COGNITIVE BEHAVIOR THERAPY FOR COMORBID OBSESSIVE-COMPULSIVE DISORDER IN HIGH-FUNCTIONING AUTISM SPECTRUM DISORDERS: A RANDOMIZED CONTROLLED TRIAL: Research Article: CBT for OCD for Adults with ASD
Open accessAbstract
BACKGROUND: High rates of anxiety disorders, particularly obsessive compulsive disorder (OCD) are reported in people with Autism spectrum disorders (ASD). Group cognitive behavioral treatment (CBT) has been found effective for anxiety in young people with ASD but not been OCD specific. One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy. METHODS: Forty-six adolescents and adults (mean age 26.9 years, 35 Males) with ASD and comorbid OCD were randomized to CBT for OCD or anxiety management (AM), a plausible control treatment. Treatments were matched in duration (mean of 17.4 sessions CBT; 14.4 sessions AM), the Yale-Brown Obsessive Compulsive Severity Scale (YBOCS) as primary outcome measure and evaluations blind to treatment group. Treatment response was defined as > 25% reduction in YBOCS total severity scores. RESULTS: Both treatments produced a significant reduction in OCD symptoms, within-group effect sizes of 1.01 CBT group and 0.6 for the AM group. There were no statistically significant differences between the two groups at end of treatment, although more responders in the CBT group (45 versus 20%). Effect sizes for self-rated improvement were small (0.33 CBT group; -0.05 AM group). Mild symptom severity was associated with improvement in the AM but not the CBT group. Family/carer factors were important for both groups, in that increased family accommodation was associated with poorer outcome. CONCLUSIONS: Evidence-based psychological interventions, both AM and CBT, were effective in treating comorbid OCD in young people and adults with ASD.
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Some previous treatment studies have included autism-specific modifications, but their effects have not been directly tested.
“Although some previous treatment studies have included autism-specific modifications (Ehrenreich-May et al., 2020;Hesselmark et al., 2014;Russell et al., 2013;Sizoo & Kuiper, 2017;Spek et al., 2013), their effects have not been directly tested.”
From A mixed methods study of autistic adults' mental health therapy experiences (2023) · cites this paper as Russell et al., 2013
The emerging literature supports the use of CBT with autistic adults as an effective intervention for mental health outcomes.
“Of interest is that the emerging literature supports the use of CBT with autistic adults as an effective intervention for mental health outcomes (e.g. Hesselmark et al., 2014; Russell et al., 2013).”
From Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project (2020) · cites this paper as Russell et al., 2013
The GRADE system, adapted for narrative synthesis, was used to assess the strength of evidence contributing to effectiveness outcomes.
“The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system,28 adapted for narrative synthesis,29 was used to assess the strength of the evidence contributing to effectiveness outcomes.”
From Approaches to improving mental healthcare for autistic people: Systematic review (2024) · cites this paper as [28]
The Data Analysis and Outcome Measurement sections describe analyses and symptom ratings for a randomized trial, not an assessment of evidence strength. Searches for GRADE and narrative synthesis found no passage addressing either method; page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredResults from 23 studies contributed to the GRADE assessment.
“Results from 23 studies contributed to the GRADE assessment.”
From Approaches to improving mental healthcare for autistic people: Systematic review (2024) · cites this paper as [28]
The Limitations section reports 23 participants allocated to each arm of a single randomized trial, not 23 studies. Searches for “GRADE assessment” and its expanded terminology found no passage describing a GRADE assessment or studies contributing to one. No page numbers were provided in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measuredThe certainty of evidence for the effectiveness of strategies (n = 19) ranged from very low to moderate.
“The certainty of evidence for the effectiveness of strategies (n = 19), as rated using the GRADE system,28 ranged from very low to moderate”
From Approaches to improving mental healthcare for autistic people: Systematic review (2024) · cites this paper as [28]
The Anxiety management treatment section reports outcomes for a CBT-versus-anxiety-management trial, not certainty ratings across 19 strategies. The Power analysis section mentions 19 participants per group, but our copy contains no GRADE assessment or very-low-to-moderate certainty range (searched for GRADE and evidence quality). Page numbers were unavailable. (LLM, conf=0.76)
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Psychosocial interventions for internalizing disorders in youth and adults with ASD
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Obsessive–Compulsive Disorder in Autism Spectrum Disorder Across the Lifespan
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Self-citationApproaches to improving mental healthcare for autistic people: Systematic review
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“These included adaptations of cognitive – behavioural therapy (CBT) for anxiety, 50,51,59 CBT for OCD, 31,52 mindfulness-based therapy for autism spectrum disorders (MBT-AS), 32,54 eye movement desensitisation and reprocessing (EMDR), 37,44 guided self-help CBT for depression, 34,39 acceptance and commitment therapy (…”
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Children with Obsessive-Compulsive Symptomology in the General Population: Different Subtypes?
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Cognitive processes in autism: Repetitive thinking in autistic versus non-autistic adults
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“Clinical and experimental research has sought to ensure a careful delineation of restricted and repetitive behaviour-related internal content and the intrusive, unwanted obsessional thoughts characteristic of OCD (e.g. Russell et al., 2013).”
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Psychological interventions for adults with autism spectrum disorders: a review
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Synaesthesia, Creativity and Obsessive-Compulsive Disorder: Is There a Link?
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- Authors
- Russell, A. J., Jassi, A., Fullana, M. A., Mack, H., Johnston, K., Heyman, I., Murphy, D. G., & Mataix-Cols, D.
- Affiliations
- King's College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Department of Psychosis Studies, Institute of Psychiatry; Kings College London; London; United Kingdom
- Corresponding author
- Russell, Ailsa J.
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2013-02-06
- Volume
- 30
- Issue
- 8
- Pages
- 697-708
- ISSN
- 1091-4269 (ISSN-L)
- OpenAlex
- W1896892849
- Cited by
- 160
- References
- 46
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 10 · 2023: 6 · 2022: 10 · 2021: 16 · 2020: 22 · 2019: 14 · 2018: 12 · 2017: 19 · 2016: 11 · 2015: 12 · 2014: 9 · 2013: 4
- FWCI
- 13.34
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- The University of Bath Online Publications Store (The University of Bath) (submittedVersion)
- Pure (University of Bath) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (RP-PG-0606-1045)
- European Commission
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- obsessive-compulsive disorder, autism spectrum disorder, comorbidities, cognitive behavioral therapy, anxiety reduction, group therapy, adolescents and adults, treatment response, family accommodation, symptom severity
- MeSH terms
- Adolescent, Adult, Aged, Child Development Disorders, Pervasive, Female, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder, Severity of Illness Index, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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