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Medication and therapy are used in combination to treat Attention Deficit Hyperactivity Disorder (ADHD) in those aged six or older.
Many different forms of therapy are out there, and one of the most common you might come across is called cognitive behavioral therapy (CBT). It's often considered one of the most effective types of therapy.
This article will walk through how CBT works, and how it helps with ADHD. It will also discuss techniques, effectiveness, and how to find a CBT therapist.
What is Cognitive Behavioral Therapy (CBT)?
Cognitive behavioral therapy or CBT is a very widely used psychotherapy and form of talk therapy intervention. Typically, it focuses on changing thought patterns to make them healthier and more beneficial to a person's life.
There are many different subtypes of CBT, and it can be adapted to help people with various life impairments and diagnosable conditions. Mental health professionals use CBT for anxiety disorders, depression, insomnia, eating disorders, relationships, stress, self-esteem, and, yes, ADHD. CBT can be performed in a group setting, an individual setting, or in other settings.
How CBT Helps with ADHD
CBT does not treat the “core symptoms” of adult ADHD such as inattention, hyperactivity or impulsivity.
However, it has other benefits and can help children with daily life such as:
- Emotional regulation skills
- Improving follow-through of tasks, decreasing procrastination.
- Symptom management
- Time management
- Self-esteem and confidence.
- If applicable, help with comorbid conditions.
Techniques
Cognitive behavioral therapy uses various techniques that help people address the challenges that can come with ADHD. Here are some of the techniques that a therapist might use with you or your child in a session for ADHD treatment:
Goal-setting and planning
Various forms of therapy, including CBT, often involve goal setting and planning. A therapist who uses CBT might help you complete tasks by teaching you to divide them into smaller and more manageable pieces or by using other techniques that can make a task more doable and less overwhelming.
Different things work for different people; external tools like timers, schedules, routines, or adjustment of beliefs that hold you back, such as those that are perfectionistic in nature, are all examples of tools that a therapist might work on with you to help with focus and distractibility.
Cognitive reframing
Cognitive reframing is when you take a maladaptive or unhelpful thought and change it into something more beneficial. In CBT, often, you will identify something called cognitive distortions. These refer to different types of negative thoughts or patterns of thought. Some examples include catastrophizing, labeling, discounting the positive, mind reading, and overgeneralizing.
Let's use catastrophizing as an example of how this can work. An example of catastrophizing might be, "I am struggling so hard with this math assignment. I will never graduate!" Thoughts like these can lead to or pair with nervousness, sadness, and trouble with self-esteem.
If you use cognitive reframing, you might take that thought and change it to, "this assignment is a challenge for me, but it doesn't mean I won't succeed. What I'm going to do is ask for help!" As you can see, this thought is more helpful and more realistic, too.
Positive self-talk
Positive self-talk essentially focuses on creating a positive internal dialogue. Something that many people with ADHD face challenges with is perfectionism or difficulty with self-esteem. Practices in positive self-talk can help you adjust your internal dialogue to make it kinder and more beneficial to your life so that you can get things done and move through life with increased confidence.
Guided discovery
Guided discovery is a technique that typically involves a clinician or therapist asking questions or otherwise prompting a client in order to help them through problem-solving or approach things differently. This may relate to cognitive distortions you have and could go alongside cognitive restructuring practices.
For example, you might say, "there's no way I can do this project at work. I'm so frustrated with myself for not being able to execute tasks even when I know that I know how. I feel like my brain is stuck!" In response, the therapist might ask you to talk about a time when you executed a similar task and succeeded in doing so. This can improve confidence and help you explore ways to approach the project so that you can get it done.
Relapse prevention
One of the things that therapy can help with is the creation of a relapse prevention plan. In this case, what that might refer to is a plan for what to do if symptoms worsen again or re-emerge. The goal of therapy is often that a client will have tools they can use long-term in their life outside of sessions, and CBT appears to be effective in this for many people.
This isn't an extensive list of all of the techniques that can be used. Other tools, like mindfulness, are also frequently applied.
Effectiveness
Various psychiatry research studies show the efficacy of CBT for ADHD.
One randomized controlled trial that looked at a group of 88 college students with ADHD who engaged in CBT found that, following treatment, participants in the study displayed a significant reduction in symptoms of ADHD as well as a decline in symptoms of depression and anxiety and improvements in executive functioning.
When researchers followed up on the group, it was established that these improvements remained 5 to 7 months after the conclusion of their treatment. Looking at mindfulness-based CBT found that it can help adults with ADHD regulate brain functioning in a way that supports attention and emotional control well-being.
While the study above focus on adults, one thing to note is that it's not just adults with ADHD that CBT can be effective for. Cognitive behavioral therapy can also be used for kids.
In fact, cognitive behavioral play therapy (a type of CBT that combines play therapy with CBT) was found in a study to reduce ADHD symptoms in children aged 7 to age 9. As for older kids or adolescents, it's common for teens to engage in forms of therapy like CBT in a way that presents similarly to the process of adults.
As for why CBT works, neural plasticity is likely the answer. Neural plasticity, which is also sometimes called neuroplasticity, refers to our brain's ability to change, and that is what CBT aims to do.
When you work to change thought patterns through CBT techniques, the new, healthier thought patterns become more natural over time. CBT can be used in conjunction with other forms of treatment, such as ADHD medication. Talk with your care team, or your child's care team, to determine the best wellness treatment routine for you or your family.
How to Find a CBT Therapist
It is relatively easy to locate a CBT therapist due to how common the modality is. Teletherapy for ADHD has been proven to be effective. If you wish to pursue CBT for ADHD specifically, however, you want to make sure that you find a therapist near you who works with ADHD. If you want to know how to find a CBT therapist but aren’t sure how, try one of the following options.
- Contact your insurance company. Call the number on the back of your insurance card and explain that you want to find a therapist who treats ADHD. If applicable, they should be able to tell you who is covered in your area.
- Ask another healthcare provider for a referral. A pediatrician or primary care doctor will often be able to provide referrals to spaces such as ADHD clinics, community centers, and private practice offices with CBT therapists who work with ADHD.
- Use a provider directory online. Websites such as psychologytoday.com have directories that allow you to search for professionals near you based on the condition you want to treat, your health insurance plan, age group, and other factors.
How Long It Takes for CBT to Work
One of the most exciting things about cognitive behavioral therapy is perhaps that, often, people see results quickly. For ADHD, the length of studies looking at the efficacy of cognitive behavioral therapy varies.
However, it's widely known that CBT can be efficacious as a short-term treatment; even just 12 sessions can help. That said, it is common to work with a therapist for cognitive behavioral therapy for longer than that. This way, a person can get all that they can out of the experience and learn a wider variety of new skills that can help them in their life. You can attend therapy for as long as you need to.
CBT is a proven natural remedy for ADHD but it can be expensive.
CBT vs. Other Treatment Options
What are some other treatment options for ADHD, and how do they compare to CBT? Here are some forms of support and therapy that may be advantageous:
- Medication. Medications such as central nervous system (CNS) stimulants are highly effective in treating ADHD. In fact, 70 to 80% of people with ADHD see symptom reduction when they take central nervous system stimulants. Other non-stimulant ADHD medications may also be used.
- Other forms of therapy. Research shows that other forms of therapy, such as acceptance and commitment therapy, can also be effective for the reduction of ADHD symptoms.
- Accommodations. Many people with ADHD require accommodations alongside treatment.
- Occupational therapy for ADHD: this is another form of therapy to develop and recover meaningful daily activities
- Parent training. Parent training can be helpful and is recommended for parents of kids who live with ADHD.
- Games and behavior tracking apps, like Joon. Studies indicate that some games used for ADHD can increase overall attention by 68% within 90 days.
In short, there are many different forms of support and treatment available for those with ADHD. Although there's not a cure for ADHD, symptom improvement is certainly possible, as research on CBT suggests. Consult with your or your child's doctor before you change any physician-recommended treatment routine.
Takeaway
Cognitive behavioral therapy (CBT) is a common, well-researched, and non-invasive method of treatment for various concerns and conditions. Research shows that this form of therapy is effective for people who live with ADHD and can help people with ADHD meet a number of different goals they might have.
Another benefit of CBT is that it can help with a variety of potential comorbid conditions, such as anxiety, depression, bipolar disorder, and insomnia. Although some adjustments may be made to the therapeutic process based on age, CBT can help people with ADHD in various age groups, including kids, teens, and adults.
This article is for informational purposes and is not a substitute for individual medical or mental health advice. Please consult with your or your child's prescribing doctor before changing, starting, or stopping a medication routine.
About
Dr. Carrie Jackson, PhD
