30061
Feasibility of Schema Therapy in Young Adults with High-Functioning Autism Spectrum Disorder in Japan: A Pilot Study
Individuals with autism spectrum disorder (ASD) have better subjective prognosis or higher quality of life (QOL) when they are diagnosed in childhood (Kamio, 2012). However, diagnosis is often delayed until adulthood in high-functioning ASD (HF-ASD) individuals, who may not receive the appropriate care or support (Mandy et al., 2012). Furthermore, undiagnosed ASD individuals are at a higher risk for mistreatment, such as bullying or abuse (White, 2009); 65%–80% of ASD adults have accompanying mental disorders, including depression and anxiety. Schema therapy (ST) is a psychotherapy that has evolved from cognitive behavior therapy with good therapeutic results on complicated diseases, such as personality disorders and post-traumatic stress disorder (Hawk & Provencher, 2012). Additionally, it has shown positive results for borderline personality disorders. However, there are few studies of ST in HF-ASD adults (Vuijk & Arntz, 2017). ST follows the process of understanding nonfunctional coping mechanisms that an ASD individual has been implementing for many years, while instilling and implementing new coping mechanisms. We believe that ST is effective in HF-ASD individuals suffering from a sense of chronic social maladaptation; therefore, we examined the effectiveness of ST in a pilot study.
Objectives:
This study evaluated the feasibility, acceptability, and preliminary effectiveness of ST in 10 HF-ASD individuals with comorbidity of psychiatric disorders.
Methods:
Ten HF-ASD individuals (age, >20 years) with at least one psychiatric symptom were administered a treatment protocol comprising 30 weekly offered sessions. A concurrent multiple baseline design was used, with a baseline of 1–3 weeks, followed by a psychological assessment using developmental tests such as autism diagnostic interview-revised and autism diagnostic observation schedule. Next, the study therapist started a psychological education with the patients about HF-ASD and ST for 5–8 weeks, which was followed by a 10-week exploration phase with weekly sessions wherein current and past functioning, psychological symptoms, and schema modes were explored and information about the treatment was provided. Subsequently, 15 weekly sessions in cognitive-behavioral interventions and 20 weekly sessions in experiential interventions were conducted. Finally, a follow-up session was conducted 3 months after the intervention. During pretreatment, posttreatment, and follow-up session, we evaluated the Global Assessment of Functioning score as the main outcome from independent researchers in this study as well as WHO-QOL scale and other psychiatric symptom severity scales .
Results:
Regarding pretreatment and posttreatment scores, we found significant reduction in symptoms of depression and improvement in social functions and QOL. Effect sizes of Cohen’s d was 3.3 for global assessment of functioning, 0.69 for WHO-QOL, 0.62 for maladaptive schema reduction increase, and 0.56 for mode reduction. Regarding follow-up score, we found significant reduction in symptoms of general anxiety, social anxiety, and obsession and significant in overall functioning (Fig.1).
Conclusions:
To our knowledge, this is the first uncontrolled clinical trial to provide evidence that ST combined with psychoeducation in ASD can be implemented and adapted for use in short-term outpatient settings. However, generalizability of this study is limited owing to the small sample size and lack of control group.