CBT for people with autism

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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

January 11, 2013 - 2:29pm

Hello Gina,

Here is a link that I found:

The theory originated with the work of George Kelly in 1955 and has similarities in orientation to humanist and pragmatic psychology.  It was also influential on theories since.  One interesting expansion came from Salmon with regards to educational practices: - linking up more phenomenological theory with it.  The work of Trevor Butt is also very interesting:

Hope this helps,



March 06, 2013 - 8:07pm

I think in adult metal health theres a move towards third wave"process based" CBT such as minfulness based CBT and ACT. I'm curious as to whether these approached are helpful for people with ASD over and above more traditional "content based" CBT. Personally I think something like ACT could be really usefull since it's fairly behavioural and doesn't require lots of boring thought analysis.

August 08, 2014 - 8:05am

This has been interesting reading for me. I am a support assistant in a mainstream secondary school trained as an ELSA. Most schools in our area, YP with anxiety, social and emotional difficulties coupled with complex co-morbid disorders are supported in schools by ELSA's. This is a support where LSA's etc are trained by EP's to work with YP in understanding, regulating and sorting through their emotions allowing the YP to be available to learn, using a range of techniques and skills suitable for each individual YP.  

This support is put in place to hopefully lessen the need for CAMHS interaction. It has proven to work considerably well and is very good at supporting the whole child through any transitions in the education system. 

August 08, 2014 - 8:18am

I recently heard from a number of autistic adults who were involved in some research regarding some CBT - they suggested that what was being proposed was useless for them, suggested what they thought would be helpful - which did not include changing their thoughts and actions - and they were misunderstood/ignored.  For me - unless an individual wishes to adapt their own thinking/behaviour in some way (and many of us do not) - what possible use is there for CBT?

September 16, 2014 - 5:38pm


Tony Attwood's two books on managing anger and anxiety (same book so don't buy both as the words, 'anger' and 'anxiety' are the only differences and only appear a handful of times in each book!) are an excellent start as you can build the tool kit using therapies and interventions that make sense to the young people.  It sits really nicely with the CAT Kit.  In pour local authoriy we've pulled together a range of techniques that enable us to use an autism friendly CBT approach.  You have to be mindful of things like Blank language levels to ensure that concepts are accessible, meaningful examples and straightforward strategies.  

All of this can be pulled together into a SCERTS framework so that you are planning for self- regulation, mutual regulation and availability for these.  If you need to then you can focus in on the transactional support element of the framework to ensure that practitioners are working em pathetically.

we are working with children who attend mainstream schools (some in enhanced provision) and it' sour bread and butter.

September 16, 2014 - 5:43pm

 Joshua Muggleton is a researcher with autism from the UK.   He has worked with Tony Attwood in Australia, and has written a report called Improving Outcomes for People with Autism Accessing Psychological Support  - This addresses adaptation of CBT and other psychological approaches for people with autism.  It’s definitely worth a read, and can be downloaded at

Vicky Bliss

April 16, 2015 - 5:44pm

In my work as a clinical psychologist specifically with adults who have autism, after 20 years of trying to adapt CBT I have found Solution Focused Brief Therapy (SFBT) a much more productive and better fit.

There are a few articles and books about this application for people with autism.

Let me know if you'd like to read them.

Kind regards

Vicky Bliss


September 10, 2015 - 6:29pm

Hi Vicky,

I'd be really interested to read the solution focused therapy articles for ASD. I'm in the middle of clinical psychology training at the moment, and hope to work with ASD in the future!

Best wishes


October 16, 2015 - 12:46pm

Just noticed this thread after the recent posting with the Google+ url, and took a quick browse some of the 4 pages.  I'm on the spectrum with a diagnosis aged 60+ from 2 years ago, and no post-diagnosis support as yet (semi-rural Scotland).  I've been lucky enough to work over the years until taking early retirement to care for a relative, and I'm also married with a small family.  However I've had various issues with workplace stress, depression and probably anxiety over the years, and have been exposed to various non-NHS CBT approaches as part of management training and later carer support training.

My experience was that it didn't seem to work, that even if I followed the "rules" of CBT, positive thinking etc, it didn't have any long-term positive effect and even caused a bit more upset by my failure to apply the techniques.  I think this may have largely been because I couldn't read the emotions of other participants in group activities correctly, including their frequent cynicism about positive thinking approaches.  Similarly, with individual book-based CBT, I could think the thoughts in isolation but became quickly confused when trying to do this and interact with others.  I've limited the amount of online browsing I've done about all this, because I feel you can get into a swamp with online information on care topics, similar to that I experienced looking at dementia care issues online.  There's a lot of information out there but most of it describes practice in the US and southern England, which doesn't translate to local experience which can be different, for better or worse.

Anyway, I have found some social support from NAS useful in terms of dealing with anxiety, and I've also found the work of a specific life coach helpful, a person I met through voluntary support she offered to a carers' centre.  Because her services were voluntary, I was able to spend some time getting to evaluate them without having to spend the large amounts of money often associated with life coaching.  Her approach (she's a middle-aged woman with children, one on the spectrum, a graduate with a degree including psychology, and some supervised validation from a life coaching institution) concentrates on what goals you might have for the next period, and how can she help with these?  She differentiates this from counselling (also available through the carers' centre) which she sees as looking to help people in distress to deal with that, where coaching is to help people do things they've decided to do.  This may be a solution-focused approach, looking at the titles of some of the book references in this thread.  I suspect that my coach uses a lot of CBT-related techniques, though, in highlighting the negative aspects of some of my thought and behaviour, it's just that she does this in a one-to-one way which is more labour-intensive than my reading a book, but is more tailored to my thoughts and responses, and better reinforced over time between sessions.

I've found these sessions helpful, and now that I've moved to being an ex-carer after my relative's peaceful death, I'm continuing them to deal with the backlog of retirement and family issues which have built up, and new ones which come up while dealing with the backlog.

I just offer these comments as a sidelight to people who may feel "CBT should work" and who have experienced some distress, but aren't confident enough in describing their own thoughts, to explain exactly why CBT doesn't work for them.  Another closing comment is that I didn't particularly realise that I might have anxiety as well as depression and workplace stress, until it came up as a side-issue from a HADS screening questionnaire I was asked to complete re depression.  So dealing with anxiety, while I'm aware that people on the spectrum may be prone to this, is a relatively new thing to me.  I've adapted to depression and stress over the years with a number of self-therapies including controlling items of diet, and exercise, but haven't really done much about anxiety as yet, beyond the coaching sessions and NAS support sessions above.  This might be an example of me, as a person on the spectrum, not being very good at identifying emotions.