An adapted form of 'low intensity' cognitive behavioural therapy (CBT) could offer help to autistic adults living with depression, according to a new study funded by NIHR.

Autism Spectrum Disorder (ASD) affects around 1% of the UK adult population. Approximately one-third of autistic people experience depression at some point in their lives, however to date surprisingly little research into treatments for depression within the autistic community has been conducted.

Co-occurring autism and mental health conditions, including depression, present particular challenges for psychologists and healthcare professionals. While there is strong evidence of effective treatments for depression for the population as a whole, including CBT, accessing mainstream therapies can be difficult for autistic people due to communication and neurocognitive differences, and many therapists are not trained to work with autistic people.

The researchers suggest that autism can exacerbate mental health challenges such as depression. Barriers to rewarding employment and social isolation can make life difficult and adjusting and adapting behaviours and activities because of autism are also challenges. For the latest study, published in the journal Autism, the team at the University of Bath's Centre for Applied Autism Research tested the feasibility and uptake for a form of low intensity CBT called Guided Self-Help, which is based on Behavioural Activation.

Behavioural Activation aims to reduce depression by helping individuals to better schedule activities that help boost positive mood, whilst also giving them techniques to become more aware of triggers for low mood. The researchers split 70 participants into two groups: a Guided Self-Help group (35), who received the new materials and sessions with a low-intensity psychological therapist; and a treatment as usual group (35), who received the treatment that is ordinarily available.

Measuring outcomes at 10-, 16- and 24- week windows, the researchers found the adapted intervention to be both well received and promising in terms of helping people to make change. 86% of participants attended five of nine Guided Self-Help sessions, with 71% attending all treatment sessions.

The authors of the study acknowledge the fact that when depressed, autistic people can struggle more than most to generate shifts in routines, behaviours and thought patterns. Acknowledging this, they suggest that Behavioural Activation coupled with new training for psychological therapists, to recognise and adapt their approach to meet the needs of autistic people, offers new opportunities to help individuals get the benefits of depression treatment.

Dr Ailsa Russell of the Centre for Applied Autism Research at the University led the study working with colleagues at the University of Bristol, Newcastle University and service providers including Avon & Wiltshire Mental Health Partnership NHS Trust and Cumbria, Newcastle,Tyne & Wear NHS Foundation.

She explained: "We know that people with autism face depression in disproportionate numbers, yet that too often traditional treatment plans fail to meet their specific needs.

"Co-occurring autism and depression is a particular challenge both in terms of helping individuals' access support, but crucially in accessing the right kind of support to help them change their thinking and get back on a healthier and happier course.

"This study focused on Behavioural Activation which shows promising signs in helping individuals to break out of negative thought cycles and our findings are positive. With new funding, we need to scale-up this work with a larger study to better inform future mental health guidance."

The team behind the study now want more evidence from a larger-scale trial to inform guidance as to whether low intensity psychological intervention is an effective treatment for autistic adults with co-occurring depression.

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