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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211. https://doi.org/10.1016/0749-5978(91)90020-t.
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40, 471–499. https://doi.org/10.1348/014466601164939.
Beacon, B. J., & Abramowitz, J. S. (2004). Cognitive and behavioral treatments for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology, 60, 429–441. https://doi.org/10.1002/jclp.10255.
Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K. E., Schoenwald, S., Evans, A. C., et al. (2015). Predictors of community therapists’ use of therapy techniques in a large public mental health system. JAMA Pediatrics, 169(374–382), 2015. https://doi.org/10.1001/jamapediatrics.2014.3736.
Brookman-Frazee, L., Drahota, A., Stadnick, N., & Palinkas, L. A. (2012). Therapist perspectives on community mental health services for children with autism spectrum disorders. Administration and Policy In Mental Health, 39, 365–373. https://doi.org/10.1007/s10488-011-0355-y.
Buck, T. R., Viskochil, J., Farley, M., Coon, H., McMahon, W. M., Morgan, J., et al. (2014). Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 3063–3071. https://doi.org/10.1007/s10803-014-2170-2.
Community Behavioral Health. (2017). 2017 Annual Report: Philadelphia Behavioral HealthChoices Program. Retrieved June 22, 2019, from the Community Behavioral Health website: https://dbhids.org/wp-content/uploads/2018/10/CBH-2017-Annual-Report-1.pdf.
Cooper, K., Loades, M. E., & Russell, A. (2018). Adapting psychological therapies for autism. Research in Autism Spectrum Disorders, 45, 43–50. https://doi.org/10.1016/j.rasd.2017.11.002.
Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., et al. (2015). The health status of adults on the autism spectrum. Autism, 19, 814–823. https://doi.org/10.1177/1362361315577517.
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive–behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58, 376–385. https://doi.org/10.1177/070674371305800702.
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50.
David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9, 4. https://doi.org/10.3389/fpsyt.2018.00004.
DiMauro, J., Domingues, J., Fernandez, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour Research and Therapy, 51, 82–86. https://doi.org/10.1016/j.brat.2012.10.003.
Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. New York: Psychology Press.
Fishman, J., Beidas, R., Reisinger, E., & Mandell, D. S. (2018). The utility of measuring intentions to use best practices: A longitudinal study among teachers supporting students with autism. Journal of School Health, 88, 388–395. https://doi.org/10.1111/josh.12618.
Fishman, J., Lushin, V., Lawson, G., Seidman, M., Beidas, R. S., & Mandell, D. S. (2019). A theory for implementation prediction (TIP): Applying causal models of behavior change to specific evidence-based practices.
Frazier, T. W., Dawson, G., Murray, D., Shih, A., Sachs, J. S., & Geiger, A. (2018). Brief report: A survey of autism research priorities across a diverse community of stakeholders. Journal of Autism and Developmental Disorders, 48, 3965–3971. https://doi.org/10.1007/s10803-018-3642-6.
Ingersoll, B., Straiton, D., Casagrande, K., & Pickard, K. (2018). Community providers’ intentions to use a parent-mediated intervention for children with ASD following training: An application of the theory of planned behavior. BMC Research Notes, 11, 777. https://doi.org/10.1186/s13104-018-3879-3.
Maddox, B. B., Crabbe, S., Beidas, R. S., Brookman-Frazee, L., Cannuscio, C. C., Miller, J. S., Nicolaidis, C., & Mandell, D. S. (2019). “I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults.
Moullin, J. C., Ehrhart, M. G., & Aarons, G. A. (2018). Development and testing of the Measure of Innovation-Specific Implementation Intentions (MISII) using Rasch measurement theory. Implementation Science, 13, 89. https://doi.org/10.1186/s13012-018-0782-1.
Pellicano, E., Dinsmore, A., & Charman, T. (2014). What should autism research focus upon? Community views and priorities from the United Kingdom. Autism, 18, 756–770. https://doi.org/10.1177/1362361314529627.
Powell, B. J., Beidas, R. S., Rubin, R. M., Stewart, R. E., Wolk, C. B., Matlin, S. L., et al. (2016). Applying the policy ecology framework to Philadelphia’s behavioral health transformation efforts. Administration and Policy in Mental Health, 43(6), 909–926. https://doi.org/10.1007/s10488-016-0733-6.
Roux, A. M., Shattuck, P. T., Rast, J. E., Rava, J. A., & Anderson, K. A. (2015). National autism indicators report: Transition into young adulthood. Philadelphia: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University.
Salsberg, E., Quigley, L., Mehfoud, N., Acquaviva, K., Wyche, K., & Sliwa, S. (2017). Profile of the social work workforce. Retrieved June 22, 2019, from the Council on Social Work Education website: https://www.cswe.org/Centers-Initiatives/Initiatives/National-Workforce-Initiative/SW-Workforce-Book-FINAL-11-08-2017.aspx.
Shattuck, P. T., Wagner, M., Narendorf, S., Sterzing, P., & Hensley, M. (2011). Post high school service use among young adults with autism spectrum disorder. Archives of Pediatrics and Adolescent Medicine, 165, 141–146. https://doi.org/10.1001/archpediatrics.2010.279.
Spain, D., Sin, J., Chalder, T., Murphy, D., & Happé, F. (2015). Cognitive behaviour therapy for adults with autism spectrum disorders and psychiatric co-morbidity: A review. Research in Autism Spectrum Disorders, 9, 151–162. https://doi.org/10.1016/j.rasd.2014.10.019.
Weiss, J. A., & Lunsky, Y. (2010). Group cognitive behaviour therapy for adults with Asperger syndrome and anxiety or mood disorder: A case series. Clinical Psychology and Psychotherapy, 17, 438–446. https://doi.org/10.1002/cpp.694.
White, S. W., Simmons, G. L., Gotham, K. O., Conner, C. M., Smith, I. C., Beck, K. B., et al. (2018). Psychosocial treatments targeting anxiety and depression in adolescents and adults on the autism spectrum: Review of the latest research and recommended future directions. Current Psychiatry Reports, 20, 82. https://doi.org/10.1007/s11920-018-0949-0.
Wolitzky-Taylor, K., Zimmermann, M., Arch, J. J., De Guzman, E., & Lagomasino, I. (2015). Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy, 72, 9–17. https://doi.org/10.1016/j.brat.2015.06.010.
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).
Conflict of interest
The authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- Autism spectrum disorder
- Cognitive–behavioral therapy
- Community mental health
- Implementation science
- Theory of planned behavior