After a lifetime of mistakes, mishaps, and missed deadlines, is it any wonder that adults with attention deficit hyperactivity disorder (ADHD or ADD) suffer dangerously low self-esteem and perpetually negative thoughts? Cognitive behavioral therapy (CBT) is a short-term, goal-oriented form of psychotherapy that aims to change these negative patterns of thinking and change the way a patient feels about themselves, their abilities, and their future. Consider it brain training for ADHD.
Originally a treatment for mood disorders, CBT is based on the recognition that cognitions, or automatic thoughts, lead to emotional difficulties. Automatic thoughts are spontaneous interpretations of events. These impressions are susceptible to distortion, such as unfounded assumptions about yourself (or others), a situation, or the future. Such unhealthy internal dialogs hinder an individual from working toward an intended goal, working to develop productive new habits, or generally take calculated risks.
CBT aims to change irrational thought patterns that prevent individuals from staying on task or getting things done. For an individual with ADHD who thinks, “This has to be perfect or it’s no good,” or “I never do anything right,” CBT challenges the truth of those cognitions. Changing distorted thoughts, and the resulting change in behavior patterns, is effective in treating anxiety, and other emotional problems.
How Does CBT Help People with ADHD?
ADHD is a chronic, persistent delay of self-regulation skills, including executive functioning skills. Delays in EFs create procrastination, disorganization, poor time management, emotional dysregulation, impulsivity, and inconsistent motivation. Although these problems are not included in the official diagnostic criteria for ADHD, they are common in adults with the condition, making it hard for them to regulate their emotions and behaviors.
Individuals who grow up with ADHD (particularly if it has gone undiagnosed) encounter more frequent and frustrating setbacks in life situations — on the job, in social interactions, and everyday organization. Because of these many setbacks, adults with ADHD or ADD become self-critical and pessimistic. This, in turn, sometimes causes them to experience negative emotions, cognitive distortions, and unhealthy self-beliefs such as thinking they are at fault when situations don’t turn out well, when, in many cases, they aren’t. They may bring the same pessimistic outlook to the future, predicting that tomorrow will go as badly as today.
Typical ADHD related thought processes are distorted in certain characteristic ways:
- All-or-nothing thinking. You view everything as entirely good or entirely bad: If you don’t do something perfectly, you’ve failed.
- Overgeneralization. You see a single negative event as part of a pattern: For example, you always forget to pay your bills.
- Mind reading. You think you know what people think about you or something you’ve done — and it’s bad.
- Fortune telling. You predict that things will turn out badly.
- Magnification and minimization. You exaggerate the significance of minor problems while trivializing your accomplishments.
- “Should” statements. You focus on how things should be, leading to severe self-criticism as well as feelings of resentment toward others.
- Personalization. You blame yourself for negative events and downplay the responsibility of others.
- Mental filtering. You see only the negative aspects of any experience.
- Emotional reasoning. You assume that your negative feelings reflect reality: Feeling bad about your job means “I’m doing badly and will probably get fired.”
- Comparative thinking. You measure yourself against others and feel inferior, even though the comparison may be unrealistic.
Learning to recognize these distorted thoughts helps you to replace them with realistic thinking.
How Exactly Does Dr. Shinar’s CBT Techniques Improve ADHD in Adults?
Dr. Shinar’s CBT methods help patients manage everyday challenges— procrastination, time management, and other common difficulties — not to treat the core symptoms of inattention, hyperactivity, and impulsivity.
CBT sessions focus on identifying the situations in which poor planning, disorganization, and poor time and task management create challenges in a patient’s day-to-day life. Sessions may help an individual deal with obligations such as paying bills or completing work on time, and encourage endeavors that provide personal fulfillment and well-being, such as sleep, exercise, or hobbies. Learning about ADHD is always a good starting point, as it reinforces the message that ADHD is not a character flaw and demonstrates the neurological underpinnings of daily challenges.
The goals and session agendas of Dr. Shinar’s CBT plan center on scenarios and challenges that the patient has encountered and, more important, expects to encounter, particularly between sessions. Dr. Shinar uses take-away reminders, follow-up check-ins, and other ways of applying new coping skills so they are used outside of the consulting room. Ultimately, the way that a patient with ADHD functions in everyday life is the best measure of whether the therapy is helping.
What Is a Typical CBT Session with Dr. Shinar Like?
CBT is administered in many different formats, and Dr. Shinar tailors sessions to a patient’s individual needs. Each session’s agenda provides a benchmark for identifying when the discussion is straying off course. Early sessions typically involve an introduction to CBT, the structure of sessions, and setting and refining therapy goals (making them specific, realistic, and actionable), as well as developing action plans for what the patient will do outside of the office.
Subsequent sessions focus on identifying the most important life situations affecting the patient, and developing coping skills to handle those situations. CBT helps in processing new experiences and finding new ways to handle setbacks. It adjusts the old rules to align with present-day life. For each agenda item Dr. Shinar and his patients decide on tackling, they work together to reverse-engineer the challenge. They try to better understand its nature, including a review of the impact of thoughts, feelings, behaviors, and other factors that have interfered with handling the situation.
Using the CBT framework breaks down the big challenges into specific tactics for navigating transition points in a day — getting up and off to work on time, starting a project that you’ve been avoiding, or setting a time to review a daily planner — which increases coping skills. These coping skills are strategized in a session, written down as reminders and used between sessions.
When Can I Expect to See Results working with Dr. Shinar?
Results come quickly. CBT typically yields benefits after only 16 to 20 sessions. However, most patients continue with CBT much longer, as it emphasizes long-term maintenance of coping skills and improvements. In fact, the length of time spent in treatment — over many months, say — is as important as the number of sessions a person undergoes.
Dr. Shinar’s CBT aims to help individuals make sustained changes in their daily lives. A patient typically stretches out sessions weekly and eventually biweekly over six months to turn his/her new skills into habits and to weave them into his/her lifestyle. This allows time and practice for mastering coping strategies for paying monthly bills, organizing work or school issues, and pursuing other tasks and endeavors in real time.
Some individuals return to CBT with Dr. Shinar for “booster sessions” to address a challenge if they’ve fallen into old habits. Some resume CBT to adapt their coping skills to a major life change, such as having a child or losing a job.