Alexithymia, Inner Thinking Patterns, and Perceptions of Mental Health Therapy Strategies Among Autistic Adults

Purpose: Autistic adults are at high risk for mental health challenges, yet there has been limited research on mental health interventions for this population. Individual differences in how thoughts and emotions are perceived may directly relate to the success of specific therapy strategies. This study examined whether alexithymia and inner thinking patterns relate to helpfulness and ease of use of mental health therapy strategies among autistic adults. Method: Participants (n = 269 autistic adults, ages 21–77) completed questionnaires assessing alexithymia, inner thinking patterns (i.e., self-talk, verbal thinking, visual thinking), and experiences with mental health therapy strategies. Ordinal logistic regressions were used to examine associations between alexithymia, inner thinking, and perceived helpfulness and ease of use of therapy strategies. Results: Autistic adults with greater alexithymia found cognitive strategies more difficult to use, while those with greater frequency of self-talk found them easier to use. By contrast, autistic adults with greater visual thinking found guided imagery strategies easier to use. There were no associations between alexithymia or inner thinking and perceived helpfulness or ease of use of behavioral strategies (exposure, behavioral activation), mind–body relaxation strategies (deep breathing, progressive muscle relaxation), or mindfulness meditation. Conclusions: The findings suggest that some mental health strategies may be more difficult to implement for some autistic adults, depending on individual thinking profiles. However, alexithymia and inner thinking patterns were unrelated to the perceived helpfulness of mental health strategies. Overall, this highlights the importance of providing individualized supports and accommodations to optimize mental health therapy for autistic adults.