Reducing specific phobia/fear in young people with autism spectrum disorders (ASDs) through a virtual reality environment intervention

PLoS One. 2014 Jul 2;9(7):e100374. doi: 10.1371/journal.pone.0100374. eCollection 2014.


Anxiety is common in children with autism spectrum disorders (ASD), with specific fears and phobias one of the most frequent subtypes. Specific fears and phobias can have a serious impact on young people with ASD and their families. In this study we developed and evaluated a unique treatment combining cognitive behaviour therapy (CBT) with graduated exposure in a virtual reality environment (VRE). Nine verbally fluent boys with an ASD diagnosis and no reported learning disability, aged 7 to 13 years old, were recruited. Each had anxiety around a specific situation (e.g. crowded buses) or stimulus (e.g. pigeons). An individualised scene was recreated in our 'wrap-around' VRE. In the VRE participants were coached by a psychologist in cognitive and behavioural techniques (e.g. relaxation and breathing exercises) while the exposure to the phobia/fear stimulus was gradually increased as the child felt ready. Each child received four 20-30 minute sessions. After participating in the study, eight of the nine children were able to tackle their phobia situation. Four of the participants completely overcame their phobia. Treatment effects were maintained at 12 months. These results provide evidence that CBT with VRE can be a highly effective treatment for specific phobia/fear for some young people with ASD.

Trial registration: ISRCTN58483069.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Breathing Exercises*
  • Child
  • Child Development Disorders, Pervasive* / physiopathology
  • Child Development Disorders, Pervasive* / psychology
  • Child Development Disorders, Pervasive* / therapy
  • Fear*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Virtual Reality Exposure Therapy*

Associated data

  • ISRCTN/ISRCTN58483069

Grant support

Dr Morag Maskey has a Daphne Jackson Fellowship sponsored by Newcastle University ( The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.