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Cognitive behavior therapy for social anxiety disorder in the context of Asperger's Syndrome: A single-subject report
Abstract
Asperger's Syndrome (AS) is a developmental disorder characterized by social impairment, highly circumscribed interests, repetitive behaviors, and motor clumsiness. The social impairment features of AS are similar to characteristics of social anxiety disorder (SAD). However, little is known about the comorbidity of these disorders or the treatment of social anxiety in the context of AS. The present single-subject report examines the use of cognitive-behavior therapy (CBT) in treating SAD in an adult with comorbid AS. The results suggest that a 14-week course of CBT was successful in reducing symptoms of anxiety and comorbid depression. In addition, improvements in social skills were observed (e.g., appropriate eye contact, conversational skills). Limitations and future directions for research and treatment are discussed.
... Participant IQs were often not reported; only one study included an adult diagnosed with co-occurring ID (i.e., Wright, 2013). Race/ethnicity information was only reported for five studies (Birdsey & Walz, 2021;Cardaciotto & Herbert, 2004;Langdon et al., 2016;Ordaz et al., 2018;Spain et al., 2017); for the five studies, the majority of participants were White. ...
... Study designs and intervention characteristics were heterogeneous. Seven studies were case studies/case series (Birdsey & Walz, 2021;Cardaciotto & Herbert, 2004;Maskey et al., 2019;Ordaz et al., 2018;Turner & Hammond, 2016;Weiss & Lunsky, 2010;Wright, 2013), four studies were nonrandomized (Bemmer et al., 2021;McGillivray & Evert, 2014;Sizoo & Kuiper, 2017;Spain et al., 2017), and two studies were RCTs (Gaigg et al., 2020;Langdon et al., 2016). Six studies examined the efficacy of CBT delivered individually (Birdsey & Walz, 2021;Cardaciotto & Herbert, 2004;Maskey et al., 2019;Ordaz et al., 2018;Turner & Hammond, 2016;Wright, 2013), six studies examined the efficacy of CBT delivered in a group format (Bemmer et al., 2021;Langdon et al., 2016;McGillivray & Evert, 2014;Sizoo & Kuiper, 2017;Spain et al., 2017;Weiss & Lunsky, 2010), and one study examined the efficacy of online self-guided CBT (Gaigg et al., 2020). ...
... Seven studies were case studies/case series (Birdsey & Walz, 2021;Cardaciotto & Herbert, 2004;Maskey et al., 2019;Ordaz et al., 2018;Turner & Hammond, 2016;Weiss & Lunsky, 2010;Wright, 2013), four studies were nonrandomized (Bemmer et al., 2021;McGillivray & Evert, 2014;Sizoo & Kuiper, 2017;Spain et al., 2017), and two studies were RCTs (Gaigg et al., 2020;Langdon et al., 2016). Six studies examined the efficacy of CBT delivered individually (Birdsey & Walz, 2021;Cardaciotto & Herbert, 2004;Maskey et al., 2019;Ordaz et al., 2018;Turner & Hammond, 2016;Wright, 2013), six studies examined the efficacy of CBT delivered in a group format (Bemmer et al., 2021;Langdon et al., 2016;McGillivray & Evert, 2014;Sizoo & Kuiper, 2017;Spain et al., 2017;Weiss & Lunsky, 2010), and one study examined the efficacy of online self-guided CBT (Gaigg et al., 2020). Treatment protocols ranged from 4 to 6 weeks (Maskey et al., 2019) to 24 weeks (Langdon et al., 2016). ...
Background
Autistic adults are more likely than adults without autism spectrum disorder (ASD) to experience clinically significant anxiety. In addition, anxiety in autistic adults is associated with poorer quality of life and myriad negative outcomes (e.g., unemployment, suicidality). Therefore, this systematic review aimed to summarize and evaluate the literature on the psychotherapeutic and psychopharmacological treatment of anxiety in autistic adults to inform clinical decision-making.
Method
Several online databases were searched for peer-reviewed journal articles with any combination of the following terms in the abstract: (1) autism, autistic, Asperger, Asperger’s, or “pervasive developmental disorder” (2) anxiety, anxious, phobia, mutism, panic, agoraphobia, or worry and (3) treatment, intervention, trial, therapy, psychotherapy, pharmacotherapy, medication, drug, antidepressant, sedative, or anti-anxiety. Data were extracted from articles meeting the inclusion criteria, and the strength of the evidence was assessed for treatments.
Results
Fifteen psychosocial treatment studies, one pharmacological treatment study, and one combined psychosocial and pharmacological treatment study met the inclusion criteria. The most investigated treatment for anxiety in adults with ASD was cognitive behavioral therapy (CBT).
Conclusions
Few studies have investigated the treatment of anxiety in autistic adults. Additionally, findings have been inconsistent across studies regarding the potential effectiveness of particular psychosocial and pharmacological treatments. More research is certainly needed before clinically useful conclusions can be made.
... Seven studies in this review examined CBT as treatment for depressive symptomatology in individuals with ASD. In all studies, sample sizes were small; samples ranged from a single participant (Cardaciotto & Herbert, 2004;Loades, 2015) to 59 participants (Sizoo & Kuiper, 2017). CBT treatment studies included clients of diverse ages. ...
... Study designs were heterogeneous. Two studies employed a single case design (Cardaciotto & Herbert, 2004;Loades, 2015). One study was a case series (Weiss & Lunsky, 2010). ...
... In all seven studies, treatment was short-term; treatment duration ranged from 9 weeks (McGillivray & Evert, 2014) to 20 weeks (Loades, 2015). Depression symptoms were most frequently assessed with the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996); three studies measured severity of depressive symptomatology with the BDI-II (Cardaciotto & Herbert, 2004;Santomauro et al., 2016;Weiss & Lunsky, 2010). Across studies, an additional four measures were used for depression symptom assessment, including the Depression Anxiety Stress Scale (DASS; Parkitny & McAuley, 2010). ...
Background
Given the prevalence of depression in persons with autism spectrum disorder (ASD), effective treatment is crucial; however, a systemic review on the topic has not been published in over a decade. This study aimed to systematically examine the efficacy of psychosocial and pharmacological treatments for depression in youth and adults with ASD to inform clinical practice.
Method
PsycINFO, PubMed, and CINAHL online databases were searched for peer-reviewed journal articles containing any combination of the following terms in the abstract: (1) autism, autistic, Asperger, or “pervasive developmental disorder,” (2) depression or depressive and (3) treatment, intervention, trial, therapy, medication, drug, or antidepressant. Evidence from studies meeting the predetermined criteria of inclusion was assessed for its strength to inform clinical decision-making.
Results
Twenty psychosocial treatment studies and five pharmacological treatment studies met the criteria of inclusion. Psychosocial interventions studied the effectiveness of cognitive remediation therapy, behavioral therapy, cognitive-behavioral therapy (CBT), combined psychosocial intervention, mindfulness-based therapy (MBT), and social, academic, and/or vocational skills training. Pharmacological interventions studied the effectiveness of anti-epileptic drug, norepinephrine reuptake inhibitor, stimulant, atypical antipsychotic, and NMDA receptor antagonist treatment.
Conclusions
Although much recent research has investigated potentially effective treatments for depression in individuals with ASD, the strength of the evidence remains generally poor. However, studies indicate preliminary efficacy for MBT. A number of investigations have examined the effect of CBT on depression in persons with ASD; however, the results are inconsistent. Further research is needed to advance clinical practice for individuals with ASD and comorbid depression.
... Table 1 summarises information about studies included in the review. Six papers met the review inclusion criteria: two RCTs (Russell et al., 2013;Spek, van Ham, & Nyklicek, 2013) one quasi-experimental study (Russell, Mataix-Cols, Anson, & Murphy, 2009), one group-based case series intervention (Weiss & Lunsky, 2010), and two case studies (Cardaciotto & Herbert, 2004;Hare, 1997). One study (Russell et al., 2013) included both adults and adolescents with ASD; the first author was contacted regarding sub-group data for the adult sample, and hence this study is included in our review. ...
... One study (Russell et al., 2013) included both adults and adolescents with ASD; the first author was contacted regarding sub-group data for the adult sample, and hence this study is included in our review. One study was undertaken in Sweden (Spek et al., 2013), three in the UK (Hare, 1997;Russell et al., 2009Russell et al., , 2013, and two in North America (Cardaciotto & Herbert, 2004;Weiss & Lunsky, 2010). A combined total of 105 adults with ASD participated in the studies. ...
... No studies were excluded based on quality assessment. It was acknowledged that there were potential biases -such as sampling, selection and measurement bias (Coolican, 2009) -inherent to the case studies (Cardaciotto & Herbert, 2004;Hare, 1997), the case series (Weiss & Lunsky, 2010), and the quasi-experimental study (Russell et al., 2009). The RCTs by Russell et al. (2013) and Spek et al. (2013) employed several methods to enhance internal study validity including independent random sequence allocation of participants to test or control conditions, blinding of assessors who supported participants to complete outcome measures, and use of intention to treat (ITT) data analysis methods. ...
... Table 1 summarises information about studies included in the review. Six papers met the review inclusion criteria: two RCTs (Russell et al., 2013;Spek, van Ham, & Nyklicek, 2013) one quasi-experimental study (Russell, Mataix-Cols, Anson, & Murphy, 2009), one group-based case series intervention (Weiss & Lunsky, 2010), and two case studies (Cardaciotto & Herbert, 2004;Hare, 1997). One study (Russell et al., 2013) included both adults and adolescents with ASD; the first author was contacted regarding sub-group data for the adult sample, and hence this study is included in our review. ...
... One study (Russell et al., 2013) included both adults and adolescents with ASD; the first author was contacted regarding sub-group data for the adult sample, and hence this study is included in our review. One study was undertaken in Sweden (Spek et al., 2013), three in the UK (Hare, 1997;Russell et al., 2009Russell et al., , 2013, and two in North America (Cardaciotto & Herbert, 2004;Weiss & Lunsky, 2010). A combined total of 105 adults with ASD participated in the studies. ...
... No studies were excluded based on quality assessment. It was acknowledged that there were potential biases -such as sampling, selection and measurement bias (Coolican, 2009) -inherent to the case studies (Cardaciotto & Herbert, 2004;Hare, 1997), the case series (Weiss & Lunsky, 2010), and the quasi-experimental study (Russell et al., 2009). The RCTs by Russell et al. (2013) and Spek et al. (2013) employed several methods to enhance internal study validity including independent random sequence allocation of participants to test or control conditions, blinding of assessors who supported participants to complete outcome measures, and use of intention to treat (ITT) data analysis methods. ...
... Table 1 summarises information about studies included in the review. Six papers met the review inclusion criteria: two RCTs (Russell et al., 2013;Spek, van Ham, & Nyklicek, 2013) one quasi-experimental study (Russell, Mataix-Cols, Anson, & Murphy, 2009), one group-based case series intervention (Weiss & Lunsky, 2010), and two case studies (Cardaciotto & Herbert, 2004;Hare, 1997). One study (Russell et al., 2013) included both adults and adolescents with ASD; the first author was contacted regarding sub-group data for the adult sample, and hence this study is included in our review. ...
... One study (Russell et al., 2013) included both adults and adolescents with ASD; the first author was contacted regarding sub-group data for the adult sample, and hence this study is included in our review. One study was undertaken in Sweden (Spek et al., 2013), three in the UK (Hare, 1997;Russell et al., 2009Russell et al., , 2013, and two in North America (Cardaciotto & Herbert, 2004;Weiss & Lunsky, 2010). A combined total of 105 adults with ASD participated in the studies. ...
... No studies were excluded based on quality assessment. It was acknowledged that there were potential biases -such as sampling, selection and measurement bias (Coolican, 2009) -inherent to the case studies (Cardaciotto & Herbert, 2004;Hare, 1997), the case series (Weiss & Lunsky, 2010), and the quasi-experimental study (Russell et al., 2009). The RCTs by Russell et al. (2013) and Spek et al. (2013) employed several methods to enhance internal study validity including independent random sequence allocation of participants to test or control conditions, blinding of assessors who supported participants to complete outcome measures, and use of intention to treat (ITT) data analysis methods. ...
... Wood et al. [85] suggested using hands-on activities or visual aids to assist with facilitating concrete discussions and clarifying the lesson. Cardaciotto and Herbert [86] modified a CBT protocol to treat SoP by adding a social skills training component to the treatment. The modification Were done in the single case design to target the client's impairments in verbal, non-verbal, and paralinguistic communications. ...
... Assessment of SoP on outcome measures administered throughout treatment revealed a steady decline in SoP severity. Cardaciotto and Herbert [86] concluded that at the end of treatment the client no longer met diagnostic criteria for symptoms related to SoP. ...
Children and adolescents with a neurodevelopmental disorder experience vulnerabilities and coping deficits that contribute to the likelihood of developing co-occurring anxiety disorders. The development of anxiety disorders, including social anxiety disorder, is very often reported in children and adolescents with autism spectrum disorder (ASD). Cognitive behavior therapy (CBT) has strong evidentiary support both in combination with medication and as a stand-alone treatment for anxiety disorders in general and more specifically for phobic-type anxiety in children, adolescents, and adults. Moreover, specific manualized CBT is an evidentiarily sound method for treating anxiety in children and adolescents with ASD.
... Although there has been an increase in research related to the impact of psychological or occupational therapies to treat developmental disorders (Anderson and Morris, 2006;Case-Smith and Arbesman, 2008;Woods et al., 2013;Cardaciotto and Herbert, 2004;Mishna and Muskat, 1998), these studies have been conducted mostly in the psychology, nursing sciences or medical disciplines and focus mostly on AS traits and therapy treatments. Fewer is known, from a services marketing perspective, about value co-creation and the wellbeing of patients with chronic disorders such as AS. ...
... Many diseases are transient and affect patients at a certain time in their lives. However, other health conditions are chronic in nature, such AS, which require permanent and lifelong therapies and family support to help improve patient quality of life and well-being (Woods et al., 2013;Cardaciotto and Herbert, 2004). For patients with developmental disorders it may be difficult to participate in the co-creation of value as they have less initiative, proactivity and ability to regulate emotions (Jennes-Coussens et al., 2006;Khouzam et al., 2004), which are some of the value co-creation activities identified in previous health research (Sweeney et al., 2015). ...
Purpose-The purpose of this paper is to investigate how family members co-create value and improve the well-being of patients with chronic developmental disorders, such as Asperger syndrome (AS) that undertake permanent therapy services. Design/methodology/approach-Qualitative methodology is used to identify family value co-creation activities and well-being outcomes. Extensive interviews with family members and professional therapists of AS patients were conducted as the main data collection method. Findings-Drawing from previous conceptualizations of value co-creation activities in health contexts, the findings of this study identify the specific value co-creation activities held by family members that influence the different dimensions of well-being for AS patients and their families: co-learning, combining therapies, changing ways of doing things, connecting, cooperation and co-production, managing daily life, motivating, protecting, regulating and establishing roles. The findings also reveal improvements in the following dimensions of patient well-being: autonomy, self-acceptance, purpose in life, positive relationships with others, control of the environment and personal growth. In addition, value co-creation activities also improve family relationships at home and the well-being of patient family members. Originality/value-This study contributes to the services literature and addresses a gap in transformative service research by exploring the value co-creation activities of family members for improving well-being outcomes of patients with chronic developmental disorders. People with chronic developmental disorders engage in permanent therapy services and tend to have below-average well-being scores, which also extends to their family members.
... Although there has been an increase in research related to the impact of psychological or occupational therapies to treat developmental disorders (Anderson and Morris, 2006, Case-Smith and Arbesman, 2008, Woods et al., 2013, Cardaciotto and Herbert, 2004, Mishna and Muskat, 1998, these studies have been conducted mostly in the psychology, nursing sciences or medical disciplines and focus mostly on AS traits and therapy treatments. Less is known, from a services marketing perspective, about value co-creation and the wellbeing of patients with chronic disorders such as AS. ...
... Many diseases are transient and affect patients at a certain time in their lives. However, other health conditions are chronic in nature, such AS, which require permanent and lifelong therapies and family support to help improve patient quality of life and well-being (Woods et al., 2013, Cardaciotto andHerbert, 2004). For patients with developmental disorders it may be difficult to participate in the co-creation of value since they have less initiative, proactivity and ability to regulate emotions (Jennes-Coussens et al., 2006, Khouzam et al., 2004, which are some of the value co-creation activities identified in previous health research (Sweeney et al., 2015). ...
Purpose
The purpose of this paper is to investigate how family members co-create value and improve the well-being of patients with chronic developmental disorders, such as Asperger syndrome (AS) that undertake permanent therapy services.
Design/methodology/approach
Qualitative methodology is used to identify family value co-creation activities and well-being outcomes. Extensive interviews with family members and professional therapists of AS patients were conducted as the main data collection method.
Findings
Drawing from previous conceptualizations of value co-creation activities in health contexts, the findings of this study identify the specific value co-creation activities held by family members that influence the different dimensions of well-being for AS patients and their families: co-learning, combining therapies, changing ways of doing things, connecting, co-operation and co-production, managing daily life, motivating, protecting, regulating and establishing roles. The findings also reveal improvements in the following dimensions of patient well-being: autonomy, self-acceptance, purpose in life, positive relationships with others, control of the environment and personal growth. In addition, value co-creation activities also improve family relationships at home and the well-being of patient family members.
Originality/value
This study contributes to the services literature and addresses a gap in transformative service research by exploring the value co-creation activities of family members for improving well-being outcomes of patients with chronic developmental disorders. People with chronic developmental disorders engage in permanent therapy services and tend to have below-average well-being scores, which also extends to their family members.
... Cognitive behavioral therapy (CBT) based on social skills has already been shown to be an effective treatment for anxiety in individuals with Asperger's Syndrome and there is increasing interest concerning therapies for people with Asperger's who experience difficulties linked to anxiety [14][15][16][17][18][19]. ...
... A certain number of authors have described how BCT approaches can be adapted to the learning and interaction styles of ASD patients [18,[33][34][35], but little focus has been brought to the BCT group dynamic such as the interdependence of personal and environmental influences as defined in the Learning via one's peers section by Grossen [28], regulating systems and any circular interactions. The participants especially appreciated the predictability of the intervention, the structure of the sessions with a daily program. ...
This work presents the results obtained in a therapeutic social skills group of adults living with Asperger's Syndrome (ASD). The treatment consists in a regular participation in specifically designed groups. Patients meeting the criteria for ASD have been selected with no psychiatric comorbidity and were thus able to optimal group interaction. They were suffering significant axiety symptoms supposed to lead to inadequate social skills as well as to result from them. Requisite participation included ten sessions in group discussions of topics propose by the patients themselves. Special attention was accorde to train the patients in detecting possible functional analysis processes leading to increasing anxiety and in training social skills. The paper concentrates in three assessments by the patient themselves of four different scales (anxiety, depression, self esteem and social skills in daily life) allowing to the comparison of baseline level (before session 1) with short term (immediately after the last session) and long term benefits of training (3 months later). These different measures revealed significant long term improvement in the patients.
These results are important because they consist in training the patients in self help. They might also contribute to better understanding of the Asperger syndrom by the scientific community as well as by the patients themselves. Finally, long term treatments such as proposed here are more likely to extend the improvement of the patients' well being to their social environment, family and professional one. It is thus both a clinical and a theoretically relevant research effort.
... Cognitive behavioral therapy (CBT) based on social skills has already been shown to be an effective treatment for anxiety in individuals with Asperger's Syndrome and there is increasing interest concerning therapies for people with Asperger's who experience difficulties linked to anxiety [14][15][16][17][18][19]. ...
... A certain number of authors have described how BCT approaches can be adapted to the learning and interaction styles of ASD patients [18,[33][34][35], but little focus has been brought to the BCT group dynamic such as the interdependence of personal and environmental influences as defined in the Learning via one's peers section by Grossen [28], regulating systems and any circular interactions. The participants especially appreciated the predictability of the intervention, the structure of the sessions with a daily program. ...
... More recently a detailed nomothetic model of vulnerability factors was published to inform cognitive behavioural practice with adults with AS (Gaus, 2011). In terms of treatment outcome there are results showing that a 14-week course of CBT was successful in reducing symptoms of both social anxiety and co-existing depression in a 23-year-old adult with AS (Cardaciotto & Herbert, 2004). Hare (1997) also demonstrated that 15 sessions of CBT led to clinically significant reductions in depression and a considerable although not entire attainment of therapy goals in a 26-year-old man with AS. ...
... This single-case study reports results suggesting the successful use of CBT for social skills deficits and social anxiety disorder in an adult who received a late diagnosis of AS. The successful outcome is in keeping with the extant literature (Cardaciotto & Herbert, 2004;Weiss & Lunsky, 2010). There was a continued improvement in social anxiety from clinically significant levels at the start of therapy to scores well into the normal range at 1-month followup. ...
Autism spectrum disorders (ASD) including high-functioning types such as Asperger's syndrome (AS) are diagnosed when there is evidence of a triad of qualitative impairments in social interaction, communication, and stereotyped/repetitive behaviours. It is not uncommon for these impairments to be accompanied by social anxiety. The present single-case study investigates the use of cognitive behavioural therapy (CBT) to treat a 47-year-old man who was assessed as having difficulties with social skills and social phobia in the context of a late diagnosis of AS. He received 20 h of CBT adapted for his AS in 15 sessions including a 1-month follow-up. Following a highly individualized formulation, treatment included modelling, role-playing, reinforcement, thought challenging, and behavioural experimentation. Results from five self-report measures showed continued improvements from the start of therapy to follow-up in social anxiety, global distress, depression and self-esteem. The client gave positive feedback about his experience of treatment. The case study is discussed with reference to limitations and some reflections for CBT in ASD.
... Studies have utilised non-randomised methods, such as case or single-arm studies (e.g. Cardaciotto and Herbert, 2004;Hare, 1997;Hillier et al., 2011;Weiss and Lunsky, 2010), quasi-experimental methods (e.g. Russell et al., 2008;Turner-Brown et al., 2008), in addition to randomised controlled designs (e.g. ...
... Second, "pre-therapy interventions" are likely to be useful, including psycho-education to enhance emotional literacy (Attwood, 2004), emotion regulation techniques (Weiss, 2014), skills to augment non-verbal and verbal interactions (e.g. Cardaciotto and Herbert, 2004), and anxiety management (e.g. Russell et al., 2013). ...
Purpose
– Empirical research indicates that adults who have autism spectrum disorders (ASD) can derive clinically and statistically meaningful benefits from individual and group-based psychological interventions, specifically those which employ skills-based, behavioural, and cognitive techniques. Given the inherent socio-communication, executive functioning, and theory of mind impairments that individuals with ASD can experience, it is deemed necessary to modify the design and delivery of interventions so as to enhance engagement and outcomes. The paper aims to discuss these issues.
Design/methodology/approach
– This general review provides a summary of the extant literature and clinical guidelines for the provision of psychological interventions for adults with ASD.
Findings
– Adaptations to the structure, process, content, and outcome measurement are outlined. It is likely that optimal treatment gains for adults with ASD are contingent on a prolonged assessment phase, pre-therapy interventions including psycho-education and skills-based interventions, thoughtful regard to the formulation of presenting difficulties, and consideration of, and methods to overcome, the difficulties that may arise when seeking to implement change, identify goals, and manage endings.
Originality/value
– This is one of the first reviews to condense the clinical implications for providing psychological interventions for adults with ASD.
... throughout the day and across environments), and such strategies have been suggested to aid the generalisation of skills (e.g. Cardaciotto and Herbert, 2004;Hare, 2013;Weiss and Autism Lunsky, 2010). PDAs may be more suitable as they remove the social demands of therapeutic work and reduce reliance on memory, which may be problematic given the difficulties with autobiographical memory common among individuals with HFA. ...
... Reaven and Hepburn, 2003;White et al., 2010), and studies involving adults have suggested using others as 'coaches' as potential solutions (e.g. Cardaciotto and Herbert, 2004;Weiss and Lunsky, 2010). The use of the PDA platform aimed to perform a similar function, in that it would act as a prompting system when individuals experienced anxiety. ...
Anxiety and stress are everyday issues for many people with high-functioning autism, and while cognitive-behavioural therapy is the treatment of choice for the management of anxiety, there are challenges in using it with people with high-functioning autism. This study used modified experience sampling techniques to examine everyday anxiety and stress in adults with high-functioning autism and to explore the feasibility of delivering real-time stress management techniques using a mobile platform. High levels of anxiety were found to be characterised by worry, confusing thoughts and being alone but was not associated with internal focus, imagery or rumination. Participants reported improved mood and less worry and anxious thinking in the active phase of the study. These results support previous studies indicating that people with high-functioning autism differ in their experience of anxiety and provided preliminary data on the feasibility of real-time stress management. The limitations of this approach are discussed together with considerations for future work in the area of developing clinical interventions on mobile platforms.
... According to Gaus (2011) , CBT may be a wellsuited intervention for adults with ASD, if the development of coping and social strategies is emphasized during CBT sessions . There is some empirical evidence concerning the efficacy of CBT in adults with ASD; two case studies and one small sample (N=3) study reported positive treatment outcome regarding symptoms of depression and anxiety (Cardaciotto & Herbert, 2004; Hare, 1997; Weiss & Lunsky, 2010). In a more recent study, Russell et al. (2013) studied 46 adults and adolescents with ASD and reported that CBT is an effective treatment method for comorbid obsessivecompulsive disorder in high-functioning younger adults with ASD (mean age, 27.06) and that treatment gains remained stable during a 12-month follow-up. ...
... However, there are some limitations regarding the use of CBT in treatment. It took the subjects a long time to grasp the concept of CBT and to apply the techniques learned to real-life situations (Cardaciotto & Herbert, 2004; Hare, 1997; Weiss & Lunsky, 2010 ). Furthermore , and more importantly, it remains unclear whether the effects of the intervention remain stable over time for other high incidence comorbid disorders in adults with ASD. ...
Individuals with autism spectrum disorders (ASD) have a higher incidence of comorbid disorders in comparison with other patient groups. Empirical evidence on treatments targeting comorbid symptoms is however scarce. Earlier research showed that mindfulness-based therapy for individuals on the autism spectrum (MBT-AS) is effective in reducing symptoms of depression, anxiety, and rumination. In the current study, it was examined whether MBT-AS is effective in alleviating a variety of psychosomatic symptoms and whether these effects were still evident after 9 weeks. Fifty participants took part in a nine-week MBT-AS training. Self-reported symptoms were evaluated at three intervals: (1) before the first session, (2) after the last session, and (3) 9 weeks after the last session. Results showed that symptoms of anxiety, depression, agoraphobia, somatization, inadequacy in thinking and acting, distrust and interpersonal sensitivity, sleeping problems, and general psychological and physical well-being declined significantly during intervention. Positive affect increased, and rumination declined significantly during treatment. Hostility symptoms did not decline significantly during treatment. All symptoms remained stable between post intervention and follow-up. This would seem to indicate that MBT-AS is effective in reducing psychological and physical symptoms and keeping them stable over the longer term. Furthermore, the outcome indicates that rumination is an important mediating factor. In conclusion, MBT-AS appears to be an effective method for reducing a variety of symptoms, and treatment gains remain stable over the longer term.
... Reviews and Meta-analyses indicate that CBT is an effective treatment for mental health symptoms, anxiety disorders (Cardaciotto & Herbert, 2004;Perihan et al., 2020;Solish et al., 2020;White et al., 2010), and depression (Wigham et al., 2017;Beck et al., 1979;Ellis, 1962). CBT also addresses social skills in individuals with ASD because social skills deficits contribute to anxiety, which intensifies social problems (White et al., 2010). ...
This meta-analysis examines the efficacy of the cognitive behavioral approach to interventions toward the improvement of executive function for children/adolescents with high-functioning autism spectrum disorder (HF-ASD). This meta-analysis paper has identified ten studies involving 437 participants with high-functioning autism spectrum disorder aged between 5 and 18. All the participants reported IQs were at or above 70. A random effect meta-analysis yielded a moderately significant effect (Hedge g = 0.72) with significant heterogeneity [Q(10) = 228.36, p < .001]. There were considerable variations in the executive function domain, i.e., working memory (hedge g = 1.23) and inhibition (g = 0.47), showing significant treatment effects. On the other hand, cognitive flexibility (g = -0.51) and planning (g = -0.07) show non-significant effects toward cognitive behavioral interventions. The finding suggests that the cognitive behavioral approach to intervention demonstrates efficacy in improving executive function in children or adolescents with high-functioning autism spectrum disorder. All the cognitive behavioral intervention studies were conducted in developed countries, so differences between the approaches between developed and developing countries were inconclusive. Future studies are needed to investigate the effectiveness of cognitive behavioral techniques in intervention for low-functioning autism spectrum disorder children.
... Gutstein & Whitney 11 propõem que as habilidades sociais sejam ensinadas em contextos que tenham significado para o indivíduo e que a motivação seja fomentada ativamente usando estratégias da TCC, tais como experimentos comportamentais, uso de reforços positivos e reestruturação cognitiva de experiências de reciprocidade social. Alguns autores sugerem ainda que programas de THS realizados por tempo prolongado (anos) tendem a ter melhores resultados, devido à repetição e prática exaustivas, e, consequentemente, têm maior chance de promover generalização 24,29 . ...
A síndrome de Asperger é um transtorno do espectro autista que cursa com comprometimento da socialização, da comunicação verbal e não verbal e da flexibilidade cognitiva e comportamental. A abordagem dessas características pelo treinamento de habilidades sociais (THS), baseado na terapia cognitivocomportamental (TCC), visa melhorar a qualidade de vida e reduzir alguns sintomas psiquiátricos nesses pacientes. Entre as dificuldades abordadas estão: 1) a compreensão social; 2) as regras de interação social e as expectativas interpessoais; 3) a conversa recíproca; 4) o uso e a interpretação das condutas não verbais; 5) o autocontrole; 6) os comportamentos estereotipados e os interesses obsessivos; e 7) a formação de amizades. O presente artigo é uma revisão crítica do tema.
... Συχνό είναι επίσης το φαινόμενο, τα άτομα με ΥΛΑ να παρουσιάζουν κοινωνική διαταραχή άγχους (SAD) ή κοινωνιοφοβία, δηλαδή αποφυγή δραστηριοτήτων που αφορούν σε κοινωνική αλληλεπίδραση όπως έξοδος για φαγητό, είσοδος σε δημόσιο χώρο, ραντεβού αλλά και εργασία. Οι ψυχολόγοι υποστηρίζουν ότι η κοινωνιοφοβία είναι άρρηκτα συνδεδεμένη με τη χαμηλή αυτοεκτίμηση και συχνά με τη μακροχρόνια παραμονή ενός ατόμου σε παρατεταμένο συναισθηματικό άγχος (Candatiotto & Herbert, 2004). ...
Για τα άτομα με ΥΛΑ η καθημερινότητα αποτελεί μία διαρκή πρόκληση, καθώς πέρα από τη συνεχή αισθητηριακή υπερδιέγερση που αντιμετωπίζουν, παρουσιάζουν ελλείμματα στις κοινωνικές δεξιότητες, στη συγκέντρωση, στην ικανότητα να ερμηνεύουν, να κατανοούν και να προβλέπουν συμπεριφορές. Το παρόν άρθρο παρουσιάζει τις συνέπειες των παραπάνω δυσλειτουργιών στην αίσθηση αυτοαποτελεσματικότητας, στην αυτοαντίληψη και την αυτοεκτίμηση ιδιαίτερα των νεαρών ατόμων με ΥΛΑ, καθώς και τις αντίστοιχες συνέπειες αυτών στην αντιμετώπιση της ανεργίας και στη λήψη επαγγελματικής απόφασης, ενώ ιδιαίτερη έμφαση αποδίδεται στο ρόλο της συμβουλευτικής ως προς την ενίσχυση των παραπάνω χαρακτηριστικών και στα χαρακτηριστικά ενός αποτελεσματικού συμβούλου που συνεργάζεται με άτομα με ΥΛΑ, στοιχείο που έχει περιορισμένα διερευνηθεί στην τρέχουσα βιβλιογραφία
... To the best of our knowledge, two randomized controlled trials (RCTs) treat anxiety in individuals with HFA and show some efficacy for children with HFA and anxiety compared to a control group [18,19]. Although the case studies suggest that cognitive-behavioral therapy (CBT) may also be effective within individuals with HFA and secondary internalizing symptoms [20,21], only few studies support this supposition. Furthermore, the symptoms and characteristics often associated with HFA would likely complicate the implementation of CBT procedures; for example, HFA individuals often suffer from a reduced ability to recognize thoughts and feelings both in themselves and in others (ToM) [22]. ...
Background: Autism spectrum disorder (ASD) is a chronic and persistent pervasive developmental disorder (PDD) whose characteristic deficit is represented by social difficulties, semantic–pragmatic alterations and a limited, unusual and repetitive pattern of interests and behaviors. Specifically, individuals with high-functioning autism (HFA) frequently exhibit associated internalizing symptoms that are not part of the diagnostic criteria but which, nonetheless, tend to impair daily functioning. In this study, we investigated how some forms of treatment could be useful in subjects with HFA who display internalizing symptoms. Theoretical background relates to standard cognitive therapy (SCT) and rational education training with mindfulness (M-ERE). Methods: In this study, we investigated how some forms of treatment could be useful in subjects with HFA and internalizing symptoms, focusing on standard cognitive therapy (SCT) and mindfulness associated with emotional rational education training (M-ERE). We selected two groups of HFA patients with significant internalizing symptoms and performed two different forms of treatment for six months: SCT and M-ERE. The aim of the study was to verify the effectiveness of an M-ERE protocol with respect to anxious and depressive symptoms in subjects with HFA. Furthermore, we wanted to compare the results obtained with this combined treatment with those obtained in HFA subjects treated with SCT. Results: Our analyses showed an improvement in the internalizing symptoms (especially those related to the anxiety dimension) of the group that followed a treatment based on mindfulness and rational emotional education for 6 months compared to the group that had instead performed a 6-month treatment based on the SCT. Conclusions: Our hypotheses were supported by the results, which highlighted the efficacy of mindfulness-based interventions in the treatment of internalizing symptoms in adolescents with HFA, and specifically showed that an M-ERE intervention appears more effective in managing anxiety compared to treatment with SCT and appears to be equally effective in the management of depressive symptoms. Not only was the M-ERE treatment effective for the management of anxious and depressive symptoms in subjects with HFA, but the efficacy for the management of anxious symptoms was greater than the SCT treatment.
... One implication is that students with a high number of autistic traits are prone to enduring stress, experiencing reduced performance, and even prematurely leaving education, just because studying at university requires frequent social contact and interaction (2). Therefore, treatment for social anxiety for autistic people [(e.g., (17)] and systematic support at universities (16) could be useful for people with many autistic traits, regardless of a formal autism diagnosis. Notably, only a portion of the people who are high in autistic traits and seek a diagnostic assessment of autism eventually qualify for an autism diagnosis (18). ...
Social anxiety (alternatively: social-contact uncertainty) in the university context can lead to reduced health, well-being, and performance, and can even cause premature leaving of education. With the present study, we intended to supplement cross-sectional studies on students' autistic traits and social anxiety with longitudinal findings. We measured autistic traits and social-contact uncertainty of 118 university students on two occasions, roughly 1 year apart. Correlation, multiple regression, and cross-lagged analyses showed that more pronounced autistic traits predicted higher future social-contact uncertainty. Social-contact uncertainty did not predict autistic traits. We conclude that university students who are high in autistic traits tend not only to be more socially anxious at the moment but have a heightened risk of still being so in the future.
... Alongside these "functional" modes of treatment, it is broadly recognized that the emotional aspects of the autistic condition call for psychotherapy, and various modes of "emotional" therapy focus on the inner reality of the child, the development of the self, the child's attempts to express him/herself, his/her anxieties, inhibitions, defenses, and the way in which she/he perceives and experiences the world. Most of the research on ASD relates to psychotherapies, such as personal construct theories, family-focused therapy, and cognitive behavioral therapy (CBT; Hare, 1997;Cardaciotto and Herbert, 2004;Wood et al., 2015;Murphy et al., 2017;Storch et al., 2020). CBT takes center stage in research with ASD and numerous randomized controlled trials (RCTs) have shown that it is effective for treating anxiety disorders in adults, adolescents, and in children diagnosed with ASD (Sukhodolsky et al., 2013;Hesselmark et al., 2014;Vasa et al., 2014;Spain et al., 2015;Wood et al., 2015). ...
Autism spectrum disorder (ASD) is a neuro-developmental condition, which requires a multi-disciplinary matrix of treatments, including functional, educational, and emotional interventions. The latter mode of treatment entails particular difficulties, inasmuch as the core deficits of this condition seem to challenge the very premises of traditional psychotherapy. Reciprocity, verbal, and symbolic expression and inter-subjective dynamics are often difficult to attain with clients diagnosed with ASD, and emotional treatment thus often turns out to be a frustrating process, which may well elicit questions as to the efficacy of psychotherapeutic emotional interventions. These core challenges, described in the literature, become particularly acute in view of the increasing number of clients diagnosed on the autistic spectrum in recent years, and the growing need for qualified therapists who have trained for working specifically with this condition. It seems, therefore, that it is high time for systematic research into the lived experience of therapists working with these clients in order to attain a better clinical and theoretical understanding of the condition itself and broaden the range of effective interventions. This study, informed by a phenomenological-hermeneutic approach which guided both the collection of data and its subsequent analysis, aims to address these issues by exploring the particular challenges faced by therapists in this field, the questions that come up in the process, modes of personal and professional coping, and the insights elicited by the therapeutic encounter. The research consisted of in-depth interviews with 28 practicing therapists from a broad range of clinical orientations, including dance/movement, arts, music, and drama therapists, clinical psychologists, and clinical social workers. The essential themes that emerged from the participants’ responses and the analysis of the findings lend support to theoretical and developmental approaches, which focus on the primacy and the foundational role of the concrete body in inter-subjective relationships and in the therapeutic process, and indicate the potential efficacy of somatic and kinetic interventions. The clinical implications of this study are thus highly relevant to the training and support of therapists working with ASD, who should be encouraged to develop greater receptivity to non-verbal modes of interaction in the therapeutic process.
... The majority of published research on the development of psychotherapies for anxiety in autism has focussed upon children and adolescents [28]. Some studies with adults have focussed on a range of intervention approaches, methods and measures of therapeutic change in a small number of single case reports [29][30][31]. One single-blind randomised trial of group CBT for autistic adults, found no difference in anxiety at follow-up between those allocated to treatment or a waiting-list control [32]. ...
Background:
Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment-Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults.
Methods/design:
This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important 'target situations' that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psycho-educational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods.
Discussion:
This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people.
Trial registration:
ISRCTN, ID: 15881562. Retrospectively registered on 9 August 2019.
... The evidence is encouraging. Case study and case series data suggest that CBT is an effective treatment for mental health symptoms, including low mood and self-harm (Hare 1997), anxiety disorders (Cardaciotto and Herbert 2004) and obsessive compulsive disorder (OCD; Reaven and Hepburn 2003). Results from randomised controlled trials (RCTs) suggest that CBT for anxiety and OCD can be more effective than treatment as usual and wait list controls and comparable to comparators (e.g. ...
Children and adults with autism spectrum disorders (ASD) can benefit from cognitive behaviour therapy (CBT), yet the prevailing opinion is that this requires adaptations to accommodate commonly experienced socio-communication and neuropsychological impairments. There are, however, no empirically-derived guidelines about how best to adapt standard practice. In a three round Delphi survey, we asked expert clinicians and clinical-researchers, based in England, about how to optimise the design, delivery and evaluation of CBT for people with ASD. Of 50 people approached, 18 consented to take part in Round 1, nine in Round 2 and eight in Round 3. Using a five-point scale, participants rated the degree to which 221 statements—pertaining to the referral process, assessment, engagement, formulation, goal setting, therapy structure, interventions and techniques, homework, outcome measurement, managing endings and therapist attributes—were integral to CBT. The consensus was that 155 statements represented essential or important components of CBT. Adaptations to the structure and process of therapy were consistently endorsed, and an individualised formulation-derived approach was favoured when deciding upon which interventions and techniques to offer. Further studies are needed to clarify if adapted CBT is associated with improved treatment outcomes and acceptability.
... Our measure of mindfulness comprised five factors (Baer et al. 2006). Debate continues, however, concerning the structure of mindfulness as comprising just one component (attention/awareness, e.g., Brown and Ryan 2003), two components (attention/awareness and acceptance, e.g., Cardaciotto and Herbert 2005), or multiple components (Medvedev et al. 2016;Qu et al. 2015). Results from the second canonical correlation function, reflecting a decentered form of mindfulness, would not have emerged had mindfulness been operationalized as either unidimensional or bidimensional. ...
Objectives
Despite mindfulness being defined as a present-focused awareness of one’s moment-to-moment experiences, there has been little research investigating its relation to temporal perspective in terms of individual’s thoughts and feelings concerning their past, present, and future lives.
Methods
The current study employed an online sample of 305 American adults (M age = 30.61, SD = 3.42; 55% female) to examine a five-factor model of mindfulness in relation to multiple components of temporal perspective: evaluation, focus, distance, overlap, and value of one’s recollected past, present, and anticipated future lives.
Results
Mindfulness factors were associated with aspects of temporal perspective encompassing all three temporal periods—including greater focus on the present, more positive evaluations of the present and future, and greater valuing of the present. Furthermore, a canonical correlation analysis (Wilk’s λ = 0.39, p < 0.001) identified two unique combinations of mindfulness, each linked with different aspects of temporal perspective (rs = 0.63 and 0.43; ps < 0.05). First, a mixture of greater awareness, nonjudgment, and describing was linked with greater focus on one’s present life and more positive evaluations of one’s past, present, and future lives. Second, a combination of greater nonreacting, observing, and describing was linked with greater focus on one’s past, present, and future lives.
Conclusions
Findings suggest that there is much to be gained by investigating mindfulness using a temporally expanded approach. Mindfulness is more than just a present-oriented construct but rather is linked in various ways with how individuals view their past, present, and future lives.
... To the best of our knowledge, no effects of reduction in depression and anxiety are described as a result of psychotropic medication in a large sample size of adults with ASD, without intellectual disability. Considering the non-psychopharmacological treatments, positive effects are found in cognitive behavioural therapy (CBT) and mindfulness based stress reduction (MBSR) [13][14][15][16][17]. And while there is some evidence for longterm results, empirical evidence is limited by the small number of subjects involved in these studies [18,19]. ...
... Over the last decade, there have been a growing number of studies supporting the efficacy of CBT for treating anxiety in children with ASD (Chalfant et al. 2007;Freitag et al. 2016;Keehn et al. 2013;Lerner et al. 2012;Reaven et al. 2012;Sofronoff et al. 2005;Storch et al. 2013;Weston et al. 2016;Wood et al. 2009;White et al. 2013). However, CBT anxiety treatment studies on adults with ASD are limited to one case study (Cardaciotto and Herbert 2004;Weiss and Lunsky 2010) and three trials utilizing a group therapy modality (Russell et al. 2013;Hesselmark et al. 2014;Weiss and Lunsky 2010). Emerging research suggests that parent involvement may serve as an active ingredient in CBT treatment of anxiety for children with ASD, as it provides parents support and training in how to facilitate skill-building in their children outside of therapy sessions (Puleo and Kendall 2011;Sofronoff et al. 2005;Lang et al. 2010). ...
The purpose of this pilot randomized controlled trial was to investigate the acceptability and efficacy of the Acquiring Career, Coping, Executive control, Social Skills (ACCESS) Program, a group intervention tailored for young adults with autism spectrum disorder (ASD) to enhance critical skills and beliefs that promote adult functioning, including social and adaptive skills, self-determination skills, and coping self-efficacy. Forty-four adults with ASD (ages 18–38; 13 females) and their caregivers were randomly assigned to treatment or waitlist control. Compared to controls, adults in treatment significantly improved in adaptive and self-determination skills, per caregiver report, and self-reported greater belief in their ability to access social support to cope with stressors. Results provide evidence for the acceptability and efficacy of the ACCESS Program.
... For example, case studies (Cardaciotto & Herbert, 2004;Hare, 1997) and studies examining group CBT for individuals with high-functioning ASD (Weiss & Lunsky, 2010;Eack et al., 2013;Pugliese & White, 2014) have demonstrated the feasibility and acceptability of group CBT as a treatment method. Despite these positive findings from single-group studies, the relatively small numbers of participants and lack of randomly assigned comparison groups limit the generalizability of the findings, and the observed improvements could be attributable to participant characteristics. ...
Autism spectrum disorder (ASD) is characterized by social impairment and circumscribed and repetitive behavior and interests. This study aimed to examine the effectiveness of group therapy, which was designed to enhance university-related behavior, in Japanese university students with high-functioning ASD, based on their specific social, communication and emotional needs. The participants included 11 students with ASD aged between 19 and 24 (mean 21.0) years. A single-group, pre-post-intervention design was implemented in the study. The Clinical global Impressions-Severity scale, Beck Depression Inventory, State Trait Anxiety Inventory, and Rosenberg Self-Esteem Inventory Scale were completed before and after group therapy. The results showed significant post intervention improvements in depressive symptom, anxiety, and self-esteem, indicating that the group therapy was effective for students with ASD.
... It has been shown that people with ASD report negative cognitions that are related to their anxiety symptomatology (Ozsivadjian, Hibberd, & Hollocks, 2014). Parents report that CBT has a positive effect on anxiety symptoms in children with ASD (Danial and Wood, 2013;Wood, Drahota, & Sze, 2009;Wood, Fujii, & Renno, 2011), but there are also indications that this applies to anxiety and depression in adults with ASD (Cardaciotto and Herbert, 2004;Weiss and Lunsky, 2010). It was found that CBT had a positive effect on depressive symptoms, but not on anxiety (McGillivray and Evert, 2014). ...
Anxiety and depression co-occur in 50–70% of adults with autism spectrum disorder (ASD) but treatment methods for these comorbid problems have not been systematically studied. Recently, two ASD-tailored protocols were published: mindfulness based stress reduction (MBSR) and cognitive behavioural therapy (CBT). We wanted to investigate if both methods are equally effective in reducing anxiety and depression symptoms among adults with ASD. 59 adults with ASD and anxiety or depression scores above 7 on the Hospital Anxiety and Depression Scale, gave informed consent to participate; 27 followed the CBT protocol, and 32 the MBSR treatment protocol. Anxiety and depression scores, autism symptoms, rumination, and global mood were registered at the start, at the end of the 13-week treatment period, and at 3-months follow-up. Irrational beliefs and mindful attention awareness were used as process measures during treatment and at follow-up. Results indicate that both MBSR and CBT are associated with a reduction in anxiety and depressive symptoms among adults with ASD, with a sustained effect at follow-up, but without a main effect for treatment group. A similar pattern was seen for the reduction of autistic symptoms, rumination and the improvement in global mood. There are some indications that MBSR may be preferred over CBT with respect to the treatment effect on anxiety when the scores on measures of irrational beliefs or positive global mood at baseline are high. Mindfulness and cognitive behavioral therapies are both promising treatment methods for reducing comorbid anxiety and depression in adults with ASD.
... Bellini 2006;Maddox & White 2015). Finally, whether interventions such as cognitive behaviour therapy (CBT), the recommended treatment of choice for SA in TD samples (NICE 2013), are clinically useful for individuals with ASD (with or without a concurrent ID) has seldom been studied (Cardaciotto & Herbert 2004;Wright 2013). ...
Background:
Individuals who have autism spectrum disorders (ASD) commonly experience social anxiety (SA). Disentangling SA symptoms from core ASD characteristics is complex, partly due to diagnostic overshadowing and co-occurring alexithymia. Causal and maintaining mechanisms for SA in ASD are underexplored, but it is feasible that there is an ASD specificity to the clinical presentation, with implications for the development of targeted treatments.
Methods:
Five focus groups were conducted with multidisciplinary professionals to investigate their perspectives about, and approaches to, working with individuals with ASD and SA. Data were analysed thematically.
Results:
Data analysis revealed two overarching themes: conceptualizing SA in ASD and service provision. Our results suggest that adaptations to service provision are pertinent, so as to accommodate inherent impairments that can mediate assessment and intervention.
Conclusions:
Future studies should establish how aspects of the care pathway can be improved for individuals with ASD and SA.
... CBT has been studied in individuals with ASD and has been found to present some challenges and limitations . For example, previous researchers have observed that a core component skill of CBT, cognitive restructuring, is often particularly diffi cult for individuals on the spectrum (Cardaciotto & Herbert, 2004 ;Spek, van Ham, & Nyklíček, 2013 ). It has also been observed that gains achieved for individuals on the spectrum while in treatment for CBT may not persist, which is hypothesized to result from diffi culty generalizing skills to other situations (Spek et al., 2013 ). ...
Depression is prevalent among persons within the autism spectrum. Individuals with Asperger’s syndrome, high-functioning autism, adolescents, and adults are particularly at risk. This chapter will review methods and procedure used to identify depression among persons with autism.
... To date, most adult treatment studies of CBT in ASD have been confined to single case reports-for example, its effectiveness for depression [16] and social anxiety disorder. [17] More recently, we reported [18] preliminary evidence from an uncontrolled pilot study of CBT for OCD in 24 adults with ASD and comorbid OCD: we found that of the 12 adults who received CBT for OCD, 7 (58%) showed a good treatment response in comparison to 2 (16%) in the treatment as usual (TAU) group with a standardized effect size (Cohen's d) for CBT of 1.01. This is reasonably consistent with published treatment response rates for behavior therapy (59%) and CBT (67%) in adults with OCD without ASD. ...
Background: Anxiety disorders, particularly Obsessive Compulsive Disorder (OCD), are commonly reported in young people and adults with Autism Spectrum Disorders (ASD). Psychological treatment has been shown to be effective in treating OCD in the general population but little is known about its effectiveness for people with ASD. A pilot study of Cognitive Behaviour Therapy (CBT) for OCD adapted for adults with ASD showed promising results and suggested that a randomised controlled trial of this intervention was merited.
Objectives: To conduct a systematic treatment study of CBT for OCD in young people and adults with ASD.
Methods: Participants were young people (age 14 and older) and adults with ASD and co-morbid OCD who were randomly allocated to 1 of 2 treatments (1)Manualised CBT for OCD adapted for people with ASD (CBT) and (2) Anxiety Management (AM). Treatments were matched with respect to therapist contact and duration. The primary outcome measure was the total severity rating on the Yale Brown Obsessive Compulsive Scale (Y-BOCS) which was clinician administered blind to treatment group. Informant and self-report symptom measures were also obtained. Follow-up ratings were made at 1, 3, 6 and 12 month post treatment.
Results: 46 people were randomised to treatment with 20 treatment completers in each group. There was a significant effect of treatment on the primary outcome measure but not of treatment group. Treatment effect sizes on the primary outcome measures were large and could be considered clinically meaningful in the CBT group (.88-1.15) and medium in the AM group (0.6). Forty five % of the CBT group were classed as treatment responders compared with 20% in the AM group. Those with mild symptom severity responded well to AM. Almost 40% of people in the AM group opted to try the experimental treatment at 1 month follow-up which differed significantly from the proportion of people in the CBT group choosing to try the other treatment. Secondary analyses indicate that AM might augment the effects of later CBT. None of the variables predicted to be moderating factors (Theory of mind, Verbal and planning abilities and scores on the Autism Diagnostic Observation Schedule) were associated with treatment outcome.
Conclusions: Psychological treatment in the form of cognitive and behavioural therapies are effective in treating co-morbid OCD in people with ASD. Further investigations should seek to refine treatment protocols to consider the precise adaptations to conventional psychological treatment which are most effective for this group.
Given the high co-occurrence of social anxiety in autism, no reviews to date have explored how cognitive and behavioural mechanisms identified to maintain social anxiety in non-autistic individuals may operate in autistic individuals. This systematic review evaluated: (1) empirical evidence underlying the Clark and Wells (1995) Cognitive Model of Social Anxiety in autistic individuals; (2) how vulnerability factors identified from autism literature (beyond core autistic traits) may be associated with social anxiety beyond the cognitive model. Published peer-reviewed English articles until 27th November 2023 were retrieved from PubMed, EMBASE, Ovid MEDLINE and PsycINFO. Quality appraisal and risk of bias were assessed using The Standard Quality Assessment Criteria for Evaluating Primary Research papers from a Variety of Fields tool. 47 articles met full inclusion criteria and included autistic individuals (with clinical diagnosis), a measure of social anxiety, and a mechanism outlined by either (or both) research questions. The majority of the 3340 participants across studies were male without intellectual disability, White/Caucasian, with 7 studies reporting an average age above 30 years old. Most studies used only self-report measures that may have inflated associations observed between social anxiety and mechanisms. All studies employed cross-sectional design, and no causality inferences could be drawn. Methodological issues around potential construct overlaps between social anxiety and autistic traits are highlighted. Overall, there is evidence in support of the as reported by Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model, as greater fear of negative evaluation from others, use of safety behaviours and somatic symptoms, and peer victimisation were associated with greater social anxiety. The review contributes evidence in support of autism specific contextual, predisposing/antecedent and maintenance factors of social anxiety beyond the original Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model. Given the potential for considerable heterogeneity for each highlighted process at an individual level across autistic individuals, clinicians can broaden formulation conversations with autistic clients to understand how autism related factors may influence the development and maintenance of social anxiety symptoms when applying and adapting the Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model.
Up to half of individuals diagnosed with autism are expected to develop a depression. It is assumed that inner neurological and cognitive disorders are specifically related to autism in general, and that individuals with autism have special problems with regard to living a good enough life. Therefore, this complex situation is about having problems with comprehending life in a sufficiently reality-oriented way and about being able to manage life and its challenges in a meaningful way, attuned to the basic demands and structures of living a life as such. On this background, we present an outline of an integrative intervention model drawing on cognitive behavioral therapy (CBT) and interventions directed at managing both everyday life and major choices in life, namely Life Psychological Intervention (LPI).
Background
Social anxiety is prevalent in idiopathic Parkinson’s disease but why this is, is not yet well understood. Social cognitions, safety-seeking behaviours and internally focused attention are all known to predict social anxiety in the general population. These associated factors have not yet been explored in idiopathic Parkinson’s disease, where disease severity and motor symptoms might also influence the experience of social anxiety.
Aims
This study aimed to explore the relationship between cognitive behavioural factors and social anxiety in Parkinson’s disease.
Method
Using a cross-sectional design, 124 people with Parkinson’s disease completed self-report questionnaires including measures of Parkinson’s disease severity, social anxiety, negative social cognitions, safety-seeking behaviours, internally focused attention, anxiety and depression.
Results
The final regression model accounted for 71.6% of variance in social anxiety. Cognitive behavioural variables accounted for the largest magnitude of unique variance (43.5%). Sex, anxiety and depression accounted for 23.4%, and Parkinson non-motor symptom severity for 4.7%. Negative social cognitions and safety-seeking behaviours were statistically significant predictors, while an internal focus of attention was not.
Conclusions
Social anxiety in Parkinson’s disease is associated with negative social cognitions and safety-seeking behaviours. Findings indicate the need for further research into cognitive behavioural approaches to social anxiety in Parkinson’s disease.
Autism spectrum disorder is characterized by social and behavioral challenges, incresing the risk of stress and psychiatric comorbity. In this open trial pilot study, the feasibility and preliminary outcomes of a 12-week acceptance and commitment therapy-based skills training group were evaluated in a psychiatric outpatient context. A total of 10 intellectually able adults (5 men; 5 women; 25-65 years) with autism spectrum disorder were assessed using self-ratings at pre- and post-assessment and 3-month follow-up. Nine participants completed the skills training, and treatment satisfaction and credibility was high. Levels of stress, depression and social disability were significantly reduced, while quality of life, cognitive defusion and psychological flexibility significantly increased. Larger and more controlled studies are needed to further evaluate the benefits of acceptance and commitment therapy for autistic adults.
Background
Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) frequently persist into adolescence and young adulthood. However, there are few clinical services that support those with these disorders through adulthood.
Objective
Our aim was to determine if clinical services meet the needs of people with ASD and ADHD, who are ‘at transition’ from childhood to adulthood.
Design
A longitudinal study of individuals with ASD and ADHD, the impact of services and treatments.
Methods
Our research methods included (1) interviewing > 180 affected individuals (and their families) with a confirmed diagnosis of ASD and/or ADHD, (2) screening for ASD and ADHD in approximately 1600 patients and (3) surveying general practitioner prescribing to 5651 ASD individuals across the UK. In addition, we tested the effectiveness of (1) new ASD diagnostic interview measures in 169 twins, 145 familes and 150 non-twins, (2) a magnetic resonance imaging-based diagnostic aid in 40 ASD individuals, (3) psychological treatments in 46 ASD individuals and (4) the feasability of e-learning in 28 clinicians.
Setting
NHS clinical services and prisons.
Participants
Focus – young people with ASD and ADHD as they ‘transition’ from childhood and adolescence into early adulthood.
Interventions
Testing the utility of diagnostic measures and services, web-based learning interventions, pharmacological prescribing and cognitive–behavioural treatments.
Main outcome measures
Symptom severity, service provision and met/unmet need.
Results
People with ASD and ADHD have very significant unmet needs as they transition through adolescence and young adulthood. A major contributor to this is the presence of associated mental health symptoms. However, these are mostly undiagnosed (and untreated) by clinical services. Furthermore, the largest determinant of service provision was age and not severity of symptoms. We provide new tools to help diagnose both the core disorders and their associated symptoms. We also provide proof of concept for the effectiveness of simple psychological interventions to treat obsessional symptoms, the potential to run treatment trials in prisons and training interventions.
Limitations
Our findings only apply to clinical service settings.
Conclusions
As individuals ‘transition’ their contact with treatment and support services reduces significantly. Needs-led services are required, which can both identify individuals with the ‘core symptoms’ of ASD and ADHD and treat their residual symptoms and associated conditions.
Future work
To test our new diagnostic measures and treatment approaches in larger controlled trials.
Trial registration
Current Controlled Trials ISRCTN87114880.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
Internalizing disorders are common in individuals with ASD. Psychosocial interventions targeting these disorders in the ASD population have burgeoned in the last decade. Cognitive-behavioural therapy, modified for ASD, is the most frequently investigated model, although other interventions, including behaviour therapy, third-wave interventions, models targeting transdiagnostic constructs, and alternative interventions and treatment delivery methods are now emerging. This review provides a summary of the efficacy of these interventions in treating internalizing disorders in youth and adults with ASD. The barriers to accessing these treatments, which are experienced by many individuals with ASD and their families, as well as future research directions, are also discussed.
Lay summary:
Depression is the most common mental health problem experienced by adults with autism. However, the current study found very limited evidence regarding how useful tools developed for the general population are for adults with autism. We therefore suggest how these tools could be adapted to more effectively assess depression in adults with autism, and improve these individuals access to mental health assessment and support.
Lay summary:
This study aimed to discover how individuals with autism spectrum disorders (ASD) fare in psychotherapy within a university counseling setting, compared to their neurotypical peers. Clients with ASD showed no difference in level of distress at intake compared to their neurotypical peers, and improved about the same amount from pre- to post-treatment. However, students with ASD stayed in treatment for significantly more sessions than neurotypical clients, and took significantly longer to achieve maximum improvement on Outcome Questionnaire-45 reports.
Autism Spectrum Disorders (ASD) encompasses a wide variety of behavior. While the descriptions of students across the spectrum can differ, it is most often students with mild or moderate ASD who are included in general education classrooms. It is also these same students who are more likely to benefit from CBT interventions. Thus, the majority of ASD-specific issues discussed in the text will highlight concerns more common to this higher functioning population.
Purpose
Individuals who have autism spectrum disorders (ASD) commonly experience anxiety about social interaction and social situations. Cognitive behaviour therapy (CBT) is a recommended treatment for social anxiety (SA) in the non-ASD population. Therapy typically comprises cognitive interventions, imagery-based work and for some individuals, behavioural interventions. Whether these are useful for the ASD population is unclear. Therefore, the purpose of this paper is to undertake a systematic review to summarise research about CBT for SA in ASD.
Design/methodology/approach
Using a priori criteria, the authors searched for English-language peer-reviewed empirical studies in five databases. The search yielded 1,364 results. Titles, abstracts, and relevant publications were independently screened by two reviewers.
Findings
Four single case studies met the review inclusion criteria; data were synthesised narratively. Participants (three adults and one child) were diagnosed with ASD and SA. There were commonalities in interventions and techniques used: participants were encouraged to identify and challenge negative thoughts, enter anxiety-provoking social situations, and develop new ways of coping. Unlike CBT for SA in non-ASD individuals, treatment also included social skills interventions. Outcomes were assessed using self- or informant-reports. Improvements in SA, depressive symptoms, social skills, and activity levels were noted. Generalisability of results is hampered, however, by the small number of studies and participants and lack of randomised controlled trial conditions employed.
Research limitations/implications
Future studies should investigate how beliefs and behaviours indicative of SA can be ameliorated in individuals with ASD.
Originality/value
This is the first review to synthesise empirical data about CBT for SA in ASD.
Cognitive-behavioral approaches have been successfully modified to treat anxiety in cognitively able children and early adolescents on the autism spectrum; however, very few studies have examined modified programs for anxiety and depression in older adolescents and young adults. This key developmental period of emerging adulthood may be a particularly challenging time for individuals on the spectrum due to a number of factors, including the development of psychiatric disorders. Anxiety disorders and depression, which often co-occur with ASD, can impede coping and resilience and thus may be particularly important targets for intervention. Given the limited research on CBT for emerging adults on the autism spectrum, the present article is largely conceptual in nature. We provide an overview of the factors contributing to vulnerability during the transition to adulthood and the limited research regarding the prevalence and psychosocial treatment of anxiety and depression in adults with ASD. Drawing from clinical experience and the literature, we then highlight the unique challenges of adapting CBT for cognitively able emerging adults on the autism spectrum relative to children and adolescents. Potential modifications are offered, but further research will be needed to establish an empirically supported approach.
Studies published so far have highlighted high rates of association between autism spectrum disorder (ASD) and mood disorders. Data have shown that prevalence rates of co-occurring ASD and mood disorders range from 1.4 % to 70 %.
A factor that seems to account this variability is the cognitive ability: high-functioning autism individuals seem more likely to develop mood symptoms. In clinical practice the diagnostic process for mood symptoms in ASD is particularly challenging because autistic symptoms can cover comorbid symptoms, and proper screening tools specifically designed for this population are needed. Indeed, studies on the neurobiological bases of these conditions suggest a genetic overlap between ASD and mood disorders, but the available findings are still unclear.
The present chapter will describe the prevalence, the phenomenology and clinical features, the diagnostic process, neurobiological and genetic bases, and treatment of mood disorders in ASD.
Applegate SL, Rice MS, Stein F, Maitra KK. Knowledge of results and learning to tell the time in an adult male with an intellectual disability: A single-subject research design. Occupational Therapy International. 2008; 15(1): 32–44. The authors examined whether knowledge of results, in the form of visual and audible feedback, would increase the accuracy
of time-telling in an individual with an intellectual disability. MEDLINE [1]Aust TR, Brookes S, Troup SA, Fraser WD, Lewis-Jones DI. Development and in vitro testing of a new method of urine preparation for retrograde ejaculation: The Liverpool solution. Fertility & Sterility. 2008; 89(4): 885–891. The investigators tested the effectiveness of a new method for oral preparation of urine for sperm retrieval after retrograde ejaculation. MEDLINE
Background
There is a growing interest in using cognitive–behavioural therapy (CBT) with people who have Asperger syndrome and comorbid mental health problems.
Aims
To examine whether modified group CBT for clinically significant anxiety in an Asperger syndrome population is feasible and likely to be efficacious.
Method
Using a randomised assessor-blind trial, 52 individuals with Asperger syndrome were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to treatment were followed up for 24 weeks.
Results
The conversion rate for this trial was high (1.6:1), while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared with those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety.
Conclusions
Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed.
Declaration of interest
None.
Copyright and usage
© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
People with autism spectrum disorder (ASD), can have difficulties in emotion processing, including recognising their own and others' emotions, leading to problems in emotion regulation and interpersonal relating. This study reports the development and piloting of the Client Emotional Processing Scale-Autism Spectrum (CEPS-AS), a new observer measure of four interrelated aspects of emotional processing: emotion recognition, self-reflection, cognitive empathy, and affective empathy. Results showed good interrater reliability (alpha: .69-.91), while inter-dimension associations were high (r = .66-.82). The measure was able to detect significant differences on the four dimensions across a short-term humanistic-experiential group therapy. The CEPS-AS shows promise as a potential addition to current self-report instruments measuring empathy or emotion processes in individuals with ASD.
This article provides an update on cognitive behavioural therapy (CBT) and Asperger's syndrome (AS), focusing on thinking styles that have not previously been addressed. More comprehensive guidance is included for practitioners working with adults with AS, with modifications to CBT.
Asperger syndrome is one of the pervasive developmental disorders, diagnosed behaviorally and characterized by social impairments and rigid and repetitive interests or behaviors paired with relatively preserved cognitive and verbal facilities. This chapter describes the diagnostic concept and the clinical manifestation of the disorder, as well as guidelines for diagnostic assessment and intervention. Existing research is reviewed within the areas of epidemiology, etiology and pathophysiology, treatment and intervention, and outcome. In closing, future directions for treatment and research are discussed.
Purpose
– Adults who have autism spectrum disorders (ASD) experience a range of core and co-morbid characteristics which impede daily functioning and quality of life. Children and adolescents with ASD derive clinically meaningful benefits from psychological interventions, including those designed to reduce socio-communication deficits and mental health conditions. Relatively little is known about the effectiveness of these interventions for the adult ASD population. The paper aims to discuss this issue.
Design/methodology/approach
– A selective search of English language, peer-reviewed publications was undertaken, in order to summarise the empirical data pertaining to psychological interventions for adults with high-functioning ASD (HF-ASD).
Findings
– Thus far, social skills interventions, cognitive behaviour therapy techniques, and mindfulness-based approaches have been researched most extensively. Interventions have primarily sought to: reduce the impact of core ASD characteristics; enhance skills; and improve co-morbid mental health symptoms. Methodological and clinical heterogeneity render it difficult to generalise study findings across population samples, but overall, interventions appear to be associated with reductions in co-morbid symptom severity, and improved functioning.
Research limitations/implications
– Further studies that seek to improve functioning, reduce co-morbid characteristics, and enhance the propensity for attaining and maintaining independence are now needed.
Practical implications
– Adaptations to standard treatment protocols are likely required in order to enhance engagement and optimise treatment gains.
Originality/value
– This is one of the first reviews to focus specifically on psychological interventions for adults with HF-ASD.
This chapter aims to provide a concise overview of the modifications considered necessary for an intervention for anxiety in children with high-functioning autism spectrum disorders (HF/ASD). There is growing literature that describes the types of programs available and recommended modifications for children with ASD and anxiety and we provide a review of those programs that are reporting significant improvements. The chapter then moves to consider the fact that children with HF/ASD often present with multiple difficulties, the basis of which is frequently emotion dysregulation. It is likely that the strategies used to manage these difficulties will have similarities with those used for anxiety. It is also the case that programs may need to be developed with these overlapping problems taken into account. The chapter proceeds to outline how this could be achieved with some examples presented from a program that is already moving in this direction—the Secret Agent Society.
A young man with Asperger syndrome who presented with severe depression and self-injurious behaviour was treated with Ig sessions of cognitive-behavioural therapy. A decrease in the levels of measured depression and self-injury were found following the therapy. It remained unclear exactly which elements of the intervention brought about the improvements. The use of cognitive-behavioural treatments with people with Asperger syndrome is discussed.
Clinicians in the field of autism are increasingly identifying individuals with Asperger syndrome. Individual and family therapy for individuals with this condition has received little attention in the literature. This article presents three case examples of individual and family therapy with male adolescents diagnosed with Asperger syndrome. Common presenting issues and treatment interventions are summarized that may apply to others diagnosed with this condition.
The objective of this study was to report on the prevalence and correlates of anxiety and mood problems among 9- to 14- year-old children with Asperger syndrome (AS) and high-functioning autism. Children who received a diagnosis of autism (n 40) or AS (n 19) on a diagnostic interview when they were 4 to 6 years of age were administered a battery of cognitive and behavioural measures. Families were contacted roughly 6 years later (at mean age of 12 years) and assessed for evidence of psychiatric problems including mood and anxiety disorders. Compared with a sample of 1751 community children, AS and autistic children demonstrated a greater rate of anxiety and depression problems. These problems had a significant impact on their overall adaptation. There were, however, no differences in the number of anxiety and mood problems between the AS and autistic children within this high-functioning cohort. The number of psychiatric problems was not correlated with early autistic symptoms but was predicted to a small extent by early verbal/non-verbal IQ discrepancy scores. These data indicate that high-functioning PDD children are at greater risk for mood and anxiety problems than the general population but the correlates and risk factors for these comorbid problems remain unclear.
The development, reliability, and discriminative ability of a new instrument to assess social phobia are presented. The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived instrument incorporating responses from the cognitive, somatic, and behavioral dimensions of social fear. The SPAI high test–retest reliability and good internal consistency. The instrument appears to be sensitive to the entire continuum of socially anxious concerns and is capable of differentiating social phobics from normal controls as well as from other anxiety patients. The utility of this instrument for improved assessment of social phobia and anxiety and its use as an aid for treatment planning are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article provides psychometric information on the second edition of the Beck Depression Inventory (BDI–II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996), with respect to internal consistency, factorial validity, and gender differences. Both measures demonstrated high internal reliability in the full student sample. Significant differences between the mean BDI and BDI-II scores necessitated the development of new cutoffs for analogue research on the BDI–II. Results from exploratory and confirmatory factor analyses indicated that a 2-factor solution optimally summarized the data for both versions of the inventory and accounted for a cumulative 41% and 46% of the common variance in BDI and BDI–II responses, respectively. These factor solutions were reliably cross-validated, although the importance of each factor varied by gender. The authors conclude that the BDI–II is a stronger instrument than the BDI in terms of its factor structure. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We conducted a meta-analysis using all available controlled treatment outcome studies of cognitive-behavioral and pharmacological treatments for social phobia (N= 24 studies, N= 1079 subjects). The mean social anxiety effect size for cognitive-behavioral treatments was .74 and for pharmacological treatments was .62. Both were significantly different from zero and the difference between them was not significant. Among cognitive-behavioral treatments, exposure-interventions yielded the largest effect size (ES) whether alone (ES = .89) or combined with cognitive restructuring (ES = .80). Selective serotonin reup-take inhibitors (ES = 1.89) and benzodiazepines (ES = .72) yielded the largest effect sizes for pharmacotherapy. According to cost projections, group cognitive-behavioral treatment offered the most cost-effective intervention.
In this paper, we present a pilot group therapy model with modifications, for boys who meet the criteria of Asperger Syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), and who have concurrent learning disabilities. It is recognized that learning disabilities are often a feature of Asperger Syndrome. Children and adolescents with learning disabilities are vulnerable to experiencing social and emotional problems, in particular difficulties with peers. The social functioning of children and adolescents who have Asperger Syndrome is greatly impeded, although they are motivated to have social contact and to make friends. This paper describes how elements of interpersonal group therapy were combined with modifications, which address the unique social and cognitive profiles of the boys in this group. Case examples are provided to illustrate the group model. The group members and their parents were interviewed after the group and two years later, to obtain their views of the group. Their responses are presented.
The development of a new, comprehensive and multicomponent treatment for social phobia is described. Initial results of a pilot study with the new treatment also are reported. The treatment was found to be effective with severe (generalized) social phobics, most of whom had co-occurring Axis I and/or II conditions. In addition to significant change on a host of outcome variables, a normative-based endstate functioning index was used to determine treatment efficacy. The results are discussed with respect to the implementation of the treatment and in terms of the need for a comprehensive approach to treating social phobia.
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
The development of the Asperger Syndrome (and high- functioning autism) Diagnostic Interview (ASDI) is described. Preliminary data from a clinical study suggest that inter-rater reliability and test-retest stability may be excellent, with kappas exceeding 0.90 in both instances. The validity appears to be relatively good. No attempt was made in the present study to validate the instrument as regards the distinction between Asperger syndrome and high-functioning autism.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
Improvement in the negative symptoms of schizophrenia including emotional and social withdrawal, poor rapport and stereotyped thinking, many of which are characteristic of developmental disorders, suggest a role for risperidone, an atypical antipsychotic, in the treatment of pervasive developmental disorders. Here we describe a 30-year-old man with Asperger's syndrome. The observed improvement in social relations, reduced aggressive behaviour and diminished repetitive thinking of this patient with Asperger's syndrome was confirmed by the patient. This case report confirms that risperidone has a role in PDD. Previous reports have only studied children with Asperger's syndrome and we believe that our report is the first to show a role for risperidone in improvement of an adult with this condition.
The contributors to this volume summarize their perspectives on social anxiety and social phobia. Three main topics are discussed: the delineation of social phobia and social anxiety, theoretical perspectives, and treatment approaches. After diagnostic issues are presented, theoretical perspectives from social psychologists, developmental psychologists, behavioral geneticists, and others, are discussed. Finally, treatment approaches such as drug therapy and psychotherapy are described. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reports the cases of 5 patients (aged 18–44 yrs) with pervasive developmental disorders (PDDs). Four Ss developed psychotic illnesses in adult life. The other was treated with antipsychotic medication for many years following a mistaken diagnosis of schizophrenia. The cases show that PDDs may be complicated by psychotic illnesses presenting in adulthood or may be mistaken for such illnesses. When abnormalities in social functioning develop in infancy or early childhood and are accompanied by abnormalities in speech or use of nonverbal communication, and by a restricted stereotyped idiosyncratic repertoire of interests and activities, a diagnosis of PDD should be considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Issues concerning use of the Beck Depression Inventory (BDI) for the self-report of depressive symptomatology are raised and considered. Discussion includes the stability of depression and the need for multiple assessment periods, specificity and the need for multiple assessment measures, and selection cut scores and the need for terminological accuracy. Recommendations for the continued use of the BDI, designed to facilitate the integration of diverse studies and improve research on self-reported depression, are provided.
Forty-seven individuals (28 male and 19 female) referred for treatment of obsessive-compulsive disorder (OCD) in childhood were followed-up 15 years later (range 6-22 years) in respect of psychiatric and personality disorders. In early adulthood, the patients could be sub-divided into 4 groups of about equal size. One group had no later OCD, another had OCD on a sub-clinical level, a third group had an episodic course of OCD, and a final group had a chronic and often very disabling OCD. Outcome was similar in males and females, except that more girls had an episodic course. Eating disorder was diagnosed in 4 (21%) of the females, and Asperger syndrome in 2 (7%) of the males, at follow-up.
For the first time since the Diagnostic and Statistical Manual (DSM) was originally published, it lists Asperger’s Disorder, more widely known as Asperger syndrome (AS), as a separate
category under the general heading of Pervasive Developmental Disorders. Instead of providing definitive answers regarding
the relationship between autism and AS, DSM-IV invites an increasing number of questions. This is particularly true regarding
its position on language and communication in AS.
The Social Phobia and Anxiety Inventory (SPAI) is a new instrument designed to assess symptoms of social phobia. Although the scale has been shown to have a good test-retest reliability, internal consistency, and construct validity, no studies have examined its concurrent validity with respect to other measures of social anxiety and avoidance. In the present study, the relationship between the SPAI and several self-report measures of social anxiety was examined in a sample of 23 patients meeting DSM-III-R criteria for social phobia. The relationship between the SPAI and other measures of psychopathology, as well as performance during a role play test and an impromptu speech, was also examined. The results strongly support the concurrent validity and the specificity of the SPAI. The Social Phobia subscale may be a better index of social anxiety symptoms than the Difference subscale.
The Social Phobia and Anxiety Inventory (SPAI) is a newly developed instrument to measure social phobia and social anxiety. In this report, the concurrent and external validity of the scale were examined. The results indicate that the SPAI successfully discriminates social phobics from non-social phobics, accurately predicts social distress, and has some ability to predict the occurrence of specific behaviors in social situations. In addition, the results suggest that the ratings made by a significant other closely matched the individual's own ratings of social distress, indicating a degree of external validity.
The growth of managed health care in the United States has placed a high premium on the goal of efficiency in the treatment of psychopathology, but without sacrificing treatment efficacy in the process. A preliminary evaluation of a brief, 6-week version of cognitive behavioral group therapy (CBGT) for generalized social anxiety disorder was conducted. Various self-report and behavioral assessment measures were collected at pre- and posttreatment, and self-report assessments were again conducted at 6- and 12-week follow-ups. The results suggest improvement during the acute 6-week treatment phase, and further improvement during the 6 weeks following treatment termination. These gains were maintained at the 3-month follow-up assessment. Effect size comparisons with prior studies revealed that the present treatment produced comparable treatment gains at the 6-week follow-up assessment to those produced by prior studies using the standard 12-week CBGT protocol. Clinical and research implications are discussed.
Cognitive Behavioral Group Therapy (CBGT) is the most widely researched intervention program for social anxiety disorder (SAD, also known as social phobia), with a number of studies demonstrating its effectiveness. Another common treatment, social skills training (SST), has also been shown to be efficacious for SAD. The present study compared the standard CBGT intervention with a protocol in which SST was integrated into CBGT. Participants met diagnostic criteria for the generalized subtype of SAD, and most also met criteria for avoidant personality disorder and other comorbid Axis I disorders. The results revealed improvement in a variety of outcome measures for both treatments, but significantly greater gains for the CBGT plus SST condition. In fact, the effect sizes obtained for this treatment were among the largest found to date in any study of SAD. Clinical implications are discussed, and directions for future research are suggested.
A meta-analytic comparison of studies testing cognitive behavior therapy (CBT; n = 12) and exposure treatment (n = 9) for social phobia indicates that the treatment modalities are equally effective. Compared to exposure, CBT did not lead to greater pretest-posttest or pretest-follow-up improvement on self-report measures of social anxiety, cognitive symptoms, or depressed/anxious mood. Length of treatment was generally unrelated to outcome, although a larger number of exposure sessions produced better results on measures of social anxiety at posttest.
We review the English-language literature on Asperger's syndrome (AS), with particular reference to diagnostic criteria and differentiation from infantile autism and personality disorders, and describe six cases seen in practice: all met DSM-III criteria for 'atypical pervasive developmental disorder'. Three also developed Tourette syndrome: the co-occurrence of the two disorders, and methods of intervention, are discussed.
Of five patients with pervasive developmental disorders (PDDs), four developed psychotic illnesses in adult life. The other was treated with antipsychotic medication for many years following a mistaken diagnosis of schizophrenia.
Forty-one patients meeting DSM-III criteria for social phobia completed a randomized comparative trial of the monoamine oxidase inhibitor phenelzine, the cardioselective beta-adrenergic blocker atenolol, and placebo. No significant differences were seen after 4 weeks of treatment in this preliminary trial. At the end of 8 weeks, however, phenelzine demonstrated greater efficacy than atenolol or placebo on dimensional ratings of overall severity of social phobia. No atenolol-placebo differences were observed. The authors shall present maintenance and discontinuation findings in a final report. Phenelzine may act in patients with social phobia by directly reducing interpersonal hypersensitivity.
SYNOPSIS
The clinical features, course, aetiology, epidemiology, differential diagnosis and management of Asperger's syndrome are described. Classification is discussed and reasons are given for including the syndrome, together with early childhood autism, in a wider group of conditions which have, in common, impairment of development of social interaction, communication and imagination.
A social skills group was conducted for 8 boys aged 8 to 12 years on a weekly basis for 14 sessions. In this descriptive paper we discuss the planning for the group, the teaching techniques used, the actual group process and a subjective assessment of outcomes. Possible directions for future interventions are also presented.
Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects.
This paper describes a total population study of Asperger syndrome using a two-stage procedure. All school children in an outer Göteborg borough were screened. Final case selection based on clinical work-up showed a minimum prevalence of 3.6 per 1.000 children (7-16 years of age) using Gillberg and Gillberg's criteria and a male to female ratio of 4:1. Including suspected and possible Asperger syndrome cases, the prevalence rose to 7.1 per 1.000 children and the male:female ratio dropped to 2.3:1. These findings are discussed as they relate to previously published results in the field and to findings obtained using Szatmari et al.'s and ICD-10 draft criteria for the disorder.
A meta-analysis was conducted using 42 treatment-outcome trials for social phobia. Six conditions were compared: Waiting-list control, placebo, EXP (within-session exposure and homework exposure), CT (cognitive restructuring without exposure exercises), CT + EXP, and SST (social skills training). All interventions, including placebo, had larger effect sizes than that of the waiting-list control, and the interventions did not differ in drop-out proportions. Only CT + EXP yielded a significantly larger effect size than placebo. Effects of treatments tended to increase during the follow-up period. These results support the use of cognitive-behavioral treatments for social phobia, especially the use of CT + EXP.
The amended (revised) Beck Depression Inventory (BDI-IA; Beck & Steer, 1993b) and the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) were self-administered to 140 psychiatric outpatients with various psychiatric disorders. The coefficient alphas of the BDI-IA and the BDI-II were, respectively, .89 and .91. The mean rating for Sadness on the BDI-IA was higher than it was on the BDI-II, but the mean ratings for Past Failure, Self-Dislike, Change in Sleeping Pattern, and Change in Appetite were higher on the BDI-II than they were on the BDI-IA. The mean BDI-II total score was approximately 2 points higher than it was for the BDI-IA, and the outpatients also endorsed approximately one more symptom on the BDI-II than they did on the BDI-IA. The correlations of BDI-IA and BDI-II total scores with sex, ethnicity, age, the diagnosis of a mood disorder, and the Beck Anxiety Inventory (Beck & Steer, 1993a) were within 1 point of each other for the same variables.
A meta-analysis of psychological and pharmacological treatments for social phobia was conducted to evaluate whether the various treatments differ in their efficacy for treating social phobia, whether they are more effective than wait-list and placebo controls, whether rates of attrition differ, and whether treatment gains are maintained at follow-up. A total of 108 treatment-outcome trials for social phobia met inclusion/exclusion criteria for the meta-analysis. Eleven treatment conditions were compared: wait-list control, pill placebo, benzodiazepines (BDZs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors, attention placebo, exposure (EXP), cognitive restructuring (CR), EXP plus CR, social skills training, and applied relaxation. The most consistently effective treatments for social phobia were pharmacotherapies. BDZs and SSRIs were equally effective and more effective than control conditions. Dropout rates were similar among all the active treatment conditions. Assessment of the durability of treatment gains for pharmacotherapies was not possible because an insufficient number of drug studies included follow-up data. The treatment gains of psychological therapies, although moderate, continued during the follow-up period. BDZs and SSRIs seem to be effective treatments for social phobia, at least in the short term. Recommendations for future research include assessing the long-term outcome for pharmacotherapies and evaluating the inclusion of a cognitive-behavioral treatment during the drug tapering period.
This paper reviews the current status of research on the phenomenology, etiology, maintenance, assessment, and treatment of childhood and adolescent social anxiety disorder (SAD). Despite being one of the most prevalent disorders of childhood and adolescence, SAD paradoxically stands as one of the least recognized, researched, and treated pediatric disorders. The small treatment outcome literature provides preliminary support to the effectiveness of various forms of cognitive behavior therapy. The majority of studies to date, however, are limited by inadequate control conditions. Other findings include some support for the utility of parental involvement in treatment, significant advancements in outcome measures (e.g., normative comparisons, indices of naturalistic social functioning), and impressive durability of gains for the majority of treatments. Future directions are suggested, including experimental and naturalistic studies of developmental pathways and maintenance factors, the incorporation of "positive psychology" constructs (e.g., positive emotions, hope, self-control) in treatment and prevention, and the continued delineation of differences between child, adolescent, and adult manifestations of SAD.
The Liebowitz social anxiety scale (LSAS) is a commonly used clinician-administered instrument. The present study reports on the properties of a self-report version of the LSAS (LSAS-SR). About 175 participants diagnosed with social phobia participated in the study. The LSAS-SR showed overall good psychometric properties as indicated by the results of test-retest reliability, internal consistency, and convergent and discriminant validity. Furthermore, the scale was sensitive to treatment change. The construct validity of the LSAS-SR, however, remains to be further explored. These findings support the utility of the LSAS-SR, which has the advantage of saving valuable clinician time compared to the clinician-administered version.
Social phobia: Diagnosis, assessment and treatment
- R G Heimberg
- M R Liebowitz
- D A Hope
- E R Schneier
Heimberg, R. G., Liebowitz, M. R, Hope, D. A., & Schneier, E R. (1995). Social phobia: Diagnosis, assessment and treatment. NewYork: The Guilford Press.
Comparative effectiveness of cognitive-behavioral treatment and pharmacotherapy for social phobia: Meta-analytic outcome From social anxiety to social phobia: Multiple perspectives
- R A Gould
- M W &johnson
Gould, R. A., &Johnson, M. W. (2001). Comparative effectiveness of cognitive-behavioral treatment and pharmacotherapy for social phobia: Meta-analytic outcome. In S. G. Hofmann & R M. DiBar-tolo (Eds.), From social anxiety to social phobia: Multiple perspectives (pp. 379-390). Needham Heights, MA: Allyn and Bacon.
Encouraging flexibility in adults with autism Adults with autism: A guide to theory and practice NewYork
- R Jordan
- S Powell
Jordan, R., & Powell, S. (1996). Encouraging flexibility in adults with autism. In H. Morgan (Ed.), Adults with autism: A guide to theory and practice (pp. 74-88). NewYork: Cambridge University Press.
Anxiety disorders: Psychological approaches to theory and treatment
- M G Craske
Craske, M. G. (1999). Anxiety disorders: Psychological approaches to theory and treatment. Boulder, CO: Westview Press.
Cognitive-behavioral treat-ments: Literature review Social phobia: Diagnosis, assessment and treatment NewYork
- R G Heimberg
- H R Juster
Heimberg, R. G., & Juster, H. R. (1995). Cognitive-behavioral treat-ments: Literature review. In R. G. Heimberg, M. R~ Liebowitz, D. A. Hope, & E R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 261-309). NewYork: The Guilford Press.
Social skills training for a case of Savant sya~drnme and Asperger's syn-drome National Institute of Men-tal Health, Clinical Global Impressions
- Nakamura
- Tc
- K Iwahashi
- L Fukunishi
- H Suwaki
Nakamura, tC, Iwahashi, K., Fukunishi, L, & Suwaki, H. (1998). Social skills training for a case of Savant sya~drnme and Asperger's syn-drome. Australian and New Zealand Journal of Psychiatry, 32, 697. National Institute of Mental Health. (1985). National Institute of Men-tal Health, Clinical Global Impressions. Psychopharmacology Bulle-tin, 21, 839-843.
Manual for the revised Beck Depression Inventory An inventory for measuring depression
- A T Beck
- R A Steer
- G K Brown
- A T Beck
- C H Ward
- M Mendelson
- J Mock
- J Erbaugh
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the revised Beck Depression Inventory. San Antonio, TX: Psychological Corporation. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
Struc-tured Clinical Interview for Axis I DSM-1V Disorders-Patient Edition
- M B First
- R L Spitzer
- M Gibbon
- J B W Williams
First, M. B., Spitzer, R. L., Gibbon, M., & Williams,J. B. W. (1994). Struc-tured Clinical Interview for Axis I DSM-1V Disorders-Patient Edition. New York: Biometrics Research Department.
Cognitive-behavioral group therapy for social pho-bia: A treatment manual. Unpublished manuscript
- R G Heimberg
Heimberg, R. G. (1991). Cognitive-behavioral group therapy for social pho-bia: A treatment manual. Unpublished manuscript, The University at Albany, State University of New York.