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37 Effective Therapy Activities for an ADHD Child

Dr. roseann capanna-hodge.

  • October 5, 2023

When you have a child with ADHD (Attention Deficit Hyperactivity Disorder), the twists and turns can be even more challenging. ADHD is a neurodevelopmental disorder that affects millions of kids worldwide. It is actually the most common mental health condition affecting children in the US. This condition makes it difficult for them to focus, control their impulses, and regulate their behavior all of which impact them socially, academically and behaviorally.  

ADHD affects the brain's executive functions, including attention, impulse control, and behavior regulation. But the good news is therapy activities, especially those focused on natural solutions for brain health, can help your child thrive.

Imagine trying to assemble a jigsaw puzzle with a few missing pieces. That's what it's like for children with ADHD when it comes to managing their thoughts and actions. It's crucial to understand that ADHD does not result from bad parenting or a lack of discipline. It's a neurodevelopmental disorder that requires patience, understanding, and the right strategies to help children learn and succeed.

Common ADHD Symptoms in Children

Before diving into therapy activities, let's take a closer look at some common symptoms of ADHD in children. Understanding these symptoms is the first step to helping your child manage the condition. Symptoms can vary from child to child but often include:

  • Inattention : Difficulty sustaining close attention in tasks or play activities.
  • Hyperactivity : An excessive amount of energy, often seen in fidgeting, restlessness, or running around.
  • Impulsivity : Acting without thinking of the consequences, interrupting others, or having trouble waiting their turn.
  • Organization and time management difficulties : Trouble keeping their belongings in order or managing tasks with a sense of time.
  • Forgetfulness : Frequently losing things like school books or toys and forgetting daily tasks.

Is it ADHD or something else?

The importance of therapy activities for children with adhd.

Therapy activities are essential because they provide a structured and supportive environment where kids with ADHD can attain a greater sense of self-confidence and accomplishment. Here's why they matter:

  • Structure and Routine: Children with ADHD perform better in structured environments. Therapy sessions that provide consistency and predictability can help them feel more secure and focused.
  • Skill Building: Most therapy activities are designed to target specific skills that kids with ADHD often struggle with. They help improve these skills gradually over time.
  • Emotional Regulation: Children with ADHD can experience intense emotions. Therapy activities teach them how to identify and manage these emotions healthily.
  • Confidence Boost: As kids learn and achieve success in therapy activities, their self-esteem and self-confidence receive a much-needed boost.

Goals and Objectives of Therapy Sessions for Children with ADHD

Therapy sessions for kids with ADHD are not one-size-fits-all. They should be tailored to the unique needs and strengths of each child. Here are some overarching goals and objectives that therapists typically aim for:

  • Improved Attention Span : Enhancing the ability to focus on tasks and follow instructions.
  • Better Impulse Control : Learning to think before acting and managing impulsive behavior.
  • Effective Communication : Building social skills, including listening and responding to others.
  • Problem-Solving Skills : Teaching children how to approach and resolve challenges independently.
  • Stress Management : Equipping kids with strategies to cope with stress and frustration.

There is a vast array of activities and therapies that can empower children with ADHD to thrive and reach their full potential. Implementing these strategies can help your child build essential skills, manage their symptoms, and embrace a brighter future filled with success and confidence.

Therapy Activities for Developing Problem-Solving Skills

Problem-solving is a fundamental life skill that everyone needs, but it's especially vital for children with ADHD. These youngsters often face challenges in this department due to their impulsive tendencies and difficulties with sustained attention. Certain therapy activities provide an excellent platform to hone these crucial problem-solving skills.

1. Scavenger Hunt 

One popular activity that therapists use is the classic scavenger hunt. This seemingly simple game packs a punch when it comes to developing problem-solving abilities. Children are given a list of items to find or clues to decipher, and they must strategize and plan their approach. This activity not only exercises their cognitive abilities but also fosters teamwork and collaboration if done in a group setting.

2. Interactive Storytelling

Another effective technique involves interactive storytelling. Therapists might present a scenario or a challenge within a story and ask the child to come up with possible solutions. This taps into their creativity and encourages them to consider various perspectives and consequences to help them understand that there's often more than one great way to tackle a problem.

3. Puzzles 

For older children and teenagers with ADHD, more complex problem-solving activities can be introduced. These might include logic puzzles, riddles, or brainteasers. Such challenges not only stimulate their intellect but also teach them persistence and patience. These are valuable skills they can carry into their academic and personal lives.

Therapy Activities for Improving Attention Span and Concentration Skills

One of the hallmark challenges for children with ADHD is maintaining attention and concentration. These skills are essential to do well in school , at home, and in social settings. These therapy activities offer effective strategies to enhance such vital skills. 

4. Memory Games

Memory games, for instance, challenge a child's ability to focus on and recall information. These brain exercises encourage them to pay attention to details and sharpen their memory skills. They require sustained focus and attention, which will help build their attention span gradually while enjoying themselves.

5. Mindfulness Exercises

Mindfulness exercises are another powerful tool in the therapist's arsenal. These activities teach children to be present in the moment, heightening their awareness and enhancing their ability to concentrate on the task at hand. Simple breathing exercises or guided imagery sessions can be particularly effective (Cairncross & Miller, 2016).

6. Interactive Computer Programs

Therapists often incorporate technology into therapy sessions, using interactive computer programs, video games, and apps designed to improve attention and concentration. These digital tools provide a dynamic and engaging way for kids to practice staying on task.

Calming and Stress-Reducing Activities for Children with ADHD

Children with ADHD often find themselves caught in a whirlwind of thoughts and emotions, which can lead to heightened stress and anxiety. The ability to calm their minds and manage stress is an essential skill that can significantly improve their quality of life. 

7. Deep Breathing 

Deep breathing exercises are a fundamental component of stress reduction therapy. These exercises teach children to take slow, deliberate breaths, allowing them to regain control over their racing thoughts. Practicing deep breathing regularly allows kids to develop a reliable method for calming themselves when stress levels rise.

8. Progressive Muscle Relaxation

Progressive muscle relaxation is a powerful tool for getting kids to connect to their bodies. By tensing and then releasing various muscle groups, children become more attuned to the physical sensations associated with stress. This heightened awareness enables them to consciously release tension, reducing overall stress levels and promoting relaxation (Jarraya et al., 2022).

9. Art Therapy 

Art therapy offers a unique outlet for emotional expression. Through creative endeavors, like an art project, children can channel their feelings into visual or tactile forms. This form of self-expression not only reduces stress but also allows them to explore and understand their emotions in a nonverbal manner (Habib & Ali, 2015).

Therapies and Activities to Enhance Social Skills in Children with ADHD

Social skills are a crucial aspect of a child's development. For children with ADHD , these skills can present unique challenges. Therapy activities are invaluable tools for enhancing social competence and helping these young individuals build meaningful relationships.

10. Group Therapy

Group therapy activities create a supportive environment where children can work together and learn from one another. Collaborative projects, team-building exercises, and cooperative games encourage cooperation, teamwork, and the development of interpersonal skills. These activities not only enhance social competence but also help children build a sense of belonging.

11. Scenario-Based Learning

Therapists often use storytelling or scenario-based activities to teach children how to navigate social dilemmas. By presenting real-life situations and discussing possible solutions, children with ADHD can develop problem-solving skills and learn to make thoughtful decisions in social contexts.

12. Board Games 

Structured activities like board games provide opportunities for children to practice turn-taking, sharing, and following rules. These are all essential components of social interactions. Games like chess or strategy-based board games require careful planning and decision-making. They encourage children to think ahead and consider the consequences of their actions, promoting impulse control.

Fun Games and Activities to Promote Impulse Control in Kids with ADHD

Impulse control is a key area of development for children with ADHD, and play therapy can make learning self-control an enjoyable and engaging experience. These activities not only help children manage their impulses but also provide them with valuable life skills.

13. Simon Says

This classic game is an excellent way to teach impulse control. Children must listen carefully and only follow commands when preceded by “Simon says.” It encourages them to think before acting and resist impulsive responses.

14. Red Light, Green Light

In this game, children practice stopping and starting on command. It helps improve their ability to control their movements and responses, a crucial skill for impulse control.

15. Emotion Recognition Games

Interactive activities that involve identifying and discussing emotions in various scenarios help young children better understand their feelings and reactions. This game fosters impulse control through emotional awareness.

16. Count to Ten

A simple but effective technique, counting to ten before reacting to a situation allows children to pause and think before acting impulsively.

Physical Activities to Help Children with ADHD Address Excess Energy

Children with ADHD often have boundless energy, which can be both a blessing and a challenge. Any physical activity that incorporates movement provides an outlet for such high energy, promoting better focus, self-regulation, and overall well-being.

17. Outdoor Sports

Encouraging children to participate in team sports like soccer, basketball, or baseball not only helps them burn off energy but also fosters discipline, teamwork, and social interaction. These after-school activities promote physical fitness while improving attention span.

18. Yoga 

Mindful movement practices like yoga and tai chi can be highly beneficial for children with ADHD. These activities promote balance, coordination, and relaxation. It helps children find inner calm and improve their self-control.

Dance classes, whether in ballet, hip-hop, or contemporary styles, offer an enjoyable way for children to express themselves physically. Dancing encourages creativity, improves body awareness, and teaches them to focus on movements and routines. Planning a dance party every so often is a great activity to release that extra energy.

20. Martial Arts

Karate, taekwondo, or judo can be excellent choices for children with ADHD. These disciplines emphasize self-discipline, self-control, and respect for others, while the physical aspect allows children to channel their energy constructively.

21. Obstacle Courses

Creating obstacle courses at home or in therapy sessions can be a fun and effective way for children to practice physical coordination and impulse control. They can navigate these courses, honing their problem-solving skills and self-regulation .

22. Hiking and Nature Walks

Spending time in nature can be an incredibly calming activity for children with ADHD. Hiking or going on nature walks allows them to explore the outdoors, connect with their environment, and release excess energy in a serene setting.

Behavior Management Strategies for Children with ADHD

Effective behavior management is crucial for children with ADHD as it helps create a structured and supportive environment where they can thrive. Behavior therapy and strategies designed for behavior management provide essential tools for both parents and children in managing ADHD-related challenges.

23. Clear and Consistent Rules

Establishing clear rules and expectations is the foundation of behavior management. Children with ADHD benefit from knowing what is expected of them. Consistency in enforcing these rules is equally important.

24. Positive Reinforcement

Rewarding desired behaviors with praise, privileges, or small incentives can motivate children with ADHD to exhibit appropriate conduct. Positive reinforcement encourages them to repeat these behaviors.

25. Time Management Skills

Children with ADHD often struggle with time management. Visual schedules, timers, and alarms help them develop a sense of time and structure their activities more effectively.

26. Consequences

While positive reinforcement is essential, consequences for behavior problems are also necessary. These consequences should be logical, immediate, and fair, helping children understand the link between their actions and the outcomes.

27. Behavior Contracts

Creating written agreements with children about their expected behavior and the consequences for both poor and good behavior can be an effective strategy. This approach promotes responsibility and accountability.

28. Coping Strategies

Teach children coping techniques to manage their emotions and impulses. Deep breathing, self-calming techniques, and self-reflection can help them handle frustration and stress constructively.

29. Parent-Child Communication

Open and effective communication is vital. Parents should encourage their children to express their feelings and concerns. This fosters trust and allows parents to better understand their child's perspective.

30. Professional Support

Seeking guidance from occupational therapists, counselors, or support groups can provide parents with valuable tools and strategies for behavior management. These professionals can offer insights tailored to the specific needs of the child.

31. Parenting Techniques

Parents can learn specialized parenting techniques , such as Parent-Child Interaction Therapy (PCIT) or Collaborative Problem Solving (CPS), designed to manage behavior challenges in children with ADHD. Joining a weekly session of any parent training program can help you manage your child's behavior better.

Learning-Based Activities for Children with ADHD

For children with ADHD, learning-based activities not only provide valuable educational experiences but also offer a structured and engaging way to improve focus, concentration, and cognitive skills. These activities are essential for helping children with ADHD succeed academically and beyond.

32. Hands-On Experiments

Science experiments and hands-on projects allow children to explore concepts practically and interactively. These activities promote curiosity, critical thinking, and a deeper understanding of scientific principles.

33. Reading and Storytelling

Encouraging children to read or listen to stories not only fosters a love of literature but also improves their attention span and comprehension. Discussing the plot, characters, and themes further enhances their cognitive abilities.

34. Math Riddles and Challenges

Math-based puzzle games, riddles, and challenges stimulate logical thinking and mathematical reasoning. They encourage children to analyze problems, strategize solutions, and build a strong foundation in math.

35. Creativity Outlets

Engaging in creative activities like drawing, painting, or crafting allows children to express themselves while honing their fine motor skills and attention to detail. Artistic endeavors encourage imagination and self-expression.

36. Coding and Technology

Learning to code or engaging in technology-based projects can be particularly appealing to children with ADHD. It allows them to focus on problem-solving and logical thinking while harnessing their enthusiasm for technology.

37. Music and Instrument Learning

Music lessons and playing musical instruments can help children with ADHD develop discipline, concentration, and the ability to follow instructions. Music education fosters creativity and cognitive development.

The BrainBehaviorReset TM Program is designed specifically to address the needs of children with ADHD. This innovative program combines the latest research in neuroscience , integrative therapy, nutrition supplementation , and holistic approaches to provide a comprehensive solution for children who face the daily challenges of ADHD. 

The program also offers insights and strategies that can empower parents and caregivers in their quest to support children with ADHD on their path to better mental health, improved focus, and enhanced overall well-being.

Parent Action Steps

☐ Begin by thoroughly understanding ADHD and its impact on your child's life.  ☐ Reach out to healthcare providers, therapists, and educators who specialize in ADHD.  ☐ Encourage your child to express their feelings, concerns, and ADHD experiences.  ☐ Create a structured daily routine that promotes predictability.  ☐ Understand that managing ADHD is a journey, and progress may be gradual.  ☐ Integrate therapy activities into your child's daily life.  ☐ Partner with your child's school to create an IEP or 504 Plan .  ☐ Take time to recharge and seek support from friends and family. ☐ Regularly evaluate your child's progress in managing ADHD.  ☐ Celebrate your child's achievements, both big and small.  ☐ Keep up-to-date with the latest research and developments in ADHD treatment. ☐ Take this ADHD Quiz to know if your child has ADHD or something else.  ☐ Try the Solutions Matcher to get personalized treatment for your child.

Cairncross, M., & Miller, C. J. (2016). The Effectiveness of Mindfulness-Based Therapies for ADHD. Journal of Attention Disorders, 24(5), 108705471562530.

Habib, H. A., & Ali, U. (2015). Efficacy of Art Therapy in the Reduction of Impulsive Behaviors of Children with ADHD Co-Morbid Intellectual Disability. Pakistan Journal of Psychology, 46(2).

Jarraya, S., Jarraya, M., & Engel, F. A. (2022). Kindergarten-Based Progressive Muscle Relaxation Training Enhances Attention and Executive Functioning in 5-6-year-old Children: A Randomized Controlled Trial. Perceptual and Motor Skills, 129(3), 003151252210803.

Always remember… “Calm Brain, Happy Family™”

Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.

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Dr. Roseann Capanna-Hodge has three decades of experience in working with children, teens and their families with attention-deficit hyperactivity disorder (ADHD), autism, concussion, dyslexia and learning disability, anxiety, Obsessive Compulsive Disorder (OCD), depression and mood disorder, Lyme Disease, and PANS/PANDAS using science-backed natural mental health solutions such as supplements, magnesium, nutrition, QEEG Brain maps, neurofeedback, PEMF, psychotherapy and other non-medication approaches. 

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Her trademarked BrainBehaviorResetⓇ Program and It’s Gonna be OK!Ⓡ Podcast has been a cornerstone for thousands of parents facing mental health, behavioral or neurodevelopmental challenges.

She is the founder and director of The Global Institute of Children’s Mental Health , Neurotastic™Brain Formulas and Dr. Roseann Capanna-Hodge, LLC . Dr. Roseann is a Board Certified Neurofeedback ( BCN ) Practitioner, a Board Member of the Northeast Region Biofeedback Society ( NRBS ), Certified Integrative Mental Health Professional (CIMHP) and an Amen Clinic Certified Brain Health Coach.  She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America ( ADAA ) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF ).

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symptoms & Executive Dysfunction

Executive Functions –7-page PDF worksheets and information to help you determine which executive functions are most affected by your ADHD. © 2022 Janna Willard, Actually ADHD

Types of ADHD, Executive Functions, Strengths –2-page PDF worksheet and information to help you understand your symptoms and your strengths. © 2022 Janna Willard, Actually ADHD

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Treatment Tracking –20-page PDF workbook to help you keep track of how your treatments are affecting you. Can be used to help keep professionals informed. © 2021 Janna Willard, Actually ADHD

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Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program, Therapist Guide (2 edn)

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Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program, Therapist Guide (2 edn)

Appendix Forms and Worksheets

  • Published: May 2017
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Accessing Treatments ThatWork Forms and Worksheets Online

All forms and worksheets from books in the TTW series are made available digitally shortly following print publication. You may download, print, save, and digitally complete them as PDFs. To access the forms and worksheets, please visit .

Problem-Solving: Selection of Action Plan

Steps for Sorting Mail

Developing an Organizational System

Strategies for Reducing Distractions

3-Column Thought Record

Preliminary Instructions for Adaptive Thinking

4-Column Thought Record

Instructions for Completing a 5-Column Thought Record and Developing a Rational Response

5-Column Thought Record

Pros and Cons of Procrastination

Treatment Strategies and Usefulness

One-Month Review

Handout A Preliminary Instructions for Adaptive Thinking

The purpose of using thought records is to identify and modify negative, automatic thoughts in situations that lead to feeling overwhelmed.

The first step in learning to think in more useful ways is to become more aware of these thoughts and their relationship to your feelings. If you are anticipating a stressful situation, or a task that is making you feel overwhelmed, write out your thoughts regarding this situation.

If a situation has already passed and you find that you are thinking about it negatively or if, in retrospect, you realize that you were having unhelpful thoughts, list your thoughts for this situation.

The first column is a description of the situation.

The second column is for you to list your thoughts during a stressful, overwhelming, or uncontrollable situation.

The third column is for you to write down what emotions or feelings you are having when thinking these thoughts (e.g., depressed, sad, angry).

The fourth column is for you to see if your thoughts match the list of “thinking errors.” These may include:

All-or-Nothing Thinking


Jumping to Conclusions (Fortune Telling/Mind Reading)


Emotional Reasoning

“Should” Statements

Labeling and Mislabeling


Maladaptive Thinking

Overly Optimistic Thinking

Handout B Instructions for Completing the 5-Column Thought Record and Developing a Rational Response

The purpose of adaptive thinking is to promote optimal thinking when you are feeling stressed. The steps that are involved can be achieved using the rest of the worksheet. Throughout the week when you are feeling stressed, sad, or overwhelmed, continue to list your thoughts for each situation. If you are anticipating a stressful situation or a task that is making you feel overwhelmed, write out your thoughts regarding this situation. If a situation has already passed and you find that you are thinking about it negatively, list your thoughts for this situation.

The third column is for you to write down what emotions you are having and what your mood is like when thinking these thoughts (e.g., depressed, sad, angry).

The fourth column is for you to see if your thoughts match the list of “thinking errors” These may include:

All-or-Nothing thinking

In the last column , try to come up with a rational response to each thought, or to the most important negative thought. The rational response is a statement that you can say to yourself to try to feel better about the situation. Questions to help come up with this rational response can include the following:

What is the evidence that this thought is true?

Is there an alternative explanation?

What is the worst thing that can happen?

Has this situation unreasonably grown in importance?

What would a good coach say about this situation?

Have I done what I can do to control it?

If I were to do anything else, would this help or hinder the situation?

Am I worrying excessively about this?

What would a good friend say to me about this situation?

What would I say to a good friend about this situation if he or she were going through it?

Why is this statement a cognitive distortion?

Is it helpful to focus on this thought at this moment?

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CBT Techniques: 25 Cognitive Behavioral Therapy Worksheets

Cognitive behavioral therapy techniques worksheets

It’s an extremely common type of talk therapy practiced around the world.

If you’ve ever interacted with a mental health therapist, a counselor, or a psychiatry clinician in a professional setting, it’s likely you’ve participated in CBT.

If you’ve ever heard friends or loved ones talk about how a mental health professional helped them identify unhelpful thoughts and patterns and behavior and alter them to more effectively work towards their goals, you’ve heard about the impacts of CBT.

CBT is one of the most frequently used tools in the psychologist’s toolbox. Though it’s based on simple principles, it can have wildly positive outcomes when put into practice.

In this article, we’ll explore what CBT is, how it works, and how you can apply its principles to improve your own life or the lives of your clients.

Before you read on, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with a comprehensive insight into Positive CBT and will give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is cbt, cognitive distortions, 9 essential cbt techniques and tools.

  • Cognitive Behavioral Therapy Worksheets (PDFs) To Print and Use

Some More CBT Interventions and Exercises

A cbt manual and workbook for your own practice and for your client, 5 final cognitive behavioral activities, a take-home message.

What Is Cognitive Behavioral Therapy

“This simple idea is that our unique patterns of thinking, feeling, and behaving are significant factors in our experiences, both good and bad. Since these patterns have such a significant impact on our experiences, it follows that altering these patterns can change our experiences” (Martin, 2016).

Cognitive-behavioral therapy aims to change our thought patterns, our conscious and unconscious beliefs, our attitudes, and, ultimately, our behavior, in order to help us face difficulties and achieve our goals.

Psychiatrist Aaron Beck was the first to practice cognitive behavioral therapy. Like most mental health professionals at the time, Beck was a  psychoanalysis  practitioner.

While practicing psychoanalysis, Beck noticed the prevalence of internal dialogue in his clients and realized how strong the link between thoughts and feelings can be. He altered the therapy he practiced in order to help his clients identify, understand, and deal with the automatic, emotion-filled thoughts  that regularly arose in his clients.

Beck found that a combination of cognitive therapy and behavioral techniques produced the best results for his clients. In describing and honing this new therapy, Beck laid the foundations of the most popular and influential form of therapy of the last 50 years.

This form of therapy is not designed for lifelong participation and aims to help clients meet their goals in the near future. Most CBT treatment regimens last from five to ten months, with clients participating in one 50- to 60-minute session per week.

CBT is a hands-on approach that requires both the therapist and the client to be invested in the process and willing to actively participate. The therapist and client work together as a team to identify the problems the client is facing, come up with strategies for addressing them, and creating positive solutions (Martin, 2016).

Cognitive Distortions

Many of the most popular and effective cognitive-behavioral therapy techniques are applied to what psychologists call “ cognitive distortions ,” inaccurate thoughts that reinforce negative thought patterns or emotions (Grohol, 2016).

There are 15 main cognitive distortions that can plague even the most balanced thinkers.

1. Filtering

Filtering refers to the way a person can ignore all of the positive and good things in life to focus solely on the negative. It’s the trap of dwelling on a single negative aspect of a situation, even when surrounded by an abundance of good things.

2. Polarized thinking / Black-and-white thinking

This cognitive distortion is all-or-nothing thinking, with no room for complexity or nuance—everything’s either black or white, never shades of gray.

If you don’t perform perfectly in some area, then you may see yourself as a total failure instead of simply recognizing that you may be unskilled in one area.

3. Overgeneralization

Overgeneralization is taking a single incident or point in time and using it as the sole piece of evidence for a broad conclusion.

For example, someone who overgeneralizes could bomb an important job interview and instead of brushing it off as one bad experience and trying again, they conclude that they are terrible at interviewing and will never get a job offer.

4. Jumping to conclusions

Similar to overgeneralization, this distortion involves faulty reasoning in how one makes conclusions. Unlike overgeneralizing one incident, jumping to conclusions refers to the tendency to be sure of something without any evidence at all.

For example, we might be convinced that someone dislikes us without having any real evidence, or we might believe that our fears will come true before we have a chance to really find out.

5. Catastrophizing / Magnifying or Minimizing

This distortion involves expecting that the worst will happen or has happened, based on an incident that is nowhere near as catastrophic as it is made out to be. For example, you may make a small mistake at work and be convinced that it will ruin the project you are working on, that your boss will be furious, and that you’ll lose your job.

Alternatively, one might minimize the importance of positive things, such as an accomplishment at work or a desirable personal characteristic.

6. Personalization

This is a distortion where an individual believes that everything they do has an impact on external events or other people, no matter how irrational that may be. A person with this distortion will feel that he or she has an exaggerated role in the bad things that happen around them.

For instance, a person may believe that arriving a few minutes late to a meeting led to it being derailed and that everything would have been fine if they were on time.

7. Control fallacies

This distortion involves feeling like everything that happens to you is either a result of purely external forces or entirely due to your own actions. Sometimes what happens to us is due to forces we can’t control, and sometimes what it’s due to our own actions, but the distortion is assuming that it is always one or the other.

We might assume that difficult coworkers are to blame for our own less-than-stellar work, or alternatively assume that every mistake another person makes is because of something we did.

8. Fallacy of fairness

We are often concerned about fairness, but this concern can be taken to extremes. As we all know, life is not always fair. The person who goes through life looking for fairness in all their experiences will end up resentful and unhappy.

Sometimes things will go our way, and sometimes they will not, regardless of how fair it may seem.

When things don’t go our way, there are many ways we can explain or assign responsibility for the outcome. One method of assigning responsibility is blaming others for what goes wrong.

Sometimes we may blame others for making us feel or act a certain way, but this is a cognitive distortion. Only you are responsible for the way you feel or act.

10. “Shoulds”

“Shoulds” refer to the implicit or explicit rules we have about how we and others should behave. When others break our rules, we are upset. When we break our own rules, we feel guilty. For example, we may have an unofficial rule that customer service representatives should always be accommodating to the customer.

When we interact with a customer service representative that is not immediately accommodating, we might get angry. If we have an implicit rule that we are irresponsible if we spend money on unnecessary things, we may feel exceedingly guilty when we spend even a small amount of money on something we don’t need.

11. Emotional reasoning

This distortion involves thinking that if we feel a certain way, it must be true. For example, if we feel unattractive or uninteresting in the current moment, we think we  are unattractive or uninteresting. This cognitive distortion boils down to:

“I feel it, therefore it must be true.”

Clearly, our emotions are not always indicative of the objective truth, but it can be difficult to look past how we feel.

12. Fallacy of change

The fallacy of change lies in expecting other people to change as it suits us. This ties into the feeling that our happiness depends on other people, and their unwillingness or inability to change, even if we demand it, keeps us from being happy.

This is a damaging way to think because no one is responsible for our own happiness except ourselves.

13. Global labeling / mislabeling

This cognitive distortion is an extreme form of generalizing, in which we generalize one or two instances or qualities into a global judgment. For example, if we fail at a specific task, we may conclude that we are a total failure in not only that area but all areas.

Alternatively, when a stranger says something a bit rude, we may conclude that he or she is an unfriendly person in general. Mislabeling is specific to using exaggerated and emotionally loaded language, such as saying a woman has abandoned her children when she leaves her children with a babysitter to enjoy a night out.

14. Always being right

While we all enjoy being right, this distortion makes us think we must be right, that being wrong is unacceptable.

We may believe that being right is more important than the feelings of others, being able to admit when we’ve made a mistake or being fair and objective.

15. Heaven’s Reward Fallacy

This distortion involves expecting that any sacrifice or self-denial will pay off. We may consider this karma, and expect that karma will always immediately reward us for our good deeds. This results in feelings of bitterness when we do not receive our reward (Grohol, 2016).

Many tools and techniques found in cognitive behavioral therapy are intended to address or reverse these cognitive distortions.

9 Essential CBT Tools

There are many tools and techniques used in cognitive behavioral therapy, many of which can be used in both a therapy context and in everyday life. The nine techniques and tools listed below are some of the most common and effective CBT practices.

1. Journaling

This technique is a way to gather about one’s moods and thoughts. A CBT journal can include the time of the mood or thought, the source of it, the extent or intensity, and how we reacted, among other factors.

This technique can help us to identify our thought patterns and emotional tendencies, describe them, and change, adapt, or cope with them (Utley & Garza, 2011).

Follow the link to find out more about using a thought diary for journaling.

2. Unraveling cognitive distortions

This is a primary goal of CBT and can be practiced with or without the help of a therapist. In order to unravel cognitive distortions, you must first become aware of the distortions from which you commonly suffer (Hamamci, 2002).

Part of this involves identifying and challenging harmful automatic thoughts, which frequently fall into one of the 15 categories listed earlier.

3. Cognitive restructuring

Once you identify the distortions you hold, you can begin to explore how those distortions took root and why you came to believe them. When you discover a belief that is destructive or harmful, you can begin to challenge it (Larsson, Hooper, Osborne, Bennett, & McHugh, 2015).

For example, if you believe that you must have a high-paying job to be a respectable person, but you’re then laid off from your high-paying job, you will begin to feel bad about yourself.

Instead of accepting this faulty belief that leads you to think negative thoughts about yourself, with cognitive restructuring you could take an opportunity to think about what really makes a person “respectable,” a belief you may not have explicitly considered before.

4. Exposure and response prevention

This technique is specifically effective for those who suffer from obsessive-compulsive disorder (OCD; Abramowitz, 1996). You can practice this technique by exposing yourself to whatever it is that normally elicits a compulsive behavior, but doing your best to refrain from the behavior.

You can combine journaling with this technique, or use journaling to understand how this technique makes you feel.

5. Interoceptive exposure

Interoceptive Exposure is intended to treat panic and anxiety. It involves exposure to feared bodily sensations in order to elicit the response (Arntz, 2002). Doing so activates any unhelpful beliefs associated with the sensations, maintains the sensations without distraction or avoidance, and allows new learning about the sensations to take place.

It is intended to help the sufferer see that symptoms of panic are not dangerous, although they may be uncomfortable.

6. Nightmare exposure and rescripting

Nightmare exposure and rescripting are intended specifically for those suffering from nightmares. This technique is similar to interoceptive exposure, in that the nightmare is elicited, which brings up the relevant emotion (Pruiksma, Cranston, Rhudy, Micol, & Davis, 2018).

Once the emotion has arisen, the client and therapist work together to identify the desired emotion and develop a new image to accompany the desired emotion.

7. Play the script until the end

This technique is especially useful for those suffering from fear and anxiety. In this technique, the individual who is vulnerable to crippling fear or anxiety conducts a sort of thought experiment in which they imagine the outcome of the worst-case scenario.

Letting this scenario play out can help the individual to recognize that even if everything he or she fears comes to pass, the outcome will still be manageable (Chankapa, 2018).

8. Progressive muscle relaxation

This is a familiar technique to those who practice mindfulness. Similar to the body scan, progressive muscle relaxation instructs you to relax one muscle group at a time until your whole body is in a state of relaxation (McCallie, Blum, & Hood, 2006).

You can use audio guidance, a YouTube video, or simply your own mind to practice this technique, and it can be especially helpful for calming nerves and soothing a busy and unfocused mind.

9. Relaxed breathing

This is another technique that will be familiar to practitioners of mindfulness . There are many ways to relax and bring regularity to your breath, including guided and unguided imagery, audio recordings, YouTube videos, and scripts. Bringing regularity and calm to your breath will allow you to approach your problems from a place of balance, facilitating more effective and rational decisions (Megan, 2016).

These techniques can help those suffering from a range of mental illnesses and afflictions, including anxiety, depression, OCD, and panic disorder, and they can be practiced with or without the guidance of a therapist. To try some of these techniques without the help of a therapist, see the next section for worksheets and handouts to assist with your practice.

How does cognitive behavioral therapy work – Psych Hub

Cognitive-Behavioral Therapy Worksheets (PDFs) To Print and Use

Essential CBT Techniques and Tools

1. Coping styles worksheet

This PDF Coping Styles Formulation Worksheet instructs you or your client to first list any current perceived problems or difficulties – “The Problem”. You or your client will work backward to list risk factors above (i.e., why you are more likely to experience these problems than someone else) and triggers or events (i.e., the stimulus or source of these problems).

Once you have defined the problems and understand why you are struggling with them, you then list coping strategies. These are not solutions to your problems, but ways to deal with the effects of those problems that can have a temporary impact. Next, you list the effectiveness of the coping strategies, such as how they make you feel in the short- and long-term, and the advantages and disadvantages of each strategy.

Finally, you move on to listing alternative actions. If your coping strategies are not totally effective against the problems and difficulties that are happening, you are instructed to list other strategies that may work better.

This worksheet gets you (or your client) thinking about what you are doing now and whether it is the best way forward.

2. ABC functional analysis

One popular technique in CBT is ABC functional analysis . Functional analysis helps you (or the client) learn about yourself, specifically, what leads to specific behaviors and what consequences result from those behaviors.

In the middle of the worksheet is a box labeled “Behaviors.” In this box, you write down any potentially problematic behaviors you want to analyze.

On the left side of the worksheet is a box labeled “Antecedents,” in which you or the client write down the factors that preceded a particular behavior. These are factors that led up to the behavior under consideration, either directly or indirectly.

On the right side is the final box, labeled “Consequences.” This is where you write down what happened as a result of the behavior under consideration. “Consequences” may sound inherently negative, but that’s not necessarily the case; some positive consequences can arise from many types of behaviors, even if the same behavior also leads to negative consequences.

This ABC Functional Analysis Worksheet can help you or your client to find out whether particular behaviors are adaptive and helpful in striving toward your goals, or destructive and self-defeating.

3. Case formulation worksheet

In CBT, there are 4 “P’s” in Case Formulation:

  • Predisposing factors;
  • Precipitating factors;
  • Perpetuating factors; and
  • Protective factors

They help us understand what might be leading a perceived problem to arise, and what might prevent them from being tackled effectively.

In this worksheet, a therapist will work with their client through 4 steps.

First, they identify predisposing factors, which are those external or internal and can add to the likelihood of someone developing a perceived problem (“The Problem”). Examples might include genetics, life events, or their temperament.

Together, they collaborate to identify precipitating factors, which provide insight into precise events or triggers that lead to “The Problem” presenting itself. Then they consider perpetuating factors, to discover what reinforcers may be maintaining the current problem.

Last, they identify protective factors, to understand the client’s strengths, social supports, and adaptive behavioral patterns.

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Download 3 Free Positive CBT Exercises (PDF)

These detailed, science-based exercises will equip you or your clients with tools to find new pathways to reduce suffering and more effectively cope with life stressors.

Download 3 Free Positive CBT Tools Pack (PDF)

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4. Extended case formulation worksheet

This worksheet builds on the last. It helps you or your client address the “Four P Factors” described just above—predisposing, precipitating, perpetuating, and protective factors. This formulation process can help you or your client connect the dots between core beliefs, thought patterns, and present behavior.

This worksheet presents six boxes on the left of the page (Part A), which should be completed before moving on to the right-hand side of the worksheet (Part B).

  • The first box is labeled “The Problem,” and corresponds with the perceived difficulty that your client is experiencing. In this box, you are instructed to write down the events or stimuli that are linked to a certain behavior.
  • The next box is labeled “Early Experiences” and corresponds to the predisposing factor. This is where you list the experiences that you had early in life that may have contributed to the behavior.
  • The third box is “Core Beliefs,” which is also related to the predisposing factor. This is where you write down some relevant core beliefs you have regarding this behavior. These are beliefs that may not be explicit, but that you believe deep down, such as “I’m bad” or “I’m not good enough.”
  • The fourth box is “Conditional assumptions/rules/attitudes,” which is where you list the rules that you adhere to, whether consciously or subconsciously. These implicit or explicit rules can perpetuate the behavior, even if it is not helpful or adaptive. Rules are if-then statements that provide a judgment based on a set of circumstances. For instance, you may have the rule “If I do not do something perfectly, I’m a complete failure.”
  • The fifth box is labeled “Maladaptive Coping Strategies” This is where you write down how well these rules are working for you (or not). Are they helping you to be the best you can be? Are they helping you to effectively strive towards your goals?
  • Finally, the last box us titled “Positives.” This is where you list the factors that can help you deal with the problematic behavior or thought, and perhaps help you break the perpetuating cycle. These can be things that help you cope once the thought or behavior arises or things that can disrupt the pattern once it is in motion.

On the right, there is a flow chart that you can fill out based on how these behaviors and feelings are perpetuated. You are instructed to think of a situation that produces a negative automatic thought and record the emotion and behavior that this thought provokes, as well as the bodily sensations that can result. Filling out this flow chart can help you see what drives your behavior or thought and what results from it.

Download our PDF Extended Case Formulation Worksheet .

5. Dysfunctional thought record

This worksheet is especially helpful for people who struggle with negative thoughts and need to figure out when and why those thoughts are most likely to pop up. Learning more about what provokes certain automatic thoughts makes them easier to address and reverse.

The worksheet is divided into seven columns:

  • On the far left, there is space to write down the date and time a dysfunctional thought arose.
  • The second column is where the situation is listed. The user is instructed to describe the event that led up to the dysfunctional thought in detail.
  • The third column is for the automatic thought. This is where the dysfunctional automatic thought is recorded, along with a rating of belief in the thought on a scale from 0% to 100%.
  • The next column is where the emotion or emotions elicited by this thought are listed, also with a rating of intensity on a scale from 0% to 100%.
  • Use this fifth column to note the dysfunctional thought that will be addressed. Example maladaptive thoughts include distortions such as over-inflating the negative while dismissing the positive of a situation, or overgeneralizing.
  • The second-to-last column is for the user to write down alternative thoughts that are more positive and functional to replace the negative one.
  • Finally, the last column is for the user to write down the outcome of this exercise. Were you able to confront the dysfunctional thought? Did you write down a convincing alternative thought? Did your belief in the thought and/or the intensity of your emotion(s) decrease?

Download this Dysfunctional Thought Record as a PDF.

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6. Fact-checking

One of my favorite CBT tools is this  Fact Checking Thoughts Worksheet because it can be extremely helpful in recognizing that your thoughts are not necessarily true.

At the top of this worksheet is an important lesson:

Thoughts are not facts.

Of course, it can be hard to accept this, especially when we are in the throes of a dysfunctional thought or intense emotion. Filling out this worksheet can help you come to this realization.

The worksheet includes 16 statements that the user must decide are either fact or opinion. These statements include:

  • I’m a bad person.
  • I failed the test.
  • I’m selfish.
  • I didn’t lend my friend money when they asked.

This is not a trick—there is a right answer for each of these statements. (In case you’re wondering, the correct answers for the statements above are as follows: opinion, fact, opinion, fact.)

This simple exercise can help the user to see that while we have lots of emotionally charged thoughts, they are not all objective truths. Recognizing the difference between fact and opinion can assist us in challenging the dysfunctional or harmful opinions we have about ourselves and others.

7. Cognitive restructuring

This worksheet employs the use of Socratic questioning, a technique that can help the user to challenge irrational or illogical thoughts.

The first page of the worksheet has a thought bubble for “What I’m Thinking”. You or your client can use this space to write down a specific thought, usually, one you suspect is destructive or irrational.

Next, you write down the facts supporting and contradicting this thought as a reality. What facts about this thought being accurate? What facts call it into question? Once you have identified the evidence, you can use the last box to make a judgment on this thought, specifically whether it is based on evidence or simply your opinion.

The next page is a mind map of Socratic Questions which can be used to further challenge the thought. You may wish to re-write “What I’m Thinking” in the center so it is easier to challenge the thought against these questions.

  • One question asks whether this thought is truly a black-and-white situation, or whether reality leaves room for shades of gray. This is where you think about (and write down) whether you are using all-or-nothing thinking, for example, or making things unreasonably simple when they are complex.
  • Another asks whether you could be misinterpreting the evidence or making any unverified assumptions. As with all the other bubbles, writing it down will make this exercise more effective.
  • A third bubble instructs you to think about whether other people might have different interpretations of the same situation, and what those interpretations might be.
  • Next, ask yourself whether you are looking at all the relevant evidence or just the evidence that backs up the belief you already hold. Try to be as objective as possible.
  • It also helps to ask yourself whether your thought may an over-inflation of a truth. Some negative thoughts are based in truth but extend past their logical boundaries.
  • You’re also instructed to consider whether you are entertaining this negative thought out of habit or because the facts truly support it.
  • Then, think about how this thought came to you. Was it passed on from someone else? If so, is that person a reliable source of truth?
  • Finally, you complete the worksheet by identifying how likely the scenario your thought brings up actually is, and whether it is the worst-case scenario.

These Socratic questions encourage a deep dive into the thoughts that plague you and offer opportunities to analyze and evaluate those thoughts. If you are having thoughts that do not come from a place of truth, this Cognitive Restructuring Worksheet can be an excellent tool for identifying and defusing them.

How is positive cognitive-behavioral therapy (CBT) different from traditional CBT?

Although both forms of CBT have the same goal of bringing about positive changes in a client’s life, the pathways used in traditional and positive CBT to actualize this goal differ considerably. Traditional CBT, as initially formulated by Beck (1967), focuses primarily on the following:

  • Analyzing problems
  • Lessening what causes suffering
  • Working on clients’ weaknesses
  • Getting away from problems

Instead, positive CBT, as formulated by Bannink (2012), focuses mainly on the following:

  • Finding solutions
  • Enhancing what causes flourishing
  • Working with client’s strengths
  • Getting closer to the preferred future

In other words, Positive CBT shifts the focus on what’s right with the person (rather than what’s wrong with them) and on what’s working (rather than what’s not working) to foster a more optimistic process that empowers clients to flourish and thrive.

In an initial study comparing the effects of traditional and Positive CBT in the treatment of depression, positive CBT resulted in a more substantial reduction of depression symptoms, a more significant increase in happiness, and it was associated with less dropout (Geschwind et al., 2019).

therapy worksheets adhd

Haven’t had enough CBT tools and techniques yet? Read on for additional useful and effective exercises.

1. Behavioral experiments

These are related to thought experiments, in that you engage in a “what if” consideration. Behavioral experiments differ from thought experiments in that you actually test out these “what ifs” outside of your thoughts (Boyes, 2012).

In order to test a thought, you can experiment with the outcomes that different thoughts produce. For example, you can test the thoughts:

“If I criticize myself, I will be motivated to work harder” versus “If I am kind to myself, I will be motivated to work harder.”

First, you would try criticizing yourself when you need the motivation to work harder and record the results. Then you would try being kind to yourself and recording the results. Next, you would compare the results to see which thought was closer to the truth.

These Behavioral Experiments to Test Beliefs can help you learn how to achieve your therapeutic goals and how to be your best self.

2. Thought records

Thought records are useful in testing the validity of your thoughts (Boyes, 2012). They involve gathering and evaluating evidence for and against a particular thought, allowing for an evidence-based conclusion on whether the thought is valid or not.

For example, you may have the belief “My friend thinks I’m a bad friend.” You would think of all the evidence for this belief, such as “She didn’t answer the phone the last time I called,” or “She canceled our plans at the last minute,” and evidence against this belief, like “She called me back after not answering the phone,” and “She invited me to her barbecue next week. If she thought I was a bad friend, she probably wouldn’t have invited me.”

Once you have evidence for and against, the goal is to come up with more balanced thoughts, such as, “My friend is busy and has other friends, so she can’t always answer the phone when I call. If I am understanding of this, I will truly be a good friend.”

Thought records apply the use of logic to ward off unreasonable negative thoughts and replace them with more balanced, rational thoughts (Boyes, 2012).

Here’s a helpful Thought Record Worksheet to download.

3. Pleasant activity scheduling

This technique can be especially helpful for dealing with depression (Boyes, 2012). It involves scheduling activities in the near future that you can look forward to.

For example, you may write down one activity per day that you will engage in over the next week. This can be as simple as watching a movie you are excited to see or calling a friend to chat. It can be anything that is pleasant for you, as long as it is not unhealthy (i.e., eating a whole cake in one sitting or smoking).

You can also try scheduling an activity for each day that provides you with a sense of mastery or accomplishment (Boyes, 2012). It’s great to do something pleasant, but doing something small that can make you feel accomplished may have more long-lasting and far-reaching effects.

This simple technique can introduce more positivity into your life, and our Pleasant Activity Scheduling Worksheet is designed to help.

4. Imagery-based exposure

This exercise involves thinking about a recent memory that produced strong negative emotions and analyzing the situation.

For example, if you recently had a fight with your significant other and they said something hurtful, you can bring that situation to mind and try to remember it in detail. Next, you would try to label the emotions and thoughts you experienced during the situation and identify the urges you felt (e.g., to run away, to yell at your significant other, or to cry).

Visualizing this negative situation, especially for a prolonged period of time, can help you to take away its ability to trigger you and reduce avoidance coping (Boyes, 2012). When you expose yourself to all of the feelings and urges you felt in the situation and survive experiencing the memory, it takes some of its power away.

This Imagery Based Exposure Worksheet is a useful resource for this exercise.

5. Graded exposure worksheet

This technique may sound complicated, but it’s relatively simple.

Making a situation exposure hierarchy involves means listing situations that you would normally avoid (Boyes, 2012). For example, someone with severe social anxiety may typically avoid making a phone call or asking someone on a date.

Next, you rate each item on how distressed you think you would be, on a scale from 0 to 10, if you engaged in it. For the person suffering from severe social anxiety, asking someone on a date may be rated a 10 on the scale, while making a phone call might be rated closer to a 3 or 4.

Once you have rated the situations, you rank them according to their distress rating. This will help you recognize the biggest difficulties you face, which can help you decide which items to address and in what order. It’s often advised to start with the least distressing items and work your way up to the most distressing items.

Download our Graded Exposure Worksheet here.

Situation Exposure Hierarchies CBT Interventions and Exercises

Some of these books are for the therapist only, and some are to be navigated as a team or with guidance from the therapist.

There are many manuals out there for helping therapists apply cognitive behavioral therapy in their work, but these are some of the most popular:

  • A Therapist’s Guide to Brief Cognitive Behavioral Therapy by Jeffrey A. Cully and Andra L. Teten (PDF here );
  • Individual Therapy Manual for Cognitive-Behavioral Treatment of Depression by Ricardo F. Munoz and Jeanne Miranda (PDF here );
  • Provider’s Guidebook: “Activities and Your Mood” by Community Partners in Care (PDF here );
  • Treatment Manual for Cognitive Behavioral Therapy for Depression by Jeannette Rosselló, Guillermo Bernal, and the Institute for Psychological Research (PDF here ).

Here are some of the most popular workbooks and manuals for clients to use alone or with a therapist:

  • The CBT Toolbox: A Workbook for Clients and Clinicians by Jeff Riggenbach ( Amazon );
  • Client’s Guidebook: “Activities and Your Mood” by Community Partners in Care (PDF here );
  • The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program by William J. Knaus and Jon Carlson ( Amazon );
  • The Cognitive Behavioral Workbook for Depression: A Step-by-Step Program by William J. Knaus and Albert Ellis ( Amazon );
  • Cognitive-Behavioral Therapy Skills Workbook by Barry Gregory ( Amazon );
  • A Course in CBT Techniques: A Free Online CBT Workbook  by Albert Bonfil and Suraji Wagage (online here ).

There are many other manuals and workbooks available that can help get you started with CBT, but the tools above are a good start. Peruse our article: 30 Best CBT Books to Master Cognitive Behavioral Therapy for an excellent list of these books.

Body Scan Meditation

1. Mindfulness meditation

Mindfulness can have a wide range of positive impacts, including helping with depression, anxiety, addiction, and many other mental illnesses or difficulties.

The practice can help those suffering from harmful automatic thoughts to disengage from rumination and obsession by helping them stay firmly grounded in the present (Jain et al., 2007).

Mindfulness meditations, in particular, can function as helpful tools for your clients in between therapy sessions, such as to help ground them in the present moment during times of stress.

If you are a therapist who uses mindfulness-based approaches, consider finding or pre-recording some short mindfulness meditation exercises for your clients.

You might then share these with your clients as part of a toolkit they can draw on at their convenience, such as using the blended care platform Quenza (pictured here), which allows clients to access meditations or other psychoeducational activities on-the-go via their portable devices.

2. Successive approximation

This is a fancy name for a simple idea that you have likely already heard of: breaking up large tasks into small steps.

It can be overwhelming to be faced with a huge goal, like opening a business or remodeling a house. This is true in mental health treatment as well, since the goal to overcome depression or anxiety and achieve mental wellness can seem like a monumental task.

By breaking the large goal into small, easy-to-accomplish steps, we can map out the path to success and make the journey seem a little less overwhelming (e.g., Emmelkamp & Ultee, 1974).

3. Writing self-statements to counteract negative thoughts

This technique can be difficult for someone who’s new to CBT treatment or suffering from severe symptoms, but it can also be extremely effective (Anderson, 2014).

When you (or your client) are being plagued by negative thoughts, it can be hard to confront them, especially if your belief in these thoughts is strong. To counteract these negative thoughts, it can be helpful to write down a positive, opposite thought.

For example, if the thought “I am worthless” keeps popping into your head, try writing down a statement like “I am a person with worth,” or “I am a person with potential.” In the beginning, it can be difficult to accept these replacement thoughts, but the more you bring out these positive thoughts to counteract the negative ones, the stronger the association will be.

4. Visualize the best parts of your day

When you are feeling depressed or negative, it is difficult to recognize that there are positive aspects of life. This simple technique of bringing to mind the good parts of your day can be a small step in the direction of recognizing the positive (Anderson, 2014).

All you need to do is write down the things in your life that you are thankful for or the most positive events that happen in a given day. The simple act of writing down these good things can forge new associations in your brain that make it easier to see the positive, even when you are experiencing negative emotions.

5. Reframe your negative thoughts

It can be easy to succumb to negative thoughts as a default setting. If you find yourself immediately thinking a negative thought when you see something new, such as entering an unfamiliar room and thinking “I hate the color of that wall,” give reframing a try (Anderson, 2014).

Reframing involves countering the negative thought(s) by noticing things you feel positive about as quickly as possible. For instance, in the example where you immediately think of how much you hate the color of that wall, you would push yourself to notice five things in the room that you feel positively about (e.g., the carpet looks comfortable, the lampshade is pretty, the windows let in a lot of sunshine).

You can set your phone to remind you throughout the day to stop what you are doing and think of the positive things around you. This can help you to push your thoughts back into the realm of the positive instead of the negative.

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17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

In this post, we offered many techniques, tools, and resources that can be effective in the battle against depression, anxiety, OCD, and a host of other problems or difficulties.

However, as is the case with many treatments, they depend on you (or your client) putting in a lot of effort. We encourage you to give these techniques a real try and allow yourself the luxury of thinking that they could actually work.

When we approach a potential solution with the assumption that it will not work, that assumption often becomes a self-fulfilling prophecy. When we approach a potential solution with an open mind and the belief that it just might work, it has a much better chance of succeeding.

So if you are struggling with negative automatic thoughts , please consider these tips and techniques and give them a shot. Likewise, if your client is struggling, encourage them to make the effort, because the payoff can be better than they can imagine.

If you are struggling with severe symptoms of depression or suicidal thoughts, please call the following number in your respective country:

  • USA: National Suicide Prevention Hotline at 988;
  • UK: Samaritans hotline at 116 123;
  • The Netherlands: Netherlands Suicide Hotline at 09000767;
  • France: Suicide écoute at 01 45 39 40 00;
  • Germany: Telefonseelsorge at 0800 111 0 111 or 0800 111 0 222

For a list of other suicide prevention websites, phone numbers, and resources, see this website .

Please know that there are people out there who care and that there are treatments that can help.

Please let us know about your experiences with CBT in the comments section. If you’ve tried it, how did it work for you? Are there any other helpful exercises or techniques that we did not touch on in this piece? We’d love to know your thoughts.

We hope you enjoyed this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

  • Abramowitz, J. S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy , 27 (4), 583-600.
  • Anderson, J. (2014, June 12). 5 Get-positive techniques from cognitive behavioral therapy. Retrieved from
  • Arntz, A. (2002). Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Behaviour Research and Therapy , 40 (3), 325-341.
  • Bannink, F. (2012).  Practicing positive CBT: From reducing distress to building success . John Wiley & Sons.
  • Beck, A. T. (1967). Depression. Hoeber-Harper.
  • Boyes, A. (2012, December 6). Cognitive behavioral therapy techniques that work: Mix and match cognitive behavioral therapy techniques to fit your preferences. Retrieved from
  • Chankapa, N. P. (2018). Effectiveness of cognitive behavioral therapy on depression and self-efficacy among out-patient female depressants in Sikkim  (Masters dissertation). Retrieved from
  • Davis, R. (2019, March 6). The complete list of cognitive behavioral therapy (CBT) techniques. Retrieved from
  • Emmelkamp, P. M., & Ultee, K. A. (1974). A comparison of “successive approximation” and “self-observation” in the treatment of agoraphobia. Behavior Therapy, 5 (5), 606–613.
  • Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy.  Behaviour research and therapy, 116 , 119-130.
  • Grohol, J. (2016). 15 Common cognitive distortions. Retrieved from
  • Hamamci, Z. (2002). The effect of integrating psychodrama and cognitive behavioral therapy on reducing cognitive distortions in interpersonal relationships. Journal of Group Psychotherapy, Psychodrama & Sociometry ,  55 (1), 3–14.
  • Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine , 33 (1), 11-21.
  • Larsson, A., Hooper, N., Osborne, L. A., Bennett, P., & McHugh, L. (2016). Using brief cognitive restructuring and cognitive defusion techniques to cope with negative thoughts. Behavior Modification , 40 (3), 452-482.
  • Martin, B. (2016). In-depth: Cognitive behavioral therapy.  Retrieved from
  • McCallie, M. S., Blum, C. M., & Hood, C. J. (2006). Progressive muscle relaxation. Journal of Human Behavior in the Social Environment , 13 (3), 51-66.
  • Pathak, N. (Ed.). (2018). Does cognitive behavioral therapy treat depression? Retrieved from
  • Pruiksma, K. E., Cranston, C. C., Rhudy, J. L., Micol, R. L., & Davis, J. L. (2018). Randomized controlled trial to dismantle exposure, relaxation, and rescripting therapy (ERRT) for trauma-related nightmares. Psychological trauma: theory, research, practice, and policy , 10 (1), 67-75.
  • Psychology Tools. (n.d.). Retrieved from
  • Therapist Aid. (n.d.). Retrieved from
  • Utley, A., & Garza, Y. (2011). The therapeutic use of journaling with adolescents. Journal of Creativity in Mental Health , 6 (1), 29-41.

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Thanks for providing in-depth information on cognitive behavioral therapy techniques.


Loved the article. This was very useful, and very much appreciate all the free resources you included. Mahalo!

Leticia N. Parris BSN RN CHLC

I am a nurse and a holistic life coach and these resources were very helpful to revise and improve my practice!

Prasun Talukdar

This is ridiculous. More ad than content. Misleading title.It is not a free website that you flood the viewers with so many ads. And if you are making so much money through ads then make the entire content free , since it is for the betterment of patients with mental health

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Susan Jaros, LCSW

Thank you for the work put into this amazing article! It encompasses every bit of CBT that is so useful for clients increasing their understanding of how “this” works in a very well-written tone. Well done!


Thank you for the useful material that is free of charge. It will come in handy especially the providers guidebook “activities and your mood” for my client who has been diagnosed with depression.

Prem Ghai

The subject CBT is well covered with comprehensive suggestions for the candidates. The aspect of voluntary access by the Therapist to the mentally challenged/deppressed people , needs to be stressed upon,as majority won’t open up.. Thnx educating on a high value subject.

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It is very informative, keep up the good work

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3 Positive CBT Exercises (PDF)

therapy worksheets adhd

DBT for Attention Deficit Hyperactivity Disorder (ADHD)

Michael Vallejo, LCSW

Have you ever felt like your brain is going a million miles an hour, and it’s impossible to focus on anything? If this sounds familiar to you or is something you observed in others, then it might be Attention Deficit Hyperactivity Disorder (ADHD). Here, we’ll explore how dialectical behavior therapy (DBT) for ADHD can be a powerful tool for managing symptoms and improving overall well-being.


ADHD is a condition that is characterized by long-term and significant patterns of inattention and/or hyperactivity and impulsivity. Some common symptoms that both children and adults exhibit may include difficulty with attention, issues with attention to detail, difficulty waiting, excessive speaking, forgetfulness, fidgeting, and more.

To be diagnosed with ADHD, these symptoms must be present before the age of 12 and significantly affect several areas of life, such as school, work, or home. ADHD can range between mild and debilitating and can harm one’s quality of life.

DBT has received more attention in recent years for its benefits in treating ADHD. It shows great potential in treating the emotional dysregulation and impulse control issues that often present in people with ADHD. Since DBT focuses on skills such as emotion regulation and distress tolerance skills, it is fit to treat those with an ADHD diagnosis.

How DBT Works for ADHD

DBT was not specifically designed for ADHD; in fact, it was originally created for patients who had borderline personality disorder. However, many of its principles and strategies can be adjusted to address the unique challenges associated with ADHD and manage its symptoms. DBT can target some of the common difficulties experienced by individuals with ADHD, including:

  • Emotional dysregulation. Individuals with ADHD, including ADHD in children , struggle when it comes to managing their emotions. This results in mood swings, impulsivity, and interpersonal conflicts. DBT skills like emotion regulation, mindfulness, and distress tolerance can help individuals of all ages better understand and cope with their emotions.
  • Impulsivity. Impulsive behavior is central to ADHD and can result in negative consequences in various aspects of life. DBT emphasizes mindfulness and distress tolerance, which can help people with ADHD pause before acting on impulses so they can make more well-thought-out decisions.
  • Interpersonal difficulties. ADHD can also affect social functioning. This can lead to challenges in communicating effectively and maintaining relationships. DBT also focuses on interpersonal effectiveness as a skill, which can help individuals navigate social situations better.

DBT Skills for ADHD

What exactly are DBT skills? These are DBT modules for ADHD or tools that one can develop and use to better cope with different challenges.


Mindfulness skills are about being grounded in the present moment while focusing on your current situation. Regularly practicing mindfulness can help you stay grounded and increase your focus. By doing this, you can recognize your impulsive behaviors and fluctuating emotions, allowing you to cope ahead for future stressors.

Related:  7 DBT Mindfulness Exercises to Help Control Your Emotions

Distress Tolerance

Many of our worst emotions can seem unbearable or intolerable, which can influence us to make hasty decisions. Distress tolerance gives you tangible skills like guided self-soothing and other easy-to-use methods that activate your parasympathetic nervous system to reduce distress. It gives you space from the emotion so that you can choose balanced behavior.

Emotion Regulation

Inconsistent self-care and dysregulated emotions can exacerbate ADHD symptoms. DBT emotion regulation skills , which can be found in DBT for adults or DBT for kids , help you stop unwanted emotions from appearing, help you regulate or change them when they start, and learn how to accept and be comfortable with them. Skills for emotion regulation also involve prioritizing balanced diets, sleep, exercise, and prescription medication age, all of which can reduce the symptoms of ADHD.

Interpersonal Effectiveness

Those with ADHD can sometimes struggle with ineffective social behaviors that can negatively affect relationships. DBT for teens and adults can help in learning how to be a good friend and keeping friends through this interpersonal skill . It provides clear instructions on maintaining relationships with others, asking for what you want, and preserving your self-respect. This skill also allows you to head off problems and resolve conflicts before they become overwhelming.

In several studies, DBT skills training has been found to improve many conditions.

Is DBT Effective for Managing ADHD Symptoms?

While research is still being done on the use of DBT for ADHD, there have been some studies that show its effectiveness.

For example, one study explored the treatment of ADHD in teens who participated in a DBT-based skills training group. Findings showed that participants with higher impulsivity, hyperactivity, conduct problems, and emotional dysregulation benefited from the DBT intervention [ * ].

Another study found that adults with ADHD who were recipients of a 14-week DBT-based group treatment significantly improved in different areas, such as ADHD symptoms, executive functioning, and overall quality of life [ * ]. This was compared to participants receiving treatment as usual. The observed improvements were maintained even after a six-month follow-up.

How Long Does it Take to See Results from DBT for ADHD?

The timeframe for seeing results from DBT for ADHD can vary depending on several factors, including the severity of ADHD, commitment to therapy, and individual differences.

Some general guidelines can help you set realistic expectations:

  • Initial benefits. Some people report feeling a sense of validation and improved emotional regulation skills within the first few weeks.
  • Skill development. Learning and mastering the core DBT skills (mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness) can take several months of consistent practice.
  • Symptom reduction. Significant reductions in ADHD symptoms like inattention, impulsivity, and hyperactivity might take three to six months or longer, depending on the factors mentioned above.

Remember, DBT is a long-term therapy approach. While initial changes can be encouraging, consistent practice is key to sustained improvements in managing ADHD and its impact on your life. Discussing your progress and expectations with your therapist throughout the process is important.

Are There Risks and Side Effects Associated with DBT for ADHD?

DBT is generally considered a safe and effective treatment for various mental health conditions, including some ADHD symptoms. However, it's important to understand that it's not without some potential challenges.

DBT can be intensive, requiring regular therapy sessions and consistent practice of the learned skills on your own. This commitment can be demanding for some individuals. It may also involve confronting difficult emotions and past experiences. While this ultimately leads to growth, it can be uncomfortable in the short term.

DBT also emphasizes changing unhelpful behaviors and thought patterns. This can be challenging, especially when dealing with ingrained habits or long-standing emotional responses.

The success of DBT heavily relies on a strong therapeutic relationship. Finding a therapist you feel comfortable with and who specializes in DBT for ADHD is crucial.

It's important to note that these are not necessarily side effects but rather potential challenges that can arise during DBT therapy.

The Bottom Line

So, is DBT good for ADHD? Of the various ways that ADHD is treated, DBT stands out for its ability to treat the emotional, behavioral, and interpersonal difficulties that come with the condition. DBT and ADHD go hand in hand and can help individuals by better managing their symptoms and enhancing their general functioning by teaching them skills like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Although further research is required to determine DBT's full efficacy in treating ADHD, the data we have suggests that it can serve as a beneficial supplement to a comprehensive therapy strategy.

For more tools on DBT, feel free to check out our printable DBT worksheets , which are visually engaging and relevant for kids, teens, and adults. We also offer ADHD resources that target the primary executive function deficits found in ADHD, but are not related to DBT treatment.


  • Meyer J, Zetterqvist V, Hallerbäck M, et al. Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training? 6 December 2022.
  • Halmøy A, Ring A, Gjestad R, et al. Dialectical behavioral therapy-based group treatment versus treatment as usual for adults with attention-deficit hyperactivity disorder: a multicenter randomized controlled trial. 28 November 2022.

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13 Printable Distress Tolerance Worksheets and Handouts

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Free Resource: Everything You Need to Know About CBT

Cognitive behavioral therapy (cbt) helps many adults with adhd to manage the negative thoughts and unhealthy habits that often accompany the condition. learn the facts about cbt in this faq..

Carl Sherman

Cognitive Behavioral Therapy: Natural Treatment for ADHD

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What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy — more commonly known as CBT — is an umbrella term for a type of therapy originally designed to treat PTSD and anxiety disorders. In recent years, however, CBT has expanded to treat ADHD in adults, opening up an effective, non-medical pathway for adults looking to better manage difficult symptoms related to organization, time management, and self-esteem.

In this free resource, you’ll learn the answers to some of the most common questions about CBT , including how it works for people with ADHD , what a session will typically look like, and where you can start searching for a competent therapist in your area.

If you’re interested in trying CBT — or just want to learn the facts about this well-regarded alternative treatment — this free resource is the place to get started. Download now!

NOTE: This resource is for personal use only.

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DBT Skills: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness

DBT Skills: The Go-To Treatment for ADD?

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ADHD Coping Skills Worksheet PDF

Paying attention, staying organized, and controlling your energy can be a challenge if you have ADHD. Our ADHD Coping Skills Worksheet PDF (Editable, Fillable, Printable) is perfect for counselors, psychologists, psychiatrists, social workers, therapists, and other mental health professionals.

Our ADHD Coping Skills Worksheet can be downloaded and used with all your clients, giving you and them the ability to fill it out on a digital device or print it out.

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Our mental health worksheets were built to streamline your mental health practice and better help your clients. Each worksheet can be used for all of your clients and saved on your computer or in the cloud for easy access.

Creating custom worksheets by a professional graphic designer can cost you hours of time and typically $30 to $100+ per hour in design costs, which quickly add up. Our mental health worksheets sell in bulk to mental health pros around the world, so we are able to offer our templates at low costs. Each purchase allows 1 mental health professional the ability to use a worksheet commercially with their clients.

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ADHD Coping Skills Worksheet PDF Template

Sharon Saline Psy.D.

How Couples with ADHD Can Reduce Conflict and Get Along Better

Strategies to help couples affected by adhd manage challenges and stay connected..

Posted June 29, 2024 | Reviewed by Devon Frye

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  • Couples with ADHD may struggle with disagreements that escalate quickly into intense arguments.
  • Focusing on what the other person can do differently is a trap; shift to thinking about what you can change.
  • Rebalance yourself before attempting to talk about anything with your partner.
  • Learn how to use the STEPS method to strategize more effective solutions to conflict.

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Every couple struggles with those moments when a switch has flipped and suddenly there’s a bubbling volcano of angry, negative emotions inside of both of you waiting to erupt. Before you know what’s happening, you each say or do things that you’ll surely regret later, but can’t stop.

In a relationship where one or both partners have ADHD , these escalations (amygdala takeovers) can happen extremely quickly due to challenges with emotional regulation , verbal impulse control, metacognition , and weaker working memory . One minute you’re OK; the next, it’s as if a match has been thrown on a pile of old painting rags and putrid fumes are polluting the health of your relationship. Significant emotional damage can ensue for both parties, potentially transforming tender love into toxic rage.

When couples struggle with anger , they often focus on what the other person could do differently or better. This is a trap: You can’t control what anyone else does; you can only control yourself. Thus, learning better tools for dealing with your own dysregulation is what’s called for.

When the amygdala becomes activated, the thinking brain (your prefrontal cortex) goes temporarily offline and feelings rule the day. In neurotypical brains, executive functioning skills help the amygdala calm down by engaging language to name the feelings instead of experiencing them, by accessing the capacity to step back and assess the situation, and by using rational thinking to find alternative solutions.

In ADHD brains, your executive functioning skills, already working so hard to accomplish and maintain daily life tasks, struggle with the extra burden of effectively dealing with a rush of strong emotions. You’ll tend to react quickly with volatility instead of responding with consideration.

How can you do something differently before and during an amygdala takeover? Focus on rebalancing yourself instead of telling your partner to calm down.

In my experience, saying “calm down” usually results in people speeding up and getting defensive. Anger, unkind words, and intense emotions emerge. The so-called "four horsemen," aptly named by psychologists John and Julie Gottman as problematic patterns in couples, appear on the scene to wreak their damage in the form of criticism, contempt, defensiveness, and stonewalling. By now, you and your partner have usually regressed to some ugly version of your 10-year-old selves.

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Rebalancing is what’s called for—and preparation will help you make that happen.

How to Rebalance

Rebalancing means creating a couple’s coping strategy in advance so you can rely on it in difficult moments. Identify what will assist each of you from steering into a tailspin. Examine your respective patterns when you have big feelings and work together to create a collaborative plan of action.

My “take a few STEPS back” method can help you with this process. Here’s how the STEPS work:

1. Self-control .

When the intensity of a conversation rises, pay attention to your body’s signals that you are becoming activated. Maybe your heart starts beating faster or you begin perspiring. Perhaps you are speaking louder and out of breath.

If you can catch your dysregulation early, you can avoid a massive eruption. Practicing self-awareness and paying attention to your body sensations when you are not activated will help you notice what is happening and give you important information about slowing things down when you are.

Try saying, “I’m feeling agitated and I’m getting upset. I need things to slow down” instead of “Why won’t you leave me alone? I just want you to stop talking to me!”

2. Time apart.

Instead of pretending that your conflicts won’t re-occur or being so relieved that they are over you want to forget them, be honest with each other and acknowledge that, yes, you will probably disagree again in the future. So, plan for those tricky moments and set up a "time apart" structure.

To do this, decide, in advance, the amount of time you will each need to restabilize, how you are going to call for a break in the action, what each of you will do, and where and when you will come back together.

3. Evaluate.

During your time apart, reflect on what just occurred. Think about what you really want at this moment, in this conversation, or regarding this issue.

therapy worksheets adhd

If you’re feeling angry and need to vent, grab a pen or your computer and start writing, planning to throw it out later. Create a voice memo if that’s useful. Perhaps draw something, go for a run, or break out the yoga mat.

Then, ask yourself what you could have done or said differently and how you could express your thoughts and desires in a more effective way. Consider what you can be accountable for. We are looking for evenness here—getting back to baseline.

4. Practice reflective listening.

Reflective listening is a key tool for improving respectful communication in couples. To use it effectively during a disagreement, it’s best to practice this technique a few times a week. This will not only improve your ability to do it with satisfaction during or after an argument but also increase your connection to your partner amid your busy lives.

Initially, set the timer for 10 minutes and build up to 20. Each person gets half of that time as the speaker, and the other half as the listener.

The speaker starts to talk about what’s on their mind and pauses after a sentence or two; alternatively, the listener can use a hand signal when their memory capacity is full. Then the listener says: “What I heard you say is X. Did I get that right? Is there anything else?” This back-and-forth continues until the timer rings. Then, switch roles.

When you are practicing this tool, feel free to talk about anything: work, friends, kids, emotions. When you are using this tool for an argument, talk about how you feel using "I" statements rather than blaming ones.


5. Strategize.

Once you’ve shared how you feel with each other and you both feel heard, it’s time to strategize the next right action. Where do you go from here? What’s something you can both do to move forward?

Collaborate on this—but know that it’s OK if you need different things. This is a judgment-free zone. The goal is to proceed with clear minds and open hearts.

Beeney JE, Hallquist MN, Scott LN, Ringwald WR, Stepp SD, Lazarus SA, Mattia AA, Pilkonis PA. The Emotional Bank Account and the Four Horsemen of the Apocalypse in Romantic Relationships of People with Borderline Personality Disorder: A Dyadic Observational Study. Clin Psychol Sci. 2019 Sep;7(5):1063-1077. doi: 10.1177/2167702619830647. Epub 2019 Apr 18. PMID: 32670673; PMCID: PMC7363036.

Gottman J, & Silver N (1999). The Seven Principles for Making Marriage Work. New York, NY: Crown Publishers.

Sharon Saline Psy.D.

Sharon Saline, Psy.D. , is a clinical psychologist and an expert in how ADHD, LD, and mental health affect children, teens and families. She is the author of What Your ADHD Child Wishes You Knew .

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Best Online Therapy Services For ADHD In 2024

Medically Reviewed

Attention-deficit/hyperactivity disorder (ADHD) is a common mental health condition affecting children and adults alike—research suggests ADHD impacts 9.6% of U.S. children and 4.4% of adults [1] General Prevalence of ADHD . CHADD. Accessed 8/30/2023. . Characterized by symptoms of inattentiveness and hyperactivity, if left untreated, ADHD can make dealing with day-to-day tasks difficult. But with proper treatment, symptoms can be managed.

Therapy can be an effective part of a treatment plan for individuals with ADHD, and with the rise of telehealth, receiving this type of treatment from the comfort of your own home has never been easier.

Below, Forbes Health highlights the best online therapy platforms for ADHD treatment, based on factors such as cost, insurance acceptance , additional services (like medication management) and more. Read on for our top picks.

Why You Can Trust Forbes Health

The Forbes Health editorial team prioritizes the accuracy and integrity of the data collected. Our ranking is based on quantitative data and is free from conflicts of interest. We carefully fact check the information featured in our ranking and are committed to producing rankings and supplemental content about mental health treatment that readers can trust. You can read more about our editorial guidelines and our online therapy methodology for the rankings below.

  • 12 telehealth platforms considered
  • 17 metrics analyzed
  • 4 editors and researchers utilized
  • Best Online Therapy Services
  • Best Online Therapy That Takes Insurance
  • Best Affordable Online Therapy
  • Best Online Couples Therapy
  • Best Online Therapy For Anxiety
  • Best Online Therapy For Depression
  • BetterHelp Online Therapy Review
  • Talkspace Online Therapy Review

Talkspace Online Therapy For ADHD

  • Therapists that have exceptional knowledge about the various types of therapy for ADHD that will help you or a loved one manage
  • Easy matching to find you the right therapist for ADHD
  • Effective and affordable mental health treatment

Best Online Therapy for ADHD in 2024

Teladoc health, sesame care, adhd advisor, methodology: how we picked the best online therapy for adhd, what is adhd, is online therapy effective for adhd, what to look for in an online therapy provider for adhd, can online therapists prescribe stimulants for adhd, summary: compare the best online therapy for adhd, our top online therapy for adhd.

  • Best Budget: Cerebral
  • Best Therapist Credentials: Teladoc Health
  • Best for Finding In-Person Care: Sesame Care
  • Best for Coaching: ADHD Advisor
  • Best for Insurance: Amwell


  • Price per session: $295 for one month of therapy (five video sessions), $365 for one month of therapy and medication
  • Number of therapists in network: Around 350
  • Session length: 45 minutes
  • Insurance accepted: Yes
  • FSA/HSA accepted: Yes
  • Modes of communication available: Live video, messaging or phone
  • BBB rating: B-
  • Trustpilot rating: 4 out of 5 stars

Cerebral tops our ranking thanks to the inclusion of providers in its network specializing in ADHD management and its bundle of therapy sessions coupled with medication management. Cerebral therapists and prescribers work together to provide ADHD treatment. In the first month of sessions, users can expect two initial meetings with their prescriber to complete their intake, according to the company. This includes the initial session and a follow-up session, occurring about 30 days after intake is complete. Users are then able to meet with their therapist five times a month, with any desired additional sessions costing an extra $65 beyond the price of the bundled sessions. Cerebral providers are unable to prescribe controlled substances, which means prescriptions to stimulant medications to treat ADHD, such as Ritalin and Adderall, are not available to users.

Victoria Clayton

Our reviewer tested Cerebral’s online therapy platform, and while she wasn’t seeking care for ADHD specifically, she was happy with the service.

“I felt as though my therapist was well trained and empathetic. She listened intently, took notes, remembered what I said from session to session and was definitely focused on my goals. I found myself making small changes as a result of what we discussed or, more accurately, the questions she asked. This seems like how good therapists work—they don’t tell you what to do, but rather encourage you to see connections and set goals.”

“After six weeks of using Cerebral, I completed another assessment. The results showed I was a bit lower on both insomnia and anxiety scales.”

Read her full Cerebral review to learn more about her experience.

  • Has providers in its network that specialize in ADHD management
  • Ability to select your own provider
  • Cerebral app allows users to track medication refills and shipping status
  • With a medication plan, users can meet with their prescriber up to two times per month
  • Monthly subscription includes five visits with a therapist, with additional visits costing $65
  • Appointments available on nights and weekends
  • Questions to your therapist asked via text messages may take up to two business days to receive a reply
  • Insurance is only accepted for people who live in certain states
  • Cannot pay for one session at a time unless you surpass the five monthly sessions
  • Does not accept Medicare
  • Not BBB accredited

Teladoc Health

  • Price per session: $99; Psychiatric treatment (and medication management) available for $299 with a psychiatrist
  • Number of therapists in network not disclosed
  • Modes of communication available: Video therapy
  • BBB rating: B
  • Trustpilot rating; 4.8 out of 5 stars

Teladoc Health is a telehealth platform offering online therapy with a licensed mental health provider for $99 per session (without insurance). Users simply log onto the platform, fill out a brief medical history and search for a licensed mental health provider specializing in ADHD in their state. Teladoc Health also offers psychiatric care as a separate service for prescriptions and medication management, if needed, which is a convenient option for those needing medication to complement their talk therapy treatment. Like many telehealth providers, keep in mind that Teladoc does not prescribe stimulant medications such as Adderall.

Angela Myers

While our reviewer didn’t try Teladoc online therapy specifically for ADHD, she did join the platform looking for help with anxiety and work-related stress.

“I experienced reliable video and audio quality during my session. The therapist was highly qualified and provided helpful advice and tactical next steps. After the appointment, I received a follow-up email and a PDF with tips on how to deal with stress.”

Read her full Teladoc review to learn more about her experience.

  • Appointments available seven days a week
  • Online therapy available for those 13 and older
  • Offers a separate psychiatric service for medication management
  • Offers an assessment for ADHD
  • Users can select their own therapists
  • High Trustpilot rating
  • Psychiatric service is pricey
  • Number of insurance providers it accepts is not disclosed
  • Does not offer therapy for children

Sesame Care

  • Price per session: Varies by provider but offers discounts of $10 off all telehealth visits with a monthly Sesame Plus membership
  • Number of therapists in network: 100+ providers in network
  • Session length: Varies by provider
  • Insurance accepted: No
  • Modes of communication available: Video, phone or in-person in limited locations
  • Trustpilot rating: 4.2 out of 5 stars

Sesame allows users to filter their provider search by both their mental health needs and the location and availability of its providers. Users can find providers that treat ADHD for either video, phone or in-person visits (depending on location) and by availability. There is also a button to filter your search for providers to those who are available within two hours. Sesame provides psychiatric care for those seeking to manage their ADHD symptoms with medication, however, Sesame providers are not able to prescribe controlled substances to treat ADHD, such as Ritalin or Adderall.

Stephanie Watson

Our reviewer—who was seeking general therapy and not specifically care for ADHD—had trouble finding a Sesame therapist in her area, and suggested reviewing provider options and availability before signing up for therapy.

“Because I live in an area with a minimal amount of therapists, I didn’t have the best luck with Sesame. For those interested in trying Sesame, first ensure that there are therapists available in your area, as finding a provider in a timely manner is important when you’re in need of mental health treatment. You can do so by checking the company’s list of providers before you sign up.”

Read her full Sesame review to learn more about her experience.

  • Monthly Sesame Plus membership provides discounts for telehealth visits
  • Users can filter for providers available within two hours
  • Provider ratings and availability are visible without booking anything
  • Offers medication management alongside therapy
  • Ability to search for providers by specialty allowing users to filter for those that treat ADHD
  • Per session prices may often be affordable
  • Does not accept insurance or Medicare
  • Does not offer discounts or savings for students
  • Session prices vary depending on your provider and location
  • Number of available therapists varies depending on location, so users may not find one appropriate for their needs
  • Website can be difficult to navigate

ADHD Advisor

  • Price per session: The initial consultation is $150. After that, therapy is $140 per week and medication management is $100 per month.
  • Number of therapists in network: 50
  • Session length: 60 minutes
  • Modes of communication available: Video and texting
  • BBB rating: N/A
  • Trustpilot rating: N/A

ADHD Advisor specializes in providing treatment for ADHD. Its providers all have a minimum of one year of experience working with people who have ADHD. Users start the process of obtaining a provider and possibly a prescription by filling out a quiz that determines whether a consultation for ADHD diagnosis is necessary. The platform offers “success coaching” to help build healthy habits alongside traditional therapy and medication management, and was founded by someone who has ADHD. Users should note that ADHD Advisor is unable to prescribe controlled substances such as stimulants used to manage symptoms of ADHD.

Valerie Williams

“ADHD Advisor’s offerings for those who want to manage their ADHD symptoms are generally impressive. I like the idea of ‘success coaching’ as an option for people who are struggling in their daily lives due to their ADHD symptoms. I also appreciate the platform’s library of articles with information about ADHD and how users can message their provider anytime via a secure portal. However, I would like to see a larger number of available providers and services for kids and teens.”

  • Offers discounts for college students
  • Provides full refunds if you’re not satisfied, notes the company
  • Has providers available on nights and weekends
  • Users can message their provider anytime via a secure portal
  • Provides free educational articles about ADHD
  • Founded by a person who has ADHD
  • Users cannot select their own provider
  • Does not offer treatment for anyone under age 18
  • Therapy not available in all 50 states
  • Only 50 active therapists in its network, which is fewer than others on this ranking


  • Price per session: $109 to $129; offers medication treatment as a separate service for $279 for the initial consultation
  • Number of therapists in network: Not disclosed
  • Modes of communication available: Live video
  • BBB rating; A+
  • Trustpilot rating: 1.8 out of 5 stars

Amwell, a telehealth platform offering an array of medical services, offers online therapy for ADHD treatment at reasonable rates. With appointment availability on nights and weekends, this platform is a convenient and affordable option for those seeking care. Additionally, its psychiatric services offer convenience for individuals with ADHD who may require medication alongside talk therapy (like the other platforms on this ranking, Amwell cannot prescribe controlled substances).

Mary Pembleton

Our reviewer tested Amwell’s therapy platform, and while she wasn’t seeking care for ADHD specifically, she was happy with the service.

“I’m no stranger to therapy. In fact, after years of regular sessions, I consider myself something of a connoisseur. I know what I like, and my standards are high. Amwell’s telehealth therapy platform exceeded them…though therapy isn’t always an enjoyable experience, I found the four sessions following my initial phone session very helpful. I came away with new effective strategies, and I plan to schedule with my Amwell therapist again.”

Read her full Amwell review to learn more about her experience.

  • Provides treatment for those 10 and older
  • Providers can offer an ADHD assessment for diagnosis
  • Offers psychiatric care as a separate service
  • Available in all 50 states
  • Affordable session rates
  • Accepts both insurance and HSA/FSA funds
  • The medication management service is on the expensive side
  • Has poor Trustpilot ratings
  • Website lacks detailed information about its services
  • Does not offer text therapy

To determine the best online therapy providers for ADHD, the Forbes Health editorial team evaluated an array of online therapy platforms on a number of metrics, including cost, fee structure, insurance, BBB ratings, TrustPilot ratings, platform features, availability, additional services offered and more. Star ratings are determined solely by the editorial team.

  • Cost including initial consultation fee, monthly subscription fee, follow-up appointment fee (45%)
  • Number of sessions included in monthly subscription (5%)
  • Acceptance of insurance and how many types of insurance (20%)
  • Whether Medicare is accepted (5%)
  • Services available in all 50 states (5%)
  • Whether providers can prescribe controlled substances (such as benzodiazepines) (5%)
  • Medication delivery offered (5%)
  • Free shipping available for medication (5%)
  • Auto-Refill available for medication (5%)

Read more about our online therapy review methodology.


  • Access high quality online ADHD treatment covering diagnosis, medication, therapy and success coaching.
  • Book an initial appointment and receive a treatment plan within 7 days.
  • The only service to offer a 100% satisfaction guarantee or your money back.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects behavior. It’s one of the most common mental disorders affecting children, but it can continue into adulthood. Symptoms of ADHD in children include an inability to stay focused, impulsive actions and excessive fidgety and squirmy movements.

The causes and risk factors of ADHD are unknown and are still being studied, although some current research shows that genetics can play a role. Other potential risk factors and causes may be brain injury, exposure to environmental risks (such as lead) in childhood, alcohol and tobacco use during pregnancy, premature delivery and low birth weight.

ADHD is considered a “chronic and debilitating disorder” with a significant impact on many parts of someone’s life, including their daily functioning, relationships and performance at school or work, according to the American Psychiatric Association (APA).

Children with ADHD may struggle in school, which can contribute to low self-esteem and depression, explains Laurie Singer, a licensed marriage and family therapist and board-certified behavior analyst. “Adults with ADHD often have difficulty in the workplace and with interpersonal relationships. For those diagnosed, ADHD can present challenges that range from minor hurdles to a debilitating condition. It can also place stress on friends, family, teachers and co-workers,” continues Singer.

A 2016 national parent survey found that many children diagnosed with ADHD also dealt with at least one other mental, emotional or behavioral disorder. About half of the children with ADHD also had a behavior or conduct problem and about three in 10 children with ADHD dealt with anxiety [2] Data and Statistics About ADHD . Centers for Disease Control and Prevention. Accessed 7/10/2023. .

Diagnosing someone with ADHD isn’t as simple as taking one medical test. It typically involves doctors and caregivers looking at a history of a child’s behavior in school and at home and seeing if it lines up with a checklist of ADHD signs and symptoms. Some ADHD symptoms (like hyperactivity) are quite common in young children, which can make diagnosis a bit more challenging. In children, symptoms should be present over a long course of time (at least six months), must be present before the child is 12 years old and must occur in more than one setting.

Types of ADHD

There are three different types of ADHD, and each person who is diagnosed will not experience the exact same symptoms or the same severity of symptoms. It’s also important to note that these presentations can change over time.

Predominantly Inattentive Presentation

This person experiences difficulties with attentiveness, and has problems with focusing and organizing. They may be easily distracted and forgetful and can struggle with paying attention, listening and taking note of small details.

Predominantly Hyperactive-Impulsive Presentation

This person has more hyperactive tendencies, like having trouble sitting still or staying quiet. They may come off as impatient, talk excessively and interrupt others often.

Combined Presentation

This person shows symptoms of both predominantly inattentive presentation and predominantly hyperactive-impulsive presentation.

The best way to treat ADHD is with a combination of behavior therapy and medication, according to the Centers for Disease Control and Prevention (CDC). For children ages 4 to 5, it is recommended to try behavior therapy before going to medication.

“Changing the environment for an individual with ADHD, whether an adult or a child, and teaching new replacement behaviors are the crux of behavior therapy,” says Singer. “Behavior therapy helps to teach an individual that they can cope, succeed and that they’re not defined by the disorder.”

Online therapy can be a safe and effective way to treat ADHD. A 2022 review of online intervention for ADHD looked at six different randomized controlled trials and over 260 people with ADHD and found that online interventions for ADHD can be effective [3] Shou S, Xiu S, Li Y, Zhang N, Yu J, Ding J, Wang J. Efficacy of Online Intervention for ADHD: A Meta-Analysis and Systematic Review . Frontiers in Psychology. 2022;13:854810. . While it didn’t look at therapy specifically, another small 2023 study looked at the efficacy of self-guided ADHD interventions done online and found that these interventions allowed for significant improvements in quality of life and self-reported ADHD symptoms [4] Kenter R, Gjestad R, Lundervold A, Nordgreen T. A self-guided internet-delivered intervention for adults with ADHD: Results from a randomized controlled trial . Internet Interventions. 2023;32:100614. .

Opting for online therapy has its share of advantages. As Singer notes, it’s usually more affordable and more accessible than traditional therapy settings. That said, she says it can be a little more impersonal than going to a therapist in person. “In-person therapy offers the chance for the therapist to form a broader understanding of the needs of the individual,” explains Singer, who notes “the strongest predictors of success with a therapy program, both in-person and online, will be the relationship an individual forms with their therapist, their commitment to following the established plan and the ability to attend sessions on a regular basis.”

An important step in online therapy is finding a great provider. It’s also important to look for a therapist who is credentialed in the field of ADHD and specializes in it, notes Singer. “This is an area where legitimate, trained professionals need to be the cornerstone,” she says.

Research and education is essential when looking for an online provider. Don’t be afraid to ask questions and to look up credentials, notes Singer.

When first meeting with a therapist, Singer recommends getting a clear understanding of what the sessions will look like, as well as knowing what your overall goals are. “The expectations should revolve around specific, personalized plans so the motivation of the individual will be the deciding factor in a successful outcome,” she says. “Understanding what ADHD is, the symptoms it produces and some steps to handle it is one thing. But doing the work necessary to cope with the disorder is all on the individual. Motivation and commitment is key.”

Additionally, many individuals with ADHD benefit from ongoing therapy sessions, so while a set amount of therapy sessions is a good place to start, consider whether the provider offers rates that are sustainable over the long term.

A mix of both behavioral therapy and medication can be necessary for some when treating the symptoms of ADHD. If you feel you may need medication for your treatment plan, keep in mind that online therapists are not able to prescribe medication unless they are a psychiatrist, notes Singer.

“Only a doctor or psychiatrist can prescribe medication,” Singer continues. A psychotherapist, board-certified behavior analyst or psychologist cannot.

Currently, stimulants can be prescribed via telehealth, a rule that was adopted during the COVID-19 pandemic, which allowed patients to receive medical care and prescriptions for controlled medications verbally. This rule was extended past the pandemic and expired in November 2023, but for existing telemedicine relationships established before that date, the rule extends to November 2024. However, many online therapy companies still do not offer this option.

Additionally, experts note that in many cases, treating comorbid conditions (such as anxiety or depression) can improve concentration and focus. Therefore, services that offer medication— such as antidepressants—can be helpful in catching any comorbid conditions.

Key Takeaways:

  • The best online therapy platforms for ADHD range from about $59 to $140 per session.
  • Those seeking therapy for the treatment of ADHD should consider whether a platform has ADHD specialists, if it provides ADHD assessments and its ability to prescribe medication.
  • Our top pick is Cerebral ; our reviewer loved the easy sign-up process and wide therapist selection.

Book Your ADHD Consultation

Fast-track your way to getting control over your ADHD with ADHDAdvisor. Book your online diagnosis and get a personalized treatment plan in under seven days.


  • General Prevalence of ADHD. CHADD. Accessed 8/30/2023.
  • Data and Statistics About ADHD. Centers for Disease Control and Prevention. Accessed 7/10/2023.
  • Shou S, Xiu S, Li Y, Zhang N, Yu J, Ding J, Wang J. Efficacy of Online Intervention for ADHD: A Meta-Analysis and Systematic Review. Frontiers in Psychology. 2022;13:854810.
  • Kenter R, Gjestad R, Lundervold A, Nordgreen T. A self-guided internet-delivered intervention for adults with ADHD: Results from a randomized controlled trial. Internet Interventions. 2023;32:100614.
  • What Is ADHD?. Centers for Disease Control and Prevention. Accessed 7/10/2023.

Next Up In Mind

  • Best Online Therapy Platforms That Take Insurance
  • Best Online Therapy For Couples
  • Best Mental Health Apps
  • BetterHelp Review
  • Talkspace Review

Information provided on Forbes Health is for educational purposes only. Your health and wellness is unique to you, and the products and services we review may not be right for your circumstances. We do not offer individual medical advice, diagnosis or treatment plans. For personal advice, please consult with a medical professional.

Forbes Health adheres to strict editorial integrity standards. To the best of our knowledge, all content is accurate as of the date posted, though offers contained herein may no longer be available. The opinions expressed are the author’s alone and have not been provided, approved or otherwise endorsed by our advertisers.

Jessica Booth

Jessica Booth is a New York-based freelance writer who regularly writes about health, wellness, parenting, food, travel, beauty and more for a variety of publications. She currently writes for Forbes Health, Insider, The Daily Beast, Brides, Redbook, Woman's Day, Women's Health, Scary Mommy, Romper and Life Savvy. Her byline has also appeared on Refinery 29, Cosmopolitan, Delish, Greatist, The Inventory, and Bustle. She previously worked as the editor-in-chief of, part of Defy Media.

Sarah Davis

Sarah is an experienced writer and editor enthusiastic about helping readers live their healthiest and happiest lives. Before joining Forbes Health, Sarah worked as a writer for various digital publications including LendingTree, theSkimm, CNBC and Bankrate. When she isn’t writing or editing, you can find Sarah with her nose in a book or enjoying the outdoors with her French bulldog, Honey.

Amber Samuels, Ph.D., L.P.C., N.C.C., C.C.C.

Amber M. Samuels, Ph.D., L.P.C. (D.C.), N.C.C., C.C.C. is a clinician, researcher and educator based in the DMV. Dr. Samuels is a licensed professional counselor (L.P.C.) in the District of Columbia, a national certified counselor (N.C.C.), a certified career counselor (C.C.C.) and an MBTI certified practitioner. Dr. Samuels holds a doctor of philosophy degree in counseling from The George Washington University, a master of science degree in clinical mental health counseling from Radford University and a bachelor of arts degree in psychology from Randolph-Macon College. Dr. Samuels is currently an assistant professor of counseling at Hood College. Prior to Hood, she served as the assistant director of training of the Community Counseling Services Center (CCSC), staff clinical supervisor and professional lecturer in counseling at The George Washington University. She has been fortunate to share her expertise in prominent media outlets such as the Associated Press, SELF Magazine and, where she advocates for stigma reduction and promotes mental health literacy by translating mental health concepts into accessible information. Dr. Samuels centers her teaching, research and practice around the mental health needs of people in the margins and has provided counseling services to adults and adolescents in a range of settings, including post-secondary, community mental health, intensive in-home and private practice. Dr. Samuels has presented at local, regional and national counseling conferences. She is currently a member of the American Counseling Association (ACA), the Association for Counselor Education & Supervision (ACES), the National Career Development Association (NCDA), Counselors for Social Justice (CSJ) and other ACA divisions. Dr. Samuels aims to train professional counselors who are culturally responsive, socially just and compassionate.


Experience of cbt in adults with adhd: a mixed methods study.

Sandy William

  • 1 School of Psychology, University of Nottingham, Nottingham, United Kingdom
  • 2 School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
  • 3 Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
  • 4 School of Social Sciences and Humanities, University of Suffolk, Ipswich, United Kingdom

Introduction: The National Institute for Health and Care Excellence (NICE) recommends Cognitive-Behavioural therapy (CBT) as the psychotherapeutic treatment of choice for adults with Attention Deficit Hyperactivity Disorder (ADHD) in the UK. However, the literature often refers to adapted CBT programs tailored for ADHD and provides limited insight into how adults with ADHD experience and perceive this form of treatment in routine clinical practice.

Methods: This mixed-methods study aims to explore ADHD individuals’ experience and perception of CBT delivered in routine clinical practice, to gain a better understanding of this treatment’s helpfulness and perceived effectiveness.

Results: A survey (n=46) and semi-structured in-depth interviews (n=10) were conducted to explore the experience of CBT and its perceived effectiveness in managing ADHD. The interviews were analysed using thematic analysis and the survey was synthesised using descriptive narratives. The thematic analysis highlighted three key themes: difficulties with the CBT framework, difficulties with CBT therapists, and consequences of CBT. The survey highlighted similar findings. Participants described the CBT framework as, generic, rigid, and too short, and described the CBT therapist as unspecialised, unempathetic, and not sufficiently adapting CBT to ADHD-related difficulties.

Discussions: Overall, participants found non-adapted, generic CBT in the UK to be unhelpful, overwhelming, and at times harmful to their mental well-being. Therefore, it is necessary for clinical bodies in the UK, while following the indicated NICE guidelines, to be mindful of adapting CBT delivery of CBT, to be most effective for people with ADHD and to mitigate potential harm.

1 Introduction

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by symptoms of persistent inattention and/or hyperactivity-impulsivity, that causes clinical impairment in academic and social functioning ( 1 ) affecting approximately 5% of children ( 2 ) and 2.5% of adults ( 3 ). While this suggests that ADHD attenuates over time, the prevalence of symptomatic adults is estimated to be 6.7% ( 3 ).

ADHD is centrally a disorder of impaired executive functions (EFs) creating a devastating effect on self-regulation ( 4 ), inhibition, planning and working memory ( 5 ). These impairments impact many different aspects of life such as education, employment and mental well-being ( 6 ) Barkley ( 7 ) argued that inhibition is the central EF impairment in ADHD, that hinders the utilisation of other functions. Moreover, a body of research reports significant deficits in the EFs of shifting and working memory for ADHD adults ( 8 – 10 ). Furthermore, Bailey & Jones ( 11 ) argued that the EF processes of inhibition, updating, and shifting are closely linked to emotional regulation. Henceforth, ADHD is also described as a disorder of emotional dysregulation ( 12 ). In a systematic review by Soler-Gutiérrez et al. ( 13 ), adults with ADHD demonstrated the consistent use of non-adaptive emotion regulation strategies when compared to controls. Bodalski et al. ( 14 ), also reported emotion regulation deficits in adults with ADHD including the use of avoidance strategies. Adults with ADHD demonstrate increased use of experiential and cognitive-behavioural avoidance strategies which mediates the relationship between ADHD, deficits in emotion regulation, and internalising disorder outcomes ( 14 ).

The National Institute for Health and Care Excellence ( 15 ) considers pharmacological treatment as the first-line treatment for adults with persisting ADHD symptoms. However, Ramsay ( 16 ) attests that individuals with ADHD who experience symptom improvement from medications still experience difficulties in academic and social functioning, due to ADHD’s high comorbidity with other psychological disorders, such as anxiety, depression, and substance abuse. For this reason, the NICE guideline (2018) recommends a structured psychological intervention in the form of cognitive-behavioural therapy (CBT) for individuals with ADHD as the first psychotherapeutic treatment of choice.

CBT is an umbrella term for a range of related therapies, including for instance cognitive therapy, behavioural therapy, and metacognitive therapy ( 17 ). These therapies share a strong commitment to developing clinical interventions grounded in empirical evidence, with CBT described as the most researched form of psychological therapy ( 18 ). The therapies encapsulated by the term CBT aim to reduce client’s experience of distress by helping the person to explore patterns in their behaviour, thinking processes and thought content, ( 19 ). Probably the most commonly practised form of non-adapted CBT in the UK, derives from a mixture of behavioural therapy principles and Beck’s cognitive therapy, to employ an active goal-oriented problem-solving approach ( 20 ). CBT is highly structured, present-oriented, and time-limited, usually lasting from 5–20 sessions ( 21 ). Typically, a CBT therapist may seek to address an individual’s cognitive distortions by challenging maladaptive core beliefs, dysfunctional assumptions, and negative automatic thoughts using techniques including Guided discovery, Socratic questioning, positive data logs, and thought records ( 21 ). Additionally, CBT therapists may employ behavioural techniques such as activity scheduling, where tasks are reduced to a controllable list, or behavioural experiments to try responding differently to identified situations or stimuli. The CBT therapeutic relationship is based on genuineness, rapport and empathy between the patient and the therapist ( 21 ).

In England, CBT is predominantly provided through the National Health Service (NHS) Increasing Access to Psychological Therapies Programme (IAPT), recently rebranded as NHS Talking Therapies for Anxiety and Depression (NHSTTAD). This programme was developed in 2008 in an attempt to radically increase the availability of CBT in primary care, in response to a range of NICE guidelines increasingly recommending CBT and other psychological therapies as the first-line interventions for anxiety and depression ( 21 , 22 ). This programme commissions a range of primary care psychological therapies services across England, with one-to-one CBT the most frequently provided therapy ( 23 ). Therapists are trained in accordance with a competency-based curriculum ( 24 ), which does not include specific content on adapting CBT for ADHD. This potentially leads to therapists having high variability in their knowledge, skills and ability to support ADHD patients. Access to NHSTTAD services is often by self-referral, with no separate formal diagnostic assessment of presenting problems required as a precursor to treatment. While the NHSTTAD programme is mainly designed for individuals with mild to moderate depression and anxiety, therapists working in NHSTTAD services often find they are working with complex cases, for which they may have insufficient training and knowledge ( 22 ) including ADHD. According to Ramsay ( 4 , 25 ), individuals with ADHD often seek treatment for comorbid depression and/or anxiety, therefore they may be highly likely to receive CBT treatment through the NHSTTAD service. Whilst statistics of the number of people accessing NHSTTAD who have an existing ADHD diagnosis, or who experience ADHD-related difficulties are not recorded, more than thirty-three thousand people seeking help from NHSTTAD services during the year 2021–22, were assessed as experiencing problems with memory, and concentration, learning and understanding ( 26 ).

Previous evidence from empirical studies reported that adults with ADHD found adapted CBT helpful for their symptoms ( 27 , 28 ). Virta and colleagues ( 27 ) reported a pilot RCT of short-term outpatient adapted CBT to adults with ADHD (n=10), delivered over 10 weekly appointments. Participants in this study reported significantly reduced symptoms as a result of engaging in adapted CBT. Two patients (20%) dropped out of adapted CBT. Solanto and Scheres ( 28 ) reported a cohort study of adapted CBT for college students (n=18) delivered in a group format, over 12 weekly sessions. Clinician’s ratings and participants’ self-report data evidenced a reduction in ADHD symptoms and student’s perceived self-efficacy in managing ADHD. One participant dropped out of group adapted CBT. These studies suggest that adapted CBT is acceptable to ADHD patients.

Numerous studies have also highlighted the efficacy of adapted CBT in reducing symptoms of ADHD and EF ( 27 – 31 ) as well as mental well-being and general functioning ( 32 , 33 ). A randomised controlled trial by Safren et al. ( 34 ) highlighted the efficacy of an ADHD-adapted CBT treatment in providing significantly better outcomes for participants over an active control treatment based on relaxation and educational support. Additionally, studies comparing CBT to treatment as usual control groups, have shown the treatment’s efficacy compared with medication-only groups ( 35 , 36 ). A meta-analysis by Knouse et al. ( 37 ) reported that studies with active control groups indicated significantly smaller effect sizes for CBT treatment, than studies without active controls. The differences in these results could be due to variations in the CBT interventions applied in each study, which varied by treatment type, format, length, and the medication status of the participants, which can arguably moderate the effect of treatment ( 37 ). Finally, Solanto and Scheres reported the effectiveness of a CBT program in reducing inattention and EF in college student with ADHD.

Additionally, there are a number of studies which have shown the efficacy and acceptability of adapted Dialectical Behaviour Therapy (DBT) for ADHD patients ( 38 – 43 ). DBT ( 44 ) is an empirically validated approach for working with distress tolerance and coping behaviours. Early DBT papers focused on reducing self-harm and suicide attempts in individuals diagnosed with personality disorder ( 45 ), whereas more recent work has applied modified DBT to diagnostically heterogenous groups ( 46 ). DBT is often considered part of the ‘third wave’ of CBT, given its focus on emotional and behavioural regulation ( 47 ). As applied to ADHD treatment, adapted DBT includes acceptance, mindfulness, functional behavioural analysis, psychoeducation and distress tolerance techniques ( 42 , 43 ). Many of the studies of adapted DBT for ADHD, have utilised group level interventions ( 38 – 43 ). The reliance on group interventions is at odds with the dominant model of one-to-one CBT used within NHSTTAD services. Furthermore, within the English context, DBT is a psychological therapy approach rarely delivered within primary care in England, given low numbers of DBT trained therapists and supervisors. The English NHS has plans to rapidly expand the availability of DBT by commissioning additional training ( 48 ), but there are still few DBT trained practitioners working with primary care populations.

Moreover, it is important to note that the majority of studies reporting on the efficacy and acceptability of CBT, have delivered ADHD adapted DBT or adapted CBT, rather than generic CBT, which is essential for treatment efficacy but the title and often content of these studies do not always reflect this important nuance. Ramsay ( 4 ) suggested the adaptation of CBT to accommodate for the executive and emotional dysfunctions experienced by adults with ADHD, using environmental engineering and EF training. This entails changing work, home, and personal settings by implementing systems to lessen dysfunction as well as delivering organisation and time management skills, ( 4 ). As adults with ADHD often have a history of negative experiences related to their EF deficits, which may foster negative cognitions about themselves or their abilities and maladaptive emotional strategies, these must be addressed in CBT to motivate change and encourage appropriate coping ( 4 , 19 ).

Knouse & Ramsay ( 49 ) argued that non-adapted CBT could be harmful to adults with ADHD, as negative experiences of therapy can occur in relation to the experience of therapy in interaction with ADHD symptoms and individuals’ sense of self. While the benefits can outweigh the negative experiences, therapists must be aware of the possibility of certain negative experiences which might occur during all stages of a CBT treatment course, and any such experiences of therapy must be managed appropriately to reduce harm and barriers to treatment.

CBT therefore appears an efficacious treatment for people with ADHD, yet one that could cause side effects, or iatrogenic harm, if not delivered in a way that is responsive to the needs of people with ADHD. However, the existing literature provides limited indepth, qualitative insight as to how adults with ADHD experience and perceive CBT treatment. In response to this gap in the literature, the present mixed-methods study aims to record and collate the CBT experiences (adapted or non adapted) of adults with ADHD, to capture and analyse the perceived impact of this form of therapy and its value for ADHD individuals. A mixed-method approach lends itself well in capturing user experiences and understanding social phenomena better ( 50 ). This study aims to explore the following research question, ‘How do individuals with ADHD experience CBT therapy in the UK?’

An explanatory sequential mixed methods design ( 51 ) was employed, consisting of an online survey, followed by in-depth, semi-structured interviews with a sub-sample of survey respondents. The survey data was collected over 3 months (June-August) in 2023. Interviews were conducted and recorded over one month in August 2023. The survey and interviews took place online and followed data protection procedures and best practices for record-keeping, and storage of personal data, in accordance with the BPS Code of Human Research Ethics ( 52 ). The study received ethical approval from the University of Nottingham School of Psychology (ethics reference number: FMHS 81–0922).

2.2 Material

The survey and interview questions were developed by the authors (who include CBT practitioners and researchers). The surveys took on average 15 minutes and included 28 questions in the form of multiple choice, 10-point Likert-scale, and free text box questions ( Supplementary Material 1 ). A demographic questionnaire gathered demographic data from the samples. On average, the interviews lasted for 30 minutes and encompassed 23 questions exploring the participants’ experience of CBT and its effectiveness in addressing their ADHD difficulties ( Supplementary Material 2 ).

2.3 Participants

Participants were recruited from across different regions of the UK, using a database of adults with a diagnosis of ADHD, collated at the University of Nottingham’s ADHD research lab. The database had been created from previous research studies with individuals who have an ADHD diagnosis who previously indicated a willingness to participate in future research studies. Additionally, participants were also recruited from, ‘The ADHD Collective’, an online community of adults with ADHD based in the UK.

Inclusion criteria were that participants were aged 18 years old or greater, had an existing diagnosis of ADHD before receiving CBT, and the course of CBT was delivered within the UK by any provider (NHS, private or others).

Participants who reported receiving CBT within a mixed, integrative or eclectic psychotherapeutic approach, such as those mixing CBT concepts with other concepts drawn from other psychotherapy approaches (e.g. psychodynamic or humanistic approaches), were excluded from the study.

2.4 Procedure

Details of the studies were sent to mailing lists by the research team. Participants in the survey were entered in a £10 Amazon voucher prize draw. Additionally, interview participants were provided with a £20 Amazon voucher code after the completion of the interview.

Participants in both the survey and interviews who wished to participate signed an online consent form. Participants who responded to the semi-structured interview invitation were interviewed over Microsoft Teams at a time of their convenience.

2.5 Analysis

The interviews were analysed using an inductive approach to thematic analysis ( 53 ), which employed an essentialist perspective in extracting codes. The thematic analysis consisted of a six-stage process ( 53 ). The analytic process began by transcribing each interview verbatim shortly after being conducted. Following this process, the lead investigator first familiarized herself with the interview data and made notes in a diary of preliminary thoughts on the content of the interviews. From this, initial codes were identified in a coding manual that was then collated and combined to be classified into broader themes using constant comparative analysis, both within and between transcripts. Finally, as the analysis evolved, these broader themes were reviewed and refined to generate the final themes proposed. An ongoing analysis allowed for a clear definition of the final themes. Semantic themes were developed using participants’ descriptions of their own experiences. Themes were then reviewed by a second researcher (BF) to ensure that they mapped to the original transcripts. Interrater reliability of themes was tested on a small proportion (2/10, 20% of interviews) of the transcripts. The results were validated collectively as a team, and any discrepancies were discussed and reconciled. The survey responses were reported descriptively and were used to triangulate the responses from the interviews.

Ten participants took part in the interviews (70% female) and 46 in the surveys (71% female). Tables 1 , 2 (Interview) and 2 (survey) describe the demographics of each group.

Table 1 Interview participants demographic characteristics.

Table 2 Survey participants demographic characteristics.

3.1 Semi-structured interviews

The codes from the thematic analysis captured three main themes: The complex structure of the CBT framework, the intricacy of the therapist relationship, Consequences of CBT.

3.1.1 The complex structure of the CBT Framework

Participants reported that the overall framework of CBT was unhelpful due to several factors. Firstly, the generic nature of CBT sessions was usually not adapted to individuals with ADHD, making therapy ineffective and experienced as highly frustrating. Secondly, the CBT sessions followed a rigid structure that was not personalised to the participants’ needs. Thirdly, the timeframe of the therapy was experienced as too short to be of benefit to the ADHD participants.

Participants reported that the CBT they received was essentially incompatible with their experience of ADHD, as it did not take into consideration the inherent EF and emotional dysregulation difficulties they experienced. Working memory deficits were not accommodated in sessions, leading to a cycle of unnecessary pressure and ineffective treatment. Moreover, participants described that the content of therapy did not account for ADHD symptoms of inconsistency, distractibility, and inattention. As a result, ADHD participants reported feeling overwhelmed and frustrated by the approach, which they found unhelpful in managing their ADHD difficulties.

“I think there’s core things about CBT that are just seen on the face of it to me to be incompatible with ADHD. So, there is an element of having, decent working metacognition, working memory and things like that [ … ] I might discuss a technique with my therapist, but I would not remember to remember that technique. It just wasn’t going to happen.” (P5).

Only one participant reported receiving adapted CBT, with a therapist who also had ADHD. This participant reported that their CBT sessions allowed for self-acceptance of their EF difficulties, which moderated their approach to facing ADHD-related difficulties. For instance, they were able to moderate their time and chunk activities to avoid resistance and boredom. Overall, through the adapted CBT course, they were able to adopt cognitive strategies in their daily life, easing their day-to-day activities.

In contrast, however, most participants reported that the goals set in generic CBT were unspecific and unhelpful in managing ADHD symptoms. They explained that there was often no obvious relation between the CBT process and the management of their ADHD difficulties. They reported that ADHD topics such as understanding ADHD, time management, organization, and emotion regulation were often not discussed.

“ In the sense of actually managing ADHD symptoms [ … ]like time management, procrastination, achieving goal, it wasn’t really helpful for that kind of stuff, which is initially what I was hoping for” (P3) .

Furthermore, participants commented on the learning aids or physical resources offered in sessions. Some participants reported an absence of any learning aids or physical resources to summarize sessions, which caused an unhelpful dependence on memory, that led to forgetfulness. Conversely, other participants reported that they received an overwhelming amount of generic CBT resources which required high levels of literacy and concentration to comprehend, and which were not adequately adapted to ADHD individuals.

“I got sent a whole load of files and stuff to read and it was just volumes and volumes and volumes and stuff [ … ] Reading stuff is something I don’t do very well, and just the thought of doing all of that just overwhelmed me. I kept losing them as well” (P6) .

Participants reported that they needed CBT to offer an acceptance and management of their ADHD condition, rather than a fixing of their condition. Some participants reported that the sessions were too focused on symptom reduction, which did not allow for an appreciation of their strengths. This focus on just part of the person’s experience was sometimes experienced as unfair, with elements of their identity as a person with ADHD being ignored, or repressed, akin to being ‘dampened down’.

Conversely, the one participant who received adapted CBT reported that this course explained the behavioural irregularities as well as the strengths of having ADHD, fostering their acceptance of the condition.

“What I liked about it was that I understood how my mind worked [ … ] So it was really kind of understanding what the strengths I think of ADHD were. I just felt that I’m more accepting of myself and I’m more aware of myself and I’m more aware of my kind of behaviours if that makes sense” (P4) .

Participants also reported that the CBT objectives were not focused on the client’s needs but followed an unhelpful systematic approach. Participants who had undergone multiple courses of CBT reported that sessions felt like a pre-written script. Moreover, other participants reported that the CBT approach did not view the participant as an individual requiring personalised treatment.

“I felt the therapist had got their own set of exercises both times that they wanted to do from their own training, and I felt that I needed a much more bespoke approach” (P9) .

However, one participant expressed that their adapted CBT course was personalised in relation to their current situational difficulties, rather than being a generic application of CBT strategies. They reported sessions not being highly structured or systematic, but rather following an organic and client-centered approach, where the direction and flow of the therapy coincided with their feelings and needs.

Participants also reported that the generic CBT courses were too short to be helpful for their ADHD. They described that the number of offered sessions was inappropriate for individuals with ADHD who require more time to process information.

“It’d have to be extended because not only are you meeting someone new … you still got to bring the courage to open up to that person and then the sessions end, don’t last long enough, and then the overall course doesn’t last long enough. And I feel like something that takes that much would need to have more time for it” (P7) .

3.1.2 The intricacy of the therapist relationship and its impact on therapy

Participants reported multiple difficulties with their therapists affecting the overall experience. Firstly, almost all therapists were reported to be unspecialised in working with ADHD symptoms and seemed to have little knowledge about the condition, demotivating participants. Secondly, many therapists were experienced as unempathetic, affecting the participants’ healing and learning. Thirdly, many participants described their therapists’ approach as non-accommodative and inflexible.

Therapists appeared to lack a genuine understanding of ADHD, which affected participants’ treatment and motivation to continue with therapy. Some participants commented that they believe therapists with extensive ADHD experience should be delivering the CBT to ADHD individuals, for it to be maximally effective. Several participants reported that they had to explain multiple times to their therapists that the techniques they were assigned would not work with their ADHD, creating a lack of being understood and their experiences invalidated. Additionally, participants reported that their therapists seemed to assume their mental health difficulties could be treated in the same way as neurotypicals, disregarding that the myriad difficulties participants experienced were intricately linked to ADHD.

“I couldn’t see the link with ADHD and she didn’t see it either. [ … ] She knew nothing [about ADHD], and she told me that straight away. So, I think it impacted every single aspect of the therapy because she would just look on the surface of the problem and never be able to understand the deeper-rooted issues and difficulties” (P8) .

In contrast, tailored CBT facilitated participants understanding of the relationship between anxiety experiences and ADHD, and this was further aided by therapist’s disclosure of personal experience and knowledge of difficulties inherent in the condition.

“I felt very comfortable with her. I felt I could be very open and felt that she understood me, which was really important. I don’t know what it would be like to have that experience with a therapist who didn’t have ADHD … but I think unless you really know somatically how it feels that might be difficult to really know what someone else is experiencing” (P4) .

Participants reported that their therapist was unempathetic during treatment. They often felt judged and dismissed, which worsened their emotional state and affected the healing process.

“I always felt like quite dictated, like talking at me when I feel like, no one can be healed or learn about themselves or anything if they feel like they’re being judged or talked down to” (P7) .

Several participants felt that their therapist was not accommodating of their difficulties, nor their explicit feedback, resulting in feeling dismissed and demotivating their activation participation in CBT.

“I was sharing things that I thought were relevant, associated with ADHD and she didn’t really embrace it. She acknowledged it and she read it and said it was interesting, but she then didn’t necessarily adapt for it. So, I felt like it was listened to but not understood and acted upon. At the end I sort of gave up sharing my thoughts, trying to prepare for it” (P6) .

Some participants reported situations where the therapist was extremely rigid and inflexible with the timing of sessions. For instance, one participant reported that their therapist asked them to leave the room very abruptly because their time had ended, whilst they were severely distressed from recalling a traumatic event. Another participant reported that their therapist cancelled the appointment due to a five-minute bus delay.

“The therapist changed the time and he kept scheduling times that I couldn’t make, So, in the end, he wasn’t able to accommodate the time that I had available for the sessions, he ended up just discharging me” (P3) .

3.1.3 Consequences of unadapted CBT

The majority of participants reported little gain from or feeling worse off after the course of CBT.

Participants reported feeling worse off due to lowered self-esteem, increased sense of failure, frustration with self, increased emotional dysregulation and hopelessness with the future. One participant reported that their inability to perform the required techniques frustrated them greatly and lowered their self-esteem. Similarly, another commented that CBT made them feel responsible for their inability to benefit from the sessions, leading to a sense of failure. Other participants felt the CBT sessions left their emotional dysregulation even worse, not knowing how else they could move forward or be helped.

“I kept forgetting to practice, so by the time I come to the next session, they would have asked me how it went with the practice and I wouldn’t have practised, I wouldn’t have had time or I would’ve forgotten. And then it felt that if I didn’t do that, we couldn’t move forward. [ … ] So it felt like I was being punished and I couldn’t do the therapy properly because I couldn’t do those exercises” (P8) .

Some participants also felt at times that CBT sessions were a complete waste of time for them and that the lack of available alternative treatments for managing ADHD, led them feeling hopeless for the future.

“It was just such a waste of time for everyone, and it’s a shame, [ … ] it made me feel worse going there, and that’s not what you hope when you do therapy, you expect to feel better afterwards. But I felt worse and it’s just not very nice” (P8) .

Conversely, Participant Four described their adapted CBT experience as,

“… very transformational … because it really helped me to understand my mind and how to kind of work, I guess with my mind more. That made me feel happier about being me rather than trying to fit into what I believe the world sort of expected of me” (P4) .

All participants completed 11 Likert-scale questions on their experience of CBT from a scale of 1 to 10, where 1 indicated ‘strongly disagree’ and 10 indicated ‘strongly agree’. The results of the Likert-scale questions are presented in Table 3 .

Table 3 Experience of CBT questionnaire.

Additionally, 41 participants responded to the remaining short-answer questions. When asked, ‘What were you hoping to get out of your CBT sessions?’ participants responded that they wanted to receive help in managing their ADHD symptoms and executive functioning and to feel better about themselves. Moreover, most participants commented that they needed help understanding their thought processes and managing their emotional regulation, anxiety, self-esteem, organization, and low motivation. In addition, many participants expressed their need for actionable tools and effective coping strategies. When asked whether the CBT sessions met these expectations, participants responded that they did not. Participants commented that they felt blamed, not understood by their therapist, and constantly needed to explain themselves. For instance, one participant replied,

“No. ADHD wasn’t understood, and I constantly felt I had to explain why some the things being asked of me were a challenge”(P124) .

When asked about the challenges of accessing CBT, most participants argued that the sessions were too time-consuming. In addition, some participants noted that the waiting time to access CBT was too long and did not allow the patient to choose their own therapist. When asked what accommodations were made to support the participants’ access and engagement with CBT, most participants noted that no accommodations were made. Only a few participants commented that they were alerted prior to their appointments and that they were given extra time. When asked what the participants had liked or disliked, found helpful or unhelpful about CBT, many participants responded that it was unhelpful because it was manualised, repetitive, and did not address the underlying causes of symptoms. Moreover, some participants commented that they found the homework, tools, and therapists unhelpful, increasing their frustration. For example, one participant wrote,

“I struggled with speaking to someone who didn’t understand ADHD and didn’t seem to want to make any effort to. Some of the tasks required more forward planning or future thinking than I’m able to engage with. I came away feeling I’d need a much more intense level of interaction and support than I could afford or was on offer”(P106) .

When asked what the CBT course included, most participants responded that the course included working on unhelpful thinking styles, managing multiple tasks, organisation and planning, and managing distractibility. Moreover, when asked whether they had anything else to add about their experiences with CBT, some participants responded that they did not find it suitable and would not recommend this form of therapy to individuals with ADHD. For instance, one participant said,

“Overall, it made me feel more inadequate as I felt I couldn’t do the stuff I was supposed to. You can’t change how you think when your brain is wired differently. ADHD isn’t a thinking or positivity problem, and CBT seemed to assume it was”(P121) .

4 Discussion

The present study aimed to explore how individuals with ADHD experienced CBT in the UK. In this study, individuals with ADHD experienced several difficulties with CBT, that was not adapted to ADHD, which could have a negative impact on their overall wellbeing. These difficulties encompassed nonalignment of an unadapted CBT framework with specific aspects of ADHD, alongside a perceived unspecialised, unempathetic and non-accommodative CBT therapist, collectively resulting in suboptimal therapeutic experiences.

Participants expressed frustrations with the generic CBT framework due to its inconsideration of the EF and emotional dysregulation impairments experienced by individuals with ADHD. Participants described being forgetful, distracted, inconsistent, and inattentive, which pertained to impairments in their EF processes of updating, shifting, and inhibition, supporting previous research highlighting these difficulties in ADHD adults ( 8 – 10 ). Moreover, the participants’ emphasis on emotional regulation difficulties further supports previous research describing ADHD as a disorder of emotional dysregulation ( 14 , 54 ). Sadly, the generic, non-adapted CBT framework was not experienced as helpful, causing a counterproductive effect where participants felt overwhelmed, frustrated, and hopeless.

Research shows that when CBT is adapted specifically for ADHD symptoms, it can provide concrete strategies for managing the core symptoms of inattention, hyperactivity and impulsivity, and the associated personal interpersonal, social and occupational concomitants of the condition ( 55 ). Additionally, adapted DBT group interventions have demonstrated high effectiveness and acceptability, in helping people manage ADHD related symptoms ( 38 – 43 ). Group delivery of therapy is not commonplace within NHSTTAD services for patients with higher levels of distress or complexity, with one to one CBT being the primary treatment option. Moreover, as previously highlighted, there are few DBT trained therapists and supervisors currently working in primary care within England, giving rise to current plans to increase numbers of DBT trained therapists ( 48 ). The implication is that at this present time, adapted DBT maybe unlikely to be delivered in primary care with fidelity to the empirical studies.

Hayes and Hoffman ( 47 ), make the point that ‘third wave’ and traditional CBT approaches are often blended in reality, and this may be reflected in the range of empirically validated key adaptations to CBT for ADHD, which include helping the person to develop and review strategies to improve attentional focus, impulse control, planning and problem-solving, cognitive restructuring in the context of ADHD, managing emotional arousal in conflict and ensuing emotional or behavioural responses (e.g. managing anger and anxiety) and pro-social skills, e.g. empathy skills including perspective taking, recognition of the thoughts and feeling of others, critical reasoning, evaluating options and negotiation skills ( 28 , 34 , 56 ).

This is consistent with a body of research showing the efficacy of CBT in reducing ADHD symptoms and improving EF ( 29 , 31 , 34 , 56 ). Moreover, in a recent meta-analysis by Young et al. ( 19 ), CBT was shown to be an effective psychotherapeutic treatment for reducing ADHD symptoms.

Potential inconsistency in results across included studies is affected by stark differences in the implementation and delivery of CBT. Ramsay ( 4 ) described the impeding effect of ADHD symptoms on standard CBT and the need for an adapted approach to CBT to accommodate the EF and emotional dysregulation difficulties in participants with ADHD. Additionally, previous studies reported CBT content targeted to address ADHD symptoms, in countries outside the UK ( 19 , 31 , 34 , 56 , 57 ). The English NHSTTAD system is unique as it is a single point of access for CBT for all resident adults seeking support with mental health, following a prescribed competency-based approach to CBT for a limited range of presenting problems ( 58 ). Therefore, CBT in NHSTTAD is not necessarily easily tailored to or adapted for specific conditions outside of its core focus on anxiety and depression. CBT programs in other countries and published studies have often been adapted for ADHD and therefore do not represent the same form of care.

The difference in outcome between adapted and generic CBT is demonstrated in the striking disparity between Participant Four’s account and those of the other participants. They received a form of CBT specifically adapted for individuals with ADHD, by a therapist who was reported as having specialist expertise in working with clients with ADHD and who also had lived experience of ADHD. This experience of CBT was found extremely helpful and meaningfully tailored to their experiences by explaining their cognitive processes and behavioural responses in the context of their ADHD diagnosis. Psychoeducation of ADHD and an adapted approach allowed for an understanding of the client’s strengths and promoted self-acceptance and moderation of their ADHD-related difficulties. This mirrors previous studies which have highlighted the benefits of psychoeducation in cognitive interventions ( 43 ). Conversely, most participants, reported that there was no obvious accounting for ADHD symptoms within their CBT sessions. Therapists appeared to lack cursory knowledge of ADHD and did not seem to understand ADHD as a root cause behind symptoms experienced, and therefore could not appropriately adapt CBT or provide relevant techniques to help clients accept and moderate ADHD-related difficulties. Similar experiences of CBT delivered in routine practice in NHSTTAD services, as not being adequately tailored to the needs of clients are reported in the literature. Omylinska-Thurston et al. ( 59 ) reported similar findings in a group of participants with severe mental health disorders, where generic CBT was not experienced as adequately addressing underlying core issues, and was delivered inflexibly, leading to CBT being perceived as a waste of time and financial resources. The pressure on NHSTTAD therapists is significant, including considerations such as measurement against key performance indicators relating to client and service recovery rates, ‘throughput’ of clients, limited session numbers, high caseloads, and a range of client problems that are less likely to respond to time-limited CBT, such as experiences of poverty, social exclusion, or systematic oppression and social injustice ( 22 ). Against such a demanding context, several studies report significant levels of stress and psychological disturbance among the NHSTTAD workforce ( 60 – 62 ). It is possible, that against this context of background stress, therapists may be struggling to provide personalised formulation and therapy adapted to the presenting needs of their clients.

Indeed, in this study, most participants reported not receiving behavioural components of CBT for ADHD, meaning that they were not given graded task assignments, activity scheduling, or other behavioural tools to help manage procrastination and anxiety. The exclusion of valid behavioural elements of CBT has been previously noted by Binnie ( 22 ), who argued that CBT delivered in NHSTTAD often tended to focus on cognitive interventions, neglecting valid behavioural components.

Participants argued that the structure of therapy was not client-centred but followed a rigid and systematic approach which neglected their feelings, needs, and self-expression. Decades of research highlight the importance of a therapeutic relationship in which the therapist is experienced as empathic and attuned to the needs of the client, (e.g. 63 ), however, this crucial element of therapy was not experienced by several participants in the present study. Omylinska-Thurston et al. ( 59 ) reported that when participants felt their therapists were unempathetic and adhered to a rigid CBT protocol, instead of attending to the participant’s individual needs, therapy was unhelpful. Binnie ( 22 ) supported this by arguing that the delivery of CBT in NHSTTAD services may omit collaborative empiricism and guided discovery where the therapist works compassionately with the client, and instead overly focuses on manualised treatment for a restrictive range of presenting problems.

In contrast, Participant Four’s, specialised therapist idiosyncratically formulated the participant’s current situational difficulties and meaningfully personalised the treatment plan to the participant’s feelings and needs. This was experienced as crucial and helpful by the participant, who was able to learn from and manage undesirable situations, supporting Omylinska-Thurston et al. ( 59 ) who argued that an adjusted client-centred (i.e. idiosyncratically formulated) CBT process can improve the therapeutic relationship and outcome of therapy.

Overall, most participants reported feeling discontent or disappointed with therapy, which led to an increased sense of failure, increased emotional dysregulation, low self-esteem and a sense of self-blame. The ineffectiveness of therapy increased their feelings of hopelessness and disappointment in themselves. According to Ramsay ( 4 ), individuals with ADHD are more inclined to have pessimistic thoughts and expectations of failure due to their past unsuccessful experiences, which runs the risk of being amplified by therapy not adjusted to consider the person’s experiences of ADHD.

The survey results further supported the insights gleaned from the conducted interviews. Similar to the interviews, participants responded that they found the non-adapted form of CBT unhelpful and challenging, further deploring their self-esteem and increasing their frustration. Moreover, the therapists’ lack of knowledge of ADHD was apparent from most survey responses, demonstrating a need for additional training for therapists, on working with people who have ADHD.

4.1 Limitations

While the present study addresses an important research gap on the experience of generic, non-adapted CBT in adults with ADHD, there are limitations to the study. A convenience sample was used to recruit participants. The sample was predominantly female, which may not be an adequate representation of the predominantly male ADHD population, limiting the generalisability of the results. Moreover, convenience sampling may attract participants with charged emotional experiences, who may deliver a more negatively, or positively exaggerated account than that of the rest of the ADHD population. Additionally, the impact of the different ADHD presentations (inattentive, hyperactive-impulsive, and combined) on participants’ experiences of CBT was not analysed, which may have left an interesting variable unexplored. Finally, it is important to acknowledge that the findings refer to a vast range of non-adapted CBT treatment episodes experienced across the UK and therefore refers to a heterogeneous form of therapy. While we could discern between private, adapted CBT programs and NHS delivered generic programs, we cannot generalise the findings broadly as we lack details on these specific programs. Finally, we did not explore the different types of CBT that might have been received. The study aimed to look into how adults with ADHD experienced CBT, adopting a broad definition of what CBT is, as we did not want to be too prescriptive, believing that individuals might not always know the exact type of CBT they have received. This variance in the nature of CBT delivered, and understanding of what type of CBT is received may reflect naturalistic practice in the NHS, however through this omission, we might have missed important information about different nuances.

4.2 Future considerations

4.2.1 implications for practice.

This study highlights that routine delivery of CBT in the UK, may not be adapted appropriately for many adults with ADHD, negatively impacting their experiences. To combat this counterproductive effect of therapy, CBT therapists treating ADHD adults must receive additional training on adapting CBT to work with the array of symptoms and common experiences of people with ADHD, to more appropriately adapt CBT techniques and resources ( 4 ). Through this adaptive framework, necessary considerations regarding the EF and emotional dysregulation difficulties of ADHD individuals should be considered, transforming the nature of standard CBT to being more explicitly aligned with the experiences of people with ADHD.

4.2.2 Implications for research

The present study illustrates the potential negative impact of CBT on adults with ADHD revealing the need for more research in this topic area. Further investigation on the difference between adapted versus non-adapted CBT would further the important nuance in how beneficial CBT may be as a first line of psychotherapy treatment. Additionally, future research should consider the effect of different ADHD presentations on the effectiveness of CBT treatments, since research suggests improvement for clients with the predominantly inattentive ADHD sub-type ( 64 ). Moreover, specific post-qualification training on adapting CBT to work with ADHD symptoms appears indicated, and the authors are developing such training packages in association with people with lived experience of ADHD.

5 Conclusion

In conclusion, the present study portrays how adults with ADHD experienced CBT in the UK, with most ADHD participants reporting negative experiences when CBT programs were not adapted. This evidence prompts future research and clinical practice to address the issues highlighted in this study for a deeper understanding of how best to accommodate adults with ADHD in therapy. Moreover, this prompts therapists and service providers in the UK to consider the current implementation of CBT to ensure CBT can be appropriately adapted and delivered by therapists with relevant training, who understand the difficulties of ADHD, to ensure that treatment is helpful, efficient and meaningful to adults with ADHD, and to mitigate against the possibility of iatrogenic harm.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving humans were approved by University of Nottingham School of Psychology ethics committee (ethics reference number: FMHS 81-0922. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

SW: Formal analysis, Investigation, Writing – original draft, Writing – review & editing. MH: Conceptualization, Methodology, Supervision, Writing – review & editing. JR: Conceptualization, Methodology, Supervision, Writing – review & editing. CH: Conceptualization, Investigation, Supervision, Writing – review & editing. BF: Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. BR received funding from the Economic and Social Research Council (Grant number: ES/X000141/1).

Conflict of interest

BF reports personal fees and nonfinancial support from Takeda and Medice.

All remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at:

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Keywords: attention-deficit hyperactivity disorder (ADHD), cognitive-behavioural therapy (CBT), adapted CBT, psychotherapy, interviews

Citation: William S, Horrocks M, Richmond J, Hall CL and French B (2024) Experience of CBT in adults with ADHD: a mixed methods study. Front. Psychiatry 15:1341624. doi: 10.3389/fpsyt.2024.1341624

Received: 20 November 2023; Accepted: 24 May 2024; Published: 19 June 2024.

Reviewed by:

Copyright © 2024 William, Horrocks, Richmond, Hall and French. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Blandine French, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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What is ADD / ADHD?

It's not uncommon that the symptoms of ADD / ADHD are misunderstood. Parents often fear that their children with ADHD are trying to be difficult, not truly understanding the challenges they face. Similarly, in adult relationships, symptoms of inattention are easily mistaken for aloofness, apathy, or uncaring.

For these reasons, psychoeducation is a crucial part of treating ADHD in children and adults alike. Not only will proper education help to clear up the misconceptions of others, it can show your clients that they aren't alone. It can help them realize that there is a very real cause for what they're dealing with.

Our What is ADHD? printout covers the most important areas of psychoeducation related to ADHD with simple and easy-to-understand language (although, this form is ultimately intended for adults). The areas that are discussed include symptoms, what ADHD really looks like, the biological basis of ADHD, and and an overview of treatment options.

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  1. ADHD Facts, Worksheets, What It Is, Causes, Signs & Symptoms For Kids

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  1. Managing ADHD

    The Managing ADHD worksheet describes five key skills that can often help those with ADHD. The skills include: creating structure, setting aside time for relationships, staying organized, creating the right environment, and living a healthy lifestyle. Each section describes the importance of the skill, and tips to implement it successfully.

  2. ADHD Worksheets

    ADHD Info for Teens. worksheet. ADHD is diagnosed in almost 1 in 10 school-aged kids. For teenagers, education about ADHD is an important part of treatment. Myths about ADHD are rampant, such as the idea that the diagnosis means "less intelligent", or that ADHD is just an excuse for behavioral and academic problems.

  3. 37 Effective Therapy Activities for an ADHD Child

    These therapy activities offer effective strategies to enhance such vital skills. 4. Memory Games. Memory games, for instance, challenge a child's ability to focus on and recall information. These brain exercises encourage them to pay attention to details and sharpen their memory skills.

  4. PDF The Adult ADHD Toolkit: Coping Inside and Out

    1. prepare more specific therapy goals with their adult patients with. ADHD. 2. recognize intervention strategies used to address procrastination, disorganization, and time management problems commonly reported by adults with ADHD. 3. identify at least one common distorted thoughts reported by adults with ADHD and how it may undermine coping ...

  5. Printables

    Information about what ADHD is, the types of ADHD, and the treatment options you may have available to you. New Diagnosis Pamphlet -print double-sided on letter-size paper and fold in thirds. New Diagnosis Booklet -print double-sided on letter-size paper and fold in half to create an 8-page booklet.


    Click below to download these free guides and worksheets curated by the editors of ADDitude. For deep dives into these and other topics, browse our full selection of eBooks here. Free Downloads. Free Guide to Hoarding Disorder Vs. ADHD Clutter. To an untrained eye, ADHD clutter may resemble hoarding disorder. Here's how to differentiate ...

  7. ADHD Triggers Worksheet

    Art Therapy Worksheets for Adolescents ... To enhance ADHD treatment, use the worksheet to reflect on your emotional reactions and triggers, put coping mechanisms into practice in everyday circumstances, and evaluate and modify your plans on a regular basis in light of new insights. ...

  8. PDF Guided Self-management Tools for Adhd

    and social activities. O˜er a daily reminder for your child to use and check their planner. The more they write down, the less they (and you) have to remember! For ways to use these tools to help with your child's homework, see Homework Help (ADHD Skill 2). You can also use a family planner and/or calendar to track family activities.

  9. PDF SELF HELP for Adult ADHD

    y.Attention exercisesSet a timer for 5 minutes (increase by 5 minutes a day) and focus your conce. ration on one activity. Take a 2 minute break before continuing (increase brea. by 2 minutes each day).Memorise information such as poems, quotes, jokes or. ords of a new language.Counting exercises: count backwards from 100.

  10. PDF Mastering Your Adult ADHD

    The most frequently discussed problems among adult patients with ADHD who had been taking medicines were (1) organizing and plan-ning, (2) distractibility, and (3) associated anxiety and depression. Other concerns included problems with procrastination, anger management, and communication issues.

  11. ADHD Focus Plan

    worksheet. For adults with ADHD, it can be difficult to focus on important tasks. ADHD may lead to procrastination, distraction, feelings of overwhelm, or simply forgetting about the task. CBT for ADHD teaches practical skills to address these challenges. The ADHD Focus Plan worksheet combines these practical skills into a simple planning process.

  12. Managing ADHD Worksheet (TherapistAid)

    The 'Managing ADHD Worksheet' is a valuable resource that outlines key skills that can be beneficial if you are struggling with ADHD. Each section provides insights into the importance of each skill and offers you practical tips for successful implementation. You can take proactive steps to improve your symptoms by integrating these skills into your daily routine.

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    bring your attention to your head including your hair and scalp and you. brain inside your head. Now take a belly breath and fill your. hole body with a cushion or air. Blow the air out gently. ring your attention back to the room.Mindfulness Of Physical Body.

  14. ADHD Problem Solving Worksheet

    How to use the worksheet? Write down the problem in the brainstorm cloud in the middle. Then discuss with the child and write down all the possible solutions they can think of. Guide them if needed. Once all the options have been listed, ask them to choose one based on what they think would be the most helpful one.

  15. ADHD Child Worksheet

    The worksheet will provide a simple template that kids with ADHD can use to plan what they need to do in the day. Their inability to focus on a task or even remembering to do important tasks is a common consequence of their condition which can be managed with daily to-do lists.

  16. Forms and Worksheets

    Speech and Language Therapy. Anaesthetics General Anaesthesia. Neuroanaesthesia. Clinical Medicine Acute Medicine. Allergy. Cardiovascular Medicine. Clinical Genetics. Clinical Pharmacology and Therapeutics ... Safren, Steven A., and others, ' Forms and Worksheets', Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program, Therapist ...

  17. CBT Techniques: 25 Cognitive Behavioral Therapy Worksheets

    Cognitive-Behavioral Therapy Worksheets (PDFs) To Print and Use. If you're a therapist looking for ways to guide your client through treatment or a hands-on person who loves to learn by doing, there are many cognitive-behavioral therapy worksheets that can help. 1. Coping styles worksheet.

  18. DBT for Attention Deficit Hyperactivity Disorder (ADHD)

    The timeframe for seeing results from DBT for ADHD can vary depending on several factors, including the severity of ADHD, commitment to therapy, and individual differences. ... 10 Family Therapy Activities to Strengthen Relationships. Therapy. 10 Best ADHD Books in 2024. ADHD. Parenting. 10 Best Telehealth Activities for Kids.

  19. Tips for Managing ADHD

    Use this worksheet as a jumping-off point to begin discussing ADHD coping strategies, as a take-home reminder of skills, or for review. Rather than covering the entire handout in one sitting, discuss and practice a few tips at a time, in-depth. A PDF file thatʼs great for printing, but locked and not modifiable.

  20. CBT Worksheets for Adults With ADHD

    What Is Cognitive Behavioral Therapy? Cognitive behavioral therapy — more commonly known as CBT — is an umbrella term for a type of therapy originally designed to treat PTSD and anxiety disorders. In recent years, however, CBT has expanded to treat ADHD in adults, opening up an effective, non-medical pathway for adults looking to better manage difficult symptoms related to organization ...

  21. ADHD Coping Skills Worksheet PDF

    ADHD Coping Skills Worksheet PDF. Paying attention, staying organized, and controlling your energy can be a challenge if you have ADHD. Our ADHD Coping Skills Worksheet PDF (Editable, Fillable, Printable) is perfect for counselors, psychologists, psychiatrists, social workers, therapists, and other mental health professionals.

  22. How Couples with ADHD Can Reduce Conflict and Get Along Better

    Sharon Saline, Psy.D., is a clinical psychologist and an expert in how ADHD, LD, and mental health affect children, teens and families. She is the author of What Your ADHD Child Wishes You Knew ...

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    ADHD is a neurodevelopmental disorder in which the connections or neurotransmitters between different brain regions work differently, leading to issues with inattention, impulsivity and hyperactivity.

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    A steady routine will help you focus on one thing at a time, with less room for distraction. Set aside a time for everything. Try to eat, sleep, work, and relax at roughly the same time every day. This will help you follow through with each of your daily tasks. It might be a struggle to keep your routine at first, but with time you'll fall ...

  25. Best Online Therapy For ADHD In 2024

    The best online therapy platforms for ADHD range from about $59 to $140 per session. Those seeking therapy for the treatment of ADHD should consider whether a platform has ADHD specialists, if it ...

  26. Experience of CBT in adults with ADHD: a mixed methods study

    1 Introduction. Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterised by symptoms of persistent inattention and/or hyperactivity-impulsivity, that causes clinical impairment in academic and social functioning affecting approximately 5% of children and 2.5% of adults ().While this suggests that ADHD attenuates over time, the prevalence of symptomatic ...

  27. Children's ADHD Skill Packet

    The Children's ADHD Skill Packet was created to accompany The Kangaroo Who Couldn't Sit Still. After reading the story, use this packet to teach children and their caregivers how to practice the same skills used by Kangaroo. The information in the Children's ADHD Skill Packet will largely be implemented by parents and caregivers, but the ...

  28. What is ADD / ADHD?

    worksheet. It's not uncommon that the symptoms of ADD / ADHD are misunderstood. Parents often fear that their children with ADHD are trying to be difficult, not truly understanding the challenges they face. Similarly, in adult relationships, symptoms of inattention are easily mistaken for aloofness, apathy, or uncaring.

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