CO-MIND: Autism-adapted group CBT for adults with an autism spectrum diagnosis and co-occurring anxiety or depression

Background

An estimated 61.8 million people worldwide met criteria for an autism spectrum diagnosis (ASD) in 2021 (Santomauro et al., 2025). More than 70% of adults with ASD meet criteria for a co-occurring psychiatric disorder during their lifetime (Lever & Geurts, 2016). Pooled lifetime prevalence estimates are 42% for anxiety disorders and 37% for depressive disorders (Hollocks et al., 2019). Despite this, to our knowledge, there is currently no standardised treatment for adults with ASD in Norwegian specialist health services.

Why this matters

Adults with ASD face an elevated risk of mental illness, suicide, poor physical health and reduced quality of life. This risk has remained high even as treatment provision has expanded, which suggests that current treatment is not sufficiently adapted to this group. Standard CBT was developed for a neurotypical population. When delivered without modification, it produces smaller improvements for people with ASD. Sensory sensitivity, a concrete and literal thinking style and differences in social communication can all limit the benefit people get from conventional treatment formats.

What the project is doing

Lovisenberg Diaconal Hospital leads CO-MIND, a randomised controlled trial of a 12-week group programme of cognitive behavioural therapy (CBT) systematically adapted for adults with ASD. The trial examines whether the programme reduces psychological distress compared with usual care, and through which mechanisms change occurs.

The programme is manualised and transdiagnostic, and runs in small groups. It is adapted for ASD through:

• sensory-adapted rooms
• visual supports
• psychoeducation about ASD
• training in recognising emotions
• concrete tasks
• individual coping plans
• a comprehensive workbook

The programme has been piloted at Lovisenberg since 2024 as an internal quality improvement project. It was well received and has continued as part of routine clinical care. The pilot showed that the programme is feasible; CO-MIND now evaluate its effect.

The project has two parts:

• Randomised controlled trial. 154 adults (18+) with ASD and clinically assessed anxiety or depression are randomly allocated (1:1) to the group programme or to treatment as usual.
  • Primary outcome: psychological distress, measured with the CORE-OM, a validated measure.
  • Assessments: at baseline, during the programme, after the programme, and at 3 and 6 months.
  • Access for the usual-care arm: participants allocated to usual care are offered the group programme after the 12-week assessment. Randomisation therefore decides when participants receive the programme, not whether they receive it.
  • Optional: heart-rate variability can be recorded during sessions to study stress regulation.
• Analyses of large datasets. Data from the Norwegian Mother, Father and Child Cohort Study (MoBa), the BUPGEN biobank and research register, and the Avon Longitudinal Study of Parents and Children (ALSPAC) are used to examine the mechanisms and genetic factors involved in the development of mental illness in ASD.

Open and robust research

CO-MIND is pre-registered on ClinicalTrials.gov (NCT07880028) and approved by the Regional Committee for Medical and Health Research Ethics (REK 987850). All randomised participants are analysed according to the intention-to-treat principle. The trial arms remain coded until unblinding, so the analysis is carried out blind. The trial follows the CONSORT 2025 reporting standard, and the analysis plan and scripts will be published openly.

What this may mean for patients and services

The trial will provide better knowledge of effective treatment for a patient group that services currently struggle to help. The group format is scalable and may increase treatment capacity. The findings will be published, and if the programme proves effective, other services could adopt it. The results will also inform training and services that promote equitable access to healthcare.

Participation

The first groups started in autumn 2026. Participants are recruited from Senter for psykisk helse og rus at Lovisenberg. Clinicians who wish to refer a patient, and patients who would like to know more, can contact the project team at emki@lds.no.