A Randomised Controlled Feasibility Trial of Immersive Virtual Reality Treatment with Cognitive Behaviour Therapy for Specific Phobias in Young People with Autism Spectrum Disorder.
Morag Maskey, Jacqui Rodgers, Victoria Grahame and 8 others
PMID 30767156WHAT IT FOUND
Children with autism and a specific phobia who received immersive virtual reality plus CBT showed greater real-life phobia improvement than those waiting, but most did not clearly improve and standard anxiety questionnaires did not show the same change.
Key findings
01The group that received Blue Room immersive virtual reality and therapist-delivered CBT showed significantly greater improvement on the main Target Behaviour rating than the control group at 2 weeks (U = 67.5, p = 0.021) and 6 months (U = 53.0, p = 0.007).
02At 6 months, six of 16 children in the immediate treatment group were classified as responders, compared with no control group children (χ² = 6.98, p = 0.018).
03Standard anxiety questionnaires did not show statistically significant group differences or time-by-group interactions.
STILL TO COME
How it was doneWhat they found
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What it does not show
The sample was small (32 children), and the trial was designed to test feasibility rather than to prove effectiveness for all children with autism. Participants had to be verbally fluent, aged 8 to 14, and have a phobia that could be represented in the virtual room, so the results do not show what would happen for children who cannot take part or whose phobia is not visually representable. The intervention combined immersive virtual reality, therapist-delivered CBT, parent observation and explanation, and post-session real-world exposure planning, so the contribution of any single component cannot be separated. Participants, clinicians and the main researcher knew group allocation, so expectation effects cannot be ruled out. The main outcome relied on parent-reported vignettes and expert ratings, not direct observation of real-life behaviour. Standard anxiety questionnaires did not detect the target-behaviour change, so their usefulness as outcome measures in this population is uncertain. Some questionnaire data were missing, and 12-month data were available from only 11 of 15 children in the immediate treatment group.
Declared interests
The funder named was the Research for Patient Benefit Programme, and the research sponsor was Northumberland, Tyne and Wear NHS Foundation Trust.
The easy way to misread this
Do not conclude that virtual reality alone caused the improvement, because the intervention combined immersive virtual reality with therapist-delivered CBT and post-session real-world exposure planning. Do not treat this as proof of effectiveness for all children with autism, because it was a small feasibility trial and more than half of treated children were not rated as responders.