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Interoceptive training to target anxiety in autistic adults (ADIE): a single-center, superiority randomized controlled trial

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posted on 2023-06-12, 09:56 authored by Lisa QuadtLisa Quadt, Sarah Garfinkel, James S Mulcahy, Dennis Larsson, Marta Silva, Anna-Marie Jones, Clara StraussClara Strauss, Hugo CritchleyHugo Critchley
Background This trial tested if a novel therapy, Aligning Dimensions of Interoceptive Experience (ADIE), reduces anxiety in autistic adults. ADIE targets the association of anxiety with mismatch between subjective and behavioral measures of an individual's interoceptive sensitivity to bodily signals, including heartbeats. Methods In this superiority randomized controlled trial, autistic adults (18–65 years) from clinical and community settings in Southern England were randomly assigned (1:1) to receive six sessions of ADIE or an active ‘exteroceptive’ control therapy (emotional prosody identification). Researchers conducting outcome assessments were blind to allocation. ADIE combines two modified heartbeat detection tasks with performance feedback and physical activity manipulation that transiently increases cardiac arousal. Participants were followed-up one-week (T1) and 3-months post-intervention (T2). The primary outcome was Spielberger Trait Anxiety Score (STAI-T) at T2. Outcomes were assessed on an intention-to-treat basis using multiple imputation for dealing with missing values. This trial was registered at International Standard Randomized Controlled Trial Registry, ISRCTN14848787. Findings Between July 01, 2017, and December 31, 2019, 121 participants were randomly allocated to ADIE (n = 61) or prosody (n = 60) intervention groups. Data at T1 was provided by 85 (70%) participants (46 [75%] ADIE; 39 [65%] prosody). Data at T2 was provided by 61 (50%) participants (36 [59%] ADIE; 25 [42%] prosody). One adverse event (cardiac anxiety following ADIE) was recorded. A statistically significant group effect of ADIE on trait anxiety continued at T2 (estimated mean difference 3•23 [95% CI 1•13 to 5•29]; d = 0•30 [95% CI 0•09 to 0•51]; p = 0•005) with 31% of ADIE group participants meeting trial criteria for recovery (compared to 16% in the control group). Interpretation ADIE can reduce anxiety in autistic adults, putatively improving regulatory control over internal stimuli. With little reliance on language and emotional insight, ADIE may constitute an inclusive intervention.


Aligning dimensions of interoception in preventative management of affective symptomatology in autism; G2022; MQ TRANSFORMING MENTAL HEALTH; MQ16PI10016_Critchley

Aligning Dimensions of Interoceptive Experience (ADIE) and anxiety disorders in autism; G2486; SUSSEX PARTNERSHIP NHS TRUST


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