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This study examined responses to a structured speech exposure task embedded within an 8\u2010week modified cognitive\u2013behavioral therapy (M\u2010CBT) program. Thirty\u2010two autistic adults with co\u2010occurring SA completed pre\u2010 and post\u2010task assessments of anxiety and related cognitive appraisals, including self\u2010focused attention, perceived performance, appearance concerns, and threat appraisals. Participants reported appropriate engagement with the task, characterized by elevated anticipatory anxiety followed by reductions in anxiety\u00a0during the speech. Responses were largely consistent with CBT models of social anxiety and with reports by those in a social anxiety disorder reference group. Participants overestimated anticipatory anxiety (predicted fear) relative to experienced peak fear during the task. Higher anxiety was associated with greater self\u2010focused attention and stronger threat appraisals, although\u00a0anxiety correlated positively with self\u2010rated performance. Importantly, the extinction of fear during the speech task was associated with post\u2010treatment response to CBT. Among participants classified as high\u2010extinction, 59% showed clinically significant improvement on the Liebowitz Social Anxiety Scale, Self\u2010Report (LSAS\u2010SR), compared with 25% of those in the low\u2010extinction group. A parallel pattern was observed in a social anxiety disorder comparison group, indicating that the extinction\u2013outcome relationship was similar across autistic and non\u2010autistic adults. This study provides evidence that autistic individuals report fear and anxiety responses in a manner largely consistent with CBT models and that extinction\u2010based processes during exposure are meaningfully associated with treatment response. Further studies employing randomized controlled trials and objective measures of fear are now needed.<\/jats:p>","DOI":"10.1002\/aur.70268","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:59:43Z","timestamp":1778144383000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exposure, Extinction, and Cognitive Appraisals in Autistic Adults With Social Anxiety: Evidence From a Structured Speech Exposure Task"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9453-9474","authenticated-orcid":false,"given":"Bruna","family":"B. Roisenberg","sequence":"first","affiliation":[{"name":"Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Child Neurodevelopment and Mental Health Team, Brain and Mind Centre University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9408-7367","authenticated-orcid":false,"given":"Kelsie A.","family":"Boulton","sequence":"additional","affiliation":[{"name":"Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Child Neurodevelopment and Mental Health Team, Brain and Mind Centre University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma E.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Child Neurodevelopment and Mental Health Team, Brain and Mind Centre University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"Yu","sequence":"additional","affiliation":[{"name":"Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Child Neurodevelopment and Mental Health Team, Brain and Mind Centre University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8178-4625","authenticated-orcid":false,"given":"Adam J.","family":"Guastella","sequence":"additional","affiliation":[{"name":"Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health University of Sydney  Sydney Australia"},{"name":"Child Neurodevelopment and Mental Health Team, Brain and Mind Centre University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021\u2010843x.113.1.136"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2013.03.003"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2010.07.009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/10883576040190020201"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/10883576060210030201"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13229\u2010021\u201000418\u2010w"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rasd.2022.102090"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/aur.2572"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.151.9.1272"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2017.11.006"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2014.11.025"},{"key":"e_1_2_10_13_1","first-page":"69","volume-title":"Social Phobia: Diagnosis, Assessment, and Treatment","author":"Clark D. 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