Effects of Cognitive-Behavioral Intervention on Emotion Regulation in Adults with High-Functioning Autism Spectrum Disorders: A Randomized Controlled Trial

Background: Adults with high-functioning autism spectrum disorders (ASD) have difficulties in social communication and therefore have deficits in understanding others’ minds. Recent research has found that they are unable to understand not only others’ but also their own minds. This could lead to difficulties in self-regulation. Some studies have reported the effectiveness of cognitive-behavioral therapy (CBT) in improving self-regulation for the children with ASD.

 Objectives: This study investigated the efficacy of group-based CBT for adults with ASD.

 Methods: The study was a randomized, waiting list controlled, open-blinded trial (This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry No. UMIN000006236). Participants were planned to be 30 adults with ASD in CBT group and the waiting list control group. Primary outcome measures were the 20-item Toronto Alexithymia Scale (TAS20), the Coping Inventory for Stressful Situations (CISS), the Motion Picture Mind-Reading (MPMR) task and a questionnaire about ASD. The secondary outcome measures were the CES-D, The QOL, the GAF scales, the State-trait Anxiety Inventory (STAI), the Social Phobia and Anxiety Inventory (SPAI) and the Liebowitz Social Anxiety Scale (LSAS). On the pre (within 4 weeks), post (within 4 weeks) and 12 week follow up period of the intervention, the all measures were examined. CBT group received group therapy over a 8-week period (1 session/week) with each session lasting approximately 100 min. Each group during therapy consisted of 4~5 adults with ASD and 2 psychologists. We used the visual materials for this intervention, mainly the Cognitive Affective Training (CAT) kit (Attwood, 2008).

 Results: A total of 82 individuals with ASD were referred to this study.  Of these, 60 (73.2 %) met inclusion criteria. For each of the outcome measures, we calculated the differences between pre- and post-assessment, pre- and follow-up assessment, and post- and follow-up assessment scores.  Differences between the control group and the waiting group were assessed using t-tests. These t-tests demonstrated significant differences (p < 0.05) between pre- and post-assessment scores on the TAS Factor 2, the ASD questionnaire (attitude), and between pre- and follow-up assessment scores on the CISS (E). Additionally, there were marginally significant differences (0.05≤p < 0.1) between pre and post-assessment scores on the CISS (T), GAF, and LSAS (A); between post- and follow-up assessment scores on the SPAI-(S) and CES-D; and between pre- and follow-up assessment scores on the GAF and LSAS (E & A).

  Conclusions: Our group-based CBT for adults with ASD improved their understanding of their own emotions and thoughts, increased their positive thinking regarding ASD, and enhanced their coping skills. There was some improvement in secondary symptoms, such as anxiety, depression, and social function. Therefore, this group-based CBT was effective. A limitation of this study was that the improvement regarding their understanding of their own emotions and thoughts, and their positive thinking towards ASD, could not be sustained. It was not clear whether such improvements were caused solely by the program’s curriculum, or by the additional effects of the group. Further studies should implement this program in the form of one-on-one sessions.