Exploring cognitive behavioral therapy (CBT) for autism

Autism spectrum disorder (ASD) is a form of neurodivergence that shapes how you view yourself and experience the world. Being autistic isn't something to cure or change, but many people find that therapy can help them improve their quality of life and overall well-being.

Cognitive behavioral therapy (CBT) is one technique that’s often used to help people with autism. Some supporters say it can help lessen anxiety and teach people healthy coping skills to respond to stress in different ways. That said, others believe that CBT isn’t an effective tool for autism. 

Below, we break down the benefits of CBT for autistic people, how it compares to other therapies, and when it can help you reach your goals. 

What is CBT, and does it work for people with autism? 

CBT focuses on the link between a person’s thoughts, feelings, and behaviors. It can show you how to identify harmful thought patterns and replace them with more positive and empowering alternatives. While CBT is considered the gold standard of psychotherapy ^[1] for a wide range of conditions, that doesn’t mean it's the right fit for everyone’s needs. 

As a goal-oriented approach, CBT focuses on improving unhelpful behaviors and beliefs. It requires people to identify and describe challenges in their lives, which can sometimes feel difficult for people with autism. Another consideration is that many autistic people find it hard to label their emotions ^[2], which can make it more challenging to find a link between those feelings and their behaviors. 

If you have trouble with uncertainty, accepting change, or communicating with others, CBT may feel a bit overwhelming at times. Fortunately, the right modifications can make CBT an effective tool for the neurodivergent community.

How CBT can be adapted for autistic people

Autistic people process information and communicate differently than neurotypical people, and it’s important that therapy accounts for those differences. Before starting therapy, your provider might conduct an assessment to learn more about your personality, your perspective, and how they can help you reach your goals.

A therapist can adapt CBT to better meet the needs of autistic people ^[3] by: 

• Adjusting the pace of sessions: Your provider may choose to slow the pace of therapy. This creates space to process topics, take breaks, and develop new skills without feeling overwhelmed.

• Creating a predictable routine: Many autistic people have a strong preference for structure and routine. To help meet those needs, your therapist might offer to provide an agenda at the start of sessions and a summary at the end. 

• Incorporating special interests: Having special interests is also common among autistic people. If you're interested in something like weather or animals, for example, it might be helpful for your therapist to incorporate those things into your care. 

• Using visual aids: Your therapist may also use visual aids to make the experience more effective. Some examples include diagrams, charts, and imagery.

• Trying group therapy: CBT in a group setting is a chance to connect with others who experience similar challenges. It offers a safe space to open up, even for people who feel uncomfortable in new social situations or find it difficult to make friends. 

When someone with autism might consider CBT

CBT is often used to address secondary issues related to life on the spectrum. For example, coping with stress or difficult situations can be particularly challenging for autistic people. 

An autistic person might consider CBT to: 

Improve social skills

Research shows that CBT can help improve social skills and reduce social anxiety ^[4]. With the support of your therapist, you might work on things like interpreting social cues, starting conversations, and managing emotional responses.

Ease sleep struggles

It’s common for people with autism to have difficulty sleeping. You might struggle to fall asleep, stay asleep, or wind down at the end of the day. 

With CBT, you can learn to identify and change thoughts or behaviors that interfere with sleep. For example, your therapist might encourage you to keep a sleep diary to help identify any factors that are impacting your sleep. 

Manage mental health conditions 

Autistic people may be more likely to have co-occurring conditions. With CBT, you can develop the skills to cope with mental health conditions like:

• Anxiety disorders

• Depression

• Attention-deficit hyperactivity disorder (ADHD) 

• Obsessive-compulsive disorder (OCD)

Improve family communication and understanding

Involving family members in CBT sessions can help improve communication and increase understanding of how you experience the world. Having the support of your loved ones can also empower you to navigate challenging situations and overwhelming emotions. 

Considerations when choosing a provider

The client-therapist relationship is at the center of any successful therapy experience. When choosing a therapist, look for someone who makes you feel seen, supported, and understood. It’s also OK if the first therapist you meet isn’t the right fit. Finding a provider who understands your needs may take more than one try.

Questions to ask a prospective therapist include:

• “How do you adapt CBT when working with autistic clients?”

• “How will we work together to create goals and monitor my progress?”

• “Do you have experience with autistic experiences like masking and alexithymia?”

• “How do you handle issues like shutdowns, meltdowns, or overwhelm during sessions?

Clinician’s take

CBT tends to work better for autistic clients when their reactions are treated as understandable responses to stress, not errors that need correcting. Feeling believed and not argued with makes the work feel supportive instead of rigid.

Brandy Chalmers, LPC

Clinical reviewer