Understanding Autistic Adults' Psychological Experiences of Anxiety Problems: A Qualitative Interview Study.
Rebecca J Roberts-Davis, Francesca G Happé, Alex Lau-Zhu
Twenty autistic adults described anxiety as a constant, chronic part of daily life, driven by intolerance of uncertainty and repetitive negative thinking.
They found CBT felt neurotypically focused and blamed them for their feelings. This is a qualitative study — it describes experiences, not treatment effects.
Key findings
1All 20 participants endorsed intolerance of uncertainty and repetitive negative thinking as relevant to their anxiety; 14 of 20 (70%) endorsed attentional biases and intrusive mental imagery. Most described their repetitive thinking as uncontrollable (17/20) and linked to catastrophising (18/20).
2Participants described anxiety as a pervasive, chronic 'undercurrent' in daily life, with a reciprocal relationship between autistic traits (sensory sensitivity, preference for routine, masking) and anxiety: being anxious heightened sensory reactivity and inflexibility, and those traits in turn provoked anxiety.
3Participants described CBT as delivered through a 'neurotypically focused' framework, with limited sessions, group formats, and a task-oriented approach that made them feel blamed for their feelings; they also reported unsustainable medication side effects and a desire for a more relational approach to care.
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What it does not show
Twenty participants, all from the UK, aged 18–55, all with a formal autism diagnosis and self-identified anxiety problems — findings may not transfer to autistic adults without a diagnosis, to other age groups, or to other cultural contexts. No non-autistic comparison group, so it is impossible to tell which experiences are specific to autism and which are shared with non-autistic people who also have anxiety. All 20 participants had received some form of anxiety treatment, and 16 of 20 had received CBT. The authors themselves note this may have shaped how participants described their cognitive experiences, making it hard to separate genuine experience from the language of prior therapy. The State-Trait Anxiety Inventory–Trait Version showed poor internal consistency (α = .54) in this sample, which the authors flag as a caution for interpreting the questionnaire data. This is a qualitative study: it produces themes and descriptions, not effect sizes or treatment recommendations. It cannot tell you whether any intervention works.
Declared interests
Funded by the UK Medical Research Council (Clinician Scientist Fellowship), the John Fell Fund (Oxford University Press), the NIHR (Imperial and Oxford Health BRCs, Maudsley BRC), the Committee for Children, and the Oxfordshire Health Service Research Committee. The authors declared no conflicts of interest. No industry or treatment-provider funding.
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