The Importance of Neuroaffirming Care in Mental Health and Substance Use Treatment: Dr. Sarah Anderson

In recent discussions surrounding mental health and substance use treatment, the concept of neuroaffirming care has emerged as an essential paradigm shift. A neuroaffirming approach not only emphasizes each person’s individuality but also recognizes and respects the diverse range of neurocognitive profiles within our world. In this article, I will look into why neuroaffirming care matters, share its key ideas, explore its background, and highlight how it’s vital in mental health and substance use treatment.

Understanding Neuroaffirming Care

Neuroaffirming care is a progressive model grounded in an understanding of the diverse ways individuals think, process information, and interact with the world. It recognizes that neurocognitive differences—such as those found in individuals with autism (ASD), ADHD, dyslexia, and other learning disabilities—are not deficits or disorders to be fixed, but rather distinct variations that enrich how individuals perceive and interact with the world around them.

This perspective sees neurodiversity as an integral part of humanity, encouraging a more inclusive approach in therapeutic settings. Unlike traditional care models, which often apply a one-size-fits-all framework, neuroaffirming care tailors interventions to meet the unique needs and preferences of each individual. Traditional approaches may standardize assessments and treatments, potentially overlooking the nuances of a person’s lived experience. In contrast, neuroaffirming care acknowledges that neurodivergent individuals may process sensory information, social cues, and cognitive tasks differently, requiring interventions that are flexible and adaptive. (Chapman & Botha, 2023)

Examples of Neuroaffirming Care:

1. Inclusive Practices: Tailoring treatment plans to align with the client’s cognitive style, preferences, and personal history.

Example: A therapist working with a neurodivergent client adapts a mindfulness exercise by allowing them to focus on a sensory object, such as holding a stress ball or rubbing a textured fabric, instead of expecting them to sit still with their eyes closed, which might feel overwhelming or inaccessible.

2. Respecting Autonomy: Allowing clients to make informed choices about their treatment and respecting those decisions, even when they differ from standardized protocols.

Example: A client with ADHD requests shorter therapy sessions to maintain focus. Rather than insisting on traditional 50-minute sessions, the therapist offers 25-minute sessions and gradually builds toward longer durations as the client feels ready.

Examples of Non-Neuroaffirming Care:

1. Rigid Protocols: Applying standardized treatment methods that do not consider a client’s neurodivergent traits, potentially leading to frustration and disengagement.

Example: Forcing a neurodivergent client to participate in a large group therapy session despite their expressed discomfort in group settings, leading them to withdraw or avoid further sessions.

2. Invalidating Experiences: Dismissing or questioning the lived experiences of neurodivergent individuals, failing to recognize and honor their reality.

Example: A therapist tells a client with sensory sensitivities that their discomfort with bright lights in the therapy room is “just in their head” instead of addressing the environmental trigger.

Statistics on Neurodivergence in Mental Health Treatment

Neurodivergent individuals often encounter significant barriers in accessing effective mental health and substance use treatment. Research indicates that approximately 73% to 81% of adults with autism have at least one co-occurring psychiatric disorder (Buck et al., 2014; Madhavan, & Sambamoorthi, 2016). Additionally, substance use disorder rates are disproportionately higher among neurodivergent individuals. Research indicates that about 50% of individuals with substance use disorders also have ADHD, and people diagnosed with ADHD are six times more likely to face challenges related to substance use (Davis et al., 2015). This statistic emphasizes the need for tailored interventions that specifically address these challenges and underscore the importance of implementing neuroaffirming care. 

While neuroaffirming care is gaining recognition, its adoption in mental health settings varies widely. Some progressive clinics and therapists are beginning to embrace neuroaffirming approaches, especially in environments that prioritize inclusivity and holistic care. However, many traditional mental health settings still rely on standard practices that may not adequately account for neurodiversity and its implications in treatment. Neuroaffirming care is more likely to be found in specialized settings, such as those focusing on developmental disorders, community mental health programs that emphasize inclusivity, and practices run by clinicians who are informed about neurodiversity principles. In contrast, more traditional settings may struggle to integrate these principles into their practices, resulting in ongoing gaps in care for neurodivergent individuals. This inconsistency in the availability of neuroaffirming care further emphasizes the need for systemic changes in mental health and substance use treatment approaches.

Historical Context of Neuroaffirming Care

The emergence of neuroaffirming care can be traced back to the neurodiversity movement, which gained momentum in the late 1990s and early 2000s (Chapman & Botha, 2023). Advocates began challenging the traditional medical model that treated neurological differences solely as deficits or disorders. Instead, they promoted the idea that neurodiversity is a natural variation of human cognition, deserving of respect and understanding. For instance, the neurodiversity movement challenged stereotypes surrounding autism, emphasizing the strengths and unique perspectives that autistic individuals bring to the table, such as innovative problem-solving and attention to detail. This paradigm shift inspired mental health professionals to rethink their approaches, focusing on affirming and accommodating differences rather than attempting to “fix” them.

Neuroaffirming Interventions in Mental Health

Neuroaffirming interventions in mental health can vary widely but generally aim to create a supportive environment that is responsive to the specific cognitive and emotional needs of neurodivergent individuals.

1. Cognitive Behavioral Therapy (CBT) Adaptations

Traditional CBT can be adjusted to incorporate the client’s unique thought processes and emotional responses, making it relevant to their experiences.

Example: A neurodivergent client with autism might struggle with abstract concepts like “challenging negative thoughts.” The therapist adapts CBT by using concrete, visual tools, such as a thought diary with emojis or a color-coded chart, to help the client identify and manage their emotions in a structured way.

In contrast, a non-neuroaffirming approach might involve using overly abstract CBT techniques that leave the client feeling confused and unsupported, causing disengagement.

2. Mindfulness Practices

Mindfulness can be tailored to fit different sensory preferences, allowing clients to engage in exercises in ways that feel comfortable.

Example: A client with sensory sensitivities may find traditional deep-breathing exercises difficult due to the focus on internal bodily sensations. Instead, the therapist encourages them to practice mindfulness by listening to calming music or focusing on a weighted blanket’s pressure.

Non-neuroaffirming practices might force clients to adhere to rigid mindfulness techniques that increase their anxiety, such as insisting on silent meditation in a setting that feels overstimulating.

3. Strength-Based Approaches

Focusing on the individual’s strengths rather than their challenges fosters a sense of empowerment and self-efficacy.

Example: A therapist working with a neurodivergent teenager emphasizes their talent for drawing as a tool for emotional expression and problem-solving, integrating art therapy into their sessions.

Conversely, non-neuroaffirming practices might focus solely on deficits, such as repeatedly pointing out the client’s difficulties with time management, without offering constructive solutions.

Neuroaffirming Care in Substance Use Treatment

Substance use treatment, much like mental health treatment, benefits immensely from a neuroaffirming approach. Individuals with neurodivergent traits may face unique challenges in recovery, including heightened sensitivity to triggers, social cues, and emotional stimuli.

1. Individualized Treatment Plans

Tailoring recovery programs to the cognitive and emotional profile of clients enhances engagement and success rates.

Example: A client with ADHD might struggle with rigid schedules in traditional 12-step programs. A neuroaffirming approach would offer flexible scheduling options or introduce apps for task management to support the client’s executive functioning challenges.

2. Peer Support Alternatives

Creating support networks that resonate with neurodivergent individuals allows them to share their experiences in a safe space.

Example: A recovery program sets up a small, sensory-friendly peer support group for neurodivergent clients, ensuring the environment is free of harsh lighting and loud noises to accommodate sensory sensitivities.

Non-neuroaffirming practices might involve placing neurodivergent clients in large, overstimulating group settings without addressing their needs, potentially driving them away from recovery efforts.

Providing Neuroaffirming Care as a Mental Health Occupational Therapist

As a mental health occupational therapist, I prioritize neuroaffirming care in my practice by actively incorporating the principles of this approach into my therapeutic relationships. This commitment not only fosters a sense of safety and respect but also empowers clients to take an active role in their healing journey.

1. Personalized Assessments:

   In my practice, I conduct thorough and personalized assessments that go beyond standardized tools. For example, I might observe a client’s sensory responses in various environments, such as noting whether fluorescent lighting in the office causes discomfort. These observations inform the design of therapy sessions and treatment goals. Additionally, I encourage clients to share their preferences and experiences, allowing for a more nuanced understanding of their unique needs and challenges.

2. Flexible Therapy Sessions:

   Recognizing that each client has different sensory sensitivities and processing styles, I ensure that my therapy sessions are flexible. For a client with sensory sensitivities, I might introduce noise-canceling headphones or provide breaks during sessions to prevent overstimulation. This adaptability allows clients to engage more comfortably and effectively in their therapy, promoting a collaborative and supportive atmosphere.

3. Collaborative Goal Setting:

   Collaboration is at the heart of my practice. When a client expresses frustration with meeting deadlines, for instance, we work together to create achievable and meaningful goals. By implementing strategies like time-blocking, the client feels ownership and agency in their progress. I emphasize that all goals are client-driven; I will never set goals that clients do not choose for themselves. This process not only fosters a sense of empowerment but also enhances motivation and commitment to the therapeutic process.

4. Creating Safe Spaces:

   A significant aspect of neuroaffirming care involves creating safe and comfortable environments. I maintain a quiet, visually calming therapy room with sensory tools like weighted blankets, fidget toys, and dimmable lights. Clients are encouraged to customize their space and choose the tools that make them feel secure and comfortable. This environment reflects a respect for their individual needs and enhances their ability to focus and engage.

5. Ongoing Feedback:

   I prioritize ongoing feedback throughout our therapeutic relationship. Regularly asking clients how they feel about the therapy process and the strategies we employ allows me to adjust approaches as needed. For example, if a client feels overwhelmed by a particular technique, we can quickly shift to a different method that aligns better with their preferences. This responsiveness is a core component of neuroaffirming care, ensuring that each client feels heard and validated.

Conclusion

Neuroaffirming care represents a critical advancement in mental health and substance use treatment paradigms, offering a more personalized and respectful approach to care that takes into account the diverse neurocognitive profiles of individuals. Specific, practical interventions—such as adapting CBT, tailoring mindfulness, and creating sensory-friendly environments—illustrate how this approach can transform the therapeutic experience for neurodivergent individuals.

With increasing awareness and acknowledgment of neurodiversity, the mental health field must continue to evolve by embracing neuroaffirming principles. In doing so, we can enhance access to treatment and support for neurodivergent individuals, ultimately contributing to their overall wellbeing and quality of life.