Blended cognitive behavioural therapy for adolescents with panic disorder co-morbid with autism spectrum disorder: a case study

Abstract

Abstract Cognitive behavioural therapy (CBT) is an effective treatment for improving anxiety symptoms in patients with autism spectrum disorder (ASD). However, some patients with ASD take extra time for learning, and they can find it hard to change their thinking styles and behaviour due to cognitive deficits. The therapist must be creative when implementing CBT in this context. Here, it may be helpful for the patient with ASD to understand CBT’s concepts by using visual aid material. Blended CBT during which the patient is shown visual aid material with his or her therapist has been suggested as effective for adults without ASD to reduce anxiety. Blended CBT combines face-to-face treatment with internet guided support and resource. Blended CBT may facilitate an understanding of essential knowledge and help people with ASD and anxiety acquire skills based on cognitive behavioural science. However, as far as we know, no previous studies have reported on the use of blended CBT for patients with panic disorder co-morbid with ASD. This study, therefore, consecutively performed 16 blended CBT sessions on a biweekly basis to treat panic disorder (PD) in an adolescent Japanese female co-morbid with ASD. The patient exhibited improvements in PD symptoms and agoraphobia after treatment: the Panic Disorder Severity Scale score decreased from 18 to 2. These results indicate that visual aid-assisted treatment may help patients with impaired imagination and social cognition related to ASD. Furthermore, this study’s therapist notes the need for paced treatments and repeated psychoeducation for patients with impairments in central coherence and cognitive flexibility. Key learning aims (1) Blended CBT may patients with panic disorder (PD) co-morbid with autism spectrum disorder (ASD) to understand concepts based on cognitive behavioural science and symptoms. (2) Blended CBT sessions can each be conducted in approximately 20 min (about one-third of the time needed for typical 45- to 90-min CBT sessions); in other words, it is less burdensome for the patient and therapist. (3) How to adjust blended CBT for those who have low average intelligence quotients (IQ) and/or ASD.