Cognitive Behavioural Therapy and Autism Ranking: Very strong positive evidence

Additional Information

NICE guidance

The National Institute for Health and Care Excellence (NICE 2013) reported

“The evidence concerning the cognitive behavioural treatment of coexisting conditions is very limited and provides no specific evidence to support the development of adaptations to CBT to make it potentially more effective for people with autism. Effective psychological interventions, predominantly CBT, exist for depression and anxiety disorders, for which there is extensive NICE guidance. The GDG considered that these interventions could be appropriate for many adults with autism. However, the evidence reviewed in this guideline does not provide any guidance on autism-specific adaptations to psychological interventions for coexisting conditions. In the absence of such evidence, and given the high prevalence of depression and anxiety disorders in adults with autism, GDG members drew on their knowledge and expertise, both of psychological interventions and autism, to develop some recommendations on how CBT (and other psychological interventions) might be adapted in order to increase their effectiveness in autism. These included a more concrete, structured, approach with a greater use of written and visual information than might typically be the case in CBT. The GDG was of the view that an emphasis on the behavioural rather than the cognitive aspects of CBT could be beneficial as could shorter sessions or regular breaks. Careful consideration should be given to the use of group-based approaches and the excessive use of metaphors or hypothetical situations should be avoided. Consideration should also be given to the increased involvement of a family member or key worker as co-therapist to support the generalisation of benefits.”

The National Institute for Health and Care Excellence (NICE 2012) reported

“In the absence of evidence of how coexisting mental health disorders (including ADHD, OCD, PTSD, depression and conduct disorder) should be treated differently in autism, the GDG agreed that management should be in line with existing NICE guidance. There was, however, evidence for clinical efficacy of CBT programmes with autism-specific modifications on coexisting anxiety for children with autism. There was evidence for a positive treatment response to CBT in terms of no longer meeting diagnostic criteria for the anxiety disorder and/or showing global improvement in anxiety symptoms. Economic analysis suggested that group-based CBT is likely to be a cost-effective intervention for the management of anxiety in children and young people with autism, whereas, individual CBT is probably not cost-effective. However, the GDG were concerned that for some individuals with autism participating in a group-based intervention would be difficult or impossible, therefore, the GDG agreed that it was important that for these children or young people individual-based CBT could be considered. The GDG recognised that CBT may not be appropriate for individuals with coexisting learning disabilities given that the intervention dictates a certain level of cognitive functioning and verbal ability to enable participation.”

NHS Choices

The NHS Choices website, accessed on 18 July 2016, states that CBT has some disadvantages:

  • “To benefit from CBT, you need to commit yourself to the process. A therapist can help and advise you, but cannot make your problems go away without your co-operation.
  • Attending regular CBT sessions and carrying out any extra work between sessions can take up a lot of your time.
  • Due to the structured nature of CBT, it may not be suitable for people with more complex mental health needs or learning difficulties.
  • As CBT can involve confronting your emotions and anxieties, you may experience initial periods where you are more anxious or emotionally uncomfortable.
  • Some critics argue that because CBT only addresses current problems and focuses on specific issues, it does not address the possible underlying causes of mental health conditions, such as an unhappy childhood.
  • CBT focuses on the individual’s capacity to change themselves (their thoughts, feelings and behaviours), and does not address wider problems in systems or families that often have a significant impact on an individual’s health and wellbeing. “
31 Oct 2017
Last Review
01 Mar 2017
Next Review
01 Mar 2020