Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools.

Sebastian B Gaigg,Brenda Meyer,Gracie Mclaven,Corinna Haenschel,Ritika Shah,Dermot M Bowler,Mikle South,Amanda Roestorf,Paul E Flaxman,Jacqui Rodgers

doi:10.1177/1362361320909184

Abstract

Anxiety in autism is an important treatment target because of its consequences for quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can ameliorate anxiety in autism but cost-effective delivery remains a challenge. This pilot randomised controlled trial examined whether online cognitive behaviour therapy and mindfulness-based therapy self-help programmes could help reduce anxiety in 54 autistic adults who were randomly allocated to either an online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme or a waitlist control group (n = 19). Primary outcome measures of anxiety, secondary outcome measures of broader well-being and potential process of change variables were collected at baseline, after programme completion, and then 3 and 6 months post-completion. Baseline data confirmed that intolerance of uncertainty and emotional acceptance accounted for up to 61% of self-reported anxiety across all participants. The 23 participants who were retained in the active conditions (14 mindfulness-based therapies, 9 cognitive behaviour therapies) showed significant decreases in anxiety that were maintained over 3, and to some extent also 6 months. Overall, results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools may provide a cost-effective method for delivering mental health support to those autistic adults who can engage effectively with online support tools.Lay abstractAnxiety in autism is an important target for psychological therapies because it is very common and because it significantly impacts upon quality of life and well-being. Growing evidence suggests that cognitive behaviour therapies and mindfulness-based therapies can help autistic individuals learn to manage feelings of anxiety but access to such therapies remains problematic. In the current pilot study, we examined whether existing online cognitive behaviour therapy and mindfulness-based therapy self-help tools can help reduce anxiety in autistic adults. Specifically, 35 autistic adults were asked to try either an existing online cognitive behaviour therapy (n = 16) or mindfulness-based therapy (n = 19) programme while a further 19 autistic adults served as a waitlist comparison group. A first important finding was that 23 of the 35 (66%) participants who tried the online tools completed them, suggesting that such tools are, in principle, acceptable to many autistic adults. In addition, adults in the cognitive behaviour therapy and mindfulness-based therapy conditions reported significant decreases in anxiety over 3 and to some extent also 6 months that were less apparent in the waitlist group of participants. On broader measures of mental health and well-being, the benefits of the online tools were less apparent. Overall, the results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools.

Highlights

The majority of autistic children, adolescents and adults have one or more associated mental health conditions (Buck et al, 2014; Simonoff et al, 2008), with co-occurring anxiety disorders among the most common concerns
The results suggest that online self-help cognitive behaviour therapy and mindfulness-based therapy tools should be explored further as a means of providing cost-effective mental health support to at least those autistic individuals who can engage effectively with such online tools
Evidence suggests that cognitive behaviour therapy (CBT) and mindfulness-based therapy (MBT) can help reduce anxiety in autism (Cachia et al, 2016; Spain et al, 2015), access to appropriate mental health services is currently inadequate for the autism community, for adults (Lake et al, 2014; Turcotte et al, 2016)

Summary

Introduction

The majority of autistic children, adolescents and adults have one or more associated mental health conditions (Buck et al, 2014; Simonoff et al, 2008), with co-occurring anxiety disorders among the most common concerns. MBTs have been attracting increasing attention as an approach for managing anxiety in autism, partly because they cultivate present moment awareness and non-judgmental attitudes towards difficult thoughts, feelings and bodily sensations (Farb et al, 2012; Guendelman et al, 2017; Nyklíček & Kuijpers, 2008) This may be effective in the context of autism where anxiety is commonly linked to sensory processing differences and elevated levels of alexithymia (ALX; see Vorst & Bermond, 2001), which is characterised by difficulties in identifying and describing one’s own emotions (Maisel et al, 2016; Milosavljevic et al, 2016; Nicholson et al, 2019).

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