View Full Version : Cognitive Behavior Therapy


ahalo
07-29-04, 04:10 PM
ADHD and Cognitive Therapy - What Makes Them a Good Match?
by Melinda White, MFT Cognitive behavioral therapy is a form of treatment which helps people make concrete, observable changes in their lives. There is a focus on the ways a person's thoughts and attitudes affect his feelings and behavior. The premise is that some people develop negative and distorted beliefs about themselves which interfere with their functioning. This can lead to depression and anxiety, as well as the procrastination that affects so many adults with Attention Deficit Hyperactivity Disorder. Cognitive therapy helps people examine the beliefs that are holding them back and learn strategies to counteract those beliefs.

ADHD is considered a neurobiological condition. Yet the traits of ADHD are not the only problem for the adult with this condition. It is often the negative self-esteem and defeatist attitudes that develop as a result of the symptoms that are the most damaging. Cognitive behavioral therapy can be especially effective in addressing these issues.

Cognitive behavioral therapy is also a practical method of treatment that helps clients deal with the day to day issues that impede their success. Many adults with ADHD have difficulty with organization, prioritizing, and follow-through. Some adults with attentional difficulties tend to ramble, have trouble remaining on topic, and often forget what they've committed to do.

Cognitive behavioral therapists use a number of techniques that focus specifically on these issues. Choosing a specific topic or topics to work on each session is one goal of the cognitive session. Determining what the client will do about the issue discussed, how he can work on it, and how to evaluate its success are all topics for treatment. Clear-cut goals are developed and there are frequent check-ins on those goals. This can prevent rambling and jumping from one topic to another which can interfere with the treatment of the ADHD client.

The cognitive behavioral approach to therapy encourages therapists to bring up issues from previous weeks to continually evaluate progress. This can be extremely helpful for the adult with ADHD who easily loses track of her long term goals as she focuses on whatever seems most pressing at the moment. Working with a cognitive therapist, the client will be reminded to attend to areas of success while also refining strategies to help deal with those incomplete tasks.

In my private practice as a psychotherapist specializing in the treatment of Attention Deficit Hyperactivity Disorder, I use a number of cognitive techniques. One method I frequently use helps adults with ADHD deal with task completion. In session, we list the tasks the client wishes to complete that week. The client then chooses the task she will work on first. We break the task into small component parts to make it less overwhelming. I next ask her to estimate how long she expects the task to take. Since adults with ADHD are notorious for underestimating the time needed for a task, I then ask my client to add an additional thirty to sixty minutes to the time allotted. In addition, I ask her to record the actual length of time the job takes.

I next ask the client to predict the obstacles that might get in the way of task completion. We then discuss methods to cope with these obstacles. These cognitive methods help the client with ADHD be more realistic about her time commitments. Examining the obstacles helps someone with attention deficits preplan ways to deal with what might come up rather than impulsively allowing the obstacles to draw her away from her task.

Since being on time has been a major issue for many of my clients, I am continually exploring techniques that will increase promptness for each individual. For one client I worked with, the usual datebooks, alarms, and phone call reminders did not work. We tried a system of picking one time of day to work on first. He chose getting out of the house on time in the morning. I asked him to keep a graph for two weeks of the time he actually left the house. Creating the graph increased his leaving on time dramatically. Tracking the times helped him focus on promptness. Having the visual record motivated him to leave early so he could record the mark on the graph where he wanted to see it. This type of record keeping is a part of the cognitive behavioral approach that can assist adults with ADHD in problem-solving.

Cognitive therapists also work with clients on examining their belief systems. When a client brings up an upsetting concern I ask him to list his automatic thoughts about the problem. It is quite often what the client tells himself about the dilemma that is the biggest issue.

Some typical negative thoughts that an adult with ADHD believes when he encounters difficulty are: "I am a loser." "I'll never make it."; "This only proves I can never be a _____."; "I'm just incompetent."

In session, we write down these thoughts. This gives the ADHD adult a place to put all the negative ideas swirling around in his head. It also gives him a chance to tune into those thoughts and how they are affecting him. It is not unusual for an adult with ADHD to avoid attending to his automatic thoughts while procrastinating on task completion because of a negative belief about himself. Making the thoughts explicit is the first step in counteracting such thoughts.

Other steps involve focusing on the distortions the client may be employing that continue to deflate his self-esteem. We also work on creating other healthier and realistic ways of viewing the event that's troubling him. These coping statements are also written down. I give the client a copy of these positive self-statements to take home with him. This is useful for any client. For the adult with ADHD who often has trouble remembering things, it is especially important to have a written record of the work to refer back to.

Adults with attention deficits tend to give up easily when barriers come up. This makes it harder for them to follow through on their commitments to others and to themselves. Cognitive therapy gives them tools to face the barriers by teaching them realistic, non-distorted ways to talk to themselves about the difficulties they encounter. This method of treatment helps an adult with ADHD learn to accept herself as she is rather than berate herself for her shortcomings. At the same time, it helps the client become more successful.

paulbf
07-29-04, 06:22 PM
Thanks, that's a useful description. A lot of it sounds like things I tried when using a coach.

I tend to think in more complex mystical/emotional terms and suspect that something so practical would not work because it's not getting at the core reasons for the negative thinking. It's like it's too superficial of an approach, as if I were being brain washed or doing something that didn't really feel right. Or I don't really know what is wrong, so I like to continue trying to explore the reasons. OTOH, I've done plenty of traditional therapy and it can be endless and unproductive also. I do like the idea of CBT focusing on progress and thinking positive rather than obsessing on the past.

ahalo
07-29-04, 06:32 PM
paulbf I can totally relate to what you're saying. I've done a lot of research on it and I'm really hoping I can find a therapist who practices it and knows what they're doing. While I would like to know what is behind some of the reasons for my responses to things, in a way I feel that I need to face forward because I know I personally have a tendency to get "stuck". I have personally practiced some of the CBT "rethinking" exercises and I actually think it's working, even when I'm doing this myself. Which is shocking to me. I hope that means I could do very well with an actual therapist :)

I find the whole idea intriguing as it is very focused on each person taking responsibility for their own thoughts, feelings, and reactions, and if they find that a thought leads to a feeling that leads to an inappropriate or self-defeating reaction, there is real work done at changing the thought. Not just TELLING ourself not to think that way, but CHANGING it. Which to me sounds SO real and genuine. It's not just about "thinking positively" because I consider myself a very optimistic person yet I have trouble coping in certain situations. And there is not that need to relate every single thought to something terrible that happened in the past; even though I would like to know why I do and think the way I do sometimes, most of the time I just am at peace with knowing that there is a good reason and not being too hard on myself.

Anyway the more I read about it the more excited I am :) I finally feel like for the first time in my life I know what's "wrong with me" and I have an idea of what I can do to turn that into something right. I've never felt that way. I hope anyone who has tried this will share their results too. I know a form of CBT (DBT) has been effective in borderline personality so maybe any ADDers with BPD who have tried that (DBT) could contribute as well.

paulbf
07-29-04, 06:48 PM
Example of a simple test thing to try? Is this like saying affirmations or something else? Web sites to read? Something in me wants to avoid this, maybe the "old me" who doesn't want to change. Ha there I go overanylizing again...

Your optimistic thoughts sound good though. They make sense to me.

ahalo
07-29-04, 07:56 PM
If you have patience for a loooooong read that doesn't necessarily apply to ADHD (towards the end it's sort of focused towards addicts, but most of it is really great) you can read the best description I've found yet here:

http://www.stanford.edu/~hdonder/therapy/

It's really excellent at explaining things and makes sense :)

EYEFORGOT
07-30-04, 08:44 AM
So how do you find this in your own area? Do I just tell my shrink "I want cognitive behavioral therapy, can you give me a referral?" or what? Are they under counselors? Would they be covered by insurance, or are they like a chiropractor, too controversial for insurance to cover? Thanks for the great description, my first goal can be "reading through long posts". :)

Dex
07-30-04, 08:56 AM
Hey, that sounds a lot like the kinds of perception problems Edward de Bono talks about in his books e.g.:

- over emphasise one part of the problem
- reducing everything to right, wrong/good or bad, can/can't
- misjudging the scale
- generalisation

I mentioned him in this thread: http://www.addforums.com/forums/showthread.php?t=8941

His belief is that problems with perception prevent intelligent people from becoming good thinkers. I just found that it had a lot of relevance to the way I think about ADD. And now, reading the above, I know why.

gabriela
07-30-04, 09:02 AM
Hey, that sounds a lot like the kinds of perception problems Edward de Bono talks about in his books e.g.:

- over emphasise one part of the problem
- reducing everything to right, wrong/good or bad, can/can't
- misjudging the scale
- generalisation

I mentioned him in this thread: http://www.addforums.com/forums/showthread.php?t=8941

His belief is that problems with perception prevent intelligent people from becoming good thinkers. I just found that it had a lot of relevance to the way I think about ADD. And now, reading the above, I know why.
sorry, i must have missed that one!!!
:o

i'm going to look into his writings, though, and as always i started my search on the 'net!
this is what i came up with:

http://www.debono.com/

paulbf
07-30-04, 12:25 PM
Thanks ahalo, yes that's a great summary, easy outline form... everything you wanted to know about disfunctional thinking on one page lol Maybe a little too simple but often our problems are that simple... just dumb thinking the same old useless stuff over & over!

I think my current shrink uses some of this stuff and it's useful though I'm not sure I'd go with that alone but maybe.

http://www.stanford.edu/~hdonder/therapy/

mctavish23
07-30-04, 01:14 PM
Thanks for the excellent post. Cognitive-Behavioral therapy has been around since roughly the 1980's and is now the most widely practiced therapy in the world.I really like the style and the fact that it's so grounded in common sense. Most therapists I know practice it; along with other techniques of course.

In July of 1999, the National Board of Cognitive-Behavioral Therapists in Ft. Wayne, Ind. was kind enough to grant me certification as a Diplomate in Psychotherapy. Diplomate status is reserved for the top 10% of therapists in the nation who practice C-B therapy. I was anonymously nominated ( and "No" I didn't nominate myself...lol. I have no clue as to who did.)In doing so, they waved the national written exam and peer review board,which normally applies.The point is that no one knew that I was an adult ADHD. They were just going on my reputation and the quality of my work.

I'm listing this here not to boast or brag but to try and point out to other adult ADHD's like myself, as well as parents of ADHD kids, that you CAN accomplish your (realistic) goals and succeed if you believe in yourself and not give up.Never let anyone tell you that you can't accomplish something (realistic) that you are capable of achieving. I've been blessed in many ways and this is one way of giving something back to the ADHD community. Thanks.:)

paulbf
07-30-04, 02:51 PM
Here's something nutty I just stumbled on which sounds like an example of a similar approach.

Eye Movement Desensitization and Reprocessing
http://netpsych.com/health/emd.htm

I know it's long but the reading went smooth for me.

ahalo
07-31-04, 01:49 AM
Yes I have heard of EMDR as a very effective therapy though I haven't read up on it, I will do so.

I think many therapists are familiar with cognitive behavior therapy so I would just suggest asking around, or if you have a current therapist ask what he/she thinks of taking that approach with you or if could recommend someone.

I'm starting with a new therapist probably and will ask about it. I might end up staying with my current therapist as it sounds like she does something similar to CBT though I don't know if it's that or not. I guess I will have to be more proactive and ask :)

Dex
07-31-04, 07:51 AM
this is what i came up with:
http://www.debono.com/
Well, that's him but MY GOD WHAT AN UGLY WEBSITE!

mctavish23
07-31-04, 11:07 AM
EMDR is an excellent trauma therapy. I've been thru it twice myself and it worked well. My therapist was subsequently sent to Okla City by the FBI to work with the rescue personnel from the bombing of the courhouse. I have also seen numerous presentations at workshops, conferences,etc.One of my colleagues has been a pratitioner of EMDR for many years. He says it's changed somewhat since I went thru it but the results remain solid. Iv'e seen it work with several others, as I have often referred people for the therapy.
The reason for the referral doesnt necessarily have to be trauma related but that is what I've seen it used for the most. While there is some controversy as to exactly how it works there's no dipsute that it does.If you're interested I hope you look into it further. Obviously, not everyone is trained to do it so you may have to ask around for an EMDR trained therapist in your area. I wish you luck if you're interested.

mctavish23
08-15-04, 11:22 PM
One thing I forgot to mention is that Cognitive-Behavioral therapy (as well as all other "talk" therapies ) doesn't work for hyperactive kids. ONLY behavior mod does.

RhapsodyInBlue
10-21-04, 02:45 PM
EMDR is an excellent trauma therapy. I've been thru it twice myself and it worked well. My therapist was subsequently sent to Okla City by the FBI to work with the rescue personnel from the bombing of the courhouse. I have also seen numerous presentations at workshops, conferences,etc.One of my colleagues has been a pratitioner of EMDR for many years. He says it's changed somewhat since I went thru it but the results remain solid. Iv'e seen it work with several others, as I have often referred people for the therapy.
The reason for the referral doesnt necessarily have to be trauma related but that is what I've seen it used for the most. While there is some controversy as to exactly how it works there's no dipsute that it does.If you're interested I hope you look into it further. Obviously, not everyone is trained to do it so you may have to ask around for an EMDR trained therapist in your area. I wish you luck if you're interested.
mctavish, I went through the EMDR and the Psych called a halt to it. I'm not sure if he didn't know what he was doing, but it was like being made to relive a trauma in the here and now, over and over again. For PTSD, there are some articles on the net [I forget where!] that say it may be dangerous for some people to go through EMDR therapy. I'm not sure about whether this would be the same for AD/HD as it was for PTSD, but I'd be interested in what your opinion is on EMDR for PTSD.:)

mctavish23
10-21-04, 04:02 PM
Keep in mind that I'm not trained in EMDR. One of the guiding principles is that it's not for everyone.The way it was explained to me by my therapist is that you don't jump right into it. Instead, you try and determine if the person is appropriate for EMDR by way of a screening session.Also, the nature of the trauma and any other underlying conditions have to be taken into consideration as well. For some people it could possibly be traumatic. The assumption of course is if that does happen, even after careful screening, then the procedure would be stopped.

RhapsodyInBlue
10-23-04, 02:30 AM
Thanks Mctavish, mine was a traumatic experience, and other docs said they would never have even attempted EMDR.

What you say in regards to the evaluation "is" important. It should be the final determining factor as to whether EMDR should be used or not.

Thank you for the reply!

paulbf
10-24-04, 12:14 AM
What is EMDR???

RhapsodyInBlue
10-24-04, 09:10 AM
Eye Movement Desensitization and Reprocessing Therapy. :)

paulbf
10-24-04, 03:05 PM
Ah, thanks, I remember reading about that but I was not aware that it is so powerful.

RhapsodyInBlue
10-29-04, 10:43 AM
Here is quite a good link Paul on EMDR......
http://www.healthyplace.com/communities/depression/treatment/emdr/q_and_a.asp

klau123
12-10-09, 04:13 PM
I live in England.
My grandmother is in a similar situation.
We were lucky to find some very interesting information at
http://www.exclusivehypnotherapy.co.uk/

Hope this gives a little contribution.