What is Cognitive Behaviour Therapy?
Many people have heard of Cognitive Behaviour Therapy (CBT) and it is often recommended as the treatment of choice for many mental health conditions.
Although CBT is often stated as the most effective treatment, many autistic people question its validity and utility amongst their population.
This article will discuss in more depth: Is CBT effective for autistic children and young people?
What is Cognitive Behaviour Therapy (CBT)?
CBT, known as a talking therapy, is often the treatment of choice for many mental health difficulties including anxiety, depression and low self esteem. It is based on the premise that how you think about a situation, impacts on the way you feel. Common 'thinking traps' include fortune telling (your brain tricks you into thinking that you know what will happen), catastrophising (thinking the worst possible outcome) and blowing things out of proportion (for example, you lost a mark in a test which means you are a total loser).
You may then behave in ways as a consequence that can inadvertently lead to the feeling ultimately getting stronger and more impactful on someone's life (for example, asking for reassurance, avoidance, or using certain behaviours believed to keep you safe from the perceived threat).
The aim of CBT is to identify 'unhelpful' negative thoughts and thinking styles, and work towards making them more realistic or 'helpful'. This is done through time and goal oriented sessions which involve practising skills within and between sessions. A person learns to identify difficult thoughts, notice thinking errors, and engage in behavioural experiments to test out the validity of the thought/belief/prediction.
How is CBT adapted for neurodivergent children and young people?
There are many ways that CBT can be adapted to make it more accessible for autistic people. The number of sessions offered is typically more and may be more 'doing' than talking in basis (for example, more focus on the 'b' bit of CBT rather than the 'c'). More time is typically spent helping the autistic person understand what a feeling is, and how to notice it within their body. There may be more visuals used within sessions to support a persons natural strength in visual thinking. Utilising a persons interests can be very effective.
In our experience, sticking to the 'book' when it comes to CBT is not helpful. It is important to be dynamic and flexible and meet the young person where they are at. It is important that we adapt any therapy to meet the young person's needs, rather than it being the other way around.
What do autistic people say about CBT?
For many neurodivergent people, CBT can be very helpful in dealing with particular challenges, as long as it is adapted to their needs. Rigidity within any therapeutic modality just does not work. The benefits of CBT are that it is time-limited, goal oriented and an active therapy so the young person can learn strategies for dealing with difficulties right from the start of therapy.
However, there is growing unrest in the autistic community of CBT and how it is being used to treat mental health difficulties. It is felt that too many autistic people are given the message that how they think is 'wrong' and therefore they must learn to think in new, better ways. This can feel very invalidating to the autistic person and too ableist in its approach.
We find that integrating aspects of CBT within therapy works well, rather than being rigid and dedicated to the approach. Noticing thinking patterns is very helpful, as is the impact these can have on our behavioural decisions and outcomes. Learning to notice feelings and be aware of our triggers is so helpful and enables us to learn ways of regulating moment to moment, rather than waiting until the last minute to do something about it.
Approaches such as Acceptance and Commitment therapy, Compassion Focussed therapy and Dialectical Behaviour therapy are also very helpful therapies to utilise in therapy.
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