Intervention Publications

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Kelly B Beck , Heather J Nuske , Emily M Becker Haimes , Gwendolyn M Lawson , David S Mandell 

Psychiatric Serivces 2024

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Abstract

Community practitioners inconsistently implement evidence-based interventions. Implementation science emphasizes the importance of some practitioner characteristics, such as motivation, but factors such as practitioners’ emotion regulation and cognitive processing receive less attention. Practitioners often operate in stressful environments that differ from those in which they received training. They may underestimate the impact of their emotional state on their ability to deliver evidence-based interventions. This “hot-cold state empathy gap” is not well studied in mental health care. In this Open Forum, the authors describe scenarios where this gap is affecting practitioners’ ability to implement evidence-based practices. The authors provide suggestions to help practitioners plan for stressful situations.

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Jamie Kulzer, Kelly Beck, Caitlin Trabert, Eric Meyer, Jenna Colacci, Michael Pramuka, and Michael McCue

Journal of Vocational Rehabilitation 2023

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Abstract

Background: There is an urgent need for services that support a successful transition to postsecondary education and employment for young adults with neurodevelopmental and cognitive disabilities (e.g. autism spectrum disorder, attention-deficit/hyperactivity disorder, traumatic brain injury).

Objective: The purpose of this expository article is to describe the Cognitive Skills Enhancement Program (CSEP), a comprehensive clinical program designed for young adults with neurodevelopmental and cognitive disabilities transitioning to postsecondary education. METHODS:CSEP was developed through a community-academic partnership between a university and a state vocational rehabilitation program. Young adult participants complete programming that addresses four primary clinical targets: (1) emotion regulation, (2) social skills, (3) work readiness, and (4) community participation with the overall goal to increase awareness and promote successful employment outcomes while they transition to post-secondary education.

Results: To date, CSEP has supported 18 years of sustained programming and clinical services to 621 young adults with neurodevelopmental and cognitive disabilities.

Conclusion: This partnership model allows for flexible responses to participant needs, implementation barriers, and advances in evidence-based practices. CSEP meets the needs of diverse stakeholders (e.g. state vocational rehabilitation, post-secondary training facilities, participants, universities) while providing high-quality and sustainable programming. Future directions include examining the clinical efficacy of current CSEP programming.

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Kelly B. Beck,  Jessie B. Northrup,  Kaitlyn E. Breitenfeldt,  Shannon Porton,  Taylor N. Day, Kristen T. MacKenzie, Caitlin M. Conner, and Carla A. Mazefsky

Autism 2022

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Abstract

Emotion dysregulation underlies psychiatric symptoms and impedes adaptive responses in autistic individuals. The Emotion Awareness and Skills Enhancement (EASE) program was the first mindfulness-based intervention designed to target emotion dysregulation in autistic adolescents (12-17 years old). This project partnered with stakeholders to adapt EASE for autistic adolescents and adults with co-occurring intellectual disability and autistic elementary-aged children, groups who often benefit from caregiver support in treatment. Over three adaptation phases, we: 1) elicited stakeholder and expert feedback to adapt the original EASE program for autistic individuals with intellectual disability; 2) redesigned the adapted manual and expanded the target age range following a small “micro-trial” with a sample of autistic adolescents and adults with intellectual disability (n=6); and 3) demonstrated feasibility and acceptability of a caregiver-client team-based approach (EASE-Teams) in a sample of 10 autistic individuals with and without intellectual disability (ages 7-25) and their caregivers. EASE-Teams was both acceptable and helpful to families. Significant improvements were noted in participant emotion dysregulation, psychiatric symptoms, and caregiver stress from their child’s dysregulation. Findings suggest that EASE-Teams may be appropriate for heterogeneous developmental and cognitive needs. Future research to establish efficacy and refine EASE-Teams with community providers is warranted.

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Kelly B. Beck,  Carol M. Greco,  Lauren A. Terhorst,  Elizabeth R. Skidmore,  Jamie L. Kulzer and  Michael P. McCue 

Mindfullness 2020

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Abstract

Objective: Adults with autism spectrum disorder (ASD) consistently report lower quality of life (QOL) compared with peers. Despite the growing population and needs of adults with ASD, many psychosocial interventions target children and adolescents while relying on high-level cognitive strategies for symptom reduction. Mindfulness-Based Stress Reduction (MBSR), which cultivates awareness and regulation skills through experiential practice instead of cognitive strategies, has been modified for autistic samples across the lifespan. However, it has not been tested if the standard MBSR curriculum is appropriate for an autistic population to improve QOL.

Methods: This pilot feasibility trial aimed to (1) establish the feasibility and acceptability of a MBSR group intervention with adults diagnosed with ASD without modification; (2) evaluate fidelity to the MBSR curriculum; and (3) calculate estimates of change in QOL, life satisfaction, positive outlook, and mindfulness. Participants included twelve adults with ASD (IQ > 70; age 22–63). Participants completed the intervention and pre-, mid-, and post-assessments.

Results: Participants reported high satisfaction with the intervention on CSQ-8 (M = 27.92, SD = 3.5) with 100% retention. Randomly selected sessions met fidelity review on the MBI-TAC. Effect size estimates suggested large improvements in positive outlook (F(2,22) = 12.42, p < .001, d = 2.12), satisfaction with life (F(2,22) = 3.22, p = .059, d = 1.08), mindfulness (F(2,22) = 3.34, p = .054, d = 1.10), and quality of life (F(2,22) = 3.09, p = .066, d = 1.059).

Conclusions: This study established feasibility and acceptability of traditional MBSR for adults with ASD and identified key supports for implementing MBSR with ASD.

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Kelly B Beck , Caitlin M Conner , Susan W White , Carla A Mazefsky 

Journal of the American Academy of Child and Adolescent Psychiatry 2020

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Abstract

Mindfulness-based interventions (MBIs) are increasingly popular and have a growing empirical basis of support for improving physical and mental health, general functioning, and quality of life. MBIs are an especially attractive approach to improve emotion regulation (ER) in adolescents who have autism spectrum disorder (ASD), as they are thought to directly target ER and can be tailored to individual needs, symptoms, and cognitive capacity. Despite growing interest in MBIs for adolescents with ASD, there are few clinical delivery resources to support clinicians untrained in the use of mindfulness within therapy. This article uses an ASD-specific MBI as an exemplar to outline common challenges and solutions for clinicians using MBIs with adolescents with ER impairment. Mindfulness teaching practices described in this article have been trialed and refined over several years with >40 participants, across three different sites, and with 16 clinicians from four clinical professional backgrounds-most of whom had no prior experience with MBIs-in the Emotion Awareness and Skills Enhancement (EASE) program trials with adolescents with ASD. Although we describe the use of an MBI program with adolescents with ASD, the suggestions offered herein are relevant to use of MBIs with other clinical populations and include basic strategies for mental health professionals untrained in MBIs to enhance delivery to patients with ER impairment.

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Caitlin M Conner , Susan W White ,  Kelly B Beck ,  Josh Golt ,  Isaac C Smith ,  Carla A Mazefsky 

Autism 2019

Free Access

Abstract

Emotion regulation impairments are common among individuals with autism spectrum disorder and are believed to often underlie commonly seen problems with aggression, depression, and anxiety. The Emotional Awareness and Skills Enhancement program was developed to reduce emotion regulation impairment and thereby improve behavioral disturbance, via mindfulness. Emotional Awareness and Skills Enhancement consists of a 16-week individual therapy treatment targeting emotion regulation impairments among individuals with autism spectrum disorder. We describe the conceptual framework and development of the program and present data on feasibility and preliminary efficacy from a pilot trial. The Emotional Awareness and Skills Enhancement manual was developed using a participatory action framework, based on emotion regulation research specific to autism spectrum disorder and input from individuals with autism spectrum disorder, therapists, and parents of children with autism spectrum disorder. Emotional Awareness and Skills Enhancement was piloted in a two-site open trial with 20 participants with autism spectrum disorder (12-17 years old, confirmed autism spectrum disorder diagnosis, IQ > 80).Outcome data support program feasibility and acceptability to participants, as well as significant improvement in emotion regulation impairments and related concerns.Findings offer preliminary support for both the feasibility and clinical effectiveness of the Emotional Awareness and Skills Enhancement program.