Updated: Oct 27
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects over 366 million people worldwide. Some of the most common symptoms of ADHD are persistent patterns of inattention, hyperactivity, and impulsive behaviour that can significantly impact a person’s daily life. But while it’s true that living with ADHD can result in significant challenges, there are treatment options that can help people improve their quality of life and functioning.
Among those options is a treatment approach known as cognitive behavioural therapy (CBT). Through CBT, people with ADHD have the potential ability to see improvements they never thought were possible. If you or someone you know has been diagnosed with ADHD, this blog is for you. Keep reading to learn more about cognitive behavioural therapy for ADHD and its many benefits.
What Is CBT?
There are a lot of people who recognize that our thoughts and our relationship to our thoughts can have a significant impact on our life. Unfortunately, however, this knowledge alone doesn’t necessarily translate into an understanding regarding how we can work with our thoughts more effectively. This is where CBT comes into play. Cognitive behaviour therapy helps people identify and modify negative thought patterns, emotions, and behaviours. It is based on the premise that our thoughts influence our feelings and actions. By targeting and changing negative thinking patterns, CBT can help reduce emotional distress and improve overall well-being. CBT can also help people learn specific behaviours and skills that can be useful for managing specific life problems as well as challenges unique to ADHD.
How CBT Works
The process of cognitive restructuring is one of the main traditional focuses of CBT. It involves identifying negative or distorted thoughts, known as cognitive distortions, and replacing them with more rational and realistic ones. By challenging irrational beliefs or assumptions, you can develop healthier and more functional perspectives.
CBT also emphasizes taking action to change unhelpful behaviours that contribute to emotional difficulties. This may involve gradually exposing yourself to situations that scare or intimidate you (exposure therapy) or practicing alternative actions and coping strategies. Behaviour activation is also frequently used for treating depression as it involves learning how to act in a way that is opposite from how we feel like doing things when depressed. For example, with depression – which often accompanies ADHD – many people find that they start to turn inward, withdraw, or isolate themselves. This in turn tends to worsen experiences of depression setting off a vicious cycle. In situations like these, behavior activation can help us learn how to reengage with people or activities even when depression is telling us not to, since this is ultimately something that can helps us break depressive cycles.
CBT equips individuals with practical skills to manage their emotions effectively. These skills may include relaxation techniques, problem-solving strategies, assertiveness training, and stress management techniques. In the case of ADHD, CBT involves skills training in ADHD-specific skills and strategies for working with the core challenges that ADHD brings to a person’s life.
CBT often includes between-session exercises or activities called homework assignments. These tasks help individuals practice new skills learned in therapy sessions in real-life situations, reinforcing the therapeutic progress. Although the word homework often brings up negative associations, especially for people with ADHD, CBT for ADHD approaches include unique ADHD-specific strategies to help make home practice easier and help with engaging in the things that are important to us in general.
How People With ADHD Can Benefit From CBT
A Complement or Alternative to Medication for ADHD
Medication is considered a front-line treatment in the treatment of ADHD. This is for good reason! Research consistently supports the effectiveness of medication for people with ADHD. While medication is effective for many people and provides significant help for many of the core ADHD symptoms, it is often not enough. Even with medication, it is usually necessary for people to learn specific skills that they can use to manage ADHD symptoms and experiences. Medication is not a cure-all. One way to think about it is that medication can make it a lot easier to use helpful skills, but you still need to learn the skills that help with ADHD. This is where CBT for ADHD comes in. CBT for ADHD teaches people with ADHD the core, specific, ADHD-related skills that are helpful for managing every aspect of the disorder. There have been a number of CBT for ADHD protocols and approaches that have been developed over the years, each of which is research-based and draws upon a deep knowledge and understanding of what ADHD is, how it affects people with the disorder, and what skills and strategies can be used to help people with the life challenges and executive function difficulties ADHD is associated with. CBT for ADHD fills in the gaps that medication for ADHD simply cannot address. In addition, CBT for ADHD can also be considered an alternative to medication. Although medication in combination with CBT for ADHD is highly recommended sometimes people are unable to take medication for one reason or another, including medical or other reasons. Sometimes, people do not want to take medication and are not open to psychopharmacological treatment for ADHD. Fortunately, CBT for ADHD has been found to be effective even when the treatment approach is provided to people not taking medication. Therefore, CBT for ADHD is not only a very useful complement to medication, it can even be used as an alternative to medication for ADHD. CBT is one of the few psychological approaches for ADHD that has been supported by research and is a powerful technology for addressing many ADHD related challenges.
S.M.A.R.T. Goals and Task Completion with CBT for ADHD
Setting and achieving goals can be difficult for people with ADHD because it requires a lot of focus and follow-through. Luckily, CBT can help with this by teaching people the skills they need to create S.MA.R.T. goals for themselves. “S.M.A.R.T. Goals” stands for goals that are specific, measurable, attainable, realistic, and time-specific.
Through CBT, people with ADHD can learn how to set (and achieve) S.M.A.R.T. goals. Once you start checking goals off your list, you may find that you naturally start to experience more positive thoughts and are able to build improved self-esteem and functioning.
Although the S.M.A.R.T. goals acronym can be a helpful framework for thinking about the process of goal-setting, CBT for ADHD approaches generally contain much more detailed and specific strategies and tools to help people with ADHD move towards their goals. After all, challenging with setting and moving towards goals is one of the fundamental challenges accompanying adult ADHD. These strategies can include learning how to break things down into smaller units, helping you ensure that your goals are connected to your values and what’s important to you, and discussing behavioural principles that facilitate task engagement and completion. For example, this could include a discussion of how to implement Premack’s Principle which helps us recognize that it’s helpful to do things that are less likely to happen (i.e. washing the dishes) before things that are more likely to happen (i.e. playing video games!).
Time Management and Organization
Time management and staying organized are two major things that many people with ADHD have a difficult time with. CBT helps individuals with ADHD develop effective strategies for managing time, setting priorities, and organizing tasks. It focuses on breaking down complex tasks into smaller, more manageable steps, creating routines, and using tools like planners or digital calendars to stay organized. Most people with ADHD have tried some form of these steps before. However, typically this is done in a way that is not at all ADHD-friendly. For example, many people with ADHD have tried to use a planner/calendar or organizational method before. Yet the default ways that neurotypical people (people without ADHD) use these tools generally do not work well for people with ADHD. CBT for ADHD includes many well known time management and productivity tools and adapts them to make them more likely to work for someone with an ADHD brain. In addition, even for people who have tried some version of these ideas before, trying them out in a comprehensive, guided process such as CBT for ADHD is simply more likely to be achievable and sustainable. Having the support of a CBT for ADHD therapist enhances structure and accountability, and allows for problems that come up to be addressed strategically, in an ADHD-informed way.
Self-Monitoring and Awareness
Many people with ADHD find themselves lacking self-awareness and struggling to regulate their emotions. This can cause problems for people in their personal and professional lives. However, this is another area where CBT may be a useful tool.
CBT encourages individuals with ADHD to become more aware of their thoughts, emotions, and behaviours. By recognizing patterns and triggers that contribute to disorganized or impulsive behaviour, individuals can learn to anticipate challenges in advance and develop coping strategies.
Executive Functioning Skills
Executive function refers to the skills that allow people to do things like meet goals, have self-control, plan for things, and follow directions. For many people with ADHD, some (or all) of these things may feel impossible to do on a consistent basis.
Through CBT, people can learn techniques like breaking down complex tasks into smaller steps, creating schedules or task lists, and using visual aids or reminders to enhance planning and organization abilities.
Another important aspect that CBT focuses on is time management. People with ADHD often struggle with managing time effectively. CBT helps them develop strategies like setting realistic goals, prioritizing tasks, using timers or alarms to track time, and establishing routines that optimize productivity.
If your ADHD has resulted in you developing behaviours that have had a negative impact on your life, CBT could be a good option for you. CBT helps people adopt healthier habits by targeting problematic behaviours related to ADHD symptoms, such as impulsivity or inattention. This involves identifying specific behaviours that would benefit from intervention and implementing positive reinforcement techniques to encourage desired actions.
Stress Reduction Technique
If you have ADHD, you probably experience higher stress levels than most people due to difficulties in managing time or completing tasks. Not only can stress take a toll on your mental health, but several studies have shown that stress can also have a negative impact on physical health. CBT teaches relaxation techniques such as deep breathing exercises or mindfulness practices that can help reduce stress levels and improve focus. Importantly these tools, like anything else can be adapted to be provided in an ADHD friendly way.
Social Skills Training
Whether you’re an introvert or an extrovert, having strong social skills is valuable for navigating the social interactions that are a simple part of life. For many people with ADHD, however, social interactions can feel overwhelming — especially those they’re unfamiliar with.
CBT treatment is a great option for people with ADHD because it can address challenges related to social skills by providing strategies for effective communication, empathy, and understanding others' perspectives.
Addressing Accompanying Depression, Anxiety, and More
It’s well known that people with ADHD are likely to have at least one other diagnosis besides for ADHD, often including depression and/or anxiety. CBT has long been a well-established approach for treating depression and anxiety. Therefore, CBT for ADHD can be easily adapted to include CBT strategies for dealing with depression, anxiety, and other common mental health challenges that come with ADHD. This flexibility is a significant strength of the CBT for ADHD treatment approach.
Book an Appointment With a CBT Therapist
CBT may not be one of the most talked about treatments for ADHD, but many believe it’s one of the best. If you’re interested in CBT interventions for ADHD in the Toronto area, our team is here to help. At Shlomo Radcliffe & Associates, we specialize in CBT for ADHD and other evidence-based psychological treatments approaches for ADHD. Contact us today to learn more about our services.