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Fears and phobias are common in people on the autism spectrum and can impact on their ability to undertake usual daily activities. Graded exposure to the anxiety-provoking stimulus is a recognized method of treatment for fears/phobias in the nonautistic population but may pose specific difficulties for autistic people. For example, real-life exposure can be too anxiety-provoking to allow treatment to take place, and imaginal exposure can be problematic. To address this, we developed an intervention that combines cognitive behavioral therapy (CBT) with immersive virtual reality (VR) exposure to reduce anxiety. Following successful trials of this intervention with young people on the autism spectrum, we report a pilot study using the same intervention with autistic adults. Eight adults (aged 18–57 years) received one psychoeducation session and then four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant completed all sessions showing that the intervention is feasible and acceptable. Outcomes were monitored at 6 weeks and 6 months postintervention. Five of the eight participants were classified as intervention responders and at 6 months after the end of intervention were experiencing real-life functional improvements. These preliminary findings show that VR-graded exposure alongside CBT may be an effective treatment for autistic people with phobias. Lay Summary Why was this study done? Anxiety is common in autistic adults. For some people, fears and phobias regarding everyday objects and situations occur frequently affecting everyday life. The main method to treat fears and phobias for people without autism is gradual exposure to the situation that causes anxiety. However, this method may be challenging for people on the autism spectrum. We wanted to test a new method of treatment that uses cognitive behavioral therapy (CBT) delivered with gradual exposure in a fully immersive virtual reality (VR) environment. What was the purpose of this study? We have already delivered this treatment successfully with autistic children. We wanted to test if this treatment would work for autistic adults. Changing traditional psychological treatments, such as CBT, to make it more suitable for autistic people is recommended by the National Institute for Health and Care Excellence. What did the researchers do? We recruited eight autistic adults (aged 18–57 years) with a fear/phobia and their supporter (parent/friend/support worker). Each adult had one session with a therapist to learn anxiety management techniques. They then had four 20-minute sessions of graded exposure with a therapist in an immersive VR room (known as the Blue Room). Each participant had a computer-generated scene designed for their specific anxiety-provoking situation. After four sessions, the participant tried real-life exposure with their supporter. We measured progress at 6 weeks and 6 months after the last VR session. What were the results of this study? Each participant completed all four sessions. This shows that the intervention was possible to deliver and acceptable to autistic people and therapists. Participants completed assessments at 6 weeks and 6 months after the VR sessions. Five of the eight participants were “responders” to the intervention. This means that 6 months after the last VR session, they still had real-life day-to-day improvements in relation to their phobia. What do these findings add to what was already known? We had not delivered this intervention to autistic adults previously. The findings show that this VR intervention has the potential to be an effective treatment for anxiety in autistic adults. What are the potential weaknesses in the study? This is a small study and future work will be a larger trial of this treatment—comparing results from people who get the intervention with people who do not. We would also want to have an outcome assessor who did not know whether people had received the intervention or not. How will these findings help autistic adults now or in the future? This new intervention has the potential to help autistic adults manage their anxiety in stressful situations and therefore may improve their quality of life.

Most models of reading agree that visual word recognition is underpinned by a highly interactive network in which both bottom–up and top–down processes contribute. What remains unknown is whether evidence of top–down effects upon letter processing are restricted to word-form level information, or whether meaning-level information also plays a role. Here we sought to investigate top–down semantic influences upon letter detection using semantic manipulations of real word imageability and semantic priming, as well as a manipulation of nonword orthographic and phonological composition which varied degree of similarity to real words. A continuous adaptive staircase procedure was used, allowing us to assess the exposure duration needed for accurate letter perception in different stimulus types. Results revealed that in terms of both exposure duration and decision reaction times, words showed an advantage over pseudohomophones and pseudowords, which in turn showed advantages over consonant strings. High imageability words were processed more efficiently than low imageability words, both in terms of the exposure duration required for accurate letter identification and also decision reaction times. The presence of a related as opposed to unrelated semantic prime significantly shortened exposure duration, but also lengthened decision reaction times. This inhibitory semantic priming effect in reaction time was attributed to the interference at the decision stage by stronger activation of the prime letters in the case of related relative to unrelated trials. Taken together, the present results establish for the first time that the semantic dimensions of imageability and semantic priming exert significant effects on letter identification, indicating meaning-level influences on the very earliest stages of written word recognition.

Most models of reading agree that visual word recognition is underpinned by a highly interactive network in which both bottom–up and top–down processes contribute. What remains unknown is whether evidence of top–down effects upon letter processing are restricted to word-form level information, or whether meaning-level information also plays a role. Here we sought to investigate top–down semantic influences upon letter detection using semantic manipulations of real word imageability and semantic priming, as well as a manipulation of nonword orthographic and phonological composition which varied degree of similarity to real words. A continuous adaptive staircase procedure was used, allowing us to assess the exposure duration needed for accurate letter perception in different stimulus types. Results revealed that in terms of both exposure duration and decision reaction times, words showed an advantage over pseudohomophones and pseudowords, which in turn showed advantages over consonant strings. High imageability words were processed more efficiently than low imageability words, both in terms of the exposure duration required for accurate letter identification and also decision reaction times. The presence of a related as opposed to unrelated semantic prime significantly shortened exposure duration, but also lengthened decision reaction times. This inhibitory semantic priming effect in reaction time was attributed to the interference at the decision stage by stronger activation of the prime letters in the case of related relative to unrelated trials. Taken together, the present results establish for the first time that the semantic dimensions of imageability and semantic priming exert significant effects on letter identification, indicating meaning-level influences on the very earliest stages of written word recognition.

Background: Longitudinal studies are essential for understanding the trajectory and prognosis of patients diagnosed with schizophrenia, in particular those who are treatment resistant as this outcome is difficult to predict. However, follow-up is challenging within this patient population due to high relapse rates, difficulties recontacting participants due to regular change of address, and patients’ symptoms leading to their refusal to take part. Methods: We describe one of the work packages of STRATA (Schizophrenia: Treatment Resistance and Therapeutic Advances) as an example of the challenges facing follow-up studies in schizophrenia research. The main aim of STRATA is to identify differences between treatment-resistant and treatment-responsive patients with schizophrenia and create a method for early identification of treatment resistant patients; thereby allowing earlier transition to more suitable treatments such as clozapine. Cohorts of patients from pre-existing studies of first-episode psychosis are presently being recontacted. Three studies across the UK (“AESOP,” Nottingham and London samples; “RPGI” and “NIFEPS,” Belfast samples) were included in STRATA. In total, 484 participants were eligible for recontact; 157 participants from AESOP, 85 from the RPGI; and 242 from the NIFEPS study. Participants were contacted via their clinical team, letter, or phone. Participants were invited to take part in a 40-minute interview in which demographic, substance use, medication history, and symptomatology (PANSS) data was collected. Participants were also asked to provide a blood and urine sample. Ethical permission was obtained to contact participants using information collected at previous visits and to obtain up to date contact addresses. Results: Out of the 484 participants who were recontacted, 13 were deceased, 9 were excluded, 23 requested information after the first contact but then ceased to respond, 47 declined to participate, and addresses were not identified for 63 participants. Thirty-four consented and completed all the assessments. The remaining 295 participants have yet to respond. Clozapine had been prescribed to 8.82% of completed participants and 47.06% have been prescribed 3 or more antipsychotics. Conclusion: The present study confirms the difficulties in longitudinal studies of patients diagnosed with schizophrenia. More research is needed in order to identify the attitudes and practices, which keep patients from participating in research. Additionally, in the general population, it is estimated that about two-third of individuals diagnosed with schizophrenia are treatment resistant. We can therefore conclude that treatment resistance is somewhat over-represented in the present sample.

To what extent does semantic information play a functional role in visual word recognition? Theories of word recognition vary in the importance assigned to semantic information in visual lexical decision, with past research suggesting that the nature of the foils is a crucial determinant of semantic reliance. Here, we explored the conditions under which semantic variables influence lexical decision. Normal readers performed visual lexical decision tasks in which imageability and semantic priming were manipulated, with nonword foils varying systematically in their orthographic and phonological similarity to the real words. The effects of imageability and semantic priming increased in magnitude as nonword foils became progressively more wordlike. These findings provide a clear illustration of the flexible use of semantic information to support normal visual word recognition.