Virtual reality as an alternative for phobias in autism

Fears and phobias are common in people on the autism spectrum and can impact on their ability to undertake usual daily activities, learning, and social inclusion. The main method to treat fears and phobias for people without autism is gradual exposure to the situation that causes anxiety, however, this method can be too anxiety-provoking for people on the autism spectrum. On the other hand, autistic people often experience difficulties with imagination and abstract thinking, which can make producing and controlling imaginal scenes difficult.

To address this, Newcastle University Medical Research Council Confidence has developed an intervention that combines cognitive-behavioral therapy (CBT) delivered with gradual exposure in a fully immersive virtual reality environment. Through the use of an immersive controllable virtual reality environment (VRE) enables the therapy team to recreate the phobic situation through computer-generated scenes. Participants can work with a therapist to practice techniques to manage their anxiety and introduce CBT techniques to help it, besides, gradual exposure may help maintain anxiety at manageable levels while the person stays in the situation and so allows the patient to habituate. Exposure to the anxiety point can be undertaken a number of times to enable the participant to develop confidence in, and mastery of, the anxiety management strategies being practiced and experience a reduction in anxious affect before moving up to a greater level of challenge.

Checking the effectiveness after good results with the young ones

This treatment was already conducted in the past with autistic children showing great results so the institution wanted to test the intervention in autistic adults. In this study, four 20- to 30-minute sessions in the virtual reality environment led to reductions in anxiety in eight of the nine autistic children who presented with phobias. The pilot study used a unique immersive virtual reality environment known as the Blue Room. The Blue Room is an immersive technology using computer-generated images projected onto the walls and ceilings of a 360-degree seamless screened room. Participants don’t need to wear a headset or goggles, and the therapist navigates with them through the scene using a handheld tablet.

For the study, there were recruited eight autistic adults (aged 18–57 years) with a fear or phobia and their supporter (parent/friend/support worker) who could accompany them. Each participant had a computer-generated scene designed for their specific anxiety-provoking situation and after four sessions, the participant tried real-life exposure with their supporter.

During the four sessions, the participants, along with the therapist, worked through exposition in relation to the phobia targeted. Participants increased the exposition once they were able to comfortably manage their anxiety at each stage of exposure. At the end of the fourth session, the therapist, participant, and supporter planned together with the steps to real-life exposure.

Of the eight participants, five were classified as treatment responders. This means that 6 months after the last virtual reality session, they still had real-life day-to-day improvements in relation to their phobia. They showed a pattern of increasing improvement with time, indicating a strengthening of the treatment effect over time. Three of the participants were nonresponders to treatment, equivocally improved and indicated no worsening of symptoms.

Good perspective for autistic adults

This is the first report of a CBT and immersive virtual reality environment intervention for adults on the autism spectrum experiencing phobias. Five of the eight adults improved in their ability to tackle their real-life phobia, and four adults were able to function in everyday life without any impact from it. The virtual reality therapy allows exposure at a level of anxiety that feels safe and is not overwhelming but it is real enough to induce anxiety at a level for habituation to occur. Observation of the anxiety reduction techniques developed in the virtual reality environment enabled the supporter to scaffold and support their use during real-world exposure.

These findings show that virtual reality alongside CBT may be an effective treatment for autistic people with phobias. This is a small study and future work will be a larger trial of this treatment comparing results from people who get the intervention with people who do not. Future research will aim to identify the mechanisms leading to effective treatment including which adaptations are required.

A new perspective has been explored for the benefit of autistic adults and their health wellbeing, this method will help them carry out an easier life alongside reducing their fears and phobias. Psious offers the platform to provide therapies with virtual reality worldwide to psychologists and other mental health professionals, it has hundreds of environments to choose from and each of them has parameters to adapt it to every patient.

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