal expressions appeared to contribute to self-identification. (2) The holistic role of metaverse spaces in psychotherapy: pretherapy spaces were perceived as a psychological transitional area, alleviating tension and anticipatory anxiety. Therapy spaces required focused design that accommodated user preferences regarding the visibility of their own avatars. Posttherapy spaces were perceived as supporting self-reflection and anonymous community connection. (3) Consideration for meta-connection: participants described a need for cyclic feedback mechanisms that could help connect session experiences with everyday reflection and intended behavior. Metaverse settings demanded distinct therapist protocols to confirm therapists&#39; attentiveness through avatar-mediated verbal and nonverbal communication to maintain therapeutic alliance. (4) Consideration for metaverse-informed psychotherapy space design: avatar customization may serve not only as a means of self-expression but also as a source of social connection or a sense of community. Technical stability, cross-platform accessibility, and user guidance were identified as key design considerations for developing psychologically engaging and technically reliable avatar-mediated psychotherapy environments.&lt;br /&gt;Conclusions: This study yields a set of qualitative design requirements for AMT, including anonymous avatars with behavioral realism rather than visual similarity, multistage spaces supporting the therapeutic journey, cyclic feedback mechanisms connecting virtual and real-world experiences, and integrated therapist competency development. These findings provide preliminary design implications for accessible and engaging AMT environments.&lt;br /&gt; (&#169; Hyeri Lee, Ji-Hyun Hwang, Chul-Hyun Cho, Jeongyun Heo. Originally published in the Journal of Medical Internet Research (https://www.jmir.org).)
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  Data: J Med Internet Res. 2018 Dec 18;20(12):e11007. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2230563817%22&quot;&gt;30563817)&lt;/searchLink&gt;&lt;br /&gt;J Affect Disord. 2020 Mar 15;265:120-131. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232090733%22&quot;&gt;32090733)&lt;/searchLink&gt;&lt;br /&gt;Fam Med Community Health. 2022 Mar;10(1):. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235304431%22&quot;&gt;35304431)&lt;/searchLink&gt;&lt;br /&gt;World J Clin Cases. 2025 Feb 6;13(4):97813. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2239917577%22&quot;&gt;39917577)&lt;/searchLink&gt;&lt;br /&gt;Cyberpsychol Behav. 2009 Dec;12(6):761-5. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2219788381%22&quot;&gt;19788381)&lt;/searchLink&gt;&lt;br /&gt;Front Psychiatry. 2016 Nov 18;7:186. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2227917128%22&quot;&gt;27917128)&lt;/searchLink&gt;&lt;br /&gt;JMIR Ment Health. 2017 Apr 03;4(2):e10. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2228373153%22&quot;&gt;28373153)&lt;/searchLink&gt;&lt;br /&gt;Aust Health Rev. 2021 Dec;45(6):675-682. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2234743787%22&quot;&gt;34743787)&lt;/searchLink&gt;&lt;br /&gt;Indian J Psychol Med. 2025 Oct 15;:02537176251379999. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2241113807%22&quot;&gt;41113807)&lt;/searchLink&gt;&lt;br /&gt;J Med Ethics. 2022 Jan;48(1):22-30. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2234610979%22&quot;&gt;34610979)&lt;/searchLink&gt;&lt;br /&gt;JMIR Ment Health. 2022 May 2;9(5):e36775. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235499910%22&quot;&gt;35499910)&lt;/searchLink&gt;&lt;br /&gt;BMC Psychiatry. 2014 Apr 11;14:109. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2224725765%22&quot;&gt;24725765)&lt;/searchLink&gt;&lt;br /&gt;Telemed J E Health. 2013 Jun;19(6):444-54. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2223697504%22&quot;&gt;23697504)&lt;/searchLink&gt;&lt;br /&gt;Front Psychol. 2021 Feb 19;12:589536. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2233679513%22&quot;&gt;33679513)&lt;/searchLink&gt;&lt;br /&gt;J Telemed Telecare. 2024 Dec;30(10):1521-1531. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2236974478%22&quot;&gt;36974478)&lt;/searchLink&gt;&lt;br /&gt;Cyberpsychol Behav. 2004 Jun;7(3):321-6. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2215257832%22&quot;&gt;15257832)&lt;/searchLink&gt;&lt;br /&gt;Front Public Health. 2025 Apr 10;13:1463494. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2240276352%22&quot;&gt;40276352)&lt;/searchLink&gt;&lt;br /&gt;J Med Internet Res. 2012 Nov 14;14(6):e152. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2223151820%22&quot;&gt;23151820)&lt;/searchLink&gt;&lt;br /&gt;Behav Ther. 2016 Sep;47(5):669-674. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2227816079%22&quot;&gt;27816079)&lt;/searchLink&gt;&lt;br /&gt;Curr Psychiatry Rep. 2024 Jun;26(6):294-303. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2238602624%22&quot;&gt;38602624)&lt;/searchLink&gt;&lt;br /&gt;JMIR Hum Factors. 2025 Feb 05;12:e66158. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2239924261%22&quot;&gt;39924261)&lt;/searchLink&gt;&lt;br /&gt;JMIR Ment Health. 2022 Mar 11;9(3):e31780. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2235275081%22&quot;&gt;35275081)&lt;/searchLink&gt;&lt;br /&gt;Br J Psychiatry. 2005 Jan;186:11-7. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2215630118%22&quot;&gt;15630118)&lt;/searchLink&gt;&lt;br /&gt;J Telemed Telecare. 2024 Feb;30(2):250-261. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2234860613%22&quot;&gt;34860613)&lt;/searchLink&gt;&lt;br /&gt;Cyberpsychol Behav Soc Netw. 2017 Aug;20(8):501-507. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2228806125%22&quot;&gt;28806125)&lt;/searchLink&gt;&lt;br /&gt;Curr Treat Options Psychiatry. 2020;7(2):198-202. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2232292687%22&quot;&gt;32292687)&lt;/searchLink&gt;&lt;br /&gt;Adv Exp Med Biol. 2024;1456:333-356. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2239261437%22&quot;&gt;39261437)&lt;/searchLink&gt;&lt;br /&gt;JMIR Ment Health. 2018 Dec 10;5(4):e11290. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2230530460%22&quot;&gt;30530460)&lt;/searchLink&gt;&lt;br /&gt;Gen Psychiatr. 2022 Jul 22;35(4):e100825. (PMID: &lt;searchLink fieldCode=&quot;PM&quot; term=&quot;%2236189180%22&quot;&gt;36189180)&lt;/searchLink&gt;
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            – D: 06
              M: 08
              Text: 2026 Aug 06
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1438-8871
          Numbering:
            – Type: volume
              Value: 28
          Titles:
            – TitleFull: Journal of medical Internet research
              Type: main
ResultId 1