CBT for adult ADHD

Domain II · Behavioural & cognitive · Steven Safren, Susan Sprich, Carol Perlman · 2005 · Massachusetts General Hospital

What it is

CBT for adult ADHD (MGH/Safren model) is a manualised, individual, skills-based programme for adults whose ADHD persists despite medication. It was developed in the Cognitive Behavioral Therapy Program at Massachusetts General Hospital / Harvard Medical School and is meant to start once medication…

Format

• Format. Individual outpatient sessions, normally weekly, with each session run like a class lesson. The 2nd-edition manual has 12 sessions. The JAMA trial delivered 12 individual sessions. The manual does not fix a session length; around 50 minutes is the usual CBT hour. The programme is designed…
• Standard session structure (every session):

Who practises it, and how they are trained or regulated

• Rate symptoms with the Adult ADHD Self-Report Scale (ASRS; WHO licensed screener, items not reproduced) and review the trend.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The plan itself being procrastinated. It is working when the target task is started and finished.
• Grandiose time estimates. It is working when the client catches red-flag thoughts and delays the rewarding activity.
• Rote use without belief in the response. It is working when the client generates responses quickly without the form.
• All-or-nothing beliefs about slips. It is working when the client can describe a concrete plan for getting back on track.
• Over-engineered filing systems, and shame about clutter. It is working when fewer items are lost and bills are paid on time.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.