Cognitive therapy for autistic young people with SAD (CAYPS) V1
Research type
Research Study
Full title
Multiple baseline mixed methods case series exploring adaptations of Cognitive therapy for Autistic Young People with Social Anxiety Disorder (CAYPS)
IRAS ID
351103
Contact name
Jiedi Lei
Contact email
Sponsor organisation
University of Oxford/Research Governance, Ethics & Assurance
Duration of Study in the UK
2 years, 4 months, 1 days
Research summary
Between 29%-57% of autistic children and adolescents have co-occurring social anxiety disorder (SAD), a rate that is significantly higher than the 7%-13% cited in non-autistic young people. When considering the presentation of social anxiety in autism, it is important to factor in additional constructs such as how a young person’s autistic identity might influence their self-image in a social setting, and how behaviours used to mask/camouflage their autistic traits may look similar to social anxiety related safety behaviours, though may serve different functions in the social situation in relation to autistic traits and social anxiety (Lei et al., 2023). To date, adaptations of social anxiety treatment for autistic individuals often remain at the level of making practical changes to sessions (e.g., have visual materials, have a clear session structure), and little is known about how adaptations need to account for autism related mechanisms that influence the development and maintenance of social anxiety in autistic individuals (Spain et al., 2017).
Extending our team’s previous work on adapting cognitive-therapy for SAD (CT-SAD) for non-autistic adolescents (CT-SAD-A), we aim to understand how to incorporate autism-related mechanisms into CT-SAD-A so that it can be adapted for use with autistic adolescents. Cognitive therapy for SAD for adolescents draws on Clark and Wells' (1995) cognitive model of social anxiety, and aims to help adolescents recognise the thoughts, images and unhelpful attentional processes and safety behaviours employed in social situations that might maintain anxiety overtime, and to take part in experiential exercises to help them discover the unhelpful consequences of self-focused attention and safety behaviours in maintaining social anxiety over time, and subsequently complete behavioural experiments to test out their anxious beliefs by modifying safety behaviours in social situations. Recent qualitative studies with autistic adults have highlighted the need for clinicians to adapt CT-SAD when supporting autistic clients, to better understand their lived experiences and how autistic symptoms may influence the development and maintenance of social anxiety over time (Spain et al., 2020; Wilson, 2024; Wilson & Gullon-Scott, 2024).
This study will adopt a multiple-baseline case-series design that will allow us to work closely with a small group of autistic adolescents with co-occurring social anxiety, to understand how to embed autism-related constructs into CT-SAD-A, to ensure treatment efficacy can be maintained without compromising young people’s autistic identity.
In the current study, we aim to undertake a case-series using a multiple-baseline design with 15-20 adolescents with a confirmed autism diagnosis (aged 11-18 years) and co-occurring diagnosis of Social Anxiety Disorder (SAD) and evaluate in real-time the adaptations that may be needed to implement Cognitive Therapy for SAD for adolescents (CT-SAD-A) in autistic adolescents.
Specific questions the study aims to address:
1. Which autism-related constructs may need to be added to the current format of CT-SAD-A to support autistic young people with SAD? For example: autistic identity, social camouflaging/masking behaviours.
2. How to embed autism-related constructs into CT-SAD-A to help autistic young people understand social anxiety in the context of their autism and lived experiences, to ensure treatment efficacy can be maintained without compromising young people’s autistic identity.REC name
South West - Central Bristol Research Ethics Committee
REC reference
25/SW/0034
Date of REC Opinion
16 Apr 2025
REC opinion
Further Information Favourable Opinion