In recent years, we’ve seen a dramatic and steady rise in attention-deficit/hyperactivity disorder (ADHD) diagnoses.1 In a landscape of mental health conditions, the symptoms associated with ADHD are often minimized and misperceived as trivial. However, the persistent executive dysfunction, emotional dysregulation, and negative, disorganized thought patterns can hinder the ability of those struggling with ADHD to perform basic tasks and maintain focus in their everyday life.
The frustration of trying surface-level organizational techniques and superficial focus strategies that offer limited relief can be disheartening. However, therapy may be the more-comprehensive approach you need to live a life with managed ADHD symptoms. Among your options for therapy, cognitive behavioral therapy (CBT) emerges as one of the most used and researched modalities, supporting cognitive restructuring and helping transform counterproductive thought patterns to improve functioning for those with ADHD.
What Is CBT?
CBT is a form of psychotherapy that helps you identify, understand, and reframe the relationship between thoughts, emotions, and behaviors. A cognitive behavioral therapist will guide you during sessions to figure out how these thought patterns impact your emotions and behavioral reaction, and offer strategies to transform the cycle.
CBT is one of the most effective, observed, and practiced forms of talk therapy.2 In the context of ADHD, CBT aims to reduce negative self-talk regarding inadequate performance, teach coping skills for emotional regulation and procrastination management, and create a structured and achievable process to perform responsibilities.
Related: What Is Dialectical Behavior Therapy? Understanding DBT and How It Works
What Is ADHD?
ADHD is a neurodevelopmental disorder that typically presents with symptoms of inattention, hyperactivity, and impulsivity. These traits tend to create executive dysfunction issues and difficulty with dopamine regulation. It’s a mental disorder that’s most commonly diagnosed during childhood, but can persist into adult ADHD — in the United States, approximately 10.5% of children and 6% of adults had a current ADHD diagnosis in 2024.3
Symptoms of ADHD
ADHD comes with core symptoms that may be difficult to distinguish from anxiety and typical, situational restlessness and struggles to focus. However, certain signs may indicate clinical ADHD, including:
- Inattention symptoms involve being persistently and easily distracted, struggling to complete tasks, difficulty focusing and organizing, and forgetfulness.
- Hyperactivity symptoms include habitual impulsive actions, difficulty remaining still, excessive talking, and struggles with patience.
- Impulsivity symptoms are characterized by blurting out answers, acting without thinking, engaging in risky behaviors, and struggles to regulate negative emotions.
Symptoms vary person to person, and they’ll typically show up differently in children versus adults with ADHD. Regardless of the affected age demographic, performing basic tasks in a school or work setting becomes increasingly difficult when battling these core ADHD symptoms, affecting work ethic, performance, and academic success as a result.
Related: Exploring the Complex Relationship Between MDD, OCD, and ADHD
How Does CBT Work for ADHD?
One of the benefits of utilizing CBT in a therapeutic space is that it can reframe any negative or impulsive thoughts to calm the overactive mind. Here are some ways that CBT work to unravel cognitive distortions common in those struggling with ADHD.
Understanding common cognitive distortions for ADHD
CBT will teach you to reframe negative thought patterns that could be exacerbating your ADHD symptoms, otherwise known as cognitive distortions. In the context of ADHD, common cognitive distortions include:
- All-or-nothing thinking: A common thinking pattern for people with ADHD that can cause difficulty resolving conflicts and accurately assessing personal mistakes driven by struggles to find the gray area of situations and outcomes.
- Catastrophizing: This is characterized by thoughts that tend to spiral out of control, causing people to assume the worst case scenario is inevitable. This can cause someone with ADHD to have decision paralysis instead of finding solutions, procrastinating, or experiencing exacerbated anxiety.
- Labeling: Using labels can be detrimental to mental health as it reinforces limited beliefs and negative self-worth. These labels may sound like “I’m lazy,” “I’m a failure,” or “I lack impulse control.”
Other cognitive distortions for people with ADHD include overgeneralization, emotional reasoning, “should” statements, and personalization.
Cognitive restructuring: the core of CBT for ADHD
Cognitive restructuring is fundamental to CBT, helping you identify, process, and replace ADHD-related cognitive distortions. These negative thoughts might be, “I never remember what I need to — I’m so unorganized,” which can be reframed as, “I sometimes forget things, but that doesn’t define me.” Your therapist will teach you to recognize when these distorted thoughts come up, examine the evidence to challenge their validity, and develop healthier thought patterns.
CBT adaptations for ADHD
It’s important to adapt CBT to the context of your unique expression of attention deficit symptoms for the best therapeutic results. A cognitive therapy approach that is tailored for ADHD treatment may include:
- Focus on executive function skills: CBT focuses on managing executive dysfunction, especially when it comes to beginning a task or breaking it down into manageable steps.
- Emphasis on implementation strategies: People with ADHD may know what to do yet struggle to implement it, which can be difficult if you struggle with time management. CBT for ADHD involves teaching skills to remind yourself of upcoming deadlines, stay on track, and design an environment that works to your benefit.
- Structured approach for organization and planning: CBT often involves between-session homework, which can be difficult if you struggle with procrastination. Adaptations will involve breaking down tasks into manageable steps, implementing a more structured format, and providing explicit instructions to account for confusion.
- Addressing ADHD-specific thought patterns: Examining self-talk such as “I never finish anything” or “I’ll never be able to focus” through Socratic questioning can help you to reframe unhelpful thoughts into more productive ones.
How many sessions of CBT are required for ADHD?
The pace of your CBT sessions will vary from person to person, and there isn’t a standardized timeline for healing. However, traditional CBT for ADHD typically follows a structure of 10 to 12 weekly or biweekly sessions that include between-session homework and exercises. If you want a rough idea of how your sessions might be organized — keeping in mind that your structure and format may look different — here’s an example module published by the National Library of Medicine that can offer some insight 4:
- Psychoeducation and organizing/planning: four sessions.
- Coping strategies for distractibility: two sessions.
- Adaptive thinking (cognitive restructuring): one session.
- Procrastination: one optional session.
- Partner involvement: one optional session.
- Relapse prevention: one optional session.
During your CBT sessions, your therapist will be assessing the severity of your symptoms, your individual learning pace, the strength of your support system, and any potential co-occuring conditions to adjust their care approach. Once you’ve completed your CBT program, you may be recommended to participate in maintenance sessions to help sustain your progress long-term.
Related: Navigating Online ADHD Prescriptions
CBT Exercises for ADHD: Adapting Cognitive Restructuring Techniques
Cognitive restructuring techniques form the foundation of CBT, but they may need to be adapted for ADHD-related challenges such as executive functioning differences, and the unique thought patterns that characterize the condition. Here are some exercises that are modified versions of traditional CBT techniques, designed to be more accessible and effective for those navigating ADHD-related cognitive distortions.
Thought records adapted for ADHD
Thought records are a common technique used by cognitive behavioral therapists that offer you a practical way to document and acknowledge negative thought patterns when they emerge. That way, you can stop the cognitive distortion before it takes hold and leads you down a thought spiral. Thought record adaptations for ADHD may take on a streamlined approach, incorporating bullet points instead of paragraphs, visual elements, and simplified analysis.
You’ll be asked to follow a step-by-step process to identify and transform dysfunctional thoughts, which may look like:
- Identifying triggering situations: Understanding why your ADHD symptoms were triggered — whether that be an overstimulating environment or lack of sleep — can help you avoid or prepare for similar situations in the future.
- Recording automatic thoughts: After recognizing the trigger, mindfully and honestly take note of your thoughts and symptoms by taking bullet points or abbreviated notes.
- Identifying the type of cognitive distortion: From all-or-nothing thinking to catastrophizing, understanding the type of cognitive distortions you’re experiencing can pave the way to reframe them.
- Challenging negative thoughts to develop healthier ones: The final step involves reframing unhelpful thoughts into more productive ones. ADHD-adapted approaches may incorporate easy-to-follow reframes that can be efficiently implemented, accounting for impediments to executive function. Ask yourself: “What evidence supports this thought?” “Is there an alternative way to view the situation?” or “What advice would I give to someone who thought this?”
Mindfulness-based cognitive restructuring
Mindfulness is a particularly effective skill for managing ADHD symptoms as the disorder is often characterized by hyperactive thinking and forgetfulness. When combined with cognitive restructuring, mindfulness teaches several skills that may help you manage ADHD and include:
- Observing thoughts without judgment: This can help you realize that you are not your thoughts, and that cognitive distortions are not absolute truths.
- Labeling unhelpful thinking patterns: Understanding what label your cognitive distortion falls under — all-or-nothing thinking, emotional reasoning, or another — can help reduce their emotional impact.
- Using mindful breathing for thought change: This can reduce symptoms of impulsivity by creating space to respond rationally and thoughtfully.
These strategies may be used in your thought record to provide relief from the constraints of cognitive distortions. By engaging in cognitive restructuring from the angle of mindfulness, you can effectively step outside of the thought spiral you may be experiencing and ground yourself in the present moment.
The “what-if” to “how-to” technique
The “what- if” to “how-to” technique is an approach to reframe ADHD-related anxieties into action-oriented prevention strategies. For example:
- “What if I miss a deadline?” can be reframed to “How can I set up reminders?”
- “What if I can’t complete complex or unpleasant tasks?” can be reframed to “How can I make this task more manageable?”
- “What if I act too impulsively?” can be reframed to “How can I make more thoughtful decisions?”
This technique transforms worry and stress into solutions, preparation, and coping strategies, interrupting the ADHD-related thought spirals you may be experiencing.
Behavioral experiments for testing ADHD-related beliefs
ADHD can come with self-told narratives such as “I am always late” or “I always blurt out responses in conversations.” Behavioral experiments are a core technique taught by CBT therapists that help you test the validity of these thoughts.
Take the example of believing that you’re always late — a low-stakes behavioral experiment may follow these manageable steps:
- Identifying the belief to test: Choose a belief that may be based in overgeneralization, but feels true. For this purpose, the belief “I am always late” will be used as an example.
- Designing a small experiment: Make sure the behavioral experiment is low stakes. For instance, consider setting a goal to arrive at the grocery store by 7 p.m. to begin shopping.
- Predicting outcomes: Write down what you think will happen. Do you think you’ll make it to the inside of the grocery store on time? Or do you think you’ll be a few minutes late?
- Evaluating results: Compare what actually happened to your prediction. Was the outcome as bad as you predicted? If not, what helped you meet your self-imposed deadline? Documenting your results can help you minimize cognitive distortions, such as catastrophizing.
Evidence Supporting CBT as an Effective Treatment for ADHD
CBT may be effective for depression and anxiety treatment, but how does it fare for ADHD? First off, it’s important for therapists to adapt their CBT approach with ADHD considerations in mind. Studies demonstrate that when therapists use generic CBT methods that aren’t sufficiently adapted to ADHD-related issues, adult patients struggle to find relief.5
However, when CBT is adapted to ADHD, there can be promising results — particularly for adolescents, college students, and medicated patients. Research shows that teenagers with ADHD who were unmedicated and underwent a CBT course reported a statistically significant decrease in symptom severity.6
Another randomized control trial revealed that college students who completed CBT noticed improvements in executive functioning and symptom severity immediately following treatment.7 Furthermore, appropriately adapted CBT for ADHD shows enhanced benefits when combined with medication for ADHD compared to pharmacological treatment alone.8
CBT as a Part of a Comprehensive ADHD Treatment Plan
When treating ADHD, a multimodal approach is widely recommended as it targets both the body and mind offering the best chance at relief. While appropriately adapted CBT can complement ADHD medication, there are other interventions that it can work alongside as well.
If first-line interventions aren’t adequate, transcranial magnetic stimulation (TMS) therapy can be an “off-label” treatment for ADHD that targets areas of the brain known to be underactive in those struggling with this disorder. TMS for ADHD can be enhanced with CBT, approaching treatment from both a neurological and psychological angle, and this form of brain stimulation has demonstrated promising results in reducing symptoms of ADHD.9 Additionally, enhancing lifestyle factors such as sleep, exercise, and nutrition can support the effectiveness of CBT for ADHD.
Related: ADHD Medications for Adults With Anxiety
How To Find a Cognitive Behavioral Therapist for ADHD
When looking for a therapist that specializes in CBT, it’s important to find one who specializes in ADHD so they have the knowledge and experience to adapt treatment for the best outcome for you. Asking your insurance provider can help you understand who’s in your network and how much you’ll pay out of pocket.
Related: Which Mental Health Professional Is Right For You?
How Neuro Wellness Spa Can Treat ADHD With CBT
If your persistent symptoms of ADHD are negatively impacting your life, reach out to Neuro Wellness Spa so we can connect you with one of our highly informed therapists who specialize in ADHD treatment. They can work with you to find the best therapy option for your symptoms, whether that be CBT, dialectical behavior therapy (DBT), or traditional talk therapy.
We recognize that ADHD can be a difficult condition to treat. That’s why we offer beyond first-line interventions if therapy and medication aren’t providing relief, such as TMS therapy and magnetic resonance therapy (MeRT). Don’t let ADHD symptoms continue to disrupt your life — get started today!
References
- Abdelnour, E., Jansen, M. O., & Gold, J. A. (2022, October 1). ADHD diagnostic trends: Increased recognition or overdiagnosis? https://pmc.ncbi.nlm.nih.gov/articles/PMC9616454/
- Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta‐analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105–115. https://doi.org/10.1002/wps.21069
- General Prevalence of ADHD – CHADD. (2024, November 7). CHADD. https://chadd.org/about-adhd/general-prevalence/
- Sprich, S. E., Knouse, L. E., Cooper-Vince, C., Burbridge, J., & Safren, S. A. (2009). Description and demonstration of CBT for ADHD in adults. Cognitive and Behavioral Practice, 17(1), 9–15. https://doi.org/10.1016/j.cbpra.2009.09.002
- William, S., Horrocks, M., Richmond, J., Hall, C. L., & French, B. (2024). Experience of CBT in adults with ADHD: a mixed methods study. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1341624
- Sprich, S. E., Safren, S. A., Finkelstein, D., Remmert, J. E., & Hammerness, P. (2016). A randomized controlled trial of cognitive behavioral therapy for ADHD in medication‐treated adolescents. Journal of Child Psychology and Psychiatry, 57(11), 1218–1226. https://doi.org/10.1111/jcpp.12549
- Anastopoulos, A. D., Langberg, J. M., Eddy, L. D., Silvia, P. J., & Labban, J. D. (2021). A randomized controlled trial examining CBT for college students with ADHD. Journal of Consulting and Clinical Psychology, 89(1), 21–33. https://doi.org/10.1037/ccp0000553
- Lopez, P. L., Torrente, F. M., Ciapponi, A., Lischinsky, A. G., Cetkovich-Bakmas, M., Rojas, J. I., Romano, M., & Manes, F. F. (2018). Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Library, 2018(3). https://doi.org/10.1002/14651858.cd010840.pub2
- Fu, B., Zhou, X., Zhou, X., Li, X., Chen, Z., Zhang, Y., & Du, Q. (2025). Efficacy and Safety of Transcranial Magnetic Stimulation for Attention‐Deficit Hyperactivity Disorder: A Systematic Review and Meta‐Analysis. Brain and Behavior, 15(1). https://doi.org/10.1002/brb3.70246