MGH Logo Cognitive behavioral therapy teaches skills for managing life challenges and evaluating negative thought patterns. Experts from the Massachusetts General Hospital revealed that this therapy mainly conducted for attention-deficit hyperactivity disorder (ADHD) seemingly enhanced symptom control in a study conducted on adult patients.

Around 4 percent of adults in the U.S. have ADHD and psychiatric medications are the primary first-line treatment. However, experts share that patients who undergo these treatments are still troubled by continuing symptoms. Previous analysis examined psychological treatment for ADHD and some have suggested benefits from cognitive behavioral therapy and they were small and short term. This study claims to be the first to conduct full-scale randomized, controlled trial of the efficiency of an individually-delivered, non-medication treatment of ADHD among adults.

“Medications are very effective in ‘turning down the volume’ on ADHD symptoms, but they do not teach people skills,” commented Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry, who led the study. “This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder.”

The study enlisted adults detected with ADHD who exhibited negligible but important symptoms while taking an ADHD medication. These participants were randomly classified to one of two therapeutic methods. They attended 12 weekly one-on-one counseling sessions with a psychologist. The control group received training in muscle relaxation and other relaxation methods, information on how to apply relaxation to ADHD symptoms and supportive psychotherapy.

“Sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit,” commented Safren, an associate professor of Psychology in the Harvard Medical School Department of Psychiatry. “The treatment is half like taking a course and half like being in traditional psychotherapy.”

The cognitive therapy sessions mainly included skills training in areas like organization and planning. In addition, they also included setting priorities and problem solving, coping with distractions, and developing adaptive thought responses to stressful situations.

“We know that ADHD medications are effective for patients who can take them, and without medications it would be harder to learn the skills taught in this study. But we have shown that learning self-management skills can help reduce symptoms even further. Now we need to determine the best ways to train clinicians in this approach and the best time to introduce this treatment, along with exploring other ways to help patients who did not benefit,” Safren added.

Symptom assessments carried out towards the end of the 12-week treatment period highlighted that participants receiving cognitive behavioral therapy had enhanced symptom control as compared to those receiving relaxation training. These benefits were maintained three and nine months later. A standard rating scale for ADHD symptoms revealed a 30 percent decrease in symptoms among more than two thirds of the cognitive behavioral therapy group but in only one third of the relaxation group.

These findings were published in the August 25 Journal of the American Medical Association.