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Cognitive Behavioural Therapy and Autism Ranking: Very strong positive evidence

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Cognitive Behavioural Therapy (CBT) is a talking therapy that can help people to manage their problems by changing the way they think and behave.

CBT is designed to help people notice and understand how their thoughts, behaviours and emotions affect each other.  It is also designed to help them learn new ways of thinking about and responding to distressing situations.

The therapist breaks down problems into feelings, thoughts and actions to work out which are unhelpful or unrealistic. The therapist then teaches the client how to replace those feelings, thoughts and actions with more helpful and realistic ones.

There are numerous interventions for people on the autism spectrum which are based on, or which incorporate, the principles of CBT.

These include multi-component CBT programmes such as Behavioral Interventions for Anxiety in Children with Autism; Exploring Feelings; and Facing Your Fears.

Please Note

The National Institute for Health and Care Excellence (NICE 2013) reported that there is evidence for the effectiveness of CBT programmes for the treatment of coexisting anxiety in children on the autism spectrum, provided those programmes are modified to meet their specific needs.

It also reported that there is insufficient evidence to determine if CBT is an effective treatment for other coexisting mental health disorders (such as depression) in children on the autism spectrum.  However it recommended that CBT could be used for the treatment of those disorders in children on the autism spectrum, as this is in line with existing NICE guidance for those disorders.

The National Institute for Health and Care Excellence (NICE, 2012) reported that the evidence for CBT in adults on the autism spectrum is very limited. However it recommended that CBT might be appropriate as a treatment for anxiety and depression in many adults on the autism spectrum, as this is in line with existing NICE guidance for those disorders, provided those programmes are modified to meet their specific needs. 

Our Opinion

  • There is a reasonable amount of high quality research evidence to suggest that multi-component CBT programmes may help reduce the symptoms of anxiety in some primary school children and adolescents on the autism spectrum who have an IQ of 70 or more.
  • There is insufficient evidence to determine whether CBT programmes can help any child or adult on the autism spectrum with other issues, such as anger or depression.
  • There is insufficient evidence to determine whether CBT programmes can help people with the core features of autism
  • There is insufficient evidence to determine whether CBT programmes can provide any benefit to adults on the autism spectrum.”

We agree with the National Institute for Health and Care Excellence that CBT programmes might be appropriate for the treatment of anxiety and depression in people on the autism spectrum provided that the therapists providing CBT are appropriately trained, experienced and accredited. They should also follow established best practice which includes

  • Carrying out a detailed assessment of the individual, including any key strengths and weakness.
  • Modifying the therapy to take account of the needs of that individual, including any strengths and weaknesses.
  • Use of a longer assessment phase and an increased number of treatment sessions to help the initial engagement with the therapist, to enhance emotional literacy, and to practice, consolidate and generalise the techniques learnt.
  • Using a range of appropriate measures to evaluate the effectiveness of the therapy.

There is a need for further research which

  • Determines if cognitive behavioural therapy can help other groups on the autism spectrum with anxiety and sleep problems.
  • Determines if cognitive behavioural therapy can help people on the autism spectrum with other issues, such as anger or depression.
  • Evaluates the individual components of CBT programmes to see which, if any, are the most effective.
  • Compares CBT with other psychotherapeutic approaches, such as mindfulness training or counselling.
  • Evaluates the longer term effects of CBT in real world settings. 

Disclaimer

Please read our Disclaimer on Autism Interventions


Updated
31 Oct 2017
Last Review
01 Mar 2017
Next Review
01 Mar 2020