Although medication is considered the first-line treatment for ADD, many adults with ADD cannot take medication due to severe side effects, or continue to struggle with ADD symptoms. As a result, interest in psycho-social treatment options like CBT has grown.
As the National Alliance for Mental Illness (NAMI) explains, “the core principles of CBT are identifying negative or false beliefs and testing or restructuring them.” Therapists who use CBT techniques work with patients to “uncover unhealthy patterns of thought and how they may cause self-destructive behaviors and beliefs.” The patient and therapist can then work to develop constructive thought patterns that lead to healthier behaviors and beliefs. A strong body of evidence shows that CBT can effectively treat several types of mental health conditions, including depression, anxiety disorders and eating disorders.
CBT for AD/HD
The CBT approach is based on the understanding that repeated, negative life experiences “undermine self concept and self esteem” by the time someone with ADD reaches adulthood, and can lead to negative self-beliefs. These negative self-beliefs may fuel depression and anxiety and contribute to unhelpful coping behaviors such as procrastination and avoidance. Researchers have also reported that “negative expectations about the future, anticipation of failure and reduced self confidence can also affect motivation.”
CBT for adults with ADD aims to change behavior patterns that reinforce ADD’s negative effects. It involves techniques that enable adults with ADD to better control ADD symptoms, and to “improve emotional adjustment, self esteem and common comorbid symptoms such as anxiety and depression.” Most CBT treatment is delivered in an individual or group setting, and includes between 8-12 sessions. Treatment techniques may include:
- Psycho-therapeutic techniques, like education to increase the patient’s understanding of adult ADD
- Cognitive techniques to restructure dysfunctional thoughts and negative beliefs
- Behavioral interventions to provide healthy strategies and skills for poor attention, executive functioning, emotional regulation and impulse control
Several studies have demonstrated cognitive therapy’s effectiveness in treating adult ADD. For example, Mary V. Solanto, PhD, Director of the ADHD Center at New York City’s Mount Sinai School of Medicine, published a study in 2010 that examined the efficacy of meta-cognitive therapy to treat adult ADD compared to supportive psychotherapy. Dr. Solanto and her colleagues found that overall, meta-cognitive therapy benefits adults with ADD in regard to time management, organization, and planning.
A systematic review published in 2016 found that CBT was effective in reducing ADD symptoms among adults when evaluated by the patients, but not when evaluated by a clinician. Self-reported symptoms of depression and anxiety were also significantly reduced when evaluated by a clinician.
CBT + ADD Medication
Dr. J. Russell Ramsay of The Penn ADHD Treatment & Research Program notes that CBT for adults with ADD is an effective treatment when combined with medication. In a study published in 2006 of 43 adults diagnosed with ADD, Ramsay and his colleague Anthony L. Rostain examined the effects of six months of CBT and ADD medication. Post-treatment, study participants who had received both medication treatment and CBT “showed significant reductions in clinician-rated ADD symptoms,” as well as reductions in anxiety and depression symptoms.
CBT, ADD and Co-morbidities
While group and individual CBT can help adults with ADD build their confidence to achieve their goals and manage their day-to-day lives, Solanto notes that some co-existing conditions should be treated first. Patients who experience severe depression, anxiety, active substance abuse, or borderline personality disorder need to be treated before they can fully benefit from an ADD-focused CBT intervention.