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

Abstract

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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References

  1. 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.

    Article  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

  8. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. New York: Psychology Press.

    Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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.

    Google Scholar 

  24. 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.

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

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Acknowledgments

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

Funding

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

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Authors

Contributions

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.

Ethical Approval

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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Keywords

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