Cognitive behavioral therapy (CBT) is a form ofpsychotherapythat focuses on identifying and adapting negative thought patterns and maladaptive behaviors.
Individuals can then develop new thinking styles and coping strategies, such as problem-solving techniques and stress management tools, to manage situations triggering distress. By changing thought and behavior habits, CBT could help improve individuals with ADHD’s capacity for emotional control.
Key Points
Rationale
ADHD persists into adulthood for many individuals, with around a 6.76% prevalence of symptomatic cases (Song et al., 2021).
Adults with ADHD struggle withunemployment,physical health issues, low quality of life, high treatment costs, and comorbidmoodandanxiety disorders(Katzman et al., 2017).
Though medications like stimulants can reduce core ADHD symptoms short-term, 30% of individuals see limited benefits or cannot tolerate side effects (Schein et al., 2022).
Moreover, discontinuing medication leads to the recurrence of symptoms over time (Rosenau et al., 2021). Nonpharmacological interventions are thus needed to improve long-term outcomes.
As CBT helps regulate emotions anddevelop coping strategies, it may ameliorate ADHD and frequently co-occurring internalizing disorders (López-Pinar et al., 2020).
However, past systematic reviews reached conflicting conclusions about CBT’s efficacy for adults with ADHD (Caye et al., 2019). Recent randomized controlled trials (RCTs) can clarify CBT’s usefulness.
Method
A meta-analysis was used in this research. Searches identifiedrandomized controlled trials (RCTs)examining CBT forADHD treatmentin adults.
Outcomes included core symptoms (inattention, hyperactivity, impulsivity) and internalizing symptoms (anxiety, depression), measured through self-reports or clinician evaluations. Effect sizes were calculated to summarize CBT’s impact across studies.
Sample
Inclusion criteria restricted the analysis to RCTs with adults aged 18+ years diagnosed with ADHD who received CBT. Twenty-eight studies met the requirements.
Statistical Measures
Standardized mean differences quantified changes in symptom severity. Meta-regression analysis determined whether clinical variables moderated treatment effects. Publication bias was evaluated through funnel plots and Egger’s tests.
Results
The meta-analysis indicates CBT significantly reduces both core and emotional ADHD symptoms in adults, including depression and anxiety.
Improvements in self-esteem and quality of life were also observed. Both individual and group CBT outperformed active controls, treatment as usual, and waitlist groups.
Though traditional CBT and other approaches likemindfulness-based cognitive therapy (MBCT)ordialectical behavior therapy (DBT)performed similarly for core symptoms, traditional CBT better reduced internalizing symptoms.
Insight
By collating evidence across 28 studies, this meta-analysis firmly establishes CBT as an effective intervention for adults with ADHD.
Critically, benefits extend beyond core symptom alleviation to include emotional symptom improvements too. This highlights CBT’s potential to address comorbid mood and anxiety disorders prevalent among the ADHD population.
The delivery method also appears flexible – individual or group settings confer benefits over standard treatment.
Strengths
This study has several major strengths:
Limitations
However, some limitations temper the conclusions:
Implications
Nonetheless, these findings carry valuable real-world implications. The data support CBT’s use to not only lessen core ADHD deficits but also ameliorate accompanying emotional difficulties.
This could improve individuals’ quality of life and productivity. CBT may enable these individuals to develop helpful lifelong strategies.
For those struggling with treatment adherence or medication side effects, CBT offers an alternative or adjunct.
The similar efficacy yet safety advantage of CBT over stimulants is noteworthy, too. Clinicians should consider referring appropriate ADHD individuals for CBT.
References
Primary reference
Liu, C. I., Hua, M. H., Lu, M. L., & Goh, K. K. (2023). Effectiveness of cognitive behavioural‐based interventions for adults with attention‐deficit/hyperactivity disorder extends beyond core symptoms: A meta‐analysis of randomized controlled trials.Psychology and Psychotherapy: Theory, Research and Practice.https://doi.org/10.1111/papt.12455
Other references
Adamis, D., Flynn, C., Wrigley, M., Gavin, B., & McNicholas, F. (2022). ADHD in adults: A systematic review and meta-analysis of prevalence studies in outpatient psychiatric clinics.Journal of Attention Disorders, 26(12), 1523–1534.https://doi.org/10.1177/10870547221085503
Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for ADHD: An evidence-based guide to select optimal treatment.Molecular Psychiatry, 24(3), 390–408.https://doi.org/10.1038/s41380-018-0116-3
Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: Clinical implications of a dimensional approach.BMC Psychiatry, 17(1), 302.https://doi.org/10.1186/s12888-017-1463-3
López-Pinar, C., Martínez-Sanchís, S., Carbonell-Vayá, E., Sánchez-Meca, J., & Fenollar-Cortés, J. (2020). Efficacy of nonpharmacological treatments on comorbid internalizing symptoms of adults with attention-deficit/hyperactivity disorder: A meta-analytic review.Journal of Attention Disorders, 24(3), 456–478.https://doi.org/10.1177/1087054719855685
Rosenau, P. T., Openneer, T. J. C., Matthijssen, A. M., van de Loo-Neus, G. H. H., Buitelaar, J. K., van den Hoofdakker, B. J., Hoekstra, P. J., & Dietrich, A. (2021). Effects of methylphenidate on executive functioning in children and adolescents with ADHD after long-term use: A randomized, placebo-controlled discontinuation study.Journal of Child Psychology and Psychiatry, 62, 1444–1452.https://doi.org/10.1111/jcpp.13419
Schein, J., Childress, A., Cloutier, M., Desai, U., Chin, A., Simes, M., Guerin, A., & Adams, J. (2022). Reasons for treatment changes in adults with attention-deficit/hyperactivity disorder: A chart review study.BMC Psychiatry, 22(1), 377.https://doi.org/10.1186/s12888-022-04016-9
Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis.Journal of Global Health, 11, 04009.https://doi.org/10.7189/jogh.11.04009
Keep Learning
Here are potential Socratic seminar questions about this research to stimulate deeper discussion in a college class:
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.
