Motivational and inspirational writer, Bryan Hutchinson is the author of several books about life with ADHD including the highly acclaimed, best selling "One Boy′s Struggle: A Memoir" and the author of the hilarious eBook that went viral "10 Things I Hate about ADHD"

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Does Cognitive Behavioral Therapy for Adults with ADHD Work and is it Better than Medication?

Controlled trial results with the potential answer in this post.
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One of the things I have come to enjoy from blogging is reporting some of the latest studies about ADHD. It’s a lot of fun and sometimes we talk about things like Coffee isn’t so bad and how to make popcorn in a paper bag, but then there are other things we find out that we weren’t really sure about and CBT is one of those things. Does it work? In my opinion and experience: YES. But don’t take my word for it alone, I’ll give you the results of the trial in a moment.
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In my first book One Boy’s Struggle I wrote about my experiences with therapy and I gave an overview in my free eBook 7 Crucial Tips for Parents and Teachers of Children with ADHD. In short, my experiences have been profound and exceedingly successful. If you have any idea of how far I have come then you may have an idea of how profound and successful the treatment really was, and continues to be. Furthermore, I do not take medication.
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But there’s is an issue with CBT and that is perception of it and our need to fix our behaviors right away, today! Medication helps solve that problem for a lot of people, and although medication can be a wonderful solution, it just doesn’t teach us any management skills or anything about ourselves. Most people with ADHD have a lot of pent up thoughts and beliefs and those can be very powerful to the point of controlling their lives; therefore, even with the best, most effective medication the adult with ADHD might still not find the success he or she was hoping for. That doesn’t knock medication; it simply means there may be more to one’s situation with ADHD than the symptoms alone. And even more so the later diagnosis is finally established.
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Too many of us have come to believe that we cannot and will not improve or succeed. And since we have ADHD, we never will accomplish our goals and our dreams. Many of us come to curse ADHD and live within a shell of anger, anxiety and despair, never realizing the real curse is in our thoughts and beliefs. That’s where therapy is most effective. Because no matter how great the medication works, it doesn’t help the things you believe or the way you perceive things. So many of us have distorted perceptions of what we really can and cannot do because we’ve been looking through the ADHD failure lens all of our lives, trying so hard to measure up to others expectations of us and after years of constantly failing it is almost impossible to see any positives, much less a way out of the darkness.
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If you relate to what I have written please read One Boy’s Struggle to truly understand how therapy improved my life radically. Prior to therapy I never believed I could write a book or much less manage to maintain a blog. However, you don’t have to purchase One Boy’s Struggle to get a good overview of my experience, please feel free to download 7 Crucial Tips for Parents and Teachers of Children with ADHD. The section about professional therapy is written mainly for adults with ADHD because, as we now know, many parents of children with ADHD also have it themselves.
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Now how about that info concerning the recent trail:
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A Randomized Controlled Trial of CBT Therapy for Adults with ADHD with and without Medication

Previous studies of psychological treatment in adults with ADHD have not controlled for medication status and include either medicated participants or mixed samples of medicated and unmedicated participants. The objective of this study is to examine whether use of medication improves outcome of therapy.
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Method: This was a secondary analysis comparing 23 participants randomized to CBT and Dectroamphetamine vs. 25 participants randomized to CBT and placebo. Both patients and investigators were blind to treatment assignment. Two co-primary outcomes were used: ADHD symptoms on the ADHD-RS-Inv completed by the investigator and improvement in functioning as reported by the patient on the Sheehan Disability Scale.
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Results: Both groups showed robust improvement in both symptoms and functioning, but the use of medication did not significantly improve outcome over and above use of CBT and placebo.
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Conclusion: This study replicates previous work demonstrating that CBT is an effective treatment for ADHD in adults. Within the limits of this pilot, secondary analysis we were not able to demonstrate that medication significantly augments the outcome of CBT therapy for adults with ADHD.
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The study was funded by GlaxoSmithKline, Clinical Trials Registry #GSK707. Author: Margaret Weiss, Candice Murray, Michael Wasdell, Brian Greenfield, Lauren Giles, Lily Hechtman. Credits/Source: BMC Psychiatry 2012, 12:30

I will say this from my experience: Not all therapists are created equal. I went to 4 therapists before finding one I felt comfortable with (and one kind of freaked me out). If you’ve tried therapy and it didn’t help you, perhaps consider finding another therapist who is more of a match for you. Keep in mind that just as with medication one size treatment does not fit all as a recent study discovered (I thought we already knew that?). And hey, who knows, with the increasing amount of diagnosis ADHD might be becoming the new normal. (Watch out world – we are taking over!)

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Jay Cross April 9, 2012 at 3:47 pm

I’m skeptical of these results. ADD is a neurological condition. Counseling has no impact on the underlying neurology. I’ll need to see studies on more than 50 people to buy this one.

Bryan Hutchinson April 9, 2012 at 7:03 pm

Hi Jay,

Understandable, but the point with CBT, as far as my experience, is that this isn’t about curing the neurological condition of ADHD, but rather to assist adults in managing the symptoms, as well as learning that there are alternative ways of doing things. More importantly though, CBT helps clarify beliefs that one may have come to believe about themselves in a negative, defeatist, self-shame way. In reality and truth, many do not want to face that aspect of themselves. As someone who has successfully experienced therapy I am not a skeptic and even if a thousand people were in a test study proving positive this would not change my experience. However, I can pretty much guarantee that if I had not had an open mind when I first entered therapy and without the knowledge that I had ADHD it might not have been as successful because I may have doubted the possibilities. Thankfully I wasn’t a skeptic. I was lucky I didn’t know what ADHD was at the time, I guess. As intellectual humans I think we sometimes we get in our own way. If we believe it can’t work, it most likely won’t.

Bryan

Sas April 18, 2012 at 1:43 am

As someone who studied psychology for years & leans more towards the sciencey neuro-biological end of the subject, I’m afraid I have to disagree with your take on it, Jay. Yes, ADHD is neurological in the sense that it’s all down to an innate difference in “brain wiring” but a) the way our brains are “wired” is not fixed, and b) not all of the problems ADDers experience are direct symptoms of the neurological disorder, they are often about how we actually deal with those symptoms day-to-day.

I’m especially disinclined to be cynical about this study because it was funded by GlaxoSmithKline who you would expect to be biased in favour of medication! Unless this is all just part of some cunning ploy to appear “balanced” :)

Sarah Gogstetter April 9, 2012 at 3:59 pm

You make a really good point here Bryan. I am on meds, but they didn’t teach me the skills and tools I have learned. The work I put in the last 11 years, paid off and helped me survive even when I went through the meds fiasco. I have very severe ADHD and severe co-existing challenges so taking meds, therapy, coaching, educating myself about ADD/ADHD and successfully overcoming multiple birth challenges have all helped me be awesome. :lol:

Bryan Hutchinson April 9, 2012 at 7:06 pm

Yep! You’re awesome, Sarah :)

yzerbee April 9, 2012 at 6:27 pm

haha word! Watch out world – we are taking over!

Jeremy April 12, 2012 at 10:20 am

This seems to disagree with the MTA study…?

Andy April 13, 2012 at 11:52 am

Thanks for writing about this important topic. As someone with ADD who is also trained in Cognitive-Behavioural Therapy, I believe CBT has immense value in treating ADD. Whether or not it’s a neurological condition makes no difference. Mind and body cannot be separated and your perception of ADD traits is just important as your experience of symptoms. Many ADDers are not held back by the symptoms nearly as much as they are by their lack of self-belief.

Re: the MTA study, Thom Hartmann would say that it was more than flawed…

Just my two cents, I am passionate about ADDers changing their negative beliefs about themselves and embracing who they are!

Nicole April 18, 2012 at 11:40 pm

So how would someone go about finding such a therapist? My diagnosis, and consequent medication, have all come from my primary care doctor.

Bryan.hutchinson July 21, 2012 at 7:17 pm

Nicole, you could ask your GP. Or better yet, see if you can find an ADHD support group near your area and contact them. Chances are someone in the group knows of a good therapist and may be able to refer you.

Bryan

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