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Enhancing self-esteem in adults with autism spectrum disorders: a pilot cognitive behaviour therapy (CBT) group intervention

Debbie Spain (Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK)
Sarah H. Blainey (Adult Autism Services, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK)

Advances in Autism

ISSN: 2056-3868

Article publication date: 3 April 2017




Psychosocial risk factors and high rates of psychiatric comorbidity render individuals with autism spectrum disorders (ASD) vulnerable to developing low self-esteem (LSE). Cognitive behaviour therapy (CBT) interventions are effective for enhancing self-esteem in typically developing populations, but the degree to which they are clinically beneficial for individuals with ASD has been little explored. The paper aims to discuss these issues.


A pilot group intervention was undertaken to investigate the effectiveness and acceptability of CBT for LSE in adults with ASD. Adaptations to standard protocols were made, in order to accommodate core ASD characteristics.


Four participants attended eight sessions: these comprised formulation of causal and maintaining mechanisms for LSE, cognitive interventions designed to reduce self-criticism and promote a more balanced self-view, and behavioural interventions intended to increase engagement in enjoyable activities, and enhance problem-solving skills and assertiveness. Self-report questionnaires were completed at four time points: baseline, at the first and last sessions, and at one-month follow-up. Data analysis indicated no change in the primary self-esteem outcome measure. Some improvements were noted on secondary outcomes, specifically in social anxiety and depressive symptoms, and general functioning.

Research limitations/implications

Further studies are needed to determine how to design and deliver CBT interventions and techniques which target LSE in individuals with ASD.


This is one of the first CBT group interventions designed to address LSE in adults with ASD.



DS is funded by a National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship (CDRF-2012-03-059). This paper presents independent research funded by the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.


Spain, D. and Blainey, S.H. (2017), "Enhancing self-esteem in adults with autism spectrum disorders: a pilot cognitive behaviour therapy (CBT) group intervention", Advances in Autism, Vol. 3 No. 2, pp. 66-75.



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Copyright © 2017, Emerald Publishing Limited

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