COGNITIVE BEHAVIORAL THERAPY FOR AUTISM AND ASPERGERS DISORDER

COGNITIVE BEHAVIORAL THERAPY FOR AUTISM AND ASPERGER’S DISORDER Using CBT and Executive Functioning Skill Building to build hope and decrease stress by Michael Uram, MA, LMFT, LPCC

WHAT IS COGNITIVE BEHAVIORAL THERAPY? Cognitive Behavioral Therapy is essentially a process of having an outside observer differentiate between your thoughts, feelings and behaviors. https: //beckinstitute. org/get-informed/what-iscognitive-therapy/ The therapist then helps you see the world as realistically as possible through identifying Cognitive Distortions and biases. Then therapist helps you plan how to change your behaviors to match the feelings that you would prefer to have through choosing which thoughts you would like to emphasize, and which thoughts you would prefer to decrease in intensity and frequency.

WHAT IS AUTISM? Autism is a term that has changed significantly from its first description. You may hear it described differently based on the specialty of the provider that you see. Currently, it describes a wide range of behaviors and levels of severity. In the DSM-5, a brief summary is: Persistent deficits in social communication and social interaction across multiple contexts AND restricted, repetitive patterns of behavior, interests, or activities. https: //www. psychiatry. org/psychiatrists/practice/ds m

THE AUTISM SPECTRUM Other than being diagnosed with Autism, I help many clients that are also diagnosed with very similar diagnoses. Most of the clients that I work with are diagnosed with the recently discontinued diagnosis of Asperger’s, which I believe is better represented as Social (Pragmatic) Communication Disorder 315. 39 (F 80. 89) in the DSM-5. https: //www. spectrumnews. org/opinion/viewpoint/eviden ce-weak-for-social-communication-disorder/ Most of the clients that I help that are diagnosed with Autism are diagnosed at Level 1 of 3 on the Severity Scale.

FOR THERAPISTS, WHAT IS THE PREFERRED METHOD OF DIAGNOSIS? For Kids, the ADOS -2 is preferred. For adults, the ADOS, module 4 is preferred. The Autistic Diagnostic Observation Scale, Second Edition has many great competitors though. More information about the ADOS-2 can be found here: https: //www. wpspublish. com/store/p/2648/ados-2 autism-diagnostic-observation-schedule-secondedition

HOW DO YOU ADAPT COGNITIVE BEHAVIORAL THERAPY FOR AUTISM? Consider Theory of Mind concerns first. My interventions are specific to the individuals level of perspective taking ability, mindsight, outsight, emotional range, and emotional intensity. For Example, Tony Attwood developed a program called Exploring Anger and Exploring Anxiety specifically for individuals diagnosed with Autism and Asperger’s: http: //www. tonyattwood. com. au/books-by-tony-m/english -books/65 -exploring-feelings It simplifies the process of how a thought morphs into a feeling and becomes a more stable core belief. It then examines how we can change our beliefs based on literal experimentation.

DOES IT CURE AUTISM? Autism is a diagnostic criteria that we are as yet uncertain of its biological origins or how to define that one has been cured, although there have been great leaps in progress over the past few years. I work on the secondary aspects of Autism, that may lead someone to no longer meet criteria for diagnosis, but I would not call it a cure.

WHAT DOES CHANGE? I have found that individuals that participate in treatment have: an increased level of emotional awareness a decreased impulse to escalate their emotions more patience more flexibility

INCREASING EMOTIONAL AWARENESS Through using the Atlas of Emotions, I have found that there is a scientific manner to explore emotions: http: //atlasofemotions. org/ If the client has difficulty understanding a wide range of emotions, which is often, I focus on six basic emotions and we role play, use Affectiva’s Affdex. Me App, and guess what emotions a person would experience. i. OS only https: //itunes. apple. com/us/app/affdexme/id 971529011? mt=8 Reading a detailed description of emotions in a book such as Paul Ekman’s Emotions Revealed, Daniel Goleman’s Emotional Intelligence and Karla Mc. Laren’s The Language of Emotions helps higher functioning adolescents and adults understand the emotional complexities in a cognitive manner that suits their learning strengths.

EMOTIONAL ESCALATION Through using Acceptance and Commitment Therapy’s six principles, I have found that individuals with Autism have increased their ability to slow down their thought process to decrease their feelings of being overwhelmed by their thoughts or their senses, especially when the person is diagnosed with the Sensory Over. Responsivity subtype of Sensory Processing Disorder: https: //www. spdstar. org/basic/subtypes-of -spd

THE SIX PROCESSES OF ACT TO DECREASE EMOTIONAL IMPULSIVITY Acceptance – of the diagnosis, of other’s perspectives, and of one’s responsibility to adapt Cognitive Defusion – allowing thoughts to not be responded to actively. Being Present – The events, people and places that are in front of us are prioritized, rather than areas of interest. Self as Context (very difficult to do), mindfulness exercises, metaphors, and experiential processes. Values (bully value is difficult to change), Committed Action ( creating goals through a Mindmap and having accountability are key. https: //contextualscience. org/the_six_core_processes_o f_act

INCREASED PATIENCE I have found that many of the interventions that have worked for treating OCD have been successful with Autism: Refocusing obsessive thoughts. Distraction is okay. Revaluing what we want. Relabel what it actually is, do we want that item or do we want the feeling that it gives us? Asking ourselves, What if we are right and the other person is right as well? Realizing that we are only rushed by our thoughts, not our bodies actual urges or real needs. http: //hope 4 ocd. com/foursteps. php

FLEXIBILITY I have found using a mind map to have a visual representation for what we can be flexible on is really helpful. If there is a topic that you are inflexible on, write it in the center of a sheet of paper or on the apps or websites that offer the tools, and then research how many ways we can actually accomplish the same goal, in a different process or with different tools, different people or different perspectives. Recently, I have been using Coggle: https: //coggle. it , Mindmeister: https: //www. mindmeister. com and Mindnode: https: //mindnode. com/ and Simple. Mind on Android: https: //play. google. com/store/apps/details? id=com. modelmak ertools. simplemindfree&hl=en They all accomplish the basic needs of this task, and charge for more functionality. I have found this really helpful when someone is very defensive or resistant, or as the Asperger Experts call it, Defense Mode.

RESOURCES https: //beckinstitute. org/an-introduction-to-cbt-forpeople-with-an-autism-spectrum-disorder/ https: //www. disabilityscoop. com/2018/02/02/autismjournal-abandons-puzzle/24668/ Wrong Planet’s forum on Patience and Flexibility for individuals diagnosed with Asperger’s: https: //wrongplanet. net/forums/viewtopic. php? t=336 593 Asperger’s Experts definition of Defense Mode: https: //www. aspergerexperts. com/defensemode/defense-mode-a-different-perspective-onunderstanding-helping-someone-with-aspergers/

FOR MORE INFO Michael Uram, MA, LMFT, LPCC www. Michaeluram. com 949 -777 -6694 Michael@michaeluram. co 1000 Quail St. , Suite 130, Newport Beach, CA 92660 145 W. Main St. , Suite 240, Tustin, CA 92780 Twitter: @Michael. Uram. MFT Facebook: www. facebook. com/michael. uram. 7