ADHD + CBT - does therapy work?

I’ve tried several kinds of therapy over the years: the worst was a single session of ‘Gestalt’ therapy that felt like I was being bullied and shamed for an hour (did I go back? did I heck) to one where the therapist repeated every single thing I said back to me. Every time. At the time I went back because I just needed somewhere to talk but oh my, it took a few sessions to learn to fade it out.

The absolute best therapy I had was from two psychologists who managed to blend different types of treatment or therapies together - they created a space where I was listened to, where I could hear what I was saying and then given enough support to change, adapt or move in a different direction. They are rare professionals though.

What is CBT?

CBT is the therapy that is most likely to be offered if you’re in the UK and finally manage to get some support. It means ‘cognitive behavioural therapy’ and the very simplified idea is that our thoughts (cognitions) determine how we act (our behaviours) and the goal is to manage our thoughts so that our behaviours change.

Anyone who lives with ADHD will answer ‘IF ONLY’ - because as usual, it’s not quite that simple.

CBT is a form of psychotherapy that focuses on identifying and challenging negative thought patterns and behaviours. You’re likely to get short, regular sessions to identify what needs to change and experiment with different strategies. In many ways, it's quite like coaching, focused on changing our experience.

The difference from coaching is that often you’re in need of healing - there are deep problems and other things going on, for example depression, anxiety and OCD which coaching is absolutely NOT appropriate for.

Research shows that CBT can be effective for treating a variety of mental health conditions, including anxiety and depression. Some studies also suggest that it can be beneficial for adults with ADHD, particularly when it comes to improving really specific topics like executive functions like time management and emotional regulation but overall, the evidence is not very strong. The improvements are more likely to be noted by the therapists and patients don’t always notice the improvements. Which makes me wonder - is it really helping?

Why CBT might not work

The first thing I’d say is - if you are offered ANY help, try it. Just give it a shot. We all know by now how hard it is to actually get support and if someone offers you a few sessions of CBT do give it a try.

The problem is that ‘manualised’ or treatments-in-a-model aren’t really one-size-fits-all solutions. Obviously I’m not neurotypical so I couldn’t say how others experience it but my most successful experiences of therapy have been when the clinicians were flexible and took account of MY needs, not what was standard.

Several of my clients have tried CBT and felt it just reinforced their feelings of failing. This could be due to a variety of factors, such as the therapist's lack of understanding of ADHD-specific challenges or the rigid structure of CBT sessions, which may not always align with the ADHD brain's need for flexibility. It could be because having one session a week or every two weeks with the expectation you’ll manage to implement the ‘homework’ in between without support is just a ridiculous demand for most people with ADHD.

So give it a try, keep an open mind because you might get an AMAZING clinician who can work with the tools of CBT and adapt it for your needs. You won’t know unless you take that chance.

The answer is…

that CBT can be a useful tool in your ADHD management toolkit, but it's crucial to work with a therapist who understands the unique challenges and strengths of ADHD. You can find out what they know about ADHD before you start work with them and if you hear things that don’t chime with your experience - trust your instincts, ok? Please listen to that inner voice because so many ADHD adults with a late diagnosis have been told to ignore it for so long and it’s usually spot on, when they share what they’ve ignored in our meetings.

You know your child - and you know your own ADHD experience - better than anyone else. You might need to be willing to take a chance and try new things - that’s the premise of all coaching sessions too, that we are ready to change and willing to try a different approach - but that isn’t the same as having someone make you feel ashamed for a legitimate ADHD trait.

Additionally, it may be beneficial to combine CBT with other forms of therapy or coaching that are more tailored to the ADHD experience. These can include Mindfulness, Dialectical Behavioural Therapy (DBT) and potentially Neurofeedback which have the most empirical support so far - but again need to be adapted to YOUR experience and needs.

If you’re interested in a mindfulness based approach, make sure you’ve signed up for the newsletter to learn more about my ADHD Mindfulness support coming soon.

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Katherine

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Further Reading

Lopez PL, Torrente FM, Ciapponi A, Lischinsky AG, Cetkovich-Bakmas M, Rojas JI, Romano M, Manes FF. Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev. 2018 Mar 23;3(3):CD010840. doi: 10.1002/14651858.CD010840.pub2. PMID: 29566425; PMCID: PMC6494390.

Young, Z., Moghaddam, N., & Tickle, A. (2020). The Efficacy of Cognitive Behavioral Therapy for Adults With ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Attention Disorders, 24(6), 875-888. https://doi.org/10.1177/1087054716664413

Champ RE, Adamou M, Tolchard B. The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review. PLoS One. 2021 Dec 21;16(12):e0261247. doi: 10.1371/journal.pone.0261247. PMID: 34932573; PMCID: PMC8691636.