Efficacy of CBT for ASD?

[Seladon]

Looking for studies and professional views, as well as anecdata from patients.

How do we know it does us any good? Has it been tested thoroughly? How has it been adapted for different needs and neurotypes? And is it suitable for all levels and types of us? (i.e. children, women, high vs. low function) Why is it assumed that this therapy can be of significant help to ASD people?

Tony Attwood seems to be split on the matter, conceding that it can be helpful in some cases, but has serious limitations for us when it comes to burnout & overload, cognitive inflexibility, sensory difficulties, and social engagement blocks. He also adds that short-term CBT is not enough to effect results in change-cautious ASD people, and that unless the ASD patient in question is anxious or traumatised the modality may not be much help.

 

[Fino]

Looking for studies and professional views, as well as anecdata from patients.

How do we know it does us any good? Has it been tested thoroughly? How has it been adapted for different needs and neurotypes? And is it suitable for all levels and types of us? (i.e. children, women, high vs. low function) Why is it assumed that this therapy can be of significant help to ASD people?

Tony Attwood seems to be split on the matter, conceding that it can be helpful in some cases, but has serious limitations for us when it comes to burnout & overload, cognitive inflexibility, sensory difficulties, and social engagement blocks. He also adds that short-term CBT is not enough to effect results in change-cautious ASD people, and that unless the ASD patient in question is anxious or traumatised the modality may not be much help.

I found therapy helpful while in the midst of trauma. Some of that therapy included CBT, but I think it was more just the talking that helped than the CBT. Any therapy since that first couple years has not been very helpful, so I’ve stopped going. I’ve found over the years that my negative emotions are not heavily influenced by my thoughts or even my circumstances. I’ve become convinced that it’s almost entirely biological, hence why medication helps so tremendously and consistently.

 

[marc_101]

I think it's very helpful for specific and concrete issues, not effective for "autism" in general. Anxiety, depression, negative pattern of thoughts, executive functioning... There is a lot of research on CBT. Probably thousand of studies. Do you have a specific need in mind?

 

[Seladon]

I found therapy helpful while in the midst of trauma. Some of that therapy included CBT, but I think it was more just the talking that helped than the CBT. Any therapy since that first couple years has not been very helpful, so I’ve stopped going. I’ve found over the years that my negative emotions are not heavily influenced by my thoughts or even my circumstances. I’ve become convinced that it’s almost entirely biological, hence why medication helps so tremendously and consistently.

Thank you for sharing your experience, and happy to hear that you've managed to move through trauma in some way. The talking element of therapy is probably the one universal balm--like they say, a problem shared is a problem halved, you're only as sick as your secrets, etc.

What you say about biological factors over emotional or psychological really resonates--feel free to expand on that if you wish, it's interesting. The body keeps the score is a popular text for a reason! Ik when I don't get my B12 or vit. D, or I'm not exercising enough, or I'm physically unwell, it feels like my ASD symptoms intensify.

 

[Seladon]

I think it's very helpful for specific and concrete issues, not effective for "autism" in general. Anxiety, depression, negative pattern of thoughts, executive functioning... There is a lot of research on CBT. Probably thousand of studies. Do you have a specific need in mind?

Yes, this seems to be the consensus I'm hearing. Of course, there is no 'cure' or effective therapy for ASD, and nor should there be, as we're not sick nor all non-functional, just different.

The volume is research is in fact what's overwhelming me, now you come to mention it (grrr executive function!), and this is what's making it hard for me to locate any papers relating directly to my question. Beyond Attwood's comments, there's nothing specific enough turning up in my searches.

As to the personal therapeutic needs I seek, really what I require from therapy is both grief/trauma release or resolution (from a long time ago), less passivity and fear of authority/exposure, and also assertiveness training. Obviously, CBT is not set up to address any of this, though it's all that's offered to many ASD people seeking help.

 

[marc_101]

As to the personal therapeutic needs I seek, really what I require from therapy is both grief/trauma release or resolution (from a long time ago), less passivity and fear of authority/exposure, and also assertiveness training. Obviously, CBT is not set up to address any of this, though it's all that's offered to many ASD people seeking help.

Based on my experience and understanding of CBT, it would be helpful for fear of authority and assertiveness. The idea of CBT is to question your thoughts so you can change your behavior.

You can work on scenarios. For example, what do you think when confronting a person of authority? What are the thoughts that emerge? Then you can develop strategies to question those thoughts and change them to something more useful. As a consequence, your emotions could change, and then, the ultimate goal, your behavior. CBT is great in that regard.

Here is an example of how it could work for assertiveness:

https://journals.sagepub.com/doi/pdf/10.1177/001100007500500408

More here:

Google Scholar

scholar.google.com

 

[Seladon]

Based on my experience and understanding of CBT, it would be helpful for fear of authority and assertiveness. The idea of CBT is to question your thoughts so you can change your behavior.

You can work on scenarios. For example, what do you think when confronting a person of authority? What are the thoughts that emerge? Then you can develop strategies to question those thoughts and change them to something more useful. As a consequence, your emotions could change, and then, the ultimate goal, your behavior. CBT is great in that regard.

Here is an example of how it could work for assertiveness:

https://journals.sagepub.com/doi/pdf/10.1177/001100007500500408

More here:

Google Scholar

scholar.google.com

@marc_101 thank you so much for those linked resources, am going to set aside time tomorrow morning to really study them closely (am lacking a bit of time rn).

Yes, the way CBT was always explained to me is that the therapists tries to 'hack' the emotions and behaviour via thought (the cognitive bit). The idea I suppose being that they're all connected in a loop.

Theoretical 'imagines' and mental walkthroughs as you describe seem to feature heavily ime. Am going to ask in my next scheduled session about strategies as pertain to assertion in particular.

This modality must be effective for some, or even a majority, or else they wouldn't use it. Where I'm encountering a block or difficulty with it personally though, is that my tendency to ruminate and overthink as well as 'overrehearse' in my head naturally makes it a case of 'adding fuel to the fire', not really getting my emotions out in the open or under control so that I can assert without either shutting down or blowing up. It's like trying to get a bolting horse to trot, kind of a backwards approach.

Tbh I think I'd prefer therapy that is either somatic or emotional, however it's beyond my financial means at the present time, which is why I'm trying to present a case to the health service that CBT might not be ideal for everyone.

 

[Rodafina]

Although CBT is a fairly regimented and specific approach to therapy, there still ought to be a good deal of personalization in its delivery. Below are some general recommendations for how to modify traditional CBT for an autistic client. Though, I think that some of these recommendations themselves would need to be modified to meet the specific needs of each client.

I recently read about just this in this article on the AANE (Association for Autism and Neurodiversity) website regarding ASD and OCD.

It is well established that when modified and tailored for Autistic youth, with and without co-occurring intellectual disability, this therapy is efficacious in treating OCD as well as anxiety. There is growing research evidence (and my personal clinical experience) that this is also the case for Autistic individuals across the lifespan and not just youth. Exposure has been shown to be the active ingredient in treating these conditions. However, when doing CBT with ERP with Autistic clients, it is important to include neuro-affirming modifications that are tailored to each individual’s needs.

Cognitive Behavior Therapy​

Some general modifications to CBT when working with Autistic clients are:

• Increase structure, predictability, and choice
• While a hallmark of general good CBT practice, it is even more important when working with Autistic clients to: collaborate on agreed upon goals that are relevant to the client (including youth)
• Tailor the therapy environment to accommodate Autistic differences
• Ensure the client has a functional way to communicate
• Use concrete and visual teaching strategies and relay information in a multi-modality fashion that include written information (vs relying solely on speaking)
• Simplify cognitive activitiesand deemphasize speaking activities
  • Social stories to teach psychoeducation & cognitive restructuring
  • Video modeling and/or role-play to teach coping strategies
  • Worksheets/questions with multiple-choice lists instead of open-ended questions
• Make abstract concepts into concrete “hands-on” activities (e.g., role-play)
• Use literal language
• Use modeling (including video)
• Incorporate “special interests” and passions into treatment delivery (not just as rewards)
• Use a reward system with highly meaningful and personalized rewards, but also be attentive to the possibility that a reward system may inadvertently feel like pressure (vs motivating) to the Autistic client
• Longer/more sessions to allow for more opportunities for repetition and practice
• Slow the pace of treatment to allow for breaks and information processing differences
• Teach skills and make adjustments/accommodations to address autism-specific difficulties that contribute to distress/anxiety*(These skills will also benefit NT individuals, but may not always be included in CBT)
  • Teach, practice and encourage Functional Communication skills
  • Teach and prompt coping skills (e.g., coping self-talk, relaxation)
  • Teach, practice and prompt Problem-Solving skills
  • Teach, practice and prompt Adaptive/Daily Living skills
  • Teach, practicum, and prompt Executive Functioning (EF) skills and use of EF modifications
  • Teach, practice, and prompt Self-Advocacy skills and willingness to accept help
• Increase focus on generalization
  • Increase caregiver/family involvement
  • Increase school involvement when working with youth.

 

[Seladon]

Although CBT is a fairly regimented and specific approach to therapy, there still ought to be a good deal of personalization in its delivery. Below are some general recommendations for how to modify traditional CBT for an autistic client. Though, I think that some of these recommendations themselves would need to be modified to meet the specific needs of each client.

I recently read about just this in this article on the AANE (Association for Autism and Neurodiversity) website regarding ASD and OCD.

Thanks so much for this link, I'm printing it and taking it to my next therapy session later this week. I fully agree that the aptness of modifications differ widely for each patient, even if all hypothetically have ASD--we're all different people, after all. E.g. there's only some on the list above that could work for me.

The connection between affirmation in treatment for ASD and OCD is new to me, so this read is really fascinating and eye-opening.