A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute


Virtual reality room can help some individuals with autism quickly overcome severe phobias

Immersive virtual reality therapy can help some children and adults with autism spectrum disorder (ASD) overcome their phobias, according to researchers in Britain. 

Morag Maskey and colleagues note that anxiety is one of the most common problems for autistic individuals and that many individuals with ASD  have specific phobias—such as a fear of dogs, elevators, airports, or balloons—that interfere significantly with daily life. The researchers also note that cognitive behavioral therapy (CBT), the most commonly used therapy for phobias, can be difficult for individuals with ASD to benefit from because it requires abstract thinking. 

In the virtual reality approach, participants enter a “Blue Room” where they navigate through a 360-degree video projection of a scene (accompanied by audio) that replicates the feared object or experience. They do not need to wear goggles because a therapist manipulates the scene using iPad controls. The therapist also uses CBT techniques to help participants become less anxious during exposure to their phobias. 

Participants move through a hierarchy of exposure (for instance, seeing a small dog first and later a larger one), proceeding to the next level only when they feel secure. This allows them to gain confidence through repeated practice at one level of challenge.

Recently, Maskey and colleagues reported the results of two studies of the Blue Room’s effects on phobias in ASD. One involved children, while the other involved adults.

In the first study, Maskey and colleagues randomized 32 children with ASD to a treatment group or a waitlist. Children in the active treatment group underwent one 45-minute introductory session and four 20-minute virtual reality sessions conducted over two weeks. Children initially on the wait list later participated in the active treatment.

The researchers report, “One-third of children from the treatment group showed improvements in their real-life targeted phobia, with children able to manage everyday activities and situations that were not possible previously. By contrast, no children in the control group showed improvement in their specific phobia during their wait phase of the trial period. Furthermore, five control group children showed a clear deterioration in target behavior rating from baseline, compared with one treatment group child. When the control group later received treatment, a similar proportion were classified as responders as to the immediate treatment group.”

In the second study, the researchers found that Blue Room treatment was also effective for many adults with ASD. In this study, eight adults ranging in age from 18 to 57 participated in virtual reality sessions. The researchers report, “For all participants, phobia was having a major impact on their lives (e.g., preventing attendance at university, preventing travel, and/or involving extensive safety rituals that limited their participation in everyday activities). 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 their phobia.”

Maskey comments that the Blue Room is effective because “we are providing the feared situation in a controlled way through virtual reality, and we are sitting alongside them to help them learn how to manage their fears.” She adds, “It is incredibly rewarding to see the effect it can have for some, overcoming a situation which just a week previously would have been so distressing.”

Maskey comments, “It is incredibly rewarding to see the effect it can have for some, overcoming a situation which just a week previously would have been so distressing.”


“A randomized controlled feasibility trial of immersive virtual reality treatment with cognitive behavior therapy for specific phobias in young people with autism spectrum disorder,” Morag Maskey, Jacqui Rodgers, Victoria Grahame, Magdalena Glod, Emma Honey, Julia Kinnear, Marie Labus, Jenny Milne, Dimitrios Minos, Helen Mc-Conachie, and Jeremy R. Parr, Journal of Autism and Developmental Disorders, February 15, 2019(free online). Address: Jeremy R. Parr, Institute of Neuroscience, Sir James Spence InstituteLevel 3, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne NE1 4LP, UK, [email protected].


“Using virtual reality environments to augment cognitive behavioral therapy for fears and phobias in autistic adults,” Morag Maskey, Jacqui Rodgers, Barry Ingham, Mark Freeston, Gemma Evans, Marie Labus, and Jeremy R. Parr, Autism in Adulthood, Vol. 1, No. 2, 2019 (free online). See address above.


“Virtual reality therapy treats autism phobias,” news release, Newcastle University, February 15, 2019.