Autism Researchers Compare Mental Health Benefits of Mindfulness and Cognitive Behavioral Therapy

With $3.7 million in funding from the Patient-Centered Outcomes Research Institute (PCORI), researchers at the University of Virginia’s Supporting Transformative Autism Research (STAR) initiative are launching a study to compare the benefits of mindfulness-based therapy and cognitive behavioral therapy (CBT) on the mental health of autistic adults. The study is part of $96 million investment in grants awarded by the Patient-Centered Outcomes Research Institute and expands STAR’s work on autism and mental health.

Research shows that both cognitive behavioral therapy and mindfulness-based therapy are effective mental health treatments for depression and anxiety in the general population. This study will help understand which is most effective for autistic adults.

"Mental health is a top priority for the autism community,” said Micah Mazurek, Novartis U.S. Foundation Professor of Education, clinical psychologist, and dual principal investigator on the study. “While we know autistic adults are at a higher risk of mental health challenges than the general population, not a lot of research has been done to learn how to support their mental health needs. We don’t yet know which treatments are most effective for autistic adults. In this study, we'll be able to directly compare two mental health treatments to see which one works best."

Cognitive behavioral therapy helps individuals identify unhelpful patterns of thought and behavior and learn strategies to develop more helpful patterns. Mindfulness-based approaches help individuals focus on the present moment to become aware of sensations and thoughts, observe them, and let them pass. The goal of mindfulness is awareness and acceptance, where the goal of CBT is to work to change thoughts and behaviors.

In a study Mazurek and colleagues published earlier this year, many autistic adults found mental health therapy to be helpful for improving anxiety and depression. However, the helpfulness and ease of use of specific strategies varied from person to person. While some participants found certain strategies to be helpful, others had difficulty connecting strategies to their daily life and found some techniques challenging to implement. They cited their unique autism-related needs as part of the reason for these challenges. 

“CBT requires monitoring and talking about your thoughts and feelings, while mindfulness is much more about learning awareness and acceptance of your experience in the present moment.”  Mazurek said. “For some autistic adults who have trouble identifying and describing their thoughts and feelings, mindfulness approaches may be much easier to implement and more effective. For others, CBT may be a better fit.”

This study will be the first to directly compare these two treatments for autistic adults and to examine individual characteristics that may relate to treatment response. The researchers hope the results will help autistic adults and their therapists decide which treatment may be the best fit for them. 

The study plans to enroll 300 autistic adults from across Virginia and North Carolina, making it the largest study of its kind. The study will be conducted virtually, through telehealth, and participants will receive therapy at no cost.  This will make it much easier for autistic adults to participate no matter where they live. Using telehealth will also allow the researchers to ensure that the sample is diverse and representative of the broader autism community. 

Mazurek, who directs the STAR initiative based at the UVA School of Education and Human Development, is leading the study in partnership with Brenna Maddox, assistant professor of psychiatry at the University of North Carolina School of Medicine and with the stakeholder engagement group, Autistic Adults and other Stakeholders Engage Together (AASET). The research team includes autistic adults, family members, clinicians, and researchers who are working together to make sure the study addresses issues that are important to the autism community.  The UVA research team includes assistant professors Rose Nevill and Heather McDaniel along with STAR team members Genevieve Bohac, Emily Fuhrman, and Keith Page.  

Recruitment and enrollment of study participants will begin in fall 2023.