Interoceptive training to target anxiety in autistic adults (ADIE): A single-center, superiority randomized controlled trial

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Quadt, L., Garfinkel, S. N., Mulcahy, J. S., Larsson, D. E., Silva, M., Jones, A. M., Strauss, C., & Critchley, H. D. (2021). Interoceptive training to target anxiety in autistic adults (ADIE): A single-center, superiority randomized controlled trial. EClinicalMedicine, 39, 101042. https://doi.org/10.1016/j.eclinm.2021.101042

Publication date: 31 Jul 2021 Added to AutiHub: 25 Sep 2026 Type: Article Article language: English
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Authors

Publication authors
8
Publication authors identified as autistic
1 / 8 (12.5%)
  1. Lisa Quadt *
  2. Sarah N. Garfinkel
  3. James S. Mulcahy
  4. Dennis EO Larsson
  1. Marta Silva
  2. Anna-Marie Jones
  3. Clara Strauss
  4. Hugo D. Critchley

Abstract

BACKGROUND: This trial tested if a novel therapy, Aligning Dimensions of Interoceptive Experience (ADIE), reduces anxiety in autistic adults. ADIE targets the association of anxiety with mismatch between subjective and behavioral measures of an individual's interoceptive sensitivity to bodily signals, including heartbeats. METHODS: In this superiority randomized controlled trial, autistic adults (18-65 years) from clinical and community settings in Southern England were randomly assigned (1:1) to receive six sessions of ADIE or an active 'exteroceptive' control therapy (emotional prosody identification). Researchers conducting outcome assessments were blind to allocation. ADIE combines two modified heartbeat detection tasks with performance feedback and physical activity manipulation that transiently increases cardiac arousal. Participants were followed-up one-week (T1) and 3-months post-intervention (T2). The primary outcome was Spielberger Trait Anxiety Score (STAI-T) at T2. Outcomes were assessed on an intention-to-treat basis using multiple imputation for dealing with missing values. This trial was registered at International Standard Randomized Controlled Trial Registry, ISRCTN14848787. FINDINGS: Between July 01, 2017, and December 31, 2019, 121 participants were randomly allocated to ADIE (n = 61) or prosody (n = 60) intervention groups. Data at T1 was provided by 85 (70%) participants (46 [75%] ADIE; 39 [65%] prosody). Data at T2 was provided by 61 (50%) participants (36 [59%] ADIE; 25 [42%] prosody). One adverse event (cardiac anxiety following ADIE) was recorded. A statistically significant group effect of ADIE on trait anxiety continued at T2 (estimated mean difference 3•23 [95% CI 1•13 to 5•29]; d = 0•30 [95% CI 0•09 to 0•51]; p = 0•005) with 31% of ADIE group participants meeting trial criteria for recovery (compared to 16% in the control group). INTERPRETATION: ADIE can reduce anxiety in autistic adults, putatively improving regulatory control over internal stimuli. With little reliance on language and emotional insight, ADIE may constitute an inclusive intervention. FUNDING MQ: Transforming Mental Health PsyImpact Grant.

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Cited references
51
With a DOI
43
Without a DOI, from raw bibliography text
6
3 / 51 (5.9%) cited references include at least one author identified as autistic.
References with data to complete
3 / 51 (5.9%)
References with detected author names
48 / 51 (94.1%)
Without detected author names
3
Without a structured title
1
Without a stable identifier
5
References with raw author names still to review
1
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
377
From DOI or external metadata
377
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
1
87 / 377 (23.1%) names are linked to an author already present in AutiHub. 290 / 377 (76.9%) names are not yet linked.
Names linked to a person identified as autistic
3 / 377 (0.8%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 3 / 87 (3.4%). Distinct people identified as autistic: 3 / 339 (0.9%).
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