Adults with ADHD often have problems with time management, prioritizing, organization and procrastination. While medication can help reduce symptoms of ADHD, it doesn’t cure ADHD or make someone instantly organized. Even with medication, adults with ADHD need to put in work and effort to improving executive functioning skills. This is where cognitive behavioral therapy (CBT) might help.
What is CBT?
Cognitive behavioral therapy is based on the theory that our thoughts control our actions and behaviors. Negative thought patterns, such as all-or-nothing thinking, "catastrophizing" or focusing on the negative lead to unhealthy behaviors and feelings of hopelessness. For example, a therapist might help an adult with ADHD look at how her thought processes are contributing to procrastination. When an individual continues to internalize thoughts such as, “I can’t be on time,” or “No matter how hard I try, I always end up being late,” these thoughts might block any attempts to change behaviors. In CBT, you challenge these types of thoughts and replace them with more realistic thoughts, such as, “I am often late for appointments but setting an alarm on my phone can help me be on time.” The word always, according to CBT theory, indicates that you can’t change. Changing the word always to often allows the individual to see the potential for change.
CBT helps identify negative thought patterns and beliefs, challenges them and, through practical solutions, helps to negate them. Keeping a thought log and consciously changing the way you think about a situation can change how you react to the situation. CBT therapy involves not only working with a therapist, often on a weekly basis, but completing “homework” assignments, such as the thought log, in between sessions. One of the major goals of CBT therapy is to help an individual develop specific strategies to employ in daily life — not just while receiving therapy, but for life.
CBT is effective in treating a number of different conditions. According to the National Association of Mental Illness (NAMI) it is used to treat depression, anxiety disorders, bipolar disorder, eating disorders and schizophrenia. It has also been found to be helpful for patients with chronic pain, sleep disorders and substance abuse.
Can CBT alone help reduce ADHD symptoms?
A single study, conducted by the Vancouver Coastal Health Research Institute, looked at whether CBT could be effective as a treatment for ADHD by itself. The researchers compared participants who used solely CBT against those who used CBT in conjunction with ADHD medications. Both groups received CBT therapy that emphasized goal attainment, organization, time management, planning, self-esteem, emotional regulation, impulse control and relationships — areas that are often problematic for adults with ADHD. All participants were assigned a CBT coach who contacted each person twice a week to help them stay focused on homework assignments provided by the therapist.
The initial trial lasted for 12 weeks. At the end of the time, both groups showed significant improvements. However, the group that received a combination of treatment — both medication and CBT — “outperformed” the group that received CBT alone. These differences diminished during the six month follow up. At that time, both groups continued to do well. Those who received combination therapy maintained their gains and those who received CBT alone continued to make improvements. Mariya Cherkasova, the lead researcher, noted that while “the combined treatment produces greater, more immediate benefits, similar levels of improvement may be reached more gradually with CBT alone, at least in the presence of continued coaching support.”
CBT effective as a supplemental treatment
A 2016 review of nine studies looking at CBT as supplemental treatment for ADHD found that it could bring about significant improvements.
Many adults with ADHD also have coexisting conditions, such as depression or anxiety. There have been many studies showing CBT as an effective treatment for these conditions and it is possible that when this type of treatment is used or adults with ADHD, that by improving symptoms of depression or anxiety, they feel better and can then focus on reducing symptoms of ADHD.
All of the research studies compared groups of adults with ADHD who received CBT to those who did not. However, in these studies, participants took medication for ADHD and therefore the studies could not conclude whether CBT was effective as a stand-alone treatment, only as an adjunct treatment.
CBT addresses the executive dysfunction that often accompanies ADHD. It works, according to CHADD, in part because, “positive thoughts and positive behaviors reinforce each other; as the person becomes more effective in managing time, s/he comes to have more positive beliefs and cognitions about the self, and these in turn help to generate and maintain more adaptive behaviors.”