Adapted cognitive behavior therapy for obsessive compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study

Oskar Flygare, Erik Andersson, Helene Ringberg, Anna-Clara Hellstadius, Johan Edbacken, Jesper Enander, Matti Dahl, Kristina Aspvall, Indra Windh, Ailsa Russell, David Mataix-Cols, Christian Ruck

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Obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) commonly co-occur. Adapted CBT for OCD in adults with ASD has not previously been evaluated outside the United Kingdom. In this study, 19 adults with OCD and ASD were treated using an adapted CBT protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale-Brown Obsessive-Compulsive Scale (YBOCS). Participants were assessed up to 3 months after treatment. There were significant reductions on the YBOCS at post-treatment (d=1.5), and improvements were sustained at follow-up (d=1.2). Self-rated OCD symptoms and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from OCD. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted CBT for OCD in adults with co-occurring ASD is associated with reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.
Original languageEnglish
Early online date12 Jun 2019
Publication statusE-pub ahead of print - 12 Jun 2019


  • cognitive behavior therapy, obsessive compulsive disorder, autism spectrum disorder

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