CBT often doesn't work on autistic people because we do not have an easy understanding of theory of mind, difficulty understanding and articulating concepts, difficulty with sensory issues, and difficulty with social interactions.
A core feature of autism is that we think differently.
Applying a non autistic model of thinking leads to gaslighting and confusion.
The thought challenging aspect of CBT is likely to be experienced as gaslighting as well, considering the challenges that autistic people face are often a realistic interpretation of what is going on.
Autistic people experience discrimination in most aspects of life and the world is not designed for us.
Futhermore there is significant additional trauma as part of the autistic experience. To challenge thoughts that are coming from the trauma is inappropriate.
A big part of CBT is behavioural activation, the idea that if you go out and you do activities that you enjoy it increases serotonin production, you'll feel happier.
People with autism tend to have sensory sensitivities, lower social batteries, and they tend to prefer routines.
Behavioural activation goes against all of that.
For example going to the cafe for breakfast and spending time with friends for a neurotypical person would cheer them up and increase their serotonin imput.
For an autistic person being exposed to and increase in sensory input, they have to socialise, and their eating routine has been changed.
Now they feel worse.
Many autistic people seeking mental health support are experiencing burnout.
To suggest to do more activities or try to work up to doing more activities or expose themselves to things that are distressing is harmful and likely to increase burnout and decrease hope.
As a society mental health is measured by function, so to an external observer that autistic person who is pushing themselves past burnout to go out and socialise, following the guidelines of the therapy recommended to them, they look more functional and therefore their mental health must be better when in reality that couldn't be further from the truth.
Autistic people need validation for the behavioural challenges that they are having and supports put in place for being able to meet needs that they cannot do themselves when they are burnt out.
Many autistic people experience alexythimia, this may be expressed as having trouble putting words to emotions.
Considering the very high rate of trauma in autistic people it is likely that many emotional reactions are emotional flashbacks or very intense emotional states that need soothing.
The way in which autistic people are taught to regulate their emotions can suppress their natural inclination such as the need to stim.
This means that for many autistic people they haven't developed the capacity to self soothe so when they are asked to do this and find it difficult then this can create a situation where they feel like they are being gaslighted and therefore feel quite hopeless.
Any CBT that is offered to neurodiverse people needs to be adapted to autism for it to have any chance of working. The NHS doesn't offer trauma informed autism specific CBT because it is too niche.
CBT is the hear and now approach when my issues stem all the way back to attachment styles as an infant and moving upwards from there.
Trauma physically changes the structure of your brain, especially when looking at developmental trauma or trauma that is happening in early childhood.
In typical brain development our cognition is supposed to be the primary development in the neocortex, then social and emotional regulation happening in the limbic system and then finally at the bottom survival in the reptilian brain.
However when trauma happens during those primary years of development this is reversed with survival being the primary focus and foundation of brain development and then working it's way up to social and emotional regulation and finally cognition.
CBT is working on the cognition and helps patients to think differently but trauma is stored in the body and is felt in the body. With bottom up approaches it focuses more on working with the body signals first.
I can't even access any sort of rational thinking or cognition when my body is screaming that we don't feel safe.
Bottom up approaches help patients learn how to cope with these big emotions, teaching us how to access safety in our bodies and then once that step is mastered then patients could access something like EMDR or processing where we are able to rewire some of the neurons in our brains and learning how to widen our capacity for cognitive thinking.
We have both afferent and efferent neurons in our body.
Afferent neurons carry information from sensory receptors which are found all over the body to the central nervous system.
Efferent neurons are then taken from the central nervous system and sent to the brain so that the brain can figure out what to do with the body, how to try to logically react to the situation.
The afferent neurons need to first be able to interpret the environment to tell the brain how to respond.
This is the body reponding to the environment first to then tell the brain how to respond.
There are way more afferent neurons then there are efferent neurons.
So when someone has a traumatic or stressful event that gets coded in your fascia, it gets coded in your nervous system, you cannot mindset your way out of it. It has to be from a body first approach.
When a person is in survival, they're in a trauma response of fight flight freeze fawn.
The nervous system is running off the amygdala. The amygdala takes priority and shuts off access to the prefrontal cortex and the body is constantly in survival mode.
Trying to rationally think through these really big emotions and trauma responses is practically impossible.
My personal experience with CBT has been incredibly invalidating and I find that CBT is so oversaturated in popular culture especially psychology culture. People assume that problems can be fixed with simple solutions.
For example communicating more effectively or simply repairing relationships. This is something that really should not be said to a trauma surviour.
Instead of correcting the thoughts, behaviours, emotions as negative what patients should instead be doing is paying attention to those emotions.
CBT is largely defined as a therapy that addresses maladaptive emotions, behaviours and thoughts through the process of learning new skills.
Effectively, CBT, assumes that a person's assumptions interpretations and expectations of events largely create negative outcomes that create issues in the person's life.
Trauma surviours are experts and hold knowledge over their experiences.
Trauma is incredibly complex and nuanced, and it is often upheld through a system of abuse.
This might look like a dysfunctional family member who are complicit with the abuse and neglect, who refuse to make an effort to heal.
A large portion of people who have maladaptive behaviours, thoughts and emotions have actually developed them in a very adaptive way.
For example avoiding that dysfunctional family member is allowing the surviour to adapt, adjust and participate in different aspects in life rather than continuing the cycle of abuse- making it an adaptive behaviour.
A CBT therapist may see this as a maladaptive behaviour based on 'inaccurate' thinking or 'inaccurate' responses to a situation.
The assumption in general is that healing can occur through finding simple solutions such as correcting negative thoughts, addressing maladaptive behaviours, framing things in a new perspective.
This actually does not allow 'negative emotions' such as anger, sadness, or grief to occur and be embodied and be expressed.
We all need to process emotion and need to create space for emotion and in a lot of ways these emotions, behaviours and thoughts are incredibly adaptive and incredibly normal considering that the event or situation that holds the trauma can be very profound.
For a lot of people it is a neccessity to be able to fully embody and fully accept and develop a relationship with their anger, grief, sadness in order to process the traumatic event.
Some bottom up approaches to therapy which are recommended for trauma patients are somatic experiencing, internal family systems, brainspotting, coherence therapy, sensorimotor psychotherapy, emotion focused therapy, art therapy, play therapy for inner child work, EMDR, animal assisted therapy and so many more.
My mom tried to be my friend,I never learned discipline
Got good at playing pretend, I swear that it's not my fault
I wish that I could rewind, wish I had another try
To finally raise myself right, I swear that it's not my fault
Got all this wasted potential, mommy said I was special
My crisis, existential, no, it's not my fault
Now I depend on these meds to calm the thoughts in my head
This is as sane as I get, oh no, it's not my fault
I could have dragged your name through the mud
'Cause you did everything that you could
Made it impossible
To like you, in the end kept my mouth shut
I'm trying to be a good person
I didn't say
All the things you did
I could just say
Protected your name
But maybe I let a little slip
'Cause I'm bad
But I could've been worse
Maybe we should look on the bright side
'Cause I held back
You'll get what you deserve
If I really wanted to, baby I could ruin you
Bad, but I could've been worse
I really could've been worse
You should thank your lucky stars
I don't like taking it too far
If I did what I really want
I'd hit you with my fucking car
I put on my prettiest dress,
And cry at my own birthday party.
Don't I look like such a mess?
I don't think I'm even sorry.
My sob story.
Disaster is my favorite compliment.
I love my party dress.
I'm having a great time,
Being the punchline
Of my own joke.
I think I'm gonna be fine
This comedy of mine,
I laugh so hard I choke.
Give it to your sister, your sister’s stronger
See if she can hang on a little longer
Who am I if I can’t carry it all?
If I falter
Under the surface
I hide my nerves and it worsens, I worry something is gonna hurt us
Under the surface
The ship doesn’t swerve as it heard how big the iceberg is
Under the surface
I think about my purpose, can I somehow preserve this?
Line up the dominoes
A light wind blows
You try to stop it tumbling
But on and on it goes
But wait, if I could shake
The crushing weight of expectations
Would that free some room up for joy?
Or relaxation? Or simple pleasure?
Instead, we measure this growing pressure
Keeps growing, keep going
‘Cause all we know is
Pressure like a drip, drip, drip, that’ll never stop, whoa
Pressure that’ll tip, tip, tip, ’til you just go pop, whoa-oh-oh
Give it to your sister, it doesn’t hurt and
See if she can handle every family burden
Watch as she buckles and bends but never breaks
No mistakes, just
Pressure like a grip, grip, grip, and it won’t let go, whoa
Pressure like a tick, tick, tick, ’til it’s ready to blow, whoa-oh-oh
Give it to your sister and never wonder
If the same pressure would’ve pulled you under
Who am I if I don’t have what it takes?
No cracks, no breaks
No mistakes, no pressure
andulkaphoto
annaxmalina
prguitarman
stormborns
gummygunk
baratheonpilled
ellievsbear
snowghoul
