Is CBT harmful for Autistic Adults (Effects of Cognitive Behavioural Therapy nobody talks about!)

Is CBT doing more harm than good? While CBT or Cognitive Behavioral Therapy is a popular and often very effective therapy, it may not be the best solution for everyone, especially for autistic individuals. Many autistic adults struggle with building self-confidence, unmasking, and burning out. CBT encourages us to slow down and take control of our thoughts and emotions which may be the exact opposite of what we need to let go of harmful masking behaviour. In this video, I will share what CBT is, how it works, what it’s good for, and crucially… what it’s not so good for and why CBT isn't always the right fit for those of us on the autism spectrum.

🎞️Timestamps:

0:00 Introduction
0:39 Is CBT Good for Autistic People?
2:03 What is Cognitive Behavioural Therapy (CBT)?
6:10 Anhedonia and Depression
6:55 Common Autistic Problems (Masking/Burnout)
4:22 Is CBT doing more harm than good?

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I'm Paul Micallef, and I discovered my own autism at age 30.

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#autism #asd #autismawareness

[graceface]

CBT kinda feels like Gaslighting in ways. I've had to tell my therapist to stop using CBT techniques at points. Like, I understand she's trying to be helpful but I'm feeling dismissed, invalidated, & disregarded by what she's saying

[sixbirdsinatrenchcoat]

I've been clinically depressed for more than two decades. I went through three rounds of CBT with three different psychs. Each one made things worse. All they did was tell me what I should be doing differently - but I already knew all of it. My problem was never a lack of knowledge, it was a lack of ability to act on that knowledge. Telling me that if I would just go for a walk every day, if I would just schedule one social meet-up a week ... and me being incapable of doing any of it consistantly ... all of it just made it feel like the depression was my own fault because I couldn't just get my act together and do the things.

.... Turns out I am autistic and have ADHD. Not only is my adhd why I couldn't do the things - together with being autistic, it's why life in general was always just a little too difficult and overwhelming. It was why I was depressed, and it was why the prescribed "therapy" made it worse.

Antidepressants helped me survive, but it was (and still is) like putting a bandaid on a blister, and then continuing to walk with the same sharp stone in your shoe.
ADHD meds have finally turned that stone into sand. It's still there, it can be irritating, but it isn't cutting me to the bone.

Like you pretty much said: Treat the cause, not the symptoms.

[slothape]

CBT made me feel like I needed to tell myself nice-sounding stories in order to feel better rather than looking at reality for what it is. Its like the real world is so painful that you need to create a fantasy world in your head just to get through it.

[sjzara]

I tried CBT for anxiety and depression. The result was increased anxiety and depression. I was told to explore unpleasant feelings and it would be safe. It wasn’t. I had a breakdown.

[marieugorek]

CBT can be particularly harmful for autistics who are undiagnosed. Pattern matching can be identified as fortune telling or catastrophization by therapists, leading them to train the client away from pattern matching. Accurate descriptions of sensory or emotional responses are often flagged as exaggerations by therapists, leading them to encourage the client to minimize and even ignore their own system's warning signals. Even when these things don't occur, most autistics who see improvement of specific anxieties often find that these improvements do not stick once something about their life circumstances change -- I think this is partially because many autistics struggle to generalize newer behaviors from one context to another, so when their overall context changes, they revert to the much older patterns of behavior which have already been over-generalized. And then there's the fact that we tend to develop trauma responses from unmet needs or with much smaller data sets/lower level inputs. Rational thought work, such as in CBT, can actually prevent one from working through the trauma responses.

[BanjoPixelSnack]

I don’t think I am autistic but I have ADHD. I found CBT made things far worse. I couldn’t get my therapist to understand that I already had coping and masking mechanisms developed during my childhood and my constant exhaustion and burnout was *because* of my coping strategies not the lack of them. I had to manage myself so tightly to keep in check all the time. I felt gaslit by being told that somehow I’m choosing to be ADHD and I just needed to choose other ways of doing things. I then had a massive overwhelm meltdown from all the added “strategies” and homework I was given. I would look at all those sheets of instructions and the daily thought diary I was supposed to keep and have a panic attack. CBT felt like pouring gasoline into an already blazing fire.

[SuperUberDae]

CBT felt like a class for how to mask more. This seems like the "wisdom" that everyone /knows/ will work if you "just give it a try". I did try, for about two years, and I feel just as bad if not worse now. But people around me saw me masking more, and to them that read like I was getting better. Now that I've quit therapy, I'm trying not to mask and accept myself as I am. The people around me see a person who is "reverting" to their more depressed state from before. The conclusion seems to them to be that I just like being depressed? Or that I've gotten comfortable with being depressed? They don't understand what a toll masking takes on me and how burnt-out I feel. I'd like to go back into therapy, but I need to find a method that will actually help me to just be me and accept all the ways that my brain is wired instead of trying to work against it.

[_TheShiv]

I absolutely despise CBT. I know it works for some people, which is great, but what gets to me is like that and SSRIs are what you automatically get pointed at no matter your own circumstances. Thank you for putting into words what I hate about it so much.

[alison-ipky]

I had a terrible therapist who tried CBT to help me with social anxiety and it was just a waste of time. I think at the root the problem is the idea that it's an irrational thought pattern - not that I think people will treat me badly because I constantly face people treating me badly - even strangers I don't even know. I've faced years and years of bullying at school so that's set me up to not like other people. Now I'm that weird looking person that seems okay for others to make fun or make assumptions. I made a list of all the times people were rude, obnoxious of outright bullied me in the two weeks between appointments and she just seemed befuddled on what to say when I just explained how big of assholes people are and how it's just perfectly acceptable to be jerks to people like me. It's not a thought pattern. It's my life.

[Wingedmagician]

CBT was driving me crazy. Aka the “Just think better” Therapy.

[DamnMandi]

CBT has been very harmful to me. It was before my ASD diagnosis, and I’ve never felt so “crazy” it seemed my therapist did not believe me and I was creating scenarios to make my life harder.
My relationship with my current therapist also began in CBT, but during the first or second session, when she started talking about tools to deal with humans better, and trying to adapt to my environment, I was extremely clear and said:
“creating all these tools and strategies has been killing me. I need to accept that my brain works differently, and that it is hard and that it is ok having a different pace on learning or having less energy. I can’t go on masking, because it is hurting me.”
Surprisingly, she understood what I was saying and we choose other types of therapy.

[isabellefaguy]

One of the problems is that doctors and other professionnals won't believe we can possibly have been through so many difficult life experiences such as violence victim several times, abuse by parents, domestic violence victim as an adult, homelesness, etc. Because a NT person may go through one of these situations we got through, but not as many, not tens of situations by their 30's. So we're viewed either as saying lies to get attention, either as people who are seeing the reality worse than it is. We're seen as irrationnals because how could our life be that bad?

[AdorkableHarleyFairy]

CBT hurt my brain so much, talk therapist kept telling me I was doing it wrong 🙄
I was being realistic after years of being abused & needing to search out any/all silver linings. They wanted me to "stay positive, " and I was burnt out from performing

[miadifferent]

When I started looking for therapy I avoided CBT at all cost. - I didn’t want to think my way out of problems and aim to better myself. I wanted to get in touch with my authentic self and FEEL who I am and what I need.

[arielnecessary]

I had CBT, but it didn't help me. I felt like it was mostly gaslighting me. The therapist also criticized me a lot. Autistic people are constantly being criticized anyway, so that just added to my feelings of inferiority. A really annoying criticism was when the therapist criticized me for having autistic traits. Well of course I have autistic traits! I have autism. Of all the people who should understand autistic traits, I would think that people in the mental health field would understand them. The therapist's toxic positivity caused me pain too, since I felt like it dismissed the realities that I have to live with.
My conclusion from all of this is that CBT is not good for autism. At least, it wasn't good for me. It caused me a lot of harm.
Excellent video, by the way.

[cleverbyhalf]

I recently began to suspect I am autistic. I have had severe anxiety for my entire life. I was diagnosed with PTSD. I have went to 3 different therapists. The last one I saw for well over a year and I never progressed. He would say "you overthink everything" or "I have never had a patient that intellectualized everything as much as you do". He kept trying to get me to a feeling place, and when I talked about what made me anxious, which was largely societal issues, he thought I was ducking getting in touch with trauma. Now in hindsight I see so many aspects of my life come into sharp focus if I use autism as a schema. My anxiety was not about trauma. It was about expectations I could not meet. It was about sensory overload. No one broke me, my parents didn't fail me. I am not a broken person. The shrink was often trying to get me to talk about my mom, but we had a beautiful relationship. It was mystifying to me, I would keep on trying to think why I was so damaged inside. CBT was harmful for me.

[upbmqge]

When I pointed that out to my therapist, he told me to "not tell him how to do his work". I never came back to his office after that.

Anyway, thanks for talking about such important topics with so much clarity, Paul. Your channel is probably the one helping me the most with this kind of stuff.

[Jae-byhf]

CBT made me worse and I felt like I was screaming into the void when I kept telling MH professionals that it didn’t work for me. Here in the UK they make you feel like if you don’t accept CBT there is no other option and then you just get shoved from pillar to post while screaming toxic positivity at me. I have just finished DBT & the self soothe/Tipp skills have been extremely helpful but the social skills were not. If anyone wants to try DBT, try to do it as an individual and make them know that the social skills do not work for you. My therapist was nice but I don’t think she understood my limitations,

[loma]

I think CBT helped hide my autism from myself and made my social struggles worse. When I had trouble socially in college, and I felt like I kept making social mistakes and needed help to understand what was going on, my therapists would say things like "oh, it's probably nothing! You're doing great!" But then I didn't make any real lasting friendships at school. Ironically, I think CBT made me worse at understanding people and social situations, because I felt that I was getting a vibe from friends that something wasn't working with the way I was approaching social things. Turns out my gut feeling on that was right, but they didn't see anything was wrong because i was much more comfortable one on one and therapists, unlike regular people, don't mind if you infodump about your life haha. so basically started to mistrust my own readings of people. This was all before I was diagnosed btw! Aside from my diagnosis process, I haven't been to therapy since, but I'm curious to hear about other approaches!

[erinancientelements]

For so long, I have not been able to figure out exactly WHY I felt like CBT was not right for me. Every therapist begins with it and you are almost made to feel guilty if you don't gel with it, but I couldn't articulate the feeling/reason. Thank you so freaking much for doing that for me!! I might also add that it was one of your videos that made me realize I was autistic! Thank you for also helping me begin the journey of self acceptance!