Cognitive-Behavioral Therapy: Advice for Adults with Aspergers

If you are an older teen or adult with Aspergers or High-Functioning Autism, and are struggling to “make it” (i.e., cope) with real-world circumstances and social situations, then this may be the most important article you’ll ever read:

The ideal treatment for Aspergers coordinates therapies that address core symptoms of the disorder, including poor communication skills and obsessive or repetitive routines. While most therapists agree that the earlier the intervention, the better, there is no single best treatment package.

Aspergers treatment resembles that of other high-functioning Autism Spectrum Disorders except that it takes into account the linguistic capabilities, verbal strengths, and nonverbal vulnerabilities of children with Aspergers. A typical program generally includes:
  • Cognitive behavioral therapy to improve stress management relating to anxiety or explosive emotions, and to cut back on obsessive interests and repetitive routines
  • Medication, for coexisting conditions such as major depressive disorder and anxiety disorder
  • Occupational or physical therapy to assist with poor sensory integration and motor coordination
  • Social communication intervention, which is specialized speech therapy to help with the pragmatics of the give and take of normal conversation
  • The training and support of moms and dads, particularly in behavioral techniques to use in the home
  • The training of social skills for more effective interpersonal interactions

Of the many studies on behavior-based early intervention programs, most are case studies of up to five participants, and typically examine a few problem behaviors such as self-injury, aggression, noncompliance, stereotypies, or spontaneous language; unintended side effects are largely ignored.

Despite the popularity of social skills training, its effectiveness is not firmly established. A randomized controlled study of a model for training mothers/fathers in problem behaviors in their kids with Aspergers showed that parents attending a one-day workshop or six individual lessons reported fewer behavioral problems, while parents receiving the individual lessons reported less intense behavioral problems in their Aspergers kids.

Vocational training is important to teach job interview etiquette and workplace behavior to older kids and adults with Aspergers , and organization software and personal data assistants can improve the work and life management of people with Aspergers.

For the sake of this article, we will look more deeply into cognitive-behavioral therapy:

Cognitive-Behavioral Therapy (CBT) is a common type of therapy. With CBT, you work with a psychotherapist in a structured way, attending a limited number of sessions. By helping you become aware of inaccurate or negative thinking, CBT allows you to view challenging situations more clearly and respond to them in a more effective way.

CBT can be a very helpful tool in treating certain disorders (e.g., Aspergers, anxiety, depression, etc.). But not everyone who benefits from CBT has a mental health condition. It can be a very effective tool to help anyone learn how to better manage stressful life situations.

CBT is used to treat a wide range of issues. It's often the preferred type of therapy because it can quickly help you identify and cope with specific concerns. It generally requires fewer sessions than other types of therapy and is done in a structured way that deals directly with specific challenges.

CBT is a useful tool to address emotional challenges. For example, it may help you:
  • Cope with a medical illness (e.g., chronic fatigue syndrome or cancer)
  • Cope with grief (e.g., loss of a loved one)
  • Identify ways to manage emotions (e.g., anger)
  • Learn techniques for coping with stressful life situations (e.g., problems at work)
  • Manage chronic physical symptoms (e.g., pain, insomnia or fatigue)
  • Manage symptoms of mental illness, either by itself or with other treatments such as medications
  • Overcome emotional trauma related to abuse or violence
  • Prevent a relapse of mental illness symptoms
  • Resolve relationship conflicts and learn better ways to communicate
  • Treat a mental illness when medications aren't a good option (e.g., during pregnancy)

Mental health conditions that may improve with CBT include:

• Anxiety disorders
• Autism spectrum disorders
• Bipolar disorders
• Depression
• Eating disorders
• Personality disorders
• Phobias
• Schizophrenia
• Sexual disorders
• Sleep disorders
• Substance abuse disorders

In some cases, CBT is most effective when it's combined with other treatments, such as antidepressants or other medications.

In general, there's little risk in CBT. Because it can explore painful feelings and experiences, however, you may feel emotionally uncomfortable at times. Because therapy sometimes involves emotional discussions, you may cry, get upset or feel angry during a session. You may also feel physically drained after a challenging session. Your psychotherapist is trained to help you cope with these feelings and emotions.

Some forms of therapy (e.g., exposure therapy) may require you to confront situations you'd rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety. But the coping skills you learn should help you later on to manage and conquer negative feelings and fears.

You might decide on your own that you want to try CBT. Or a doctor, relative, friend, employer or someone else may suggest therapy to you. Here's how to get started:

• Find a psychotherapist. You can find a psychotherapist on your own — looking through the phone book or on the Internet, for instance. Or you can get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). Before selecting a psychotherapist, check his/her credentials. Your psychotherapist should be a licensed counselor, psychologist or other mental health provider experienced in CBT.

• Review your concerns. Before your first appointment, spend some time thinking about what issues you'd like to work on. While you also can sort this out with your psychotherapist, having some sense in advance may provide a starting point.

• Understand the costs. If you have health insurance, contact your health plan to be sure you understand what coverage it offers for therapy. Some health plans cover only a certain number of therapy sessions a year. Also, talk to your psychotherapist about fees and payment options.

It's likely that you'll go to a psychotherapist's office for CBT sessions. A psychotherapist may have an office in a medical clinic, an office building or a home office. Therapy can also take place in a hospital if you've been admitted for treatment. You'll probably meet weekly with your psychotherapist for one-on-one sessions that last 45 to 60 minutes. CBT may also be done in groups — either with family members or with individuals who have similar issues.

Your first session is usually a time for the psychotherapist to gather information about you and to determine what concerns you'd like to work on. The psychotherapist may ask you to fill out forms about your current and past physical and emotional health. This information helps the psychotherapist gain a deeper understanding of your situation. Your psychotherapist will also want to know whether you might benefit from other or additional treatment (e.g., medications). It might take a few sessions for your psychotherapist to fully understand your situation and concerns, and to determine the best approach or course of action.

The first session is also an opportunity for you to interview your psychotherapist to see if his or her approach and personality are going to work for you. Make sure you understand:

• His/her approach
• How many therapy sessions you may need
• The goals of your treatment
• The length of each session
• What type of therapy is appropriate for you

If you don't feel comfortable with the first psychotherapist you see, try someone else. Having a good "fit" with your psychotherapist can help you get the most benefit from CBT.

In general, conversations with your psychotherapist are confidential. However, in certain situations a psychotherapist may be required by law to report serious concerns to authorities — such as threatening to commit suicide, threatening to harm another person or admitting to abusing a child. Talk to your psychotherapist about any worries you might have regarding confidentiality.

For CBT, you and your psychotherapist will most likely sit facing each other during sessions. Your psychotherapist will encourage you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your psychotherapist can help you gain more confidence and comfort.

CBT is generally focused on specific problems, using a goal-oriented approach. Each session may have a specific agenda to guide discussion. As you go through the CBT process, your psychotherapist may ask you to do "homework" — activities, reading or practices that build on what you learn during your regular therapy sessions. Along with homework, your psychotherapist will likely encourage you to apply what you're learning in your daily life.

Although there are different ways to do CBT, it typically includes these steps:

• Become aware of your thoughts, emotions and beliefs about these situations or conditions. Once you've identified the problems you want to work on, your psychotherapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (i.e., your "self-talk"), your interpretation of the meaning of a situation, and your beliefs about yourself, other individuals and events. Your psychotherapist may suggest that you keep a journal of your thoughts.

• Challenge negative or inaccurate thinking. As you continue to examine your thought patterns, your psychotherapist may encourage you to test the validity of your thoughts and beliefs. This may include asking yourself whether your view of a situation is based on fact or based on an inaccurate perception of what's going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. Many thought patterns are first developed in childhood. Thoughts and beliefs that you've held for a long time feel normal and correct, so it can be a challenge to recognize inaccuracies or negative tendencies in your thinking. With practice, helpful thinking and behavior patterns will become a habit, and won't take as much effort.

• Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your psychotherapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.

• Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a specific mental illness. You and your psychotherapist may have to spend some time deciding what problems and goals you want to focus on.

Your psychotherapist's approach will depend on your particular situation and preferences. Your psychotherapist may combine CBT with another therapeutic approach — for example, interpersonal therapy, which focuses on your relationships with other individuals.

CBT is generally considered short-term therapy — about 10 to 20 sessions. You and your psychotherapist can discuss how many sessions may be right for you. Factors to consider include:
  • How long you have had your symptoms or have been dealing with your situation
  • How much stress you're experiencing
  • How much support you receive from family members and other individuals
  • How quickly you make progress
  • The severity of your symptoms
  • The type of disorder or situation

CBT may not cure your condition or make an unpleasant situation go away. But overall, it's an effective treatment. It can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life.

CBT isn't effective for everyone. But you can take steps to get the most out of your therapy and help make it a success, including:

• Approach therapy as a partnership. Therapy is most effective when you're an active participant and share in decision making. Make sure you and your psychotherapist agree about the major issues and how to tackle them. Together, you can set goals and gauge progress over time.

• Be open and honest. Success with therapy depends on your willingness to share your thoughts, feelings and experiences, and on being open to new insights and ways of doing things. If you're reluctant to talk about certain things because of painful emotions, embarrassment or fears about your psychotherapist's reaction, let your psychotherapist know about your reservations.

• Do your homework between sessions. If your psychotherapist asks you to read, journal or do other activities outside of your regular therapy sessions, follow through. Doing these homework assignments is important because they help you apply what you've learned in the therapy sessions.

• Don't expect instant results. Working on emotional issues can be painful and often requires hard work. It's not uncommon to feel worse during the initial part of therapy as you begin to confront past and current conflicts. You may need several sessions before you begin to see improvement.

• If therapy isn't helping, talk to your psychotherapist. If you don't feel that you're benefiting from therapy after several sessions, talk to your psychotherapist about it. You and your psychotherapist may decide to make some changes or try a different approach.

• Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some thought to what you want to discuss.

If you are struggling with life – now you know what you can do about it! Good Luck!!!

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