Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review Article Accepted Version Spain, D., Sin, J., Harwood, L., Mendez, M. A. and Happé, F. (2017) Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review. Advances in Autism, 3 (1). pp. 34-46. ISSN 2056-3868 doi: https://doi.org/10.1108/AIA-07-2016-0020 Available at http://centaur.reading.ac.uk/70088/ It is advisable to refer to the publisher’s version if you intend to cite from the work. See Guidance on citing . To link to this article DOI: http://dx.doi.org/10.1108/AIA-07-2016-0020 Publisher: Emerald All outputs in CentAUR are protected by Intellectual Property Rights law, including copyright law. Copyright and IPR is retained by the creators or other copyright holders. Terms and conditions for use of this material are defined in the End User Agreement . www.reading.ac.uk/centaur
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Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review Article
Accepted Version
Spain, D., Sin, J., Harwood, L., Mendez, M. A. and Happé, F. (2017) Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review. Advances in Autism, 3 (1). pp. 3446. ISSN 20563868 doi: https://doi.org/10.1108/AIA0720160020 Available at http://centaur.reading.ac.uk/70088/
It is advisable to refer to the publisher’s version if you intend to cite from the work. See Guidance on citing .
To link to this article DOI: http://dx.doi.org/10.1108/AIA0720160020
Publisher: Emerald
All outputs in CentAUR are protected by Intellectual Property Rights law, including copyright law. Copyright and IPR is retained by the creators or other copyright holders. Terms and conditions for use of this material are defined in the End User Agreement .
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CBT for social anxiety in ASD
Figure 1 – PRISMA diagram
Papers initially identified
(n = 1363)
Papers retrieved for initial screening
(n = 1200)
Papers retreived for full-text review
(n = 22)
Papers included in the review
(n = 4 case studies)
Additional papers identified
(n = 1)
Papers excluded
(n = 19)
Papers excluded
as titles & abstracts irrelevant
(n = 1178)
Duplicate papers excluded
(n = 163)
CBT for social anxiety in ASD
Table 1: Overview of included studies
Study Participants Interventions Modifications Outcome Measures Results
Cardaciotto & Herbert
2004
US
Male, aged 23
Diagnosis
- Asperger syndrome
- Social anxiety disorder
- Low mood
Modality
Individual sessions
Duration
14 sessions
Intervention remit
- Improve social skills
- Reduce anxiety and
avoidance of social
situations
- Enhance assertiveness
- Augment employment
skills
Formulation
Longitudinal model
Techniques
- Psychoeducation
- Skills rehearsal
- Role play
- In vivo exposure
- Cognitive restructuring
- Homework
- Psychoeducation about
abstract and complex
constructs
- Inclusion of social skills
training
- Simplified and discrete
tasks
- Numerous opportunities
for rehearsal
Social anxiety
- SCID IV
- LSAS
- STAI
Mental health
- BDI II
General functioning
- CGI
Behavioural assessment
- Role play tasks
- General reductions in
anxiety and avoidance
behaviours
- Increased coping
strategies
- Post-treatment, the
patient no longer met
criteria for SAD
- Global functioning
ratings changed from
severely ill to much
improved
- Low mood symptoms
lifted
Schleismann & Gillis
2011
US
Male, aged 6
Diagnosis
- Asperger syndrome
- Social anxiety disorder
Modality
- Individual sessions
- Augmented by carer
involvement
Duration
12 sessions
Intervention remit
- Simplification of
abstract concepts
- Visual schedule to
outline session activities
- Inclusion of social
stories
- Cue cards and visual
aids
- A parent-training
Social anxiety
- RCMAS
- FSSC
General functioning
- VABS II
Behavioural assessment
- BASC 2PRS
- General reductions in
anxiety and avoidance
behaviours
- Increased coping
strategies
- Increase in approach
behaviours and social
CBT for social anxiety in ASD
- Reduce anxiety and
avoidance of social
situations
Formulation
Maintenance model
Techniques
- Psychoeducation
- Development of coping
skills
- Skills rehearsal
- In vivo exposure
- Parent training
- Homework
Carer-component
- Psychoeducation
- Behavioural skill
training
- Modelling and rehearsal
- Feedback
component
- Numerous opportunities
for rehearsal and
modelling
initiation
Turner and Hammond
2016
UK
Male, aged 47
Diagnosis
- Asperger syndrome
- Social anxiety disorder
- Low mood
Modality
Individual sessions
Duration
15 sessions
Intervention remit
- Improve social skills
- Reduce anxiety and
avoidance of social
situations
Formulation
Longitudinal and
maintenance models
- Inclusion of social skills
training
- Modelling of
appropriate social skills
- Psychoeducation about
abstract or complex
constructs
- Simplified and discrete
tasks
- Cue cards and visual
aids (mind maps)
- Coping statements
- Numerous opportunities
for rehearsal
Social anxiety
- LSAS
- SPWSS
Mental health
- BDI II
- RSE
General functioning
- CORE OM
- General reductions in
anxiety and avoidance
behaviours
- Increased coping
strategies
- Post-treatment, social
anxiety symptoms had
reduced to below the
clinical cut-off
- Global functioning
ratings changed to
indicate significant
improvement
CBT for social anxiety in ASD
Techniques
- Psychoeducation
- Skills rehearsal
- Diarising activities
- In vivo exposure
- Cognitive restructuring
- Attention training
- Behavioural
experiments
- Homework
- Low mood symptoms
lifted
- Self-esteem enhanced
Wright
2013
UK
Male, aged 19
Diagnosis
- Autism
- Intellectual disability
- Social anxiety disorder
Modality
Individual sessions
Duration
11 sessions
Intervention remit
- Reduce anxiety and
avoidance of social
situations
- Increase activity levels
Formulation
Longitudinal model
Techniques
-Psychoeducation
- Relaxation techniques
- Positive self-talk
- In vivo exposure
- Cognitive restructuring
- Psychoeducation about
abstract or complex
constructs
- Simplified and discrete
tasks
- Use of cue cards
- Increased focus on
formulation development
Mental health
- BSI
- An idiosyncratic
measure to rate physical
symptoms of anxiety
- General reductions in
anxiety and avoidance
behaviours
- Increased activity levels
- Improvements in
general mental health
SCID IV - Structured Clinical Interview for Disorders; LSAS - Liebowitz Social Anxiety Scale; STAI - Social Phobia and Anxiety Inventory; BDI II - Beck Depression Inventory II; CGI -
Clinical Global Impression; RCMAS - Revised Children’s Manifest Anxiety Scale; FSSC - Fear Survey Schedule for Children; VABS II - Vineland Adaptive Behaviour Scales II; BASC –
2PRS - Behaviour Assessment System for Children-2 Parent Rating Scales; SPWSS - Social Phobia Weekly Summary Scale; RSE - Rosenberg Self-esteem Scale; CORE - OM - Clinical
Outcomes in Routine Evaluation; BSI - Brief Symptom Inventory