Randomised Controlled Trial of the Use of the BLUE Room Virtual Reality Treatment to Reduce Situation Specific Anxiety in Young People with ASD
Young people with ASD are prone to anxiety; around 50% of those with ASD meet criteria for at least one anxiety disorder. Specific fears and phobias are one of the most frequent subtypes.
Graduated exposure and participant modelling are identified as evidence-based treatments for specific fears/phobias, but may require adaptation for individuals with ASD. One adaptation may be the use of a virtual reality environment (VRE) to reproduce the anxiety provoking situation. This removes the need to use imagination, and provides a way to gradually increase exposure to an anxiety provoking stimulus.
Following a successful development study with 9 children (Maskey et al 2014, PLoS One), we investigated further whether the Newcastle Blue Room Treatment may be effective for children attending child mental health services by conducting a randomised trial. The treatment involves sessions in an immersive VRE with a therapist.
To test the effectiveness of virtual reality exposure in overcoming a specific fear/phobia, reporting outcomes at 6 months after treatment.
32 verbally fluent young people with ASD aged 8-14 years, who have a specific fear/phobia, were recruited from two mental health trusts. Children were randomised to immediate treatment (n=16) or delayed treatment (n=16; receiving treatment after their six month follow-up). Each participant received one preparatory home visit, followed by four 20 minute sessions in the fully immersive VRE with a scene designed specifically around their specific fear/phobia. During each session, they received coaching in relaxation techniques and coping self-statements from a therapist who accompanied them. The Newcastle Blue Room Treatment uses state of the art technology (http://blueroomisv.com/).
Before and after each VRE session, the child and parent (who was observing from another room) rated the child’s anxiety using a six point scale. Anxiety at baseline and six-month end point was measured using the Spence Children’s Anxiety Scale and the FEAR survey. Vignettes describing the anxiety to be addressed during the treatment, and the family impact, were written at baseline. Subsequently, a blinded researcher contacted the families 2 weeks and 6 months post-intervention (or equivalent for the delayed arm) and completed vignettes characterising the child’s anxiety-related behaviour at those timepoints. Change in symptoms across time as depicted in the vignettes was the primary outcome measure. The vignettes were compared by an expert panel (blinded to timepoint and treatment group) to assess degree of improvement/deterioration of symptoms and impact on a 9 point scale. The top three points described a responder.
At six months follow up the immediate treatment group had improved significantly more than the control group (t= -3.230, p=0.005). Half of the immediate treatment group met criteria for being a ‘responder’; none of the delayed treatment group responded. Results from other outcome measures will be presented at the conference.
This study has shown that the individually tailored, Newcastle Blue Room Treatment comprising virtual reality exposure in conjunction with CBT is an effective treatment for children with ASD and situation specific anxiety, specific fears and phobias.