Using Virtual Reality Environments to Augment Cognitive Behavioral Therapy for Fears and Phobias in Autistic Adults

Abstract

Fears and phobias are common in people on the autism spectrum and can impact on their ability to undertake usual daily activities. Graded exposure to the anxiety-provoking stimulus is a recognized method of treatment for fears/phobias in the nonautistic population but may pose specific difficulties for autistic people. For example, real-life exposure can be too anxiety-provoking to allow treatment to take place, and imaginal exposure can be problematic. To address this, we developed an intervention that combines cognitive behavioral therapy (CBT) with immersive virtual reality (VR) exposure to reduce anxiety. Following successful trials of this intervention with young people on the autism spectrum, we report a pilot study using the same intervention with autistic adults. Eight adults (aged 18–57 years) received one psychoeducation session and then four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant completed all sessions showing that the intervention is feasible and acceptable. Outcomes were monitored at 6 weeks and 6 months postintervention. Five of the eight participants were classified as intervention responders and at 6 months after the end of intervention were experiencing real-life functional improvements. These preliminary findings show that VR-graded exposure alongside CBT may be an effective treatment for autistic people with phobias. Lay Summary Why was this study done? Anxiety is common in autistic adults. For some people, fears and phobias regarding everyday objects and situations occur frequently affecting everyday life. The main method to treat fears and phobias for people without autism is gradual exposure to the situation that causes anxiety. However, this method may be challenging for people on the autism spectrum. We wanted to test a new method of treatment that uses cognitive behavioral therapy (CBT) delivered with gradual exposure in a fully immersive virtual reality (VR) environment. What was the purpose of this study? We have already delivered this treatment successfully with autistic children. We wanted to test if this treatment would work for autistic adults. Changing traditional psychological treatments, such as CBT, to make it more suitable for autistic people is recommended by the National Institute for Health and Care Excellence. What did the researchers do? We recruited eight autistic adults (aged 18–57 years) with a fear/phobia and their supporter (parent/friend/support worker). Each adult had one session with a therapist to learn anxiety management techniques. They then had four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant had a computer-generated scene designed for their specific anxiety-provoking situation. After four sessions, the participant tried real-life exposure with their supporter. We measured progress at 6 w...

Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment–Autism (PAT-A©) pilot randomised controlled feasibility trial

“…Participants interact with and navigate through a specific phobia scenario with the support of a therapist. Feasibility studies support the use of this VRE as an acceptable and effective treatment for specific phobia in both autistic young people and adults [33,46,47].…”

“…Arnold et al [49] reported an Intraclass Correlation Coefficient (ICC) of 0.895 across a panel of five raters. This has been a preferred outcome measure in our previous trials, and it has demonstrated utility in recording change in anxiety associated with a specific real-life goal or situation [46,47,[50][51][52].…”

“…One single-blind randomised trial of group CBT for autistic adults, found no difference in anxiety at follow-up between those allocated to treatment or a waiting-list control [32]. Novel interventions combining Virtual Reality Environments (VREs) and CBT for the treatment of specific phobias have demonstrated feasibility and acceptability and some evidence of acceptability and efficacy in autistic adults [33]. Trials of mindfulness-based psychotherapies have also obtained favourable outcomes [34,35], for a range of symptoms such as anxiety, depression and rumination.…”

How to use the Advantages of AR and VR Technique to Integrate Special Visual Training Strategies in Non-Verbal Communication Skills Training for Children with Autism

“…This also shows that it is difficult for autistic children to use simple images and integrate their creative imagination into a more profound on-the-spot experience, and such a perceptual environment can only be achieved in real life. However, some autistic children have a fear of the real environment, and the complexity of the information in the environment makes those with poor communication more afraid and likely to retreat, which means it cannot really achieve the purpose of training [70]. Therefore, transpositional thinking skills and empathy (also known as defects in the Theory of Mind (ToM)the ability to interpret another person's interests, intentions, and emotions) has…”

“…VR technology has sensory advantages in situation simulation and social training, especially in the early stages of its application. It is often used to solve the problems that autistic children are afraid to face in the real world, and to help them to simulate and experience different situations, such as going to school, taking busses, shopping, or to solve different levels of social fear problems [70]. However, most of these training styles are still in the stage of scenario simulation, which is also the most common and best operating mechanism of VR technology.…”