CBT for ADHD: How It Works, Examples & Effectiveness

How Does CBT Treat ADHD?

Cognitive behavioral therapy (CBT) treats ADHD by focusing on two main components that drive ADHD symptoms: the cognitive element, which is the negative thinking that developed due to ADHD, and the behavioral element, which is how a person reacts to situations due to their thoughts. The goal of CBT is to help challenge a person’s thoughts and change their problematic behaviors by teaching them time management strategies, organizational skills, and social skills.

CBT techniques can be particularly beneficial in treating core ADHD symptoms in adults by enhancing executive functioning, controlling impulsiveness, and reducing stress.¹ Additionally, adults with ADHD have a greater likelihood of having or developing depression or anxiety. For this reason, treatment approaches that incorporate CBT may be significantly helpful in overcoming co-morbid symptoms and managing distress in adults with ADHD and depression or ADHD and anxiety.²

Cognitive Element of CBT for ADHD

The cognitive element of CBT refers to thoughts and cognitive processes. When treating ADHD with CBT, a clinician would target the thought processes and patterns an individual living with ADHD experiences. This might include addressing disorganized or impulsive ways of thinking, as well as helping a person feel a sense of increased mastery over their cognitive processes.

CBT can help someone with ADHD cope with and overcome negative thinking patterns, like:³

• All-or-nothing thinking: People with ADHD often see things as black and white. Not being able to complete something “perfectly” is felt or thought of as a failure, which can cause people to procrastinate.
• Overgeneralization: People with ADHD can look at things broadly, taking one isolated negative incident and interpreting it as a recurrent pattern of defeat.
• Fortune telling: A person living with ADHD tends to think that things will turn out terribly and, therefore, predict the worst-case scenario regardless of any contradictory evidence.
• “Should” statements: Someone with ADHD may be inclined to develop this cognitive distortion when they feel they have not lived up to an “ideal” outcome.
• Mental filtering: Someone with ADHD may fixate on a small negative detail and, from there, will only see the negative aspects of any experience.
• Comparative thinking: Although using others and societal standards as points of reference is common, this becomes a distortion when the comparison is unrealistic.
• Disqualifying the positive: A person with ADHD may dismiss a rewarding experience to sustain a negative belief that contradicts their experience.

Behavioral Element of CBT for ADHD

The behavioral element of CBT refers to behaviors or actions a person engages in. When treating a person living with ADHD using a CBT model, a clinician might target a person’s actions or behavioral patterns that are causing difficulty or stress. For example, a person may be impulsive and feel they have little control over their actions.

CBT can help someone with ADHD cope with and overcome problematic behaviors, like:

• Impulsive actions
• Difficulty completing one task before moving on to another one
• Trouble managing time spent on an activity
• Difficulty sitting still
• Fidgeting

8 CBT Techniques for ADHD

The therapy process in CBT involves learning specific techniques to help change thoughts and behaviors. The client learns these techniques in the therapy session, and after learning the technique, the therapist gives the client homework on how to practice it in daily life.

Here are eight CBT techniques used to treat ADHD:

1. Cognitive Restructuring

Cognitive restructuring is the process of breaking down negative thinking patterns by identifying irrational thoughts and replacing them with rational ones. Though this may not seem like an integral part of a treatment plan for ADHD, individuals with ADHD often struggle with all-or-nothing thinking, negative talk, and comparison. These thoughts directly feed into unhealthy behaviors.

For example, if a person thinks, “I will never be able to accomplish this task perfectly,” they will be less likely to try and, therefore, struggle more with ADHD-induced procrastination. Cognitive restructuring challenges these thoughts, which allows the person to act differently.

Free Cognitive Restructuring for ADHD Worksheet

Cognitive restructuring can change negative thought patterns that contribute to procrastination and disorganization.

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Here are some examples of how a person with ADHD can use cognitive restructuring:

• “I am a failure” can be replaced with “Sometimes the way my brain works makes it difficult for me to complete tasks on time, but that does not reflect on my worth or who I am as a person.”
• “There is something wrong with me” can be replaced with “I live in a world that places a lot of unrealistic expectations about what I should be able to accomplish. I am not going to let that impact the way I feel about myself.”
• “I’ll never get this done” can be replaced with, “If I employ the strategies I’ve learned, I will be able to finish this task, maybe just not as quickly as I thought I would.”
• “I should be able to do this” can be replaced with, “It’s okay to ask for help when something is too difficult or challenging for me.”
• “I am stupid” can be replaced with “My ADHD brain works differently than other people’s brains, but that does not reflect my capability or intelligence.”

2. S.M.A.R.T. Goals

S.M.A.R.T. goals are goals that are Specific, Measurable, Achievable, Realistic, and Timely. A CBT clinician will likely incorporate the use of S.M.A.R.T. goals into their treatment structure, as well as teach clients how to set these kinds of goals for themselves.

S.M.A.R.T. means the goals are:⁴

• Specific: The client knows exactly what they want to accomplish. The goal is clearly defined.
• Measurable: The client will know if progress is being made and when they have achieved their goal.
• Attainable: The client has the skills and resources necessary to reach the goal.
• Realistic: It is something the client will devote their time and energy to accomplishing.
• Time specific: An appropriate amount of time is set for completing the goal.

Setting SMART Goals With ADHD Worksheet

SMART Goals is a structured goal-setting method that can help individuals with ADHD to create clear, actionable objectives.

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For example, in the scenario of a teenager who is often delayed while going to school due to forgetting important items, SMART goals can help this teenager stay more focused so they don’t forget important school items and can get to school on time.

The S.M.A.R.T. Goal for this teen would be:

• The specific goal in this situation is getting to school on time.
• It is measurable by tracking the time when they get to school.
• It is attainable because the teenager will have learned ways to organize themselves, such as making a checklist of items or organizing them the night before.
• It is realistic to assume the teenager is motivated and committed to this goal.
• Time specificity could be 1-2 weeks for this particular example.

3. Activity Scheduling

Activity scheduling is a tool that can assist people with ADHD who typically struggle with organizing, initiating, and sustaining actions over time. This technique consists of teaching the client a variety of skills and strategies that enable them to be intentional, realistic, and specific about time management, organizing responsibilities, planning activities, and so forth. The therapist will generally suggest and encourage the regular use of calendars, planners, checklists, phone reminders, or anything else that is practical and works well for a particular individual.⁵

4. Positive Self-Talk

People living with ADHD tend to experience more recurrent life setbacks, which can negatively impact how they view themselves and everything around them. As part of CBT, a person can counteract this issue by learning to alter any demoralizing self-talk with more realistic, uplifting messages of self-assurance and compassion. Thus, a positive internal dialogue can make it easier for someone with ADHD to feel more optimistic, driven, and confident in fulfilling tasks and endeavors while also diminishing unpleasant feelings when confronted with life challenges.⁵

5. Distractibility Delay

People with ADHD often have a difficult time staying focused on any given task, shifting their attention toward less important endeavors or becoming easily derailed. Distractibility delay interventions provide helpful tools that individuals can use to stay on task while managing distractions or interruptions in the environment. This may involve creating a distraction-free area, developing a plan for how to handle interruptions, jotting down distracting thoughts to revisit them later, and setting reminders to ensure you’re staying on task.⁵

6. Successive Approximation or “Breaking It Down”

Individuals struggling with ADHD can feel overwhelmed when faced with a big project or complicated task. Successive approximation can teach the person with ADHD to work their way up to completion by breaking a complex task into small pieces and getting started, which is generally the most difficult part. This technique can help someone master simpler steps and build on that as they move through a continuum towards their desired goal.⁵

7. Thought Journaling

Thought journaling is the process of writing down thoughts and feelings with the goal of better understanding them. This exercise can help individuals living with ADHD become more intentional and aware of thought patterns that are causing problems for them, as well as how these thoughts make them feel. Research has found that journaling can help decrease stress as well as facilitate healing and change.⁶

8. Role Play

Role play is the process of a clinician and client acting out scenarios in order to help the client change their thoughts and feelings about a specific scenario. Role play can help with ADHD by demonstrating to individuals living with ADHD that there are other options and ways of responding to situations they may not have considered before. For example, a counselor may role-play with a client, demonstrating how to talk with their professor about an assignment they are having trouble finishing.

Examples of CBT For ADHD

Everyone’s experience with ADHD is unique to them, but CBT can help with a variety of ADHD issues. Whether it’s trouble focusing at work or school, a behavioral issue, or problems getting out the door in the morning, CBT can provide techniques that lead to lasting change.

Here are some examples of how CBT can help with ADHD:

Trouble With Being Late & Staying Motivated

Melissa is a 45-year-old business professional. She was fired from her previous job after she received multiple reprimands for showing up late and not meeting deadlines for her assignments. She says she has a difficult time motivating herself to do activities that she doesn’t enjoy and often forgets the due dates for her assignments.

Melissa is starting a new job and has decided to see a therapist to help her understand why she is struggling with these issues. Her therapist diagnosed her with ADHD, and together, they developed a treatment plan to combat time blindness, including daily planning of assignments and appointments, time management strategies, and cognitive restructuring to help her work through her feelings of frustration and a sense of failure.

Trouble With Academic Performance

Todd is 16 and in high school. His mom describes him as lazy and unmotivated. She worries that he will not be able to get into college after he graduates due to his poor academic performance. Though Todd does well on tests, he struggles with homework and lengthy assignments. His teachers say he doesn’t follow along during lectures and interrupts other students while they are talking.

Todd’s mom takes him to see a psychiatrist who diagnoses him with ADHD. The psychiatrist prescribes Todd medication and refers him to a CBT therapist to work on his behavioral issues. In therapy, Todd learns how to set goals for himself and break those goals down into smaller, easy-to-accomplish steps.

He applies this to his homework assignments and begins turning them in on time after he learns how to use Motion, an ADPD time management app, to keep track of assignments and due dates. He also learns social skills that help him have more productive interactions with peers and teachers.

Behavioral Problem & Inattention

Jay is 7 years old and starting 2nd grade. He was referred to the school counselor for behavioral issues. His teacher said she couldn’t keep Jay in his seat; he would constantly leave his desk and wander around the room. During a conference with his parents, the school counselor learned that Jay is also having trouble at home.

His mom says she has to ask him multiple times to do simple tasks like picking up his toys or getting ready for bed. She says he becomes easily frustrated when making decisions and that leads to emotional outbursts. Jay’s school counselor completes testing and determines Jay has ADHD and is struggling with ADHD-induced meltdowns. She refers Jay to a CBT therapist who begins working with Jay and his parents.

Together, they develop a detailed routine for Jay that begins when he wakes up and ends when he goes to bed. They break down more complicated tasks like getting ready for bed into simple steps: Take a bath, put on pajamas, brush his teeth, comb his hair, read a story, then go to sleep. Having a routine helps Jay feel secure and more in control.

The therapist also works with Jay on his lack of impulse control due to ADHD. The therapist helps his parents implement effective rewards and consequences for his behaviors. The parents and therapist consult with his teacher and pass along the behavior strategies they’ve used with him that she can use with him in class.

Is CBT Effective for Treating ADHD?

CBT has long been established as one of the leading therapeutic approaches utilized for treating many mental health conditions. It is also one of the top-researched types of therapy and is, therefore, a highly evidence-based treatment approach.⁷

Here are some studies that show the effectiveness of treating ADHD with CBT:

• In a series of studies, there was found to be a significant improvement in those with ADHD who received a combination of CBT and medication as compared with those who only received medication. These findings were found true for children, adolescents, and adults with ADHD.^{8, 9}
• In a randomized control trial examining the efficacy of CBT on college students with ADHD, measured over two semesters, it was found that these college students had overall improved executive functioning and better use of disability accommodations.¹⁰
• In a randomized clinical trial for adults with ADHD and substance abuse disorder, it was found that after 15 sessions of CBT therapy, these adults had reduced symptoms of ADHD and substance utilization.¹¹
• In a review of studies pertaining to ADHD treatment for children aged 6 to 12, followed longitudinally for 24 months, it was found that CBT, in addition to medication, was found to be the most effective in mitigating ADHD symptoms than medications alone, though medications did have improvements as well.¹¹
• CBT has also been proven effective in treating ADHD along with the often co-occurring conditions, such as anxiety, depression, and conduct disorder.⁷

What to Expect During CBT Treatment

Generally, the CBT treatment structure for ADHD focuses on addressing common ADHD symptoms or deficits and providing the tools for dealing with organizing and planning, coping with distraction, and modifying dysfunctional thinking and behavioral patterns. The course of treatment may differ from person to person, but typically, there are 10 to 12 sessions, with one session a week, each session lasting one hour.

In the first few sessions, the counselor will typically educate the client about their condition and how treatment can help. From there, a discussion about the areas the person wants to work on will follow, which may relate to time management, prioritizing responsibilities, completing projects, and so on. Then, the therapist and client will work together to develop a treatment plan to meet the desired therapy goals.

A CBT session focuses on areas of daily functioning, and tasks can range from staying on top of financial responsibilities to encouraging endeavors that facilitate personal well-being, including sleep, exercise, and hobbies.¹² The person in therapy may be given homework between sessions to help them practice newly acquired skills in their day-to-day life.

How to Find a CBT Therapist for ADHD

Knowing how to choose a therapist can feel overwhelming. When contacting a provider, you can ask if they are familiar with cognitive behavioral therapy and how much clinical experience they have using CBT specifically for ADHD. There are many online ADHD treatment platforms that can provide therapists specializing in CBT.

In addition to working with a qualified CBT therapist, there are also many ADHD and CBT apps that can be used to bolster what you are learning in therapy to combat ADHD symptoms. Apps such as InFlow can help you master CBT skills, receive personalized coaching, and gain access to a community of people who are also working on developing CBT skills for their ADHD.

How Much Does CBT Cost?

The cost of CBT for ADHD depends on whether your therapist takes your insurance or if you will be paying out-of-pocket. For therapists who take your insurance, there is usually a copay ranging from $10 to $100. Out-of-network providers or those who do not accept insurance may charge anywhere from $80 to $200 a session. Therapists and practices may offer sliding scale prices for sessions to ensure you are able to attend the full course of treatment.