Project Summary

What is the research about?

Autistic adults are at a greater risk for mental health problems compared to the general population. Depression and anxiety are the most common mental health conditions among autistic adults. These mental health problems can lead to long-term negative effects on health, day-to-day functioning, and quality of life. In addition, depression and anxiety increase autistic adults’ risk of suicide.

Autistic individuals have identified mental health as a top research priority; however, studies have not yet been conducted to determine which interventions are most helpful for autistic adults. The two mental health interventions that have been studied most are cognitive-behavioral therapy and mindfulness-based therapy. Both treatments have been shown to improve depression and anxiety in the general population, and both have shown to be effective for autistic adults. However, it is not clear which treatment is most effective for autistic adults or whether patient characteristics may affect treatment response and fit. This project is designed to fill this gap.

The research team includes autistic adults, family members, clinicians, and researchers. This collaborative study aims to provide knowledge to help patients and clinicians select the most effective mental health intervention for autistic adults with depression and anxiety.

Who can this research help?

Findings from this study will help autistic adults, clinicians, and other key stakeholders select which mental health intervention is the best fit for individual patients. The findings of this study will be shared widely to ensure that more autistic adults experiencing depression or anxiety have access to treatments that work.

What is the research team doing?

The lead researchers have partnered with a PCORI-funded stakeholder engagement group (Autistic Adults and other Stakeholders Engage Together) to develop this proposal. The research team is working with outpatient mental health clinics that serve urban and rural areas of North Carolina and Virginia. Patient participants will be randomly assigned to receive one of the two study treatments described below:

Cognitive-behavioral therapy helps patients:

  • Identify negative or unhelpful thoughts,
  • Develop more balanced and helpful thoughts,
  • Identify patterns of behavior that affect thoughts and mood, and
  • Develop more helpful ways of thinking and behaving to reduce distress

Mindfulness-based therapy helps patients:

  • Learn how to mindfully focus on the present moment
  • Learn to become aware of sensations and thoughts, and to observe and let them to pass without judging them
  • Apply mindful practices in daily life, and
  • Handle stressors in a better way

Patient participants will be 300 autistic adults (age 18 or older) with co-occurring anxiety and/or depression.

Patient participants will be assessed pre-treatment, post-treatment, and at a 6-month follow-up. Patients will be asked about symptoms of anxiety and depression, overall clinical severity, quality of life, well-being, functional impairment, use of emergency services for mental health or suicidal crisis, and acceptability and feasibility of the treatment they received. Study assessors, masked to treatment condition, will also complete a clinical interview with participants at pre-treatment, post-treatment, and 6-month follow-up.

To see if the interventions are acceptable and feasible, the team will interview the study clinicians and 60 autistic adults (30 from each treatment condition).

Autistic individuals, family members, and clinicians will be involved in each phase of the study, including shared leadership and decision-making roles, research team member roles, and advisory roles.

The team will share study findings widely so that any helpful discoveries can reach those in need to improve mental health outcomes for autistic adults.

Project Information

Brenna Maddox, PhD
Micah Mazurek, PhD
The University of North Carolina at Chapel Hill
$4,058,499 *

Key Dates

36 months *
November 2022
2022

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: January 20, 2023