Mechanisms of Change in Behavioral Activation: Adapting Depression Treatment for Autistic People
Open accessAbstract
Despite high rates of co-occurring depression, few studies have developed or adapted treatments targeting depressive symptoms for autistic adults. Behavioral activation is widely accepted as an empirically-supported approach for treating depression in other populations. Careful attention to the mechanisms targeted by behavioral activation is an essential step toward adapting behavioral activation protocols for use with autistic adults. We consider the mechanisms targeted by behavioral activation and provide a framework for research to explore the facilitators and barriers to the use of behavioral activation to treat depression in autistic adults. Drawing upon clinical experience and extant literature, the suggestions presented are aimed at highlighting considerations for clinicians wanting to use behavioral activation programs in their clinical practices with autistic adults and to promote the research needed to establish behavioral activation as an evidence-based practice for treating depression in adults on the autism spectrum.
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Low behavioral activation is associated with more severe internalizing symptoms in autistic adolescents and adults.
“Emerging research in autistic adolescents and adults shows that low BA is associated with more severe internalizing symptoms”
From The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives (2024) · cites this paper as Bal et al., 2023
In “Potential mechanisms of change in Behavioral Activation” (page unavailable), the paper says autistic transition-age youth with internalizing symptoms are particularly at risk for a decrease in activities. This supports a link between symptoms and reduced activity, but it does not establish that lower behavioral activation is associated with *more severe* symptoms across both autistic adolescents and adults. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThere has been little research on distress tolerance, behavioral activation, and depressive and anxiety symptoms in autistic adolescents to guide diagnostic practices and treatment planning.
“To our knowledge, there has been little research on distress tolerance, behavioral activation, and depressive and anxiety symptoms in autistic adolescents to guide diagnostic practices and treatment planning.”
From The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives (2024) · cites this paper as Bal et al., 2023
The paper's Abstract identifies a research gap concerning how behavioral activation treats depression in autistic people and says this work could inform treatment recommendations. Its focus is autistic adults, however, and the passages do not establish a lack of research on distress tolerance or on the stated combination of symptoms in autistic adolescents to guide diagnostic practices. (LLM, conf=0.84)
Experimental — accuracy not yet measuredBehavioral activation may be an important intervention target in autistic adolescents and adults.
“and may be an important intervention target (Bal et al., 2023; Schwartzman & Bonner, 2023)”
From The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives (2024) · cites this paper as Bal et al., 2023
The ‘Potential mechanisms of change in Behavioral Activation’ section describes BA as an attractive option for autistic individuals and says its targets warrant attention in autistic adults. The cited passages do not extend that recommendation specifically to autistic adolescents, so the claim’s age range is broader than the source supports. No page number is available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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- Authors
- Bal, V. H., Wilkinson, E., Glascock, V., Hastings, R. P., & Jahoda, A.
- Affiliations
- Rutgers, The State University of New Jersey (US)
- University of Warwick (GB)
- University of Glasgow (GB)
- Corresponding author
- Bal, Vanessa H.
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2023-11
- Volume
- 30
- Issue
- 4
- Pages
- 589-596
- ISSN
- 1077-7229 (ISSN-L)
- PMC
- PMC10611425
- OpenAlex
- W4226267244
- Cited by
- 24
- References
- 51
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 7
- FWCI
- 2.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cognitive and Behavioral Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Rutgers University Community Repository (Rutgers University) (submittedVersion)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Funders
- State of New Jersey Department of Health
- National Institute of Mental Health (K23MH115166)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- behavioral activation, depression, autism spectrum disorder, autistic adults, treatment adaptation, mechanisms of change, evidence-based practice, barriers and facilitators
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