1/30/2018 Remodeling Minds Using Cognitive Behavior Therapy (CBT) methods in the emotional and behavioral regulation of Autism Spectrum Disorders 1
1/30/2018 We may all look at the same things…but see them very differently Those with Autism Spectrum Disorders often: • Have faulty thinking patterns (symbolic imagery rather than concept imagery; polarized thinking; automatic thoughts) called Cognitive Distortions. 2
1/30/2018 Cognitive Behavior Therapy (CBT) is based on the idea that how you think determines how you feel and how you behave. (TherapistAid.com) CBT can help an individual with Autism Spectrum disorder expand their thinking, become more flexible and alter their own behavior patterns. CBT is not a cure for ASD, but it can help alleviate core symptoms. We can change the way we FEEL and BEHAVE by changing the way we THINK. The ABC’s of CBT: A= Activating Event (or the Situation ) B= Belief (or how we think about the situation) C=Consequence (your belief has consequences that impact the way you feel and/or behave) As Autism is a “Spectrum” disorder, so must be the CBT methods we use to treat it. Traditionally, CBT focused on cognitive thought patterns and involved extensive talk therapy. CBT can be used with varying levels of ASD, but the cognitive components sometimes must be de-emphasized . For example, we may have a low-verbal child who screams at the sight of a black chair. We can use CBT methods to analyze and remediate problem behaviors associated with this black chair. In contrast, we may have a highly verbal individual who demonstrates OCD behavior by having a 3 series knocking pattern every time he knocks on a door. Let’s explore CBT treatment methods… When we look at this black chair below, it may remind us of something and we will think about it in a context that is familiar to us. Someone with Autism may remember using that chair in one context only. They may have trouble visualizing this chair in any other context that was not once “experienced.” 3
1/30/2018 A: • Teacher asks me to sit in black chair B : The black chair is for work. • The black chair means I have to put in effort. • The black chair is not fun. • I do not like the black chair. • C : Cry and Whine • Expand thinking and flexibility by having them “experience” the black chair in a different way. Interrupt the rigidity through Cognitive Restructuring. Cognitive Restructuring is a therapeutic process of identifying and challenging negative and irrational thoughts. This model typically requires the participating individual to engage in a talk therapy process, participate in metacognitive (think about how they think) strategies, and have the ability to eventually self regulate their own behavior. However, CBT principles can be used with anyone regardless of level of functioning (as seen in the black chair example .) 4
1/30/2018 Do we need to Re-Think about the necessity of this knocking pattern? Activating Events often begin with a TRIGGER. Work to identify the stimulus (such as a person, place, situation, or thing that contributes to an unwanted emotional or behavioral response) for each situation. Example: Drinking out of someone else’s water bottle. Explore the Trigger by identifying the stimulus, thinking of the causative emotional state and thoughts associated with it. Example: Drinking out of someone else’s cup causes anxiety. I start to sweat and my heart begins beating faster. I think that the cup carry tons of germs and I could get sick and possibly die. I must wash out my mouth with antiseptic mouth was fifty times to try and rid myself of all the germs! 5
1/30/2018 Begin Exploring the Trigger, Thoughts and Behaviors through Socratic Questioning . Thought to Be Questioned: • What is the evidence for this thought? Against it? • Am I basing this thought on facts, or on feelings? • Is this thought black and white, when it is really more complicated? • Could I be misinterpreting the evidence? Am I making assumptions? • Might other people have different interpretations of this same situation? What are they? • Am I looking at all the evidence, or just what supports my thought? • Could my thought be an exaggeration of what’s true? • Am I having this thought out of habit, or do the facts support it? • Did someone pass this thought/belief to me? If so, are they a reliable source? • Is my thought a likely scenario, or is it the worst case scenario? Common beliefs people with ASD include: • “I must stay in control because there may be danger” • “If I try to fit in, I will fail” • “If I stay away from people, I won’t get hurt.” • “I can’t understand what is going on in my world” • “I am flawed” • “I am weird” 6
1/30/2018 We want to teach “flexibility” but we need to be sure we don’t “flood” the client….develop new thinking patterns….gently…slowly and at a pace that makes them slightly uncomfortable but not so much to encourage them to crawl out of their skin! “CBT often focuses on “the rules of the game” in social situations, which may be intuitive to others but are generally very hard for a person to ASD to penetrate. CBT helps them learn to better read social interactions and read others reactions and behavior more accurately so they can more easily monitor and adjust their own behavior and responses.” (https://www.beckinstitute.org/an-introduction-to-cbt-for-people-with-an-autism-spectrum-disorder/) We do want to encourage our clients to “think through” the rules of the game in social situations through “social mapping”….but a formal “algorithm” may be a bit much! 7
1/30/2018 Using Visual Strategies help individuals' with ASD organize their thoughts TherapistAid.com Be sure your client can identify and give examples of various emotional states Work to help your client identify when they are experiencing a specific emotional state. See the incredible 5 point scale by Dunn Buron and Curtis (2003) 8
1/30/2018 Depending on the age of your client, develop strategies to help them alter their own emotional states. 9
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1/30/2018 Label “good thinking” versus “faulty thinking” Michelle Garcia Winner 11
1/30/2018 Michelle Garcia Winner • Essential to Re-Think “triggers” and thought patterns associated with it through Socratic Questioning • Important to be “gentle” and “strategic” when running “practice trials” to de- sensitize someone with ASD to develop new thinking patterns . Remember, they typically have extreme patterns of rigid thinking that slowly and carefully need to be counteracted with flexible thinking • Individuals with ASD are commonly “Visual Thinkers” and therefore visual emotional and thought identification strategies are often helpful. • A difference in CBT with ASD in relation to other behavior therapy methods, is that we work to create an “awareness” of and “bring attention” to the problem behavior. Once the individual becomes aware of their own irrational thoughts, they can work to change them. However, motivation to change the behavior is critical when employing any method of self regulation. If you change the way you Think….you can change the way you Live… 12
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