A qualitative evaluation of cognitive-behavioural therapy components for social anxiety in autistic adults: Lived experiences from a modified group program

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Roisenberg, B. B., Boulton, K. A., Thomas, E. E., Perry, N., Yu, D., & Guastella, A. J. (2026). A qualitative evaluation of cognitive-behavioural therapy components for social anxiety in autistic adults: Lived experiences from a modified group program. Autism, 30(5), 1147-1164. https://doi.org/10.1177/13623613261424830

Publication date: 26 Mar 2026 Added to AutiHub: 18 Oct 2026 Type: Article Article language: English
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Authors

Publication authors
6
Autistic authors reported by the publication
At least 1
  1. Bruna B Roisenberg
  2. Kelsie A Boulton
  3. Emma E Thomas
  1. Nina Perry
  2. Dorothy Yu
  3. Adam J Guastella

Abstract

Cognitive-behaviour therapy (CBT) is an evidence-based treatment for social anxiety. However, despite the high prevalence of social anxiety among autistic adults, much less is known about how autistic people experience each CBT component used in treatment. This qualitative study explores autistic adults’ perspectives on a modified cognitive-behaviour therapy group programme for social anxiety, focusing on the perceived effectiveness of CBT components and the identification of needed modifications. Twenty-seven participants who completed the intervention took part in semi-structured interviews. Thematic analysis identified core themes related to therapeutic impact (application of CBT group strategies) and participant experiences (suggestions for future iterations of social groups). Overall, exposure tasks were viewed as helpful in reducing anxiety, particularly when structured and predictable. Cognitive restructuring was often experienced as effective; however, its impact was sometimes limited by persistent and deeply held core beliefs and past negative experiences. Social strategies and anxiety management skills were appreciated for their structured format and educational elements, but generalizability was sometimes raised as a limitation. Participants also recommended additional adaptations, including flexibility in content delivery and modifications to the physical environment. Findings highlight overall support of cognitive-therapy components for reducing social anxiety in adults, but also benefit to tailoring CBT approaches to theneeds of autistic adults. Results from this study offer practical guidance from autistic people to enhance the acceptability and effectiveness of future CBT interventions. Lay abstract Many autistic adults experience social anxiety, making everyday interactions feel stressful or overwhelming. To help with this, clinical researchers developed a group therapy programme based on cognitive-behaviour therapy adapted for autistic adults. While cognitive-behaviour therapy is commonly used to treat anxiety, there has been relatively little research into how autistic people experience group-based versions of this therapy. This study aimed to understand how participants felt about the programme and how it could be improved. The intervention included eight group sessions where participants learned about social anxiety and autism, social strategies and took part in guided activities to build confidence. The programme encouraged a supportive environment where autistic individuals could safely try out new ways of connecting with others without feeling pressure to hide who they are. To understand how helpful the programme was, researchers interviewed participants about their experiences. Many said the programme helped them feel more confident and less anxious in social situations. For example, they found role-playing in a safe group setting especially useful. Participants also appreciated that the therapy was adapted to suit their needs. However, the study also highlighted some areas for improvement. Some participants found parts of the programme challenging, especially unstructured activities or settings. Others suggested the programme could be more flexible, offer clearer instructions or be better prepared for people who had past negative experiences with therapy. These early findings suggest that cognitive-behaviour therapy can be effective when thoughtfully adapted for autistic adults. This work helps lay the foundation for more inclusive, autism-informed mental health services that support social confidence in a way that feels safe and empowering.

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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: 23 Oct 2026 08:00.

Cited references
75
With a DOI
69
Without a DOI, from raw bibliography text
6
6 / 75 (8.0%) cited references include at least one author identified as autistic.
References with data to complete
2 / 75 (2.7%)
References with detected author names
73 / 75 (97.3%)
Without detected author names
2
Without a structured title
2
Without a stable identifier
6
References with raw author names still to review
2
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
328
From DOI or external metadata
328
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
6
128 / 328 (39.0%) names are linked to an author already present in AutiHub. 200 / 328 (61.0%) names are not yet linked.
Names linked to a person identified as autistic
16 / 328 (4.9%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 16 / 128 (12.5%). Distinct people identified as autistic: 16 / 278 (5.8%).
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