Efficacy of the Emotion Awareness and Skills Enhancement (EASE) Program in Autism: A Randomized Controlled Trial

Abstract

Objective: Autistic adolescents and adults often struggle with emotion dysregulation, and advocates consistently encourage more research on mental health. This study aimed to establish efficacy for psychotherapeutic intervention for emotion dysregulation for autistic adolescents and young adults.

Method: In this multisite randomized controlled trial, a primarily mindfulness-based intervention called the Emotion Awareness and Skills Enhancement (EASE) Program, developed to improve emotion dysregulation in autistic adolescents and young adults, was compared to a rigorous active control condition (ACC) that allowed for personalized and evidence-based intervention as long as it did not include EASE core elements. It was hypothesized that the EASE group would demonstrate a steeper decline in emotion dysregulation, as well as decreased mental health problems, compared to those in ACC. A total of 109 participants were randomized, 102 began treatment, 89 participants completed all treatment sessions. intent-to-treat (ITT; n = 109) analyses were conducted, with supplemental per protocol analyses (PP; n = 76).

Results: Primary outcomes included emotion dysregulation severity and its interference with daily functioning, whereas secondary outcomes assessed mental health symptoms. Condition-naive interviews, which gauged impairment related to dysregulation, showed that the EASE group had more treatment responders (63%) compared to ACC (44%) (p = .052, odds ratio = 2.85), but this difference was not statistically significant. EASE participants demonstrated greater declines in emotion dysregulation than those in ACC (Reactivity, b = -0.168, p = .017; Dysphoria, b = -0.182, p = .010) at endpoint. EASE participants demonstrated improvement in internalizing and externalizing symptoms, relative to baseline, based on self- and caregiver-report, whereas ACC participants showed improvement only in caregiver-reported externalizing symptoms. All effects were stronger in PP analyses, suggesting the possible importance of treatment dosage.

Conclusion: Findings suggest that EASE improves emotion dysregulation for autistic adolescents and young adults.

Clinical trial registration information: Emotion Awareness and Skills Enhancement Program (EASE; https://clinicaltrials.gov/study/NCT03432832 DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as living with a disability.

Keywords: autism; emotion regulation; intervention; mental health; mindfulness.