Albert Ellis and Aaron Beck were the two main therapists responsible for what we call cognitive behavioural therapy. It was mainly Beck however who felt there was a strong connection between thoughts and feelings and said that “people who were upset had negative thoughts that tended to be unrealistic, and by uncovering and challenging these thoughts, long-lasting and positive change can result” https://www.klearminds.com/blog/history-cognitive-behavioural-therapy-cbt/
CBT looks at how what Beck called ‘automatic thoughts’ are influenced by core beliefs, that lead to emotions and consequent behaviour (A-activating event, B- beliefs, C- consequent emotions and consequences). The idea is that all these things are connected.
CBT focuses on these unhelpful and negative core beliefs that we can hold about ourselves, others and the world. These beliefs (that might for example sound like “I am unloveable” etc) lead to the creation of demands, rules, shoulds and musts and then these influence our automatic thoughts, that might be very persistent.
Autistic trauma is often linked to stigma:
Much of our trauma as autistic people is often not based upon our core beliefs or irrational fears, but upon genuine factors, mostly stigma associated with being different in a world that expects us to comply and shape shift in order to be more acceptable in neurotypical environments. This leads to autistic people masking, hiding, suppressing their differences and different ways of being; we end up complying with neurotypical standards to essentially stay safe.
Autistic people experience ableism, abuse, bullying and many can regularly be victimised in some way https://www.sunderland.ac.uk/more/news/story/new-report-finds-widespread-abuse-of-autistic-people-1931
Many of the experiences an Autistic person goes through can often be missed, dismissed or ignored and we might be told “everyone experiences that”.
Autistic thinking styles and emotions:
CBT does not take into account brains that process thoughts, feelings and emotions differently. It is also top down therapy and autistic people are bottom up thinkers/processors. It also doesn’t take into account Alexithymia or interoception differences, sensory trauma, social communication differences, masking or environmental triggers.
Autistic people often find it easier to look at pragmatic solutions and discuss what to do, rather than try to change the way they think or feel. Expecting autistic people to be flexible in the way they think and process thoughts and information is unhelpful and harmful. Sometimes an autistic person might also be asked about what they feel or to imagine what something might be like for another person and this might be harder for many autistic people, often due to alexithymia and the problem of double empathy.
“Studies have shown that approximately 50% of autistic adults have alexithymia, this means that a significant proportion of autistic people struggle to identify, name and communicate their mood.“ Dr Alice Nicholls
Sensory trauma
CBT might lead to autistic people being taught about how to be brave and ‘resilient’ in environments that are actually causing them trauma (due to social, communication and sensory differences). This is in reality a form of exposure therapy - a way to help people who have experienced anxiety in a certain place, to change the way they perceive the environment, change their thoughts and therefore their emotions and behaviour. This works for irrational fears. However, environments causing sensory overload are not irrational fears. Teaching an autistic person to be brave in a traumatising environment -will only lead to further masking and increase their trauma. Autistic people cannot be desensitised to environments causing sensory overload.
Behaviour
Repetitive behaviour known as stimming (clapping, flapping, tapping, fidgeting, jumping, and many other things) is not OCD as many might mistakenly assume. Stimming is in most cases helpful for autistic people and a human, natural way to self regulate (there are times when a stim might be harmful, dangerous). The fact is that all humans stim but it’s only pathologised in autistic people.
Sensory overload, meltdowns and shutdowns are not behaviour, as many can assume. They are trauma responses, involuntary and not due to our core beliefs or automatic thoughts. A therapist or someone using CBT who is not neuro informed, might not appreciate this (and the individual might not understand this either) and may try to look at the individual’s core beliefs and automatic thoughts to see how these led to the ‘behaviour’. This is not just unhelpful but could be ableist and stigmatising.
Regarding communication, it’s important to point out that not all behaviour is actually communication. Often an autistic or AuDHD person may experience thoughts and urges that are connected to brain chemistry, are not triggered by activating events and are not rooted in core beliefs. For example lower levels of dopamine and GABA etc (chemical messengers) affects inhibition and can lead to intrusive thoughts, etc https://neuroclastic.com/wp-content/uploads/2022/02/Disinhibition-Part-1.pdf
A therapist might also not be aware of monotropism and that Autistic people are more likely to be monotropic (www.monotropism.org). A monotropic brain will focus intensely on fewer things and things outside the ‘attention tunnels’ can become muted (a link to Interoception and the ability to detect hunger, thirst, pain etc). Constant changes of focus can be very debilitating for a monotropic brain and can lead to exhaustion and burnout. It’s also common for a monotropic brain to get stuck and focused on something unhelpful and not be able to stop, move on, (sometimes possible OCD).
OCD
A person with OCD might engage in similar behaviors to stims, but they are not regulating or comforting. “Instead, they’re compulsions that the person feels driven to perform to prevent something bad from happening”. https://psychcentral.com/autism/ocd-and-autism#ocd-and-autism
“Causes of anxiety in autism may include:
sensory overload
disruption of routine
change in environment
misunderstandings
social challenges
Causes of anxiety in OCD may include:
intrusive and unwanted obsessive thoughts
interrupted rituals
fears of bad things happening
social shame
For autistic people, rigid thinking can be found in:
the need to stick to a routine to feel secure
social conflict if they interpret language too literally
reluctance to look at things in a different way
Sometimes rigid thinking can be an asset to autistic people if it helps them to be goal-oriented and have a strong work ethic.
Rigid thinking with OCD stems from the urgent need to perform rituals that keep unwanted thoughts away or that protect against imagined harm. When a person with OCD feels like they need to wash, check, count, or arrange items to prevent something bad from happening, they become rigid about making sure they complete those rituals.” (https://psychcentral.com/autism/ocd-and-autism#ocd-and-autism)
A therapist might also perceive an autistic person’s fixed interests as obsessive. Autistic people are more likely to have what’s known as a monotropic brain and therefore more likely to focus intensely on fewer things (special interests and passions). These things can be comforting, regulating and bring a great deal of joy; the autistic person can often become an expert in these areas of interest and may build a career around these passions.
Groups
In therapy or therapeutic groups, autistic people might mask a great deal in order to feel accepted and acceptable and get through the session. They might feel they have to give eye contact and perform other body language and join in with small talk (esp if there are these neurotypical expectations from group leaders). Not enough personal space and feeling highlighted might also feel really uncomfortable in groups and will be exhausting. There may be an internal pressure to be perfect NAS not make mistakes and fear of humiliation and victimisation from others in the group.
Not recognising Autistic Burnout
When experiencing burnout, autistic people are exhausted and can often be very shutdown. Essentially they are traumatised and any therapy can be unhelpful and especially talking therapies.
“Autistic burnout refers to the way autistic people can become exhausted as the result of every day stressors. These stressors may seem inconsequential to a therapist if they are not familiar with the sources of stress for autistic people. Unfortunately, they may also interpret the symptoms of autistic burnout as depression. Many common approaches to treating depression in neurotypical people involve gradually increasing the persons activity levels. This is likely to exacerbate autistic burnout.” Dr Alice Nicholls
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