Factors Influencing the Use of Cognitive–Behavioral Therapy with Autistic Adults: A Survey of Community Mental Health Clinicians


Cognitive–behavioral therapy (CBT) can improve anxiety and depression in autistic adults, but few autistic adults receive this treatment. We examined factors that may influence clinicians’ use of CBT with autistic adults. One hundred clinicians completed an online survey. Clinicians reported stronger intentions (p = .001), more favorable attitudes (p < .001), greater normative pressure (p < .001), and higher self-efficacy (p < .001) to start CBT with non-autistic adults than with autistic adults. The only significant predictor of intentions to begin CBT with clients with anxiety or depression was clinicians’ attitudes (p < .001), with more favorable attitudes predicting stronger intentions. These findings are valuable for designing effective, tailored implementation strategies to increase clinicians’ adoption of CBT for autistic adults.

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The authors are grateful to our community partners and the study participants.


This work was funded by the National Institute of Mental Health (F32MH111166; PI: Maddox) and the FAR Fund (PI: Maddox).

Author information




RSB, LB-F, BBM, and DSM conceived of the study. RSB, LB-F, JMF, BBM, DSM, JSM, and CN developed and reviewed the survey questions. SRC participated in the coordination of the study and data collection. BBM participated in data collection, performed the statistical analyses, and drafted the manuscript. JMF, BBM, and DSM led the interpretation of the data. All authors read and revised earlier drafts of the manuscript. All authors approved the final manuscript for publication.

Corresponding author

Correspondence to Brenna B. Maddox.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study were in accordance with the Ethical Standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Maddox, B.B., Crabbe, S.R., Fishman, J.M. et al. Factors Influencing the Use of Cognitive–Behavioral Therapy with Autistic Adults: A Survey of Community Mental Health Clinicians. J Autism Dev Disord 49, 4421–4428 (2019). https://doi.org/10.1007/s10803-019-04156-0

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  • Adults
  • Autism spectrum disorder
  • Cognitive–behavioral therapy
  • Community mental health
  • Implementation science
  • Theory of planned behavior