Can Cognitive Behavioral Therapy (CBT) Help Manage ADHD?
Inability to focus, being easily distracted, hyperactivity, poor organization skills, and impulsivity – these are only some of the symptoms of ADHD (attention deficit hyperactivity disorder), a neuro-behavioral disorder that affects 11% of school-age children and 4.4% of adults in the US.
As a result of encountering setbacks in their everyday life due to their symptoms, many people with ADHD become self-critical. They tend to blame themselves for experiencing difficult emotions, low self-confidence, or anxiety. That's where cognitive behavioral therapy (CBT) comes in.
Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people with ADHD identify and change destructive or disturbing thought patterns that negatively influence their behavior and emotions.
But how exactly does CBT work? Let's dive in.
What Is CBT and How Does It Work for ADHD?
CBT is based on the idea that how we think (cognition), how we feel (emotion), and how we act (behavior) all interact. In other words, our thoughts determine our feelings and our behavior. Therefore, negative or unrealistic thoughts can cause us distress and distort our perception of reality, thereby causing us to behave irrationally.
A therapist who specializes in CBT aims to help someone with ADHD identify their harmful thoughts, assess whether these thoughts are an accurate depiction of reality, and, if they are not, employ strategies to challenge and overcome them.
This approach is problem-oriented and, unlike many other psychoanalytic approaches, it doesn't focus on discussing the person's past to gather understanding and insight. Instead, CBT focuses on the present circumstances and emotions in real time while looking for an effective solution to a specific problem.
For example, if a person with ADHD struggles with poor time management and procrastination, one of the CBT approaches would be to first uncover the role of negative thoughts and emotions that may contribute to procrastination and identify the person's rationalizations, such as "I'll watch a TV show and then I'll sort out my mail."
Then, it offers a specific solution for the problem. For instance, a therapist may ask something along the lines of, "When you walk through the door after work, you may drift towards the television and rationalize that you need to relax. What can you do differently to make sure that you get your mail before you sit down? Where can you sort through your mail that day? What will you say to those rationalizations in favor of procrastination?"
After talking through the thoughts with a therapist, a person with ADHD is usually provided with a CBT worksheet and exercises that they can do at home in order to practice behavioral change and enhance their therapy experience.
Most Used CBT Techniques for ADHD
CBT is not a one-size-fits-all approach. Depending on the type of issue a person wants help with, their therapist will help figure out which CBT technique or combination of techniques best suits their particular needs.
Some of the most used CBT techniques when it comes to ADHD are:
Cognitive restructuring/reframing: A therapist will ask about a person's thought process in certain situations to identify negative thinking patterns. Once the person is aware of negative thinking patterns, they can learn to restructure/reframe those thoughts to be more positive and productive.
Exposure therapy: A therapist will safely expose a person with ADHD to the things that provoke their fear or anxiety, while simultaneously providing guidance on how to cope with them in the moment. As a result, they become less vulnerable and more confident in their coping abilities. For example, suppose a person with ADHD fears social contact. In that case, their therapist would slowly introduce them to small groups and then to crowds, either directly or through guided visualizations.
Role-playing: People with ADHD often experience social difficulties due to inattention, impulsivity, or/and hyperactivity. During role-play, the therapist and a person with ADHD would act out different scenarios to see how the person would behave in certain situations. The therapist would then provide immediate and frequent feedback about inappropriate behavior or social miscues. This approach can be helpful to teach, model, and practice positive social skills as well as ways to respond to challenging situations.
Relaxation techniques: Relaxation techniques such as progressive muscle relaxation (a method that reduces tension by alternating tightness and relaxation in the muscles), deep breathing exercises, and imagery (concentrating on a specific object, sound, or experience to calm your mind) can help lower stress and increase a sense of control.
Journaling: A life with ADHD often comes with intense feelings and impulsive responses. Journaling is an excellent way to slow down spiraling thoughts and examine them through writing. Furthermore, by having the opportunity to reflect, they may experience a boost in self-efficacy and feel more confident that they can achieve things.
Cognitive behavior therapy worksheets and exercises: Because CBT is an action-oriented approach, homework is crucial to the behavioral change process. And CBT tools such as worksheets and exercises can be an effective way to learn, internalize, and practice skills learned in therapy.
The Efficacy of Cognitive Behavioral Therapy for ADHD
Various research initiatives have studied the impact of CBT on the symptoms of ADHD in adults and supported the statement that CBT can help adults better address their ADHD-related challenges.
For example, one neuroimaging study included ten adults with ADHD who took MRI scans within one week before and after 12 CBT sessions. During the seasons, CBT therapists focused on psycho-education about ADHD and training in organization and planning, as well as learning skills to reduce distractibility and cognitive restructuring.
The study showed improvements in participants' symptom ratings and beneficial changes in the frontoparietal network and cerebellum: the same brain regions that are typically monitored in studies of medication treatment for ADHD. Positive brain connectivity changes in these regions are correlated with enhanced achievement of executive functions – a set of cognitive skills needed for self-control and managing behaviors.
Can CBT Help Children With ADHD?
Children with ADHD can be highly creative, inventive, and have astounding problem-solving skills. But they can also struggle with low self-esteem, troubled relationships, and poor performance in school.
Luckily, there's a CBT-based approach that has been extensively researched and proven to be successful in reducing the oppositional and aggressive behavior, impulsivity, and other tricky symptoms that children with ADHD experience.
This approach is known as Behavioral Parent Training, or BPT. It helps parents set clear expectations for children and encourage positive behavior by learning how to do things such as strategically praising and rewarding them.
During BPT training, caregivers learn about:
Spending one-on-one time with their child
Teaching their child to be receptive to positive attention
Using praise to increase positive behavior
Using ignoring and consequences to reduce negative behavior
The skills learned by taking behavioral parent training last a lifetime and can result in better communication and a happier parent-child relationship.
How Long Does It Take to See Results?
The effects of CBT typically begin to appear after 12-15 one-hour sessions. However, many people with ADHD continue with cognitive behavioral therapy because it helps them maintain the coping skills they learned in the long term.
These useful and practical skills can be used in everyday life, even after therapy session