Improving Emotion Regulation in Teens with Autism through Mindfulness

Background: Research indicates that impaired emotion regulation (ER), or the ability to modulate one’s arousal and emotional state, underlies many of the co-occurring psychiatric and behavioral concerns that are frequently seen in ASD (Mazefsky & White, 2014). The majority of psychosocial treatment research in ASD has focused on the remediation of anxiety in children via cognitive-behavioral therapy (CBT). While largely efficacious, response has been variable with effect sizes lower than in non-ASD youth (Kreslins et al., 2015); further, anxiety protocols generally do not address other common problems such as explosive behavior, meltdowns, irritability, anger, and depression that stem from impaired ER. ER impairments may magnify the developmental vulnerability of adolescence for those with ASD who do not have co-occurring intellectual disability. Adolescents with ASD face a critical gap in empirically based treatment options to support the transition to adulthood. To address this significant treatment need, we developed the Emotion Awareness and Skills Enhancement (EASE) Program. EASE is a 16-session individual therapy program for verbal adolescents and young adults with ASD designed to improve ER capacity.

Objectives: We sought to develop and evaluate a novel treatment targeting ER impairment in adolescents and adults with ASD. EASE emphasizes awareness of one’s own emotional responses as a foundational skill that promotes the ability to manage intense negative emotions, which is taught through mindful awareness. Mindfulness may be ideally suited for improving ER, as it involves cultivating awareness of emotional states and distress tolerance, and an open and accepting attitude through the use of meditative practices and activities (Kabat-Zinn et al. 1985).

Methods: We utilized a participatory action framework for manual development. After development of the first draft of materials, we sought input from individuals with ASD, therapists experienced in MBIs, ASD, and manualized intervention trials, and parents of children with ASD. Refinements to the treatment were made based on feedback received. In a pilot, two-site open clinical trial, eligible participants (i.e., 12-17 years old, confirmed diagnosis of ASD, IQ > 80) received the treatmentulti-method data were collected at pre, post, and three-month follow-up.

Results: Pilot data support feasibility (20 eligible participants enrolled within less than six months), acceptability to consumers (based on quantitative and qualitative data and high retention rates), and viability of dissemination (high treatment fidelity across 8 therapists and 2 sites). Preliminary analyses suggest that EASE is associated with statistically significant improvements with moderate to large effect sizes. Clinical Global Impressions-Improvement (CGI-I) scores (made by an independent rater) that take functioning across environments and overall symptom impairment into account correspond to a mean of “Much Improved” and 100% of participants demonstrated at least some improvement. Declines in emotional reactivity, irritability, and depression were also observed.

Conclusions: EASE is a new mindfulness-based intervention, developed for adolescents and adults with ASD. The primary treatment target is improved emotion regulation, which should have downstream positive effects on socialization, mental health, and more global and functional outcomes.