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CBT for people with autism

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GinaGomez
GinaGomez

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I'm really interested in how we can adapt psychological therapies such as CBT for people with autism. There are a few really useful articles so far on Network Autism (e.g. Professor Ann Ozivandijan's presentation and Tim Lacey's article on treating depresson, but I'm really keen to hear other people's professional experience. What aspects of CBT are useful for people on the spectrum? What needs to be adapted? What research needs to be done in future? What has worked for you?
 

Edited on February 23, 2017 - 9:20am

October 11, 2012 - 2:40pm

In my experience as someone with AS who also works with people who have AS, CBT is often not that effective. What is usually effective is real-life behavioural therapy with support in the real world, because CBT in an office environment is too abstract, too removed and too short in duration. It tends to work best for the people who just have anxiety or depression, but AS is completely biological in origin and as such it can produce OCD and anxiety that takes longer to resolve. The OCD, for example, can develop because the underlying AS has not received recognition and so the person concerned develops obsessions that stem from literal thinking and misinterpreting information.

It is also  perfectly possible, however, that the OCD that often occurs as a co-existing condition with AS, developed out of the same biological processes that caused the AS, as opposed to being a mainly psychological maladaption. Therefore, OCD , when occuring in conjunction with AS, might not respond to the same treatement in the same way as it would if AS were not present.

Another problem with CBT is that people with AS  find it hard to identify emotions.

 

November 01, 2012 - 1:25pm

In response to the original post: In my experience it is not so much that the model of CBT needs to be radically modified, but rather the communicational and relational style of the individual therapist, or facilitator. It does seem to the case that good therapeutic outcomes are less to do with the therapeutic model utilised than with the creative competency, understanding and compassion of the individual therapist.

November 01, 2012 - 1:39pm

Hello Stephen - I'd agree with your second sentence, but not the first.  I think current models can be radically improved, and if so could help in the development and training of future therapists.  Also, by some models dominating, it can become the case that they become job spec criteria and so on - and thus can put off practitioners from applying who are creative and compassionate - yet have no wish to follow the dominant model.  Models have a purpose, and they should be continually revised to answer their critics and not seen as certainties (imv) but working models.

Neill23

November 20, 2012 - 4:07pm

I find the NICE guidlines for autism in adults makes some good recomendations for adaptions to standard CBT/pyshcology'

1.6.2 For adults with autism and coexisting mental disorders, offer psychosocial interventions informed by existing NICE guidance for the specific disorder.

1.6.3 Adaptations to the method of delivery of cognitive and behavioural interventions for adults with autism and coexisting common mental disorders should include:

  • a more concrete and structured approach with a greater use of written and visual information (which may include worksheets, thought bubbles, images and 'tool boxes')

  • placing greater emphasis on changing behaviour, rather than cognitions, and using the behaviour as the starting point for intervention

  • making rules explicit and explaining their context

  • using plain English and avoiding excessive use of metaphor, ambiguity and hypothetical situations

  • involving a family member, partner, carer or professional (if the person with autism agrees) to support the implementation of an intervention

  • maintaining the person's attention by offering regular breaks and incorporating their special interests into therapy if possible (such as using computers to present information).

I hope this helps,

regards

November 20, 2012 - 4:26pm

Although some of this seems sound (particularly utilising interests) - I would question the focus on 'changing behaviours' - or 'cognitions' for that matter - unless the person themselves is specifically wanting/asking for change in this regard, or that they are causing harm to themselves and others, and then a more negotiated approach involving understanding meaning is needed, which is very difficult if the individual receiving the treatment is unable to get their views across and the practitioner may be imposing incorrect understandings on the recipient.

As an autistic adult - I do not wish to have CBT or social skills training, yet that is all that is generally recommended (if anything is).  Not that I would want counselling anyway (although there are other methods that I would consider potentially more helpful for people other than myself).

Neill23

November 20, 2012 - 5:54pm

Hi there's some good recomendations in the nice guidance for autism in adults for adaptions to CBT

a more concrete and structured approach with a greater use of written and visual
information (which may include worksheets, thought bubbles, images and 'tool
boxes')
placing greater emphasis on changing behaviour, rather than cognitions, and using
the behaviour as the starting point for intervention
making rules explicit and explaining their context
using plain English and avoiding excessive use of metaphor, ambiguity and
hypothetical situations
involving a family member, partner, carer or professional (if the person with autism
agrees) to support the implementation of an intervention
maintaining the person's attention by offering regular breaks and incorporating their
special interests into therapy if possible (such as using computers to pres

i hope you find this helpful

 

Neill23

November 21, 2012 - 1:52pm

Sorry I repeated myself I get stuck sometime it's called preserverance I'm told. I totally agree you should only engage in therapy if you have stuff or difficulties that impair you and you want to change personally as an asd/adhd adult I had psychology at the maudsley was very helpfull in my insight and understanding of my functioning and helped me to develop copping strategies which have been invaluable but it's no solution and and doesn't work for some but I am sure it helped me so much because it was adapted and focused on my ASD and my anxiety and because the psychologist gave me time to discuss weekly issues I have dealing with people and get feedback this then free up my mind to discuss copping strategies.

That Mental Health Network breifing just released states the need for mental health services to be more accessable to autistic people and makes the point that under the equality act 2010 mental health has to make reasonable adjustment to their services to make them sutiablt for people with autism so hopefully this go some way to improve peoples experiences with psychology in the near future.

regards

Neill

GinaGomez

January 11, 2013 - 9:46am

Hi All,

After having started this thread, I have just started training to be a clinical psychologist, and I'm currently working in an IAPT service (primary care psychology service for adults). I am not seeing anyone with autism at the moment, but I am learning how to do CBT.

Your comments and posts are really interesting, and I have a few questions, which perhaps you would be interested to answer, but no worries if not!

Firstly, Damian- I can see that you are not interested in receiving CBT or counselling approaches. What approaches do you think would be helpful for you - what could psychology services offer you that would be appealing?

Neil- I'm pleased that you found CBT helpful, when it was adapted- what adaptations did you find particularly helpful?

Dawn- your references are wonderful, thank you!

All- what are your experiences of autism/asperger's in IAPT/ primary care psychology services? What do psychologists in these busy services need to know about autism?

Best wishes

Gina

 

January 11, 2013 - 10:40am

Hello Gina,

To quote the dreaded wikipedia: "...is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to behavior therapy, cognitive therapy, and to therapy based upon a combination of basic behavioral and cognitive principles and research."

Philosophically it is based on normative functionalism and/or behaviourism - both of which I see as damaging ideologies when applied to diverse (dis)positionalities.  At its worst it is used to impose such a view on people devaluing such differences as 'dysfunctional' and 'maladaptive'.  If the autistic person feels that they are being held back by their own thoughts and actions in some way, and works in mutual respectful collaboration with the therapist, than it can be more useful (yet not for all - i.e. I was offered it despite not seeing my thoughts and actions as such - and with no alternative).  It is often also applied through a non-autistic gaze, missing out on how autistic perceptions and mental representations differ.

Counselling approaches are often based on the humanist psychology of Carl Rogers.  I have less issue with this kind of approach philosophically, yet in practical terms it can be ineffective too - due to the lack of input from the therapist.

What I like in this area are practices based more on personal construct theory, which seeks to establish an understanding of the personal constructs an individual utilises to frame their own perceptions, and does not assume these (when different to idealised 'norms') to be maladaptive, but works with them in a more constructive and mutually respectful way.

Hope this helps,

Damian

 

GinaGomez

January 11, 2013 - 1:51pm

Thanks Damian- that's interesting. I don't know much about personal construct theory so I will look it up, but seems to make sense they way you explain it.

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