Adapted cognitive behavior therapy for obsessive–compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study

Abstract

Obsessive–compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive–compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale–Brown Obsessive–Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale–Brown Obsessive–Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive–compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive–compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive–compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.

How do core autism traits and associated symptoms relate to quality of life? Findings from the Longitudinal European Autism Project

“…QoL) tend to suggest fewer treatment gains in the areas of everyday functioning that may be particularly important to many autistic people and their families (Fletcher-Watson & McConachie, 2015; McConachie et al, 2015). For example, though cognitive behavioural therapy (CBT) is the most widely supported intervention approach for managing anxiety symptoms in autism (Kreslins et al, 2015; Sukhodolsky et al, 2013; White et al, 2018), improvements in QoL following CBT are not consistently identified (Flygare et al, 2020; van Steensel & Bogels, 2015).…”

Feasibility of internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder in youth with autism spectrum disorder: A clinical benchmark study

“…Cognitive behavior therapy (CBT) is recommended as the first-line treatment for OCD ( American Psychiatric Association, 2007 ). When appropriately adapted and delivered by specialist clinicians, CBT can be effective for OCD in autistic individuals ( Kose et al, 2018 ; Flygare et al, 2020 ; Martin et al, 2020 ), though the reported effects are somewhat smaller compared to those reported in non-autistic individuals with OCD ( Murray et al, 2015 ; Jassi et al, 2021 ). For example, in the largest naturalistic study to date, 53% of 172 children with OCD and ASD were classed as treatment responders, compared to nearly 77% of non-autistic children with OCD ( Jassi et al, 2021 ).…”

Vagus Nerve Stimulation as a Treatment for Fear and Anxiety in Individuals with Autism Spectrum Disorder

“…It is not always practical to return to the site of the trauma, so imaginal exposure therapy can be used in the therapist’s office. Imaginal exposure therapy, wherein patients are exposed to their own thoughts and mental images, benefitted young people with ASD who had obsessive-compulsive disorder to a lesser degree than typically developing children [ 39 ]. A central part of in vivo and imaginal exposure therapy is homework, where patients are asked to reinforce what they have learned in therapy outside of the clinical setting [ 40 ].…”