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As the number of autistic students attending college has increased, more colleges have created programs to support them. However, mental health support is often not included as a component of those programs. This is a critical lack since autistic adults face more anxiety than their non-autistic peers. A 2020 study found that 20% of autistic adults were diagnosed with anxiety disorders compared to 8.7% of their non-autistic peers. Few empirical studies have evaluated the impact of mental health interventions for autistic college students.

In 2021 and 2022, Brian Freedman, Ph.D., senior associate director of the Center for Disabilities Studies and assistant professor at the University of Delaware, conducted an OAR-funded study to evaluate the initial effectiveness, feasibility, and acceptability of Facing Your Fears, a cognitive behavioral therapy (CBT) intervention for autistic college students with co-occurring anxiety.

Facing Your Fears has been shown to significantly reduce anxiety symptoms both at the end of treatment and at a three-month follow-up. It uses CBT, which is one of the most widely used treatments for anxiety and has been identified as an evidence-based practice for autistic people. A limited-time psychotherapy, CBT teaches patients how thought patterns impact emotional experiences and behaviors and how to change those patterns.



The study included two phases.

Adapting the intervention: Dr. Freedman and his team convened an advisory board of five autistic students on the University of Delaware campus. The group represented first-year students through graduate students with diversity in gender, sexuality, race, and ethnicity. The group provided feedback on the Facing Your Fears program that helped the research team adapt the intervention. The board continued to meet with the team to give feedback on the adaptations.

Randomized controlled trial: The research team recruited seven students to participate in the intervention, four in the 2021 fall term and three in the 2022 spring term. Two of those students withdrew from the program, one due to dissatisfaction with the intervention and one because they left the university. Dr. Freedman initially intended to recruit 15 students. However, he had difficulty recruiting students to participate because many felt overwhelmed with responsibilities and managing mental and physical health in the pandemic and difficulty with scheduling.

The team collected weekly data from the fall group, including answers to open-ended questions about the content as well as suggestions for adaptations. Facilitators also completed logs each week that captured information regarding the feasibility of implementing the Facing Your Fears program.

Based on that feedback, the researchers adjusted future sessions. Both rounds of intervention concluded with a post-intervention focus group led by Dr. Freedman.



Findings indicated that it is feasible to implement Facing Your Fears on a college campus, although some modifications may be needed. For example, a group therapy approach may not be feasible for all autistic students because not all participants will necessarily participate throughout the duration of the program. As noted above, two students withdrew during the intervention.

Participants found the group format to be helpful so they could learn from one another. They also said that the way they cope with anxiety is a little different after the intervention because they understand worry and have new strategies to use. Some participants also noted that one semester may not have been long enough to learn and practice the skills.

Due to the nature of descriptive statistics and small sample sizes. However, the research team was able to measure changes in individual students. In the fall group, there was no change in anxiety. One student had an increase in depressive symptoms from the beginning to the end of the intervention, and another had an increase in academic distress and a decrease in family distress.

In the spring group, there were positive changes in mental health for two out of three participants although no changes in general anxiety for any of the participants. One student had a decrease in social anxiety. Another student had decreased scores in depression, academic difficulty, eating concerns, and anger/frustration but no changes in anxiety. One student showed an increase in anxiety. The research team hypothesized that the mixed results might reflect how students’ mental health changes over the course of a semester, depending upon expectations and tasks.

Due to low recruitment rates and differing levels of anxiety among the participants, it was not possible to determine if Facing Your Fears is a viable treatment model for autistic students through this pilot study. The research did suggest that autistic college students are willing to participate in counseling and that the right match of intervention to student can result in positive change.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.