Group CBT Reduces Hostile Attribution Bias in Young Adults With ASD Traits

Addressing Social Cognitive Distortions in Autism Spectrum Disorder

Adolescents and young adults with autism spectrum disorder often face significant hurdles in social communication and adaptive functioning, which can lead to a diminished quality of life [1, 2, 3]. While behavioral therapies such as the Early Start Denver Model (a developmental, relationship-based intervention) show efficacy in younger children, the therapeutic landscape for older patients requires more targeted interventions [3, 4]. Standard cognitive behavioral therapy is frequently employed to manage comorbid anxiety, but a randomized trial of 167 children (mean age 9.9 years) found that cognitive behavioral therapy adapted for autism spectrum disorder significantly improved anxiety scores on the Pediatric Anxiety Rating Scale compared to standard protocols (p =.04) [4]. Clinicians are also evaluating adjuncts such as music therapy, which has demonstrated a significant reduction in total Autism Treatment Evaluation Checklist scores (standardized mean difference = -2.52, 95% confidence interval: -3.69 to -1.35), and mindfulness-based cognitive therapy to support family mental health [5, 6]. A new study now examines how targeting specific cognitive distortions through group-based interventions might influence social outcomes and well-being in this vulnerable population.

Targeting Maladaptive Social Interpretations

Adolescence represents a critical developmental window marked by heightened self-consciousness and an increased sensitivity to social evaluations, a period where neurodivergent individuals may be particularly vulnerable to social missteps. During this phase, many individuals develop a hostile attribution bias (the cognitive tendency to interpret ambiguous or neutral social cues as intentionally malevolent). This bias is clinically significant because it can lower an individual's quality of life and contribute to the development of future mental health problems, including depression and social anxiety. While these challenges are common in neurotypical development, adolescents and young adults with autism spectrum disorder traits often exhibit more pronounced difficulties. Their specific cognitive styles and interpersonal vulnerabilities make them particularly susceptible to misinterpreting social intent, which can further exacerbate social isolation and functional impairment in school or workplace settings.

To address these social cognitive distortions, researchers evaluated the psychological effects of a structured intervention using group cognitive behavioral therapy. This therapeutic modality aims to correct maladaptive biases by providing participants with structured cognitive and social experiences, allowing them to test their assumptions in a safe, peer-mediated environment. The study recruited 21 adolescents and young adults with autism spectrum disorder traits from a hospital psychiatric outpatient department. The intervention consisted of an 8-session group cognitive behavioral therapy program specifically designed to target hostile attribution bias and clinical suspiciousness (a state of hyper-vigilance regarding the motives of others). Although 21 individuals were initially enrolled, 15 participants completed the full program and were included in the final analyses. The researchers focused on quantifying changes in hostile attribution bias, social functioning, and subjective quality of life to determine if targeting these specific cognitive pathways could improve overall clinical outcomes.

Quantifying Improvements in Social Communication

To evaluate the efficacy of the intervention, the researchers utilized several standardized psychological indices to track changes in cognitive and social domains. Hostile attribution bias was measured using the Ambiguous Intentions Hostility Questionnaire (a tool designed to assess how individuals interpret social scenarios with unclear motives), while social functioning was quantified through the Social Responsiveness Scale, Second Edition (SRS-2), which identifies the presence and severity of social impairment. Additionally, the study included subjective quality of life as a primary psychological index to capture the participants' own perceptions of their well-being. To determine the magnitude of clinical change, the authors calculated change rates for each participant using the formula ((post − pre)/pre × 100). Group-level changes were evaluated using paired analyses (a statistical method comparing the same group at two different time points), while exploratory associations between different change rates were examined using Spearman correlations (a non-parametric measure of the strength and direction of the relationship between two variables).

The 8-session group cognitive behavioral therapy program yielded statistically significant improvements across all primary measures, suggesting a robust response to the structured curriculum. The researchers found that group cognitive behavioral therapy significantly reduced hostile attribution bias, demonstrating an effect size of 0.698 and a p-value of 0.017. This reduction suggests that participants became less likely to interpret ambiguous social interactions as intentionally malevolent, potentially lowering their baseline social stress. Furthermore, social communication and interaction scores on the Social Responsiveness Scale, Second Edition, improved significantly, with an effect size of 0.780 and a p-value of 0.012. These data points indicate a measurable enhancement in the core social deficits often associated with autism spectrum disorder traits, suggesting that targeted cognitive interventions can translate into broader improvements in interpersonal functioning.

Beyond social and cognitive metrics, the intervention also impacted the participants' overall sense of well-being, which is often the most important outcome for families. The findings showed that subjective quality of life significantly improved following the program, characterized by an effect size of 0.752 and a p-value of 0.011. For the practicing clinician, these results provide evidence that addressing specific cognitive distortions, such as the tendency to misattribute hostility to others, can lead to concurrent gains in both objective social communication skills and the patient's subjective experience of their daily life. The use of standardized effect sizes (a quantitative measure of the magnitude of the experimental effect) allows for a clear comparison of the intervention's impact across these different clinical domains, showing a consistently moderate-to-large effect across all primary outcomes.

The Divergence of Cognitive and Subjective Outcomes

While the group-level data demonstrated broad improvements across all metrics, exploratory individual-level analyses revealed a discordant pattern between the reduction of cognitive bias and the enhancement of quality of life. Specifically, the researchers identified that smaller reductions in hostile attribution bias, represented by less negative change rates, were associated with greater increases in subjective quality of life (ρ = 0.597, p = 0.019). This statistical relationship suggests that the patients who experienced the most significant gains in their perceived well-being were not necessarily the same individuals who demonstrated the largest decreases in their tendency to interpret ambiguous social cues as hostile. This finding is critical for clinicians to consider, as it suggests that a patient may feel significantly better even if their underlying cognitive biases remain relatively stable.

These findings indicate that improvements in cognitive bias and perceived well-being may arise through partly distinct or non-linear pathways rather than a simple one-to-one relationship. For the practicing clinician, this suggests that while group cognitive behavioral therapy effectively targets social cognitive distortions, the resulting improvements in a patient's quality of life may be mediated by factors other than the correction of hostile attributions alone, such as the benefits of social inclusion or improved emotional regulation. Overall, the study suggests that group cognitive behavioral therapy may reduce hostile attribution bias and improve quality of life and social functioning in adolescents and young adults with autism spectrum disorder traits. This pilot study, which provides a framework for future interventions targeting social cognition, is registered with the University Hospital Medical Information Network (UMIN000030140).

References

1. Vos T, Abajobir AA, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017. doi:10.1016/s0140-6736(17)32154-2

2. Cedeno-Bruzual M, Sáez-Alarcón C, Cintra MAT, et al. Animal-Assisted Therapy in Children Living with Autism Spectrum Disorder: A Literature Review of Randomized Controlled Trials. Principles and Practice of Clinical Research Journal. 2023. doi:10.21801/ppcrj.2023.93.5

3. Santos C, Barreto II, Silva ASD, et al. Behavioral therapies for the treatment of autism spectrum disorder: A systematic review. Clinics. 2024. doi:10.1016/j.clinsp.2024.100566

4. Wood J, Kendall P, Wood KS, et al. Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder: A Randomized Clinical Trial.. JAMA psychiatry. 2019. doi:10.1001/jamapsychiatry.2019.4160

5. Yang Y, Wang Y, Li W, Su L. Effect of music therapy on children with autism spectrum disorders in the Chinese population: a systematic review and meta-analysis. Frontiers in Psychiatry. 2025. doi:10.3389/fpsyt.2025.1611182

6. Papadopoulos D, Maniadaki K. Effects of Mindfulness-Based Cognitive Therapy on Parental Mental Health and Child Behavior in Families of Children with Autism Spectrum Disorder: A Randomized Controlled Trial. Children. 2025. doi:10.3390/children13010053