What I will say is that maintaining full situational awareness and keeping my racecraft sharp is more difficult in a sim, because the quantity and quality of the inputs just aren't as good as the real world.
Sims obviously aren't nearly as physically demanding (though a full-length grand prix will still leave me in a sweat by the end from concentration), but I find I have significantly more mental overhead in the real world as it's far more intuitive. And if the physical risk is a persistent stressor that takes attentional overhead while racing, then congrats, you're wired like a functioning human, not a racing driver!
Games can also get immersive and your adrenaline pumping. Now I'm not a racing pilot, and have very little track experience, but I know a few people who have, and have a nice setup for iracing at home, which according to them allows them to hone their reaction speed and try out moves and train moves. Yes you remove the physical part, but you do get immersed in the situation.
Point in case, Max Verstappen trained a specific overtake move on the Spa circuit at the Blanchimont corner on iracing with his teammates there [1]. And then he pulled off exactly that same move in a real race [2], which was one ballsy move to pull off irl.
But it's a very good example of the sims allowing them to fail without much risk gives them the possibility to experiment at will, and at least partially train their brains to handle such a situation.
[1] https://www.youtube.com/watch?v=0Y5-DZNjBOg
[2] https://www.youtube.com/watch?v=788IiRsxMqM (sadly potato quality)