Cognitive-Behavior Therapy for Social Anxiety Does Not Increase Reports of Camouflaging Behavior in Autistic Adults: Results From an Exploratory Study

Camouflaging has been defined as the masking or compensation of autistic traits during social interactions, often as a response to the stigma associated with autism and social expectations. Social anxiety has been closely linked to camouflaging, as autistic individuals may adopt camouflaging strategies to navigate social expectations and to reduce the risk of being negatively evaluated. Understanding the relationship between social anxiety and camouflaging in autism is essential for developing effective clinical interventions. This study investigated the effects of a modified Cognitive Behavioral Therapy (CBT) group intervention, the Engage Program, on camouflaging and social anxiety. Specifically, the objective was to determine whether the CBT program would reduce social anxiety symptoms and if this reduction would also be associated with improvements in camouflaging behaviours. Seventy-one autistic adults participated in an 8-week modified CBT group intervention for social anxiety. Camouflaging behaviors were assessed using the CAT-Q scale, and social anxiety levels were measured using three established and validated self-report measures. Pre- and post-intervention scores were analyzed to determine change following treatment, and correlations between social anxiety and camouflaging measures were explored. As expected, the CBT intervention program significantly reduced social anxiety symptoms across all measures, showing moderate effect sizes from pre- to post-treatment. However, no significant changes in camouflaging behaviors were observed from pre- to post-treatment. Despite this, reductions in social anxiety symptoms were correlated with decreases in camouflaging behaviours, particularly for the compensation and assimilation subscales. Autistic participants who showed the most benefit from therapy on social anxiety measures also showed the greatest reduction in their camouflaging scores from pre- to post-treatment. These findings suggest that improvements in social anxiety symptoms from CBT are also associated with reductions in camouflaging. Importantly, CBT did not lead to an increase in camouflaging behaviors in autistic adults. This study supports the overall benefits of CBT for autistic adults and suggests a need for more randomized controlled studies.