How to Optimise Cognitive Behaviour Therapy (CBT) for People with Autism Spectrum Disorders (ASD): A Delphi Study
Open accessAbstract
Children and adults with autism spectrum disorders (ASD) can benefit from cognitive behaviour therapy (CBT), yet the prevailing opinion is that this requires adaptations to accommodate commonly experienced socio-communication and neuropsychological impairments. There are, however, no empirically-derived guidelines about how best to adapt standard practice. In a three round Delphi survey, we asked expert clinicians and clinical-researchers, based in England, about how to optimise the design, delivery and evaluation of CBT for people with ASD. Of 50 people approached, 18 consented to take part in Round 1, nine in Round 2 and eight in Round 3. Using a five-point scale, participants rated the degree to which 221 statements—pertaining to the referral process, assessment, engagement, formulation, goal setting, therapy structure, interventions and techniques, homework, outcome measurement, managing endings and therapist attributes—were integral to CBT. The consensus was that 155 statements represented essential or important components of CBT. Adaptations to the structure and process of therapy were consistently endorsed, and an individualised formulation-derived approach was favoured when deciding upon which interventions and techniques to offer. Further studies are needed to clarify if adapted CBT is associated with improved treatment outcomes and acceptability.
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Clinicians report that 'autism specific' adaptations accounted for around 40% of the 'active ingredients' that made CBT with autistic people more effective.
“Clinicians report that ‘autism specific’ adaptations accounted for around 40% of the ‘active ingredients’ that made CBT with autistic people more effective (Spain & Happé, 2020).”
From A Pilot Randomised Control Trial Exploring the Feasibility and Acceptability of Delivering a Personalised Modular Psychological Intervention for Anxiety Experienced by Autistic Adults: Personalised Anxiety Treatment-Autism (PAT-A) (2024) · cites this paper as Spain & Happé, 2020
The ASD-Specific Adaptations to CBT section reports that 40% of approaches and attributes deemed integral were ASD-specific, supporting the proportion. It does not show that these adaptations made CBT more effective: the Abstract says further studies are needed to determine whether adapted CBT improves treatment outcomes. Page numbers were not provided in our copy. (LLM, conf=0.88)
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- Authors
- Spain, D., & Happé, F.
- Affiliations
- King's College London (GB)
- Corresponding author
- Spain, Debbie
- ORCID
- Spain, Debbie
- Venue
- Journal of Rational-Emotive & Cognitive-Behavior Therapy
- Published
- 2019-12-14
- Volume
- 38
- Issue
- 2
- Pages
- 184-208
- ISSN
- 0894-9085 (ISSN-L)
- 1573-6563
- OpenAlex
- W2996582381
- Cited by
- 97
- References
- 54
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 19 · 2023: 24 · 2022: 15 · 2021: 11 · 2020: 3
- FWCI
- 4.21
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Rational-Emotive & Cognitive-Behavior Therapy (publishedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research (CDRF–2012–03-059)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- cognitive behavioral therapy, autism spectrum disorder, treatment adaptation, expert consensus, homework, outcome measurement, treatment acceptability, children and adults with autism
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