Cognitive behavioral therapy (CBT) for ADHD

While more traditional forms of psychoanalysis and therapies require people to delve into their past experiences to understand their emotional problems, cognitive behavioural therapy (CBT) focuses more on the feelings the patient is experiencing at the moment and tries to help them recognise their reactions and immediate emotions in response to these experiences.

CBT traces its roots back to the 1960s—to Aaron Beck and Albert Ellis' research and to the people who popularized this form of therapy after them. According to Beck and Ellis' early foray into the subject, people have an immediate response to events, situations or anything that creates stimulation in the brain and prompts a response through emotion, which could range from positive feelings to feelings of negativity, or at their worst, cause anxiety or lead to depressive thoughts.

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CBT helps children having difficulty with their thoughts and emotions to recognise and understand what they are feeling, and helps them in addressing and dealing with such emotions. With this type of therapy, children are able to deal with their emotions after understanding their strengths and evaluating their weaknesses.

This form of therapy will help identify the patterns and beliefs, challenge their rationale behind the negative feelings or emotions and help the patient to overcome these thoughts with the help of constructive discussions and mind exercises. 

Many different types of psychological disorders may bring up negative thoughts and behaviours in response, and they are typically addressed with the help of CBT, which systematically and gradually exposes the patient to the situations and events that lead them to such a reaction. This is done so that when the patient is exposed to a similar situation in the future, they are able to manage their responses and consequently address their irrational thoughts and beliefs.

CBT typically has the following flow:

• Identifying the situations or events that lead to an emotional response
• Recognising or becoming aware of the feelings and emotions that come out in response to these situations
• Recognising the pattern of negative thinking
• Addressing the negative thinking patterns and altering them with practice

As mentioned earlier, CBT is a helpful tool to address various issues affecting the mental health of a person. Among the various branches of psychotherapy, CBT is often preferred for children with ADHD as it provides the children with an early understanding of their own behavioural patterns and how they can address them through certain changes to their behaviour and thinking.

CBT typically requires fewer sessions as compared to other forms of psychotherapy and can provide a quick redressal to the challenges a person has been facing. It is particularly helpful in the following ways:

• Identifying one's own behaviour and responses to certain triggering situations and events
• Learning effective ways to deal with and manage stressful situations
• Managing symptoms of different kinds of mental illness or disorders
• As an effective alternative to strong medications that may have side effects
• Preventing the symptoms or signs of mental illness from resurfacing
• Learning to cope with traumatic past experiences involving physical, mental or sexual abuse
• Helping cope with grief or loss or a loved one
• Discovering new and more effective ways to communicate and forge relationships
• Learning to deal with a serious illness

According to several studies, CBT is even more helpful when it is used in tandem with other treatments like medications such as antidepressants. However, research into the subject has also shown that CBT by itself can be beneficial even without the help of medications.

Some of the primary signs of ADHD—whether it is in children or adults—include a habit to procrastinate, being inactive for large parts of the day, lack of productivity, being impulsive and hyperactive, fidgety and having a general difficulty in accomplishing tasks. People with ADHD also frequently experience feelings of being inadequate, not good enough, striving for perfection but not being able to get things done—and repeat in the pattern of these thoughts and feelings.

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Many people struggle with feelings of pessimism and self-criticism as they grow older, particularly when disorders like ADHD go undiagnosed in childhood. CBT, however, helps to first identify this chain of thought in people and then sets about addressing them gradually.

People with ADHD can benefit from CBT as it helps in instilling self-belief and self-esteem, helps to increase or improve productivity and helps them become more positive and caring about their own well-being and happiness.

This form of therapy focuses on helping people to manage their time more efficiently, work on their daily patterns of procrastination and other struggles. Some of the common behavioural changes one can address are the habit of missing regular bill payments and being careless about finishing tasks at work, leaving them to be completed another day.

Following sessions can include instilling positive behaviours such as getting better sleep, working out or exercising daily and picking up or sticking to hobbies such as playing a sport, reading, cycling, and so on.

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It is also important for people with ADHD to understand that it is a mood disorder and it can be addressed through some simple course correction work. CBT helps people with ADHD to organise better, improve their self-esteem and plan their days to be more productive—both in terms of their work and in their personal life.

CBT sessions are typically tailored to the patient's specific problems and look at ways these problems can be addressed. Every session can be target-oriented, and look at small goals to achieve by the end of the session. Patients undergoing this type of therapy are also encouraged to read and understand more about the kind of therapy they are being administered, to be more aware of their thoughts and emotions.

As ADHD can affect different people differently, CBT to address the problems may also be customised based on the person's own signs and symptoms. As a result, progress in patients can vary in terms of tangible results—some may experience relief after only 15 sessions, while others may take a few months to be able to see positive changes.

If possible, it can be very beneficial to children with ADHD to get behavioural therapy throughout their growing-up years. This is because childhood and adolescence can be periods of intense changes—learning to cope at these pivotal stages can lay the foundation for the rest of the children's lives.

It is well-known that many mental health disorders in India go undiagnosed, thanks to the stigma attached to mental health. But more and more people are now becoming open to discussing their problems in therapy.

Of course, it is important to choose the right therapist by carrying out your own research after outlining your problems. A network of friends, colleagues and peers can be helpful in identifying the right therapist for you.

It is also important to keep a checklist of the problems you (or your child) may have been experiencing that made you reach out for a CBT session in the first place, to be able to discuss them at length when you go for your first session with a therapist.

CBT or other forms of therapy sessions can be uncomfortable, as they may bring back experiences from the past and force you to tackle those feelings once again. However, a skilled therapist can help you in dealing with those emotions with compassion and allow you to freely express yourself, which can enable you to continue with your sessions in a productive manner.

It is also important for patients with ADHD as well as other conditions to also listen to their therapist and complete the tasks they are assigned in-between sessions, as CBT is typically goal-oriented and prompts you to complete some tasks as you go along in your therapy sessions. These tasks help you to become more organised and skilled at implementing the same in other aspects of life as well.