(PS3-B41) From Avoidance to Activation: Adapting Behavioral Activation for Autistic Adults

Many misperceptions exist around the quality of life and life-enriching opportunities for autistic individuals. Myths regarding autistic people’s social disinterest contribute to ongoing misperceptions about low social motivation and limited life satisfaction. In truth, autistic individuals express ongoing desire for social connection, increasing life satisfaction, and joy (Jaswal & Akhtar, 2018; Moseley & Sui, 2019). However, this population also faces elevated rates of anxiety and depression compared with the general population (e.g., Conner et al., 2020). This high prevalence has been characterized as a “mental health crisis”, given the gap between rates of internalizing disorders and the scarcity of interventions that support autistic adults (Mandy, 2022).  

The present study evaluates the efficacy and acceptability of a strengths-based, group behavioral activation therapy (GBAT) for autistic adults. GBAT is a transdiagnostic intervention for depression and anxiety, emphasizing exposures and alternatives to avoidance. The intervention consists of 10 group sessions (1.5 hours each) and 1 individual goal-setting session. All participants completed idiographic target-problem measures, pre- and post- diagnostic assessments, and group satisfaction questionnaires and interviews. 

After initial piloting of GBAT, participant feedback indicated adaptations d to assist in maximize engagement  and acceptability should include more individualized support and adapted group content. This poster highlights adaptations and implementation over the course of three conditions: GBAT Pilot (GBAT), GBAT with 3 additional individual sessions (GBAT+I), and GBAT with additional engagement activities (GBAT+E). GBAT+E is underway (all data through group midpoint currently collected). 

In the GBAT pilot, 5 participants (M age = 24.8 SD = 4.5; 2 female, 2 male, 1 nonbinary) completed the intervention, with attendance ranging 7-10 sessions (M= 9.2, SD = 1.3). Post-group results indicate that participants felt that they “minimally improved” or “much improved” on at least one of their target problems, and that the quality of the group was “good” or “excellent.” In GBAT+I, 4 participants (Mage = 27 SD = 8.5; 3 female) enrolled in the intervention. Of these, 3 adults completed the intervention, with attendance ranging between 8-10 sessions each (M=8.7, SD = 1.5), with 100% attendance at individual sessions. Almost all target problems reduced in self-reported clinical interference. In both groups, participants reported that “most” or “almost all” of their needs were met by the group. In GBAT+E, 6 participants are actively enrolled (Mage = 28.5 SD = 6.6; 3 female, 2 male, 1 nonbinary).  

Preliminary evaluation of the GBAT conditions indicates feasibility of adaptations and potential to increase the acceptability and treatment gains for autistic adults. Initial outcomes also suggest a link between the intervention and improvement in clinical diagnoses, goal advancement, and group satisfaction for autistic adults. Discussion will include the process of adapting interventions, including methods for obtaining participant feedback and working with a stakeholder group.