Adapting psychological therapies for autism
Open accessAbstract
Background Psychological interventions informed by cognitive behavioural theory have proven efficacy in treating mild-moderate anxiety and depression. They have been successfully adapted for autistic children and adults who experience disproportionately high rates of co-occurring emotional problems. There has been little research into the perspectives and experience of psychological therapists adapting cognitive behavioural therapy (CBT) as part of routine clinical practice. We surveyed therapist skills, experience and confidence in working psychologically with autistic people, in order to highlight gaps and needs, as well as strengths in terms of therapist skills when working with this group.Method Fifty therapists attending a training event completed a survey about their experience of adapting CBT for autistic clients, alongside a measure of therapist confidence.Results Almost all therapists reported making adaptations to CBT practice when working with autistic clients. Key challenges identified were rigidity in thinking and pacing sessions appropriately. Therapists were relatively confident about core engagement and assessment skills but reported less confidence in using their knowledge to help this group. Therapist confidence was not associated with years of practice or number of adaptations made, but was positively associated with level of therapy training received.Conclusions This study highlights a need for training and ongoing supervision to increase therapist confidence in and ability to make appropriate adaptations to CBT treatment protocols for autistic people.
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The result of adaptations to interventions has been shown to be effective for the treatment of various mental health problems of autistic people.
“El resultado de estas adaptaciones se ha demostrado eficaz para el tratamiento de diversos problemas de salud mental de las personas autistas (Cooper et al., 2018;Spain et al., 2015).”
From Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa (2022) · cites this paper as Cooper et al., 2018
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).”
From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Cooper et al., 2018
Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach.
“Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach.”
From Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting (2023) · cites this paper as Cooper et al., 2018
Clinicians report limited experience and training in working with autistic people.
“Clinicians report limited experience and training in working with autistic people (Cooper et al., 2018; Ainsworth et al., 2020).”
From Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting (2023) · cites this paper as Cooper et al., 2018
These challenges extend to general aspects of many services, such as uncertainty and confusion at the point of service access, travel required to attend specialist services and increased demands on autistic clients to engage in novel and communication-focused appointments.
“These challenges are not limited to the therapeutic process but extend to general aspects of many services, such as there being uncertainty and confusion at the point of service access, travel required to attend specialist services and in the increased demands on autistic clients to engage in novel and communicationfocused appointments (Cooper et al., 2018).”
From Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting (2023) · cites this paper as Cooper et al., 2018
The uncertainty-reducing adaptations add to existing recommendations for therapy-specific modifications.
“These adaptations add to existing recommendations for therapy-specific modifications (Walters et al., 2016; Cooper et al., 2018).”
From Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting (2023) · cites this paper as Cooper et al., 2018
The findings agree with and replicate prior recommendations.
“The findings agree with and replicate prior recommendations (Spain et al., 2015; Cooper et al., 2018; Ainsworth et al., 2020; Maddox et al., 2020).”
From Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting (2023) · cites this paper as Cooper et al., 2018
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- Authors
- Cooper, K., Loades, M. E., & Russell, A.
- Affiliations
- University of Bath (GB)
- University of Bristol (GB)
- Corresponding author
- Cooper, K.
- Venue
- Research in Autism Spectrum Disorders
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 45
- Pages
- 43-50
- ISSN
- 1878-0237 (ISSN-L)
- 1750-9467
- PMC
- PMC6150418
- OpenAlex
- W2770749461
- Cited by
- 190
- References
- 31
- Citations by year
- 2026: 31 · 2025: 28 · 2024: 26 · 2023: 40 · 2022: 28 · 2021: 19 · 2020: 11 · 2019: 4 · 2018: 3
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Research in Autism (publishedVersion)
- PubMed (publishedVersion)
- Pure (University of Bath) (publishedVersion, cc-by-nc-nd)
- Bristol Research (University of Bristol) (publishedVersion, cc-by-nc-nd)
- Explore Bristol Research (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute for Health and Care Research (DRF-2016-09-021)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Counseling Practices and Supervision
- Keywords
- autism spectrum disorder, cognitive behavioral therapy, treatment adaptation, therapist confidence, therapist training, therapist supervision, anxiety, depression, clinical practice
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