Cognitive behavioral therapy and treatment of ADHD

The difference between cognitive behavioral therapy (CBT) and other forms of psychotherapy is that it emphasizes the interaction of cognition (automatic thinking, images, belief systems, and behavior). Of course, CBT does not ignore emotions, but uses problematic thinking and behavior patterns as an entry point for understanding and solving people’s difficulties in seeking treatment.

CBT was originally designed to treat depression, and studies have consistently shown that it is an effective way to treat emotional problems. Subsequent studies have shown that CBT can help solve other common problems, such as various types of anxiety, drug abuse, other emotional problems, and some medical problems, such as dealing with sleep problems or headaches.

In the past decade, many clinical researchers have worked to modify CBT to solve the coping difficulties associated with adult ADHD.

The role of CBT in the treatment of adult ADHD

In terms of treating the core symptoms of ADHD, drugs are considered the first-line treatment for ADHD. There are a variety of drug treatments for ADHD, the benefits of which work through the effects on brain function, usually improving sustained attention, managing distractions, and impulse control.

For many people, the improvement of these symptoms will lead to improved functions in their daily lives, such as better tracking of objects, reduced body restlessness and better impulse control, and the ability to stay focused on work within a reasonable period of time Or reading time, to name a few.

Beyond drugs

However, despite adequate medical treatment, many people may continue to struggle with the effects of ADHD. That is, individuals may continue to experience residual symptoms of ADHD and/or have ongoing difficulties in implementing coping strategies that they know will be helpful.

In addition, people with ADHD may have difficulty managing their emotions in daily life, which is an increasingly recognized feature of ADHD, or they may experience depression, anxiety, substance abuse, or low self-confidence. These adults with ADHD need extra help to experience better happiness and function in daily life.

Some adults with ADHD may continue to experience symptoms and face emotional difficulties even after they start taking medication. Adding CBT to their treatment plan can help.

It has been found that CBT is a useful adjuvant treatment that can directly solve the various injuries and coping problems associated with adult ADHD. Although the response solutions seem simple—use daily plans, start processing tasks early before deadlines, and break large tasks into smaller tasks—but they can be difficult to implement.

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Facing these long-standing challenges can also trigger negative thoughts, pessimism, self-criticism, and frustration, which can create additional obstacles to follow-up actions. There may also be a small number of ADHD patients who are unable to take drugs due to medical contraindications, intolerable side effects, unresponsiveness, or simply refusing to use drugs for which CBT may be the main treatment.

Therefore, CBT may be recommended in cases where the use of drugs alone is not sufficient to solve the problems associated with ADHD.

Daily life with CBT and ADHD

A common example is a patient who was late for the first meeting on the grounds that solving “time mismanagement” is the goal of CBT. Such incidents are used to “reverse engineer” the various components of the problem to deepen the understanding of how ADHD (and other factors) may contribute to the development and maintenance of its functional problems. In this case, “time mismanagement” ,” and provide some preliminary ideas on coping strategies.

This review also allows for personalized treatment based on individual circumstances, making it an important opportunity to develop strategies for the implementation of coping skills.

Continuing the above example, the “time management” problem related to late appointments can have multiple causes, such as:

  • Poor schedule (for example, there is no daily planner with a record of appointments)
  • Confusion (for example, unable to find paper with appointment date and time)
  • Poor problem-solving skills (for example, not considering the option of obtaining appointment time, such as researching the office number and calling to confirm)
  • Poor planning (for example, not setting a realistic time frame for appointments, taking travel, parking, etc. into account),
  • Excessive focus on distracting tasks (for example, working on a computer)

There may also be issues related to the expectations of appointments, which creates obstacles to follow-up actions. Anxiety can be distracting and lead to avoidance behavior. Perceptions that interfere with the task are either negative (e.g., “This doctor will not tell me anything I haven’t heard of”) or positive (e.g., “I believe there will be many parking spaces” or “It’s nothing The big deal “If I’m late”) will also affect the follow-up work.

Each of these components of “time mismanagement” provides opportunities for change. As the various difficulties associated with ADHD are identified, recurring themes will appear, and the various coping techniques discussed can be applied to various situations to improve overall functioning.

CBT is not a “quick fix”, skills must be implemented in a consistent way, but the combination of increased awareness of the effects of ADHD and a plan to deal with these effects provide a template that can understand the factors experienced before as transcendence factors one’s control .

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Use CBT to change behavior

Procrastination is one of the most common problems reported by adults with ADHD. Although almost everyone with ADHD sees procrastination as a problem, everyone’s struggles are unique.

After defining procrastination as a treatment goal, encourage the patient to share specific examples of procrastination in his or her daily life, preferably the most recent. We slowly and collaboratively review the ultimate goal of the task in a specific way, whether it is simple, such as organizing a shopping list, or more complex, such as writing a paper for a college class.

Then we examine the relationship between the individual and the task, whether it is recent procrastination or current expectations for the task. We discuss the plan of the task, the components of the task, in order to break it down into steps (also called “blocks”), and identify any potential obstacles or factors that may affect the follow-up work.

An important aspect of this process is also to explicitly explore the individual’s cognitive and emotional responses to this task. Questions we frequently ask include:

  • “What do you think about carrying out this task?”
  • “When you think about this task, what emotions did you notice?”
  • “How does your skin feel when you face this task?”

The purpose of these questions is to reveal the role of negative thoughts and emotions that can lead to procrastination. We also want to determine the person’s “evasion behavior” and rationalization, such as “I will check my email before I can start work”.

CBT intervention operates in the way that executive functions are designed to work, helping individuals to plan, organize, and orchestrate their time, energy, and effort to complete tasks that may not be rewarded immediately (although the rewards are small, the number of small steps is usually Minimize), but this will bring greater and more valuable results.

The individual determines a specific plan to perform a specific task at a specific date and time to increase the possibility of follow-up (for example, “When you walk in the door after get off work, you may turn to the TV and rationalize that you need to “organize”; you can What are the different things to do to make sure you receive your mail before you sit down? Where can you organize your mail that day? What would you say about the rationalization of delays?”).

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The goal of CBT is to “stick” coping strategies so that people with ADHD can remember and use them in their daily lives.

This process is not always easy, and change usually occurs in a “two steps forward, one step back”, but these skills provided in a relationship with a therapist who understands adult ADHD may be helpful for many people .

It is invaluable to be able to discuss your own observations of ADHD and the problems you may encounter with experienced healthcare professionals. Many people find that these types of discussions with doctors are therapeutic and affect changes in their daily lives.

ADHD discussion guide

Get our printable guide to make an appointment for your next doctor to help you ask the right questions.

Looking for CBT professionals

Some organizations are dedicated to disseminating CBT, such as the Behavioral and Cognitive Therapy Association and the Cognitive Therapy Academy, which have therapist locator functions on their websites. However, many practitioners who are very skilled in CBT may not be familiar with the problems faced by adults with ADHD. Similarly, some organizations dedicated to ADHD have professional directories on their websites that include various mental health professionals, but these clinicians may not be familiar with the CBT method.

The National Resource Center associated with Childhood and Adult ADHD (CHADD) lists adult ADHD providers and programs. Attention Deficit Disorder Association (ADDA) is an organization dedicated to solving adult ADHD-related problems. It also provides a list of provider.

There are more and more adult ADHD clinics in the United States and around the world, many of which provide CBT-oriented treatment methods. Harvard University/Massachusetts General Hospital and New York University’s Mount Sinai School of Medicine have all carried out active projects in the United States. In Canada, Finland, and Germany, there are some excellent programs that explore psychosocial treatments for adult ADHD.

People often get to know the excellent therapists in their area by contacting these resources or clinics in their area and knowing whether there are qualified therapists nearby to consult. Unfortunately, because CBT for adult ADHD is a clinical specialty that no clinician has access to, there may not be experienced therapists in some places.

However, more and more published treatment manuals and clinical-oriented professional books can serve as useful resources for clinicians.