The Use of a Positive Reframing Intervention during Social Conversation in Adults with ASD
Recent research has indicated that adults with autism spectrum disorders (ASD) are frequently diagnosed with comorbid anxiety and depression disorders (Ryden & Bejerot, 2008; Clarke et al., 2009), as well as higher levels of negative emotions and difficulty with emotion regulation (Samson et al., 2012; Kasari & Sigman, 1997). Furthermore, many adults with ASD have difficulty in social interactions, romantic relationships, and employment (Howlin, 2000). It may be proposed that increased levels of expressed negativity may create difficulties in social conversation, having detrimental ramifications on the development of social friendships, romantic relationships, and ability to acquire and maintain employment.
Positive reframing, or changing one’s conceptual and emotional viewpoint in relation to how situation is experienced (Watzlawick, Weakland, & Fisch, 1974), has been empirically validated as a beneficial treatment for a range of psychological conditions, including depression (Lambert, 2010), anxiety (Goldin et al., 2012), PTSD (Moore et al., 2010), and depression and anxiety in parents of children with ASD (Benson, 2010). However, the effectiveness of a positive reframing intervention implemented with adults with ASD has yet to be investigated.
The current study investigated the use of a positive reframing intervention in decreasing negative comments during social conversation in adults with ASD. Additionally, global ratings of affect and self-report measures of depression, anxiety, and hopelessness were analyzed before and after implementation of intervention.
Five adults aged 21-37 diagnosed with ASD participated in this study. Prior to intervention, each participant was receiving occupational intervention not addressing excessive negative comments to conversational partners. A multiple baseline design was employed to evaluate the use of a combination treatment package consisting of self-management and systematic video feedback. During assessment and intervention phases, each participant participated in weekly naturalistic conversational probes. These interactions were videotaped and coded for negative comments and affect. Additionally, self-report measures of depression and anxiety including the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and the Beck Anxiety Inventory (BAI) were completed at baseline and every four intervention sessions to assess for general emotional functioning.
Results indicated that despite continuing vocational interventions, all participants engaged in negative commenting and experienced persistent symptoms of depression and anxiety during the baseline phase. Following the positive reframing intervention, all participants exhibited decreased negative commenting and increased positive affect during social conversation. Furthermore, decreases in depression, anxiety, and hopelessness were indicated by the BDI-II, BAI, and the BHS. High levels of inter-observer agreement were found between video coders, as well as high Kappa coefficients.
The present study provides preliminary evidence that a positive reframing intervention may be effective for improving adults' social interactions with peers. The addition of self-report measures may provide new insight in regard to the potential for such an intervention to improve symptoms of depression and anxiety as well. Furthermore, preliminary data suggests that such an intervention may produce collateral gains in affect. These results have significant implications for improving social interactions, developing friendships, and accessing and maintaining employment.