Autism, Phobias, and Virtual Reality

Autism Spectrum Disorder (ASD) is a complex set of neurodevelopmental conditions. Autism is typically characterised by early-onset impairments in communication, social interaction, and behaviours. Due to its complexity and pervasiveness Autism can be extremely challenging for individuals and their families. Despite the similarities in core profiles and definitions, individuals with Autism have enormous variability in expression and severity of symptoms. Therefore, Autism is a difficult condition to apply blanket approaches and policies towards.

Anxiety, specifically phobias, is frequently reported as the most common coinciding condition for individuals with Autism. Individuals with Autism experience fears and phobias more often than typically developed individuals and towards a larger variety of stimuli. Fears and phobias experienced by those with Autism are significant, persistent and interfere in their daily lives. Alongside the “typical” presentations of anxiety; such as sweating, increased heart rate, shaking, avoidance, escape, and distraction; fearful individuals with Autism may display additional challenging behaviours e.g. repetitive or ritualistic behaviours, sensory behaviours, socially inappropriate behaviours, and increases in self-injury and aggression.

Exposure therapy is when individuals are exposed to the stimulus they fear in a controlled setting in a managed and supported way. Typically, individuals are supported to develop coping techniques that help them reduce anxiety and phobia symptoms when faced with their fear. Through exposure and development of coping techniques individuals learn alternate safe ways to respond to feared stimuli and experience exposure to a situation in which their imagined worst-case scenario did not happen.

Individuals with Autism may experience intellectual challenges and communication issues; this can make it difficult to use certain approaches and therapies. It is important that individuals understand what therapies, such as exposure, entail and that they can communicate their consent and willingness to participate. Exposure therapy for individuals with Autism faces several complications including their difficulty with imagination and abstract thinking, there are also issues with the possibility of extreme reactions to a feared object. Physical safety is a possible issue as individuals might hurt themselves or others in attempts to escape the situation. There is also the extreme emotional distress associated with being exposed to a feared stimulus.

Virtual Reality has been used by Autism therapists since the mid-1990s for a variety of situations e.g. job interviews, public speaking, eye contact, crowded spaces, unfamiliar locations etc. Virtual reality exposure allows the recreation of a feared situation in a virtual environment which reduces the need for autistic individuals to have imaginative and abstract thinking skills. Virtual reality exposure allows for individuals with Autism to experience “real world” scenarios in safe highly controlled environments that would otherwise be too dangerous to attempt e.g. exposure to dogs while walking along a footpath. These scenarios allow individuals to practice coping techniques to manage the anxiety they feel in those situations and allows them to repeat and rehearse their reactions and coping techniques. These programs are highly manageable, can be individualised, are primarily visual, and reduce language and social interaction demands.

Virtual reality exposure offers individuals with Autism an opportunity to address fears and phobias that negatively impact their everyday lives in a safe and controlled environment. The ability to develop coping techniques and practice scenarios through virtual realities can significantly improve the lives of individuals and empower them to use developed coping techniques in these scenarios.