A Randomised Controlled Feasibility Trial of Immersive Virtual Reality Treatment with Cognitive Behaviour Therapy for Specific Phobias in Young People with Autism Spectrum Disorder
Open accessAbstract
We examined the feasibility and acceptability of using an immersive virtual reality environment (VRE) alongside cognitive behaviour therapy (CBT) for young people with autism experiencing specific phobia. Thirty-two participants were randomised to treatment or control. Treatment involved one session introducing CBT techniques and four VRE sessions, delivered by local clinical therapists. Change in target behaviour was independently rated. Two weeks after treatment, four treatment participants (25%) and no control participants were responders; at 6 months after treatment, six (38%) treatment and no control participants were responders. At 6 months post-treatment, symptoms had worsened for one treatment and five control (untreated) participants. Brief VRE exposure with CBT is feasible and acceptable to deliver through child clinical services and is effective for some participants.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Maskey et al. found acceptability and feasibility of using CBT in a virtual reality setting.
“Maskey et al., (2019a, 2019b, 2019c, 2019d) found acceptability and feasibility of using CBT in a virtual reality setting.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
A Children's Global Assessment Scale (CGAS)
Shaffer, D. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790100074010 · Cited by 3,716 · see citing works
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e318179964f · Cited by 3,399 · see citing works
Autism screening questionnaire: diagnostic validity
Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999) · British Journal of Psychiatry · doi:10.1192/bjp.175.5.444 · Cited by 1,464 · see citing works
Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis
van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-011-0097-0 · Cited by 1,463 · see citing works
Parsons, T. D., & Rizzo, A. A. (2008) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2007.07.007 · Cited by 994 · see citing works
The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders
Maples-Keller, J. L., Bunnell, B. E., Kim, S.-J., & Rothbaum, B. O. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000138 · Cited by 862 · see citing works
Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C., & Davies, E. B. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12663 · Cited by 846 · cited 1× · see citing works
“Increasingly, new technologies, such as virtual reality (VR), are being used with the neurotypical population to augment traditional psychological treatments (Hollis et al. 2016; Freeman et al. 2017; Valmaggia et al. 2016).”
BackgroundValmaggia, L. R., Latif, L., Kempton, M. J., & Rus-Calafell, M. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.01.015 · Cited by 500 · see citing works
Ung, D., Selles, R., Small, B. J., & Storch, E. A. (2015) · Child Psychiatry & Human Development · doi:10.1007/s10578-014-0494-y · Cited by 231 · see citing works
Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010) · Developmental Neurorehabilitation · doi:10.3109/17518420903236288 · Cited by 226 · see citing works
Moree, B. N., & Davis, T. E. (2010) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2009.10.015 · Cited by 220 · cited 4× · see citing works
“…hierarchies, the use of more concrete visual tactics, incorporation of a child’s specific interests, and inclusion of parents in treatment (Moree and Davis 2010); additional adaptations may include psychoeducation about recognising and understanding emotions, problem solving, and a…”
BackgroundInfluentialMaskey, M., Lowry, J., Rodgers, J., McConachie, H., & Parr, J. R. (2014) · PLoS ONE · doi:10.1371/journal.pone.0100374 · Cited by 215 · see citing works
Self-citationUnusual fears in children with autism
Mayes, S. D., Calhoun, S. L., Aggarwal, R., Baker, C., Mathapati, S., Molitoris, S., & Mayes, R. D. (2013) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2012.08.002 · Cited by 92 · cited 1× · see citing works
“visiting a particular location), of everyday objects (toilets, machines, foods), or of people with certain personal characteristics (Mayes et al. 2013).”
Background
Flagged first, then by citations
Research works printed but not linked: 31
- Arnold LE Vitiello B McDougle C Scahill L Shah B Gonzalez NM Parent-defined target symptoms respond to risperidone in RUPP autism study: Customer approach to clinical trials Journal of the American Academy of Child & Adolescent Psychiatry 2003 42 12 1443 1450 10.1097/00004583-200312000-00011 14627879 · DOI · Paper page
- Baird G Simonoff E Pickles A Chandler S Loucas T Meldrum D Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP) Lancet 2006 368 9531 210 215 10.1016/S0140-6736(06)69041-7 16844490 · DOI · Paper page
- Bian, D., Wade, J. W., Zhang, L., Bekele, E., Swanson, A., Crittendon, J. A., et al. A novel virtual reality driving environment for autism intervention. In International Conference on Universal Access in Human-Computer Interaction, 2013 (pp. 474–483): Springer.
- Botella C Fernández-Álvarez J Guillén V García-Palacios A Baños R Recent progress in virtual reality exposure therapy for phobias: A systematic review Current Psychiatry Reports 2017 19 7 42 10.1007/s11920-017-0788-4 28540594 · DOI · Paper page
- Burnham JJ Gullone E The Fear Survey Schedule for Children—II: A psychometric investigation with American data Behaviour Research and Therapy 1997 35 2 165 173 10.1016/S0005-7967(96)00089-7 9046680 · DOI
- Evans DW Canavera K Kleinpeter FL Maccubbin E Taga K The fears, phobias and anxieties of children with autism spectrum disorders and down syndrome: Comparisons with developmentally and chronologically age matched children Child Psychiatry & Human Development 2005 36 1 3 26 10.1007/s10578-004-3619-x 16049642 · DOI
- Freeman D Reeve S Robinson A Ehlers A Clark D Spanlang B Virtual reality in the assessment, understanding, and treatment of mental health disorders Psychological Medicine 2017 47 14 2393 2400 10.1017/S003329171700040X 28325167 PMC5964457 · DOI · Paper page
- Ghaziuddin M Ghaziuddin N Greden J Depression in persons with autism: Implications for research and clinical care Journal of Autism and Developmental Disorders 2002 32 4 299 306 10.1023/A:1016330802348 12199134 · DOI · Paper page
- Gullone E King NJ Tonge B Heyne D Ollendick TH The Fear Survey Schedule for Children—II (FSSC-II): Validity data as a treatment outcome measure Australian Psychologist 2000 35 3 238 243 10.1080/00050060008257485 · DOI
- Josman N Ben-Chaim HM Friedrich S Weiss PL Effectiveness of virtual reality for teaching street-crossing skills to children and adolescents with autism International Journal on Disability and Human Development 2008 7 1 49 56 10.1515/IJDHD.2008.7.1.49 · DOI
- Kandalaft MR Didehbani N Krawczyk DC Allen TT Chapman SB Virtual reality social cognition training for young adults with high-functioning autism Journal of Autism and Developmental Disorders 2013 43 1 34 44 10.1007/s10803-012-1544-6 22570145 PMC3536992 · DOI · Paper page
- King GA Law M King S Hurley P Hanna S Kertoy M Measuring children’s participation in recreation and leisure activities: Construct validation of the CAPE and PAC Child: Care, Health and Development 2007 33 1 28 39 17181750
- Leyfer OT Folstein SE Bacalman S Davis NO Dinh E Morgan J Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders Journal of Autism and Developmental Disorders 2006 36 7 849 861 10.1007/s10803-006-0123-0 16845581 · DOI · Paper page
- Lind SE Williams DM Bowler DM Peel A Episodic memory and episodic future thinking impairments in high-functioning autism spectrum disorder: An underlying difficulty with scene construction or self-projection? Neuropsychology 2014 28 1 55 67 10.1037/neu0000005 24015827 PMC3906795 · DOI
- Lydon S Healy O O’Callaghan O Mulhern T Holloway J A systematic review of the treatment of fears and phobias among children with autism spectrum disorders Review Journal of Autism and Developmental Disorders 2015 2 2 141 154 10.1007/s40489-014-0043-4 · DOI
- Maskey M Warnell F Parr JR Le Couteur A McConachie H Emotional and behavioural problems in children with autism spectrum disorder Journal of Autism and Developmental Disorders 2013 43 4 851 859 10.1007/s10803-012-1622-9 22895777 · DOI
- Mattila ML Hurtig T Haapsamo H Jussila K Kuusikko-Gauffin S Kielinen M Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study Journal of Autism and Developmental Disorders 2010 40 9 1080 1093 10.1007/s10803-010-0958-2 20177765 · DOI
- Mitchell P Parsons S Leonard A Using virtual environments for teaching social understanding to 6 adolescents with autistic spectrum disorders Journal of Autism and Developmental Disorders 2007 37 3 589 600 10.1007/s10803-006-0189-8 16900403 · DOI
- Nauta MH Scholing A Rapee RM Abbott M Spence SH Waters A A parent-report measure of children’s anxiety: Psychometric properties and comparison with child-report in a clinic and normal sample Behaviour Research and Therapy 2004 42 7 813 839 10.1016/S0005-7967(03)00200-6 15149901 · DOI · Paper page
- NICE (2013). Autism Spectrum Disorder in under 19’s: Support and management. National Institute for Health and Care Excellence. CG170. 34283415
- Ollendick TH Reliability and validity of the revised fear survey schedule for children (FSSC-R) Behaviour Research and Therapy 1983 21 6 685 692 10.1016/0005-7967(83)90087-6 6661153 · DOI
- Ollendick TH King NJ Muris P Fears and phobias in children: Phenomenology, epidemiology, and aetiology Child and Adolescent Mental Health 2002 7 3 98 106 10.1111/1475-3588.00019 · DOI · Paper page
- Parsons S Cobb S State-of-the-art of virtual reality technologies for children on the autism spectrum European Journal of Special Needs Education 2011 26 3 355 366 10.1080/08856257.2011.593831 · DOI
- Roth AD Pilling S Using an evidence-based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders Behavioural and Cognitive Psychotherapy 2008 36 02 129 147 10.1017/S1352465808004141 · DOI · Paper page
- Silverman, W. K. (1996). Anxiety disorders interview schedule for DSM-IV.: parent interview schedule (Vol. 1). Oxford: Oxford University Press.
- Smith MJ Ginger EJ Wright K Wright MA Taylor JL Humm LB Virtual reality job interview training in adults with autism spectrum disorder Journal of Autism and Developmental Disorders 2014 44 10 2450 2463 10.1007/s10803-014-2113-y 24803366 PMC4167908 · DOI
- Sofronoff K Attwood T Hinton S A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome Journal of Child Psychology Psychiatry 2005 46 11 1152 1160 10.1111/j.1469-7610.2005.00411.x 16238662 · DOI
- Sparrow, S., Cicchetti, D., & Balla, D. (2005). Vineland-ii. Vineland adaptive behavior scales. Survey forms manual. Minneapolis: NCS Pearson Inc.
- Spence SH A measure of anxiety symptoms among children Behaviour Research and Therapy 1998 36 5 545 566 10.1016/S0005-7967(98)00034-5 9648330 · DOI · Paper page
- Strickland DC McAllister D Coles CD Osborne S An evolution of virtual reality training designs for children with autism and fetal alcohol spectrum disorders Topics in Language Disorders 2007 27 3 226 10.1097/01.TLD.0000285357.95426.72 20072702 PMC2804985 · DOI
- Weiss, J. A., Thomson, K., Burnham Riosa, P., Albaum, C., Chan, V., Maughan, A., et al. (2018). A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism. Journal of Child Psychology and Psychiatry. PMC6220772 29687457
Cited by
Sorted by citations
Virtual reality in the diagnostic and therapy for mental disorders: A systematic review
Wiebe, A., Kannen, K., Selaskowski, B., Mehren, A., Thöne, A.-K., Pramme, L., Blumenthal, N., Li, M., Asché, L., Jonas, S., et al. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102213 · Cited by 223 · see citing works
Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy
Lindner, P. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-020-00090-7 · Cited by 120 · see citing works
Sharma, S., Hucker, A., Matthews, T., Grohmann, D., & Laws, K. R. (2021) · BMC Psychology · doi:10.1186/s40359-021-00658-8 · Cited by 109 · see citing works
Schröder, D., Wrona, K. J., Müller, F., Heinemann, S., Fischer, F., & Dockweiler, C. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101893 · Cited by 85 · see citing works
Halldorsson, B., Hill, C., Waite, P., Partridge, K., Freeman, D., & Creswell, C. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13400 · Cited by 84 · see citing works
Understanding, recognising and treating co-occurring anxiety in autism
Rodgers, J., & Ofield, A. (2018) · Current Developmental Disorders Reports · doi:10.1007/s40474-018-0132-7 · Cited by 62 · see citing works
Self-citationMaximizing the impact of virtual reality exposure therapy for anxiety disorders
Anderson, P. L., & Molloy, A. (2020) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2020.10.001 · Cited by 38 · see citing works
Rodgers, J., Goodwin, J., Garland, D., Grahame, V., Isard, L., Kernohan, A., Labus, M., Osborne, M. M., Parr, J. R., Rob, P., et al. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05645-5 · Cited by 34 · see citing works
Self-citationParr, J. R., Brice, S., Welsh, P., Ingham, B., Le Couteur, A., Evans, G., Monaco, A., Freeston, M., & Rodgers, J. (2020) · Trials · doi:10.1186/s13063-020-4161-2 · Cited by 28 · see citing works
Self-citationRodgers, J., Brice, S., Welsh, P., Ingham, B., Wilson, C., Evans, G., Steele, K., Cropper, E., Le Couteur, A., Freeston, M., et al. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-023-06112-5 · Cited by 15 · see citing works
“Using a well-recognised procedure with high levels of agreement between expert raters (Arnold et al., 2003; Maskey et al., 2014; Maskey et al., 2019a, 2019b, 2019c, 2019d), pairs of anonymised vignettes from baseline and 3 month follow-up were compared to identify whether there has been any change…”
BackgroundMethodSelf-citationLi, M., Patel, J., Ibrahim, S., & Katapally, T. R. (2025) · doi:10.1101/2025.08.20.25334071 · Cited by 2 · see citing works
- Authors
- Maskey, M., Rodgers, J., Grahame, V., Glod, M., Honey, E., Kinnear, J., Labus, M., Milne, J., Minos, D., McConachie, H., & Parr, J. R.
- Affiliations
- Royal Victoria Infirmary (GB)
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust (GB)
- Newcastle University (GB)
- Tees, Esk and Wear Valleys NHS Foundation Trust (GB)
- Corresponding author
- Parr, Jeremy R.
- ORCID
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2019-02-15
- Volume
- 49
- Issue
- 5
- Pages
- 1912-1927
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- PMC
- PMC6484088
- OpenAlex
- W2911424512
- Cited by
- 112
- References
- 13
- Citations by year
- 2026: 12 · 2025: 18 · 2024: 13 · 2023: 11 · 2022: 20 · 2021: 17 · 2020: 16 · 2019: 4 · 2018: 1
- FWCI
- 13.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- Research for Patient Benefit Programme (PB-PG-0213-30067)
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- immersive virtual reality, cognitive behavioral therapy, specific phobia, autism spectrum disorder, youth, feasibility, acceptability, virtual reality exposure therapy
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Adult, Child, Female, Humans, Male, Phobic Disorders, Cognitive Behavioral Therapy, Virtual Reality Exposure Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
