Adults who take medications to treat their attention-deficit/hyperactivity disorder may still be easily distracted or struggle with impulsivity that disrupts their daily lives. New research suggests that a type of counseling may help people improve their persistent symptoms, even long after their sessions end.
Steven Safren, director of behavioral medicine in Massachusetts General Hospital’s psychiatry department, led a team of researchers who studied 86 adults with ADHD who were being treated with various medications. The participants were randomly assigned to receive either cognitive behavioral therapy or to learn relaxation techniques for three months. Both groups also got educational support about ADHD.
In individual cognitive behavioral therapy sessions, the participants learned how to solve problems, organize and plan tasks based on their attention spans, reduce distractibility, and break down overwhelming challenges into more manageable chunks. They were also trained to think about distressing situations in new ways.
In the relaxation group, the participants learned progressive muscle relaxation and other calming techniques. They were also trained to call on these skills when feeling distracted or overwhelmed.
After six and nine months, a clinician, who did not know which treatment the participants got, assessed the 70 people who finished treatment and completed follow-up evaluations. Two-thirds of the people in the cognitive behavioral therapy group improved, compared with a third of the people in the relaxation group, based on a scale that measures ADHD symptoms.
The study, which appears in the Journal of the American Medical Association, provides good evidence for adding cognitive behavioral therapy to medications for adults with ADHD, especially in light of other research, Safren said in an interview.
Medications work well, but they don’t treat the problem fully, he said.
“Medications don’t teach skills and organization, or deal with distraction,” he said. "The goal of treatment for patients in cognitive behavioral therapy is to learn how to become their own therapists, to get them to practice their skills long enough that they become habitual.”
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