Psychotherapy in autism: anxiety and depression

Anxiety disorders

For children and adolescents without intellectual disability, the guideline recommended (grade of recommendation A to B): therapy should take place over about three to six months in a group of peers with autism and an anxiety disorder, with additional individual sessions. A manualised cognitive behavioural therapy should be used, with psychoeducation about anxiety, discussion of one’s own fears, concrete ways of coping and exposure exercises practised as homework. Parents or key caregivers should be involved and support implementation in everyday life. ^{[1, Rec. 73]}

In addition, the guideline named the following adaptations to autism ^{[1, Rec. 73]}:

• written and visual information, structured worksheets,
• concrete task wording and a clearly structured sequence,
• clear and concrete language,
• where available, involving a parent or caregiver in the sessions,
• regular breaks,
• where possible, involving special interests.

For adults without intellectual disability, it recommended (consensus-based) essentially the same approach in a group with additional individual sessions and the same adaptations. Adults for whom a group is difficult or not possible should be offered the services in an individual setting. ^{[1, Rec. 74]}

Depression

The guideline was more cautious here. Diagnosed depressive episodes can be treated in adolescents with autism who have sufficiently high verbal cognitive skills (roughly from an IQ of 85) and no suicidality with a depression-specific cognitive behavioural therapy in a group. The focus is strongly on practice-based elements such as exercise, positive activities, stress regulation and relaxation (grade of recommendation 0, evidence level 2 to 3). ^{[1, Rec. 82]} The same applied to adults, additionally with mindfulness and daily exercises (grade of recommendation 0, evidence level 2). ^{[1, Rec. 85]}

For adults with autism and depressive episodes, the guideline says the National Disease Management Guideline on unipolar depression should be observed, regardless of cognitive skills and based on the clinical assessment of specialist doctors or licensed psychotherapists. ^{[1, Rec. 84]}

Suicidality and crises

The guideline stated: suicidality should be assessed as a matter of routine, and if there is suicidality, crisis intervention should be started immediately. In the assessment, the communicative particularities of people with autism should be taken into account. ^{[1, Rec. 90]}

If you or someone you know is in an acute crisis: in acute danger call the emergency number 112. Children and adolescents can reach the Kinder- und Jugendtelefon of Nummer gegen Kummer on 116 111 (Monday to Saturday, from 14 to 20 hrs). ^[4] Adults can reach the TelefonSeelsorge on 0800 111 0 111, 0800 111 0 222 or 116 123, day and night, free of charge and anonymous. ^[3]

What else you should know

• Psychotherapy can be adapted. The guideline explicitly named adaptations so that therapy becomes accessible for people with autism. ^{[1, Rec. 73]}
• Not every therapy fits. When searching, ask about experience with autism and about how the therapy is adapted. This is a practical tip from the editorial team.
• Medication for anxiety and depression is not covered here; doctors decide on this together with you.
• More background: Common co-occurring conditions, Support in autism: overview.

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Empf. 73, 74, 82, 84, 85, 90). – Guideline (in German); expired on 23 March 2026 (see no. 2)
2. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
3. TelefonSeelsorge Deutschland. https://www.telefonseelsorge.de/ – Counselling service (website in German)
4. Nummer gegen Kummer e. V. https://www.nummergegenkummer.de/ – Counselling service (website in German)