Thrive On the Autism Spectrum

Recognizing a Worry

So many individuals with Asperger’s and autism get caught up in worries, repetitive thoughts, ruminations. Often, worry is the number one difficulty that individuals on the autistic spectrum have to deal with. We all face failure, rejection, unpleasant situations and uncomfortable emotions. But the difference in how well you manage is about how well you can let go and move past those difficulties.

Worry is about the past, looking at all the things that have gone wrong for you. And, worry is about the future, recreating all those negative situations and imagining them into the your future. That’s why present based programs, things like Eckhart Tolle’s the Power of Now, or Mindfulness Based Stress Reduction can be so effective: they help you move out of the past, out of the future, and focus on the now. Even a simple step like pausing for a breath or two can reset your anxiety level, move you out of thinking about the past or imagining the future, and take you right into the present moment.

It’s Not About You

“It’s not you, it’s me.” A cliched breakup line? Yes, it is. A true statement? Yes, again.

So often, when I’m talking to people, they’re stressed about someone else’s reaction to something that happened. They told a story, and the listener wasn’t paying attention. They tried to invite someone for lunch and the invitation wasn’t accepted. Or, a close friend has drifted away, for no clear reason. Then they start analyzing, worrying, ruminating. “What did I do wrong?” “Why does this always happen?” What should I do differently next time?”

For individuals with any degree of anxiety about social interactions, these “rejections” can feel so devastating, so personal. Of course it’s important to examine the situation, see if you did play some role in things not working out too well. But then, it’s okay to let it go and stop dwelling on it. We all lead busy lives, with so many obligations, pulled in so many different directions. Most of the time, you didn’t do anything wrong. You colleague really does have something else to do at lunchtime. Or, your story was fine, the listener was just caught up in remembering an important obligation.

Often, the true social damage happens after this minor disconnect. An insecure individual can read too much into it, start over-thinking, get too worried, pull back too much, turn a little issue into a big pattern of social issues. On the other hand, socially confident people assume the best, about their ability to be a good friend, and their interactions with others. If a friend says he’s busy, they assume he is, and issue the invitation again. If an invitation is rejected, they try again. After all, chances are, it’s about them, not you.

Mindfulness and Dealing with Stress

Stress and anxiety can be major problems for individuals on the autism spectrum. For all of us, modern life can be overwhelming, pressured, fast paced and demanding. For those on the spectrum, the stresses can be even greater, because they may include social anxiety, sensory problems, career difficulties, or managing repetitive thoughts.

One very effective way of dealing with stress is through mindfulness. Mindfulness, as the term is used in modern American society, is based on Buddhist ideas, although it is not a religious concept. Jon Kabat-Zinn, in his classic book Wherever You Go There You Are (1994) defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” (p. 4) and states that it is “simply … the art of conscious living.” Kabat-Zinn is a Professor of Medicine Emeritus and the founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Mindfulness Based Stress Reduction is a program the center developed to integrate mindfulness and mindfulness meditation into modern medicine and healthcare. Mindfulness techniques have been shown to be effective not just for medical conditions, but for managing stress and anxiety as well.

You can learn more about mindfulness in Kabot-Zinn’s Wherever You Go There You Are, or his Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (1990). There are also websites and online videos on mindfulness based stress reduction, as well as eight week courses available in locations throughout the country.

Emotion and Feeling

Managing emotions is a challenge for many individuals, young or old, whether neurotypical or somewhere on the autism spectrum. Everyone’s struggles are a bit different, with some people veering toward worry and anxiety, others tending to sadness or depression and still others prone to anger. A great deal of my work as a therapist is in helping people manage their troubling emotions, whatever emotions they happen to be.

When working with emotions, it’s helpful to pay attention to the feelings of the body, the actual somatic sensations. Many individuals are more comfortable staying in their heads, intellectualizing and reasoning, rather than physically feeling. If you’re intellectual, pride yourself on your academic achievements or thinking strengths, this could apply to you. If you struggle with overwhelming sensory issues, or physical activities like athletics, then it’s not surprising if you also avoid the more bodily experiences of emotions.

The best way to manage feelings is to actually feel them. Try it now. Stop talking, stop doing anything, try to quiet that conversation in your head. Take a breath, and feel what’s going on in your body. 

Anger Management and Asperger’s, Part III: Allowing Anger

Anger can be a scary emotion, and many people try to suppress it.  Kids may think they’re not allowed to get angry, parents may not want their kids to show their anger, and adults may think anger is, somehow, wrong.  The reality is that anger is a part of being human. Anger allows us to feel the injustice of situations, it helps us set healthy boundaries, and it can provide the power to make great changes.

Most small children start expressing anger when they don’t get something that they want. That’s still true of older kids and adults, but as children develop, they also will get angry when they perceive a situation as unfair. Our innate sense of justice gets triggered, especially when we’re the ones being mistreated.

The goal in anger management is not to get rid of or suppress anger, it’s to allow the emotion in a healthy and even a useful way. I often ask clients, “How are you allowed to express anger?” Frequently, the question is answered with a puzzled silence or, “But, I’m not allowed to get angry.” My suggestion, to everyone trying to manage anger, is to think in advance about what’s allowed.

Parents should discuss anger with their kids, during a calm time. What are the family rules about anger? Some families forbid the use of certain words, name-calling, breaking things, throwing things. Other families are more liberal. Whatever your family’s rules, there has to be some allowed form of anger expression. And remember, siblings get mad at each other. That doesn’t mean they hate each other, or that they will not get along in the future.

For adults, just acknowledging your own anger may make you feel better. Writing in a journal, or writing (not mailing!) a letter can get the thoughts out of your head. Physical activity, like running or dancing, may help use that energy up. Others feel better if they put their emotions into creative activities. Music can be either expressive or soothing. Focusing on change may make anger easier to manage, whether it’s starting a neighborhood watch, or thinking about what you can control in your marriage.

It’s important to pay attention to how the emotion of anger feels, physically in your body. So many people tend to be head oriented, they forget about the body. And, the body is where emotions live. Being more body focused can help you manage your feelings and move on.

For more on this topic, be sure to check out my earlier blog posts on anger management. Anger Management and Asperger's, Part I: Understanding Anger and Anger Management and Asperger's, Part II The Feeling of Anger.

Repetitive Thinking and the Autism Spectrum

One of the most troublesome aspects of autism and Asperger’s can be the tendency toward repetitive thoughts, also referred to as stuck thoughts or ruminations. While this trait is probably tied to the ability toward extreme focus that can be such a strength for those on the spectrum, it’s a problem when individuals can’t shift away from thinking about things that are not of their choosing. Often, individuals get caught up in worries, dwelling on past slights from others or their own mistakes or have problems letting go of past traumas.

Frequently, people will refer to this issue with the term “obsession”, but I don’t like to use obsession in this case. Technically, “obsession” as used in the mental health sense refers to stuck images, thoughts or ideas that are a part of Obsessive Compulsive Disorder. Although some individuals with ASDs also have OCD, that’s not always the case.The content of thoughts in OCD also tend to be different than those found with ASDs. (For an excellent article on this, see McDougle, C. J., Kresch, L. E., Goodman, W. K., et al (1995) A case-controlled study of repetitive thoughts and behaviour in adults with autistic disorder and obsessive-compulsive disorder. American Journal of Psychiatry, 152, 772 -777)

An excellent book for self treatment of OCD is Brain Lock: Free Yourself from Obsessive Compulsive Disorder, by Jeffrey M. Schwartz, M. D. Schwartz presents a four step program involving learning to recognize obsessive thoughts, labelling them as a part of OCD, focusing on something else for at least a brief while, and then finally “revaluing” these obsessive thoughts. You can find a clear explanation of these four steps on the website for the Westwood Institute for Anxiety Disorders, Inc.

Neither the book nor the website talk specifically about the autism spectrum and repetitive thoughts, but Brain Lock does have an interesting chapter on the Four Steps and Other Disorders, and states that they can be applied to “almost any behavior you genuinely want to change.” (p. 187) The ideas in this book are certainly worth considering for those on the autism spectrum dealing with this troublesome issue.

Depression and the Autism Spectrum

Depression and the Autism Spectrum

Depression and antidepressants are big news this week with Newsweek’s February 9, 2010 story by Sharon Begley, “The Depressing News About Antidepressants: Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.” (Sharon Begley also wrote the book Train Your Mind, Change Your Brain, which I discussed in an earlier post.)The article goes on to explain the placebo effect, and what analysis of numerous studies on antidepressants, both those published and not published are showing about the effect of the drugs, and the often superior results of psychotherapy.

Depression is a concern for many on the Autism Spectrum, with almost a third of individuals with autism and Asperger’s also dealing with depression. (Mohammad Ghaziuddin’s Mental Health Aspects of Autism and Asperger Syndrome has a good review on this topic if you’re looking for details.) Social isolation, difficulty managing relationships, chronic stress from sensory issues, and practical matters like underemployment can all be contributing factors. For more info, you can find an earlier article I wrote on "Depression with Asperger's Syndrome and Autism".

Dr. Michael Yapko, a Clinical Psychologist and MFT, has published and spoken extensively on the ideas that depression is the result of many lifestyle  and social choices and curing depression does not come from a pill. He is the author of Depression Is Contagious, which I haven’t yet read, but it’s in my stack of books. You can hear an interview of Dr. Yapko, where he discusses his book and theories on the importance of social connections and good problem solving skills in managing depression.

Please note: If you’re currently taking antidepressants and these articles are concerning to you, don’t just stop taking them. Please talk to your prescribing physician. It can be very dangerous to stop taking any prescribed medication, or to alter the dose, and any changes to medications should be made under a doctor’s supervision.

Anger Management and Asperger’s, Part II: The Feeling of Anger

Anger management skills are important for everyone, not just those with Asperger’s and autism. But for those on the spectrum, managing anger may be especially difficult. In my post of 10/1/09, I discussed understanding anger. In today’s post, I’ll be discussing the actual physical sensation of anger.

Like all emotions, anger comes with a physical feeling. And that’s important, because often that physical feeling is the first subtle clue that the emotion is present. Many individuals experience anger as a tightness in the hands, arms, and jaw. Some people may get a stomachache or a headache. What’s of interest is how you specifically experience anger.

For many of my clients on the autism spectrum, they are more comfortable with reason and intellect, and may be less attuned to the sensations in their bodies. For those with sensory issues, the physical sensations in their bodies may be so overwhelming that they try to tune them out. Whatever the reason, disconnecting from the physical may mean that subtle, early signs of anger are not recognized.

It’s possible to re-experience all the feelings of anger just by remembering an upsetting event. This may be the perfect opportunity to tune in to your experience, without feeling as overwhelmed as when you’re actually in an angry situation. The next time you’re remembering something that made you angry, close your eyes and scan your body. Note what feels different. This is how your body reacts to anger.

Recognizing anger is an important step in managing it. Look for upcoming posts for further info on this topic.

Anger Management and Asperger's Part 1: Understanding Anger

Anger management is an problem for many individuals, whether or not they have Asperger’s or an ASD. It’s one of the topics that gets searched for most frequently by readers of this blog. In an earlier post I referenced an Anger Management article I wrote for Autism Asperger’s Digest Magazine, but until now I haven’t written anything on anger management specifically for this blog. Because anger management is such a big topic, I’m not going to attempt to cover it all in one post.

We’ve all had that feeling of anger growing, and getting out of control. Sometimes when we lose our tempers, a part of us may even know it’s happening, but the anger still seems to have taken on a life of its own. Anger management techniques can help us manage before the situation gets out of control.

With my therapy clients who are dealing with ADHD, autism, or Asperger’s and anger, I start by exploring what anger is. Most important: anger is not a bad emotion! Anger is powerful, strong and it drives people to make changes in situations that just aren’t working. So the point is not to eradicate anger, but to control it. To manage it.

Another important fact about anger is that the emotion often exists concurrently with other emotions. People may react with rage when what they’re really feeling is disappointment, shame or guilt, fear, or sadness. All of those other emotion can have an aspect of weakness and powerlessness. It may feel safer and more empowered to shift that helpless feeling over to the power of rage. I often ask clients to reflect on what the emotion behind the anger is. What’s the uncomfortable feeling the anger covers?

Next we’ll explore the physical sensation of anger and how important that knowledge can be for managing it. Please check back for further posts !

Asperger’s, Autism and Psychotherapy

I’m a therapist, also called a counselor, a psychotherapist, or even a "shrink",  and I work with people who have Asperger’s, autism, or other ASDs. But that doesn’t mean I’m trying to cure someone of their autism. That’s a confusing distinction, but it’s important.

Many individuals on the autism spectrum are struggling with the symptoms from a mental disorder, such as depression, anxiety, or getting caught up in repetitive thoughts. Those are all things that can be treated with psychotherapy, (and sometimes other means), and often “cured” or at least managed so that the symptoms aren’t a problem.

Other individuals on the autism spectrum are trying to deal with issues that go along with their autism, such as difficulties with social signals or managing relationships. Those symptoms can also be managed through psychotherapy.

But the important thing is that in neither of these cases is psychotherapy meant to take the autism away from an individual. It’s not trying, or even wanting, to “cure” autism or Asperger’s.

I think that many autistic people don’t want to be changed. They appreciate and enjoy their cognitive strengths. They derive a great deal of pleasure from their special interests. They relish alone time. And they have no interest in becoming a social, outgoing, maybe even shallow, neurotypical.

The good news is that people can have the best of both worlds. Therapy can manage depression, anxiety, or other symptoms so they’re not a problem. People looking for more satisfying relationships or professional success can learn to adapt in the ways they choose to. And at the same time, all the strengths and special characteristics of ASDs don’t have to be erased.

You can learn more about this topic at my Therapy and Coaching for Asperger's, Autism and ADHD website or in my ezine article on Depression with Asperger’s and Autism.