Hi, I tend to agree with you regarding CBT versus trauma and PTSD. CBT is born out of studies to show effective treatments for the things they target. It’s not a one size fits all. And trauma and grief are not things that can be over come with a worksheet and some mental tricks. Unfortunately some recoveries are a function of time and compassion. It can be highly effective for certain things and people that engage with the process. But ADHD can make that harder to keep consistent. I found a low-effort easy to get into talk therapy quite useful and more targeted to me. That being said it can depend a lot, I spent many years finding a therapist that suited my experiences. One thing my therapist is not, is an ADHD specialist, so I may need to find someone for just that. It’s not wrong to seek a multi-pronged approach to solving your own mental challenges.
I had CBT about a decade ago, long before I was diagnosed with ADHD. I found it useful but with a lot of footnotes to that. I did a computer based course with a human therapist generally around to help and then checked in with a human therapist for a 1 to 1 every few sessions.
I was very skeptical but thought I had nothing to lose by trying it, and the waiting list for 1 to 1 CBT or counselling was much longer and I just wanted it started while I was in the right frame of mind. I told the therapist from the off that I wouldn’t write everything down/do the worksheets, but I would be able to talk through what I’d done during the week.
I felt no positive effects for weeks and weeks, and then on the second last week, it sort of clicked. Not sure if it was the CBT or the anti l-depressants kicking in or both, but I definitely felt a benefit. I still use the methods now if I’m starting to get overwhelmed/anxious/panicky.
If the therapist had been strict and insisted on written workbooks I would have quit though. It would have just been an extra thing to do, when I was already overwhelmed.
Thanks for this Rach. I'm a CBT therapist, myself formally diagnosed with ADHD age 55. Most of my clients are ADHDers, many of them are doctors (I used to be a primary care doctor for years).
You've presented a balanced picture of ADHD and yes, it is a skills acquisition based talking therapy, so there is between-session work to do - hence the exercises and handouts, based on research-evidenced protocols. I use them too, but collaboratively and creatively, with the client's goals in mind, not as a roll-out 'one size fits all' thing. Nor is the agenda meant to be rigid - it provides a predictable, structure that allows the session to be kept on track. What's actually on the agenda needs to be decided together and I'm pleased that you raised issues outside the therapist's - they're your sessions and your needs you're addressing!
I think that CBT DOES need to be adapted for us ADHDers and not many therapists have this experience, even now sadly. I know my clients value the fact that I have lived experience of ADHD, but clearly, that's a bonus - it's having a therapist with training in adapting 'standard' CBT that's key here.
As for the trauma issue - the reality is that ADHDers do experience trauma more than neurotypicals, for many reasons: increased exposure to adversity in childhood; rejection sensitivity dysphoria; internalised shame and self-doubt; higher risk taking and self-medicating with alcohol and drugs; and increased vulnerability to neglect or abuse. An ADHD experienced CBT therapist CAN work well with trauma but it's a nuanced piece of work and you'd have to find the right clinician.
Sorry, didn't mean this to become an essay, it's just that I really appreciated you writing this piece! Thanks
Thanks for this Rach. I'm a CBT therapist, myself formally diagnosed with ADHD age 55. Most of my clients are ADHDers, many of them are doctors (I used to be a primary care doctor for years).
You've presented a balanced picture of ADHD and yes, it is a skills acquisition based talking therapy, so there is between-session work to do - hence the exercises and handouts, based on research-evidenced protocols. I use them too, but collaboratively and creatively, with the client's goals in mind, not as a roll-out 'one size fits all' thing. Nor is the agenda meant to be rigid - it provides a predictable, structure that allows the session to be kept on track. What's actually on the agenda needs to be decided together and I'm pleased that you raised issues outside the therapist's - they're your sessions and your needs you're addressing!
I think that CBT DOES need to be adapted for us ADHDers and not many therapists have this experience, even now sadly. I know my clients value the fact that I have lived experience of ADHD, but clearly, that's a bonus - it's having a therapist with training in adapting 'standard' CBT that's key here.
As for the trauma issue - the reality is that ADHDers do experience trauma more than neurotypicals, for many reasons: increased exposure to adversity in childhood; rejection sensitivity dysphoria; internalised shame and self-doubt; higher risk taking and self-medicating with alcohol and drugs; and increased vulnerability to neglect or abuse. An ADHD experienced CBT therapist CAN work well with trauma but it's a nuanced piece of work and you'd have to find the right clinician.
Sorry, didn't mean this to become an essay, it's just that I really appreciated you writing this piece! Thanks
CBT saved my life. It was introduced to me as “emotions are a choice”. That wasn’t a good session. As we started using different frameworks in group, it began to make sense until it became a natural part of my thinking.
I don’t recognize much of what you wrote about as being CBT. One framework that I’ve seen used a lot in ADHD coaching is the STEAR Map.
Situation
Thought
Emotion
Action
Result
If you aren’t getting the result you want because you have an emotion that doesn’t serve you well, change your thought.
A tool to help that is putting your thought “on trial”. The book “Mind Over Matter” is excellent for learning this.
As for this not working for PTSD, grief, or any other trauma... what have you done well when you started? I used to be able to benchpress over 200 lbs. It took months of work to get there... and I can’t since I stopped. Practice CBT for a year and then say if it works on trauma. I’m 2 years in and have greatly reduced the emotions I struggle with.
And it’s not an either/or with therapy. They work beat together.
When using CBT to target ADHD, you should be using (and if necessary giving to the therapist) the specific CBT programs specifically tailored for ADHD. From Drs Mary Solanto, or Russell Ramsay, or Steven Safren, or Susan Young
I tried CBT few years ago for my anxiety, (before I even knew about my ADHD) but it did not even work for me. Maybe it was the person I talked to.
I'm open to try it again. Hopefully I might get the right one.
It could be worth trying it again or CBT combined with something else
I'd like to give it a go, your article was really helpful
The thing with ADHD and Autism is we are all different.
But I tried CBT before I got it. So no clue how it would work today.
Sad it did not work out for you. Hope you find something else that does!
Hi, I tend to agree with you regarding CBT versus trauma and PTSD. CBT is born out of studies to show effective treatments for the things they target. It’s not a one size fits all. And trauma and grief are not things that can be over come with a worksheet and some mental tricks. Unfortunately some recoveries are a function of time and compassion. It can be highly effective for certain things and people that engage with the process. But ADHD can make that harder to keep consistent. I found a low-effort easy to get into talk therapy quite useful and more targeted to me. That being said it can depend a lot, I spent many years finding a therapist that suited my experiences. One thing my therapist is not, is an ADHD specialist, so I may need to find someone for just that. It’s not wrong to seek a multi-pronged approach to solving your own mental challenges.
Love
D
Thank you!! This is exactly it and you put your points across so nearly! 🙌
I had CBT about a decade ago, long before I was diagnosed with ADHD. I found it useful but with a lot of footnotes to that. I did a computer based course with a human therapist generally around to help and then checked in with a human therapist for a 1 to 1 every few sessions.
I was very skeptical but thought I had nothing to lose by trying it, and the waiting list for 1 to 1 CBT or counselling was much longer and I just wanted it started while I was in the right frame of mind. I told the therapist from the off that I wouldn’t write everything down/do the worksheets, but I would be able to talk through what I’d done during the week.
I felt no positive effects for weeks and weeks, and then on the second last week, it sort of clicked. Not sure if it was the CBT or the anti l-depressants kicking in or both, but I definitely felt a benefit. I still use the methods now if I’m starting to get overwhelmed/anxious/panicky.
If the therapist had been strict and insisted on written workbooks I would have quit though. It would have just been an extra thing to do, when I was already overwhelmed.
Thanks for this Rach. I'm a CBT therapist, myself formally diagnosed with ADHD age 55. Most of my clients are ADHDers, many of them are doctors (I used to be a primary care doctor for years).
You've presented a balanced picture of ADHD and yes, it is a skills acquisition based talking therapy, so there is between-session work to do - hence the exercises and handouts, based on research-evidenced protocols. I use them too, but collaboratively and creatively, with the client's goals in mind, not as a roll-out 'one size fits all' thing. Nor is the agenda meant to be rigid - it provides a predictable, structure that allows the session to be kept on track. What's actually on the agenda needs to be decided together and I'm pleased that you raised issues outside the therapist's - they're your sessions and your needs you're addressing!
I think that CBT DOES need to be adapted for us ADHDers and not many therapists have this experience, even now sadly. I know my clients value the fact that I have lived experience of ADHD, but clearly, that's a bonus - it's having a therapist with training in adapting 'standard' CBT that's key here.
As for the trauma issue - the reality is that ADHDers do experience trauma more than neurotypicals, for many reasons: increased exposure to adversity in childhood; rejection sensitivity dysphoria; internalised shame and self-doubt; higher risk taking and self-medicating with alcohol and drugs; and increased vulnerability to neglect or abuse. An ADHD experienced CBT therapist CAN work well with trauma but it's a nuanced piece of work and you'd have to find the right clinician.
Sorry, didn't mean this to become an essay, it's just that I really appreciated you writing this piece! Thanks
Thanks for this Rach. I'm a CBT therapist, myself formally diagnosed with ADHD age 55. Most of my clients are ADHDers, many of them are doctors (I used to be a primary care doctor for years).
You've presented a balanced picture of ADHD and yes, it is a skills acquisition based talking therapy, so there is between-session work to do - hence the exercises and handouts, based on research-evidenced protocols. I use them too, but collaboratively and creatively, with the client's goals in mind, not as a roll-out 'one size fits all' thing. Nor is the agenda meant to be rigid - it provides a predictable, structure that allows the session to be kept on track. What's actually on the agenda needs to be decided together and I'm pleased that you raised issues outside the therapist's - they're your sessions and your needs you're addressing!
I think that CBT DOES need to be adapted for us ADHDers and not many therapists have this experience, even now sadly. I know my clients value the fact that I have lived experience of ADHD, but clearly, that's a bonus - it's having a therapist with training in adapting 'standard' CBT that's key here.
As for the trauma issue - the reality is that ADHDers do experience trauma more than neurotypicals, for many reasons: increased exposure to adversity in childhood; rejection sensitivity dysphoria; internalised shame and self-doubt; higher risk taking and self-medicating with alcohol and drugs; and increased vulnerability to neglect or abuse. An ADHD experienced CBT therapist CAN work well with trauma but it's a nuanced piece of work and you'd have to find the right clinician.
Sorry, didn't mean this to become an essay, it's just that I really appreciated you writing this piece! Thanks
Love this article, thanks so much for the info. I have talking therapy but it's not CBT and I love it, but wonder if I would benefit from CBT too
Love this article, thanks so much for the info. I have talking therapy but it's not CBT and I love it, but wonder if I would benefit from CBT too
CBT saved my life. It was introduced to me as “emotions are a choice”. That wasn’t a good session. As we started using different frameworks in group, it began to make sense until it became a natural part of my thinking.
I don’t recognize much of what you wrote about as being CBT. One framework that I’ve seen used a lot in ADHD coaching is the STEAR Map.
Situation
Thought
Emotion
Action
Result
If you aren’t getting the result you want because you have an emotion that doesn’t serve you well, change your thought.
A tool to help that is putting your thought “on trial”. The book “Mind Over Matter” is excellent for learning this.
As for this not working for PTSD, grief, or any other trauma... what have you done well when you started? I used to be able to benchpress over 200 lbs. It took months of work to get there... and I can’t since I stopped. Practice CBT for a year and then say if it works on trauma. I’m 2 years in and have greatly reduced the emotions I struggle with.
And it’s not an either/or with therapy. They work beat together.
When using CBT to target ADHD, you should be using (and if necessary giving to the therapist) the specific CBT programs specifically tailored for ADHD. From Drs Mary Solanto, or Russell Ramsay, or Steven Safren, or Susan Young
My CBT wasn’t specifically to target ADHD it was for anxiety and depression. But I agree it’s different for people that also have ADHD
I agree there’s not a one sized fits all approach