Medication is the treatment most people hear about after an ADHD diagnosis. But many adults also want to know whether therapy can help, either instead of medication or alongside it. The therapy most often recommended is cognitive behavioural therapy, or CBT.
Here is what CBT for ADHD involves, what the national guidance says about it, how it works with medication and how to tell whether it is right for you.
CBT does not change how your brain works. It changes what you do about it, day to day.
The short answer: does CBT help ADHD?
CBT can help many adults with ADHD manage the practical and emotional effects of the condition, such as disorganisation, procrastination and the frustration that builds up after years of struggling. It is not a cure, and for most adults it is not a replacement for medication when symptoms are causing significant problems.
It tends to work best as part of a wider plan, and it can be particularly useful for people who cannot take medication or who still struggle despite it.
What NICE recommends for adults
The national guideline on ADHD, NICE NG87, recommends offering medication to adults whose symptoms are still causing significant impairment after changes to their environment have been made and reviewed.
It then recommends considering non-drug treatment for adults who:
- Have made an informed choice not to take medication
- Have difficulty taking medication consistently
- Have found medication ineffective, or cannot tolerate it
NICE also suggests considering it alongside medication for adults who have benefited from medication but whose symptoms are still causing significant problems. When non-drug treatment is used, NICE says it should include, as a minimum, a structured supportive psychological intervention focused on ADHD and regular follow-up, in person or by phone. It may involve elements of CBT or a full course.
If you are still deciding about medication, our guide to whether to take ADHD medication sets out the questions to think about.
How CBT for ADHD differs from general CBT
Many people know CBT as a treatment for anxiety or depression, where the focus is mostly on unhelpful thoughts. CBT for ADHD is more practical. It still looks at thinking patterns, but much of the work is about building systems and habits that make up for difficulties with planning, attention and getting started.
Programmes for adults are usually built from modules such as:
- Understanding ADHD: how it affects you specifically, and why some strategies have not worked before
- Organisation and planning: one calendar and one task list, and breaking large jobs into small steps
- Managing distraction: setting up your surroundings and planning focused blocks of time
- Getting started: tackling procrastination, for example by committing to just five minutes
- Unhelpful thinking: noticing thoughts such as “I always fail” and replacing them with more balanced ones
Our guide to ADHD time management includes some of the everyday strategies CBT builds on.
What happens in a CBT session
CBT sessions are structured. A typical session starts by looking back at what you tried since last time, then introduces a new skill, and ends by agreeing what you will practise before the next session.
The practice between sessions matters. The aim is to use the strategies in real life until they become habits, not just to talk about them in the room.
With us, sessions are weekly by secure video call and are booked in blocks of six, so you can see how things are going before you continue. You can find out more on our CBT for ADHD page.
What the research shows
The evidence for CBT in adult ADHD is promising rather than conclusive. One of the best-known trials, published in JAMA in 2010 by Safren and colleagues, studied adults who were already taking medication but still had significant symptoms. Those who received CBT improved more than those who received relaxation training with educational support.
That is consistent with NICE, which suggests considering non-drug treatment alongside medication when symptoms persist, or instead of it for people who do not take medication.
CBT with or without medication
Medication and CBT work in different ways. Medication can reduce core symptoms such as inattention and impulsivity, and our guide to which medications help with ADHD explains the main options. CBT helps you build the skills and routines that medication alone does not teach.
Many adults find the two work well together. If you are starting medication, it may make sense to wait until your dose is settled before beginning CBT, so you can tell which changes are helping. Talk to your prescriber about the timing. Our article on ADHD titration explains how that settling period works.
When CBT can help with more than ADHD
Many adults with ADHD also live with anxiety, low mood or low self-esteem, often after years of being told they are not trying hard enough. CBT is well established for anxiety and depression, so it can address these alongside ADHD. Our article on ADHD and anxiety explains how the two interact.
Strong emotional reactions to criticism are also common. Our guide to rejection sensitive dysphoria looks at this in more detail.
Other therapies that may suit you
- Dialectical behaviour therapy (DBT): combines CBT techniques with mindfulness and skills for managing intense emotions
- EMDR: not a treatment for ADHD itself, but it can help with painful experiences, shame and trauma. See our EMDR therapy for ADHD page
- ADHD coaching: goal-focused and practical, but coaching is not a regulated therapy. Our guide on how to find an ADHD coach explains the difference
- Family involvement: partners or family members can help with planning and support at home
Our ADHD and autism therapy services page sets out the therapy programmes we offer for adults, teenagers, children and families.
Is CBT right for you?
CBT asks for time and effort between sessions, so it suits people who want practical tools and are able to practise them. It may be a good fit if you:
- Have decided not to take medication, or cannot take it
- Take medication but still struggle with organisation, procrastination or motivation
- Also live with anxiety or low mood
- Want to understand your ADHD and build routines that last
If you have not been assessed yet, a diagnosis can help you and your therapist understand what is driving your difficulties. Our ADHD assessment page explains how that works.
Questions to ask before you start
- Does the therapist have experience of working with adults with ADHD?
- Will the sessions be structured, with practice between them?
- How will progress be reviewed, and when?
- Is the therapist registered or accredited? In the UK, CBT therapists can be accredited by the BABCP, and practitioner psychologists must be registered with the HCPC
If you need help now
CBT is not an emergency service. If you are struggling to cope or feel unsafe, please see our urgent help and crisis support page.
Conclusion
CBT will not take ADHD away, but it can give you practical ways to manage it, whether you take medication or not. NICE says non-drug treatment, which may include CBT, should be considered for adults who choose not to take medication or cannot, and alongside medication when symptoms still get in the way.
If you would like to talk about whether CBT is right for you, contact our team and we will help you choose the right next step.
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