Cognitive Behavioral Therapy For Managing ADHD Symptoms

There are several options when it comes to mental health treatment for attention-deficit/hyperactivity disorder (ADHD). Cognitive behavioral therapy (CBT) is a treatment approach that can help alleviate the cognitive, emotional, and behavioral challenges associated with the disorder. CBT is a type of talk therapy that focuses on how negative thinking patterns, called cognitive distortions, can lead to maladaptive behaviors. In this article, we explore the benefits of CBT for ADHD and explain how CBT works. 

What is attention-deficit/hyperactivity disorder?

Attention-deficit/hyperactivity disorder (ADHD) is a behavioral disorder that can make it hard to focus on everyday tasks, stick to a routine, or make decisions. Some people are diagnosed with attention-deficit/hyperactivity disorder as children. Others are diagnosed with adult ADHD. Still, symptoms usually start to show in early childhood. The symptoms can have a significant effect on people’s daily lives by impacting their social life, professional or academic work, and emotional state.

What is cognitive behavioral therapy (CBT)? 

Blending components of cognitive therapy and behavioral therapy, cognitive behavioral therapy (CBT) helps participants understand how their feelings, actions, and beliefs are connected. CBT is a type of talk therapy that focuses on how negative thoughts (cognitions) lead to negative behaviors. We frequently interpret situations using automatic thoughts, which can be helpful in some cases and detrimental in others. Negative or irrational automatic thought patterns, called cognitive distortions, are sometimes at the root of our maladaptive emotions and behaviors. 

Therapists who utilize CBT improve attention-deficit/hyperactivity disorder symptoms by helping participants reframe negative thought patterns. During CBT sessions, patients may learn skills that can reduce their symptoms and improve their daily life. 

Guided counseling is the process in which the therapist asks open-ended questions that prompt introspection. This type of talk therapy can help reveal negative thought patterns behind certain dysfunctional behaviors. Once the patient gains a deeper understanding of their thought patterns, a CBT therapist can help them learn coping skills and strategies to chane those negative thought patterns and eventually improving their behavior and avoiding negative emotions. 

Here is a list of the most common cognitive distortions:

• Black-and-white thinking: all-or-nothing thinking that places things in extremes
• Overgeneralization or labeling: grouping things based on patterns 
• Disqualifying the positive: rejecting positive experiences 
• Mental filter: focusing on one individual piece of information and ignoring the rest
• “Mind reading” or “fortune telling”: jumping to conclusions
• Catastrophizing or minimizing: exaggerating the significance of negative events or minimizing the significance of positive events 
• Emotional reasoning: believing that emotions are facts 
• “Should” statements: a rigid belief that you or someone else “should” or “ought” to do something a certain way 
• Personalization: taking everything personally
• Control fallacies: the belief that we are either completely in control or not in control at all 
• The fallacy of fairness: expecting life to always be “fair” and becoming distressed when it is not 

How CBT treats adolescent and adult ADHD 

Along with approaches like medication management and other types of psychotherapy, CBT is often one of the first types of treatment recommended for mental health conditions like anxiety disorders, depression, and ADHD because of its proven benefits. CBT can be especially beneficial for patients with ADHD. This may be because it focuses on teaching behavioral skills to make positive behavioral changes and can be applied immediately. 

To treat attention-deficit/hyperactivity disorder in children 12 and under, modalities like parent training and medication treatment are typically recommended. When it comes to adolescents and adults, psychotherapy is considered a primary modality, often alongside stimulant or non-stimulant medication. While medication can alleviate many of the symptoms of ADHD, there are often residual symptoms that must still be addressed. Counseling can improve those symptoms for many adults and children; and a CBT therapist familiar with attention-deficit/hyperactivity disorder can provide this often-crucial component of treatment. 

But does CBT improve symptoms of ADHD? According to a systematic review of nine randomized controlled trials, CBT is an effective method of treatment for adults with ADHD. Clinical experience and research suggest that CBT can be effective with or without combined medication. One 2019 study compared the effectiveness of CBT alone with combined CBT sessions and medications for treating adult ADHD. The study showed that CBT alone was an effective form of treatment for the core symptoms of ADHD. 

Benefits of CBT to treate attention-deficit/hyperactivity disorder include:

• Learning time management skills 
• Interrupting and replacing negative thought patterns 
• Practicing new skills 
• Increasing awareness of thought patterns that lead to negative behaviors 
• Improving emotional control
• Enhancing executive function
• Reducing symptoms of anxiety and depression
• Preventing reckless risk-taking 

Some of the potential benefits of CBT for attention-deficit/hyperactivity disorder include improving productivity and developing positive habits as well as learning coping strategies for emotional control. The core principle of CBT is that by recognizing and changing negative thought patterns, people can change their behavioral patterns and alleviate negative feelings. Talk therapy can help people with ADHD spend time learning how to recognize negative thoughts when they arise and replace them with more positive thoughts. 

For people with ADHD, negative thoughts may lead to dysfunctional behaviors—such as poor impulse control or distractibility—that impact their productivity or social life. CBT to manage attention-deficit/hyperactivity disorder focuses on the restructuring of negative thought patterns regarding planning, organizing, and prioritizing. With the help of a CBT therapist, people with ADHD can make progress towards their goals, reduce negative behaviors, and develop positive habits that can be implemented in day-to-day life. 

CBT techniques

CBT focuses on recognizing and replacing negative thought patterns, or cognitive distortions. Learning about the different types of cognitive distortions and how to recognize them can increase self-awareness. 

When people think of talk therapy, they may think of the type of therapy portrayed in television and films. This could consist of a therapist prompting a patient to reflect on their past to discover the possible origins of negative thought patterns. However, there are many different types of counseling techniques. Looking back on the past can have benefits for treating some mental health conditions, but CBT largely focuses on addressing thoughts, emotions, and behaviors in the here and now. 

Being aware of negative thought patterns can help prevent negative behaviors such as reckless or impulsive decision-making. Cognitive restructuring through counseling is one way that adults with attention-deficit/hyperactivity disorder can prevent dysfunctional behaviors and improve well-being. With CBT techniques, patients may be able to recognize these negative thoughts and use the coping skills they learn in counseling to replace them with more positive thoughts. 

Someone with ADHD may engage in mental filtering each time they receive feedback at work, causing them to focus only on the negative aspects of their supervisor’s comments. During a CBT session, a therapist might help the individual find ways of recognizing when information is being filtered out, which can lead to them identifying the positive comments their supervisor makes (and, potentially, interpreting similar situations more objectively). 

CBT techniques for treating ADHD: 

• Behavioral experiments
• Role-playing 
• Planning
• Practicing tasks 
• Exposure therapy 
• Guided discovery (talk therapy)
• Reframing negative self-talk  
• Relaxation techniques 
• Worksheets

A CBT technique that may be particularly helpful for people with attention deficit disorder is measuring your “distractibility delay.” This technique is a type of behavioral experiment designed to reveal how distractibility may impact your productivity. Using a timer, a CBT therapist can help you measure how long you can focus on a task before becoming distracted. Then, you can work together to develop coping skills and techniques for overcoming distractions and achieving higher levels of productivity. Clinical experience suggests that individuals who incorporate CBT into their treatment plan experience improvements in daily functioning and self-esteem. 

Ideally, the benefits of CBT will expand beyond the sessions, and the patient will continue to develop healthy habits and skills on their own. Patients may learn how to recognize cognitive distortions in counseling and then use the coping skills they learn to reduce negative behavioral patterns in their everyday life. Using these new skills should become easier with practice.  

ADHD comorbidities 

People with ADHD are more likely to experience comorbidities with other mental health conditions such as depression or anxiety due to their symptoms. Adults with ADHD are three times more likely to have major depression and four times more likely to have a mood disorder. ADHD is also commonly comorbid with substance use disorder, bipolar disorder, and obsessive-compulsive disorder. One of the benefits of CBT programs is that the techniques used can be beneficial for overall mental health and well-being, treating ADHD and comorbidities simultaneously. For example, the CBT program at Massachusetts General Hospital is designed to address ADHD and concerns like insomnia, schizophrenia, and chronic pain. 

Positive behavioral changes from CBT skills can help adults with ADHD perform better at school and work and have more fulfilling social interactions. This can reduce stress and other factors that might lead to anxiety and depression. Skills learned in CBT counseling can also help individuals with CBT be more successful in their careers and might even help to prevent accidents by reducing risk-taking behaviors such as reckless driving. 

Another comorbidity with ADHD that many people may not know about is substance use disorders. ADHD has been associated with an increased risk of substance misuse since individuals may use unhealthy coping skills to try to manage their symptoms. CBT may be a way to learn positive coping skills to reduce the risk of substance dependency for adults with ADHD. 

How to find a CBT therapist

Not all therapists are the same. You may have the best results with a CBT therapist who specializes in treating patients with ADHD. An experienced professional may be able to recommend CBT techniques to treat your current symptoms and concerns.

Factors to consider when choosing a CBT therapist:

• Comfort 
• Cultural awareness
• Experience level
• Area of expertise 
• Location
• Cost

Online CBT for ADHD

An online CBT therapist may be a more available option for some patients. Individuals with ADHD often have difficulty keeping appointments due to distractibility, impulsivity, and other symptoms. One of the benefits of online therapy is that it allows more flexible scheduling and appointment times compared to traditional in-person counseling. Online therapy can be connected using in-app messaging, video chat, email, or phone. Some people may also find that getting counseling from home puts them at ease when discussing their symptoms.  

When comparing the effectiveness of online counseling to in-person ADHD counseling treatment, studies have shown that online interventions can be effective. Online therapy could be particularly effective for treating ADHD symptoms for people who cannot go to office-based appointments or are averse to in-person sessions due to social anxiety or other concerns.