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You go to therapy in order to talk about your feelings and dig deep down into the past, right?
Not always. When it comes to therapy, plenty of options exist, and treatments can take very different approaches toward improving mental health.
Take cognitive behavioral therapy (CBT), for example. This approach emphasizes the thoughts and patterns of behavior creating difficulties for you in the present, rather than any experiences you had in the past.
If you live with attention deficit hyperactivity disorder (ADHD), you might have more than a little experience with unwanted beliefs and thought patterns that:
- affect concentration or ability to focus
- derail motivation and productivity
- get in the way of things you want to do
CBT can teach specific strategies to address those unhelpful thoughts and beliefs and promote positive changes in behavior.
According to the key concepts behind CBT, distorted thoughts, emotions, and beliefs play a major role in your choices and actions.
Consider the following scenario:
You think, “If I make a mistake, I’ll look really incompetent,” as you prepare to start an important report for work. The amount of work involved overwhelms you, and soon, your worries about completing the assignment incorrectly become a more persistent anxiety.
Before long, these thoughts and emotions can affect how you handle situations:
Anxious about making a mistake, you can’t bring yourself to start the project, so you put it aside. The deadline, of course, looms closer. As a result, you become even more worried about doing a good job with the time you have left.
The outcome of the situation can easily reinforce those unhelpful beliefs:
Waiting too long to get started leaves you with no choice but to rush through the report at the last minute. When you present the assignment, your co-workers point out a few mistakes in your data. Your supervisor later sends a terse e-mail saying they were hoping for a more thorough and accurate report
In time, these patterns usually show up across daily life — at work or school, at home, and in your relationships:
You might begin to focus more heavily on your mistakes and ignore your accomplishments, believing you can’t do anything right. But this self-doubt can make it harder to contemplate even trying.
CBT can help you learn to recognize and adjust these thoughts to more realistic beliefs that don’t get in your way:
Doing your best work is important to you. So you get started on assignments right away when you have plenty of time to do research and check your work. Your first step always involves breaking the work down into smaller tasks that feel easier to handle, so you don’t get overwhelmed.
CBT can also teach:
- relaxation techniques
- problem-solving strategies
- skills to regulate emotions and better understand how others think and feel
Therapy for the ‘here and now’
Cognitive distortions or irrational thought patterns can certainly stem from earlier life experiences, and there’s no denying that exploring the past can have therapeutic value.
Still, you won’t spend much time sharing stories from your childhood or talking about your relationship with your parents or caregivers in CBT.
This approach focuses on helping you shift your response to difficult experiences by addressing distressing thoughts and emotions as they come up in the present.
For many people living with ADHD, medication can help ease symptoms and improve quality of life. But medication can’t help you learn new skills that promote long-term change. That’s where therapy can make the most difference.
The main components of CBT for ADHD include:
- organization and planning
- navigation of distractions
- development of adaptive thinking skills
- reduction of procrastination behaviors
Psychoeducation makes up an important part of the process because understanding specific symptoms can often help you address them more easily. Your therapist will:
- explain more about ADHD
- describe key ways it can affect thoughts, emotions, and behavior
- break down the process of therapy
From there, you’ll share some of the concerns that led you to seek therapy. Maybe you:
- have trouble getting started on tasks or completing them
- tend to forget (or put off) important plans and appointments
- have a hard time managing emotions, especially when stressed or overwhelmed
- notice frequent relationship tension and conflict
Your therapist will then offer guidance with developing a plan to achieve SMART goals related to these challenges. SMART stands for:
In other words, these concrete goals will align with your needs in the present.
At work, you have a hard time focusing whenever you begin data entry tasks at your computer. These tasks are tedious and take a long time, so your thoughts begin to wander almost immediately. Then, you get angry with yourself. “This is so simple,” you say. “Why can’t I just get it done?”
Frustration further limits your ability to concentrate, and you frequently end the day miserable, with little accomplished.
In therapy, you might begin to explore strategies for boosting your motivation to handle tedious but necessary tasks. You can also begin learning mindfulness and acceptance skills that help you acknowledge and navigate uncomfortable emotions getting in the way of daily goals and reinforcing unhelpful behaviors, like avoidance.
Several studies have evaluated the effectiveness of CBT for ADHD:
2016 studyexplored the benefits of CBT for 46 teenagers taking ADHD medication. The results suggested CBT can go a long way toward improving ADHD symptoms that don’t seem to respond to medication.
- In a 2018 study of 88 college students living with ADHD, researchers found that CBT could help reduce ADHD symptoms, improve executive function, and help ease feelings of anxiety and depression. What’s more, these benefits held for at least 5 months after treatment ended.
- A 2018 review considered 14 low to moderate quality studies exploring CBT’s potential benefits as an ADHD treatment. The review authors noted that CBT seemed helpful for reducing hyperactivity, inattention, and impulsivity. They also found that a combination of CBT and medication seemed more helpful for reducing anxiety and depression and improving day-to-day function than medication alone.
In CBT, the therapy process involves specific techniques designed to help create change.
You’ll learn these strategies in the therapy room, but you won’t leave them there — one main goal of CBT involves learning to reach for these strategies as challenges come up.
Techniques often used to address ADHD symptoms include the following.
Planning and scheduling activities
Your therapist can help you explore useful methods to:
- consistently plan activities and responsibilities
- organize your daily schedule
- manage time productively
They’ll also teach specific strategies to put those skills into practice and keep using them.
You probably already know planners can help you keep track of appointments and bills. Every time you try to keep one, though, you lose it, forget to write in it, or get frustrated with the amount of time it takes to write everything down.
So, your therapist may encourage you to try a phone app that allows you to set weekly or monthly reminders all at once, cutting back the time you spend planning.
This technique helps you explore patterns of negative thoughts that create challenges at work or in your relationships.
Maybe you tend to:
- Catastrophize: “I messed up twice last week at work. They’re definitely going to fire me.”
- Overgeneralize: “I lost that application paperwork. I can’t be trusted with anything.”
- Mind read: “I know I get carried away and jump into conversations or interrupt people. Everyone must think I’m so annoying.”
Your therapist can help you recognize these patterns and then reframe them into more constructive and realistic thoughts.
“I never do anything right,” for example, might become, “Sometimes I make impulsive choices that don’t play out well. Taking time to think things through can help me make better decisions.”
This technique often accompanies cognitive restructuring. Your therapist will ask questions about your beliefs, assumptions, and self-perceptions to get a better idea of how you approach situations.
When they notice negative self-beliefs, they might help you consider alternate perspectives by asking you about the facts or evidence for and against that belief.
- You say: “I can’t get anything done.”
- They might respond with: “OK, you told me about one day when you didn’t do much of what you planned. Now tell me about a day when things went well for you.”
Describing that day can help you realize you can, in fact, get things accomplished.
It’s pretty common to chastise yourself when you fail to accomplish your goals, but talking down to yourself often fuels feelings of anxiety, depression, and self-hatred.
As part of CBT, you’ll learn how to replace negative self-talk with more positive messages of self-compassion and encouragement.
Positive self-talk can help you feel more motivated to stick to your goals and complete tasks, but it can also reduce negative emotions that come up when you face challenges.
If you tend to get overwhelmed by the sheer magnitude of tasks, this technique can teach you how to divide them into smaller, more manageable pieces.
You can also learn to set time limits to reduce distraction and frustration. For example, you might note in your planner that you’ll work for an hour, then take a 15-minute break.
You have 3 weeks to move out of your apartment. You try to break the work down by rooms, but you don’t find “packing up the living room” or “cleaning the kitchen” any more manageable.
Instead, you create a to-do list of several distinct steps.
- box up books
- box up DVDs
- clean and dust shelves
- remove art from walls
- wrap art in sheets
- wash walls
- wash windows
When you live with ADHD, distractions can often complicate the process of getting things done. While working on a task you don’t enjoy, you might think of several more appealing activities you could do instead.
Escaping from higher priority or urgent tasks by doing less important ones can create an illusion of productivity. After all, you’re doing some work. But it’s still a form of procrastination.
The distractibility delay technique teaches you to jot down any distractions you think of so you can set them aside until you complete the task at hand.
Your therapist might also offer guidance on:
- creating a distraction-free workspace
- using an alarm or other reminder to check in with yourself and make sure you’re staying on task
- scheduling and taking regular breaks
- adjusting perfectionistic beliefs
Once you learn these skills, your therapist may assign some homework to help you practice them throughout the week until they feel more natural. At your next session, they’ll ask whether you noticed any changes in your emotions, thoughts, or behavior.
It can take some time to find the right therapist, but you can get started by narrowing down the type of therapy you’d like to try:
- in-person therapy
- teletherapy with a local therapist
- internet-based CBT programs
Prefer face-to-face counseling? You can search for a therapist who specializes in CBT for ADHD using internet search engines or therapist directories, like the American Psychological Association’s psychologist locator.
As a general rule, you’ll get more out of therapy when you have a good relationship with your therapist. It’s always worth taking the time to find someone you can open up to comfortably.
The first (or second) therapist you try may not work out, but that’s OK. They understand the importance of finding the right therapist.
Online therapy can be a good option, too. Internet-based CBT programs provide the option to practice CBT techniques on your own, though many programs also connect you with a guiding therapist or coach.
Online-Therapy is a self-directed CBT program that offers 8 lessons plus worksheets. It also includes unlimited messaging with your therapist and 30 minutes of live therapy per week over video, voice, or text.
CBT for ADHD aims to help you address and revise cognitive distortions and habits affecting your productivity and emotional mindset.
This approach doesn’t just help improve your motivation and focus, either. It can also lead to improved emotional and mental well-being overall.
Crystal Raypole writes for Healthline and Psych Central. Her fields of interest include Japanese translation, cooking, natural sciences, sex positivity, and mental health, along with books, books, and more books. In particular, she’s committed to helping decrease stigma around mental health issues. She lives in Washington with her son and a lovably recalcitrant cat.