A Randomized Controlled Trial Comparing Online Mindfulness and CBT Programs to Alleviate Anxiety in Adults with ASD.

Background: Anxiety Disorders are around five times more common in ASD than in the general population and are widely recognised as an important treatment target due to the consequences for an individual’s quality of life and broader wellbeing. The choice and effective delivery of treatments, however, is complicated because the mechanisms that mediate anxiety in ASD remain poorly understood and the frequent necessity to interact with therapists is costly and also problematic because of the high demands on social-communication skills. Maisel et al., (2016) have recently shown that Intolerance of Uncertainty (IoU), Alexithymia (Alx) and Non-reactive thinking (NR) play a critical role in mediating anxiety in ASD, suggesting that Cognitive Behavioural Therapies (CBT) and Mindfulness-Based Therapies (MBT) may be differentially effective by targeting IoU and Alx/NR respectively.

Objectives: 1) To examine the effectiveness of online CBT and MBT programs to alleviate anxiety in ASD, 2) to establish whether treatment effects are mediated by changes in IoU and Alx/NR, 3) to determine whether reductions in anxiety translate into wider benefits for the wellbeing of individuals with ASD.

Methods: Thus far, thirty-three adults with ASD have been randomly allocated to either a CBT (n = 10), MBT (n = 10) or Waitlist (WL) group (n = 13), matched at baseline for age, ASD symptoms and IQ. Participants in the CBT and MBT groups received instructions on how to pursue respectively the existing online programs Serenity (http://serene.me.uk/) or BeMindful (http://bemindful.co.uk/) for between 4 – 6 weeks. Participants learned different stress and anxiety management strategies each week, and a reflective diary served to monitor how frequently and feasibly these were practiced in daily life. Participants in all groups completed measures of Anxiety (BAI, STAI-T, LSAS, GAD-7), broader wellbeing (HADS, CORE-OM), intolerance of uncertainty (IoU-12), Alexithymia (BVAQ) and Mindfulness (FFMQ) at enrolment and again at completion of the 6-week period.

Results: At baseline, results confirmed that IoU and NR are significant and independent predictors of trait (STAI; R²=.37) and generalised (GAD; R²=.22) anxiety, which in turn are highly correlated with the CORE-OM index of general wellbeing (STAI: r = 0.81; GAD: r = 0.75). Across the 21 participants (5 MBCT, 7 CBT & 9 WL) tested so far at time 2, reductions are evident particularly in generalised anxiety (F(1,19) = 7.01, p < .05) with large effects in both the CBT (Cohen’s d = .85) and MBT (Cohen’s d = .74) but not the WL group (Cohen’s d = .13). Improvements in more general wellbeing (CORE-OM) were also evident (F(1,19) = 5.90, p < .05) and the preliminary data suggest that IoU and NR do indeed play a role in mediating treatment benefits. Contrary to predictions no effects were observed in relation to Alexithymia.

Conclusions: Online CBT and MBT programs provide viable treatment options for anxiety in ASD that translate into wider benefits for general wellbeing. The discussion will focus on feedback from participants that provides useful pointers on how to tailor existing programs more specifically to the needs of those with ASD.