Cognitive Behavior Therapy Can Help People on the Autism Spectrum

Categories: ASD and DD, Adult-focused; ASD and DD, Child-focused


For the last 20 years, Cognitive Behavior Therapy (CBT) – a form of treatment that explores relationships among a person’s thoughts, feelings, and behaviors – has become the treatment of choice for anxiety, depression, and attention deficit hyperactivity disorder (ADHD),  as well as other mental health disorders.
CBT teaches people to label and modify dysfunctional thinking patterns (e.g., “There is no point in getting out of bed today because nothing is going to go right.”) and helps them identify ways to change their everyday actions (“If I get up a little earlier, I can have a nice breakfast.”). This seemingly simple combination has resulted in major improvements for many struggling adults and children.
Over the years, the principles of CBT have also been used to address many problems including gambling, marital struggles, and chronic pain. Although there is much evidence to support the effectiveness of CBT, many people have assumed that it cannot be used to help individuals with autism spectrum disorder (ASD), even though many of these individuals have co-occurring conditions such as anxiety, depression, or ADHD.
Most people with ASD also have communication challenges, and may have intellectual deficits as well – characteristics that some therapists have thought would interfere with their ability to engage in the treatment. Fortunately, over the last few years, more and more therapists are finding that CBT works with some individuals in this population.
People with ASD have trouble discussing the “why” (e.g., Why don’t I want to go play with that group of kids? Why don’t I want to go to band practice?). As a result, it is hard to help them change their thoughts. What we can do is to teach them to recognize when they feel anxious and help them identify other uncomfortable emotions as well.
Emotion identification is usually difficult for people with ASD, and teaching them to recognize what they are feeling helps them feel in control. CBT helps them learn that “it isn’t me who doesn’t want to go to band practice, it is my anxiety that won’t let me go!”
Once they understand that they are anxious, and that their anxiety is something they can address, we can teach them helpful strategies to confront and control it. For people with autism, this is frequently as simple as a new breathing technique or a way to focus on something else. Then we can teach them to “face their fears,” accept that their anxiety is playing a trick on them, and discover that the situation usually isn’t as bad as it seems.
People with ASD frequently have trouble applying the skills they learn in a therapy session to a new situation. Because of this, we have learned we have to provide therapy in the place where they are struggling. At the May Center School for Autism and Developmental Disabilities in Randolph, our therapists teach students to use the skills we talk about in the classroom. To help them apply new skills to situations they encounter outside of school, outpatient therapists may need to break the typical “in office” model and provide therapy at home or in the community.
We are starting to learn that CBT works for people with ASD too. Drawing on the groundbreaking research being conducted by the May Institute, the Virginia Tech Autism Clinic, and the UCLA Center for Research and Treatment, we hope to continue to further the revolution and find new ways this intervention can help people with ASD and other special needs.
By Nathan Lambright, Psy.D., BCBA-D
May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis, serving individuals with autism spectrum disorder (ASD) and other developmental disabilities, brain injury and neurobehavioral disorders, and other special needs. Founded more than 65 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. May Institute operates five schools for children and adolescents with ASD and other developmental disabilities, including one in Randolph, Mass. For more information, call 800.778.7601 or visit