Adapting cognitive behaviour therapy for adults with autism: a lived experience-led consultation with specialist psychological therapists
Open accessAbstract
The aim of this study was to investigate, from a lived experience perspective, specialist psychological therapists’ views on therapeutic adaptations to cognitive behaviour therapy (CBT) for autism that are most helpful for service users and enable best practice. Psychological therapist participants took part in semi-structured interviews led by a researcher with lived experience of autism. A thematic analysis was carried out. Participants ( n =8) reported that challenges for service users were anxiety about the therapeutic relationship; communication difficulties with understanding and being understood ; emotion recognition difficulties impeding trust and development of the therapeutic relationship; relationships with family interfering with the intervention; information processing impairments, necessitating a slower pace to the intervention; and avoidance of therapy due to anxiety. Goals were forming relationships and building social confidence and skills . Demographic differences were age , with older service users deemed less open to change and younger service users less mature and more often accompanied by family; and gender , with female service users deemed more socially able than males. Therapeutic adaptations were to increase collaboration ; support emotional literacy , to help service users understand their own and others’ emotions; focus on special interests ; use visual prompts , to improve communication and understanding; be consistent , to build trust and reduce anxiety; accommodate sensory needs , to reduce anxiety and build engagement; avoid metaphors , to reduce communication difficulties; and use role-play , to build and enhance social skills. Therefore, adapting CBT may support clinicians and reduce challenges for people with autism, while lived experience perspectives ensure adaptations meet service users’ needs. Key learning aims: (1) To use a lived experience perspective to explore expert psychological therapists’ views of challenges and adaptations when delivering CBT for adults with autism. (2) To investigate the benefits of adapting CBT when working with adults with autism. (3) To understand the importance of involving people with lived experience in the development and co-production of psychological interventions.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Research on VR for related techniques such as mindfulness is at the very early stages with predominantly single case studies and typically involves populations of adults without a mental health condition.
“However, this research is at the very early stages with predominantly single case studies and typically involves populations of adults without a mental health condition.”
From A Virtual Reality–Based Cognitive Defusion Application for Youth Depression and Anxiety: Mixed Methods Experimental Study. (2025) · cites this paper as [34]
The Discussion mentions virtual environments used to help clinicians understand service users’ experiences, but does not assess VR mindfulness research. Searches for mindfulness, single-case studies, and participants without mental health conditions found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredA small number of studies have examined the use of VR for related techniques such as mindfulness, with preliminary evidence of positive outcomes.
“A small number of studies have also examined the use of VR for related techniques such as mindfulness [31-34], with preliminary evidence of positive outcomes.”
From A Virtual Reality–Based Cognitive Defusion Application for Youth Depression and Anxiety: Mixed Methods Experimental Study. (2025) · cites this paper as [34]
The Discussion mentions virtual environments designed to help clinicians understand service users’ experiences, but does not discuss VR mindfulness studies or their outcomes. A search of our full-text copy for mindfulness found no passage addressing the claim. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Braun, V., & Clarke, V. (2021) · Counselling and Psychotherapy Research · doi:10.1002/capr.12360 · Cited by 3,198 · see citing works
Müller, E., Schuler, A., & Yates, G. (2008) · Autism · doi:10.1177/1362361307086664 · Cited by 462 · see citing works
Camm-Crosbie, L., Bradley, L., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2019) · Autism · doi:10.1177/1362361318816053 · Cited by 415 · cited 1× · see citing works
“, 2017), this population often struggles to access treatment (Geurts and Jansen, 2012; Camm-Crosbie et al., 2019).”
BackgroundThe key principles of cognitive behavioural therapy
Fenn, K., & Byrne, M. (2013) · InnovAiT: Education and inspiration for general practice · doi:10.1177/1755738012471029 · Cited by 363 · cited 1× · see citing works
“Most of these commonalities are consistent with the key elements of CBT for mild to moderate conditions (Fenn and Byrne, 2013), but the findings of this study highlight the need to focus more on certain aspects of CBT.”
BackgroundSocial anxiety in autism spectrum disorder: A systematic review
Spain, D., Sin, J., Linder, K. B., McMahon, J., & Happé, F. (2018) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2018.04.007 · Cited by 302 · see citing works
Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder
Wood, J. J., Kendall, P. C., Wood, K. S., Kerns, C. M., SELTZER, M. H., Small, B. J., Lewin, A. B., & Storch, E. A. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.4160 · Cited by 272 · see citing works
Lugo-Marín, J., Magán-Maganto, M., Rivero-Santana, A., Cuellar-Pompa, L., Alviani, M., Jenaro-Rio, C., Díez, E., & Canal-Bedia, R. (2019) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2018.12.004 · Cited by 243 · see citing works
Beyond the default colon: Effective use of quotes in qualitative research
Lingard, L. (2019) · Perspectives on Medical Education · doi:10.1007/s40037-019-00550-7 · Cited by 226 · cited 1× · see citing works
“The quotes selected were guided by the principle of authenticity, which suggests that appropriate quotes are reasonably succinct and representative of the dominant patterns in the data (Lingard, 2019).”
BackgroundDiagnostic Issues and Controversies in DSM-5: Return of the False Positives Problem
Wakefield, J. C. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032814-112800 · Cited by 217 · see citing works
Weston, L., Hodgekins, J., & Langdon, P. E. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.08.001 · Cited by 215 · see citing works
Diagnostic and Statistical Manual of Mental Disorders ☆
del Barrio, V. (2017) · Reference Module in Neuroscience and Biobehavioral Psychology · doi:10.1016/b978-0-12-809324-5.05530-9 · Cited by 212 · see citing works
Thornicroft, G., & Tansella, M. (2005) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00001858 · Cited by 203 · see citing works
Adapting psychological therapies for autism
Cooper, K., Loades, M. E., & Russell, A. (2018) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2017.11.002 · Cited by 190 · cited 3× · see citing works
“delivering CBT for people with autism (Cooper et al., 2018; Ramsay et al., 2005).”
BackgroundResultInfluentialSpain, D., Sin, J., Chalder, T., Murphy, D., & Happé, F. (2015) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2014.10.019 · Cited by 167 · see citing works
Best, C. S., Arora, S., Porter, F., & DOHERTY, M. J. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2518-2 · Cited by 103 · cited 1× · see citing works
“Individuals with autism are likely to be affected by challenges with communication, social interactions, empathetic reasoning, flexible thinking styles, and other environmental factors (Best et al., 2015; Müller et al., 2008; Zajenkowska et al., 2021); and they can be affected by high rates of comorbid mental health c…”
BackgroundSpain, D., & Happé, F. (2020) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-019-00335-1 · Cited by 97 · see citing works
Tincani, M., Travers, J. C., & Boutot, A. (2009) · Research and Practice for Persons with Severe Disabilities · doi:10.2511/rpsd.34.3-4.81 · Cited by 90 · see citing works
A retrospective chart study: The pathway to a diagnosis for adults referred for ASD assessment
Geurts, H. M., & Jansen, M. D. (2012) · Autism · doi:10.1177/1362361311421775 · Cited by 83 · cited 1× · see citing works
“, 2017), this population often struggles to access treatment (Geurts and Jansen, 2012; Camm-Crosbie et al., 2019).”
BackgroundGuidelines for conducting research studies with the autism community.
Gowen, E., Taylor, R., Bleazard, T., Greenstein, A., Baimbridge, P., & Poole, D. (2019) · PubMed · Cited by 82 · see citing works
Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects
Huggins, C. F., Donnan, G. L. J., Cameron, I. M., & Williams, J. H. G. (2020) · Autism · doi:10.1177/1362361320964306 · Cited by 73 · see citing works
Riches, S., Khan, F., Kwieder, S., & Fisher, H. L. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2349 · Cited by 27 · see citing works
Self-citationRamsay, J. R., Brodkin, E. S., Cohen, M. R., Listerud, J., Rostain, A. L., & Ekman, E. (2005) · Psychotherapy · doi:10.1037/0033-3204.42.4.483 · Cited by 25 · see citing works
Jose, C., George-Zwicker, P., Tardif, L., Bouma, A., Pugsley, D., Pugsley, L., Bélanger, M., Gaudet, J., & Robichaud, M. (2020) · Research Involvement and Engagement · doi:10.1186/s40900-020-00233-2 · Cited by 22 · cited 1× · see citing works
“Involving people with lived experience in the development and coproduction of psychological interventions and mental health provision has been shown to lead to services and research that are better at meeting the needs of service users (Cox and Miller, 2021; Gowen et al., 2019; Jose et al., 2020; Thornicroft and Tanse…”
BackgroundBlainey, S. H., Rumball, F., Mercer, L., Evans, L. J., & Beck, A. (2017) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2108 · Cited by 11 · cited 1× · see citing works
“Although research has provided support for the effectiveness of psychological interventions for adults with autism (Blainey et al., 2017), this population often struggles to access treatment (Geurts and Jansen, 2012; Camm-Crosbie et al.”
BackgroundZajenkowska, A. M., Rogoza, R., Sasson, N. J., Harvey, P. D., Penn, D. L., & Pinkham, A. E. (2021) · British Journal of Clinical Psychology · doi:10.1111/bjc.12283 · Cited by 10 · see citing works
Cox, L. A., & Miller, C. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x2100026x · Cited by 5 · cited 1× · see citing works
“Involving people with lived experience in the development and coproduction of psychological interventions and mental health provision has been shown to lead to services and research that are better at meeting the needs of service users (Cox and Miller, 2021; Gowen et al., 2019; Jose et al., 2020; Thornicroft and Tanse…”
Background
Flagged first, then by citations
Cited by
Sorted by citations
Adapting Safety Plans for Autistic Adults with Involvement from the Autism Community
Goodwin, J., Gordon, I., O’Keeffe, S., Carling, S., Berresford, A., Bhattarai, N., Heslop, P., Nielsen, E., O’Connor, R. C., Ogundimu, E. O., et al. (2024) · Autism in Adulthood · doi:10.1089/aut.2023.0124 · Cited by 17 · see citing works
“Autistic adults may experience anxiety in developing therapeutic relationships 26 and may take longer to establish such relationships.”
O'Brien, C., Jellett, R., & Flower, R. L. (2025) · Autism in Adulthood · doi:10.1089/aut.2023.0135 · Cited by 10 · see citing works
“…evidence of adaptations to specific therapies as useful for Autistic adults (e.g., dialectical behavior therapy 22 and cognitive behavioral therapy 21,23 ), there is limited evidence-based information available on whether and how to adapt psychological practice to meet the needs of Autistic…”
Gerber, A. S., Nahmias, A. S., Schleider, J. L., & Lerner, M. D. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06341-2 · Cited by 10 · see citing works
“Crucially, CBT is resource-intensive and often requires adaption to meet the needs of autistic youth (Kerns et al., 2016 ; Riches et al., 2023 ; Spain & Happé, 2020 ), limiting access to high qual - ity intervention.”
Miller, P. K., Bowden, S. L., Dewison, N., Ingham, B., Thwaites, R., & Dagnan, D. (2025) · Autism · doi:10.1177/13623613251341610 · Cited by 6 · see citing works
“There are similarities in the issues identified in the current study and those identified by studies such as that by Riches et al. (2023), such as the challenges of expectation management and pacing, understanding how emotions and social relationships operate in the lives of autistic people, and…”
Bell, I. H., Li, C., Thompson, A., Ellinghaus, C., O’Sullivan, S., Reynolds, K. A., Wadley, G., Liu, Y., Bendall, S., Gleeson, J., et al. (2025) · JMIR Mental Health · doi:10.2196/70160 · Cited by 3 · see citing works
“This is also consistent with the perspectives of clinicians and individuals with lived experience of developmental disorders, who advocate for novel therapeutic strategies that better accommodate sensory needs and learning styles, including VR [34].”
Marco, D. D., DClinPsy, P. W., & Troop, N. (2025) · Counselling and Psychotherapy Research · doi:10.1002/capr.12902 · Cited by 3 · see citing works
Adapting cognitive behavioral therapy for anxiety in autistic children: A commentary
Onwumere, D., & Patten, K. (2024) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2024.102404 · Cited by 2 · see citing works
Autistic Shame: Reflections on an Underrecognized Determinant of Autistic Mental Health
Doherty, M. (2026) · Autism in Adulthood · doi:10.1177/25739581261479601 · Cited by 1 · see citing works
McCrossin, R. (2024) · Preprints.org · doi:10.20944/preprints202402.0185.v1
McCrossin, R. (2024) · Preprints.org · doi:10.20944/preprints202402.0185.v2
McCrossin, R. (2025) · Preprints.org · doi:10.20944/preprints202504.1047.v1
Riches, S., Hammond, N., Bianco, M., Fialho, C., Nicholson, S. L., & Acland, J. (2024) · Mental Health and Digital Technologies · doi:10.1108/mhdt-02-2024-0008
Self-citationBolton, M. J. (2025) · doi:10.31234/osf.io/t3kfw_v2
Callen-Davies, J., Zohhadi, S., & Gregson, N. (2026) · Clinical Case Studies · doi:10.1177/15346501261446311
“For psychological therapists delivering interventions to autistic adults, successfully integrating family members can be considered challenging, with concerns about differing goals or therapy interference (Riches et al., 2023).”
Therapeutic Alliance and Autism: A Scoping Review
Losh, A., & Russell, K. (2026) · Counselling and Psychotherapy Research · doi:10.1002/capr.70142
Lewis, D., Miller, P. K., Dickie, I., Ingham, B., Thwaites, R., & Dagnan, D. (2026) · Counselling and Psychotherapy Research · doi:10.1002/capr.70187
Kleszczewska-Albińska, A. (2026) · Psychiatria i Psychologia Kliniczna · doi:10.15557/pipk.2026.0022
- Authors
- Riches, S., Hammond, N., Bianco, M., Fialho, C., & Acland, J.
- Affiliations
- King's College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Corresponding author
- Riches, Simon
- Venue
- The Cognitive Behaviour Therapist
- Publisher
- Cambridge University Press (CUP)
- Published
- 2023
- Volume
- 16
- ISSN
- 1754-470X (ISSN-L)
- OpenAlex
- W4367019661
- Cited by
- 17
- References
- 25
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Cognitive Behaviour Therapist (publishedVersion, cc-by)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, autism spectrum disorder, treatment adaptation, lived experience, psychotherapists, therapeutic relationship, anxiety, communication difficulties, emotion recognition, sensory needs, visual prompts, role play, social skills, autistic adults
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
