Targeting Emotion Dysregulation in Autism

Kelly Beck, PhD, LPC, CRC, assistant professor of psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, is a treatment developer of the Emotion Awareness and Skills Enhancement (EASE) Program, an outpatient mental health intervention for autistic adolescents and adults that targets emotion dysregulation. Through multiple years and phases of research, the EASE Program was designed to address one of the most common and most significant challenges experienced by autistic individuals – emotion dysregulation.

Emotion dysregulation, difficulty monitoring and managing emotional responses in ways to meet your goals, affects autistic individuals far more frequently and with higher severity than the general population and has been associated with depression, anxiety, aggression, suicidality, and greater use of emergency and psychiatric services. Instead of treating each of those conditions separately, the EASE Program targets the underlying process.

"Almost every problem we see, from unemployment, to poor learning outcomes, and suicide risk, comes back to the same thing: how hard it is to manage emotions, and how the environment and society treat the person," Dr. Beck says.

A multisite randomized controlled trial published in 2025 in the Journal of the American Academy of Child & Adolescent Psychiatry found that EASE reduced emotion dysregulation more than a rigorous comparison therapy, providing some of the strongest evidence to date for an intervention developed specifically for this problem in autistic adolescents and young adults.

Addressing a Gap in Autism Mental Health Care

Although many evidence-based psychotherapies are available for anxiety, depression, and other psychiatric conditions, most were not designed for autistic individuals or have been evaluated for efficacy across the range of communication and cognitive abilities seen in clinical practice in the autism community.

Families looking for mental health care often encounter another challenge in providers who want to help but lack interventions specifically designed for autistic people.

"Families are desperate for help," Dr. Beck says. "They go looking for care for their child, and providers tell them they don't have the expertise or the right treatment."

Those experiences shaped the development of the EASE Program from the start. A team of clinical scientists from the University of Pittsburgh and University of Alabama worked with autistic individuals, families, clinicians, and community partners throughout the program's development while repeatedly refining the intervention through successive clinical studies.

The goal was to create a treatment that could be used across the wide range of presentations seen in autism, including individuals with limited speech.

"We were deliberate about making the therapy work across a wide range of presentations," Dr. Beck says. "Most mental health treatments were never developed or tested for someone with limited speech."

What the EASE Program Involves

The EASE Program consists of 16 individual therapy modules that can be delivered in person or virtually. Drawing on mindfulness-based approaches with selected cognitive behavioral therapy techniques, participants first learn to recognize changes in their emotional state using an individualized "Noticing My Emotions" scale before practicing strategies to regulate emotional responses in everyday situations.

Program activities are adapted to each individual's cognitive, sensory, and communication needs. The program does not expect participants to conform to a single therapeutic approach. The intervention is individualized so it can be used across the diverse presentations encountered in autism. A substantial portion of the program is devoted to practicing new skills in situations that resemble everyday challenges, which can help participants apply emotion regulation strategies outside the therapy setting.

Evaluating the EASE Program

After almost 10 years of development and refinement, Dr. Beck and colleagues conducted the program's largest clinical evaluation to determine if the EASE Program provided benefits beyond the individualized evidence-based therapies available through experienced autism clinicians.

Published in 2025 in the Journal of the American Academy of Child & Adolescent Psychiatry, the multisite randomized controlled trial enrolled 109 autistic adolescents and young adults, ages 12 to 22, at the University of Pittsburgh and the University of Alabama. Participants were randomly assigned to receive either the EASE Program or an active comparison therapy designed to reflect high-quality clinical care rather than a waitlist or minimal intervention.

Therapists in the control group were permitted to deliver individualized, evidence-based interventions, with the principal difference being that they did not use the core components of the EASE Program itself.

Participants receiving the EASE Program experienced significantly greater reductions in emotion dysregulation severity at the completion of treatment. On clinician-rated measures of how emotion dysregulation affected daily functioning, a greater proportion of participants receiving EASE were classified as treatment responders than those receiving the comparison therapy, particularly among individuals who completed all 16 treatment sessions.

Participants in the EASE group also demonstrated improvements in internalizing and externalizing symptoms reported by both patients and caregivers. Although both groups maintained improvements three months after treatment, participant attrition during follow-up limited conclusions regarding longer-term differences between the two approaches. No treatment-related adverse events were reported.

Rather than comparing EASE with no treatment, the study demonstrated that an intervention developed specifically for autistic individuals could outperform individualized evidence-based care delivered by clinicians experienced in treating autism.

Expanding Access to Autism-Specific Mental Health Care

The clinical trial is an important milestone in the EASE Program's development. It is one step toward a broader goal of expanding access to effective mental health care for autistic individuals beyond academic medical centers.

The EASE Program is now being evaluated in community mental health settings to better understand how the intervention performs in the environments where most autistic individuals receive care.

"We design sophisticated treatments, test them with PhD-level therapists, then ask busy community counselors to deliver them. It doesn't always work," Dr. Beck says. "You have to build tools and treatments with and for the people who are going to use them, which is what we have tried to do with the EASE program."

Future studies will examine the durability of treatment benefits and better define how the intervention produces its effects. Ongoing implementation studies will work to determine what is needed for broader adoption in community practices where many autistic individuals continue to face limited access to mental health services designed with their unique needs in mind.

Further Reading

Learn more about Dr. Beck, UPMC Children’s Behavioral Science Division, and the University of Pittsburgh School of Medicine Department of Psychiatry.

References

White SD, Conner CM, Beck K, Mazefsky CA. Efficacy of the Emotion Awareness and Skills Enhancement (EASE) Program in Autism: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2025.