Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 19, 2025
Date Accepted: Dec 30, 2025
Communicative behaviors of autistic individuals in an internet-based intervention– a mixed method analysis of participant messages.
ABSTRACT
Background:
To meet the needs of individuals diagnosed with autism, internet-based interventions have been developed with a variety of objectives. A deeper understanding of the mechanisms of change may help tailor interventions to individual needs. The communicative behaviors of autistic individuals participating in text-based internet interventions remain largely unexplored, as are their potential relation to clinical outcomes. An improved understanding of client behaviors may help therapists to better tailor their support, promote engagement and enhance treatment outcomes.
Objective:
This study aimed to explore the communicative behaviors of autistic individuals participating in an internet-based intervention and to examine whether different behavioral patterns were associated with treatment outcomes or adherence.
Methods:
Messages from 34 participants enrolled in an 18-week internet-based cognitive behavioral -therapy program were analyzed using abductive qualitative content analysis. Correlational analyses were employed to examine the relationships between qualitative categories and change scores on outcome measures and module completion rates.
Results:
Fourteen behavioral categories were identified and grouped into three overarching domains: 1. This is me encompasses the participants narratives on identity, personality, autistic functioning, current and past circumstances and worldview. 2. Working with the treatment included statements related to engagement with the treatment process, and 3. I struggle comprised expressions about past and present negative experiences and suffering. Correlational analyses revealed associations between several behavioral categories and improvements in Quality of Life and treatment adherence.
Conclusions:
The findings highlight the importance of self-narrative formulation among autistic individuals and suggest that certain communicative behaviors— particularly those involving identity reflection and recognition of treatment gains — were positively associated with therapeutic outcomes. The findings enhance our understanding of how autistic individuals engage in ICBT and may serve as a valuable source of information for therapists in guiding both their expectations of client outcomes and identifying participants that may benefit from additional support. Clinical Trial: ClinicalTrials.gov NCT03570372
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