A Cognitive-Behavioral Therapy Model
for Adults with ADHD

Imageby Mark Katz, PhD

MANY ADULTS WITH ADHD experience problems in managing their time and organizing, prioritizing, and planning important day-to-day activities. These problems can have far-reaching ramifications, potentially affecting their personal relationships, their careers, their financial security, and their overall physical and mental health.

Mary V. Solanto, PhD, is among the experts who have identified specific behavioral and cognitive interventions that can help. Solanto directs the ADHD Center at the Mount Sinai School of Medicine, where she and her colleagues have developed a twelve-week group treatment model. The sessions are briefly summarized in the sidebar below.

The program incorporates a series of behavioral and cognitive strategies that directly target common trouble spots impacting the lives of adults with ADHD. Interventions address the weaknesses associated with executive functions, such as time management, organization, planning, and prioritizing. Also addressed are the feelings of demoralization, anxiety, and depression that can so often co-occur in adults who struggle with ADHD.

As they progress through the program, group members learn mantras or maxims that serve as self-instructive cues, reminding them of important strategies and adaptive responses and helping them to generalize strategies and adaptive responses during the course of their day. Examples of these maxims include:

 Image “If it’s not in the planner, it doesn’t exist.”
 Image “If you’re having trouble getting started, then the first step is too big.”
 Image “Do all things in the order of priority.”
 Image “Getting started is the hardest part.”
 Image “A place for everything – and everything in its place.”
 Image “Out of sight, out of mind.”
 Image “What you don’t do today won’t go away—it will just be that much harder tomorrow.”

This treatment model can be adapted for use in individual therapy. This allows clinicians to tailor the program to those who may not be good group candidates, or for those whose unique treatment needs are best served in one-to-one sessions.

An efficacy study published in the American Journal of Psychiatry in 2010 found the model to be successful in helping adults improve in areas associated with executive functions.

Two optional sessions were not part of the study. One focused on changing automatic thoughts and cognitive distortions, expanding upon material covered in the fifth session. The other is titled Getting to Bed, Getting Up, and Getting to Work on Time. “Being late to work is a common problem for adults with ADHD,” says Solanto. “However, you can’t get to work on time if you don’t get up on time, and you can’t get up on time if you don’t get to bed on time.” The session provides strategies that promote consistency.

Solanto will conduct an institute on this treatment model at CHADD’s conference in Orlando in November 2011. Solanto’s recently published book, Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction (Guilford Press, 2011), includes the detailed treatment manual she and her colleagues have written for clinicians who wish to replicate the program.

Session-by-Session Overview

Here is an overview of the twelve-session cognitive-behavioral treatment program for adults with ADHD developed by Mary Solanto and her colleagues.

Session 1
Making Peace with the Diagnosis and Committing to Growth
Participants identify their personal goals for the group, the emotions that can impede progress, and inner resources and strengths they can call upon to help facilitate change.

Session 2
Time Management: Time Awareness and Scheduling
Group members learn the importance of having constant access to timepieces (watches, clocks), how to become more accurate in estimating time, how to select a planner that will work best, and how to effectively use a planner to create to-do lists and schedules.

Session 3
Time Management: Making Tasks Manageable and Rewarding Yourself
Participants learn how to break large and boring tasks into smaller more manageable chunks, and how to use personal rewards in ways that make unpleasant tasks more enjoyable.

Session 4
Time Management: Prioritizing and To-Do Lists
Group members learn how to separate important tasks from less important ones, how to create to-do lists that take into account high-priority responsibilities, and how to insure that enough time is set aside to complete daily tasks, especially the more important and urgent ones.

Session 5
Time Management: Overcoming Emotional Obstacles
Participants learn how to identify “automatic thoughts” that represent “cognitive distortions”—a negative and devaluing form of self-talk that can lead to feelings of anxiety and depression—then learn how to challenge and replace these cognitive distortions with a more realistic array of positive and adaptive thoughts.

Session 6
Time Management: Activation and Motivation
Group members learn strategies for getting started on tasks and ways to stay motivated so that tasks are completed. In the process, they also learn ways to avoid distractions, both sensory and social.

Session 7
Getting Organized: Setting Up an Organizational System
Participants learn to use organizational strategies that allow for important things to be easily identifiable and readily accessible.

Session 8
Getting Organized: Implementing an Organizational System
Group members continue to work on their organizational system, focusing on organizing physical spaces at home or at the office, incorporating previously learned self-management strategies into the process.

Session 9
Getting Organized: Maintaining an Organizational System
Participants learn systems and strategies for filing things away, putting things in places where they belong, creating more organized workspaces, and dealing with the mail.

Session 10
Plan a Project—And Get It Done!
Using the time management, organizational, planning, self-motivational and other strategies learned in previous sessions, participants plan a project and the steps required to get it done.

Session 11
Project Planning: Implementation
Participants continue to focus on the project they identified in last week’s session, and review strategies learned in earlier sessions to make sure they are being successfully applied.

Session 12
Looking to the Future
Group members self-evaluate their progress, identify needs for future growth, and discuss options for addressing these needs. Participants also receive a written summary of key strategies learned during the course of the program.

A clinical and consulting psychologist, Mark Katz is the director of Learning Development Services, an educational, psychological, and neuropsychological center located in San Diego. He is a contributing editor to Attention magazine and a member of its editorial advisory board, a former member of CHADD’s professional advisory board, and a recipient of the CHADD Hall of Fame Award.
This article originally appeared in the October 2011 issue of Attention magazine. Copyright © 2011 by Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights reserved. No portion of this article may be reproduced without written permission from CHADD.
Posted in: 2011, October