‘I live with my emotions much better now’: A qualitative study of autistic adults’ subjective experience of dialectical behaviour therapy

Abstract

Many Autistic adults without intellectual disability experience emotion dysregulation, which is associated with non-suicidal self-injury and suicidal behaviour. Dialectical behaviour therapy has been shown to be feasible, acceptable and potentially effective is supporting Autistic adults without intellectual disability with improved emotion regulation. Since dialectical behaviour therapy research is in its early stages in the field of autism, it is crucial to better understand the subjective experience of Autistic adults who received dialectical behaviour therapy to improve its pertinence for this population. Twenty-two Autistic adults presenting with emotion dysregulation with non-suicidal self-injury and/or suicidal behaviour/ideation who received a comprehensive dialectical behaviour therapy were interviewed using a semi-structured approach. A reflexive thematic analysis was conducted. Three superordinate themes were identified from the thematic analysis: (1) dialectical behaviour therapy is highly useful, structured and demanding; (2) dialectical behaviour therapy leads to changes in emotion labelling, emotion regulation and relationships; and (3) self-acceptance and feeling empowered to handle life’s challenges. Ideas to foster the pertinence of dialectical behaviour therapy for Autistic adults were also collected. Our findings indicate that dialectical behaviour therapy was experienced as highly helpful despite the effort it requires. Participants reported changes in emotion experience, social relationships, self-concept and quality of life, probably due to increased emotion awareness, emotion control and self-regulation. Suggestions include the increased use of modelling to foster skills acquisition.

Lay Abstract

Many Autistic adults struggle with their emotion regulation. Dialectical behaviour therapy is the main therapy available to teach emotion regulation skills to people with this kind of struggle. Prior work has shown that dialectical behaviour therapy might be effective for Autistic people. Yet interest in dialectical behaviour therapy is new in the field of autism, so it is important to understand whether and how the therapy may help Autistic adults better live with their emotions. This article uses interviews conducted with 22 Autistic people following dialectical behaviour therapy. We outline several factors that might make dialectical behaviour therapy effective for Autistic people. For instance, dialectical behaviour therapy seems to help Autistic people better label and understand their emotions, but also accept and respect themselves. Nevertheless, dialectical behaviour therapy is demanding and some changes are suggested to improve the effects of dialectical behaviour therapy, such as providing a less intensive format to diminish fatigue. Our article provides evidence for the usefulness of dialectical behaviour therapy to help Autistic adults better deal with their emotions and improve their quality of life. Building from the experience of Autistic people, our study highlights the perceived benefits of dialectical behaviour therapy and the potential changes (e.g. reduction of text) to improve the utility of dialectical behaviour therapy for Autistic adults.