Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T11:10:46.790Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive behavioural therapy in the treatment of social skills deficits and social phobia in a man with an autism spectrum disorder: a single-case study

Published online by Cambridge University Press:  03 February 2016

Mark A. Turner  and
Neil Hammond
Mark A. Turner*
Affiliation:
Adult Autism Spectrum Disorders Service, South London and Maudsley NHS Foundation Trust National Services, Maudsley Hospital, Denmark Hill, London, UK
Neil Hammond
Affiliation:
Adult Autism Spectrum Disorders Service, South London and Maudsley NHS Foundation Trust National Services, Maudsley Hospital, Denmark Hill, London, UK
*
*Author for corresponding: Dr M. A. Turner, Room 28, Counting House, St John’s Institute of Dermatology, Guy’s Hospital, Great Maze Pond, London SE1 9RT, UK (email: mark.turner@gstt.nhs.uk).
Get access Rights & Permissions [Opens in a new window]

Abstract

Autism spectrum disorders (ASD) including high-functioning types such as Asperger's syndrome (AS) are diagnosed when there is evidence of a triad of qualitative impairments in social interaction, communication, and stereotyped/repetitive behaviours. It is not uncommon for these impairments to be accompanied by social anxiety. The present single-case study investigates the use of cognitive behavioural therapy (CBT) to treat a 47-year-old man who was assessed as having difficulties with social skills and social phobia in the context of a late diagnosis of AS. He received 20 h of CBT adapted for his AS in 15 sessions including a 1-month follow-up. Following a highly individualized formulation, treatment included modelling, role-playing, reinforcement, thought challenging, and behavioural experimentation. Results from five self-report measures showed continued improvements from the start of therapy to follow-up in social anxiety, global distress, depression and self-esteem. The client gave positive feedback about his experience of treatment. The case study is discussed with reference to limitations and some reflections for CBT in ASD.

Keywords

Autism spectrum disorderssocial skillssocial anxiety.
Type
Practice article
Information
the Cognitive Behaviour Therapist , Volume 9 , 2016 , e3
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended follow-up reading

Gaus, V (2007). Cognitive-Behavioural Therapy for Adult Asperger Syndrome. New York: The Guilford Press.Google Scholar
Wells, A (1997). Cognitive Therapy of Anxiety Disorders: a Practice Manual and Conceptual Guide. Chichester: John Wiley & Sons.Google Scholar

References

Ambery, FZ, Russell, AJ, Perry, K, Morris, R, Murphy, DGM (2006). Neuropsychological functioning in adults with Asperger syndrome. Autism 10, 551–564.CrossRefGoogle ScholarPubMed
Anderson, S, Morris, J (2006). Cognitive behaviour therapy for people with Asperger Syndrome. Behavioural and Cognitive Psychotherapy 34, 293–303.CrossRefGoogle Scholar
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Association.Google Scholar
Baker, SL, Heinrichs, N, Kim, H-J, Hofmann, SG (2002). The Liebowitz social anxiety scale as a self-report instrument: a preliminary psychometric analysis. Behaviour Research and Therapy 40, 701–715.CrossRefGoogle ScholarPubMed
Bandura, A (1977). Self-efficacy: toward a unifying theory of behavioural change. Psychological Review 84, 191–215.CrossRefGoogle Scholar
Barnhill, GP, Tapscott Cook, K, Tebbenkamp, K, Smith Myles, B (2002). The effectiveness of social skills intervention targeting nonverbal communication for adolescents with Asperger syndrome and related pervasive developmental delays. Focus on Autism and Other Developmental Disabilities 17, 112–118.CrossRefGoogle Scholar
Baron-Cohen, S, Leslie, AM, Frith, U (1985). Does the autistic child have a ‘theory of mind’? Cognition 21, 37–46.CrossRefGoogle ScholarPubMed
Baron-Cohen, S, Wheelwright, S (2004). The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders 34, 163–175.CrossRefGoogle ScholarPubMed
Beck, AT (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.Google Scholar
Beck, AT, Steer, RA, Ball, R, Ranieri, W (1996 b). Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of personality assessment 67, 588–97.CrossRefGoogle Scholar
Beck, AT, Steer, RA, Brown, GK (1996 a). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Bellini, S (2004). Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities 19, 78–86.CrossRefGoogle Scholar
Cardaciotto, L, Herbert, JD (2004). Cognitive behavior therapy for social anxiety disorder in the context of Asperger's syndrome: a single-subject report. Cognitive and Behavioral Practice 11, 75–81.CrossRefGoogle Scholar
Cath, DC, Ran, N, Smit, JH, van Balkom, AJLM, Comijs, HC (2008). Symptom overlap between autism spectrum disorder, generalized social anxiety disorder and obsessive-compulsive disorder in adults: a preliminary case-controlled study. Psychopathology 41, 101–110.CrossRefGoogle ScholarPubMed
Chalfant, A, Rapee, R, Carroll, L (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. Journal of Autism and Developmental Disorders 37, 1842–1857.CrossRefGoogle ScholarPubMed
Clark, DM, Ehlers, A, Hackmann, A, McManus, F, Fennell, M, Grey, N, Waddington, L, Wild, J (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology 74, 568–578.CrossRefGoogle ScholarPubMed
Clark, DM, Wells, A (1995). A cognitive model of social phobia. In: Social Phobia: Diagnosis, Assessment, and Treatment (ed. Heimburg, R. G., Liebowitz, M. R., Hope, D. A. & Schneier, F. R.), pp. 69–93. New York: The Guilford Press.Google Scholar
Colle, L, Baron-Cohen, S, Wheelwright, S, van der Lely, HKJ (2007). Narrative discourse in adults with high-functioning autism or Asperger syndrome. Journal of Autism and Developmental Disorders 38, 28–40.CrossRefGoogle ScholarPubMed
Evans, C, Connell, J, Barkham, M, Margison, F, McGrath, G, Mellor-Clark, J, Audin K (2002). Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM. British Journal of Psychiatry 180, 51–60.CrossRefGoogle ScholarPubMed
Evans, C, Mellor-Clark, J, Margison, F, Barkham, M, Audin, K, Connell, J, McGrath, G (2000). CORE: clinical outcomes in routine evaluation. Journal of Mental Health 9, 247–255.CrossRefGoogle Scholar
Fresco, DM, Coles, ME, Heimberg, RG, Liebowitz, MR, Hami, S, Stein, MB, Goetz, D (2001). The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine 31, 1025–1035.CrossRefGoogle Scholar
Gaus, V (2007). Cognitive-Behavioural Therapy for Adult Asperger Syndrome. New York: The Guilford Press.Google Scholar
Gaus, V (2011). Adult Asperger syndrome and the utility of cognitive-behavioral therapy. Journal of Contemporary Psychotherapy 41, 47–56.CrossRefGoogle Scholar
Ghaziuddin, M, Weidmer-Mikhail, E, Ghaziuddin, N (1998). Comorbidity of Asperger syndrome: a preliminary report. Journal of Intellectual Disability Research 42, 279–283.CrossRefGoogle ScholarPubMed
Gilchrist, A, Green, J, Cox, A, Burton, D, Rutter, M, Couteur, AL (2001). Development and current functioning in adolescents with Asperger syndrome: a comparative study. Journal of Child Psychology and Psychiatry 42, 227–240.CrossRefGoogle ScholarPubMed
Hare, D (1997). The use of cognitive-behavioural therapy with people with Asperger Syndrome. Autism 1, 215–225.CrossRefGoogle Scholar
Hill, EL (2004). Executive dysfunction in autism. Trends in Cognitive Sciences 8, 26–32.CrossRefGoogle ScholarPubMed
Hopko, DR, Lejuez, CW, Ruggiero, KJ, Eifert, GH (2003). Contemporary behavioral activation treatments for depression: Procedures, principles, and progress. Clinical Psychology Review 23, 699–717.CrossRefGoogle ScholarPubMed
Howlin, P (2003). Outcome in high-functioning adults with autism with and without early language delays: implications for the differentiation between autism and Asperger syndrome. Journal of Autism and Developmental Disorders 33, 3–13.CrossRefGoogle ScholarPubMed
Howlin, P, Yates, P (1999). The potential effectiveness of social skills groups for adults with autism. Autism 3, 299–307.CrossRefGoogle Scholar
Humphreys, K, Minshew, N, Leonard, GL, Behrmann, M (2007). A fine-grained analysis of facial expression processing in high-functioning adults with autism. Neuropsychologia 45, 685–695.CrossRefGoogle ScholarPubMed
Jolliffe, T, Baron-Cohen, S (1999). A test of central coherence theory: linguistic processing in high-functioning adults with autism or Asperger syndrome: is local coherence impaired? Cognition 71, 149–185.CrossRefGoogle ScholarPubMed
Lang, R, Regester, A, Lauderdale, S, Ashbaugh, K, Haring, A (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: a systematic review. Developmental Rehabilitation 13, 53–63.Google ScholarPubMed
McPartland, JC, Reichow, B, Volkmar, FR (2012). Sensitivity and specificity of proposed DSM-5 diagnostic criteria for autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry 51, 368–383.CrossRefGoogle ScholarPubMed
Mesibov, G (1984). Social skills training with verbal autistic adolescents and adults: a program model. Journal of Autism and Developmental Disorders 14, 395–404.CrossRefGoogle ScholarPubMed
Ozonoff, S, Miller, J (1995). Teaching theory of mind: a new approach to social skills training for individuals with autism. Journal of Autism and Developmental Disorders 25, 415–433.CrossRefGoogle ScholarPubMed
Padesky, CA, Mooney, KA (1990). Clinical tip: presenting the cognitive model to clients. International Cognitive Therapy Newsletter 6, 13–14.Google Scholar
Reaven, J, Hepburn, S (2003). Cognitive-behavioural treatment of obsessive-compulsive disorder in a child with Asperger syndrome. Autism 7, 145–164.CrossRefGoogle Scholar
Rosenberg, M (1965). Conceiving the Self. New York: Basic Books.Google Scholar
Russell, AJ, Mataix-Cols, D, Anson, MAW, Murphy, DGM (2009). Psychological treatment 21 for obsessive-compulsive disorder in people with autism spectrum disorders – a pilot 22 study. Psychotherapy and Psychosomatics 78, 59–61.CrossRefGoogle Scholar
Salkovskis, PM (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy 19, 6–19.CrossRefGoogle Scholar
Sinclair, SJ, Blais, MA, Gansler, DA, Sandberg, E, Bistis, K, LoCicero, A (2010). Psychometric properties of the Rosenberg self-esteem scale: overall and across demographic groups living within the United States. Evaluation & the Health Professions 33, 56–80.CrossRefGoogle ScholarPubMed
Skokauskas, N, Gallagher, L (2010). Psychosis, affective disorders and anxiety in autistic spectrum disorder: prevalence and nosological considerations. Psychopathology 43, 8–16.CrossRefGoogle ScholarPubMed
Sofronoff, K, Attwood, T, Hinton, S (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry 46, 1152–1160.CrossRefGoogle ScholarPubMed
Sze, K, Wood, J (2007). Cognitive behavioural treatment of comorbid anxiety disorders and social difficulties in children with high-functioning autism: a case report. Journal of Contemporary Psychotherapy 37, 133–143.CrossRefGoogle Scholar
Thwaites, R, Freeston, MH (2005). Safety-seeking behaviours: fact or function? how can we clinically differentiate between safety behaviours and adaptive coping strategies across anxiety disorders? Behavioural and Cognitive Psychotherapy 33, 177–188.CrossRefGoogle Scholar
Weiss, JA, Lunsky, Y (2010). Group cognitive behaviour therapy for adults with Asperger syndrome and anxiety or mood disorder: a case series. Clinical Psychology & Psychotherapy 17, 438–446.CrossRefGoogle ScholarPubMed
Wellman, HM, Baron-Cohen, S, Caswell, R, Gomez, JC, Swettenham, J, Toye, E, Lagattuta, K (2002). Thought-bubbles help children with autism acquire an alternative to a theory of mind. Autism 6, 343–363.CrossRefGoogle ScholarPubMed
Wells, A (1990). Panic disorder in association with relaxation induced anxiety: an attentional training approach to treatment. Behavior Therapy 21, 273–280.CrossRefGoogle Scholar
Wells, A (1997). Cognitive Therapy of Anxiety Disorders: a Practice Manual and Conceptual Guide. Chichester: John Wiley & Sons.Google Scholar
WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization.Google Scholar
Wood, JJ, Drahota, A, Sze, K, Har, K, Chiu, A, Langer, DA (2009). Cognitive behavioural therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry 50, 224–234.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.