PFA Tips: Cognitive-Behavioral Therapy
By Gregory S. Chasson, Ph.D., Assistant Professor, Department of Psychology, Towson University
Often times we get stuck on the idea of finding a cure and lose sight of the tremendous advances that have been made in the treatment of Autism Spectrum Disorders (ASD). Not long ago, experts considered autism a disorder of “cold mothering,” with treatments ranging from harmless to dangerous. Even today, our search for a cure often blinds us to the best available approaches, leading to devastating news stories about new treatments causing harm to children (for example, Holding Therapy; Hanson & Spratt, 2000). Even more, parents and professionals are often overwhelmed with the explosion of information-sometimes contradictory and unsubstantiated-about the nature and treatment of ASD. Parent tips on finding good treatment are long overdue.
The following is a presentation of a specific model of psychotherapy called Cognitive-Behavioral Therapy (CBT), which includes a wide range of techniques for an equally wide range of psychiatric disorders (e.g., obsessive-compulsive disorder, depression, anxiety). Recently, however, principles and methods of CBT have been adapted to address the needs of high-functioning individuals with ASD and their families. Most excitingly, preliminary research (e.g., Sofronoff, Attwood, & Hinton, 2005) shows that CBT can have a meaningful and positive impact on their functioning and distress.
While many aspects of CBT can be applied to young children as part of early intensive behavioral intervention, the current discussion applies only to CBT for High-Functioning Autism and Asperger’s Disorder. In addition, it is important to note that CBT is not a cure for ASD, but it can provide critical skills and learning to improve lives.
What is Cognitive-Behavioral Therapy?
One of many psychotherapy approaches, CBT is based on the idea that how we feel, think, and behave are naturally intertwined. For this reason, CBT sets out to help patients identify the relationships between unhealthy thinking patterns, disruptive behavior, and negative emotional responses in upsetting or impairing situations. Overall, the treatment requires active participation by the patient in the form of in-session exercises, as well as homework assignments to be completed in between sessions.
CBT for High-Functioning Autism and Asperger’s Syndrome
Cognitive-Behavioral Therapy for ASD is a collection of many techniques. The following is a non-exhaustive set of its common approaches:
Assessment CBT involves careful evaluation of ASD symptoms and common co-occurring problems, such as depression and suicidal thinking, anxiety, and compulsive ritualizing.
Education CBT often includes a heavy dose of teaching the patient and family with a style that is tailored to the language skills and functioning level of the patient. Topics may include diagnosis, common signs and symptoms, and treatment philosophy and techniques.
Advocacy and Resources The CBT therapist often plays an important role in helping patients obtain outside services and connecting them to available resources, such as employment agencies, support groups, and speech-language therapy.
Social Skills Training Many individuals with ASD have never developed the necessary social skills to navigate our complex social world. CBT sets out to help individuals with ASD build those social skills. This aspect of treatment includes teaching and practicing social rules (e.g., do not discuss your lousy day in depth when a stranger asks how you are doing today) and social principles (e.g., it is sometimes okay to tell a white lie to avoid upsetting somebody). Often treatment includes discussing and practicing higher level skills, like understanding the emotions and intentions of others.
Habit Reversal and Ritual Prevention Those with ASD often present with repetitive movements, rituals, self-harm behavior, and insistence on routines. CBT strategies have been developed to specifically address these concerns with other types of psychiatric problems but can be helpful for those with ASD.
Cognitive Restructuring This is the fancy term for helping patients identify unhealthy thinking patterns and correct them. Correcting thinking patterns may involve examining past evidence, identifying common thinking errors, conducting a real world experiment to test assumptions about the world, and using written and verbal exercises to address problematic thinking. As an example, an adult with Asperger’s Syndrome may present to treatment with a belief that others appreciate being corrected on grammar. As a behavior experiment, a patient may be asked to take an informal survey of neighbors and colleagues to test this assumption-that is, to see if people typically appreciate having their conversational grammar corrected.Such an experiment would likely show that people actually dislike being corrected on their speech, a discovery that may help the patient reject his or her mistaken belief.
Miscellaneous Depending on what the patient needs, various CBT approaches can be applied. These may include skills for problem solving, goal setting, assertiveness, time management and increasing daily activities, and sleep hygiene.
How Can I Find a CBT Therapist?
Finding a CBT therapist can be tricky, as many professionals have some background in this approach but do not have the extensive training necessary to adapt standard CBT techniques to treat those with ASD. Pathfinders for Autism provides an extensive and growing internet database of local resources, some of which includes local CBT providers. In addition, the Association for Behavioral and Cognitive Therapies offers a list of CBT treatment providers. Be sure to ask providers what types of CBT techniques are typically employed to treat patients with ASD, as those mentioned should correspond to some degree with the techniques mentioned above.
CBT Solutions of Baltimore
Hanson, R. F., & Spratt, E. G. (2000). Reactive attachment disorder. What we know about the disorder and implications for treatment. Child Maltreatment, 5(2), 137-145.
Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomized controlled trial of CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46, 1152-1160.
Pathfinders for Autism does not endorse any treatment, service or provider. We strive to provide accurate, up-to-date information to individuals, families and professionals to assist them in making informed decisions about what best suits their unique needs.
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