Written in December 2022

CBT is short for Cognitive Behavioural Therapy, and it's often used to treat anxiety and depression, especially when negative and harmful thoughts are part of how these conditions present. CBT works by challenging negative and intrusive thoughts, accepting and understanding that these are irrational, and replacing them with positive thoughts, or learning to let go of (or ignore) unwanted thoughts.

It works brilliantly for some things, like social anxiety where people fear that others are laughing at them, or talking about them. In reality, most people are so wrapped up in themselves that they don't notice other people, so challenging the belief that “everyone's looking/laughing at me” works, because it is usually irrational.

CBT can be useful for some aspects of autistic mental health if they are truly irrational beliefs. I once had an irrational fear that my choice of socks somehow had an impact on whether my then-partner made it home safely from work. This was clearly an irrational thought and it was impacting on the quality of my mental health, so I challenged it by choosing different socks than the “safe” ones, and lo and behold my partner was unharmed on they way back from work. It took a few repeats of this to resolve the irrational thought process, but it worked.
 

The problem with CBT and autistic mental health is that often the impactful thing on our mental health is the cumulative effect of sensory and societal overload, or the expectations of others. Fearing going to the supermarket because it elicits a shutdown or meltdown isn't irrational at all – shutdowns and meltdowns are horrible to experience so of course we want to avoid them. A shutdown or meltdown is a perfectly normal autistic reaction to overwhelm; it's how our autistic brains protect themselves when overwhelmed. The answer is not exposure therapy, or getting used to it, or understanding that most people dislike the supermarket environment, or even that we should just somehow “not have a meltdown” because it doesn't achieve anything.
 

The answer to the fear of a shutdown or meltdown in the supermarket is NOT TO GO TO THE SUPERMARKET or to change things about the visit, such as going to a 24 hour store at 3am, or wearing headphones, or sunglasses, or having someone with us. CBT won't help us deal with the sensory overwhelm of environments that are overstimulating, but it will gaslight us into thinking that the problem is our reaction to the environment, and not the environment itself.
 

When CBT challenges our thoughts and those thoughts are normal autistic reactions to over (or under) stimulation, to sensory or social issues, to problems understanding others or whatever else it is that is the subject of therapy it gaslights us. It teaches us that our autistic reactions and experiences are wrong, that the problem lies within us, and not externally. It teaches us that we don't need to solve a problem or make an adaptation to accommodate our sensory, social or communication needs, but that we need to change how we are (how we function) in order to fit in.
 

This leads to feelings of uselessness, to low self-esteem and poor mental health. In a world where we're expected to change and fit in by default, we shouldn't have to experience this attitude from therapists. We need tools and strategies to deal with the world, not ways to further internalise the shame or guilt we probably already feel because we're different. CBT is not a suitable therapeutic intervention for autistic and other neurodivergent people and in the long term it can contribute to worsening mental health.