Tina K. Veale, Ph.D.Eastern Illinois University

Cognitive Behavior Therapy for Individuals with ASDs

Why Cognitive Behavior Therapy?

Theory-of-Mind (ToM) deficitsIncrease skill in reading and interpreting nonverbal

signalsAddress problem-solvingDevelop social inferencingImprove ability to take perspective of others

Executive function deficitsMemoryPlanningInitiatingSequencingVigilance

Why Cognitive Behavior Therapy?

Emotional regulation difficultiesIdentification of emotional signalsInterpretation of emotional messagesControl of emotional response

Philosophical FoundationsBased 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.

Cognitive Behavior TherapyBased 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.

Client-Therapist Relationship

Central to cognitive-behavior therapyTrusting relationship is desirable.

Early and ongoing goal of interventionTherapist is not all-knowing.

Respects the knowledge and opinions of the client.

Therapist’s RolesAssist 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.

Therapist No-Nos

Therapist does NOT tell the client what to do.May make suggestions on request or

with permission.

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.

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.

Client’s RolesIdentify 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.

Affective EducationDiscuss why we have emotionsExplore a variety of emotions

Begin with positive feelings…..then later look at the negative aspects of emotion.

Study nonverbal signals that indicate emotionLearn to “read face/voice/body/space”

messagesIdentify different levels of expression

Use an instrument to gauge the emotion: Emotionometer

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.

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.

Cognitive RestructuringCorrect distorted conceptualizations

or dysfunctional beliefsChange current thinking with:

Logical evidenceRational thinkingControl of emotions

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.

Therapy Sessions

Present agenda for the session.Lead discussion of relevant topics.

ListenQuestion

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.

Homework

Homework is keyPractice skills learned in therapy.Bring examples as follow-up for the next

session.

CBT StrategiesSocial stories (Gray, 1998)

Outline appropriate social behaviorDescribe thought processes of others in

response to behaviorsComic strip conversations (Gray, 1998)

Speech/thought bubblesHelps us “see” what others are thinking

Color-coded emotionsHelps us “see” feelings

Re-enact social scenariosPlan alternate actions

CBT StrategiesThe Emotional Toolbox

HammerGet 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.

CBT Strategies

Emotional ToolboxScrewdriver/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.”

CBT StrategiesEmotional Toolbox

MagnetFind 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.

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?

Let’s Practice:“Not Fair!!!”Paul—age 8Paul 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?

Let’s Practice: You Hurt My Feelings!

Tariq—age 10 yearsMath 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.

Contact Information

Tina K. Veale, Ph.D., CCC-SLPEastern Illinois University600 Lincoln Avenue2207 Human Services CenterCharleston, IL 61920(217) 581-7445tkveale@eiu.edu