Emotion Regulation and Empathy in an Adult Social Skills Intervention

Background: Empathy and emotion regulation (ER) are critical contributors to success in social and vocational settings for adults with autism spectrum disorder (ASD). Individuals with ASD often have difficulties both reading and regulating emotional states, which may interfere with their ability to react appropriately in social situations (Mazefsky, Pelphrey, & Dahl, 2012; Mazefsky & White, 2014). It is believed that impairments in ER may relate to challenges with perspective-taking, which is key to empathy (Baron-Cohen & Wheelwright, 2004). Empathy and ER are two treatment considerations and potential targets that may help to optimize outcomes in psychosocial interventions for adults with ASD.

Objectives: To examine baseline levels and resulting changes in empathy and emotion regulation endorsements in the context of the Social Tools and Rules for Transitions (START) Program for Young Adults with ASD.

Methods: Twenty-eight young adults with ASD and fluent language use (18-25 years, M = 20.72) participated in a young adult version of the START program, an experiential social competence and motivation intervention (Vernon, Miller, Ko, Barrett, McGarry, 2017). Participants were randomly assigned to immediate treatment (n = 12) or waitlist control (n = 16) groups for 20 weeks. The peer-mediated START sessions were facilitated by undergraduates and consisted of individual check-in/check-out meetings, free socializing periods, interactive topic discussions (e.g., conversation skills, relationships, social momentum, and employment), and structured social games. Participants and mentors also went on weekly social community outings. Participants completed self-report measures at baseline and post-intervention/post-waitlist, including the Empathy Quotient (EQ) and BASC-3. Higher scores on the EQ are associated with greater levels of empathy, while higher scores on the Emotional Symptoms Index (ESI) composite of the BASC-3 are associated with greater internal distress and emotional disturbance.

Results: For all participants, there was a significant negative correlation between the EQ and the BASC-3 ESI at baseline (r(26) = -.543, p = .003; Figure 1). For the treatment group, a linear regression revealed that baseline ESI scores predicted change in empathy scores from baseline to post-intervention (r² = .595, F(1,9) = 13.25, p = .005; Figure 2). A repeated measures ANOVA yielded a significant Group x Time interaction for the EQ, F(1,23) = 5.41, p = .029. The BASC-3 ESI scores did not change significantly from baseline to post-intervention.

Conclusions: Results indicate significant improvements in empathy in the context of the START socialization program. Findings also indicate that individuals with fewer symptoms of emotional dysregulation at baseline report higher empathy, suggesting a possible relationship between emotional control and the ability to infer and relate to the emotional states of others. Greater ER difficulties at baseline were linked to greater improvements in empathy scores. This finding suggests that ER profiles may be one predictor of individual difference in response to psychosocial interventions. ER may be addressed indirectly through practice enhancing emotional language in the START intervention (Mazefsky & White, 2014). Future research will explore ER as an important treatment target that underlies increased social understanding and relatedness for adults with ASD.