Dialectical Behavior Therapy (DBT) is acognitive-behavioraltreatment that emphasizes building skills inmindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Through structured individual and group sessions, DBT helps individuals identify and change problematic thoughts and behaviors.
For ADHD, DBT skills like mindfulness and organization can target inattention andimpulsivity, whileemotional regulationstrategies address mood lability and stress management.
By teaching practical coping tools and promoting self-awareness,DBT can help adults with ADHDbetter manage their symptoms and improve overall functioning and quality of life.
Key Points
Rationale
Previous research has indicated potential benefits of structured skills training groups for core ADHD symptoms in adults, but evidence remains inconclusive (Bramham et al., 2009; Philipsen et al., 2007).
Adults with ADHD often experience difficulties beyond core symptoms, such asproblems with executive functioning, emotional regulation, and quality of life (Newark & Stieglitz, 2010).
Dialectical behavior therapy (DBT) targets emotional regulation and executive functioning, which are important mediators of differences in adult ADHD (Halleland et al., 2019; Skirrow & Asherson, 2013), making DBT a promising approach.
A pilot study found DBT-based group treatment improved self-reported executive functioning in college students with ADHD (Fleming et al., 2015). However, the effects of DBT-based treatment on executive functioning and emotional regulation have not been thoroughly examined in larger clinical trials of adults with ADHD.
Examining these broader measures of functioning is important for capturing clinically relevant treatment effects.
This multicenter randomized controlled study aimed to evaluate the efficacy of a manualized DBT-based group treatment compared to treatment as usual on self-reported executive functioning, emotional regulation, core ADHD symptoms, mood symptoms, and quality of life in a naturalistic clinical sample of adults with ADHD.
Method
Procedure
Sample
Measures
Statistical Analysis
Results
Insight
This study demonstrates that a structured, intensive DBT-based group treatment can lead to meaningful improvements in executive functioning, ADHD symptoms, depressive symptoms, and quality of life compared to treatment as usual for adults with ADHD.
Interestingly, while emotional regulation did not differ between groups immediately post-treatment, improvements in this domain emerged at 6-month follow-up, suggesting potential delayed or continuing effects of the DBT skills training.
The large effect on core ADHD symptoms is particularly notable given that most participants were already on stable medication treatment. This supports DBT group treatment as an effective adjunctive intervention for medicated patients with residual symptoms.
The naturalistic, multicenter design with few exclusion criteria suggests good generalizability of the findings to real-world clinical practice. Sustained effects at 6-month follow-up indicate the DBT skills may be incorporated into patients’ longer-term coping.
However, the lack of effect on anxiety symptoms suggests DBT in this format may not sufficiently address co-occurring anxiety. Longer-term follow-up would help determine if the delayed improvements in emotional regulation continue to develop.
Overall, this study provides strong evidence for DBT-based group treatment as a feasible and efficacious treatment option for adults with ADHD, addressing not only core symptoms but also the critical domains of executive and emotional functioning.
With its emphasis on skills acquisition and rehearsal, DBT appears well-suited to the learning needs of ADHD. Examining mediators and moderators of treatment response could help further refine and target the intervention.
Strengths
The study had many methodological strengths, enhancing the reliability and generalizability of the findings:
Limitations
While the study had notable strengths, some limitations should be considered when interpreting the results:
These limitations suggest caution in broadly generalizing the results and point to avenues for further research to replicate and extend the findings.
Implications
The results support DBT-based group treatment as an effective adjunctive intervention for adults with ADHD, particularly for those with residual symptoms after medication treatment.
The group format offers a cost-effective way to deliver skills training and support to multiple patients. However, additional treatment may be necessary for co-occurring anxiety.
To implement DBT group treatment in real-world settings, clinician training and structural supports will be needed. Future research should explore patient and provider experiences, predictors of treatment response, and cost-effectiveness to guide implementation and optimization efforts.
Overall, this study highlights the potential of DBT as a skills-based approach to help adults better cope with ADHD symptoms and improve functioning.
With its focus on building mindfulness, emotional regulation, and interpersonal effectiveness, DBT may be uniquely suited to address the multifaceted challenges of adult ADHD.
References
Primary reference
Halmøy, A., Ring, A. E., Gjestad, R., Møller, M., Ubostad, B., Lien, T., Munkhaugen, E. K., & Fredriksen, M. (2022). Dialectical behavioral therapy-based group treatment versus treatment as usual for adults with attention-deficit hyperactivity disorder: a multicenter randomized controlled trial.Bmc Psychiatry,22(1), 738.https://doi.org/10.1186/s12888-022-04356-6
Other references
Bramham, J., Young, S., Bickerdike, A., Spain, D., McCartan, D., & Xenitidis, K. (2009). Evaluation of group cognitive behavioral therapy for adults with ADHD.Journal of Attention Disorders, 12(5), 434-441.https://doi.org/10.1177/1087054708314596
Fleming, A. P., McMahon, R. J., Moran, L. R., Peterson, A. P., & Dreessen, A. (2015). Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students.Journal of Attention Disorders, 19(3), 260-271.https://doi.org/10.1177/1087054714535951
Halleland, H. B., Sørensen, L., Posserud, M. B., Haavik, J., & Lundervold, A. J. (2019). Occupational status is compromised in adults with ADHD and psychometrically defined executive function deficits.Journal of Attention Disorders, 23(1), 76-86.https://doi.org/10.1177/1087054714564622
Newark, P. E., & Stieglitz, R. D. (2010). Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective.ADHD Attention Deficit and Hyperactivity Disorders, 2(2), 59-72.https://doi.org/10.1007/s12402-010-0023-1
Philipsen, A., Richter, H., Peters, J., Alm, B., Sobanski, E., Colla, M., Münzebrock, M., Scheel, C., Jacob, C., Perlov, E., Tebartz van Elst, L., & Hesslinger, B. (2007). Structured group psychotherapy in adults with attention deficit hyperactivity disorder.The Journal of Nervous and Mental Disease, 195(12), 1013-1019.
Skirrow, C., & Asherson, P. (2013). Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder.Journal of Affective Disorders, 147(1-3), 80-86.https://doi.org/10.1016/j.jad.2012.10.011
Keep Learning
Here are some reflective questions related to this study that could prompt further discussion:
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.
