Cognitive Behavior Therapy for Individuals with ASDs

1. Cognitive Behavior Therapy for Individuals with ASDs Tina K. Veale, Ph.D. Eastern Illinois University

2. Why Cognitive Behavior Therapy? • Theory-of-Mind (ToM) deficits • Increase skill in reading and interpreting nonverbal signals • Address problem-solving • Develop social inferencing • Improve ability to take perspective of others • Executive function deficits • Memory • Planning • Initiating • Sequencing • Vigilance

3. Why Cognitive Behavior Therapy? • Emotional regulation difficulties • Identification of emotional signals • Interpretation of emotional messages • Control of emotional response

4. Philosophical Foundations • Based on a stoic philosophy. • Assumes that people do not want to feel bad. • Assumes that people can be motivated to change. • Does not teach people how to feel. • Helps them to explore and understand their feelings and the feelings of others around them. • Allows people to decide how to solve their problems. • Allows them to plan how to change their behavior.

5. Cognitive Behavior Therapy • Based on the philosophy that behaviors are mediated internally rather than externally. • Negative thoughts cause negative behaviors. • The environment does not directly cause behaviors. • Seeks to help clients change the way they think. • Shifts locus of control from external to internal. • Encourages client to acknowledge and examine all possible aspects of his/her behavior and that of others. • Expands realm of possible solutions to problems. • Teaches the client to become his/her own therapist over time.

6. Client-Therapist Relationship • Central to cognitive-behavior therapy • Trusting relationship is desirable. • Early and ongoing goal of intervention • Therapist is not all-knowing. • Respects the knowledge and opinions of the client.

7. Therapist’s Roles • Assist the client in forming and articulating his/her goals. • Facilitate an understanding of how to attain those goals. • Lead discussion relative to the goals. • Question the client in a manner that can lead to self-discovery. • Guide problem solving. • Evaluate effectiveness. • Modify future approaches. • Empower individual to employ methods on own.

8. Therapist No-Nos • Therapist does NOT tell the client what to do. • May make suggestions on request or with permission.

9. Socratic Method • Ask questions to facilitate examination and understanding events and feelings. • Help client take the perspective of others. • Encourage client to consider why other people feel the way they do.

10. Educational Model • Assumes the client is able to learn: • A new way of dealing with issues. • A new way of thinking through problems. • Assumes client has valid ideas for change. • Once people know why and how they feel better, they can continue to do so on their own.

11. Client’s Roles • Identify and explain problems in terms of concrete behaviors. • Stay open to new interpretations and ideas. • Respond to therapist’s inquiries. • Participate in problem solving. • Agree to try to new approaches. • Observe and report back on effectiveness of interventions.

12. Affective Education • Discuss why we have emotions • Explore a variety of emotions • Begin with positive feelings…..then later look at the negative aspects of emotion. • Study nonverbal signals that indicate emotion • Learn to “read face/voice/body/space” messages • Identify different levels of expression • Use an instrument to gauge the emotion: Emotionometer

13. Inductive Thinking • Start with the client’s thoughts and perceptions. • Teach the client to question his/her own ideas. • Think of thoughts as hypotheses. • Consider thoughts of others. • Understand that thoughts can be changed.

14. Rational Thinking • Teach the client that rational thinking is based on facts; whereas, irrational thinking is often based on incorrect assumptions. • Evaluate opinions vs. facts. • Do not jump to conclusions.

15. Cognitive Restructuring • Correct distorted conceptualizations or dysfunctional beliefs • Change current thinking with: • Logical evidence • Rational thinking • Control of emotions

16. Steps of CBT • Therapy focuses on client’s problem. • Identify common, inaccurate assumptions that have led to the problem. • Identify thoughts, opinions, feelings of everyone in situation. • Help client re-evaluate situation based on new perspective. • Guide problem-solving.

17. Therapy Sessions • Present agenda for the session. • Lead discussion of relevant topics. • Listen • Question • Teach skills to manage problems identified. • Focus client on how to achieve a goal. • Help client develop a plan of action. • Discuss how to evaluate behavior. • Determine a reporting system.

18. Homework • Homework is key • Practice skills learned in therapy. • Bring examples as follow-up for the next session.

19. CBT Strategies • Social stories (Gray, 1998) • Outline appropriate social behavior • Describe thought processes of others in response to behaviors • Comic strip conversations (Gray, 1998) • Speech/thought bubbles • Helps us “see” what others are thinking • Color-coded emotions • Helps us “see” feelings • Re-enact social scenarios • Plan alternate actions

20. CBT Strategies • The Emotional Toolbox • Hammer • Get physical—swing that hammer! Physical exercise helps manage emotions. • Paintbrush • Relax—and paint a tranquil picture. Engage in relaxing activities, such as drawing, reading, or listening to music. Relaxation helps with emotional control and rational thinking.

21. CBT Strategies • Emotional Toolbox • Screwdriver/wrench • These tools are for changing your thinking. • Engage in neutral thinking: “I can stay calm.” • Be confident in your ability to control your feelings. • Do a reality check • Use logic to check whether thinking is accurate • Nurture self esteem • “I am capable. I can learn. I can do this.”

22. CBT Strategies • Emotional Toolbox • Magnet • Find a companion animal or person who can help manage feelings. • Engage in social activity to improve emotions. • Special Interests • Engage in special interest as a source of solitude.

23. Let’s Practice:What Happened this Week? • Client: Lindsey—age 15 • What happened this week? • In gym, started playing volleyball. • “No one wants to choose me for their team!” • “Gym is so boring!” • “I need more time to get my science project done. I just spend most of my time sitting on the sidelines anyway. It only makes sense to excuse me from gym and let me work on my project. At least this way, I’ll get something done!” • How can we help Lindsey understand this situation?

24. Let’s Practice:“Not Fair!!!” • Paul—age 8 • Paul forgot to bring his daily planner to his third grade class today (required by his teacher) • The teacher has a well-documented response-cost procedure in place—students receive points toward a prize everyday when they bring/complete their planners, but lose points when they forget to bring the planner. • Paul has forgotten so many times that he now has no points. • Next week is the spring picnic. To attend, he needs to have at least 5 points. There is no way he can earn that many points in time for the picnic. • How can we help Paul resolve this problem?

25. Let’s Practice: You Hurt My Feelings! • Tariq—age 10 years • Math whiz!! • Assigned to work with a group of struggling math student in his 5th grade class. • Some of the students are complaining about Tariq because he: • Sent nonverbal signals that the kids were taking too long to do their work. • “Encouraged them” by saying, “Come on, this is so easy a kindergartner can do it!” • Took the work away from one girl and “corrected” it in front of the group. • Tariq doesn’t understand why the students aren’t more thankful for his help.

26. Contact Information Tina K. Veale, Ph.D., CCC-SLP Eastern Illinois University 600 Lincoln Avenue 2207 Human Services Center Charleston, IL 61920 (217) 581-7445 tkveale@eiu.edu