A mixed methods study of autistic adults' mental health therapy experiences

Abstract

Autistic adults are at high risk for co‐occurring mental health problems and need access to effective and appropriate mental health treatment. However, the relative effectiveness or acceptability of specific mental health strategies among autistic adults has not been previously examined. The current study sought to gain a deeper understanding of autistic adults' experiences and preferences regarding mental health strategies using a mixed methods approach. Autistic adults (n = 303, ages 21–77) completed online surveys and open‐ended questions about their mental health and therapy experiences. Most (88.8%) had participated in therapy, with cognitive approaches being the most common. Regarding overall therapy experiences, qualitative analyses revealed four primary themes and nine subthemes. Therapist acceptance and understanding were seen as critical for therapy success, and many participants felt that therapy was helpful for personal growth. However, many participants found that talking in session was challenging and noted that aspects of the session format affected their ability to engage in therapy. Regarding specific strategies, four cross‐cutting themes and eight strategy‐specific subthemes were identified. A variety of strategies were seen as helpful for reducing anxiety and improving mood. However, autistic adults reported trouble generalizing strategies to daily life and found some techniques to be difficult to implement due, in part, to their unique autism‐related needs. As the first study of its kind, the results underscore the importance of establishing a safe and accepting therapeutic relationship, providing accommodations to support communication needs, and considering individual differences and preferences when selecting mental health strategies for autistic clients.

The Assessment and Treatment of Post-traumatic Stress Disorder in Autistic People: A Systematic Review

“…Autism-specific adaptations of TF-CBT have been theoretically proposed in areas of emotion regulation, graduated exposure, cognitive restructuring, and psychoeducation (Stack & Lucyshyn, 2019), and randomised controlled trials have shown efficacy of adapting CBT to treat depression in autistic adults (Russell et al, 2019a) and anxiety in autistic adolescents (Storch et al, 2015). For psychotherapies, more generally, the person-environment fit is an essential consideration and specific adaptations should be considered when a patient is autistic (Brook, 2023;Mazurek et al, 2023). Anecdotal reports highlight the importance of careful consideration of the individual needs of an autistic person suffering from PTSD for successful use of psychological therapies, including narrative exposure therapy (NET) (Fazel et al, 2020) and adapted CBT (Carmassi et al, 2019), and use of trauma-informed care to manage symptoms (Kildahl & Jørstad, 2022).…”

Challenges and opportunities for conceptualizing intuitive eating in autistic people

“…Collectively, these aspects of IE are noteworthy: while existing treatment systems may be modified in terms of their delivery (e.g., web‐based), accumulating evidence suggests they are limited in scope to flexibly respond to and/or accommodate the needs of autistic people (e.g., differing communication styles and information processing) and, thus, less beneficial compared to neurotypical groups (Babb et al, 2021, 2022; Kinnaird, Norton, Stewart, & Tchanturia, 2019). For example, commonly used approaches, such as cognitive behavioral therapy and dialectical behavioral therapy, require verbal communication and cognitive skills (e.g., identifying, describing, and challenging difficult thoughts) that are often inaccessible, and are oriented toward a paradigm that inherently “pathologizes” an autistic persons' individual characteristics (Adamson et al, 2020; Babb et al, 2021; Camm‐Crosbie et al, 2019; Lipinski et al, 2021; Mazurek et al, 2023; see also Mandy, 2022). Unfortunately, such an approach for accommodating autistic needs in current interventions remains exceedingly rare, with a recent systematic review (Li et al, 2021) finding only one available ED treatment pathway specifically adapted for autistic behaviors (i.e., the PEACE pathway; Tchanturia et al, 2020).…”

Hidden Struggles: Shedding Light on Depression and Anxiety in Adults With Autism Spectrum Condition

“…Additionally, feelings of incompetence and low self-esteem may be intensified by observing their peers forming positive relationships. According to researchers, adults with ASC who perceived themselves as having low social competence reported high depression rates, and those who felt unlike to others also reported high depression rates (see also Mazurek et al, 2023;Nah et al, 2018;Hillier et al, 2011).…”