CBT for adult ADHD: what the trials found

Trials of cognitive behavioral therapy (CBT) for adult ADHD found people who had it ended treatment with fewer symptoms than comparison groups. Trials of mindfulness-based cognitive therapy found the same direction. Evidence on how long gains last and on everyday functioning is thinner, and each study's limits are covered below.

What did the pooled trials of CBT for adult ADHD find?

A 2016 review pooled trials in which adults with ADHD were assigned either to cognitive behavioral therapy or to a comparison group (Young, 2016). Everyone was over 18, most were also taking ADHD medication, and average ages ran from roughly the early 30s to the mid 40s. The review pooled eight trials in two comparisons, and the trials it included had 386 adults in all.

The review made two comparisons. Against people on a waiting list, the therapy group had fewer ADHD symptoms right after treatment, and the difference was moderate to large. Against people who got some other kind of active support instead, the gap was smaller, in the small to moderate range. When the reviewers set aside the trials that relied only on people rating themselves, the advantage held in both comparisons. Setting aside the lowest-quality trials, it held against the waiting list.

The limits shape what this result can tell you. Several of the trials didn't show true random assignment. It wasn't possible to keep therapists or participants unaware of who was getting the therapy. There were too few trials to check whether less flattering results had gone unpublished, and most trials reported only an overall symptom score rather than breaking symptoms down.

The review couldn't pool results on whether any benefit lasted after treatment ended. It also couldn't pool results on everyday functioning, other conditions people had, or quality of life, because the data were too thin or too inconsistent. The review left those questions open, and an open question isn't the same as a no. If attention is the part of ADHD you're reading up on, what actually helps ADHD focus covers what the research found more broadly.

A 12-session trial of one-to-one cognitive behavioral therapy

A 2010 trial at Massachusetts General Hospital studied 86 adults aged 18 to 65 who were already taking ADHD medication and still had clear symptoms, so its results describe that group and weren't tested in anyone else (Safren, 2010). About nine in ten participants in each group were White (90.7%).

Half were randomly assigned to 12 one-to-one sessions of cognitive behavioral therapy. The other half spent the same amount of time in relaxation training with education and support, so both groups had similar contact time.

After treatment, assessors who didn't know which group someone was in rated symptoms lower in the therapy group, and the difference was unlikely to be down to chance. About two in three people in the therapy group (67%) saw their symptoms drop by at least 30%, compared with a third (33%) in the relaxation group. People's own symptom ratings also improved faster during treatment in the therapy group.

Among people who responded fully or partly to the therapy, the gains held at the 6-month and 12-month check-ins.

During the follow-up year, people who hadn't responded were offered further care, including the other treatment in the trial, so the two groups can't be cleanly compared after treatment ended. Only one-to-one sessions were tested, not groups.

Try this today: write down the one or two ADHD symptoms that cause you the most trouble in an ordinary week, so you have something specific to describe if you talk this over with a clinician.

The focus and cognition section gathers related articles on attention and thinking.

Mindfulness-based cognitive therapy in adults with ADHD

A 2018 trial in the Netherlands studied 120 adults with ADHD from three specialist adult ADHD clinics or self-referral (Janssen, 2018). At the start, 60% of the program group and 48% of the usual-care group took ADHD medication. They were randomly assigned either to an 8-week group program of mindfulness-based cognitive therapy on top of the care they were already getting, or to that usual care alone. The program involved weekly two-and-a-half-hour sessions, a six-hour silent day and about 30 minutes of daily home practice.

Clinicians who weren't told which group people were in rated core ADHD symptoms lower in the program group after treatment. The difference was small, and it held through 6 months of follow-up. Symptoms dropped by at least 30% for 27% of the program group and 4% of the usual-care group. The program group also reported fewer symptoms themselves, plus more mindfulness skill, self-compassion and positive mental health. Day-to-day functioning didn't differ between the groups, either after treatment or at follow-up.

An earlier trial, from 2015, tested an adapted 12-week version with 103 adults aged 18 to 65 at a specialist adult ADHD clinic in Nijmegen, Netherlands (Hepark, 2015). Compared with people on a waiting list, the program group had fewer ADHD symptoms, rated both by investigators and by participants. Depression, anxiety and everyday functioning didn't improve.

That 2015 trial is preliminary. Many people dropped out of both groups and there was no outcome data for them, and the main analysis counted only people who attended at least six sessions, which may overstate the effect. With no follow-up, whether any change lasted is unknown.

The 2018 trial compared the program with usual care rather than another active treatment. Whether clinicians stayed unaware of group assignment wasn't checked, and teachers ranged from beginner to advanced. Side effects weren't tracked systematically apart from serious events, and 15% dropped out of the program. More in the program group kept their medication stable, so medication changes can't be fully ruled out as a cause.

If you're weighing any of this, talk it through with a clinician who knows your situation.