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Taking Off The Mask Practical Exercises To Help Understand And Minimise The Effects Of Autistic Camouflaging

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Taking Off the Mask: 4-Part Neurodiversity Book Summary Series

Part 4: Taking Off The Mask - Practical Exercises To Help Understand And Minimise The Effects Of Autistic Camouflaging

Executive Summary: Dr. Hannah Belcher’s groundbreaking book reframes camouflaging (masking) not as a personal failing or intentional deception, but as an adaptive survival response to social trauma and environmental pressure. Drawing on both personal experience and extensive research, Belcher demonstrates that while all humans modify their behavior socially, autistic camouflaging is qualitatively different—more elaborate, more resource-intensive, more sustained across contexts, and beginning earlier. The book provides evidence-based cognitive behavioral strategies, mindfulness practices, and behavioral experiments that help autistic adults understand their masking patterns, develop self-compassion, and gradually reduce the mental health burden of constant performance. Rather than advocating total unmasking (which the author recognizes as neither realistic nor desirable for many autistic people), Belcher focuses on building awareness and finding safe spaces where autistic individuals can relax without performing. The research is unequivocal: camouflaging directly increases suicide risk through both resource depletion and identity loss, making this not merely a quality-of-life issue but a life-or-death concern.

What Is Camouflaging and Why It’s More Than Just “being Social”

Camouflaging (also called masking or “adaptive morphing”) encompasses the behavioral strategies autistic people use to appear non-autistic and fit into social environments. The 2017 Hull study identified three core components: Masking—hiding autistic traits like stimming or avoiding eye contact; Compensation—developing explicit strategies to overcome social difficulties, such as memorizing conversation scripts or practicing facial expressions; and Assimilation—experiencing pressure to fit in and feeling like one must perform for acceptance.

Critically, autistic camouflaging differs qualitatively from the general social mimicry all humans engage in. While all humans modify their behavior in social contexts—a universal evolutionary survival mechanism rooted in our need for group belonging—autistic camouflaging is more elaborate, more resource-intensive, more sustained across contexts, and begins earlier. It requires conscious effort for tasks non-autistic people do automatically. Non-autistic people may adjust behavior in professional settings but relax at home; autistic camouflagers often maintain the performance across all contexts, depleting cognitive resources that could be used for learning, work, creativity, or emotional wellbeing.

The evolutionary roots run deep. Humans have survived through collective intelligence and group belonging—not individual strength. Yuval Noah Harari’s research shows our ancestors leapt the food chain through ability to imagine social relationships and maintain group cohesion. This creates deep, unconscious fears of rejection and exclusion that persist even though physical group protection is no longer necessary for survival. All humans experience this; autistic people face a compounded version because they must hide not just social preferences but fundamental neurological differences in how they process information, regulate emotions, and interpret social cues.

Why Camouflaging Intensifies in Autism: the Perfect Storm of Executive Function, Socialization, and Stigma

Research reveals several factors converge to create intense camouflaging in autistic people. Paradoxically, autistic people are statistically more likely to experience executive dysfunction overall, yet those with stronger executive function skills use them intensively for camouflaging, depleting resources available for other tasks. The author describes her own selective strength-and-deficit pattern: difficulty organizing multi-step morning routines but exceptional memory for social interactions, enabling her to study and mimic others’ behavior. This means some autistic people have photographic memories for social scripts while struggling with basic organization.

Gender socialization further intensifies the pattern. Research shows autistic females score significantly higher on the Camouflaging Autistic Traits Questionnaire (CAT-Q) than autistic males (average 124 vs. 110 out of 175). However, Cassidy found that 89% of autistic women and 91% of autistic men attempted to camouflage, but women camouflaged in more places, more often, and for longer. Notably, non-binary autistic individuals showed even higher camouflaging scores than both males and females, indicating gender is one layer in a complex system. Girls are socialized from birth to be gentle, sympathetic, and sensitive to others’ needs, while boys face stereotypes of aggression and independence. The cumulative effect: girls develop camouflaging abilities earlier and maintain them more pervasively, leading to later diagnosis and deeper burnout.

Approximately 29% of autistic people meet clinical criteria for social anxiety disorder—far exceeding general population rates. A 2002 study reported 94% of mothers said their autistic child experienced bullying; while later studies report lower rates, bullying remains statistically significant. A 2016 National Autistic Society survey found 48% of autistic adults experienced workplace bullying or harassment. Experiencing rejection or disgust from others after expressing authentic needs teaches children that their true self is unacceptable—leading to lifelong patterns of hiding to stay safe. The author describes feeling intense shame from minor social missteps years later. Erving Goffman’s concept of the social “stage” becomes a “stage surrounded by hot lava” for autistic people—social interactions feel like “The Floor is Lava,” constantly requiring jumps to meet others’ expectations while risking emotional harm.

The Devastating Mental Health Consequences: Exhaustion, Identity Loss, and Suicidal Risk

Research unequivocally links camouflaging to worse mental health outcomes. Higher CAT-Q scores correlate with increased anxiety and depression (Hull et al. 2019). Most alarmingly, Dr. Sarah Cassidy’s research demonstrates camouflaging is a significant predictor of suicidal behaviors in autistic people—a relationship that holds even after controlling for age, sex, employment, depression, and anxiety. This is not correlation but causation: camouflaging directly increases suicide risk.

Camouflaging exhausts through two distinct mechanisms. Resource depletion occurs because the mental skills required—memorizing social scripts, inhibiting stims, monitoring facial expressions and body language, maintaining eye contact, managing vocal intonation, predicting social reactions—consume cognitive resources like a computer running multiple programs simultaneously. The author performed worse academically at university when living in shared housing requiring constant camouflaging versus her earlier academic success when socially isolated. During COVID-19 lockdowns, many autistic people reported anxiety reduction for the first time, specifically because reduced social demands meant they could stop camouflaging—a natural experiment proving the causal link.

Identity loss compounds the exhaustion. Almost 60% of Hull’s participants reported not feeling like their true selves due to camouflaging, describing isolation despite being surrounded by others. Many late-diagnosed autistic adults have suppressed childhood interests (preferred toys, TV shows, clothing styles, collecting behaviors) to fit in at university or work, only to feel empty and robotic in adulthood. Goffman warned that when social performance contradicts one’s authentic self, it creates alienation and psychological harm. The author reclaimed her childhood silky teddy bear after diagnosis, discovering she’d been denying herself comfort during depression due to shame about the object’s childishness. Recovery required deliberately reintroducing authentic interests and learning to do activities purely for enjoyment rather than productivity.

Paradoxically, camouflaging prevents the very thing it supposedly enables—authentic connection. By hiding one’s true self, autistic people prevent others from ever truly knowing them, creating profound isolation despite appearing socially integrated. Dr. Sarah Cassidy’s research shows “thwarted belonging” (unmet need for human connection) correlates with suicidality, and camouflaging directly causes thwarted belonging. The performance becomes a barrier to the intimacy autistic people desperately need.

The Double Empathy Problem: Reframing Autistic “social Deficits” as Mutual Incomprehension

A persistent myth claims autistic people lack empathy and Theory of Mind—the ability to understand that others have beliefs and perspectives different from one’s own. This myth has historically led clinicians to miss diagnoses in camouflaging individuals. However, recent research radically challenges this narrative.

2014 research by Geoffrey Bird and Essi Viding proposes that autistic people may struggle with regulating shared feelings rather than lacking empathy. They empathize too much and become overwhelmed, sometimes shutting down completely to cope. This is opposite to the “lacking empathy” stereotype.

Damien Milton’s 2012 double empathy problem theory suggests the problem is not autistic deficits but mutual incomprehension. Autistic people lack non-autistic social norms while non-autistic people lack autistic social culture. It’s a two-way communication breakdown, not a one-directional deficit. Research by Morrison et al. (2020) found that autistic people rated other autistic people’s behavior as less favorable than non-autistic behavior, but this didn’t reduce their social interest in autistic peers the way it did for non-autistic people—autistic people were more interested in connecting with other autistic people despite perceiving social differences. Sasson’s work showing 10-second video clips of autistic people were rated as more socially awkward and less likeable despite actual identical behavior demonstrates non-autistic bias.

The asymmetrical effort required is striking: the author spent 30 years studying non-autistic society and 10 years in therapy to understand it, while struggling to get workplaces to watch a one-hour autism awareness webinar.

The Transformative Power of Autistic Community Connection

A turning point for many autistic people comes through connecting with other autistic people. Despite years of non-autistic friendships where they felt accepted, autistic friendships often feel fundamentally different: no fear of saying something wrong, mutual understanding without explanation, direct communication without small talk, ability to monologue about special interests without rebuke, no assumption that lack of eye contact means disinterest. Conversations don’t begin with “Hi, how are you?” but “Did you know…” or “I feel rubbish today…”

The author describes this as discovering that “social interactions weren’t supposed to be this exhausting and difficult, that I too could have that fluidity of socialising that I never thought attainable”—like puzzle pieces fitting together. Donna Williams wrote in “Somebody Somewhere” that feeling “normal” requires being among people like ourselves. Dr. Nancy Bagatell’s case study of Ben showed that exposure to social skills training encouraging “fitting in” deepened depression until Ben encountered other autistic people and reframed autism as identity rather than disorder. Ben realized he could have a meaningful life as an autistic person, not despite autism.

The implication is profound: if autistic people feel comfortable and “normal” around other autistic people, the problem is not autism but non-autistic intolerance. This insight reframes the entire solution: rather than autistic people camouflaging better, the actual solution is building more inclusive environments and reducing stigma.

Understanding Camouflaging Patterns Through the Cat-Q

The Camouflaging Autistic Traits Questionnaire (Hull et al. 2019) is the first validated self-report measure of camouflaging, containing 25 items across three dimensions. Scores range 25-175; scores over 100 typically indicate stronger camouflaging. Masking items assess hiding autistic traits. Compensation items measure strategies to overcome social difficulties. Assimilation items evaluate pressure to fit in.

Research by Cage and Troxell-Whitman (2019) identified two broad categories of camouflaging reasons: conventional reasons (getting by at work or school) and relational reasons (managing social situations with loved ones). Similarly, camouflaging occurs in two context types: formal situations (around professionals) and interpersonal situations (around friends and family). Many camouflaging behaviors occur at an unconscious level, making them difficult to recognize initially.

The questionnaire helps identify which camouflaging strategies you use, in which contexts, and how they affect your wellbeing—not to eliminate all camouflaging, but to identify which behaviors are helpful versus harmful. Some camouflaging may help (e.g., professional presentation for a job interview), while other camouflaging harms (e.g., masking throughout an entire work day causing post-work shutdowns and meltdowns with family).

Critical Reframing: Camouflaging As Adaptive Survival, Not Deception

The author emphasizes critical reframing: camouflaging is not something done wrong or to intentionally deceive others. It’s a natural, adaptive response to social trauma and environmental pressure. The brain did what it needed to survive and keep you safe. Many camouflaging strategies enabled positive outcomes—friendships, education completion, professional presentations, community connection. The point is not to reverse time but to recognize that strategies once protective may no longer serve your wellbeing as an adult. Choice becomes possible once awareness develops.

The author describes her “vicious cycle”: camouflaging creates exhaustion → exhaustion causes depression/anxiety → mental health crisis forces isolation → isolation removes camouflaging pressure → brief recovery → cycle restarts. Understanding this cycle enables intervention.

Practical Strategies & Techniques

Strategy 1: Identifying and Challenging Distorted Thinking Patterns

Camouflaging stems from anxiety, which stems from distorted thinking. Before attempting to reduce camouflaging, you must address the underlying thought patterns. The brain’s “old brain” (basic emotion system designed for threat detection) generates automatic negative thoughts about social judgment that feel like facts but are often cognitive distortions. Research shows compassion-focused training can reverse these negative effects by activating brain regions associated with emotion regulation.

Seven Common Thinking Errors in Autistic Camouflagers:

  1. Ignoring the good: Focusing only on one social mistake while overlooking positive interactions
  2. Blowing things out of proportion: Treating minor errors as having serious consequences
  3. Fortune telling: Predicting negative futures based on automatic thoughts rather than reality
  4. Mind reading: Believing you know what others think without evidence
  5. Negative labeling: Labeling yourself negatively based on one mistake
  6. Setting the bar too high: Demanding perfection or declaring yourself worthless for any error
  7. Should statements: Using unrealistic expectations about how you “should” have acted
  8. Feelings as facts: Treating emotions as evidence of truth

To challenge distortions: write down a social situation that triggered anxiety, identify the automatic thought that arose, detect which thinking error(s) apply, and create a “compassionate thought” that avoids blame and assumptions while focusing on realistic, supportive perspectives.

Example: When the author forgot to ask a friend how she was, she catastrophized that the friend would think her selfish, wouldn’t want to be her friend anymore, and that she was an idiot. By reframing with compassion, she recognized that one small mistake doesn’t define the friendship, that her friend makes similar mistakes, and that she does ask how people are doing across other conversations.

Strategy 2: Building Distress Tolerance Through Radical Acceptance (dbt-Informed)

Distress intolerance—the belief that overwhelming emotions are unbearable and must be immediately stopped—often leads to avoidance behaviors that reinforce anxiety long-term. Dialectical Behavior Therapy (DBT) techniques for managing intense emotions are valuable, but require autistic-specific adaptation.

Radical Acceptance Coaching Script:

  • What are you feeling? Label the emotion and physical sensations
  • Accept the feeling: Acknowledge it will pass on its own; you are not your emotions
  • Focus on the present: Redirect attention to breath, sounds, physical sensations
  • What if it comes back? Normalize waves of emotion and continue observing

Critical Autistic Adaptation: While non-autistic individuals may overcome fears through exposure (“feel the fear and do it anyway”), autistic people need a different approach: “Feel the fear and then gradually make adaptations that help you to do it anyway, but only eventually when you’re ready.” This means taking small steps rather than forcing immediate confrontation with anxiety-provoking situations. Build in soothing activities afterward and maintain self-compassion throughout.

Strategy 3: Mindfulness and Imagery-Based Mental Rehearsal for Emotional Regulation

Mindfulness—meditative awareness of present surroundings, feelings, and bodily sensations—has been empirically shown to treat anxiety and depression by literally changing neurobiology. Research by Tang, Hölzel, and Posner (2015) demonstrates that mindfulness affects brain plasticity, rewiring the anterior cingulate cortex (attention) and fronto-limbic network (emotional regulation). A meta-analysis by Hartley, Dorstyn, and Due (2019) found significant improvements in subjective wellbeing for all autistic participants in mindfulness studies.

Simple Soothing and Relaxation (5-10 Minutes): Close your eyes and ground your feet on the floor. Notice your breathing and sensory input. Take deep, slow breaths. Progressively tense and relax muscles from toes to head. Allow distracting thoughts to pass like trains through a station without fighting them.

Imagery Relaxation With Mental Rehearsal (15-20 Minutes): Begin with soothing and relaxation. Imagine a past scene that made you feel happy and relaxed, vividly describing what you see, hear, smell, and feel. While in this calm state, imagine a future stressful scenario. Mentally rehearse the situation going well while feeling as calm as in the safe memory. The neuroscience is powerful: the brain cannot distinguish imagined from real experiences. Mental rehearsal literally creates neural pathways for calm performance, comparable to practicing a skill physically.

Strategy 4: Behavioral Experiments—testing Predictions About Unmasking

Behavioral experiments, a core CBT technique, test predictions about what will happen if you don’t camouflage. The method involves forming a specific hypothesis, designing a test, observing what actually happens, and reflecting on whether beliefs were accurate.

Example 1: Disclosing Autism-Related Needs:

  • Prediction: “If I tell my manager I need quiet time to focus, she’ll think I’m difficult and not promote me”
  • Test: Request a quiet space or flexible schedule from manager
  • Actual outcome: Manager was supportive, colleagues admired honesty, ability to focus improved
  • Reflection: The feared consequence didn’t occur; disclosure actually improved work performance

Example 2: Minor Social “errors”:

  • Prediction: “If I don’t ask a friend how they are in a brief conversation, they’ll think I’m selfish”
  • Test: Have a brief conversation where you focus on your own experiences
  • Actual outcome: Friend revealed she was too absorbed in her own concerns to even notice or judge
  • Reflection: People are often too self-focused to notice perceived social errors

Example 3: Public Stimming:

  • Prediction: “If I stim on public transport, people will judge or ridicule me”
  • Test: Stim openly on a train during a brief journey
  • Actual outcome: No adverse reactions; felt “liberating and calming” to stim freely
  • Reflection: Most people don’t notice; those who do often don’t judge

Implementation guidelines: Choose safe people and settings initially; test predictions gradually rather than all at once. Recognize that while some people may judge, others often don’t notice or care. Start small to build confidence.

Strategy 5: Reconnecting With Authentic Interests and Values

Many late-diagnosed autistic adults discover they’ve lost touch with what they genuinely enjoy, having spent years doing what they “should” do. Recovery involves deliberately revisiting activities once suppressed.

Stimming As Self-Regulation, Not Symptoms: Stimming—repetitive movements or noises—is not a symptom of autism but a self-regulatory coping strategy for anxiety in non-adapted environments. Kapp et al. (2019) found autistic adults describe stimming as a mechanism to cope with overwhelming environments, sensory overload, chaotic thoughts, and uncontainable emotion. Many suppress stims into “socially acceptable” forms or hide them privately due to stigma, losing access to crucial emotional regulation tools.

Practicing Authentic Activities: Revisit activities once enjoyed: team sports, children’s TV, biking, computer games, reading, collecting, building Lego, drawing, music. Create a “Soothing and Enjoyable Activity List” including fidget toys, stimming, singing, dancing, art, photography, special interests, animal interaction. Try these activities in private first, then gradually in semi-public spaces, then public. Track what brings joy and monitor whether shame gradually reduces as you normalize these activities.

Values Alignment and Identity Recovery: The Cognitive Adaptation Model (Taylor 1983) explains that life-changing information (like autism diagnosis) requires re-evaluating identity through three steps: (1) finding meaning in experiences, (2) regaining control, and (3) enhancing self-esteem. Identify people you admire and what values they embody. List values most important to you personally. Note past examples of living those values and future scenarios to practice them more.

Strategy 6: Practicing Self-Compassion As Foundation for Recovery

Because camouflaging stems from anxiety and self-criticism, attempting to unmask without addressing underlying thought patterns will likely fail or increase suffering. Self-compassion—treating yourself with the same kindness you’d offer a struggling friend—is foundational recovery work.

Professor Paul Gilbert’s research in The Compassionate Mind (2009) explains how the brain operates through conflicting systems: the “old brain” (basic emotion system for threat detection) and the “new brain” (enabling language and social imagination). The old brain’s threat responses—triggered by imagined social failures—are often no longer relevant but drive anxiety and depression. Compassion-based training can reverse these negative effects. Neuroscientist Olga Klimecki and colleagues (2013) found that compassion training reversed negative responses to suffering and activated brain regions associated with emotion regulation and reward.

Practicing Self-Compassion: When facing a social mistake or difficulty, pause and acknowledge suffering: “This is hard; social situations are genuinely difficult for autistic people.” Recognize common humanity: “I’m not alone in struggling with social interaction; many autistic people experience this.” Respond to yourself as you would a struggling friend: “I made one social mistake; that doesn’t define me or my relationships.” Practice regularly; like building muscle, compassion strengthens with repetition.

The author emphasizes: “We experience enough criticism from others that the very least we can do is to give ourselves the break we so desperately need.”

Key Takeaways

  1. Camouflaging is a trauma response rooted in evolutionary fears and social rejection, not a personal failing or deception. All humans modify behavior socially, but autistic camouflaging is qualitatively different—more elaborate, more resource-intensive, more sustained across contexts, and beginning earlier. The intensity and duration create exhaustion and burnout. Understanding camouflaging as adaptive survival, not choice or manipulation, is critical to reducing shame and enabling recovery.

  2. Camouflaging is a significant predictor of suicidal behaviors in autistic people, operating through both resource depletion and identity loss. Research shows the correlation holds even after controlling for age, sex, employment, depression, and anxiety. Camouflaging depletes cognitive resources needed for learning, work, and creativity, while preventing authentic connection and causing “thwarted belonging”—the unmet need for genuine acceptance. Recovery requires addressing the root causes: reducing self-criticism through compassion-based interventions and reconnecting with authentic identity and interests.

  3. The problem is not autistic deficits but mutual incomprehension and non-autistic stigma. The “double empathy problem” theory suggests that autistic people lack non-autistic social norms while non-autistic people lack autistic social culture, resulting in two-way communication breakdown rather than one-directional deficit. When autistic people connect with other autistic people, they discover social interaction doesn’t have to be exhausting and direct communication works. The profound insight: if autistic people feel comfortable and “normal” around other autistic people, the actual problem is non-autistic intolerance, not autism.

  4. Self-compassion and challenging distorted thinking are foundational before reducing camouflaging, as camouflaging stems from anxiety and internalized shame. The brain’s threat system generates catastrophic predictions about social judgment that feel like facts but are often thinking errors. Before attempting behavioral change, autistic people must retrain their thought patterns through identifying distortions, practicing radical acceptance of overwhelming emotions (with autistic-specific adaptations for gradual rather than forced exposure), and systematizing self-kindness.

  5. Unmasking is a gradual, personalized process requiring safe spaces and values-based motivation, not total authenticity across all contexts. There is no single “right” amount of unmasking; some autistic people will continue masking in certain contexts for safety or employment, while finding genuine rest in safe relationships or alone time. The practical aim is awareness, choice, and protecting mental health. Behavioral experiments reveal that feared social consequences often don’t occur.

  6. Reconnecting with authentic interests and stimming—reframed as self-regulation rather than symptoms—is essential identity recovery work. Many autistic adults have suppressed childhood interests and stimming due to social pressure, losing access to both joy and crucial emotional regulation tools. Recovery involves deliberately revisiting suppressed activities in safe contexts (private first, then gradually public), tracking what brings joy, and practicing values-aligned activities that build genuine self-worth independent of others’ approval.

  7. The goal is not universal unmasking but creating safe spaces where autistic individuals can occasionally remove the mask and relax, while maintaining practical safety in less accepting contexts. Nearly all autistic people interviewed reported exhaustion from camouflaging, yet most felt they still needed to continue because societal acceptance depends on it. The book’s aim is not to encourage total authenticity everywhere but to help autistic people understand themselves better and manage exhaustion through finding regular time where camouflaging is not required.

  8. Being a “safe person” for autistic individuals—explicitly accepting stimming, monologuing, eye contact avoidance, and direct communication—is transformative support that reduces camouflaging burden and improves long-term mental health. Parents, educators, and friends can meaningfully reduce camouflaging exhaustion by actively accepting autistic traits and reinforcing that the person is likeable and acceptable as they are. A teacher telling a student “I appreciate how deeply you think about dinosaurs and love hearing your thoughts” reduces pressure to mask.

  9. Late autism diagnosis reveals that having camouflaged extensively doesn’t mean there was something “wrong” with your diagnosis or that you’re “not really autistic”—it means you adapted to survive in an unwelcoming environment. Some autistic people may choose to continue masking in certain contexts after diagnosis; others may choose to reduce it. The critical issue is having genuine choice, which only becomes possible with full self-awareness and complete information about camouflaging’s impacts. Autonomy in deciding one’s own relationship with masking is the actual goal, not a specific outcome.

  10. Societal stigma, not autism, is the root problem requiring change. Autistic children grow up in societies that constantly communicate their behaviors are inappropriate, abnormal, or wrong. This persistent stigma creates high levels of self-criticism, shame, and disconnection from authentic self. Until societal attitudes shift (which will not happen overnight), autistic people must prioritize their own wellbeing and protection. However, the long-term solution requires systemic change: reducing stigma, building inclusive environments, and accepting neurodiversity as a natural human variation rather than a disorder to hide.

  11. The variability in how different autistic people relate to camouflaging is normal and valid—autonomy in choosing one’s own relationship with masking is the goal. Some autistic people want to reduce camouflaging significantly and feel liberated by unmasking. Others feel camouflaging helps them feel confident and liked. The critical issue is awareness and genuine choice—which only becomes possible through self-understanding and information about camouflaging’s impacts. A person consciously choosing to mask in professional contexts while unmasking at home has different psychological consequences than someone unconsciously running on social autopilot across all contexts.

  12. Understanding camouflaging as a learned survival response that can gradually shift through self-awareness, compassion, behavioral experiments, and safe spaces enables recovery without requiring total life restructuring. The author’s personal journey illustrates this: identifying the “vicious cycle” (camouflaging → exhaustion → depression → isolation → brief relief → cycle restart), practicing self-compassion instead of self-blame, gradually testing predictions about unmasking, and creating safe relationships where authenticity is possible. This is not about becoming a “completely authentic” person everywhere; it’s about building agency, reducing burnout, and recovering parts of yourself previously lost to performance.

Resources for Support and Further Learning