CBT aims to modify thought patterns and behaviors, potentially aiding in areas such as organization, time management, and emotional regulation.
Studying the effectiveness ofCBT for ADHDis crucial because it can inform best practices in mental health care, ensure that treatments are evidence-based, and potentially improve outcomes for individuals with ADHD.
Understanding how CBT works specifically for ADHD can lead to more tailored and effective interventions, ultimately enhancing the quality of life for those with the condition.
Key Points
Rationale
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition affecting approximately 2.5% of adults (Song et al., 2021).
While pharmacological treatment is considered the first-line approach, the National Institute for Health and Care Excellence (NICE, 2018) recommends Cognitive-Behavioral Therapy (CBT) as the primary psychotherapeutic treatment for adults with ADHD in the UK.
However, the literature often refers to adapted CBT programs tailored for ADHD, providing limited insight into how adults with ADHD experience and perceive this form of treatment in routine clinical practice.
This study aims to explore ADHD individuals’ experience and perception of CBT delivered in routine clinical practice, to gain a better understanding of this treatment’s helpfulness and perceived effectiveness.
The next step in research is to investigate how CBT can be effectively adapted for adults with ADHD in routine clinical settings.
Method
Procedure
The study was conducted over a period of 3 months (June-August) in 2023. Participants completed an online survey, which took an average of 15 minutes and included 28 questions in various formats.
Sample
The study included 46 participants for the survey (71% female) and 10 participants for the interviews (70% female).
All participants were adults with a prior ADHD diagnosis who had received CBT within the UK.
Measures
The study used a custom-designed survey and interview protocol.
Statistical measures
The survey data was analyzed using descriptive statistics and narratives.
The interview data was analyzed using thematic analysis, following Braun and Clarke’s (2006) six-stage process.
Results
The key themes that emerged from the thematic analysis were:
- The complex structure of the CBT framework
Participants reported that the CBT framework often felt rigid, overwhelming, and incompatible with their ADHD symptoms, such as difficulties with working memory, attention, and consistency.
“I think there’s core things about CBT that are just seen on the face of it to me to be incompatible with ADHD.” (P5)
- The intricacy of the therapist relationship and its impact on therapy
Many participants reported that their therapists lacked specific knowledge about ADHD, which led to misunderstandings and ineffective interventions.
This lack of ADHD-specific expertise resulted in participants feeling misunderstood, dismissed, or unable to engage effectively with the therapy process.
“I couldn’t see the link with ADHD and she didn’t see it either. [ … ] She knew nothing [about ADHD], and she told me that straight away.” (P8)
- Consequences of unadapted CBT
Rather than experiencing therapeutic benefits, many participants reported feeling worse after their CBT sessions.
They described increased feelings of failure, lowered self-esteem, heightened frustration with themselves, and a sense of hopelessness about their ability to benefit from therapy.
Some participants even reported that the unadapted CBT exacerbated theiremotional dysregulation, leading to increased distress rather than relief.
“It was just such a waste of time for everyone, and it’s a shame, [ … ] it made me feel worse going there, and that’s not what you hope when you do therapy, you expect to feel better afterwards.” (P8)
The survey results supported these themes, with participants reporting that non-adapted CBT was unhelpful and challenging, often depleting their self-esteem and increasing frustration.
Insight
This study reveals that adults with ADHD often experience significant difficulties with non-adapted CBT in the UK.
The generic CBT framework was frequently perceived as incompatible with ADHD-related challenges, particularly in terms of executive function deficits and emotional dysregulation.
Therapists’ lack of specialized knowledge about ADHD was a major barrier to effective treatment.
This contrasts with studies showing the efficacy of ADHD-adapted CBT programs, emphasizing the critical importance of tailoring therapeutic approaches to the specific needs of individuals with ADHD.
Further research could focus on developing and testing ADHD-specific adaptations to CBT that can be implemented in routine clinical practice.
Additionally, investigating the training needs of therapists to better equip them for working with ADHD clients could be a valuable next step.
Strengths
The study had many methodological strengths including:
Limitations
The study also had several limitations, including:
These limitations imply that while the study provides valuable insights, caution should be exercised in generalizing the results to all adults with ADHD or all CBT programs.
Implications
The results of this study have significant implications for clinical psychology practice and the delivery of mental health services to adults with ADHD. They suggest that:
Variables that may influence these results include the specific type of CBT delivered, the level of ADHD-specific knowledge and training of the therapist, and the severity and presentation of ADHD symptoms in individual clients.
References
Primary references
William, S., Horrocks, M., Richmond, J., Hall, C. L., & French, B. (2024). Experience of CBT in adults with ADHD: a mixed methods study.Frontiers in Psychiatry,15, 1341624.https://doi.org/10.3389/fpsyt.2024.1341624
Other references
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology.Qualitative research in psychology,3(2), 77-101.
Gjervan, B., Torgersen, T., Nordahl, H. M., & Rasmussen, K. (2012). Functional impairment and occupational outcome in adults with ADHD.Journal of attention disorders,16(7), 544-552.https://doi.org/10.1177/1087054711413074
National Institute for Health and Care Excellence (NICE). (2018).Attention deficit hyperactivity disorder: diagnosis and management.Retrieved fromhttps://www.nice.org.uk/guidance/ng87
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.
Keep Learning
Socratic questions for a college class to discuss this paper:
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.
