Using CBT for adult ADHD to turn intentions into actions
A central issue that is typically misunderstood by individuals who are not familiar with Attention-Deficit/Hyperactivity Disorder (ADHD) is that the difficulties faced by adults with ADHD is not the result of not knowing about helpful coping skills or due to some sort of resistance to their use. Rather, ADHD is a problem with turning intentions into actions, including using the standard coping skills that everyone knows will be helpful. This is the insidious nature of ADHD – it makes carrying out your best laid plans more difficult than you would expect.
Whereas medications are extremely helpful in reducing the core symptoms of ADHD, they do not necessarily also produce improvements in many domains of life, such as being better organized, managing time, and managing the tendency to procrastinate. Psychosocial treatments designed for adult ADHD, particularly cognitive behavior therapy (CBT), have been designed, studied, and continue to evolve to target these domains of functioning in day-to-day life.
Adults with ADHD, particularly if it has gone undiagnosed until relatively later in life are at greater risk for experiencing more than their fair share of frustrations in life, such as in school, at work, and/or in relationships. The conclusions drawn about these frustrations of take the form of excessive self-criticism and pessimism about the future. Coupled with associated negative emotions and avoidant behaviors, these negative outlooks are a recipe for further problems for adults with ADHD.
However, the CBT model can be used to help gain understanding of the impact of ADHD on your endeavors. Rather than repeatedly telling yourself to “try harder” to get organized or to procrastinate less, a skilled CBT therapist helps you develop a template with which to “see your ADHD” in terms of various pivot points that get you off task.
For example, procrastination is a common ADHD problem. Many people will describe feeling busy all day only to look back on the day and see that they did not make any progress on their most important objective. Focusing on the main task that got pushed to the side, there are often distorted thoughts related to the task. In particular, there is an automatic expectation that the task will be overwhelming, tedious, and fruitless, resulting in the rash decision to do something else instead, perhaps some sort of chore, but something that is viewed as more manageable than the priority task. This cognitive reaction is probably coupled with some feeling of discomfort, dread, or simply a sense of “ugh.” Switching to another task is an escape behavior that provides immediate relief from the task but sneakily rewards avoidance and now leaves you with less time for the task. These cognitive, emotional, and behavioral reactions happen in a flurry in nanoseconds and before you know it, you are off doing something else, only later facing the all-too-familiar regret of not being able to follow through on your plans.
However, the aforementioned disentangling of the different facets of procrastination in ADHD (and everyone with ADHD is different, so your procrastination profile may be somewhat different) helps make sense of and better understand of how your plans go awry. With this understanding, you can now deploy tactics for implementing specific coping skills at each of these pivot points in order to increase the likelihood of getting started on tasks and, most importantly, being able to follow through on the plans that are important to you.
J. Russell Ramsay, Ph.D.: Associate Professor of Clinical Psychology, Adult ADHD Treatment and Research Program, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Author of The Adult ADHD Tool Kit with Dr. Anthony Rostain (Professor of Psychiatry at the Hospital of the University of Pennsylvania and the Children’s Hospital of Philadelphia)