Using Cognitive Behavior Therapy To Address Emotional Well-Being In Youth With ASD

Youth with autism spectrum disorders often struggle with emotional awareness and understanding, leading to behavioral difficulties and mental health issues. Research indicates that strategies stemming from cognitive behavioral therapy (CBT) are effective in promoting emotional understanding and regulation. Using case presentations and materials from our clinic program, this session will focus on providing effective strategies to assist youth with ASDs in better understanding and regulating their own thoughts and feelings. This presentation will focus on cognitive behavioral therapy (CBT) for verbal youth with ASDs. Over the course of the session the following five questions will be answered through the presentation of case studies, examples of therapy materials, and recent research:

• Why is psychotherapy important for youth with ASDs?
• How do the core deficits of ASDs influence the effectiveness of psychotherapy?
• What is CBT and how can it be modified for use with youth with ASDs? 
• How can emotional awareness and understanding be taught?
• How does teaching emotional awareness lead to better regulation of emotions?

Youth with ASDs have social and emotional difficulties which, if not addressed as part of a comprehensive intervention program, often lead to significant mental health issues. Not only do social skills deficits make it difficult for youth with ASDs to understand the thoughts and emotions of others, they also contribute to difficulties understanding and interpreting one’s own thoughts and feelings. These deficits in turn can lead to difficulties with modulating emotions and behavior. Further, coping skills, or our ability to manage challenging life situations, are learned socially, most often in ways that are not explicitly taught. Therefore, many high functioning youth with ASDs struggle with experiencing negative thoughts and feelings without possessing the skills necessary to problem solve and cope with such situations. The unfortunate combination of experiencing difficulties with emotion regulation along with having ineffective coping skills can lead to behavioral episodes, social rejection, impaired self esteem, anxiety, and depression, and can increase the risk of inpatient hospitalization. These outcomes place stress on the importance of providing effective psychotherapy for verbal individuals with ASDs.

Emotion identification and understanding are pre-requisite skills for therapy, as is metacognition, or thinking about thinking. With neurotypical youth, it is assumed that they possess the underlying skills necessary to begin cognitive behavioral therapy (e.g., can identify their own and others’ emotions, can label thoughts). With youth, and often adults with ASDs, the discrepancy between ability and required skill, necessitates either the teaching of these skills to increase “therapy readiness” or the adaptation of traditional CBT treatment strategies. This session will outline specific teaching strategies and the adaptation of components of CBT to more effectively teach emotion awareness and understanding to youth with ASDs. Through participating in CBT, youth are taught to identify their emotions related to various environmental and social triggers. Once able to identify their feelings, they are then taught how to manage and regulate these emotions using external stimuli, behavioral changes, or internal/thought-based techniques.

CBT is an evidence based form of psychotherapy that is structured and goal oriented. It was initially developed for the treatment of depression but has been successfully adapted for the treatment of a wide range of issues, including anxiety, social skills deficits, and anger management. Although originally developed for adults, CBT has been shown to be highly effective in treating issues facing children and teens. CBT focuses on the thoughts, feelings, and behaviors that contribute to an individual’s distress. By focusing on the connection between thoughts, feelings, and behaviors, CBT teaches children and teens to develop more effective coping skills. CBT also targets social skills deficits by directly teaching social norms and expectations as well as strategies for successful social interactions and relationship development. Several studies as well as anecdotal evidence support the use of CBT in autism spectrum disorders (Reaven et al., 2009; Wood, Drahota, Sze, Har, Chiu & Langer, 2009; Sze & Wood, 2007; Gaus, 2007; Anderson & Morris, 2006). This session will highlight the process by which, at varying points in the therapeutic process, CBT can effectively teach thoughts and feelings identification for children and teens with ASDs.

Participants in this session will learn the importance of teaching thoughts and feelings identification and understanding to youth with ASDs as well as how emotion understanding leads to emotion regulation. Additionally, they will be introduced to the CBT model, which when adapted appropriately can be a highly effective approach for reducing social and emotional difficulties and improving the overall functioning of children and teens with ASDs. Specific teaching strategies and activities for emotional awareness, understanding, and regulation will be highlighted using case examples from our clinic’s CBT program.