Improving Cognitive Behaviour Therapy for Autistic Individuals: A Delphi Survey with Practitioners

This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.

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Spain, D., Milner, V., Mason, D., Iannelli, H., Attoe, C., Ampegama, R., Kenny, L., Saunders, A., Happé, F., & Marshall-Tate, K. (2022). Improving Cognitive Behaviour Therapy for Autistic Individuals: A Delphi Survey with Practitioners. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 41(1), 45-63. https://doi.org/10.1007/s10942-022-00452-4

Publication date: 8 Apr 2022 Added to AutiHub: 18 Sep 2026 Type: Article Article language: English
Publisher source (DOI) Full text OpenAlex source

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Authors

Publication authors
10
Publication authors identified as autistic
1 / 10 (10.0%)
  1. Debbie Spain
  2. Victoria Milner
  3. David Mason *
  4. Hannah Iannelli
  5. Chris Attoe
  1. Ruwani Ampegama
  2. Lorcan Kenny
  3. Aleks Saunders
  4. Francesca Happé
  5. Karina Marshall-Tate

Abstract

Abstract There is emerging evidence of the effectiveness of individual and group cognitive behaviour therapy (CBT) for autistic individuals, in particular to address anxiety, obsessive compulsive disorder and depression. Many CBT studies have incorporated relatively stringent standards, with regards to participant inclusion/exclusion criteria, delivery of manualised approaches and assurance of therapist training and oversight. We know less about what happens in routine CBT practice and, importantly, how service provision can be improved for autistic individuals. The present study recruited 50 CBT practitioners to a three round Delphi survey. The aims were to elicit professionals’ perspectives regarding barriers to the acceptability and effectiveness of CBT for autistic individuals, and to generate consensus, both about ways of enhancing service provision, as well as the autism-relevant training needs of CBT practitioners. Study findings indicated six barriers to accessible and effective CBT for autistic individuals, relating to service provision, practitioner-related factors, client-related factors, CBT-related factors, national guidelines, and systemic considerations. There was participant consensus that changes in five domains (specifically relating to process issues, service provision, practitioners, techniques and therapeutic approach) could improve the CBT care pathway. Consensus was generated about the training needs of CBT practitioners: training about autism, CBT-specific issues, co-occurring conditions and engagement, were deemed fundamental for enhancing practice. Participants also identified autism-relevant issues for clinical supervision. Further sustained research is needed to determine the effects of adapted service provision and improved practitioner knowledge and skills on the outcomes of autistic individuals who have CBT.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 2 Oct 2026 07:53.

Cited references
30
With a DOI
22
Without a DOI, from raw bibliography text
7
2 / 30 (6.7%) cited references include at least one author identified as autistic.
References with data to complete
4 / 30 (13.3%)
References with detected author names
26 / 30 (86.7%)
Without detected author names
4
Without a structured title
4
Without a stable identifier
6
References with raw author names still to review
4
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
112
From DOI or external metadata
112
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
10
56 / 112 (50.0%) names are linked to an author already present in AutiHub. 56 / 112 (50.0%) names are not yet linked.
Names linked to a person identified as autistic
3 / 112 (2.7%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 3 / 56 (5.4%). Distinct people identified as autistic: 2 / 100 (2.0%).
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