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

Maddox, Brenna B.; Crabbe, Samantha R.; Fishman, Jessica M.; Beidas, Rinad S.; Brookman-Frazee, Lauren; Miller, Judith S.; Nicolaidis, Christina; Mandell, David S.

doi:10.1007/s10803-019-04156-0

Original Paper
Published: 05 August 2019

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

Brenna B. Maddox^1,2,
Samantha R. Crabbe¹,
Jessica M. Fishman^1,3,
Rinad S. Beidas^1,2,4,
Lauren Brookman-Frazee^5,6,7,
Judith S. Miller^1,8,
Christina Nicolaidis^9,10 &
David S. Mandell¹

Journal of Autism and Developmental Disorders volume 49, pages 4421–4428 (2019)Cite this article

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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

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
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
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
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
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
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
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.
Article PubMed PubMed Central Google Scholar
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
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
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
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
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
Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. New York: Psychology Press.
Google Scholar
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
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.
Article PubMed Google Scholar
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
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.
Article PubMed Google Scholar
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
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
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
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.
Article PubMed Google Scholar
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
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
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
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).

Author information

Authors and Affiliations

Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Brenna B. Maddox, Samantha R. Crabbe, Jessica M. Fishman, Rinad S. Beidas, Judith S. Miller & David S. Mandell
Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
Brenna B. Maddox & Rinad S. Beidas
Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
Jessica M. Fishman
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Rinad S. Beidas
Department of Psychiatry, University of California, San Diego, CA, USA
Lauren Brookman-Frazee
Child and Adolescent Services Research Center, San Diego, CA, USA
Lauren Brookman-Frazee
Autism Discovery Institute at Rady Children’s Hospital, San Diego, CA, USA
Lauren Brookman-Frazee
Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Judith S. Miller
School of Social Work, Portland State University, Portland, OR, USA
Christina Nicolaidis
Department of Medicine, Oregon Health and Science University, Portland, OR, USA
Christina Nicolaidis

Authors

Brenna B. Maddox
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Samantha R. Crabbe
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Jessica M. Fishman
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Rinad S. Beidas
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Lauren Brookman-Frazee
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Judith S. Miller
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Christina Nicolaidis
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David S. Mandell
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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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Published: 05 August 2019
Issue Date: November 2019
DOI: https://doi.org/10.1007/s10803-019-04156-0

Keywords

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