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Introduction

In recent years, an important topic has arisen; is Cognitive Behavioral Therapy (CBT) adaptable for children and teens diagnosed with Autism? Fortunately, researchers have worked to develop modifications to CBT, such as making it more repetitive as well as including concrete thinking. Susan White, a CBT researcher notes that CBT should also address social skills in individuals with Autism because “the core social deficits in young people with ASD contribute to the experience of anxiety, which then serves to intensify the teen’s social problems.” With this new adaptive approach to CBT, individuals diagnosed with ASD were able to distinguish their maladaptive thoughts, feelings, and behaviors to work on replacing their thoughts and behaviors to be more adaptive (Anderson, 2012).

Theory

Cognitive behavioral therapy (CBT) is based on the theory that our thoughts cause our feelings and behaviors instead of external factors, like people, situations and events. Our thoughts have a direct relation to our feelings and behaviors (“What is Cognitive Behavior Therapy”, n.d.). The basis of CBT is helping clients change their distorted thinking and behavior to improve their mood and functioning.  If core beliefs are changed, then how they think and feel change, which leads to a change in behavior. CBT uses a variety of cognitive and behavioral techniques to aid the client to change their maladaptive thinking and behavior. The techniques must be practiced in therapy and also lived in real life situations to be the most effective. The CBT process is a short, structured, process that revolves around the collaborative nature of the client and therapist (Taylor, 2011).

Evidence

A randomized controlled trial completed by Storch, et. al. (2015) looked at the effects of a personalized CBT treatment intervention versus treatment as usual for adolescents with high functioning Autism who also had anxiety. The study found that the CBT intervention reduced anxiety symptoms and impairments while also showing improvements in social awareness, cognition, and communication. These gains were prevalent for over a one-month interval. In addition, the CBT protocol gave the parents skills to manage disruptive behavior.

Case Study

Sam is an 18-year-old boy who has a dual-diagnoses of autism spectrum disorder and anxiety. He is currently a freshman at a local college studying marine biology. He lives at home with mom, dad, and sister. Sam is struggling with his new college environment. He has become overwhelmed with the large crowds and fast pace on the college campus. Sam was referred to occupational therapy services after disrupting his crowded auditorium lectures multiple times. He has also been participating in a small study group, in which he has shown maladaptive coping skills. Sam has been seeing the OT for a couple sessions and we will now begin using cognitive behavioral therapy.

Intervention Plan

Problem Statement

Client is having difficulty managing high stress social interactions due to lack of appropriate coping skills.

Long term goals

1- Client will report independently implementing 1 coping strategy during a high stress social interaction in real world setting for increased performance in college in four months.

2-  Client will report zero outbursts during one study group session for increased quality of peer interaction in four months.

Short term goals

1-Client will list five triggers that impact his participation in study skills groups in one treatment session to increase coping skills.

2- Client will accurately demonstrate steps for progressive relaxation techniques in two treatment sessions to improve coping strategies.

3-  Client will implement 1 relaxation technique in a simulated high stress situation with one verbal cue in four treatment sessions.

Intervention format

Individual

Setting

The treatment sessions will take place in the occupational therapist’s office for 45 minutes sessions.

Supplies

None

Agenda & description

• Sam arrives at the OT office to begin the initial session of CBT (1 minute)
• The OT and Sam go through the following steps to facilitate CBT: (40 minutes)
  • Relationship building- the OT asks Sam what the problem is and what he wants to address
  • Initial Interview and Assessment- The OT has already completed an occupational profile on Sam from previous sessions. The OT will implement guided discovery as to identify Sam’s maladaptive coping skills.
  • Define Problems- empower Sam to create a problem list
  • Set goals- Set 3 STG and 2 LTG to work on from the problem list
  • Determine client appropriateness and readiness-
  • Teach CBT to improve coping skills- Sam was educated on the cognitive model and process of CBT. The OT discussed the importance of homework and learning to be one’s own therapist.
  • Educating the client about CBT- The OT validated the use of CBT and the shared the benefits of using it to improve Sam’s maladaptive coping skills.
  • Assign homework- The OT assigns homework for Sam to make a list of triggers that affect his participation in his study groups prior to the subsequent session.
• Summarize and elicit feedback (4 minutes)- The OT summarizes the problems and goals identified. Remind Sam to complete the homework. The OT will close the session by answering any questions that Sam may have and having Sam reflect on the session.

Documentation

S- Sam reports feeling frustrated during study groups and admits to having outbursts towards his classmates. He mentions feeling overwhelmed and not knowing how to cope with his feelings.

O- Sam participated in a 45 minute OT session with a focus on CBT. Sam with guidance was able to identify some of his problems during his previous study session. Out of this list Sam identified the most important long term goal he would like to work on from the previous problem list which is to be in a high stress situation and be able to idendepently implement an adaptive coping strategy without having any outburst. Sam was then educated on the CBT process and evidence with a focus on the importance of being ones therapist in the future. Sam was then assigned homework to complete a list of triggers before his next session.

A- Sam was eager to identify his goals and work towards learning how to cope during his study groups. He shows good intent and understanding to be ones therapist after completing his 4 month training of CBT. These factors prove that he is a good candidate to complete cognitive behavioral therapy.

P- Next session we will review assigned homework and will teach him to utilize a daily diary to document high stressful situations encountered throughout the week.

References

Anderson, C. (2012). Cognitive Behavioral Therapy and Autism Spectrum Disorders. Retrieved February 16, 2018, from https://iancommunity.org/cs/simons_simplex_community/cognitive_behavioral_therapy

Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., . . . Murphy,1. K. (2015). A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depression and Anxiety, 32(3), 174-181. http://dx.doi.org.ezproxy.fiu.edu/10.1002/da.22332

Taylor, Renee R. (2011). Overview of Cognitive Behavioral Therapy, Cognitive BehavioralTherapy for Chronic Illness and Disability (pp.15-17). Spring Street, New York: Springer Science +Business Media, Inc.

What is Cognitive Behavior Therapy | Beck Institute. (n.d.). Retrieved February 16, 2018, from What is Cognitive Therapy.