Nonpharmacologic Strategies

Cognitive Behavioral Therapy for Adults With ADHD

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Whereas behavior modification is appropriate for children with ADHD, cognitive behavioral therapy lends itself well to managing symptoms in adults with ADHD.1 As the name implies, cognitive behavioral therapy joins together cognitive and behavioral therapies as a management approach.2

Cognitive Therapy

Centers on the premise that how a person interprets an event is more important than the actual event. Treatment focuses on thoughts rather than overt behaviors, with the goal of reducing dysfunctional thoughts as a means to improve adjustment.2

Cognitive Behavioral Therapy

Blends these 2 therapeutic approaches based on 3 core beliefs2:

  • Cognitive activity affects behavior.
  • Cognitive activity can be monitored and modified.
  • Cognitive change can result in behavioral change.

Behavioral Therapy

Emphasizes the role of basic learning principles (eg, observational learning) in developing and maintaining behavior, both adaptive and maladaptive. Focuses on the stimuli and conditions that maintain maladaptive behaviors, rather than the thoughts driving these behaviors.1

Evidence for Effectiveness of Cognitive Behavioral Therapy in Adults With ADHD

The literature on cognitive behavioral therapy in ADHD suggests that patients with ADHD who receive this form of psychological treatment, whether delivered in individual or group sessions, may attain symptom improvement.2,3

In a study involving patients with ADHD already receiving ADHD medication treatment, those individuals randomly assigned to also receive cognitive behavioral therapy reported reductions in the core symptoms of ADHD (ie, inattention, hyperactivity, impulsivity) both at the end of treatment and at the end of follow-up 3 months later. The cognitive behavioral therapy program applied in this study included the following 5 components3:

  • Neurocognitive skills: for example, learning strategies to improve attention control, memory, impulse control, and planning
  • Problem solving: for example, developing skilled thinking, problem identification, consequential thinking, managing conflict, and making choices
  • Emotional control: for example, managing feelings of anger and anxiety
  • Social skills: for example, recognizing the thoughts and feelings of others, empathy, negotiation skills, and conflict resolution
  • Critical reasoning: for example, evaluating options and developing effective behavioral skills

References

  1. Murphy K. Psychosocial treatments for ADHD in teens and adults: a practice-friendly review. J Clin Psychol. 2005;61(5):607-619.
  2. Antshel KM, Hargrave TM, Simonescu M, Kaul P, Hendricks K, Faraone SV. Advances in understanding and treating ADHD. BMC Med. 2011;9:72.
  3. Emilsson B, Gudjonsson G, Sigurdsson JF, et al. Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. BMC Psychiatry. 2011;11:1-10.