Autistic adults’ experiences of cognitive-behavioural group therapy for social anxiety: Relational experiences of participation

Authors

Abstract

Autistic adults often report high levels of social anxiety and significant life impacts from this anxiety on well-being and functioning. Although cognitive-behavioural therapy in group settings has been adapted for autistic populations, there is a paucity of research exploring how autistic individuals experience CBT interventions. This qualitative study investigated autistic adults’ experiences of a modified cognitive-behavioural therapy group programme for social anxiety. Twenty-seven autistic participants were recruited through clinical services and community outreach. Following the intervention, participants completed semi-structured individual interviews about their experience of the programme. Participants reported both therapeutic benefits and challenges following their participation. Themes included reflections on group dynamics, mental health impacts, social functioning and daily life applications of strategies. Peer connection emerged as a core facilitator of engagement, while structured strategies were credited with bolstering social confidence and self-awareness. However, challenges, such as sensory sensitivities, the role of previous therapeutic experiences and difficulties applying strategies beyond the therapy context, were also highlighted. Lay Abstract Autistic adults often report high levels of social anxiety. To support autistic people with social anxiety, we developed a group therapy programme, the Engage Program, an intervention designed specifically for autistic adults. Our study aimed to better understand what it is like for autistic adults to take part in group therapy and what aspects of the programme were most helpful, or not. The programme aimed to provide a safe space where participants could explore social interactions in a way that felt comfortable and authentic. Rather than encouraging people to hide or ‘camouflage’ their autistic traits, the programme focused on building confidence, self-understanding and meaningful connections with peers. Sessions included guided discussions, structured activities and shared experiences. We interviewed participants who had completed the group programme to hear directly from them about their experiences. Many said they felt less alone and more socially confident after taking part in the group. They appreciated connecting with others who understood their experiences, and they said this helped them feel more accepted and supported. They also reported that participating in the group helped them understand their social strengths and challenges more clearly. However, not everything worked for everyone. Some participants found aspects of the therapy challenging, especially if they had sensory sensitivities or difficult past experiences with therapy. In the future, we want to explore how to make group therapy more flexible and accessible, especially for those who may struggle in traditional settings. This research shows that group therapy can be a powerful way to support autistic adults, especially when it is designed with their needs and preferences in mind.

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