Center for Medical Ethics and Health Policy Staff Publications
Publication Date
9-1-2022
Journal
Journal of Consulting and Clinical Psychology
DOI
10.1037/ccp0000755
PMID
36279220
PMCID
PMC9891710
PubMedCentral® Posted Date
9-1-2023
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Keywords
Adolescent, Humans, Male, Female, Autistic Disorder, Anxiety Disorders, Cognitive Behavioral Therapy, Adaptation, Psychological, Cognition, exposure therapy, autism, ASD, children, CBT, cognitive therapy
Abstract
Objective: To evaluate improvement during the (a) cognitive and (b) exposure therapy phases of cognitive-behavioral therapy (CBT) for autistic youth with anxiety disorders.
Method: Participants were 148 autistic youth (aged 7-13; 77% male; 64% White) with clinically significant anxiety who were randomized to standard or adapted CBT. Clinician-rated anxiety severity was recorded at each appointment. Trajectories of change during (a) the cognitive phase and (b) the exposure phase of treatment were analyzed using piecewise multilevel modeling.
Results: Compared to the psychoeducation and cognitive therapy phases, the exposure phase corresponded with significantly more rapid symptom reduction, b = -.11, 95% CI [-.13, -.071]. This finding was true for standard CBT, which included nine sessions prior to exposure initiation (on average), as well as for CBT personalized for autistic youth, which introduced exposure following the fifth session (on average). In contrast, compared with improvements during initial psychoeducation sessions, the introduction of cognitive skills corresponded with significantly slower symptom reduction, b = .066, 95% CI [.020, .11]. This finding was also true for both adapted and standard CBT.
Conclusions: Results underscore the central role of exposure in the treatment of anxiety among autistic youth and question the utility of cognitive strategies without subsequent practice of these skills during exposure. Assuming a working relationship, therapists should consider moving through the preexposure coping phase of CBT quickly. Future research should evaluate the extent to which exposure can maintain its potency while minimizing coping skill preparation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).