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An Introduction to CBT for people with an Autism Spectrum Disorder

By Torrey Creed, PhD     Adjunct Faculty, Beck Institute

While a description of CBT for Autism Spectrum Disorders (ASD) would require a large volume (at least), let’s highlight several important areas to consider when working with people with an autism spectrum disorder (ASD). 5299266366_0b6c8ae172_oFirst, a word about what we do not do in CBT for ASD: we do not treat the ASD itself. CBT will not move someone to being neurotypical, nor should it. Instead, we focus on secondary issues that are related to the experience of life on the autism spectrum: depression, bullying, stress, anger, aggression, anxiety, social skills deficits, and limited social support.

 

People with ASD have unique cognitive and behavioral styles, which vary with the severity of their ASD symptoms. Therefore, as with any client, we creatively adapt and adjust CBT to meet the strengths and needs of the individual. People on the ASD spectrum are generally very concrete thinkers, so we need to modify standard CBT to be more experiential and concrete than usual. Individuals who are cognitively on the higher end of functioning may benefit from a mix of both cognitive and behavioral strategies, but when their functioning is more impaired, the therapist de-emphasizes cognitive techniques.  The ideas described below may be a better fit for a higher-functioning client,  but most can be made more concrete for someone whose cognitive style makes abstract thought even more challenging.

 

As with all CBT clients, we start with a cognitive conceptualization, identifying key cognitions and behaviors to target in treatment. Engagement and the therapeutic relationship are key with any client, but building these with clients with ASD may be even more essential, and also challenging. Therefore, from the beginning of treatment, we help clients explore their goals, passions, and values, then identify specific steps that CBT can help them make in service of that long term goal. Framing treatment about things the individual truly values can increase both engagement and the relationship. Aspects of the ASD or the sequelae from secondary issues (e.g. information from the case conceptualization) are framed as challenges to reaching the goals, and CBT then becomes a way to address those challenges in order to move toward the tailored goals.

 

A component of treatment often focuses on the “rules of the game” in social situations, which may be intuitive to others but are generally very hard for a person with ASD to penetrate. CBT helps them learn to better read social interactions and read others’ reactions and behavior more accurately so they can more easily monitor and adjust their own behavior and responses. We help people work toward self-acceptance and compensatory strategies to mitigate the impact of things that cannot be changed (like specific cognitive deficits). We also help them learn to recognize and modify unhelpful patterns of information processing which contribute to stress, anxiety, and depression. Our major focus, as in any CBT, remains on teaching cognitive and behavioral skills and strategies that will help the person move closer to his or her goals, as well as preventative strategies to decrease or prevent symptoms of comorbid mental health concerns, such as anxiety disorders and depression.

 

Common beliefs of people with ASD include “I must stay in control because there may be danger;” “If I try to fit in, I’ll fail;” “If I stay away from people, I won’t get hurt;” “I can’t understand what is going on in [my] world;”  or “Everyone takes advantage of me.” They also have negative beliefs about themselves, “I’m flawed;” “I’m weird,” “I’m out of control;” “I’m incompetent;” or “I’m vulnerable.” These beliefs may pose serious challenges to reaching a person’s individualized goals, and often these beliefs can become self-fulfilling prophecies. Helping people to shift to more accurate and more helpful cognitions is a powerful tool in helping them realize their goals and potential.

 

When the client is a child with ASD, that child is usually the identified client; however, working with families is also essential. Families may struggle with ASD-related issues, including a child’s obsessive interests, angry outbursts, poor self-care, repetitive rituals, and odd behavior. Parents may also experience frustration (with the child, or with others’ reactions to the child), and siblings may have strong reactions to their own experiences of being in a family with a child with ASD. Helping family members to identify ways in which their patterns of thinking, feeling, or behaving may be more or less helpful (or accurate) can help shift the dynamic of the family in a positive direction.

 

There is much more to learn about CBT with individuals with ASD. The work can be challenging but is also highly creative-and rewarding, as we see them and their families reaching their own meaningful goals.

CBT for Children and Adolescents: Advanced Workshop

Topics covered include how to:

  • Develop an individualized cognitive case conceptualization for youths with OCD or other anxiety disorders or Autism Spectrum Disorder
  • Create a tailored treatment plan from early treatment through relapse prevention
  • Deliver specific, empirically based CBT interventions for individuals and for families, and
  • Determine whether those interventions have been effective.

Training focuses on therapy with clients between the ages of 7 and 18 with Autism Spectrum Disorder, OCD or other anxiety disorders.

This workshop features a special question and answer and role-play session with Dr. Aaron Beck. Participants are encouraged to prepare or have in mind cases for discussion or role-play.

When:    June 1-3, 2015
Where:      Beck Institute, Suburban Philadelphia
Time:   8:45am – 4pm
Faculty: Torrey Creed, PhD
Enrollment:  Limited to 42 participants
CE/CMEs:  18

 

To register:   

https://www.beckinstitute.org/advanced-cbt-for-children-and-adolescents/

June 20 – 22, 2011, Cognitive Behavior Therapy Workshop Level ll: Personality Disorders and Challenging Problems

Last week Beck Institute held its second Cognitive Behavior Therapy Workshop Level II: Personality Disorders and Challenging Problems. Psychologists, psychiatrists, social workers, councilors, and other professionals traveled from all over the world, including Brazil, Romania, Singapore, Switzerland, Turkey, Uzbekistan, Zimbabwe and seven U.S. states, to receive training in Cognitive Behavior Therapy. Participants received professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.  Lectures and role-plays emphasized the need for the therapeutic alliance in order to differentiate the therapist from everyone else.  The need to identify core beliefs and automatic thoughts as soon as possible was also stressed.  Dr. Sokol discussed patient collaboration and made it clear that a therapist should always be there for the client.  The use of mood checks was discussed and participants were told that a patient will start with negative emotions and it is critical to probe them for positives to counter the negatives.

CBT Worksheet Demonstration

Dr. Judith Beck (right) demonstrated how to use a variety of CBT worksheets for therapists to use, such as the Cognitive Conceptualization Diagram. Dr. Beck encouraged workshop participants to roleplay with one another to practice CBT techniques. One of the highlights of the workshop was watching Dr. Aaron Beck (above-left) conduct a live patient session.  Dr. Beck started the session with a mood check and followed with setting the agenda.   Following the patient interview, Dr. Beck led a case discussion with workshop participants. All participants are pictured (below) with both Drs. Beck.

May 23 – 25, 2011, Cognitive Behavior Therapy Workshop Level I: Depression and Anxiety

May 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurses and other professionals from mental health, medical, and related fields traveled from 16 states and 8 countries (including Brazil, Cayman  Islands, Denmark, Peru, Romania, Sweden, Switzerland, and Turkey) to attend this month’s Cognitive Behavior Therapy Workshop Level I on Depression and Anxiety at Beck Institute.

Participants had the opportunity to gain professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed and engaged in demonstration role-plays among other activities.

Cognitive Therapy Demonstration

Participants had the benefit of watching Dr. Aaron Beck conduct a live patient session, which was viewed via closed-circuit television. Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured above left), during which he explained what the next session should include. Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one. Participants noted some key techniques that Dr. Beck used which they found to be quite useful:

  • Normalizing patient’s emotions and beliefs
  • Providing patient with language with which they can describe and validate their thoughts
  • Instilling hope and reassuring successful treatment
  • Trying a variety of methods including imagery
  • Collaboration with the patient in terms of treatment model to prevent the patient from seeing the therapist as an authority figure
  • Finding some light anecdotes, humor can be a nice touch in sessions

Following the questions regarding the patient session, Dr. Beck answered participants’ questions on other subjects, such as Positive Psychology and CBT, and CBT with depressed patients in chronic pain. Dr. Judith Beck (pictured right) spoke about cognitive behavior therapy with depressed patients and their automatic thoughts.  She emphasized psychoeducation, treatment planning, goal setting, and activity scheduling with patients.  Dr. Leslie Sokol (pictured below) spoke about the need for anxiety and the need to learn how to control it, rather than mask it with medication.  She emphasized the use of Socratic questioning and interoseptive exposure experiments in treatment.  Dr. Norman Cotterell (pictured below) spoke about suicidality.

We are so pleased that so many professionals from all over the world were able to come to the Beck Institute for such an exciting workshop!

More event highlights:

May 2 – 4, 2011, Cognitive Behavior Therapy Workshop Level II: Personality Disorders and Challenging Problems

Earlier this month, Beck Institute held the first Cognitive Behavior Therapy Workshop Level II: Personality Disorders and Challenging Problems.  In attendance were psychologists, psychiatrists, social workers, councilors, and other professionals from Brazil, Canada, Hong Kong, Sweden, Thailand, and nine U.S. states.  This higher level workshop provided extra training and guidance to professionals that wished to improve their abilities for the benefit of their clients.

Demonstration of Cognitive Behavioral Therapy Techniques

The workshop focused on the use of CBT for challenging problems, anger management, substance abuse, and Axis II disorders.  The Beck Institute faculty used role-plays and discussions to demonstrate the CBT techniques that would be useful with various patients. On day two, Dr. Aaron Beck spoke about research being done currently on the use of CBT with Schizophrenic patients.  Treatments are looking into the negative symptoms of patients and working with them to change their emotions regarding the hallucinations.  Random assignment of medication in Britain has shown that patients, who discontinue use of medication, still improve with CBT.  The workshop attendees were then able to see Dr. Aaron Beck use the techniques he pioneered in two role-plays.  Attendees brought real patient scenarios in front of the group in order to gain insight into treatment. The first role-play was about a lawyer in her late 30’s who went through a recent divorce.  She now has signs of depression, social anxiety, and OCD.  After the role-play, participants noted the following:

  • Dr. Beck followed a pattern of asking questions to elaborate on emotions and beliefs and then providing capsule summaries of the patient’s beliefs in an attempt to narrow in the focus of the problem.
  • Using mental rehearsal as an intervention, the patient would be able to see the rationality, or lack thereof, of her beliefs.
  • After focusing in on the problem, Dr. Beck analyzed the situation and assigned the patient homework (attending a party) that would push her anxieties.

The second role-play was about an unemployed man in his 40’s who has an unstable relationship, little friends, and constantly complains about the way he is treated.  This patient has a history of abuse and shows signs of social anxiety.  Attendees noted the following in Dr. Beck’s approach:

  • Dr. Beck focused on trying to conceptualize the patient’s views.
  • Using gentle interruptions and positive feedback, Dr. Beck was able to give the patient advice without looking like an authority figure.
  • The conversation was always pulled back into that which the patient had control over.

Participants received professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.

April 4 – 6, 2011, Cognitive Behavior Therapy Workshop Level I

April 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, and other professionals from mental health, medical, and related fields traveled from 18 states and 8 countries, including Australia, Brazil, Canada, France, Ireland, New Zealand, Peru, and United Arab Emirates. Pictured above-left, Dr. Aaron T. Beck conducts a roleplay with Ricardo Luiz Malina Losso, a psychiatrist from Brazil, to demonstrate useful techniques to use for challenging problems when working with patients. Dr. Beck also conducted a live patient session that was viewed (via closed-circuit television) by participants in the April 4 – 6, 2011, Cognitive Behavior Therapy Workshop Level I at Beck Institute.

Cognitive Behavioral Therapy Treatment Plan

Following the patient interview Dr. Beck answered questions from participants in a case discussion (pictured below), during which he explained what the next session should include (see video clip here). Dr. Beck explained agenda setting, beginning with a review of homework and went on to explain that he asks patients, “What problems do you want my help in solving today?” to guide them into naming the problems (as opposed to giving a full description at that moment), then prioritize the problems and let him know roughly about how much of the session they’d like to devote to each one.

(Right) Dr. Judith Beck conducts a roleplay with David Black, a psychologist from Missouri.  Dr. Beck discussed how to differentiate between practical and psychological problems, and how to use a cognitive framework to understand why psychological problems arise. Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, observed

and engaged in demonstration roleplays among other activities. More event highlights:

Level I Cognitive Behavior Therapy Workshop for Professionals at Beck Institute: February 7 – 9, 2011

February 2011: Psychologists, psychiatrists, physicians, social workers, professors, counselors, nurse practitioners, and other professionals from mental health, medical, and related fields traveled from 15 states and 4 countries, including Brazil, Canada, Japan, and Turkey. Pictured above-left, Aaron T. Beck, M.D. answers questions after conducting a live patient session that was viewed (via closed-circuit television) by participants in the Cognitive Behavior Therapy workshop at Beck Institute. (Below/right) Judith S. Beck, Ph.D. and Julie Hergenrather, Ph.D., announce upcoming Level II Cognitive Behavior Therapy Workshops at Beck Institute and answer questions on our Beck Supervision Program – a distance learning program that provides intensive, one-on-one supervision from your home state or country.  Level II CBT Workshops are designed for experienced professionals who have already received at least some basic training in CBT and seek to enhance their ability to deliver CBT efficiently and effectively to clients who pose a challenge in treatment. Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, and observed demonstration roleplays among other activities. More event highlights:

Advanced Cognitive Behavior Therapy Experiential Workshop at Beck Institute: November 8 – 10, 2010

Aaron T. Beck, M.D.NOVEMBER 2010: (Left) Dr. Aaron Beck answers questions after conducting a live patient session that was viewed (via closed-circuit television) by participants in the Advanced Experiential Cognitive Behavior Therapy Workshop. The workshop was attended by psychiatrists, psychologists, social workers, counselors and other professionals who traveled from Australia, Brazil, Canada, Mexico, Saudi Arabia, Singapore, United Kingdom, and ten U.S. states. (Right) Dr. Judith Beck conducts a roleplay with Saima Salman, MSc, a psychotherapist from Singapore. The Advanced Workshop was designed for professionals at intermediate and advanced levels of trainingJudith S. Beck, Ph.D. and experience who wanted to enhance their ability to deliver cognitive behavior therapy efficiently and effectively to clients who pose a challenge in treatment. Participants presented cases from their practices. Beck Institute faculty (Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.) taught the group advanced conceptualization techniques and treatment planning, then demonstrated cognitive behavior therapy interventions through demonstration roleplays and supervised participants in dyadic roleplays. Many topics were covered, including anger, early trauma, self harm behavior, binge eating, substance abuse, anxiety, chronic depression, hopelessness and suicidalitiy. Developing the therapeutic relationship and engaging reluctant patients in treatment were emphasized. 123456

Cognitive Behavior Therapy Workshop for Professionals at Beck Institute: September 27 – 29, 2010

Aaron T. Beck, M.D.SEPTEMBER 2010: Psychologists, psychiatrists, social workers, professors, school counselors, nurse practitioners, and other professionals from mental health, medical, and related fields traveled from 18 states and 10 countries, including Australia, Brazil, Canada, Germany, Hong Kong, Jamaica, Japan, Netherlands, Pakistan and United Kingdom. Pictured above-left, Aaron T. Beck, M.D. answers questions after conducting a live patient session that was viewed (via closed-circuit television) by participants in the Cognitive Behavior Therapy workshop at Beck Institute.

Aaron T Beck, M.D., also met with scholarship winners Ellen Driessen, MSc, Jordana Muroff, Ph.D., LICSW, and Scott Ries, MSW, who were all granted full tuition scholarships to attend one of our 3-Day workshops.  They represent three out of ten winners from our Scholarship Competition held in March 2010, which received over 880 entries from around the world!

Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, and observed demonstration roleplays among other activities. More event highlights:

Beck Institute Participants (1)Beck Institute Participants (2)Judith S. Beck, Ph.D. and Aaron T. Beck, M.D.Leslie Sokol, Ph.D.Norman Cotterell, Ph.D.Judith S. Beck, Ph.D.

Special Cognitive Behavior Therapy Workshop for Students and Post-Doctoral Fellows: August 9 – 11, 2010

Aaron T. Beck, M.D. AUGUST 2010: Post-doctoral fellows, psychiatry residents, social work interns, nurses, and other graduate students from mental health, medical, and related fields traveled from 20 states and 8 countries, including Brazil, Canada, Denmark, Hong Kong, Ireland, Lebanon, Mexico, Turkey, and United Kingdom. Pictured above-left, Aaron T. Beck, M.D. answers questions from students in the Cognitive Behavior Therapy workshop hosted by Beck Institute. (Below/Right) Torrey Creed, Ph.D., conducts a roleplay demonstrating techniques in Cognitive Behavior Therapy for children and adolescents. Participants received professional training in Cognitive Behavior Therapy from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Torrey Creed, Ph.D. Trainees participated in seminars and case discussions, reviewed videos of therapy sessions, and observed demonstration roleplays among other activities. More event highlights: Aaron T. Beck, M.D. and Judith S. Beck, Ph.D.Judith S. Beck, PhDLeslie Sokol, Ph.D.Leslie Sokol, Ph.D. (lecture)Judith S. Beck, Ph.D.