View Full Version : Anybody Have Experience with Psychosocial Treatments for Adults?


20thcenturyfox
10-30-16, 07:00 PM
I notice MetaCognitive Therapy is mentioned as having established efficacy for adult ADHD, according to randomized double blind studies. And there may be a few other behavioural variants on CBT by now which are considered "effective" for adult ADHD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633586/

But does anyone here have personal experience with any of them?

I noticed there was a thread asking the same question back in 2013, but none of the posters had personal experience: http://www.addforums.com/forums/showthread.php?p=1501851#post1501851

So just wondering if anyone on ADDF now has experience with any of these therapies, and give us your report. Anything else in the cognitive universe you would recommend?

john2100
10-30-16, 07:19 PM
I would like to see a video of a full 1h therapy in progress.
Too much theory about it on youtube but nothing practical for adults.

Before I spend thousands on it I would like to see what it actually is.

aeon
10-30-16, 07:23 PM
Meds are expensive, but therapy of this sort is an order of magnitude more so, so my therapist recommended I stick with my Dexedrine.


Cheers,
Ian

20thcenturyfox
10-30-16, 09:50 PM
The books for the 2 US programs which have had controlled studies reported are

Cognitive Behavioral Therapy: Targeting Executive Dysfunction, by Mary Solanto, 2011, $23.80 from Guilford Press (has free downloadable worksheets);
Mastering Your Adult ADHD, a Cognitive Behavioral Program Client Workbook, by Steven Safren, $35.57 from Amazon
Mastering Your Adult ADHD, a Cognitive Behavioral Program Therapist Guide, $40.44

Reportedly the Aussies have been doing similar work and have developed both a peer-reviewed therapist led "programme" and a self-study workbook (perhaps along the same lines as their depression self-study workbook which is available free online), but I haven't been able to find any additional published material on either one since it was peer reviewed in 2002.

Not peer-reviewed, and likely more of a collection of practical management tips, not true cognitive-behavioral therapy, but highly regarded by customer ratings--and at quite inexpensive at $10.31 is Russell Barkley's "Taking Charge of Your Adult ADHD."

I would guess the ADD Forum could probably accommodate groups of individuals wanting to work through either of the first 2 programs, using their own purchased or borrowed copies of a book.

If we had separate threads for each chapter--or even each exercise--people could start or finish at any time, and use the threads to compare notes or create accountability with others who happen to be working on the same exercises or issues at the same time.

Not suggesting this would fully replace a qualified therapist, but as the posters here make obvious, not everyone has access to a qualified therapist or group program.

20thcenturyfox
10-31-16, 05:14 PM
I would like to see a video of a full 1h therapy in progress.
Too much theory about it on youtube but nothing practical for adults.

Before I spend thousands on it I would like to see what it actually is.

I recently learned I am eligible for a 3-days-a-week-for-10-weeks "intensive group program" for people with anxiety and/or depression. So it is generic, not targeted at ADHD. But I was interested because it is mostly CBT with a "Behavioural Activation" component (and I have become interested in behavioural activation because--though developed for depression-- it targets one of my biggest weaknesses, motivation, through another major weakness, goal-directed or reward-seeking activity).

There's a waiting list, so if I get a referral soon, I might expect to start sometime in the New Year. And since I won't be spending thousands on it, I guess I don't feel the same need to "see what it actually is" in advance. I intend to treat it more as a buffet, where I can take whatever looks good and leave aside anything that doesn't seem helpful (and hope some well-meaning soul doesn't try to jam too much down my throat!).

At any rate, I do know it is not designed for ADHD specifically, and I won't know till I get there how easy it will be to incorporate ADHD remedial and compensatory schemes into the pre-ordained CBT and BA framework.

In researching these programs for ADHD, it occurred to me that if I purchase one or both of the US ADHD program books, they might not only give me some ideas about which general executive functions, skills and strategies are considered most foundational for ADHD, but also some specific "homework-type" exercises I might be able to graft onto this program to tailor it a little better to my needs.

And because of the "peer-reviewed" aspect, the books themselves may offer a little added authority to my efforts to make it more ADHD friendly.

Wish me luck, and I'll report back on the experience.

mildadhd
10-31-16, 10:27 PM
I think the therapy promotes productive emotional responses, and productive cognitive responses.

I am not sure why the authors emphasize "support vs MCT", when "support" is also a major component of what the authors call "meta cognitive therapy"?

(p10) Meta-Cognitive Therapy..

..Support from, modeling of, and reinforcement by other group members and the therapist are important components of the treatment that serve to stimulate, enhance and maintain positive gains.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633586/



I do think the therapy will..

.."serve to stimulate, enhance and maintain" positive emotional responses and positive cognitive responses.

I think I might try working on some type of affective-cognitive/cognitive-affective therapy as well.

Thanks.

Have fun!

G

Cyllya
10-31-16, 11:09 PM
After trying three therapists who do CBT, I've given up on the idea. I might still try an ADHD coach, but I'm pessimistic about that too.

Many of the rating scales they use to track progress during studies are things that don't capture all of my symptoms, especially the most problematic.

(Honestly, I tend to think cognitive therapy in general is dumb. I mean, it definitely has its uses in certain situations, but you're likely to just end up with a therapist being needlessly argumentative.)

The description of "Meta-Cognitive" Therapy's principles, from that pubmed article, make it sound more useful. "In MCT cognitive-behavioral principles are employed to: (i) provide contingent self-reward (e.g., for completing an aversive task); (ii) dismantle complex tasks into manageable parts; and (iii) sustain motivation toward distant goals by visualizing long-term rewards." Still dubious that it's helpful, but it looks like it's at least targeting the right problem?

Before I spend thousands on it I would like to see what it actually is.

To be fair, you probably only need to spend a couple hundred dollars to see what it is, rather than thousands. (That still sucks, of course.)

I am not sure why the authors emphasize "support vs MCT", when "support" is also a major component of what the authors call "meta cognitive therapy"?

The support group was the control group, e.g. they are just giving each other tips and emotional support and stuff. The MCT group was getting MCT and supporting each other on MCT practices.

mildadhd
10-31-16, 11:27 PM
The support group was the control group, e.g. they are just giving each other tips and emotional support and stuff. The MCT group was getting MCT and supporting each other on MCT practices.

Support is emotional.

Supportive class mates is emotional.

A supportive teacher is an emotionally attuned teacher.

Attunement relationship is a emotion relationship.

There is emotional support in both groups.

-Emotional support without cognitive therapy.

-Emotional support with cognitive therapy.

G

20thcenturyfox
11-01-16, 04:56 PM
After trying three therapists who do CBT, I've given up on the idea. I might still try an ADHD coach, but I'm pessimistic about that too.

Many of the rating scales they use to track progress during studies are things that don't capture all of my symptoms, especially the most problematic.

(Honestly, I tend to think cognitive therapy in general is dumb.....

What was your experience with the 3 CBT therapists, and was there something about CBT that stood out as being the problem?

TBH it's the behavioural aspect that interests me the most, and definitely I'm concerned about having enough time and emphasis on learning a FEW skills and strategies to manage my symptoms and myself.

While it will merely be a waste of time if they try to cover too much, it could be very discouraging if they try to force-feed self-esteem and positive thinking, without giving me practical tools and the time to practice them in my environment with my own challenges. Some encouragement would be nice, too, but I won't push my luck. My self-esteem was just fine when I was functioning well, but now that I cannot seem to motivate or manage myself on any level, I have no intention of continuing to take up space with no means of making things happen for myself and others.

kilted_scotsman
11-01-16, 07:11 PM
A couple of things....

1) The classic study of this is Yalom, Leibermann & Miles where they found the type of therapy practised by the leader had almost no effect in comparison with the personal leadership style of the group leader. The study also showed that Group Therapy can cause psychological casualties and these were concentrated in groups led by leaders with particular styles.

2) One to one research comes up with similar findings, the type of therapy supposedly used by the therapist has almost no effect when rated alongside the therapists ability to create a safe and trusting relationship with the client..... however the clients willingness to "do the work" is the most likely predictor of success.

The neuropsychotherapist Cozolino thinks that there are four factors that make for effective therapy.....
1) the creation of safe trusting relationship
2) mild to moderate stress
3) Cognitive framework as well as emotional work
4) Creation of a new narrative

Personally I have no doubt that therapy is beneficial for many people with ADHD, and find Cozolino's framework useful as it indicates that "holding" type of therapies such as Person centred that focus on relationship to the exclusion of other factors don't work for ADHD. Likewise CBT without the safe & trusting relationship or creation of new narrative have lower success rates.

All these things depend 100% on the therapist..... a therapist or group leader who follows a kind of script is to be avoided..... trouble is it's almost impossible to suss that out before you've paid over cash.

Group Therapy is powerful stuff..... well led, with a group who get the "process not content" thing groups are very successful..... badly led groups are dire and can cause long-lasting psychological damage. For this reason I tend to have a good one to one personal therapist in place when I partake of therapeutic group work.

I don't regard therapy or groups as a cure.... and am willing to pay for them not because I'm ADHD but because I've found them useful, particularly around relationships with partner/friends/colleagues. This means I don't throw the baby out with the bathwater if I have a bad experience.