Cognitive behaviour therapy for anxious autistic children: A session-by-session program evaluation

The 'Exploring Feelings' program (Attwood, 2004) will be delivered across six 1.5 hour sessions delivered weekly, with parents and children in separate yet concurrent groups, each with two group leaders. Group leaders will be a paired combination of the lead researcher, and volunteer research assistants pooled from generally registered psychologists and provisional psychologists who are interested in assisting with the Study. Children will be taught to confront negative cognitions regarding maladaptive emotional judgements through the weekly introduction of new tools or coping strategies, which are added to the ‘Emotional Toolbox’. At the end of each session, children will be provided with ‘project work’ to be completed before the next session. Project work is comprised of tasks that the child is to do outside of sessions that relates the session content, such as collecting ideas from family members or friends about ‘tools’ they use to help manage anxiety, or physically putting together a ‘toolbox’ of items that the child identifies would be helpful to them to manage their anxiety in other settings (e.g., school, home). It is expected that 'project tasks' should take no more than 30 minutes across a week to complete and are to be supported/accompanied by parents where possible. Completion of project work is encouraged but incomplete project work does not preclude children from ongoing participation. Parents will receive psychoeducation about autism and emotion regulation while observing the tools being taught to the children by group leaders. Parents will be encouraged to support their child with project tasks during the parent sessions. Two additional social skills sessions will be provided at the conclusion of the 'Exploring Feelings' program. These sessions will be of the same duration and frequency (i.e., 1.5 hours each week over two weeks) and will explicitly target asking something to someone, asking to participate, discussing with someone, playing a social game, and saying no. A total of eight sessions are provided overall (i.e., six of the 'Exploring Feelings' program and two social skills sessions). Adherence to the program will be monitored by weekly attendance reviews and 'check-ins' at the commencement of each session regarding strategies employed over the preceding week. Informal parent feedback will be obtained during parent sessions. Table 1 Session Overview of the Exploring Feelings Program Session Number Content of Session and Central Themes 1 Introduction of participants; Being happy; Feeling relaxed; Explanation of the project (things to be happy about, happiness diary, pleasures book, relaxation pictures, cue cards, feeling anxious list). Strengths and talents, Being Happy, Feeling Relaxed. 2 Review main points session 1; Discuss project work; Why we feel anxious; Heroes who become anxious; A time when I have felt anxious; An emotional toolbox to fix the feeling; Session 2 project. Heroes who become anxious, A time when I have felt anxious, An emotional took box (physical tools), An emotional toolbox (relaxation tools) 3 Review main points in session 2; Discuss project work; An emotional toolbox part 2; Session 3 project. Social Tools, Thinking Tools, Other Tools, Inappropriate Tools. 4 Review main points in session 3; Discuss each person’s emotional toolbox and how have been used since last session; Thermometer activity. Practice using the Toolbox. 5 Review main points in session 4; Discuss thermometer’s and review strategies; Social Stories; Antidote to poisonous thoughts; Social story project. Antidote to poisonous thoughts. 6 Review key points from session 5; Discuss each person’s Social Story and antidotes to poisonous thoughts; Sharing Strategies. Sharing Strategies. 7 Social skills I – Conversation skills including asking something to someone, asking to participate, discussing with someone. 8 Social skills II – Playing a social game, saying no. All participants meeting inclusion criteria for the study (i.e., autistic, aged 6-10 years, Elevated or Clinical Total Anxiety) will be allocated to a treatment group. Three groups will be run each week. Treatment groups will comprise of 5-6 participants and differ only by the day/time of program administration (i.e., three groups running each week but on different days and/or different times). All treatment groups will receive the same program (Exploring Feelings), with all sessions provided in the same order. The lead researcher is Rachel Pearce. Rachel is a registered psychologist (AHPRA No. PSY0000976955) and Board Certified Behaviour Analyst (BACB CN 1-09-5275) with over 15 years’ experience in clinical practice. Rachel will be responsible for compiling the documentation and resources required for the proposed study (e.g., consent forms, flyers, participant information sheets, intake forms etc etc), identifying the likely participant pool, training research assistants, administering key measures, program delivery, data collection and analysis. All measures pertaining to study inclusion and outcomes will be administered, scored, and interpreted by the lead researcher. However, assistance will be required to deliver the program outlined and assistance will be obtained by additional registered psychologists currently employed at Caterpillar Clinic, or provisional psychologists currently completing their AHPRA 4+2 internship (meaning they have completed an Honours degree in psychology and are currently completing two-year postgraduate practical training) to obtain registration as a general psychologist if they are willing and able to do this. This is completely voluntary for the registered and provisional psychologists and not a requirement of their employment at the Clinic. Participants will attend Caterpillar Clinic to complete in-person measures required for the study, which is providing the location for the proposed research. Caterpillar Clinic is a private child psychology practice located in Cairns, Far North Queensland. Each room is furnished in a child- and family-friendly manner. Two rooms will be allocated for QUT participants and sign posted as such during the course of the study. It is likely that the program and parent sessions will be delivered out of the Clinic’s standard office hours (i.e., after 5 p.m. or on Saturdays) so as not to provide any impact to the Clinic’s operations nor confuse research participants with Clinic attendees, and not to interfere with children’s schooling or parent’s work schedules.