Cognitive Behavioral Therapy and Autism

Cognitive Behavioral Therapy or CBT is a therapeutic intervention used in higher functioning autistic individuals as a way of overcoming problems related to anxiety (including obsessive compulsive disorders), depression, and self-esteem. It was originally developed in the 1950’s and 60’s by different psychiatrist/psychologists, most prominent among them being Aaron Beck. In its beginning CBT grew from practitioners’ dissatisfaction with the results of psychoanalysis and the lack of quantitative outcome measures that the former discipline offered.

Cognitive Behavioral Therapy upholds the value of rationality in helping define individualized programs with specific and realistic goals to help treat psychopathologies and induce positive emotions. It is not about examining why bad things happen to people but about providing patients the proper tools to come to grips with aversive situations, facing the triggers causing their dissatisfaction, and finally helping them master their state of mind.

CBT upholds that thoughts, behaviors and emotions are all interconnected. In this regard positive changes to emotional problems may be achieved by targeting changes in thoughts and behaviors. It also upholds that thoughts should be considered as only opinions that can be changed. Therapy usually lasts some 12 to 24 sessions that require complete transparency to the patient. The therapist reviews the problems, analyzes them (when are they present?, severity, how often they occur?), and provides a hypothesis driven execution of a program tailored to that particular individual. A CBT therapist will help you institute a program with exercises and questionnaires that will improve your problems. The therapist will also help identify factors that may impair your judgment (e.g., alcohol use), and help treat stress, fatigue or pain that may add to your ongoing burden.


CBT has been widely used, and has had positive results, in major depression. This condition is characterized by sad mood, changes in appetite and sleep patterns, feelings of worthlessness and poor concentration and memory. People with major depression may keep their jobs but the same brings no pleasure, and is done with more difficulty (like swimming in molasses). People with major depression tend to avoid social contact. Unfortunately social contacts of patients with major depression also avoid contact for fear that whatever they say may hurt that individual. Some outcome measures used when treating major depression include the Beck Depression Inventory and the Hoplessness Scale.

Events with a negative emotional impact rapidly worsen with time. People tend to overpersonalize and magnify the importance of such events. In this regard you have to deal with them early on, as soon as possible. People caught in a downward cognitive spiral need to stop ruminating, fantasizing and to avoid all or none thinking. You can acknowledge the truth in some of your negative thoughts, but bring them into proper perspective. Will the event matter after 5 years? Is there a silver lining to the experience? Are your thoughts fair? CBT helps you be kind to yourself.
Remember that evolution has taught us to remember things that put us in danger or that can be considered as threats. This makes it more difficult to find the things that give us pleasure or for which we should feel gratitude. We need to learn to shift our attention from failure and loss to those of achievements, things that are positive in life.

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