Modified CBT for Social Anxiety and Social Functioning in Young Adults with Autism Spectrum Disorder

Abstract

Background: There is a strong research imperative to investigate effective treatment options for adolescents and adults with Autism Spectrum Disorder (ASD). Elevated social anxiety, difficulties with social functioning, and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the efficacy of a group intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress. Method: Ten groups of participants completed an eight-week, modified Cognitive Behavioural Therapy (CBT) group intervention targeting both social anxiety and social functioning, that included social skills training, exposure tasks and behavioural experiment components. Seventy-eight adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 38 (M = 22.77; SD = 5.31), were recruited from the community, Headspace centres and the Autism Clinic for Translational Research. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires (administered either online or through the return of hard-copy booklets), and participants were invited to provide anonymous feedback on the intervention (at the mid-point and end of the intervention). Results: Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p <.001), and specific subdomains of social functioning improved post intervention, particularly in social motivation (p=.032) and restricted interests and repetitive behaviours (p=.025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p < .05). All improvements demonstrated small effect sizes. Participant feedback was positive and indicated strong satisfaction with the program. Limitations: The absence of a control group and follow up measures, reliance on self-report instruments as outcome measures, and the exclusion of those with intellectual disability represent significant limitations to this study.Conclusions: These findings indicate that a group CBT intervention is an effective treatment for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The standalone nature of the intervention combined with positive participant feedback indicates potential clinical utility, and warrants further study in a randomised-controlled, follow-up design.

Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting

“…While no statistically significant changes were observed in social aspects of autism, such as social cognition, social awareness, or communication, significant improvements were found in AM, related to cognitive and behavioral inflexibility. The finding is in line with research on modified CBT for autistic individuals, which has observed changes in the SRS subscales of social motivation and AM but not overall social functioning (Bemmer et al, 2021). Also, this result may align with the NeuroACT program's overarching treatment goal of making social difficulties less of an obstacle to being active in social relationships without training the social skills themselves.…”

Social anxiety symptoms in autism spectrum disorder and social anxiety disorder: Considering the reliability of self‐report instruments in adult cohorts

“…Given evidence suggesting that individuals with ASD may report higher levels of social anxiety when they are describing core ASD characteristics such as social difficulties (Spain et al, 2018), it is possible that participants with ASD may have reported increased social anxiety symptoms that were actually more reflective of ASD symptoms. However, a bidirectional link between social anxiety and social impairment in ASD has been proposed as a key contributor to the high prevalence of social anxiety in ASD (Bemmer et al, 2021; White et al, 2014). The social difficulties commonly seen in ASD may contribute to the development and maintenance of SAD, and this elevated anxiety may subsequently exacerbate pre‐existing social difficulties.…”

Using formative research to develop HEARTS: A curriculum-based healthy relationships promoting intervention for individuals on the autism spectrum

“…Prior research has demonstrated that the social networks of autistic adults may be enhanced through classes and low level community interventions, such as providing one-to-one personalized support and opportunities to participate in peer groups and social activities (McConkey et al, 2021). In addition, cognitive behavior therapy (CBT)-type approaches have been found to be effective for social anxiety and to improve social motivation (Bemmer et al, 2021), and interventions such as PEERS and Circles have been found to improve friendship quality and conversational skills in adolescents and young adults aged 15–26 years old (Rose et al, 2021; Wyman & Claro, 2020). Job-based social skills interventions have also been found to improve autistic adults’ social-pragmatic skills such as social awareness, reciprocal social communication, and social avoidance (Gorenstein et al, 2020).…”