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Fear and anxiety is among the most common presenting problems for people with Autism and other Intellectual and Developmental Disabilities (IDD). Anxiety interferes with participation in home, school, community settings, contributing to significant functional impairment, aggressive and self- injurious behavior, parent stress, and diminished family quality of life. Although CBT has been shown to be efficacious in treating anxiety in autistic youth (e.g., Wood et al., 2020), these treatments are time- and resource- intensive, manual- based, often inaccessible, and have largely excluded those with intellectual disability (ID). Thus, traditional CBT on its own may not be appropriate for all individuals with IDD, and could benefit from being integrated with Positive Behavior Support (PBS) (Neufeld, Law, & Lucyshyn, 2014). Using a family- centered PBS approach to treat anxiety in individuals with IDD can increase treatment accessibility and acceptability, promote generalization of skills, and facilitate maintenance over time.
This workshop covers how to address anxiety using a multicomponent intervention package that integrates PBS and CBT. CBT procedures include gradual exposure, psychoeducation, and cognitive restructuring. These CBT-for-anxiety strategies as well as PBS practices that are traditionally used to address challenging behavior are incorporated into a PBS Prevent-Replace-Respond framework with PBS Prevention strategies including:
• Incorporating “special interests” into treatment
• Increasing predictability
• Providing choices between various aspects of the exposure
• Modeling and/or verbally prompting an approach response
PBS Response/consequence strategies including:
• Positively reinforcing attempts to approach a feared situation
• Minimizing reinforcement/accommodation for anxious behaviors
And, PBS Replacement strategies including:
• Teaching a competing response, (e.g., waving hi to a dog instead of running away)
• Functional Communication Training (e.g., teaching to ask for a break from the anxiety-provoking situation)
• Teaching a relaxation response
This winter, ICI hosted an awareness level training on integrating PBS and CBT, covering the topics discussed above. To view a recording of this presentation, as well as slides, visit mnpsp.org. The materials are on the right side of the homepage, under the New Positive Support Awareness Training Series header.
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