Cognitive Behavioral Therapy and the Treatment of ADHD

What sets认知行为治疗(CBT) apart from other forms of psychotherapy is the emphasis it places on the interactive role ofcognitions—automatic thoughts, images, belief systems—and behaviors. CBT certainly does not ignore emotions, but rather targets problematic thinking and behavior patterns as the entry point to understanding and addressing the difficulties for which people seek treatment.

CBT最初设计为抑郁症和研究的治疗，一贯表明它是一种有效的情绪问题的治疗方法。随后的研究表明，CBT有助于其他常见问题，例如各种类型的焦虑，物质使用，其他情绪问题以及一些医疗问题，例如处理睡眠问题或头痛。

过去十年已经看到许多临床研究人员，他们在修改CBT以解决与之相关的困难成人adhd.。

The Role of CBT in Adult ADHD Treatment

Medications are considered the first line of治疗ADHD就治疗ADHD的核心症状而言。有各种各样的medication treatments for ADHDwhose benefits operate through their effects on brain functioning, generally producing improvements in sustained attention, managing distractions, and impulse control.

对许多人来说,这些症状改善to functional improvements in their daily lives, such as being better able to keep track of items, experiencing less physical restlessness and greater impulse control, and being able to sustain focus on work or reading for reasonable lengths of time, to name a few.

Beyond Medication

Many individuals, however, may continue to struggle with the effects of ADHD despite adequate medication treatment. That is, individuals may continue to experience residual symptoms of ADHD and/or have ongoing difficulties with implementing the coping strategies that they know would be helpful.

此外,患有ADHD可能与斗争difficulties managing their emotions in daily life, an increasingly recognized feature of ADHD, or may experience problematic levels of depressed mood, anxiety, substance use, or low self-confidence. These adults with ADHD require additional help to experience improved well-being and functioning in their daily lives.

已发现CBT是一种有用的辅助治疗，直接解决了与上述成人ADHD相关的损伤和应对问题。虽然应对解决方案似乎是简单使用的每日计划者，但在截止日期之前开始良好地处理任务，将大型任务分解为较小的任务 - 它们可能难以实现。

面对这些长期的挑战，也可能引发负面思想，悲观，自我批评以及挫折的感觉，从而产生额外的障碍。由于医疗禁忌症，不可忍受的副作用，不响应，或者仅拒绝CBT可能是中央处理方法的药物，也可能存在少数药物。

Hence, CBT may be recommended in cases in which medications alone are not sufficient to address problems associated with ADHD.

CBT and Daily Life With ADHD

一个常见的例子是一个患者迟到，第一次谈判引用了解决“糟糕的时间管理”是CBT的目标。这些事件用于“反向工程师”问题的各个组成部分，以便提供对ADHD（和其他因素）的提高了解可能有助于开发和维护其功能问题，在这种情况下，“差time management," and to provide some initial ideas for coping strategies.

这种审查还允许治疗对个人的情况进行个性化，从而使其成为对执行应对技能实施的相关和突出的机会。

To continue with the aforementioned example, the issue of "time management" related to being late for an appointment could have several causes, such as:

• 保持不良的时间表（例如，没有每日策划者与约会的记录）
• Disorganization (e.g., not being able to find the piece of paper with the appointment date and time)
• 解决糟糕的问题（例如，没有考虑获得预约时间的选择，例如研究办公室的号码并致电确认）
• Poor planning (e.g., not setting a realistic time frame for leaving for the appointment, factoring in travel, parking, etc.),
• Becoming over-focused on distracting tasks (e.g., working on the computer)

There may also be issues related to anticipation of the appointment that creates barriers to follow-through. Feelings of anxiety can be distracting and lead to avoidant behaviors. Task-interfering cognitions, either negative (e.g., "This doctor will not tell me anything I have not already heard") or positive (e.g., "I'm sure there will be plenty of parking" or "It won't matter much if I'm late") can also affect follow-through.

Each of these components of "poor time management" offers an opportunity for change. As the various difficulties associated with ADHD are identified, there will be recurring themes that emerge and the various coping skills discussed can be applied to various situations to improve overall functioning.

CBT不是一个“快速修复”必须implem和技能ented in a consistent fashion, but the combination of increased recognition of the effects of ADHD and a plan for handling them provides a template for making sense of what had previously been experienced as factors beyond one's control.

Changing Behaviors With CBT

Procrastinationis one of the most common problems reported by adults with ADHD. Although virtually every patient with ADHD cites procrastination as an issue, every individual's struggle is unique.

After having defined procrastination as a target for treatment, the patient is encouraged to share specific examples, preferably recent ones, of procrastination in his or her daily life. We slowly and collaboratively review in specific terms the ultimate goal of the task, be it simple, such as organizing a shopping list, or more complex, such as writing a paper for a college class.

We then review the individual's relationship with the task, either recent experiences of procrastination or the current anticipation of the task. We discuss the plan for the task, the component parts of the task in order to break it down into steps (also known as "chunking"), identifying any potential barriers or factors that could influence follow-through.

An important aspect of this process also is to explicitly explore the individual's cognitive and emotional reactions at the prospect of this task. Questions we commonly ask include:

• “想到你的想法是关于执行这项任务的想法？”
• “当你想到这项任务时，你会注意到什么情绪？”
• “当你面临这项任务时，你的皮肤就像是什么样的？”

这些问题的目的是揭示可能导致拖延的负面思想和情绪的作用。我们还想确定该人的“逃生行为”和合理化，例如“我先查找我的电子邮件，然后我会开始工作。”

The CBT interventions operate in the way执行职能are designed to operate, to help individuals to be able to plan, organize, and choreograph their time, energy, and effort in order to accomplish tasks that may not be immediately rewarding (although the small rewards of completing small steps is often minimized) but that are associated with larger, more rewarding outcomes.

Individuals identify the specific plan for implementing specific skills on a specific day and time on a specific task to increase the likelihood of follow-through (e.g., "When you walk in the door after work, you may drift towards the television and rationalize that you need to 'veg out;' what can you do differently to make sure that you get your mail before you sit down? Where can you sort through the mail for that day? What will you say back to those rationalizations for procrastination?").

The process is not always an easy one and it is common that change occurs in a "two steps forward, one step back" manner, but these sorts of skills delivered in the context of a relationship with a therapist who understands adult ADHD can be helpful for many people.

Being able to discuss your own observations about your ADHD as well as questions you may have with an experienced healthcare professional can be invaluable. Many people find these types of discussions with their doctors to be therapeutic and to affect change in their day-to-day lives.

寻找CBT专业

有致力于传播CBT的组织，例如行为和认知疗法和认知治疗学院，在其网站上具有治疗师定位器特征。然而，许多在CBT技术人员中熟练的从业者可能不熟悉成年人面临的问题。同样，有些组织致力于adhd，他们的网站上有专业目录，包括各种心理健康专业人士，但这些临床医生可能不熟悉CBT方法。万博手机客户端

The National Resource Center (associated with Children and Adults with ADHD [CHADD]) has listings of adult ADHD providers and programs and the Attention Deficit Disorder Association (ADDA), which is an organization devoted to issues related to adult ADHD, also offers a listing of providers.

在美国和世界各地越来越多的成人ADHD专业诊所，包括许多提供所需的治疗方法。哈佛大学/马萨诸塞州综合医院和山。西奈医学院，NYU都有活跃的计划。有优秀的计划，探索加拿大，芬兰和德国成人ADHD的心理社会治疗。

Very often people find out about good therapists in their area by contacting these resources or clinics in their region and finding out if there are qualified therapists nearby who can be consulted. Unfortunately, because CBT for adult ADHD is a clinical specialty to which all clinicians are not exposed, there may be some locations without experienced therapists.

However, there are increasing numbers of published treatment manuals and clinically oriented professional books that can serve as useful resources to clinicians.