Cognitive Behavioural Therapy and Autism Ranking: Very strong positive evidence

Key Features


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.

CBT is a short-term approach in which individuals are encouraged to identify specific, measurable goals they would like to work towards.    

Different forms of CBT

There are several multi-component CBT programmes (such as Behavioral Interventions for Anxiety in Children with Autism; Building Confidence; Cool Kids; Coping Cat; Exploring Feelings; and Facing Your Fears) which have been designed for, or adapted to meet, the needs of people on the autism spectrum.

CBT can be delivered in a range of formats including:

  • individual therapy – one-to-one sessions with a therapist
  • group therapy – with others who wish to tackle a similar problem
  • a self-help book – where you carry out exercises from the book
  • a computer programme – known as computerised CBT (CCBT)

Common Elements

Most forms of CBT share some common elements including:

  • Assessment: Designed to provide an evaluation of the participants’ language, cognitive, and emotional skills before they begin the therapy.  This may include an evaluation of any key strengths, weakness and areas to work on.
  • Psychoeducation: Designed to increase the participants’ behavioural and cognitive skills and enhance their emotional development.  For example, the therapist may tell the participants about the symptoms of social anxiety and explain some of the different strategies for dealing with this. Or the therapist may teach the participants how to use one or more relaxation techniques.
  • Cognitive restructuring: Designed to help the participants identify negative thoughts and then challenge those thoughts with alternative thoughts or interpretations. For example, the participants may role play a situation that one of them finds distressing, learning how to replace unrealistic and negative thoughts about that situation with more realistic and positive alternative thoughts.
  • Exposure: This technique puts the participants into problematic situations in a controlled setting and teaches them to face their distress by using the skills they have acquired in the psychoeducation and cognitive restructuring components of therapy.

Adaptations for people on the autism spectrum

A number of authors (such as Spain et al, 2015) and the National Institute for Health and Care Excellence, 2012, have suggested how CBT should be adapted to make it more effective for use with people on the autism spectrum.  Those adaptations include:

  • Carrying out a detailed assessment of the individual’s language, cognitive, and emotional skills. This should include identifying any key strengths and weakness (such as difficulties in processing verbally presented information) before starting the therapy.
  • 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.
  • Modifying the therapy to take account of the strengths and weaknesses of the participants (such as using thought bubbles for participants who have difficulties processing verbally presented information).
  • Placing greater emphasis on changing behaviour, rather than cognitions, and using the behaviour as the starting point for intervention.
  • A more structured approach, with clearly defined objectives, tasks broken down into smaller, more manageable steps and regular, predictable breaks
  • Giving explicit and direct instructions, such as providing a list of rules or social scripts.
  • Using plain English and avoiding excessive use of metaphor, ambiguity and hypothetical situations.
  • Incorporating participants’ special interests and strengths into therapy if possible (such as using computers to present information).
  • Involving a family member, partner, carer or professional (if the participants agree) to support the implementation of an intervention.
  • Using a range of appropriate measures to evaluate the effectiveness of the therapy (such as standardised assessment measures of anxiety that researchers understand alongside personalised assessment measures of anxiety that the participants understand).
31 Oct 2017
Last Review
01 Mar 2017
Next Review
01 Mar 2020