Cognitive Behavioral Therapy (CBT) for Autism

Autism is a neurodevelopmental disorder and not a single disease entity. Autism referred to as an autism spectrum disorder (ASD), is a part of developmental disorders that begin in childhood and last through adulthood. People with ASD exhibit unique behavioral and cognitive styles varying significantly in the severity of symptoms in each individual. 

Health professionals and therapists do not treat ASD. They creatively adjust cognitive behavioral therapy (CBT) to meet the challenges and needs of the individual. Therapists focus on secondary issues like stress, aggression, anxiety, communication, and social skills deficits. These ASD symptoms impact the daily life experiences of people with ASD on the autism spectrum. 

Studies have revealed that 40% of people with ASD suffer from high anxiety or anxiety-related disorder. It often interferes with adaptive functioning. Moreover, it can be hard to differentiate between anxiety and ASD symptoms. Anxiety and ASD behaviors look similar.

To address anxiety, depression, and mental health problems like mood disturbances in people with ASD, therapists use modified cognitive behavioral therapy (CBT). 

CBT helps individuals alter their thoughts and behaviors that contribute to anxiety, depression, and other problems.

CBT is a short-term goal-focused therapy. The researchers have developed CBT considering the following behavioral and psychological aspects: 

• What we think and how we think. How we feel emotionally and what we do as interdependent. 
• Our thoughts, thinking styles, and coping strategies can indirectly sustain the negative affect
• Physiological anxiety can reinforce the use of ineffective responses and encourage negative thoughts.

Cognitive behavioral therapy (CBT) helps in two different ways.

1. The cognitive component: It helps children to change their thought about a situation, 
2. Behavioral Aspect: It guides children to change their reactions to a particular situation

What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is an evidence-based therapy that aids patients to realize their thoughts, attitudes, and expectations. Its basis is the concept that our behavior, thinking, and feelings are intertwined. It assists people with ASD to change false and negative beliefs and helps them successfully navigate life.

The followings are the goals of CBT in people with autism spectrum disorder:

1. Help them note their thoughts, feelings, and behaviors.
2. Guide them to replace negative thoughts with positive and realistic ones.
3. Help them change problematic and interfering behaviors.

CBT therapy aims to alleviate or alter the negative emotions or behaviors in children with ASD. It changes behaviors through reinforcements and constant monitoring.    

Research and practice have found CBT effective in treating different emotional and mental health issues in autistic. It helps the patient identify and challenge negative and interfering thoughts. The child with ASD can also learn practical self-help strategies to cope with their condition.

 The therapist teaches the child strategies to modify thoughts and respond differently to change unwanted feelings during a particular situation. CBT can help children develop social and problem-solving skills and consequently improve their relationships with others.

 With cognitive behavioral therapy, the child with ASD and their parents gain a better understanding of the difficulties experienced by the child. It thus teaches coping skills to help children manage emotional distress. The child also learns to overcome the physical symptoms, negative thoughts, and problematic behaviors that often accompany depression and anxiety.

How is CBT used in clinical practice?

CBT often involves a variety of intervention components. When you use CBT with people with ASD, the CBT typically includes:

• It explains the cause of anxiety and depression
• Teach coping strategies like relaxation.
• Identify triggers and situations that cause anxiety
• Discusses how anxiety affects daily life,
• Expose the person gradually to challenging situations and manage anxiety as it arises

How Does Cognitive Behavioral Therapy Work?

Cognitive behavioral therapy stems from the concept that you learn human behavior. It is a psychological approach. Therefore, you can acquire new behaviors and unlearn the existing ones. CBT changes thinking and some behaviors that hinder positive results.

The followings are the main steps involved in CBT:

1. Identifying the causes/symptoms that upset the person with ASD.
2. To recognize and become aware of thoughts and feelings.
3. Recognizing negative or inaccurate thinking
4. Reduce and reshape negative thought processes into a more positive ones.

CBT focuses more on the patient’s current thoughts and beliefs, whereas psychotherapy methods are more on exploring the past to learn about the feeling of the person with ASD.

In CBT, the therapist breaks the problem into smaller parts and helps the person with ASD understand. It, therefore, is easier to see how the different parts are connected and their impact on thoughts and emotions. The therapist might explore various components, like situations, thoughts, emotions, physical feelings, and actions.

When the autistic recognize these parts of the problem, they can find the problem, its effects, and how to deal with it. Therefore, CBT helps people with ASD learn to swap negative thoughts with positive ones.

The studies have found CBT helpful with various psychological disorders, like anxiety, depression, panic disorders, eating disorders, post-traumatic stress, obsessive-compulsive disorder, psychosis, and bipolar. Recently, CBT has been successfully used to treat symptoms associated with an autism spectrum disorder.

Benefits of Cognitive Behavioral Therapy for Autism

Cognitive-Behavioral therapy combines many techniques for ASD. Some of the common CBT approaches in autism are:

Reduce anxiety 

Anxiety is the most common impairing problem in people with autism. Anxiety also leads to many medical conditions and disorders in people with ASD. One study shows that about 70% of autistics suffer from various emotional problems. These all co-occurring medical disorders develop anxiety in them. 40% of the autistics develop depression or any other form of anxiety-related issues.

A study has found that CBT helps people with autism cope and manage anxiety and other emotional issues.

Helps to Handle Stressful Situations

People with autism spectrum disorder find it difficult to handle stressful situations. CBT helps to identify the causes of interfering behaviors, helping people with ASD to recognize the scenarios themselves. Once autistics learn responses to certain behaviors, they will also learn to cope with anxiety and fear. Therefore, they can reduce negative thoughts and change them with positive ones. 

Help Autistics to Change Maladaptive Beliefs

Besides negative thoughts, autistics also show maladaptive beliefs. These beliefs are false or irrational. Some of these beliefs are just black and white unhelpful thinking. The person with ASD thinks about the extreme situation. For instance, the ability to complete a task, the autistics might think they’ll do well or poorly.

Secondly, the person with ASD generalizes everything based on a single event. They may believe they will fail in all other tasks if they fail in one job. Lastly, due to negative thinking, some autistics blame themselves for something that was not their fault.

Researchers have found cognitive behavioral therapy effective in addressing these thinking styles in autistics.

Assessment  

CBT helps evaluate ASD symptoms and other co-occurring problems. It helps to assess co-morbidities such as depression, anxiety, stress, and suicidal thinking.

Education  

CBT often enriches a person with autism and family members with the skills and the function of autistic. It teaches topics like diagnosis, symptoms, treatment strategies, and techniques.

Social Skills Training  

People with ASD have deficits in social skills to navigate this complex social world. CBT helps people with ASD to develop social skills and social principles. It teaches practicing and discussing social rules and understanding the emotions and intentions of others.

Habit Reversal 

Repetitive movements, self-injury, and insistence on routines and rituals are a hallmark of those with ASD. There are CBT strategies specifically to address these concerns. CBT strategies also handle other types of psychiatric problems in people with ASD.

Cognitive Restructuring  

CBT helps people with ASD in cognitive restructuring. It is the process where autistics identify unhealthy thinking patterns and correct them. 

Restructuring involves the process of evaluating past evidence and errors in thinking. The therapist conducts tests on the assumptions about the world through the use of written and verbal exercises to change the problematic thinking pattern.

Conclusion

Families of people with autism may struggle with ASD-related issues like obsessive interests, angry outbursts, self-injury, poor self-care, repetitive rituals, and unique behavior. So working with families is also critical as parents may experience frustration. 

Cognitive behavioral therapy helps to equip children with autism and assist families with coping skills. It will help families understand and manage emotional distress and accompanying physical symptoms, negative thoughts, and problematic behaviors. 

More research is required to learn about CBT with people with ASD. The work may be challenging, but it will be highly creative and rewarding. New findings will help autistics and their families reach their own meaningful goals.