Cognitive Behavioral Therapy

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Cognitive Behavioral Therapy

Basic Characteristics

  • Description

Comprehensive Behavioral Therapy(CBT) is based on a cognitive science model of psychological change that aims to promote retrievable memories of adaptive responses that can compete and suppress memories of previously learned maladaptive responses in "real world" conditions. As such, the target goals, such as social skill development, need to developed with some procedure for enhancing memory retrieval. Learning should occur in the actual place where socialization takes place rather than in simulated social situations. Deep semantic processing increases the chance of memory retrieval for a specific memory, so questions that incorporate hints of the correct answer can be posed to children to encourage them to put the correct answers in their own words.1

CBT is frequently recommended as a treatment for children with anxiety disorders and has medium to large effect sizes in several random clinical trials. However, one third of children who undergo CBT treatment still have an anxiety disorder after treatment. Random clinical trials testing the effectiveness of CBT on youth with high functioning autism and anxiety disorder show that 71-80% of youth who complete treatment no longer meet criteria for anxiety disorder post treatment. These gains were maintained at a follow-up evaluation. Another study suggested that children in FCBT group were more involved during the treatment sessions, which could explain efficacy differences. 4


In a randomized controlled trial, a CBT program decreased anxiety in children with ASD. Anxiety disorders are associated with greater impairments in social responsiveness and repetitive behaviors in children with ASD. It has been proposed that ASD children who suffer from anxiety may be more likely to benefit from CBT intervention techniques.1 One study comparing improvement of anxiety in those with comorbid ASD and anxiety disorder and typically developing youth with anxiety disorder showed that those with ASD had significantly less improvement through an individual CBT (ICBT) program as compared to the typically developing groups. The odds of a typically developing child responding to ICBT was 6.2 times more than a child with moderate ASD symptoms. Children with moderate ASD who were treated instead with family CBT (FCBT) were 8.67 times more likely to respond to FCBT than the ASD children treated with ICBT. Thus, FCBT is more effective as a anxiety treatment for youth with moderate ASD symptoms than ICBT. This may be because parents who participate in CBT are more likely to practice CBT skills at home with the child,

  • History

Many social skills training programs have had trouble changing core autistic symptoms such as social communication deficits.1Additionally, few studies have shown whether skills taught in social skills training programs are generalizable2



One study found that participants had significant improvement on the Social Responsiveness Scale after Cognitive Behavioral Therapy. These improvements were maintained 3 months after post-treatment. Additionally, researchers found that anxiety reduction correlated with autism symptom improvement, and vice versa, which suggests that the severity of autistic symptoms could be connected to anxiety for children with both ASD and anxiety disorders.1

Most studies examining a Cognitive Behavioral Therapy for use in ASD child populations had programs which were modified from the traditional CBT. They often had increased structure and predictability in delivery of treatment components, incorporation of visual aids, increased parental involvement, and consideration of the child's special needs and interests.3

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1. Wood JJ et. al. Brief report: effects of cognitive behavioral therapy on parent-reported autism symptoms in school-age children with high-functioning autism. PMID 19562475

2. Kasari C et. al. New directions in behavioral treatment of autism spectrum disorders.Curr Opin Neurol. 2010 Apr;23(2):137-43. PMID 20160648

3. White SW et. al. Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism.Clin Child Fam Psychol Rev. 2010 Mar;13(1):77-90. PMID 20091348

4. Puleo CM et. al. Anxiety Disorders in Typically Developing Youth: Autism Spectrum Symptoms as a Predictor of Cognitive-Behavioral Treatment. J Autism Dev Disord. 2010 Aug 7 PMID 20694508

Related Information

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