Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment–Autism (PAT-A©) pilot randomised controlled feasibility trial

Abstract

Background: Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment-Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults. Methods/design: This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important 'target situations' that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psychoeducational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods. Discussion: This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people.

Consensus statements on optimal adult post-autism diagnosis support and services: Delphi process following a UK survey of autistic adults, relatives and clinicians

“…Future research is needed to explore what types of groups would be most helpful and how these may be delivered, for example, autistic-led peer-support groups (Crane et al, 2021; Leedham et al, 2020) or adapted social prescribing (Charlton et al, 2021; Crompton, Hallett, et al, 2020; Crompton, Ropar et al, 2020; Maitland et al, 2021). Individual support may also be informed by recent developments in psychological therapies for autistic people experiencing anxiety/depression (National Autistic Society, 2021; Parr et al, 2020; Russell et al, 2019).…”

The importance and availability of adjustments to improve access for autistic adults who need mental and physical healthcare: findings from UK surveys

“…Examples include the codesign (with autistic people, relatives and clinicians) and evaluation of a personalised, flexible psychological intervention for anxiety in autistic adults (PAT-A). 36 We have also codesigned an intervention to investigate how autistic people aged 50 and over can be encouraged to access the healthcare they need (Trial registration: ISRCTN 75726745). To address the primary care needs of autistic adults, we have codesigned and are evaluating the use of primary care healthchecks for autistic people ( https://research.ncl.ac.uk/autismhealthchecks/ ).…”

Autistic Self-Advocacy and the Neurodiversity Movement: Implications for Autism Early Intervention Research and Practice

“…These debates and discussions have had genuine impact within some areas of autism research, predominantly that focused on adults. Examples of this impact include: (a) debates over whether the social difficulties experienced by autistic people are best understood as being a problem within the individual, or a problem between two (mis-matched) individuals, and the resulting research into the Double Empathy Problem and diversity in social intelligence (Milton, 2012 ; Crompton et al, 2020 ); (b) calls from the autistic community for a greater emphasis on improving mental health and quality of life in autistic individuals (Autistica, 2015 ; National Autistic Taskforce, 2019 ) and an increase in research into effective, person-centered mental health interventions (e.g., Crane et al, 2019 ; Cassidy et al, 2020 ; Parr et al, 2020 ) and (c) research into community preferences over the language used to describe autism and autistic people (e.g., Kenny et al, 2016 ; Bury et al, 2020 ). Despite these impacts within adult-focussed research, these debates are still rarely directly addressed in early intervention research, where the impact of the autistic viewpoint is often implicit or not present at all.…”