Leveling Up Dialectical Behavior Therapy for Autistic Individuals with Emotion Dysregulation: Clinical and Personal Insights

Keenan, Elliot Gavin; Gurba, Ava N.; Mahaffey, Brittain; Kappenberg, Catherine Faith; Lerner, Matthew D.

doi:10.1089/aut.2022.0011

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…In addition, the individual format of the intervention allowed the therapist to adapt the sessions to better fit the needs of the participant. For example, the client’s interests and passions were used in the therapeutic tasks, which may have contributed to increase the acceptability of CFT ( 60 ).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the participant develops a compassionate identity through which he can respond to parts of oneself that might suffer. During the therapy process, the clinician adapted CFT exercises to fit the interests of the participant ( 60 ). For example, the participant’s interest in writing was used to create dialogues between different selves based on the CFT framework.…”

Section: Methodsmentioning

confidence: 99%

“…The intervention is illustrated through the presentation of some key therapeutic practices below. Based on the key adaptations suggested by Keenan et al’s ( 60 ) first-hand account of DBT, the main adaptations of CFT for this specific person consisted of connecting the therapeutic tasks to his specific interests, that is, the arts (literature, classical music, and visual arts). Hence, the key practices outlined below were developed based on Julian’s interests.…”

Section: Methodsmentioning

confidence: 99%

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Compassion focused therapy for self-stigma and shame in autism: a single case pre-experimental study

Riebel,

Krasny-Pacini,

Manolov

et al. 2024

Front. Psychiatry

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IntroductionExposure to public stigma can lead to the internalization of autism-related stigma (i.e., self-stigma), associated with negative health, occupational and social outcomes. Importantly, self-stigma is linked to shame and social isolation. Although elevated self-stigma has been reported in autistic adults, to the best of our knowledge, interventions designed to target this issue are lacking. Compassion is an effective way to reduce the emotional correlates of self-stigma (i.e., shame) and their impacts on mental health. However, no study has investigated whether compassion focused therapy (CFT) can effectively reduce self-stigma in autistic adults. The present study aims at investigating whether and how self-compassion improvement following CFT may reduce self-stigma and shame in an autistic individual.MethodsA single case pre-experimental design (SCED) was used with weekly repeated measures during four phases: (i) pure baseline without any intervention (A), (ii) case conceptualization (A’), (iii) intervention (B) where CFT was delivered, (iv) follow-up without intervention (FU). The participant is a 46-year-old autistic man with high self-stigma and shame. Self-report measures of self-compassion and self-stigma and a daily idiographic measure of shame were used.ResultsThere was a large increase in self-compassion between pure baseline (A) and the intervention phase (A’B) (Tau-U = 0.99), maintained at follow-up. Similarly, there was a moderate decrease of self-stigma (Tau-U = 0.32). In contrast, when we compared the whole baseline phase AA’ (i.e., considering the conceptualisation phase as baseline) to the intervention (B), there was no change in self-stigma (Tau-U = −0.09). There was no change in self-stigma between the intervention (B) and follow-up (Tau-U = −0.19). There was a moderate decrease in daily shame reports between the baseline (AA’) and the intervention (B) (Tau-U = 0.31) and a moderate decrease between the pure baseline (A) and intervention phase (A’B) (Tau-U = 0.51).ConclusionCFT was feasible for this autistic client and our results show that CFT led to the improvement of self-compassion. Changes on self-stigma measures were moderate. Self-stigma may need more time to change. Because self-stigma is involved in poorer social functioning and mental health in autistic adults, our results are promising and suggesting conducting more large-scale studies on CFT in autistic adults.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Compassion focused therapy for self-stigma and shame in autism: a single case pre-experimental study

Riebel,

Krasny-Pacini,

Manolov

et al. 2024

Front. Psychiatry

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“…This is of particular importance as evidence-based interventions targeting ED in autistic individuals are lacking, especially for adults (202), and that ED might be associated with self-harm and suicidal behaviors in this population (40, 41), especially autistic adults without intellectual disability (86). Furthermore, our application of the Linehan's biosocial model to ASC might promote specific adaptations to autistic people, increasing the acceptability and efficacy of DBT applied to this population (184). For example, increased scaffolding and modeling from the therapist and the use of a psychoeducational biosocial model that integrates the ASC specificities highlighted here might be particularly valuable to this aim.…”

Section: Discussionmentioning

confidence: 99%

“…Highlighting the ASC-related difficulties and adding them to the biosocial model allowed to specifically target them, especially in individual sessions. Indeed, as highlighted in a first-person account of an autistic person who benefitted from DBT (184), DBT therapists need to consider the specific needs and motivational factors of autistic clients to increase the pertinence of DBT. Here, this means to be aware of ASC-related features that are likely to contribute to ED, integrate them in the biosocial model, as well as in the targets and goals of the therapy.…”

Section: Emotional Vulnerabilitymentioning

confidence: 99%

Linehan’s biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization

Bemmouna,

Weiner

2023

Front. Psychiatry

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Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan’s biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan’s model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan’s biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan’s model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.

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Through the lens of artificial intelligence: A novel study of spherical video-based virtual reality usage in autism and neurotypical participants

Schmidt,

Glaser,

Palmer

et al. 2023

Computers & Education: X Reality

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Leveling Up Dialectical Behavior Therapy for Autistic Individuals with Emotion Dysregulation: Clinical and Personal Insights

Cited by 5 publications

References 40 publications

Compassion focused therapy for self-stigma and shame in autism: a single case pre-experimental study

Compassion focused therapy for self-stigma and shame in autism: a single case pre-experimental study

Linehan’s biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization

Through the lens of artificial intelligence: A novel study of spherical video-based virtual reality usage in autism and neurotypical participants

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