Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study

Probably not a substantial claim: may not pass S3 (load-bearing).

A meta-analysis including 37 studies revealed a prevalence of self-harm of 42% in autistic individuals, irrespective of age and the presence or absence of intellectual disability (ID).

“A meta-analysis including 37 studies revealed a prevalence of self-harm of 42% in autistic individuals, irrespective of age and the presence or the absence of intellectual disability (ID) (Steenfeldt-Kristensen et al., 2020).”

• cites Steenfeldt-Kristensen et al., 2020 sourceSupported

Classified as probably not a substantial claim.

Self-harm and suicidal behaviors are prevalent among autistic adults without intellectual disability (ID).

“Self-harm and suicidal behaviors are prevalent among autistic adults without intellectual disability (ID).”

• cites Hollocks et al., 2019 sourceCould not verify

  The Abstract and the ‘Presence of ID’ section report anxiety and depression prevalence, including estimates for adults without ID, but do not report self-harm or suicidal-behavior prevalence. Searches for ‘self-harm’ and ‘suicide’ found only a reference to a study of suicidal ideation, not a finding that establishes the claim. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites Licence et al., 2019 sourcePartly supported

  The Results report self-harm in 24.1% of a sample without identified adaptive-functioning impairments, but the Participants section says only 19 of the 83 participants were adults; that figure is not an adult-specific prevalence estimate. The paper describes heightened suicidality in autistic samples in its introductory discussion, but does not establish the prevalence of suicidal behaviors specifically among autistic adults without ID. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Cassidy et al., 2020 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In a sample of recently diagnosed autistic adults without ID, 66% self-reported suicidal ideation and 35% self-reported plans or attempts of suicide.

“Indeed, in a sample of recently diagnosed autistic adults without ID, 66% self-reported suicidal ideation and 35% self-reported plans or attempts of suicide (Cassidy et al., 2014).”

• cites Cassidy et al., 2014 sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Autistic adults are at greater risk of co-occurring psychiatric disorders, self-harm and suicidal behaviors compared to the general population.

“Autistic adults are at greater risk of co-occurring psychiatric disorders, self-harm and suicidal behaviors compared to the general population (Hollocks et al., 2019; Licence et al., 2019; Cassidy et al., 2020; Moseley et al., 2020).”

• cites Hollocks et al., 2019 sourcePartly supported

  The Summary of main findings (page not specified) reports higher rates of co-occurring anxiety and depression in autistic adults than estimates for the general population. The paper does not report a corresponding comparison for self-harm or suicidal behaviors; suicidal ideation appears only in a reference title. (LLM, conf=0.89)

  Experimental — accuracy not yet measured
• cites Licence et al., 2019 sourcePartly supported

  The introduction reports greater psychiatric-disorder risk in autistic people than in neurotypical people and describes heightened suicidality in autistic samples. The Discussion compares a 24.1% self-harm rate in its child-and-adult sample with 5–17% in neurotypical samples, and cites a high rate in autistic adults. The copy does not establish a specifically adult, general-population comparison for suicidal behaviors, so that part of the sentence is more specific than the evidence. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites Cassidy et al., 2020 sourcePartly supported

  The paper’s opening section states that autistic adults are significantly more likely than the general population to experience non-suicidal self-injury, and that autistic people are more likely to die by self-harm or suicide. In “Prevalence and Risk Markers,” it says co-occurring psychiatric conditions increase suicidality risk among autistic adults, but does not say those conditions are more common in autistic adults than in the general population. The psychiatric-disorders comparison is therefore unsupported by this source. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Licence et al. (2019) reported a prevalence of self-harm of 24% in their autistic sample.

“Consistent with these findings, more recently, Licence et al. (2019) reported a prevalence of self-harm of 24% in their autistic sample.”

• cites Licence et al., 2019 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Suicidal ideation and suicidal attempts have been reported at high rates in autistic individuals, with the prevalence of suicidal attempts ranging between 7 and 47%.

“In addition to self-harm, suicidal ideation and suicidal attempts have also been reported at high rates in autistic individuals (Hedley & Uljarević, 2018; Dell'Osso et al., 2019), with the prevalence of suicidal attempts ranging between 7 and 47% (Zahid & Upthegrove, 2017).”

• cites Hedley & Uljarević, 2018 sourceNot checked — no full text of the source
• cites Dell'Osso et al., 2019 sourceSupported
• cites Zahid & Upthegrove, 2017 sourceSupported

May combine two claims.

In ASD, ED has been identified as a risk factor in the emergence of self-harm, as autistic individuals may use self-harming behaviors as a way to regulate painful emotions.

“In ASD, ED has also been identified as a risk factor in the emergence of self-harm, as autistic individuals may use self-harming behaviors as a way to regulate painful emotions, i.e., low-energy affective states such as depression or high-energy affective states such as anger and anxiety (Moseley et al., 2019).”

• cites Moseley et al., 2019 sourcePartly supported

  In the Discussion’s ‘Predictors of self-injury’ section, the authors report that alexithymia predicted self-injury in autistic people without intellectual disability, and that participants used self-injury to regulate low-energy states such as depression and high-energy states including anxiety and anger. They explicitly distinguish alexithymia from emotional dysregulation, however, and do not establish emotional dysregulation itself as a risk factor for the emergence of self-harm. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Several studies on clinical and non-clinical samples revealed a significant positive association between ED and self-harm, as well as a significant positive association between ED and suicidal ideation and attempts.

“Several studies on clinical and non-clinical samples revealed a significant positive association between ED and self-harm (Wolff, 2019), as well as a significant positive association between ED and suicidal ideation and attempts (Turton et al., 2021).”

• cites Wolff, 2019 sourceSupported
• cites Turton et al., 2021 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Briefer DBT formats have the advantage of being more feasible, cost-effective, and easily implementable in clinical settings.

“Moreover, briefer formats have the advantage of being more feasible, cost-effective, and easily implementable in clinical settings (McMain et al., 2018).”

• cites McMain et al., 2018 sourcePartly supported

  The Background describes the potential cost-effectiveness and ease of delivery of six-month DBT, and the Discussion says it could be a less resource-intensive alternative if outcomes are comparable. But the Background also says its health-economic impact has not been evaluated, so the paper does not establish cost-effectiveness or easier implementation as demonstrated advantages. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

In autistic individuals, DBT has been recommended to treat ED but its feasibility and preliminary efficacy have not been investigated.

“In autistic individuals, DBT has been recommended to treat ED but its feasibility and preliminary efficacy have not been investigated (Hartmann et al., 2012; Mazefsky and White, 2014).”

• cites Hartmann et al., 2012Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Mazefsky and White, 2014 sourcePartly supported

  In Current Approaches to Practice, the paper says DBT has been considered for adaptation to clients with ASD and that there have been no clinical trials or published treatment-outcome research. This supports the lack of published efficacy evidence, but it does not specifically establish that feasibility has not been investigated. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

In a sample of autistic children and adolescents, greater ED was associated with an increased likelihood of suicidal ideation and attempts.

“Indeed, in a sample of autistic children and adolescents, Conner et al. (2020) reported that greater ED was associated with an increased likelihood of suicidal ideation and attempts.”

• cites Conner et al., 2020 sourcePartly supported

  The Results report that higher emotion-regulation impairment was associated with parent-reported suicidal ideation and with a combined measure of suicidal behaviors or attempts in the ASD groups. The Discussion > Limitations states that the study did not assess suicide attempts separately, so it cannot establish the claimed association with attempts specifically. Page numbers were not provided in our copy. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two population-based cohort studies led in Denmark and Sweden reported respectively a 3.7 and a 9-fold increase in death by suicide among autistic adults without ID compared to the general population.

“More generally, two population-based cohort studies led in Denmark and Sweden highlighted the importance of this problem in autistic individuals, as they reported respectively a 3.7 and a 9-fold increase in death by suicide among autistic adults without ID compared to the general population (Hirvikoski et al., 2016; Kõlves et al., 2021).”

• cites Hirvikoski et al., 2016 sourcePartly supported

  Table 4 (Clinical implications; page unavailable) reports a suicide-mortality odds ratio of 9.40 (95% CI 7.43–11.90) for the Swedish high-functioning ASD group versus controls, supporting the approximately ninefold figure for autistic people without intellectual disability. The estimate is not restricted to adults, so the paper does not establish that figure specifically for autistic adults. The Danish 3.7-fold figure is attributed to the other cited study, not assessed here. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Kõlves et al., 2021 sourcePartly supported

  The Danish study’s Results > Suicide report a 3.75-fold higher suicide rate for people with ASD overall, but a 4.73-fold rate for those with ASD without intellectual disability—not the claimed 9-fold rate for that subgroup. The study supports an elevated suicide rate, but not the sentence’s subgroup-specific magnitude; its Swedish-study figure cannot be assessed from this source. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Participants had previous diagnoses of ASD supported by the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule, Second Edition revised module 4 (ADOS-2), as well as previous IQ assessments based on the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) indicating the absence of ID (Total IQ above 80).

“They had previous diagnoses of ASD supported by the Autism Diagnostic Interview-Revised (ADI-R; Rutter et al., 2003) and the Autism Diagnostic Observation Schedule, Second Edition revised module 4 (ADOS-2; Hus & Lord, 2014; Lord et al., 2012), as well as previous IQ assessments based on the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV; Wechsler, 2011) indicating the absence of ID (T”

• cites Rutter et al., 2003Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Hus & Lord, 2014 sourceSupported
• cites Wechsler, 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In clinical populations, the BHS proved to discriminate between individuals with a high and moderate risk of suicide, as well as individuals with and without a history of suicide attempts.

“In clinical populations, the BHS proved to discriminate between individuals with a high and moderate risk of suicide, as well as individuals with and without a history of suicide attempts (Granö et al., 2017; Balsamo et al., 2020).”

• cites Granö et al., 2017 sourceNot checked — no full text of the source
• cites Balsamo et al., 2020 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

In autistic individuals, the WHOQoL-BREF has good psychometric properties.

“In autistic individuals, the WHOQoL-BREF has good psychometric properties (McConachie et al., 2018).”

• cites McConachie et al., 2018 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Missing data were handled by considering the overall mean of the scale or subscale.

“In case of missing data, we considered the overall mean of the scale or the subscale (Kaushal, 2014).”

• cites Kaushal, 2014 sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Their reports are in line with findings showing that COVID-19 pandemic increased distress and depression in autistic individuals and decreased their quality of life.

“Their reports are in line with findings showing that the COVID-19 pandemic increased the level of distress and depression in autistic individuals and decreased their quality of life (Mutluer et al., 2020; Patel et al., 2021).”

• cites Mutluer et al., 2020 sourcePartly supported

  The Discussion (page unavailable) reports increased distress, stress, and low mood in families with ASD during the pandemic, and worsening behavioral problems in individuals with ASD. It does not establish increased depression in autistic individuals or a decrease in their quality of life; its discussion of increased depression concerns typically developing children, not the ASD sample. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Patel et al., 2021 sourcePartly supported

  The main text (page unavailable) says COVID-19 likely increased distress among autistic people and may have worsened their mental health, including risk of depression. It also acknowledges a lack of published research, so it does not present these as established findings. It does not report a decrease in autistic people's quality of life; its reference to quality concerns the care delivered by caregivers. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Recent research has highlighted high prevalence of self-harm and suicidal behaviors in this population and lack of psychological interventions aiming to address them.

“The latter point is particularly important given that recent research has highlighted the high prevalence of self-harm and suicidal behaviors in this population and the lack of psychological interventions aiming to address them (Licence et al., 2019; Cassidy et al., 2020; Moseley et al., 2020).”

• cites Licence et al., 2019 sourcePartly supported

  The Discussion (page not supplied) reports a 24.1% prevalence of self-harm in the autistic sample, and the paper notes heightened suicidality in autistic people. It also describes difficulty accessing mental-health support and a shortage of trained professionals, but does not establish a lack of psychological interventions specifically aimed at self-harm or suicidal behavior. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites Cassidy et al., 2020 sourceSupported
• cites Moseley et al., 2020 sourcePartly supported

  The paper states that autistic people appear to have higher rates of suicide and self-injury (section labeled Abstract > Conclusions; page unavailable). It calls for support and intervention, but our copy does not establish a lack of psychological interventions targeting self-harm and suicidal behavior. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Participants judged the adaptations introduced to DBT as relevant, consistent with findings suggesting adaptations are required to foster feasibility of psychotherapies in autistic individuals.

“They also judged the adaptations introduced to DBT as relevant, consistent with findings suggesting that adaptations are required to foster the feasibility of psychotherapies in autistic individuals (Weston et al., 2016; Cooper et al., 2018).”

• cites Weston et al., 2016 sourcePartly supported

  The Discussion (p. 12) says CBT should be adapted to meet the needs of people with ASDs, supporting the general rationale for adaptations. It also says whether those adaptations improve treatment engagement remains largely untested; it does not establish that adaptations are required for the feasibility of psychotherapies generally. The participants’ judgment of DBT adaptations is a finding of the citing study, not one attributed to Weston et al. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites Cooper et al., 2018 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

In other clinical samples than autistic adults, previous findings suggest that DBT may have a significant positive effect on some (i.e., "Strategies" and "Goals") or all of the DERS subscales.

“In other clinical samples than autistic adults, previous findings suggest that DBT may have a significant positive effect on some (i.e., “Strategies” and “Goals”) or all of the DERS subscales (e.g. Gibson et al., 2014; Neacsiu et al., 2014; Alavi et al., 2021).”

• cites Gibson et al., 2014 sourceNot checked — no full text of the source
• cites Neacsiu et al., 2014 sourceNot checked — no full text of the source
• cites Alavi et al., 2021 sourceSupported

May combine two claims.

Overall, the significant improvement in self-reported ED is consistent with our clinical observations and with findings relative to DBT in several disorders.

“Overall, the significant improvement in self-reported ED is consistent with our clinical observations and with findings relative to DBT in several disorders (Panos et al., 2014; DeCou et al., 2019).”

• cites Panos et al., 2014 sourcePartly supported

  The Results and Discussion report that DBT reduced suicidal and self-harming behavior in patients with borderline personality disorder. The Introduction identifies emotional regulation as a DBT target, but the paper does not establish improvement in self-reported emotional dysregulation; the Discussion says evidence is insufficient to conclude that DBT teaches skills needed for long-term improvement. This paper therefore supports a DBT finding in one disorder, not the broader implication that it found improvement in emotional dysregulation across several disorders (page numbers unavailable in our copy). (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites DeCou et al., 2019 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

This is consistent with several findings suggesting that emotion regulation skills use is a key change mechanism of DBT.

“This is consistent with several findings suggesting that emotion regulation skills use is a key change mechanism of DBT (Lynch et al., 2006; Neacsiu et al., 2010; Mehlum, 2021).”

• cites Lynch et al., 2006 sourceNot checked — no full text of the source
• cites Neacsiu et al., 2010Not checked yet

  Not checked in the free run.

• cites Mehlum, 2021 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

This heterogeneity might be considered as representative of variability present among autistic population.

“However, this heterogeneity might be considered as representative of the variability present among the autistic population (Masi et al., 2017).”

• cites Masi et al., 2017 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Our study was disrupted by COVID-19 pandemic, which was the case for clinical research in general.

“Finally, our study was disrupted by the COVID-19 pandemic, which was the case for clinical research in general (Padala et al., 2020; Sathian et al., 2020).”

• cites Padala et al., 2020 sourceSupported
• cites Sathian et al., 2020 sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Alexithymia cannot be reduced to "Awareness", i.e., being aware of one's emotions; it also encompasses difficulties in describing feelings, externally orientated thinking and constricted imaginal processes.

“However, we note that alexithymia cannot be reduced to “Awareness”, i.e., being aware of one's emotions. Indeed, it also encompasses difficulties in describing one’s feelings, externally orientated thinking and constricted imaginal processes (Goerlich, 2018).”

• cites Goerlich, 2018 sourceSupported

May combine two claims.

All measures were self-reported, which can be problematic since autistic individuals might present with high levels of alexithymia, which can interfere with ability to recognize emotional states.

“Fifth, all the measures were self-reported. This can be particularly problematic since autistic individuals might present with high levels of alexithymia, which can interfere with their ability to recognize their emotional states (Kinnaird et al., 2019; Ziermans et al., 2019).”

• cites Kinnaird et al., 2019 sourceSupported
• cites Ziermans et al., 2019 sourceSupported

Borderline on S1 (asserted), S4 (based): unclear from the text.

All participants reported that DBT had a beneficial effect on their self-harm and/or suicidal behaviors, including suicidal ideation.

“All participants reported that DBT had a beneficial effect on their self-harm and/or suicidal behaviors, including suicidal ideation.”

• AssumptionRests on an assumption: The DBT diary card self-reports of self-harm and suicidal behaviors are accurate.

May combine two claims.

DBT is feasible and highly acceptable to autistic adults without ID.

“Our results suggest that DBT is feasible and highly acceptable to autistic adults without ID.”

• AssumptionRests on an assumption: The COVID-19-related interruption of group sessions did not substantially affect the feasibility, acceptability, or preliminary efficacy of DBT.
• AssumptionRests on an assumption: The Client Satisfaction Questionnaire for psychotherapeutic services (CSQ-8) is a valid measure of satisfaction with psychotherapy in autistic adults without ID.

Probably not a substantial claim: may not pass S3 (load-bearing).

The internal consistency of the BDI-II for baseline scores in the current sample was excellent (α = 0.96).

“The internal consistency of the BDI-II for baseline scores in the current sample was excellent (α = 0.96).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The internal consistency of the GAFS-8 for baseline scores in the current sample was excellent (α = 0.93).

“The internal consistency of the GAFS-8 for baseline scores in the current sample was excellent (α = 0.93).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The internal consistency of the BHS for baseline scores in the current sample was good (α = 0.82).

“The internal consistency of the BHS for baseline scores in the current sample was good (α = 0.82).”

Classified as probably not a substantial claim. May combine two claims.

Among ten participants initially approached, seven (three women and four men) were included and received at least half of the therapy, two were excluded and one declined to participate.

“Among the ten participants initially approached, seven (three women and four men) were included and received at least half of the therapy, two were excluded and one declined to participate.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Total IQ scores ranged from 81 to 156 (M = 108.8; SD = 25.69).

“Total IQ scores ranged from 81 to 156 (M = 108.8; SD = 25.69) (Table 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The seven participants were aged between 19 and 56 years (M = 27.71; SD = 13.34).

“The seven participants were aged between 19 and 56 years (M = 27.71; SD = 13.34).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two participants were excluded respectively due to frequent hospitalizations related to a comorbid bipolar disorder and failing to complete post-treatment measures.

“Two participants were excluded respectively due to frequent hospitalizations related to a comorbid bipolar disorder and failing to complete post-treatment measures.”

May combine two claims.

On "Clarity" subscale, 4 (57%) of seven reported reliable improvement post-treatment and 3 (50%) of 6 at follow-up.

“On the “Clarity” subscale, reliable improvement was reported by 4 (57%) participants out of seven post-treatment and by 3 (50%) out of 6 at follow-up.”

• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

May combine two claims.

For the five participants who completed therapy, attendance rate was 96%; for the two who participated only in first half, rate was 100% before dropout.

“Specifically, for the five participants who completed the therapy, the rate was 96% and for the two participants who only participated in the first half of the therapy, the rate was 100% before dropout.”

May combine two claims.

The seven participants completed all assessments and missing data were rare (less than 5%).

“The seven participants completed all assessments and missing data were rare (less than 5%).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Five main themes emerged from thematic analysis of transcripts.

“Five main themes emerged from the thematic analysis (Braun & Clarke, 2006) of the transcripts (Table 4):”

• cites Braun & Clarke, 2006 sourceNot checked — no full text of the source

May combine two claims.

One dropout was due to concerns related to COVID-19 risk when group sessions resumed in June 2020 after 2 months of lockdown; the other was due to professional reasons.

“One dropout was due to concerns related to the risk of contracting COVID-19 when the group sessions were resumed in June 2020 after 2 months of lockdown and the other was due to professional reasons.”

May combine two claims.

The decrease in mean GAFS-8 score was neither significant post-treatment (p = 0.293, r = − 0.52) nor at follow-up (p = 0.293, r = − 0.52).

“Regarding alexithymia, the decrease in the mean GAFS-8 score was neither significant post-treatment (p = 0.293, r = − 0.52) nor at follow-up (p = 0.293, r = − 0.52).”

May combine two claims.

Self-reported level of depression returned to baseline for 1 participant after improving post-treatment and worsened for another at follow-up.

“The self-reported level of depression returned to baseline for 1 participant after improving post-treatment and worsened for another one at follow-up.”

May combine two claims.

Participants reported high satisfaction with therapy; CSQ-8 mean score was 3.59 out of 4 (Range = 3.13-4; SD = 0.31).

“Participants, including the two who completed only half the therapy, reported high satisfaction with the therapy as the CSQ-8 mean score was 3.59 out of 4 (Range = 3.13–4; SD = 0.31) (Fig. 1).”

May combine two claims.

Mean DERS "Awareness" subscale decreased significantly post-treatment (p = 0.036, r = − 1.00) and maintained at follow-up (p = 0.031, r = − 1.00).

““Awareness” (post-treatment: p = 0.036, r = − 1.00; follow-up: p = 0.031, r = − 1.00)”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some participants suggested interactions between participants during group sessions could be further encouraged by facilitators.

“Some participants suggested that interactions between participants during group sessions could be further encouraged by the facilitators.”

May combine two claims.

Theme (a): The environment of the group, described as "caring" and "reassuring", allowed participants to "feel confident"; some mentioned activity to normalize anxiety in first session helped them feel more relaxed.

“(a) The environment of the group, described as “caring” and “reassuring”, allowed them to “feel confident”. Some mentioned that the activity to normalize anxiety in the first session helped them to feel more relaxed;”

May combine two claims.

Mean DERS "Impulse" subscale decreased significantly post-treatment (p = 0.036, r = − 1.00) and maintained at follow-up (p = 0.034, r = − 1.00).

““Impulse” (post-treatment: p = 0.036, r = − 1.00; follow-up: p = 0.034, r = − 1.00)”

May combine two claims.

Mean DERS "Strategies" subscale decreased significantly post-treatment (p = 0.035, r = − 1.00) and maintained at follow-up (p = 0.036, r = − 1.00).

““Strategies” (post-treatment: p = 0.035, r = − 1.00; follow-up: p = 0.036, r = − 1.00)”

May combine two claims.

Mean BDI-II scores decreased significantly post-treatment (p = 0.031, r = − 0.93), showing decrease in self-reported depression.

“Mean scores on the BDI-II and BHS also decreased significantly post-treatment (respectively, p = 0.031 and r = − 0.93; p = 0.022 and r = − 1.00) showing a decrease in self-reported levels of depression and hopelessness.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some participants suggested adding short and regular skills reviews during group sessions.

“Some participants suggested adding short and regular skills reviews during the group sessions;”

May combine two claims.

One participant reported a decrease in intensity of suicidal ideation and a higher "tolerance threshold" towards situations that usually triggered suicidal thoughts post-treatment and at follow-up.

“One participant also reported a decrease in the intensity of suicidal ideation and a higher “tolerance threshold” towards situations that usually triggered suicidal thoughts post-treatment and at follow-up.”

• AssumptionRests on an assumption: The DBT diary card self-reports of self-harm and suicidal behaviors are accurate.

May combine two claims.

Their intention to return to care unit if needed scored 3.43 and likelihood to recommend therapy to a friend scored 3.57 out of 4.

“Their intention to return to the care unit if needed and their likelihood to recommend the therapy to a friend also scored high, respectively 3.43 and 3.57 out of 4.”

May combine two claims.

Three participants had initial BDI-II autism-specific T-score in severe range and were in moderate range post-treatment; one participant changed from "possibly depressed" to "unlikely depressed" post-treatment.

“Three participants had initial BDI-II autism-specific T−score on the severe range (1 almost certainly depressed and 2 very likely depressed), and they were on the moderate range post-treatment (Likely and possibly depressed); one participant’s BDI-II autism-specific T−score changed from “possibly depressed” to “unlikely depressed” post-treatment.”

May combine two claims.

2 (30%) participants showed reliable worsening at follow-up on "Clarity" subscale, one after reliably improving post-treatment.

“2 (30%) participants showed a reliable worsening at follow-up on this scale, one of them after reliably improving post-treatment.”

• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

May combine two claims.

At follow-up, 2 (50%) participants reported no self-harming behaviors during 4 months following end of therapy; other 2 (50%) reported few self-harming behaviors (2 to 4) during 4-month follow-up.

“At follow-up, 2 (50%) participants reported that they had not engaged in self-harming behaviors during the 4 months following the end of the therapy; and the other 2 (50%) reported having had few self-harming behaviors (ranging from 2 to 4) during the 4-month follow-up period.”

• AssumptionRests on an assumption: The DBT diary card self-reports of self-harm and suicidal behaviors are accurate.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The participant without a follow-up measure joined the group mid-therapy and completed therapy with a time lag.

“The participant without a follow-up measure is the one who joined the group mid-therapy and completed the therapy with a time lag.”

May combine two claims.

Theme (d): Individual weekly therapy sessions were considered essential as they allowed participants to "dissect specific real-life situations", "put skills together", and "step back from emotional episodes".

“(d) the individual weekly therapy sessions were considered essential as they allowed participants to “dissect specific real-life situations”, “put skills together”, and “step back from emotional episodes”;”

May combine two claims.

Theme (b): The group setting of skills training was considered rewarding due to diversity of profiles; led them to "feel less alone with personal difficulties" and to "meet people like me".

“(b) the group setting of the skills training was considered rewarding due to the diversity of profiles; this led them to “feel less alone with personal difficulties” and to “meet people like me”.”

May combine two claims.

Theme (e): DBT helped participants start building a life worth living as they felt they could "accept themselves and their ASD more", "survive crisis episodes", "allow themselves to have more fun activities", "identify one's values" and take steps in valued directions.

“(e) DBT helped participants to start building a life worth living as they felt that they could “accept themselves and their ASD more”, “survive crisis episodes”, “allow themselves to have more fun activities”, “identify one's values” and to take steps in valued directions.”

May combine two claims.

On "Impulse" subscale, 3 (43%) of 7 reported reliable improvement post-treatment and 5 (83%) of 6 at follow-up.

“Reliable improvement was reported on the “Impulse” subscale by 3 (43%) participants out of 7 post-treatment and by 5 (83%) out of 6 at follow-up.”

• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

May combine two claims.

On "Awareness" subscale, 1 (14%) of 7 showed reliable improvement post-treatment and 2 (33%) of 6 at follow-up.

“On the “Awareness” subscale, one (14%) participant out of 7 showed reliable improvement post-treatment and 2 (33%) out of 6 at follow-up.”

• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One participant reported having "a new and healthier life", which led her to grieve the life before therapy where suicide attempts and hospitalizations were frequent.

“One participant reported having “a new and healthier life”, which led her to grieve the life before therapy where suicide attempts and hospitalizations were frequent.”

May combine two claims.

On "Strategies" subscale, 5 (71%) of seven demonstrated reliable improvement post-treatment and 3 (50%) of 6 at follow-up.

“On the subscale level, 5 (71%) participants out of seven demonstrated reliable improvement at the “Strategies” subscale post-treatment and 3 (50%) out of 6 at follow-up.”

• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

May combine two claims.

On "Goals" subscale, 2 (28%) of seven reported reliable improvement post-treatment and 3 (50%) of 6 at follow-up.

“On the “Goals” subscale, reliable improvement was reported by 2 (28%) participants out of seven post-treatment and by 3 (50%) out of 6 at follow-up.”

• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

May combine two claims.

On "Non-acceptance" subscale, 2 (28%) of seven reported reliable improvement and one (14%) reported reliable worsening post-treatment.

“Finally, on the “Non-acceptance” subscale, reliable improvement was reported by 2 (28%) participants out of seven and reliable worsening by one participant (14%) post-treatment.”

• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

May combine two claims.

Theme (c): Skills learned were considered "useful", "diverse", "applicable" and "effective".

“(c) the skills learned were considered “useful”, “diverse”, “applicable” and “effective”.”

May combine two claims.

All participants reported increased depression and anxiety related to pandemic, and one lost a family member due to COVID-19.

“Indeed, all of them reported increased depression and anxiety related to the pandemic, and one of them lost a family member due to COVID-19.”

May combine two claims.

In only one participant, DERS total score did not improve, although self-harming behaviors did, with complete cessation post-treatment and at follow-up.

“In only one participant, DERS total score did not improve, although self-harming behaviors did, with a complete cessation post-treatment and at follow-up.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Our sample was homogeneous in terms of ethnicity, as all participants were white Europeans.

“Our sample was homogeneous in terms of ethnicity, however, as all participants were white Europeans.”

May combine two claims.

The intervention used in Hartmann et al. (2019) mainly targeted social communication difficulties, hence the in-session practices focused exclusively on social situations.

“Importantly, the intervention used in the study by Hartmann et al. (2019) mainly targeted social communication difficulties, hence the in-session practices focused exclusively on social situations.”

• cites Hartmann et al., 2019 sourceNot checked — no full text of the source

May combine two claims.

These studies have limitations: the severity of ED was not considered; individuals with severe comorbidities were excluded in Conner and White (2018) and those with suicidal ideation were excluded in Hartmann et al. (2019).

“These studies have some limitations, however. First, the severity of the ED was not considered; second, individuals with severe comorbidities were excluded in the study by Conner and White (2018) and those with suicidal ideation were excluded in the study by Hartmann et al. (2019).”

• cites Conner & White, 2018 sourceNot checked — no full text of the source
• cites Hartmann et al., 2019 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

DBT has been found to be effective in several psychiatric disorders characterized by ED, e.g., complex post-traumatic stress disorder (c-PTSD), depression, anxiety and eating disorders.

“In addition to BPD, DBT has been found to be effective in several psychiatric disorders characterized by ED, e.g., complex post-traumatic stress disorder (c-PTSD), depression, anxiety and eating disorders (Safer et al., 2001; Lynch et al., 2003; Chen et al., 2008; Harley et al., 2008; Bohus et al., 2013; Neacsiu et al., 2014).”

• cites Safer et al., 2001 sourceNot checked — no full text of the source
• cites Lynch et al., 2003 sourceNot checked — no full text of the source
• cites Chen et al., 2008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The first study (Conner & White, 2018) evaluated the feasibility and preliminary efficacy of a 6-week individual mindfulness intervention aiming to enhance emotion regulation abilities.

“The first study (Conner & White, 2018) evaluated the feasibility and the preliminary efficacy of a 6-week individual mindfulness intervention aiming to enhance emotion regulation abilities.”

• cites Conner & White, 2018 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The second study (Hartmann et al., 2019) assessed the effectiveness of a 12-week CBT- and DBT-informed group intervention aiming to enhance emotion regulation and social communication abilities.

“The second study (Hartmann et al., 2019) assessed the effectiveness of a 12-week CBT- and DBT-informed group intervention aiming to enhance emotion regulation and social communication abilities.”

• cites Hartmann et al., 2019 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Some findings indicate that brief DBT formats (e.g. 6-month, 16-week) are effective in treating ED.

“The optimal duration of DBT has been understudied, but some findings indicate that brief formats (e.g. 6-month, 16-week) are effective in treating ED (e.g. Koons et al., 2001; Stanley et al., 2007; Pasieczny & Connor, 2011; Neacsiu et al., 2014; Delparte et al., 2019).”

• cites Koons et al., 2001 sourceNot checked — no full text of the source
• cites Stanley et al., 2007 sourceNot checked — no full text of the source
• cites Pasieczny & Connor, 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The efficacy of DBT has also been studied in adults with attention-deficit/hyperactivity disorder (ADHD), suggesting its clinical pertinence in neurodevelopmental disorders.

“In addition, the efficacy of DBT has also been studied in adults with attention-deficit/hyperactivity disorder (ADHD) (Hirvikoski et al., 2011; Philipsen et al., 2014; Fleming et al., 2015), suggesting its clinical pertinence in neurodevelopmental disorders.”

• cites Hirvikoski et al., 2011 sourceNot checked — no full text of the source
• cites Philipsen et al., 2014 sourceNot checked — no full text of the source
• cites Fleming et al., 2015 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The internal consistency of the WHOQoL-BREF domains for baseline scores in the current sample was good (α = 0.83 physical, 0.94 psychological, 0.74 social, 0.85 environment).

“The internal consistency of the WHOQoL-BREF domains for baseline scores in the current sample was good (α = 0.83 for the “Physical health” domain, α = 0.94 for the “Psychological health” domain, α = 0.74 for the “Social relationships” domain and α = 0.85 for the “Environment” domain).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

McVey et al. (2021) provided preliminary evidence for the utility of the DERS in autistic adolescents and adults, supporting a 6-factor structure similar to that found in the general population.

“McVey et al. (2021) provided preliminary evidence for the utility of the DERS in autistic adolescents and adults. Their results supported a 6-factor structure, similar to that found in the general population (Gratz & Roemer, 2004).”

• cites McVey et al., 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Gratz & Roemer, 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Client Satisfaction Questionnaire for psychotherapeutic services (CSQ-8) has excellent psychometric properties when assessing psychotherapy outcomes.

“The measure has excellent psychometric properties when assessing psychotherapy outcomes (Attkisson & Zwick, 1982; Sabourin et al., 1989).”

• cites Attkisson & Zwick, 1982 sourceNot checked — no full text of the source
• cites Sabourin et al., 1989 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The Difficulties in Emotion Regulation Scale (DERS) has adequate internal consistency (Cronbach's α = 0.93), test-retest reliability (r = 0.88), and construct and predictive validity among a college sample.

“The DERS has adequate internal consistency (Cronbach's α = 0.93), test–retest reliability (r = 0.88), and construct and predictive validity among a college sample (Gratz & Roemer, 2004).”

• cites Gratz & Roemer, 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Eight-item General Alexithymia Factor Score (GAFS-8) is the only alexithymia score to be thoroughly validated in the autistic population to date.

“The GAFS-8 is the only alexithymia score to be thoroughly validated in the autistic population to date (Williams & Gotham, 2021).”

• cites Williams & Gotham, 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In autistic adults, the BDI-II has strong reliability and validity, as well as a moderate ability to discriminate between depressed and non-depressed individuals.

“In autistic adults, the BDI-II has strong reliability and validity, as well as a moderate ability to discriminate between depressed and non-depressed individuals (Williams et al., 2021).”

• cites Williams et al., 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The Beck Hopelessness Scale (BHS) has rarely been used to assess hopelessness in autistic individuals.

“The BHS has rarely been used to assess hopelessness in autistic individuals (Cashin et al., 2013; Koegel et al., 2016).”

• cites Cashin et al., 2013 sourceNot checked — no full text of the source
• cites Koegel et al., 2016 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The small sample size (n = 7) does not allow assuming normality of the data distribution, so the Wilcoxon signed-rank test was used.

“Given that the small sample size (n = 7) does not allow us to assume the normality of the data distribution, we used the Wilcoxon signed-rank test (Wilcoxon, 1945), a non-parametric alternative to the one-sample ttest, to analyze the preliminary efficacy outcomes.”

• cites Wilcoxon, 1945 sourceNot checked — no full text of the source

May combine two claims.

Hartmann et al. (2019) found no significant improvement in emotion regulation among autistic participants, but a significant improvement in social communication, which was a major focus of their treatment.

“Their results showed no significant improvement in emotion regulation among autistic participants, but they found a significant improvement in social communication, which was a major focus of their treatment.”

• cites Hartmann et al., 2019 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

In both clinical and non-clinical samples, the BHS has good psychometric properties.

“In both clinical and non-clinical samples, the measure has good psychometric properties (e.g. Beck et al., 1974; Bouvard et al., 1992; Steed, 2001; Kliem et al., 2018).”

• cites Beck et al., 1974 sourceNot checked — no full text of the source
• cites Bouvard et al., 1992Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Steed, 2001 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Medication was unchanged during the study.

“Medication was unchanged during the study.”

May combine two claims.

The test-retest value from the French version does not consider minor modifications introduced in DERS total and subscale scores with autistic adults, so RCI calculation is approximate but informative.

“We note that this test–retest value does not consider the minor modifications introduced in the calculation of DERS total score and subscale scores with autistic adults. The calculation of the RCIs is therefore approximate, nevertheless informative.”

• cites Dan-Glauser & Scherer, 2013 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: The stability of the DERS has not yet been tested in autistic samples.
• AssumptionThe authors state this as an assumption: The test–retest reliability of the French version of the DERS is sufficiently applicable to the modified DERS total and subscale scores in autistic adults for the RCI calculation to be informative.

Probably not a substantial claim: may not pass S3 (load-bearing).

The WHOQoL-BREF has good psychometric properties.

“The WHOQoL-BREF has good psychometric properties (Skevington et al., 2004).”

• cites Skevington et al., 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Meta-analysis on 144 studies showed that the Beck Depression Inventory-Second Edition (BDI-II) has strong psychometric properties.

“Meta-analysis on 144 studies showed that the BDI-II has strong psychometric properties (Erford et al., 2016).”

• cites Erford et al., 2016 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Inclusion criteria were a DERS total score above the cut-off of 96 at baseline reflecting severe ED and exhibiting self-harming and/or suicidal behaviors, including suicidal ideation, in the last year prior to the study.

“In addition to a diagnosis of ASD without ID, adult participants had to meet the following two criteria to ensure that they fit the targeted severity: (a) having a DERS total score above the cut-off of 96 at baseline reflecting severe ED (Neaciu et al., 2014) and (b) exhibiting self-harming and/or suicidal behaviors, including suicidal ideation, in the last year prior to the study (Table 2).”

• cites Neaciu et al., 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• AssumptionRests on an assumption: The DERS cut-off of 96/97 validly identifies severe emotion dysregulation in autistic adults without ID.

May combine two claims.

Our results are the first to suggest that DBT might be feasible and clinically pertinent for autistic adults without ID presenting with self-harm and/or suicidal behaviors.

“Importantly, our results are the first to suggest that DBT might be feasible and clinically pertinent for autistic adults without ID presenting with self-harm and/or suicidal behaviors.”

May combine two claims.

DBT was feasible and highly acceptable to participants.

“Firstly, our results reveal that DBT was feasible and highly acceptable to participants.”

May combine two claims.

Our results suggest that DBT is feasible and might be efficacious in reducing ED in this context.

“Our results suggest that DBT is feasible and might be efficacious in reducing ED in this context.”

May combine two claims.

Adherence to DBT was high and participants were highly satisfied with both group and individual sessions.

“Indeed, adherence to DBT was high and participants were highly satisfied with both group and individual sessions.”

May combine two claims.

Participants' subjective experience of DBT was overall positive, including group skills training, individual sessions, and impact on building a life worth living.

“Their subjective experience of DBT was overall positive, including group skills training, individual sessions, and the impact of DBT on building a life worth living.”

Probably not a substantial claim: may not pass S1 (asserted). May combine two claims.

Given significant improvement in DERS mean scores, acquisition of emotion regulation skills enabled participants to cope more effectively with stressful situations.

“Given the significant improvement in DERS mean scores, we hypothesize that the acquisition of emotion regulation skills enabled participants to cope more effectively with stressful situations.”

Classified as probably not a substantial claim.

In our sample, improvement observed on depression, hopelessness and quality of life was not sustained at follow-up due to effects of COVID-19 pandemic on participants' mental health.

“In our sample, we hypothesize that the improvement observed on these dimensions was not sustained at follow-up due to the effects of the COVID-19 pandemic on the participants’ mental health.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This discrepancy might be explained by contextual factors: assessments were conducted while this participant was experiencing work-related problems and grieving loss of a family member.

“This discrepancy might be explained by contextual factors: The post-treatment and the follow-up assessments were conducted while this participant was experiencing work-related problems and grieving the loss of a family member.”

May combine two claims.

These discrepant outcomes are due to the "Clarity" mean score being impacted by worsening of scores in two participants at follow-up; one was grieving loss of a loved one at assessment.

“These discrepant outcomes are due to the “Clarity” mean score which was impacted by the worsening of scores in two participants at follow-up; one of them was grieving the loss of a loved one at the time of the assessment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In France, as in other European countries, psychological care for autistic adults is still underdeveloped, despite government efforts in recent years.

“Moreover, it should be noted that in France, as in other European countries, psychological care for autistic adults is still underdeveloped, despite government efforts in recent years (Micai et al., 2021).”

• cites Micai et al., 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The significant improvement in mean score of "Awareness" subscale was not reflected in individual results, as only one of seven showed reliable improvement post-treatment and two of six at follow-up.

“However, the significant improvement in the mean score of the “Awareness” subscale was not reflected in the individual results, as only one participant out of seven showed a reliable improvement post-treatment and two out of six at follow-up.”

May combine two claims.

Our study is different from previous research due to approach based entirely on DBT and population of interest (autistic adults without ID exhibiting self-harm and/or suicidal behaviors associated with severe ED).

“However, our study is different from previous research due to: (a) the approach adopted, based entirely on DBT, and (b) the population of interest, i.e., autistic adults without ID exhibiting self-harm and/or suicidal behaviors associated with severe ED.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This underdevelopment may have had an impact on subjective feedback of participants, as most were glad to have access to a psychological treatment conceived to address their specific needs.

“This may have had an impact on the subjective feedback of the participants, as most of them were glad to have access to a psychological treatment conceived to address their specific needs.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

Regarding "Goals" and "Non-acceptance" subscales, skills related to these domains were less intensely addressed by the program than skills related to "Awareness", "Impulse" and "Strategies".

“Regarding the “Goals” and”

May combine two claims.

There was no control group, which does not allow providing definitive evidence that improvements found here are due to DBT.

“Second, there was no control group, which does not allow providing definitive evidence that the improvements found here are due to DBT.”

Classified as probably not a substantial claim.

Our study is the first to assess feasibility, acceptability and clinical pertinence of DBT in autistic adults without ID.

“Given that our study is the first to assess the feasibility, acceptability and clinical pertinence of DBT in autistic adults without ID, several limitations are to be noted.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Alexithymia has rarely been measured in DBT protocols, and it is still unknown whether and how it changes in other clinical populations during DBT.

“Alexithymia has rarely been measured in DBT protocols (Bianchini et al., 2019; Holmqvist Larsson et al., 2020), and it is still unknown whether and how it changes in other clinical populations during the course of DBT.”

• cites Bianchini et al., 2019 sourceNot checked — no full text of the source
• cites Holmqvist Larsson et al., 2020 sourceNot checked — no full text of the source

May combine two claims.

These results highlight specific and robust impact of DBT on self-reported ED, which proved resilient despite highly stressful conditions related to pandemic.

“These results highlight the specific and robust impact of DBT on self-reported ED, which proved resilient despite the highly stressful conditions related to the pandemic.”

May combine two claims.

Overall, our results are the first to suggest that DBT is feasible and provide preliminary evidence for its efficacy for treatment of severe ED in autistic adults without ID exhibiting self-harm and suicidal behaviors.

“Overall, our results are the first to suggest that DBT is feasible and they provide preliminary evidence for its efficacy for the treatment of severe ED in autistic adults without ID exhibiting self-harm and suicidal behaviors.”

May combine two claims.

The sample size (n = 7) was small, which does not allow generalizing results to target population.

“First, the sample size (n = 7) was small, which does not allow generalizing the results to the target population.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Since this was a feasibility trial, we favored feasibility-e.g., reduction of participants' social anxiety-over maximization of neutrality.

“Indeed, since this was a feasibility trial, we favored feasibility—e.g., reduction of participants’ social anxiety—over the maximization of neutrality.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interviews and qualitative analysis were conducted by therapists involved in study, which might have interfered with neutrality required in process.

“Sixth, the interviews and the qualitative analysis were conducted by the therapists involved in the study, which might have interfered with the neutrality required in the process.”

May combine two claims.

Study sample was heterogeneous in age, IQ, and severity of self-harm and suicidal behaviors, making it difficult to determine clinical characteristics of autistic adults that can benefit most from treatment.

“Fourth, the study sample was heterogeneous in terms of age, IQ, and severity of self-harm and suicidal behaviors, making it difficult to determine the clinical characteristics of the autistic adults that can benefit the most from the treatment.”

May combine two claims.

It is possible that participants became more aware of their emotions following DBT, but still had difficulties in labeling them, as well as flexibly orienting attention and imagination processes.

“Hence, it is possible that the participants became more aware of their emotions following DBT, but they still had difficulties in labeling them, as well as flexibly orienting their attention and their imagination processes.”

• AssumptionRests on an assumption: Attention and imagination peculiarities are core difficulties found in autistic individuals, which were only marginally targeted by our DBT intervention.

Probably not a substantial claim: may not pass S2 (checkable).

These results bear important clinical relevance, given lack of evidence-based psychological treatments targeting specific needs of large number of autistic adults presenting with ED associated with self-harm and/or suicidal behaviors.

“These results bear important clinical relevance, given the lack of evidence-based psychological treatments targeting the specific needs of a large number of autistic adults presenting with ED associated with self-harm and/or suicidal behaviors.”

May combine two claims.

Duration of participation was heterogeneous (two patients completed half of therapy) due to dropouts caused by pandemic, which may have influenced outcomes.

“Third, the duration of participation was heterogeneous (two patients completed half of the therapy) due to the dropouts caused by the pandemic, which may have influenced outcomes.”