Does CBT Work for Autism?

Cognitive-behavioural therapy, or CBT, is a form of therapy that is hot right now. With a glance at the literature it seems well-evidenced and nearly every corporation that is hiring therapists wants those who can practice it. Insurance companies go nuts for it. Podcasts and other media tout it. But how good is it, really, in the context of autism counselling?

CBT for Autism: Some Pros

Before I torpedo this modality later on, I want to address some benefits for our community. When looking for autism counselling, many autistics find cognitive behaviour therapy helpful for making sense of their thought patterns and changing some of their ways that hold them back. CBT has a very clear model and step-by-step processes; some people find this clarity and directiveness soothing.

There are a lot of written resources out there for CBT like worksheets and books; autistics love a good research deep dive and we can be more thorough when there is a lot of content! CBT incorporates routine, which can be great for autistics in the right context.

The concept behind CBT is that adapting your thinking/feeling/behaviour patterns is one way to kick anxiety and depression and get out of unhealthy cycles. Depending on what your patterns are and why they are causing harm, CBT may be an empirically supported quick fix.

Problems with CBT for Autism

Autistics who are learning to unmask and have experience with CBT might already see the problem, though: CBT is based on the premise that the source of your problems might be the way that you are, internally, and that changing yourself is likely the answer. CBT’s main approach is challenging your thinking as if it is flawed.

CBT Can Become Glorified Masking

But what if you have spent your whole life doubting your natural ways of thinking, feeling, and behaving, and that self-denial has been your main source of distress? CBT can start to feel like gaslighting.

As an example, autistic people are often anxious in social situations after years of rejection and hostility. Is the answer to do mental exercises to manage the anxiety or dismiss it as irrational? Or find a better friends group and work toward allowing yourself to not socialise when you don’t feel up to taking risks? Or some third thing?

It’s not always worksheets, is my point – maybe your anxiety is understandable.

Western Psychology & Toxic Individualism

This is one of the failings of Western psychology. It is individualistic in origin and often focuses on solely on developing the inner self as if nothing else is changeable.

But we can affect changes in our environments and our communities, and sometimes mental health is recognising that not all your problems are of your own creation.

And sometimes, your place of work or study is the one that needs to change. It is possible to self-advocate without falling into self-indulgence. It is possible to defy ableist norms without abandoning the inner work.

What Else is CBT Good For?

CBT can be very effective for short-term interventions. It can be great for panic attacks, if what you’re looking at is actually panic attacks and not meltdowns. (Sidebar: autism counselling can be good for telling these apart). CBT was developed to get people out of crisis and it works for that. Some people also find it helpful for specific mental health experiences that are based on maladaptive thinking, like disordered eating.

Unfortunately because CBT claims to have measurable metrics and those metrics look good and fast-acting, capitalism took off with it and it gets overprescribed.

It’s also not as helpful for long-term growth arcs; it’s not built for that. Often we go to therapy for long-term growth. Companies will rarely pay for more than six or 12 sessions though; they are not interested in helping you figure out why you have bad dreams about your dad. Getting you back to work though? That they will invest in. CBT’s popularity is coloured by this.

Does Your Autism Need Fixing?

At its core, CBT is a fixer. It is designed to identify problems and make fast solutions for them.

Maybe you are seeking therapy as an autistic person because you are struggling. Are you sure your thoughts, feelings, and behaviours are the problem?

For many autistics, unlearning shame/ableism, expanding self-compassion, and making lifestyle changes are key to mental health. Maybe you feel you have some problematic patterns and a mixture of CBT and something else would be helpful.

There’s nothing wrong with holding yourself accountable. But at the end of the day, a lot of autistics overestimate how much is “wrong” with them.

Don’t let the overuse of this modality influence you into doubting your experience.

The Bottom Line

So, does CBT work for autism? CBT is good for some things in some contexts.

Still, my general impression is that it’s done more harm than good for autistics in the context of therapy. Other experts will argue with me.

It might be helpful to think about what you are hoping to get out of therapy and whether CBT will help you meet those goals. It can also be something you collaborate with with your therapist to change up how much CBT is mixed in. Personally, I find the humanistic method most helpful for moving toward a neuro-affirming lifestyle, and mileage will vary.

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