“Resist, Reframe, Redo the Bullying, the Lying, the Harassment”: A Qualitative Investigation of Social Anxiety and Therapy as an Autistic Person

Background: Autistic people commonly report social anxiety. There may be distinctive aspects of the autistic experience of social anxiety, as well as aspects of therapy for social anxiety that need to be adapted for autistic people. This study investigated these issues through the firsthand perspectives of autistic people. Methods: Fifteen autistic adults took part in semistructured interviews about their experiences of social anxiety and cognitive behavioral therapy (CBT) for social anxiety, the first-line intervention for social anxiety. Interviews were analyzed using reflexive thematic analysis. Results: Autistic people perceived differences in their experience of social anxiety compared with non-autistic people. These included the impact of (1) autistic traits, (2) traumatic experiences of living in a neurotypical world, and (3) nonsocial factors that contribute to anxiety in social situations for autistic people. Participants also questioned the cognitive and behavioral components of conventional CBT for social anxiety (as they had experienced it); argued for a trauma-informed approach to social anxiety; and explained how the social process of therapy needed adaptation for autism. Conclusion: These perspectives will help therapists and researchers refine their formulation of social anxiety in autistic people and inform the development of autism-adapted social anxiety interventions.