Cognitive Behavioural Therapy (CBT)
Cognitive Behavioral Therapy or CBT for short is a commonly used form of therapy for a wide range of mental health conditions. We talked to Dr. J. Russell (“Russ”) Ramsay, co-founder and co-director of the University of Pennsylvania’s Adult ADHD Treatment and Research Program, to learn more about how CBT can help those with ADHD.
Disclaimer: the information contained on this website does not constitute medical advice. If you have concerns about your own health or the health of someone else, you should speak to your doctor.
What is cognitive behavioral therapy and how can it be effective for those with ADHD?
Cognitive Behavioral Therapy (CBT) is a talk therapy. It emphasizes the role of cognitions; how we think and interpret our environment and the influence that behaviors have on our emotions. It was initially developed as a treatment for depression and has been generalized for other things like anxiety.
How has CBT been adapted for ADHD?
For ADHD, it's been adapted to tackle the negative thinking that may come as a result of having ADHD. It helps people better understand exactly how and why they don't do things rather than the logic of ‘I just procrastinated again, I need to work harder at not procrastinating’.
How time intensive is CBT?
The short answer is yes. We're not just talking about the number of sessions. Patients have to use the skills in day-to-day life so there’s always opportunities to work on it. I'll tell people that hopefully our meetings are productive but we want things happening out in the real world between meetings. With colleagues who have done research in this area, we agree that it's not just the number of sessions or the frequency – rather than doing 10 sessions in 10 weeks consecutively, we’d prefer to spread these out over a few months because we want to give patients the time to absorb these skills.
What are the core benefits of doing CBT for ADHD?
This doesn't show up in the official criteria but we now know that it helps with patients’ emotional state; not necessarily the mood or anxiety disorders, but the reactions to the same things anybody reacts to; good news or bad news can be more distracting for those with ADHD. They could have a short sharp temper or get really upset briefly and not know how to manage those feelings. By that point they're already disrupted at work – which is often when ADHD gets picked up in adults. So, I think these feelings are among the targets. Some of the main coping areas again are procrastination, time management, organization and impulse control, the more familiar features of ADHD.
Is CBT just for adults or is it can it be used with children with ADHD?
It's not used as much for children. There is some emerging research on older adolescents and teenagers that CBT can be effective but for children, there is less focus on the cognitive and more focus on the behavioral. At grade school, around the ages of 7-10 there’s more focus on working with teachers and the home environment. We work on the structure teachers and parents can implement. For example, we can create a reward system for the follow through on homework. We can also help by breaking things down with adult supervision. Read our interview with expert pediatrician Nerissa Bauer here. CBT is commonly used for adolescents and adults.
Is it easy to get access to Cognitive Behavioral Therapy (CBT) for ADHD?
In the UK, CBT is the National Health Service’s (NHS) recommended therapy approach. They’re leading the way with this approach supported by academics like Phil Asherson, Jessica Bramham and Susan Young. But CBT is widely available in most countries. The challenge is finding those who specialize in CBT for ADHD. There are a lot of good manuals out there to help clinicians to easily adapt their approach for ADHD. However, finding a real expert can still be a little difficult.
In the US, there are some large institutions and local specialty centers that specialize in CBT for ADHD. As a therapist, we can refer to specialists elsewhere and sometimes people are willing to travel. Frankly speaking, there are regions that don't have any resources in this area.
However, there are also some very good self-help books that people can use:
- Fast Minds by Craig Surmon M.D
- Taking Charge of Adult ADHD by Russell Barkley PhD
- Mastering your Adult ADHD by Steven Safren
- The Adult ADHD Toolkit by Russell Ramsay
- Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook by Ari Tuckman
- Succeeding with Adult ADHD by Abigail Levrini
- Cognitive-Behavioural Therapy for ADHD in Adolescents and Adults: A Psychological Guide to Practice by Susan Young
- ADHD Workbook for Teens: Activities to Help You Gain Motivation and Confidence by Lara Honos-Webb PhD
Is CBT a standalone treatment for ADHD?
It's generally considered that medications are the first form of treatment. Mainly because they can be very helpful for a lot of people. The combination of medication with CBT is effective because the medications give some symptom relief and the behavioral therapy can help support the day-to-day management of ADHD. For some people, using medications alone is like right finding the right eyeglasses. Now that they can see clearly, they're better readers, so they’re happy to stick with the medications.
On the other hand, just because someone can focus better does not mean they will no longer struggle with procrastination.
Could you give us an example of an activity or task that’s involved with CBT for ADHD?
One very common, and very personalized tool is building a daily planner like some sort of calendar system. It could be paper-based, or it could be digital. It could be something else - anything that helps externalize information rather than carrying it around in our head (our working memory). We only have so many ‘shelves’ to put information and if we run out of ‘shelves’ things start falling off.