Cognitive defusion for reducing distressing thoughts in adults with autism

Abstract Background Cognitive fusion occurs when people over-identify with their thoughts, leading to a strong emotional response and a narrowed behavioral repertoire. Cognitive defusion (CD) is a technique used in acceptance and commitment therapy (ACT) to teach people how to pay attention to the process of thinking, thereby reducing the negative effect of over-identification and allowing people to behave in more adaptive ways. CD has been widely studied in neurotypical (NT) samples, but there is little research on cognitive fusion and related interventions for people diagnosed with autism (AS). Method Sixty-eight adult participants (AS group n  = 27; NT group n  = 41) answered questionnaires measuring psychological distress and dispositional levels of cognitive fusion. In a lab setting, participants next identified a personal distressing thought, then were randomized into a brief (5-minute) cognitive defusion technique or an equally-brief active distraction technique. Before and after the intervention, participants completed measures assessing the believability of their distressing thought and how much discomfort the thought caused. Results The AS group reported higher overall trait levels of cognitive fusion than the NT group. Cognitive fusion was moderately- to strongly-related with psychological distress in both participant groups. The brief interventions worked equally well in immediately reducing thought believability and thought discomfort for AS and NT groups. Conclusions The current study provides support for cognitive fusion as a contributing factor to the psychological distress experienced by people with AS, and that a brief intervention technique can effectively reduce fusion at least in an immediate context. More work is needed to explore the specific short-term and long-term efficacy for interventions aimed to reduce cognitive fusion.