Communicative Behaviors in an Internet-Based Intervention for Individuals With Autism: Mixed Methods Analysis

BACKGROUND: To meet the needs of individuals diagnosed with autism, internet-based interventions have been developed with a variety of objectives. A deeper understanding of the mechanisms of change may help tailor interventions to individual needs. The communicative behaviors of individuals with autism participating in text-based internet-based interventions remain largely unexplored, as do their potential relations to clinical outcomes. An improved understanding of participants' behaviors may help therapists better tailor support, promote engagement, and enhance treatment outcomes. OBJECTIVE: This study aimed to explore the communicative behaviors of individuals with autism participating in an internet-based intervention and to examine whether different behavioral patterns were associated with treatment outcomes or treatment adherence. METHODS: Messages from 34 participants enrolled in an 18-week internet-based cognitive behavioral therapy program were analyzed using abductive qualitative content analysis. Correlational analyses were used to examine the relationships between qualitative categories and change scores on outcome measures and rates of module completion. RESULTS: Fourteen behavioral categories were identified and grouped into three overarching domains: (1) "This is me," which encompasses the participants' narratives on identity, personality, autistic functioning, current and past circumstances, and worldview; (2) "Working with the treatment," which included statements related to engagement with the treatment process; and (3) "I struggle," which comprised of past and present negative experiences and challenges. Correlational analyses revealed associations between several behavioral categories and improvements in quality of life and treatment adherence. CONCLUSIONS: The findings highlight the importance of self-narrative formulation among individuals with autism and suggest that certain communicative behaviors-particularly those involving identity reflection and recognition of treatment-related gains-were positively associated with therapeutic outcomes. The findings enhance our understanding of how individuals with autism engage in internet-based cognitive behavioral therapy and may serve as a valuable source of information for therapists when guiding expectations regarding client outcomes and identifying participants who may benefit from additional support. TRIAL REGISTRATION: ClinicalTrials.gov NCT03570372; https://clinicaltrials.gov/study/NCT03570372.