Dr Antonia Dittner on making CBT accessible for adults with ADHD
Many adults with ADHD struggle to access CBT that meets their needs. For many, engagement with therapy such as cognitive behavioural therapy can be difficult. Executivexecutive functioning differences can affect their experiences, including remembering appointments, staying engaged during sessions and implementing coping skills between sessions. Therapists also report low confidence in supporting this client group.
In response to this, Consultant Clinical Psychologist, Dr Antonia Dittner and colleagues have written a guide for working with adults with ADHD called CBT to Support Adults with ADHD: A Therapist’s Guide.
We spoke to Antonia about the book with a focus on how clinicians can follow the practical, step-by-step approach to ensuring their practice can be tailored to individual needs, rather than a one-size-fits-all model.
A step-by-step guide
The book offers a practical, step-by-step approach to using formulation-driven CBT, tailored to the needs of individuals rather than a ‘one-size-fits-all’ model.
Antonia said: “The purpose of the book is to provide a neuroaffirmative, concrete, practical guide for people delivering cognitive behavioural therapy. Many adults with ADHD say that ADHD can be a barrier to receiving support in mainstream mental health services.
Because ADHD affects executive functioning, it can also affect how someone engages with therapy, from remembering appointments and staying focused in sessions to managing tasks between appointments.
“These things can impact on how people experience the therapy session itself, but also maybe doing some of the between-session tasks as well,” Antonia said
“In the book, we explain how therapists can tailor therapy and adapt it to support the executive functioning differences seen in adults with ADHD.”
The book highlights practical adaptations clinicians can make to better support people with ADHD, such as:
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Structuring sessions more clearly
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Adjusting communication to support information processing differences
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Allowing breaks or movement where needed
Going beyond skill focused support
She explained that in addition to support with practical skills, people with ADHD often need support with the emotional impact that ADHD may have on a person’s life and daily functioning.
“The impact of ADHD often extends beyond the symptoms or characteristics themselves. The book also describes how to use a formulation driven approach to address the beliefs and coping associated with adult ADHD. Many people with ADHD say they have experienced more negative feedback or difficulties compared with their peers. Their beliefs and coping make sense given their experiences, and very often have been protective but have outlived their usefulness. For example, it is understandable that someone who found certain tasks difficult or felt criticised for their efforts may have learned to avoid or give up on things."
Developing a shared understanding of how these challenges have developed and are maintained helps reframe them and offers new ways to manage. This may be via psychoeducation, adjusting the environment with appropriate supports and adaptive skills to help with executive functioning differences. It also allows us to identify and address thoughts (e.g. I can’t concentrate so there is no point in trying) behaviours (e.g. procrastination) and ways of manging emotional experiences that maintain challenges and distress.
Creating a neuroaffirmative approach to therapy
At the heart of the book is a neuroaffirmative approach, helping clinicians support clients to see ADHD characteristics as differences, not deficits.
“It takes a neuroaffirmative approach where we don’t see the differences as deficits, but simply differences. We support people with any distress they may be experiencing as a result, and help them think about ways to cope.. IIt’s really to give clinicians the confidence to use what they already know and to draw on some relatively straightforward, additional techniques, to be able to meet the needs of this client group, who are currently underserved.”
Click here to purchase CBT to Support Adults with ADHD: A Therapist’s Guide