Contains Video1Description and Demonstration of CBT for ADHD in Adults
Section snippets
Description of CBT for ADHD in Adults
Our CBT for ADHD in adults follows a modular approach. Each module corresponds to a set of skills addressing a common domain of impairment in adults with ADHD. Accordingly, there are three “core modules” that we recommend administering to all clients, and two optional modules. The core modules are (1) psychoeducation and organizing/planning, (2) coping with distractibility, and (3) adaptive thinking. The optional modules are (4) addressing procrastination and (5) involvement of a partner or
Psychoeducation and Organization/Planning
This module typically spans 4 sessions and involves orienting the client to a CBT model of treatment, providing psychoeducation about ADHD in adulthood, and training the client in organization and planning skills. The first set of skills in the organization and planning module is development and regular use of a calendar and task list system for appointments, schedule, and “to-do” items. We consider the calendar and task list the foundation for subsequent skills and central to the entire
Problem Solving
“Steve” is a 38-year-old man. At this stage of the treatment, he would have already worked on developing a calendar and task list system and a system for using priority ratings for task list items. The goal of this session is to teach him to use problem solving to deal with items on his task list that are overwhelming or where there is not a clear solution. This session is framed as teaching skills to help with tasks that end up being pushed off from day to day or week to week. When the
Distractibility
The distractibility module addresses the fact that many clients with ADHD report that they are unable to complete tasks because other, less important tasks or distractions get in the way. The primary goals of the distractibility module are to help the client become more aware of the environmental factors that are contributing to distractibility and to develop techniques to manage their tendency to move from one task to another without finishing the first. As the clients move along with the
Adaptive Thinking
The primary goal of the adaptive thinking module is to help the client become more aware of thoughts that are causing difficulties for him or her and develop strategies to modify these thoughts. The cognitive restructuring procedures used in the three-session adaptive thinking module are those used by Beck (1995), except that they account for specific skills deficits due to ADHD. As detailed by McDermott (2000), cognitive restructuring training in this population must account for the tendency
Additional Modules
The current manuscript was designed to provide an overview of this treatment approach, and show some examples of common issues among the most important modules. The treatment, however, also includes two additional modules that are optional based on the client's needs and circumstances. The first is a one-session module on procrastination, and the second is a one-session module that involves a spouse or partner. The module with the spouse or partner provides educational information about ADHD in
Relapse Prevention
The final session of the treatment is focused on relapse prevention. In this session, all strategies that the client has learned are reviewed and rated according to their usefulness. The therapist guides the client in developing a plan for continued use and addresses how the client can get back on track if he or she experiences a reemergence of symptoms. Plans are made for the client to complete a self check-in 1 month after treatment ends.
Conclusion
This manuscript with case illustrations provides a brief description of cognitive behavioral therapy for ADHD in adults as developed and tested by our team. Additional details about the treatment can be found in the published manual and client workbook (Safren et al., 2005, Safren et al., 2005). For therapists who have not worked with this population before, the video components that accompany this article also provide examples of the types of problems typically reported by adults with
Acknowledgment
This research was supported by NIH Grant MH069812 to Steven A. Safren and Susan E. Sprich.
The authors thank Robert Safion for helpful comments on an earlier version of the manuscript.
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2023, Behavior TherapyCitation Excerpt :Stimulant medication is the first-line recommended treatment for ADHD in youth. Recent studies demonstrate that behavioral treatments can also be effective for improving ADHD symptoms (Antshel et al., 2014; Fabiano et al., 2009; Gould et al., 2018; Safren et al., 2005; Sprich et al., 2010, 2016), particularly in conjunction with stimulant medication (on behalf of MTA Cooperative Group, 1999) and for residual symptoms following pharmacological treatment (Sprich et al., 2016). It is noteworthy that CBIT tends to be “tic specific,” and does not result in differential changes to co-occurring psychiatric symptoms and/or psychosocial functioning (Woods et al., 2011).
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2015, Cognitive and Behavioral PracticeCitation Excerpt :The goal of such exercises is to change the distorted content of the cognitions. Overly positive cognitions can also be targeted using this model (Sprich et al., 2010). For instance, Table 1 is an example of a daily thought record addressing this type of thought.
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2015, Cognitive and Behavioral PracticeCitation Excerpt :Missed sessions are rescheduled and made up in order to maximize the likelihood of each participant receiving all 12 sessions over a 20-week period of time. The intervention was informed by our CBT intervention work with adults and adolescents with ADHD over the past 12 years as detailed in our published therapist guide, patient manual, and clinical description article (Safren, Otto, Sprich, Perlman, Wilens and Biederman, 2005; Safren, Perlman, Sprich, & Otto, 2005; Safren, Sprich, et al., 2005; Sprich et al., 2010). Modules to foster behavioral change include providing psychoeducation, maximizing motivation with motivational interviewing (Miller & Rollnick, 2012), and CBT skills training components.
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2023, Thriving in College with ADHD: A Cognitive-Behavioral Skills Manual for Therapists
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Video patients/clients are portrayed by actors.