DBT-Informed Group Treatment to Improve Emotion Regulation and Social Interactions in Young Adults with Autism Spectrum Disorder

Background: Few treatments are currently available to treat common difficulties experienced by individuals with autism spectrum disorder (ASD) in adulthood, especially for emotion regulation (ER), and social interaction. Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment approach that continues to be adapted for a variety of diagnoses from its original conception for Borderline Personality Disorder. DBT includes skill training sessions on mindfulness, interpersonal effectiveness, ER, and distress tolerance. To our knowledge, DBT has not yet been used for ASD. Given the ER difficulties young adults with ASD (YA) face, with overwhelming negative affect regulation (e.g. intense anxiety and anger), treatment components of DBT may lend themselves to successful adaptation with this population.

Objectives: The overarching goal of this study was to pilot a DBT-informed intervention to target ER difficulties in YA with ASD, with a particular focus on anxiety and anger. Specific aims included modification of existing interventions to develop a manualized DBT-informed intervention to meet the needs of YA with ASD and examination of feasibility and preliminary effectiveness of the intervention in reducing ER difficulties and improving social interaction skills.

Methods:  8 YA participants (3 females, ages 18-25) were recruited from clinical providers and advocacy organizations. All participants’ ASD diagnoses and IQ (> 80) were confirmed through administration of the ADOS and WASI by research team members. 2 senior clinicians with ASD expertise led the 14 session groups (12 consecutive weekly sessions with 1 and 6 month follow up sessions) in an outpatient clinic of a medical school. Group sessions were 90 minutes and included a 30-minute didactic portion and a 60-minute imaginary and in-vivo exposure to practice specific anxiety and anger management skills. Through feedback from two previous pilot groups, DBT treatment duration was shortened to 12 weekly sessions and mindfulness practice, modeling in social interaction, video clips, and images were added into each session. Participants also practiced imaginary and real life exposures to manage their anxiety, in clinical and community settings. Effectiveness of treatment was measured by improvements in the Social Responsiveness Scale (SRS), Buss-Perry Aggression Questionnaire, Aberrant Behavior Checklist, Emotion Regulation Questionnaire, and Social Phobia and Anxiety Inventory-2

Results:  Preliminary paired samples t-tests assessed changes in ER before and after the initial 12 sessions. Results showed that participant report on the SRS SCI (awareness, cognition, communication and motivation), awareness, and cognition subscales (all p < 0.04) subscales significantly improved. Results from the parent report on the SRS total score, and SCI, RRB, and communication subscales had trending results towards improvement (all p < 0.08). Post-treatment data collection will be completed in December 2016. RM-ANOVA will be conducted to evaluate changes over time and maintenance of treatment effects.

Conclusions: This treatment study used clinical adaptations from established manualized treatment approaches (DBT and CBT) to improve ER and social interaction skills of YA. DBT intervention was able to be successfully modified and delivered to YA’s with ASD. Preliminary evidence suggests that this intervention may serve to improve deficits commonly experienced by YA’s, in particular social interaction skills/awareness.