Most adults with attention deficit hyperactivity disorder (ADHD) need medication, but that's not always enough. That's why many experts recommend meds and psychotherapy. But as Mark, a 30-something sales representative from New York City, discovered recently, not all forms of therapy work particularly well for ADHD.
Since being diagnosed with ADHD 10 years ago, Mark has been on, off, and finally back on medication. He also worked with several psychotherapists — to no avail. "They either didn't know much about ADHD, or they wanted me to deal with the 'emotional issues' behind it," he says. "That wasn't helpful."
Eight months ago, Mark started to work with a new therapist. Now things are looking up. He says he feels much better about himself and his marriage.
"A lot of stuff I did got on my wife's nerves — forgetting things she asked me to do, or getting them wrong because I didn't really hear her," Mark says. "I still make mistakes, but they're fewer and farther between. And she knows that I'm really working on it."
For many years, Mark's to-do lists remained mostly undone. Now he's able to cross off 80 percent of the items. Even the tasks that used to seem overwhelming — filing receipts, clearing his desk of clutter — get done without difficulty.
"I think of therapy as a partner in the recovery process," says Lori, a 35-year-old secretary at a small college in Pennsylvania. "I used to feel that, as much as I tried, nothing would change. Now, when intense feelings come up, instead of reacting to them spontaneously and being devastated and discouraged, I take a step back and feel there's hope."
New Tricks for an Old Dog
The form of therapy that worked so well for Mark and Lori — and for countless others with ADHD — is called cognitive-behavioral therapy. CBT was developed 40 years ago, and since then it has proven highly effective in treating anxiety and depression. But only within the last decade has it been used for ADHD.
There's no evidence that CBT can replace drug therapy for ADHD, or even permit lower dosages. But research suggests that it works better for ADHD than do other forms of therapy. One recent study, from Boston's Massachusetts General Hospital, found that a combination of drug therapy and CBT was more effective at controlling ADHD symptoms than was drug therapy alone.
"CBT picks up where medication leaves off," says Steven A. Safren, Ph.D., leader of the study and assistant professor of psychology at Harvard University. "Even after optimal treatment with medication, most adults have residual symptoms, and this treatment appears to make them better."
Results come quickly. Traditional forms of therapy can go on for years, whereas cognitive-behavioral therapy typically yields its benefits in only 12 to 15 one-hour sessions.
What's It All About?
Traditional therapy focuses on emotions and mines the past to find causes of current problems.
With cognitive-behavioral therapy, the focus is on thinking, and the way transient thoughts and enduring beliefs about oneself and the world influence how one feels and acts. It's a tool for getting organized, staying focused, and improving one's ability to control anger and get along with others.
This might sound a lot like what's offered by ADHD coaches and self-help books. But knowing what to do is seldom enough — irrational thoughts and expectations stop you from doing it. CBT eliminates these roadblocks.
Next: ADHD Distorted Thinking