Enhancing self-esteem in adults with autism spectrum disorders: a pilot cognitive behaviour therapy (CBT) group intervention

2017 ◽  
Vol 3 (2) ◽  
pp. 66-75 ◽  
Author(s):  
Debbie Spain ◽  
Sarah H. Blainey
Keyword(s):  
Autism Spectrum Disorders ◽  
Group Intervention ◽  
Cognitive Behaviour Therapy ◽  
Self Esteem ◽  
Autism Spectrum ◽  
Behaviour Therapy ◽  
Content Type ◽  
Cognitive Behaviour ◽  
Spectrum Disorders ◽  
Adults With Asd

Purpose Psychosocial risk factors and high rates of psychiatric comorbidity render individuals with autism spectrum disorders (ASD) vulnerable to developing low self-esteem (LSE). Cognitive behaviour therapy (CBT) interventions are effective for enhancing self-esteem in typically developing populations, but the degree to which they are clinically beneficial for individuals with ASD has been little explored. The paper aims to discuss these issues. Design/methodology/approach A pilot group intervention was undertaken to investigate the effectiveness and acceptability of CBT for LSE in adults with ASD. Adaptations to standard protocols were made, in order to accommodate core ASD characteristics. Findings Four participants attended eight sessions: these comprised formulation of causal and maintaining mechanisms for LSE, cognitive interventions designed to reduce self-criticism and promote a more balanced self-view, and behavioural interventions intended to increase engagement in enjoyable activities, and enhance problem-solving skills and assertiveness. Self-report questionnaires were completed at four time points: baseline, at the first and last sessions, and at one-month follow-up. Data analysis indicated no change in the primary self-esteem outcome measure. Some improvements were noted on secondary outcomes, specifically in social anxiety and depressive symptoms, and general functioning. Research limitations/implications Further studies are needed to determine how to design and deliver CBT interventions and techniques which target LSE in individuals with ASD. Originality/value This is one of the first CBT group interventions designed to address LSE in adults with ASD.

scholarly journals How to Optimise Cognitive Behaviour Therapy (CBT) for People with Autism Spectrum Disorders (ASD): A Delphi Study

2019 ◽  
Vol 38 (2) ◽  
pp. 184-208 ◽  
Author(s):  
Debbie Spain ◽  
Francesca Happé
Keyword(s):  
Autism Spectrum Disorders ◽  
Delphi Study ◽  
Cognitive Behaviour Therapy ◽  
Outcome Measurement ◽  
Autism Spectrum ◽  
Behaviour Therapy ◽  
Adults With Autism ◽  
Cognitive Behaviour ◽  
Spectrum Disorders ◽  
Neuropsychological Impairments

AbstractChildren 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.

Psychological interventions for adults with autism spectrum disorders: a review

2015 ◽  
Vol 1 (2) ◽  
pp. 79-86 ◽  
Author(s):  
Debbie Spain ◽  
Laura Harwood ◽  
Lucy O'Neill
Keyword(s):  
Mental Health ◽  
Autism Spectrum Disorders ◽  
Autism Spectrum ◽  
Psychological Interventions ◽  
Behaviour Therapy ◽  
Treatment Protocols ◽  
Content Type ◽  
Cognitive Behaviour ◽  
Spectrum Disorders ◽  
The Impact

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.

scholarly journals Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review

2017 ◽  
Vol 3 (1) ◽  
pp. 34-46 ◽  
Author(s):  
Debbie Spain ◽  
Jacqueline Sin ◽  
Laura Harwood ◽  
Maria Andreina Mendez ◽  
Francesca Happé
Keyword(s):  
Systematic Review ◽  
Social Skills ◽  
Social Anxiety ◽  
Cognitive Behaviour Therapy ◽  
Controlled Trial ◽  
Autism Spectrum ◽  
Behaviour Therapy ◽  
Social Situations ◽  
Content Type ◽  
Cognitive Behaviour

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.

Trauma-focussed cognitive-behaviour therapy for people with mild intellectual disabilities: outcomes of a pilot study

2016 ◽  
Vol 10 (5) ◽  
pp. 299-310 ◽  
Author(s):  
Biza Stenfert Kroese ◽  
Sara Willott ◽  
Frances Taylor ◽  
Philippa Smith ◽  
Ruth Graham ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Group Intervention ◽  
Cognitive Behaviour Therapy ◽  
Complex Ptsd ◽  
Behaviour Therapy ◽  
Impact Of Event Scale ◽  
Event Scale ◽  
Content Type ◽  
Cognitive Behaviour ◽  
People With Intellectual Disabilities

Purpose Trauma-focussed cognitive-behaviour therapy (TF-CBT) is the most effective treatment for post-traumatic stress disorder (PTSD). Individuals who present with complex PTSD are among the most complex and challenging patients seen by intellectual disability psychology and psychiatry services. The purpose of this paper is to study TF-CBT intervention for people with intellectual disabilities and complex PTSD. Design/methodology/approach Three groups of adults with intellectual disabilities (ID) presenting with complex PTSD (n=3, n=5 and n=4) were treated using a 12-week manualised intervention adapted from a procedure routinely used in adult mental health services. Participants completed the Impact of Event Scale as adapted for people with intellectual disabilities (IES-ID) before and after the intervention, and interviews conducted to ascertain their experiences of the group were analysed using interpretative phenomenological analysis (IPA). Findings The ten participants who completed the intervention showed a 27 per cent decrease in median Impact of Event Scale Intellectual Disabilities scores, equivalent to a medium effect size (d=0.50). Five themes were identified from the interviews: being listened to; it is nice to know you are not the only one; being in a group can be stressful; the importance of feeling safe; achieving and maintaining change. Participants also provided constructive feedback to promote improvements to the manual. Research limitations/implications A feasibility study followed by methodologically robust clinical trials is now needed to establish the effectiveness of the intervention and its utility in clinical practice. Practical implications This small study has confirmed the potential of TF-CBT as an intervention for extremely vulnerable individuals with ID who present with complex PTSD. Social implications The findings indicate that a group intervention is both feasible for and acceptable to adults with ID. Originality/value To date, no study has investigated the effectiveness and feasibility of a TF-CBT group intervention for adults with mild ID.

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