Mindfulness-based cognitive therapy (MBCT) is an approach to psychotherapy integrating cognitive behavioral therapy withmindfulnessmeditation practices. Rather than an standardized program, MBCT uses evidence-based psychological strategies to cultivate moment-to-moment nonjudgmental awareness.
Key Points
Rationale
Previous research demonstrated the potential for mindfulness-based interventions (MBIs) to improve attention regulation and executive functioning (Chiesa et al., 2011; Malinowski, 2013; Tang et al., 2015), suggestingmindfulness may benefit adults with ADHD.
A few MBIs adapted for adult ADHD showed preliminary efficacy in reducing core symptoms and improving functioning (Cairncross & Miller, 2016; Hepark et al., 2015; Mitchell et al., 2015). However, further rigorous research was needed to establish feasibility and effectiveness.
Moreover, little was known about ADHD patients’ perspectives on barriers and facilitators to engaging in MBCT. Qualitative research could provide richer insight into their experiences to inform further protocol refinements.
This pilot study aimed to explore feasibility, potential effectiveness in alleviating symptoms, processes of change, and perceived barriers and facilitators of an adapted MBCT program for adult ADHD.
The long-term goal was to develop an evidence-based psychosocial treatment for ADHD, given issues around medication non-response and interest in non-pharmacological options.
Method
This mixed-methods pilot study combined self-reportquestionnaireson ADHD symptoms and functioning with qualitative semi-structured interviews on barriers, facilitators, and process of change.
Sample
Fourteen patients had the inattentive subtype, 14 the combined subtype, 1 the hyperactive/impulsive subtype, and 2 were undifferentiated.
Statistical Analysis
Quantitativepre-post treatment changes were analyzed using paired-samples t-tests and Cohen’s d effect sizes.
Results
Sixteen percent dropped out during the MBCT program. Completers showed significant pre-post improvements in ADHD symptoms, with a 26% clinically significant response rate.
Total executive functioning also improved significantly, mainly in domains of self-monitoring, working memory, planning, task monitoring, and organization.
Further benefits were found in self-compassion and mental health, but not physical health. Mindfulness skills did not significantly change, except for a trend toward increased acting with awareness.
Qualitative analysis revealed facilitators like partner support, clear teacher communication, shared experiences with fellow ADHD participants, reflection exercises, and movement practices.
Barriers included life stressors, switching medication, lack of training repetition, lengthy meditations, self-criticism, procrastination, and ADHD symptoms interfering with participation and home practice.
Most patients described a process of change moving through stages like stopping current activities to focus inward, noticing thoughts/emotions, allowing and accepting experiences, gaining self-insight, shifting self-perspective, improving self-regulation skills, consciously changing behaviors, and enhancing wellbeing and self-compassion.
Insight
This mixed-methods pilot provides preliminary evidence that MBCT may be a feasible and effective psychosocialtreatment option for adults with ADHD. The modest dropout rate suggests most could tolerate the training despite ongoing symptoms interfering at times.
Quantitative gains in reducing core ADHD symptoms and improving executive functioning align with benefits seen in previous initial studies of mindfulness for ADHD.
The qualitative interviews deliver valuable insights into patient experiences. They highlight the importance of adaptations like added movement, clear teacher communication, and bonding with fellow participants also facing attention challenges.
At the same time, too extensive changes may reduce effectiveness since patients largely endorsed standard components like reflection, sitting meditation, and the daylong retreat. Dropout predictors like more baseline dysfunction could inform exclusion criteria.
Patient accounts of the change process demonstrate how mindfulness training may impart self-regulation skills needed to moderate ADHD impairments. By repeatedly bringing attention to present experiences, participants cultivated awareness and acceptance of thoughts and emotions rather than over-identifying or avoiding them.
This meta-cognitive shift opened room to pause before responding, enhancing reflection and impulse control. Some translated emerging attentional stability into improved working memory, planning, and task monitoring in daily life.
Many described replacing habitual behaviors with conscious choices more aligned with intentions. Over time, reduced reactivity and self-judgment led to improved well-being.
Strengths
This study has several key strengths:
Limitations
However, certain limitations should be considered:
Implications
The collective results clearly demonstrate the need for continued optimization and testing of MBCT as an innovative psychosocial option for adults struggling to manage ADHD challenges.
Quantitatively corroborating patient-reported alleviations in core symptoms and executive dysfunction signals preliminary clinical efficacy.
Integrating qualitative change models with established theories on cognitive deficits and emotion dysregulation in ADHD could fruitfully advance mechanistic models.
Replication in methodologically rigorous RCTs is imperative, as is determining cost-effectiveness relative to heavily relied-upon pharmacotherapy.
If outcomes withstand further scrutiny, MBCT could significantly expand non-medication choices for those not responding optimally to stimulants or wishing to augment with skill-building approaches.
Once protocols are refined for optimal feasibility and effectiveness, MBCT could be integrated into multidimensional care models in an individual or group format. The group modality provides opportunities to normalize struggles, reduce stigma, and build supportive networks.
Evaluating predictors and moderators of response would facilitate treatment matching and personalization. Digital delivery could enhance accessibility for adults unable to attend intensive in-person trainings.
For relevant populations, combined treatment could potentiate outcomes superior to either standalone option.
Overall, MBCT shows promise for empowering adults to proactively develop capacities for navigating lifelong ADHD symptom management.
References
Primary reference
Janssen, L., de Vries, A. M., Hepark, S., & Speckens, A. E. M. (2020). The feasibility, effectiveness, and process of change of mindfulness-based cognitive therapy for adults with ADHD: A mixed-method pilot study.Journal of Attention Disorders, 24(6), 928–942.https://doi.org/10.1177/1087054717727350
Other references
Cairncross M., Miller C. (2016). The effectiveness of mindfulness-based therapies for ADHD: A meta-analytic review.Journal of Attention Disorders, 1-17.https://doi.org/10.1177/1087054715625301
Chiesa A., Calati R., Serretti A. (2011). Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings.Clinical Psychology Review, 31, 449-464.https://doi.org/10.1016/j.cpr.2010.11.003
Hepark S., Janssen L., de Vries A., Schoenberg P. L., Donders R., Kan C. C., Speckens A. E. (2015). The efficacy of adapted MBCT on core symptoms and executive functioning in adults with ADHD: A preliminary randomized controlled trial.Journal of Attention Disorders, 1-12.https://doi.org/10.1177/1087054715613587
Malinowski P. (2013). Neural mechanisms of attentional control in mindfulness meditation.Frontiers in Neuroscience, 7, Article 8.https://doi.org/10.3389/fnins.2013.00008
Mitchell J. T., Zylowska L., Kollins S. H. (2015). Mindfulness meditation training for attention-deficit/hyperactivity disorder in adulthood: Current empirical support, treatment overview, and future directions.Cognitive and Behavioral Practice, 22, 172-191.http://dx.doi.org/10.1016/j.cbpra.2014.10.002
Tang Y.-Y., Holzel B. K., Posner M. I. (2015). The neuroscience of mindfulness meditation.Nature Reviews Neuroscience, 16, 213-225.https://doi.org/10.1038/nrn3916
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
