Which Interventions Reduce Anxiety in Autistic People?

You might see that anxiety affects autistic people in different ways. For example, 69% of autistic kids ages 9-13 have high anxiety.

27% of autistic adults have some type of anxiety disorder, and about 42% of autistic adults have experienced an anxiety disorder at some point. Almost half, or 49%, of autistic kids have an anxiety diagnosis.

To help reduce anxiety, you can try adapted cognitive behavioral therapy (CBT), mindfulness, exposure therapy, medication, relaxation training, Interoception Therapy, or ABA. Studies show that adapted CBT and mindfulness are effective in helping many autistic people reduce anxiety.

These methods often require adjustments in how individuals communicate and perceive their surroundings, making them distinct from approaches used for neurotypical anxiety.

Key Takeaways

• Adapted cognitive behavioral therapy (CBT) helps lower anxiety in autistic people. It uses pictures and simple steps to teach coping skills.
• Mindfulness techniques like breathing exercises and grounding can help reduce anxiety. Doing these often with sensory-friendly tools works better.
• Exposure therapy lets people face their fears slowly. It is important to use coping skills during these sessions for better results.
• Medication can help with very strong anxiety. SSRIs are often given, but a doctor should watch for side effects.
• Making a calm space can help lower anxiety. Use soft lights, noise-canceling headphones, and visual supports to make rooms feel better.
• Having routines makes life more predictable and helps with anxiety. Visual schedules can help you follow daily tasks more easily.
• Self-advocacy is very important. Tell others about your needs and triggers to get support.
• Finding good providers and support groups can give extra help. Look for professionals who know about autism and anxiety for the best care.

Therapies to Reduce Anxiety

Adapted CBT

Modifications

Adapted cognitive behavioral therapy (CBT) can help lower anxiety in autistic people. This therapy changes regular CBT to better fit autistic people’s needs.

Therapists often use more pictures and charts to show ideas. They give written steps and clear examples to help you follow along. Instead of just talking about thoughts, therapists focus on changing actions.

They might use your favorite topics to keep you interested. Family members sometimes join sessions to help you practice at home.

Using pictures and simple words helps you learn coping skills.

Some common changes are:

• Using picture schedules and social stories.
• Splitting tasks into small steps.
• Practicing skills in real life.
• Focusing on your strengths and experiences.

Effectiveness

Research shows adapted CBT can lower anxiety in autistic kids and adults. For example, a 6-week CBT program helped kids with Asperger syndrome feel less anxious.

Another study found a 16-week group CBT worked better than no treatment for kids with autism spectrum disorder (ASD). Many studies say CBT helps kids with ASD handle anxiety.

Adapted CBT works best when therapists use pictures, written steps, and include caregivers. Focusing on real behavior changes also helps. Some people need extra help to use these skills in daily life.

Mindfulness

Techniques

Mindfulness teaches you to pay attention to the present moment. This can help calm your mind and body and lower anxiety. Many autistic people like sensory-friendly mindfulness tools and routines. Here are some things you can try:

Benefits

Mindfulness can help you handle stress and lower anxiety. Studies show mindfulness programs can lower stress and anxiety for autistic adults. Kids with ASD also feel less anxious and have better moods after mindfulness training.

Mindfulness works best when you use sensory-friendly tools and practice often. Some people need extra help to stay focused during mindfulness.

Exposure Therapy

Relaxation Training

Relaxation training teaches you how to calm down before facing things that make you anxious. You can use things like muscle relaxation or deep breathing.

Studies show that these skills help autistic people have fewer anxiety behaviors. For example, kids who learned these skills had fewer tantrums and hurt themselves less.

Therapists use pictures and simple words to teach relaxation. They explain why it matters and show you how to use these skills at school or home.

Application

Exposure therapy helps you face fears in a safe way. You start with easy steps and practice coping skills as you go.

Research shows exposure therapy can help autistic youth get better faster, especially if you practice coping skills during sessions. Starting exposure early in therapy can help even more.

But exposure therapy does not help everyone. It may not help you handle things like loud sounds or rough textures.

Sensory problems can make exposure therapy hard for some autistic people. Therapists need to change the plan to fit your sensory needs and not cause more anxiety.

Exposure therapy is not right for everyone. Talk to your therapist about what feels comfortable before you start.

Medication

Medication can help if you have anxiety and are autistic. Doctors give medicine when therapy does not help enough. Medicine is also used when anxiety is very strong. Medicine works better when you use it with other treatments.

Common Types

SSRIs

Doctors often pick SSRIs to treat anxiety in autistic people. Some SSRIs you might know are:

• fluvoxamine (Luvox)
• fluoxetine (Prozac)
• sertraline (Zoloft)
• citalopram (Celexa)
• escitalopram (Lexapro)

SSRIs help some people feel less anxious. Studies do not always agree on results. Fluvoxamine did not help kids in some studies.

Fluoxetine may help adults feel less anxious. SSRIs can cause side effects like mood changes or feeling more active. Teens may have thoughts about hurting themselves. Doctors watch you closely when you start SSRIs.

Other Options

Other medicines can help with anxiety too. Mirtazapine is a NaSSA. It helps with anxiety and may make you want to eat more or feel sleepy. Buspirone is another choice. Most people do well with buspirone. It can help lower anxiety. Benzodiazepines are used for short-term anxiety. These can cause memory problems or make you want to keep taking them. Doctors do not use benzodiazepines for a long time.

Safety

Side Effects

You should know about side effects before you take medicine. The table below shows what researchers found about common anxiety medicines for autistic people:

Talk to your doctor if you notice changes in mood, sleep, or behavior when you start a new medicine.

Monitoring

Doctors need to check on you often when you take medicine for anxiety. You may see your doctor a lot at first. They look for side effects and see if the medicine helps you feel less anxious.

Tell your doctor right away if you have any problems. Regular visits help keep you safe and make sure you get the best results.

Environmental Changes

Changing your environment can help if you feel anxious. You can make your space calmer and easier to handle. Focus on two things: sensory modifications and routines.

Sensory Modifications

Reducing Overload

Bright lights, loud sounds, or crowded places can be too much for many autistic people. You can make things better by using adaptive sensory environments. These places help you feel safe and relaxed. Here are some ways to lower sensory overload:

• Make spaces with soft lights and comfy chairs.
• Wear noise-canceling headphones to block loud sounds.
• Find quiet spots when you need a break.
• Use calming things like weighted blankets or fidget tools.

Studies show these changes can lower anxiety, especially in places like hospitals or dental offices. You may feel less stressed when your senses are not overloaded.

Try different sensory tools to see what helps you feel calm.

Visual Supports

Visual supports help you know what will happen next. You can use pictures, charts, or written schedules to plan your day. These tools make routines easier to follow. Many autistic people feel less anxious about changes or surprises when they use visual supports.

• Use picture schedules to show daily activities.
• Put visual reminders in places like your bedroom or classroom.
• Try color-coded charts for chores or tasks.

Routines

Predictability

Having routines gives you order. When you know what will happen, you feel safer. Predictability helps you focus and talk to others. Research shows routines help you manage feelings and lower anxiety.

Implementation

You can build routines by starting with easy steps. Pick regular times for meals, homework, or bedtime. Use visual schedules to remind you of each step.

Ask family or teachers to help keep routines steady. If something changes, update your schedule so you know what to expect.

• Make a morning checklist to start your day.
• Use alarms or timers to switch between activities.
• Look at your schedule each night to get ready for tomorrow.

Small changes in your space and routine can help you feel less anxious and more confident.

Accommodations

School Supports

Flexible Schedules

Flexible schedules at school can help you. You might start later or leave early if you feel stressed. Some schools let you take breaks when you need them.

These schedules help you handle your work and avoid stress. Planners and timetables show what will happen each day. Knowing your schedule makes you feel more sure and less anxious.

• School mental health staff can help you with anxiety.
• Many schools use clear planners and timetables to help you know what to expect.
• Programs like TEACCH give you tasks in quiet places, so you can focus better.

Ask your teacher if you can use a visual planner or checklist to help you remember your day.

Sensory-Friendly Spaces

Sensory-friendly spaces are places to relax when things get too loud or bright. These spaces have soft lights, quiet spots, and comfy chairs.

You can use noise-canceling headphones or fidget tools there. Many schools have sensory rooms or quiet areas for breaks. These spaces help you calm down and get ready to learn again.

• Sensory-friendly spaces help you feel safe and less overwhelmed.
• Visual supports, like picture schedules, make routines easier to follow.
• School interventions can lower anxiety symptoms by a lot.

Workplace Supports

Adjustments

You may need changes at work to feel good and do well. Many jobs let you pick your hours, so you can start or finish at times that work for you.

You can ask for less light or noise in your workspace. Some bosses give clear written steps and check in often. These changes help you handle anxiety and stay on task.

1. Know common anxiety signs, like sensory issues and social worries.
2. Ask for workplace help, like flexible hours and clear instructions.
3. Use mental health supports, such as cognitive behavioral therapy.

• Changing things like noise and lighting can help you feel better.
• Flexible support and work hours are important if you feel anxious.

Advocacy

Advocacy means asking for what you need at work. You can ask for autism awareness training for your team. This training helps coworkers understand and support you.

A supportive workplace lets you talk about anxiety and take breaks. You should feel okay going to appointments or using coping skills during work.

When people understand each other at work, everyone feels respected and supported.

You can use these school and work accommodations to lower anxiety and feel more confident every day.

Identifying Triggers

It is important to know what causes your anxiety. Many autistic people have different things that make anxiety worse. You can learn to notice these triggers and make a plan to deal with them.

Personal Triggers

Sensory Factors

Some sounds, lights, or textures might bother you. Sensory triggers are very common for autistic people. Loud noises in the lunchroom or bright classroom lights can cause stress.

You can write in a journal when you feel anxious and what is happening. This helps you find patterns and see which sensory things affect you most.

Common sensory triggers:

• • Sudden loud sounds like fire alarms or shouting
  • Bright or blinking lights
  • Itchy clothes or tags
  • Strong smells

Try noise-canceling headphones or sunglasses to help with too much sensory input.

Social Factors

Social situations can also make you feel anxious. You might feel nervous in big groups or when routines change. Not knowing what will happen can be hard.

Some people worry about making eye contact or talking to others. You can write down which social events make you anxious. This helps you get ready and ask for help if you need it.

Social triggers to watch for:

• • Group work at school or meetings at work
  • Changes in your schedule
  • Meeting new people
  • Speaking in front of others

Coping Plans

Collaboration

You do not have to handle anxiety by yourself. Family, teachers, or therapists can help you make a good coping plan.

They can help you notice triggers and practice new skills. Research shows that plans using adapted CBT or mindfulness help Reduce Anxiety in autistic people.

Anxiety disorders are very common in autistic people. Almost half of autistic adults and 40% of children have high anxiety. Caregivers and doctors need to know what causes anxiety and how to help.

Self-Advocacy

You can help with your own coping plan. Tell others what helps you feel calm or what makes you anxious. Ask for breaks when you need them. Use visual supports or calming tools. Practicing self-advocacy helps you feel more in control and sure of yourself.

• Steps for self-advocacy:
  • Tell trusted adults or friends about your triggers
  • Ask for changes in your space when you can
  • Use coping skills like deep breathing or grounding

A review found that personal coping plans, especially with mindfulness and CBT, help you manage anxiety better. When you know your triggers and have a plan, you can face hard things with more confidence.

Other Interventions

Interoception Therapy

Overview

Interoception Therapy helps you notice signals inside your body, like your heartbeat or breathing. Many autistic people have trouble noticing these signals.

This can make it hard to know when you feel anxious or upset. The therapy teaches you to pay attention to these feelings and link them to emotions.

You might learn to notice when your heart beats fast or your stomach feels tight. Therapists use activities and exercises to help you practice these skills.

• The ADIE intervention is a kind of interoception therapy made for autistic adults.
• This method helps you notice and handle body signals that connect to anxiety.
• Interoception, especially in the heart, is important for anxiety in autistic people.

Benefits

Interoception Therapy can help you handle anxiety better, especially if talking therapies are hard for you. Research shows the ADIE intervention lowered anxiety symptoms in autistic adults.

The study had 121 people, which is the biggest clinical trial for anxiety in autistic adults so far. The therapy works well because it helps your body and mind work together. You may find it easier to spot early signs of anxiety and use coping skills sooner.

• Working on interoceptive abilities can help you lower anxiety.
• The therapy helps people who find it hard to talk about feelings.
• Studies show that interoception and anxiety are linked in complex ways, which may explain why results are sometimes different.

Interoception Therapy may be best for people who do not get help from other therapies.

ABA

Strategies

Applied Behavior Analysis (ABA) uses different ways to help you manage anxiety. Therapists teach relaxation skills, like deep breathing or muscle relaxation, to help you calm down.

Visual aids and social stories show you what to expect in new or stressful times. Role-playing lets you practice social skills in a safe place. Mindfulness activities help you focus on the present moment.

Self-reinforcement means you reward yourself for using coping skills. Positive reinforcement helps you build good habits.

• Systematic desensitization helps you face fears slowly, so they become less scary.
• Cognitive behavioral techniques help you challenge negative thoughts.
• Social skills training and behavioral analysis help you handle social triggers.

Considerations

ABA has some things to think about. Some people worry that ABA tries to make you act like everyone else, instead of accepting your differences.

Therapists sometimes try to stop behaviors like hand-flapping or stimming, even though these can help you feel calm.

Critics say stopping these harmless actions can hurt your well-being. Some self-advocates believe ABA can cause harm by punishing natural autistic behaviors.

• ABA may cause problems like learned helplessness, low self-esteem, or anxiety if not used carefully.
• Long-term effects of ABA are not well known, but risks include less motivation and weaker social skills.
• It is important to be kind and listen to autistic voices when choosing ABA-based interventions.
• Punishing harmless behaviors can have bad outcomes, even if the goal is to stop harmful actions.

Always talk with your therapist about what you need and how you feel about ABA strategies.

Finding Resources

Qualified Providers

Therapist Search

There are many professionals who help autistic people with anxiety. Some therapists know a lot about autism and anxiety. They use methods like adapted CBT or mindfulness.

When you look for a provider, think about these things. Find therapists who understand your age and how you talk. Pick professionals who know about sensory sensitivities and how these affect anxiety.

Choose providers with certifications and experience with autistic people. Look for therapists who use treatments that research supports. Some providers include families in therapy sessions. Make sure clinics are easy to get to and fit your budget.

Groups like ECHO Autism and the AASPIRE Toolkit have lists to help you find autism-competent providers.

Questions to Ask

When you meet a new therapist, you can ask questions to see if they are right for you. Here are some good questions. What experience do you have with autistic people?

Which therapies do you use for anxiety? How do you change your approach for sensory needs? Do you include families or caregivers in sessions?

What training or certifications do you have? How do you check progress in therapy? Can you give therapy in a way that matches my communication style?

These questions help you know what to expect and make sure the provider fits your needs.

Support Groups

Online Options

You can join online support groups made for autistic people with anxiety. These groups give you a safe place to share feelings and learn from others.

Some popular online groups are Adulting on the Spectrum, Navigating A New Autism Diagnosis, GRASP, and Association for Autism and Neurodiversity.

Online groups use forums, video calls, or chat rooms. You can join from home and talk to people who understand your experiences.

Modified group CBT programs, online or in person, help autistic children lower anxiety. Community settings use these programs to support more people.

Community Resources

Many community organizations help autistic people with anxiety. You can find local or national groups that give information, support, and referrals.

Some examples are Autism Response Team, ECHO Autism provider directory, AASPIRE Toolkit, Pennsylvania’s ASERT, NAMI, and SAMHSA’s 24-hour services.

Other mental health organizations also offer support. These include Mental Health America, Depression and Bipolar Support Alliance, Anxiety & Depression Association of America, The Trevor Project, and The Jed Foundation.

These resources help you get support, learn new skills, and connect with others who have similar experiences.

You can use different ways to lower anxiety. Adapted CBT, mindfulness, exposure therapy, medication, and exercise all help. Plans made just for you work best. These plans fit your needs and help you feel safe.

• Doing exercise, having routines, and using visual schedules help you stay calm.
• Support groups, mindfulness, and self-care help families and caregivers.

Remember, you and your team can choose the best supports for you.

FAQ

What is the most effective therapy for anxiety in autistic people?

Adapted CBT helps many autistic people with anxiety. Therapists change CBT to match your needs. You learn coping skills with pictures and written steps. You also practice these skills in real life.

What sensory tools help reduce anxiety?

You can try noise-canceling headphones, weighted blankets, or fidget toys. These tools help you stay calm in loud or bright places. Try different tools to find what helps you most.

What should you do if medication causes side effects?

Tell your doctor if you notice changes in mood, sleep, or behavior. Your doctor can change your medicine or suggest something else. This helps you feel better and stay safe.

What routines help lower anxiety?

Daily routines like morning checklists and visual schedules help you feel safe. Eating meals at the same time each day also helps. Predictable routines make stress easier to handle.

What is Interoception Therapy?

Interoception Therapy teaches you to notice signals inside your body. You learn to connect things like your heartbeat or breathing to your feelings. This helps you use coping skills sooner.

What accommodations can schools provide?

Schools can give you flexible schedules and sensory-friendly spaces. They can also offer visual planners. These supports help you feel more comfortable and less anxious at school.

What should you ask a therapist before starting treatment?

Ask if they have experience with autistic people and which therapies they use. Ask how they change sessions for sensory needs. You can also ask if families join therapy.

What online support groups exist for autistic people with anxiety?

You can join groups like Adulting on the Spectrum, GRASP, or Navigating A New Autism Diagnosis. These groups are safe places to share and learn coping skills.