A systematic review and narrative synthesis of the effectiveness of cognitive behaviour therapy with randomized controlled trials on emotional regulation among individuals with autism spectrum disorder

This systematic review evaluated the effectiveness of cognitive behavioral therapy (CBT) on emotional regulation (ER) in individuals with autism spectrum disorder by synthesizing evidence exclusively from Randomized Controlled Trials (RCTs). A comprehensive search of numerous databases was conducted until March 2025. Eligible studies were RCTs with a confirmed ASD diagnosis, assessing a clinician-led CBT intervention against a control condition, and using a standardized measure of ER. Study quality was assessed using the Cochrane RoB 2 tool. Four RCTs comprising 162 participants (ages 4-50 years) met the inclusion criteria. Two studies reported significant parent-rated reductions in emotional lability and negativity following CBT, with medium to large effect sizes. However, no significant improvements were observed in adaptive emotion regulation skills. A notable informant discrepancy was evident, as parent-reported benefits were not reflected in child self-reports. The single adult-focused study reported no sustained significant effects on the primary ER outcome. Overall risk of bias was a concern, with only one study rated as low risk. The evidence base is limited by the small trials, methodological weaknesses, and inconsistent effects. Future research should prioritize larger, methodologically rigorous RCTs with active control conditions, multi-method assessments, and interventions targeting a broader range of individuals with ASD.