Adult ADHD: Cognitive Behaviorial Therapy Proven Effective

August 26, 2010 Douglas Cootey

A new study out of Massachusetts General Hospital (MGH) shows that Cognitive Behaviorial Therapy (CBT) taken in tandem with ADHD medication is an effective treatment for Adult ADHD compared with relaxation techniques.

ADHD Medication Side-Effects Left Me Disabled

I have said for years on my blog, A Splintered Mind, that pills don't teach skills. Sometimes you can't afford them. Sometimes you run out of them. Sometimes they don't work. Sometimes you don't want them. Whatever the reason, there are times when you must handle adult ADHD on your own without the aid of medications. If you rely only upon psych meds to treat your ADHD, then these times will have you at a disadvantage.

Personally, I can't take medications for ADHD. I suffer from side-effects when on them. In fact, 17 years and 11 months ago, I was permanently disabled because of the ADHD medication side-effects and developed chronic motor tic disorder. All encounters with psych meds after that incident exacerbated the tic symptoms, so I had to stay away from them. Instead, I looked into CBT. It was a life saver for me, providing me with coping mechanisms to handle my ADHD distractions and impulses.

Effectiveness of CBT and ADHD Medications in Treatment of Adult ADHD

Until now, research on CBT has been slim, but a major study appearing in the August 2010 report of the Journal of the American Medical Association has shown that people who utilized CBT along with ADHD medications saw significant reductions in the ADHD symptoms up to nine months after their CBT training—especially the symptoms that the psychmeds couldn't alleviate.

"Medications are very effective in 'turning down the volume' on ADHD symptoms, but they do not teach people skills," stated Steven Safren, director of Behavioral Medicine in the MGH Department of Psychiatry. "This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder."

According to Dr. Safren, who led the study, "sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit," as well as coping with the proverbial distractions, and learning adaptive thinking in stressful situations.

The study showed an amazing 30% reduction of adult ADHD symptoms in more than two thirds of the CBT group but only one third of the relaxation group. Very impressive.

Going forward, Dr. Safren was hopeful. "We know that ADHD medications are effective for patients who can take them, and without medications it would be harder to learn the skills taught in this study, but we have shown that learning self-management skills can help reduce symptoms even further. Now we need to determine the best ways to train clinicians in this approach and the best time to introduce this treatment, along with exploring other ways to help patients who did not benefit."

My own experiences with CBT have been very positive, which is why I heartily recommend the therapy to anybody who asks me questions about treating ADHD. The question of whether to medicate or not is one you must make with your therapist. I know many successful people who have ADHD but who do not medicate it. They have developed coping mechanisms that help alleviate the worst of the symptoms, but most importantly, they developed a lifestyle that capitalized on their ADHD strengths. Some adults with ADHD find that the medication actually hampers those strengths, making them average in comparison.

Obviously, barring side-effects, if ADHD is impairing your quality of life, medications are available to help you. However, they should not be the only solution you seek. Remember, pills don't teach skills. CBT can help you learn techniques that help you manage your ADHD and take back your life.


JAMA August 2010 Report


What is CBT?

APA Reference
Cootey, D. (2010, August 26). Adult ADHD: Cognitive Behaviorial Therapy Proven Effective, HealthyPlace. Retrieved on 2024, June 16 from

Author: Douglas Cootey

September, 5 2010 at 9:15 pm

I have schizoaffective disorder. As far as I know there have been no studies about the effect of CBT on this illness. Even my psychiatrist was a bit reluctant at first, but we gave it a shot together and it worked. Pills make you sleep at night, so that you can function over day. But they do not make you happy. You have to work on your thinking patterns to calm your soul down. In my opinion patients in general expect too much from pills. I believe the winning combination is: pills+ lyfe style change + CBT or some other technique to change the thinking patterns + back to nature. I wrote a blog on the last aspect (Support - registered as Helen).

In reply to by Anonymous (not verified)

Douglas Cootey
September, 6 2010 at 6:22 pm

Well stated. Thanks for commenting. Good luck with your progress. You have a wonderful attitude.

September, 1 2010 at 4:58 am

I am an adult (52yr.) with ADD. I've been taking meds for almost 10 years now and completely agree that the quieted the noise but gave me no skills.
I have had about 4 years (much of it prior to ADD diagnosis) of conventional therapy which I have also found extremely useful. Remember that at my age, I grew up without ADD in the child-rearing lexicon and you pick up an awful lot of baggage that way.
Most recently, I spent almost a whole year with a CBT therapist. I found that CBT for the ADD has an ironic challenge. The therapy requires that I actively do written excercises between sessions. Well, for me, that just translated into homework... and we all know where that leads us. Personally, I feel I got "some benefit" but going the first 40 years of life undiagnosed leaves a real rats-nest in the brain to untangle.
Regardless of my own tepid response to CBT, I heartily endorse it to others with ADD as having potential. The thing is, is that there are no magic bullets. All you can do is just keep trying different things which, over time, will give you an inventory of tools that help you. Even though I strongly qualify my own success with it, it is easy for me to see how it might be a fairly powerful tool for another ADD sufferer.

In reply to by Anonymous (not verified)

Douglas Cootey
September, 6 2010 at 6:29 pm

Written homework. Interesting. My CBT didn't give me work like that. We'd set goals, I'd work on them for the week, then report back. After that, we'd refine and repeat unless we needed to pursue a different direction/problem. It is very important to see a CBT who specializes in the unique challenges of ADHD. If your CBT advertised that he/she was versed in ADHD, then perhaps they didn't understand how you process information very well. Don't write off CBT quite yet.

August, 30 2010 at 4:49 am

I'm a mother of sons, who are now adults Some have ADHD, and the others have ADD. Without being aware, I raised my boys with CBT. I realized when they were young that having a set routine helped them be better focused and have better social skills. Without a schedule they were in constant chaos. So, meals were at the same time daily, and they had a list on the fridge for chores. I kept them busy with activities, and they had play time outside to get their wiggles out. The oldest took ritalin for school days only. The others did not. My oldest had trouble with med side affects, just like you, Douglas. So I talked with Doctors and my husband and I developed a plan that would help bring peace to our sons & home. Most days it worked, some times it didn't. The plan changed from year to year, just as my boys changed over time. Taking control of your difficulties is always a good way to go.

In reply to by Anonymous (not verified)

Douglas Cootey
September, 6 2010 at 6:32 pm

Keeping on top of it is tough. The brain is as stubborn as it is resilient. Change is tough work. Good for you in persevering.

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