A Biofeedback-Based Embodied Awareness Intervention for Adults with ASD: Feasibility of a Community-Based Treatment

Background: As the number of adults living with ASD continues to grow, a lack of resources and lack of available interventions exacerbate their low quality of life, including low levels of education and employment, and high levels of co-morbid anxiety and depression. Here we build upon existing research showing the effectiveness of mindfulness-based interventions on individuals with ASD, to provide a low-cost biofeedback-enhanced training which can be implemented by non-professional staff, and may help autistic individuals grasp abstract contemplative techniques. We hypothesize that the intervention will decrease participants’ anxiety and autism symptoms, and increase their self-awareness, self-determination, and empathy.

Objectives: (a) To determine whether a biofeedback-based embodied awareness intervention is feasible in a community setting and whether adults with ASD can improve in levels of physiological regulation; (b) to determine whether the intervention decreases participants’ anxiety and autism symptoms, and increases their self-awareness, self-determination, and empathy; and (c) to determine whether improvements in physiological regulation are related to psychological measures.

Methods: Fourteen adults with ASD, residing in assisted living, were provided with 16 weekly half-hour biofeedback-based embodied awareness sessions with non-professional trainers, in which they learned to reduce their arousal levels through combined biofeedback and embodied awareness techniques, and apply those to everyday life. Quantitative and qualitative data was collected pre- and post-intervention. Physiological measures included changes in Heart Rate (HR), and HRV coherence (i.e., Low Frequencies (0.04 to 0.15 Hz)/All Frequencies). Psychological measures examined self-awareness (Toronto Alexithymia Scale; TAS), self-determination (ARC), anxiety (Glasgow Anxiety Scale; GAS), autism symptoms (Social Responsiveness Scale; SRS), and empathy (Reading the Mind in the Eyes Test; RMET).

Results: Participants were capable of successfully improving their physiological arousal levels on the biofeedback setup and we found initial indications for gains in all hypothesized domains on the quantitative measures.

Participants’ HR decreased through the time of the intervention by an average of 8.38bpm (t(12)=2.86, p=.014). At the same time, their HRV coherence increased, on average, during each session (M=6.92, SD=8.3), both measures indicating greater relaxation.

Participants showed a trend towards a reduction in ASD symptoms (SRS Self- and Caregiver report), a decrease in anxiety (GAS), an increase in self-determination (ARC), an increase in adaptive behaviors to challenging situations, and an increase in empathy (RMET); though these differences did not meet statistical significance. They did not show a decrease in alexithymia (TAS).

We further found a correlation between a decrease in anxiety symptoms (GAS pre-post) and the rate of increase in HRV coherence (rho=-.694, p=.008), suggesting that as participants gained control of their HRV, anxiety levels decreased.

Qualitative reports by participants and counselors revealed that participants applied the techniques in many real-life situations, and these had far-ranging effects on their emotional regulation, work and social motivation, and self determination.

Conclusions: The study provides proof-of-concept for a low-cost, community-based intervention which can ameliorate the lives of adults with ASD. Future studies should continue to examine the impacts of biofeedback-based embodied awareness interventions at various levels of intensity, and across different sub-populations of the autism spectrum.