Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-27T05:05:29.898Z Has data issue: false hasContentIssue false

26 - Adapting CBT for Treating Anxiety Disorders and Depression in Adults with ADHD

from Part Six - Specialist Applications of Cognitive Behavioral Therapy for Anxiety Disorders and Depression

Published online by Cambridge University Press:  06 January 2022

By
Laura D. Eddy ,
Laura E. Knouse  and
Steven A. Safren
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
Get access

Summary

There is compelling evidence supporting the use of cognitive behavioral therapy (CBT) to treat depression and anxiety disorders; furthermore, recent evidence supports the use of CBT to treat attention-deficit/hyperactivity disorder (ADHD) in adults as well. High comorbidity among these conditions requires healthcare providers to recognize and treat problems with anxiety and depression in adults with ADHD, or ADHD in adults with anxiety and depression. This chapter reviews relevant research on the comorbidity of internalizing conditions in adults with ADHD and provides three guiding principles for tailoring CBT to treat depression and anxiety disorders in adults with ADHD: comprehensive case conceptualization, addressing therapy-interfering behaviors, and a functional approach to cognitive and behavioral avoidance.

Keywords

cognitive behavioral treatmentADHDcomorbiditydepressionanxietycase conceptualizationfunctional approachtherapy-interfering behaviorsavoidance
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 553 - 572
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, L. A., Spencer, T., & Biederman, J.: (2003). Adult ADHD Investigator Symptom Rating Scale – AISRS. Massachusetts General Hospital and New York University School of Medicine.Google Scholar
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.Google Scholar
Barkley, R. A. (2011a). Barkley Adult ADHD Rating Scale-IV (BAARS-IV). Guilford Press.Google Scholar
Barkley, R. A. (2011b). Barkley Functional Impairment Scale (BFIS). Guilford Press.Google Scholar
Barkley, R. A. (2011c). The Barkley Deficits in Executive Functioning Scale (BDEFS for Adults). Guilford Press.Google Scholar
Barkley, R. A. (2015). Executive functioning and self-regulation viewed as an extended phenotype: Implications of the theory for ADHD and its treatment. In Barkley, R. A. (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 405–434). Guilford Press.Google Scholar
Barkley, R. A., & Fischer, M. (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 503–513.Google Scholar
Barkley, R. A. & Murphy, K. R.: (2006). Attention-deficit hyperactivity disorder: A clinical workbook (3rd ed.). Guilford Press.Google Scholar
Barkley, R. A., Murphy, K. R, & Fischer, M. (2008). ADHD in adults: What the science says. Guilford Press.Google Scholar
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011). Unified protocol for transdiagnostic treatment of emotional disorders. Oxford University Press.Google Scholar
Beck, A. T., & Steer, R. A. (1993). Manual for the Beck Anxiety Inventory. Psychological Corporation.Google Scholar
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. Psychological Corporation.Google Scholar
Bunford, N., Evans, S. W., & Wymbs, F. (2015). ADHD and emotion dysregulation among children and adolescents. Clinical Child and Family Psychology Review, 18(3), 185–217.Google Scholar
Biederman, J., Ball, S. W., Monuteaux, M. C., Mick, E., Spencer, T. J., McCreary, M., … & Faraone, S. V. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 426–434. doi:10.1097/CHI.0b013e31816429d3Google Scholar
Biederman, J., Faraone, S. V., Keenan, K., Benjamin, J., Krifcher, B., Moore, C., … & Tsuang, M. T. (1992). Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder: Patterns of comorbidity in probands and relatives in psychiatrically and pediatrically referred samples. Archives of General Psychiatry, 49(9), 728–738. doi:10.1001/archpsyc.1992.01820090056010Google Scholar
Boonstra, A. M., Oosterlaan, J., Sergeant, J. A., & Buitelaar, J. K. (2005). Executive functioning in adult ADHD: A meta-analytic review. Psychological Medicine, 35(8), 1097.Google Scholar
Brod, M., Johnston, J., Able, S., & Swindle, R. (2006). Validation of the adult attention-deficit/hyperactivity disorder quality-of-life scale (AAQoL): A disease-specific quality-of-life measure. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 15(1), 117–129. doi:10.1007/s11136-005-8325-zGoogle Scholar
Brown, T. E. (1996). Brown Attention-Deficit Disorder Scales: Adolescents and Adults. Psychological Corporation.Google Scholar
Chapman, A. L., & Rosenthal, M. Z. (2016). Managing therapy-interfering behavior: Strategies from dialectical behavior therapy. American Psychological Association.Google Scholar
Conners, C. K., Erhardt, D., & Sparrow, E. (1999). Conners Adult ADHD Rating Scales. Multi-Health Systems.Google Scholar
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376–385.Google Scholar
Daviss, W. B., Diler, R. S., & Birmaher, B. (2009). Associations of lifetime depression with trauma exposure, other environmental adversities, and impairment in adolescents with ADHD. Journal of Abnormal Child Psychology, 37(6), 857–871. doi:10.1007/s10802-009-9318-0Google Scholar
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). Manual for the AD/HD Rating Scale-IV. Guilford.Google Scholar
Eddy, L. D., Dvorsky, M. R., Molitor, S. J., Bourchtein, E., & Langberg, J. M. (2015). Longitudinal evaluation of the cognitive-behavioral model of ADHD in a sample of college students with ADHD. Journal of Attention Disorders, 1–11.Google Scholar
Edwards, A. C., & Kendler, K. S. (2012). Twin study of the relationship between adolescent attention-deficit/hyperactivity disorder and adult alcohol dependence. Journal of Studies on Alcohol and Drugs, 73(2), 185–194.Google Scholar
Epstein, J., Johnson, D. E., & Conners, C. K. (2001). Conners’ Adult ADHD Diagnostic Interview for DSM-IV. Multi-Health Systems.Google Scholar
First, M., Williams, J., Karg, R., & Spitzer, R. (2015). Structured Clinical Interview for DSM-5 – Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV). American Psychiatric AssociationGoogle Scholar
Flory, K., Molina, B. S., Pelham, W. E. Jr., Gnagy, E., & Smith, B. (2006). Childhood ADHD predicts risky sexual behavior in young adulthood. Journal of Clinical Child and Adolescent Psychology, 35(4), 571–577.Google Scholar
Gathje, R. A., Lewandowski, L. J., & Gordon, M. (2008). The role of impairment in the diagnosis of ADHD. Journal of Attention Disorders, 11(5), 529–537. doi:10.1177/1087054707314028Google Scholar
Gordon, M., Antshel, K., Faraone, S., Barkley, R., Lewandowski, L., Hudziak, J. J., … & Cunningham, C. (2006). Symptoms versus impairment. Journal of Attention Disorders, 9(3), 465–475. doi:10.1177/1087054705283881Google Scholar
Halldorsdottir, T., & Ollendick, T. H. (2014). Comorbid ADHD: Implications for the treatment of anxiety disorders in children and adolescents. Cognitive and Behavioral Practice, 21(3), 310–322. doi:10.1016/j.cbpra.2013.08.003Google Scholar
Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 80(6), 1041–1051. doi:10.1037/a0029451Google Scholar
Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry, 69, 621–632.Google Scholar
Jarrett, M. A, & Ollendick, T. H. (2008). A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: Implications for future research and practice. Clinical Psychology Review, 28(7), 1266–1280.Google Scholar
Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E. V. A., … & Ustun, T. B. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.Google Scholar
Kessler, R. C., Adler, L., Barkley, R. A., Biederman, J., Conners, C. K., Demler, O., et al. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. doi:10.1176/appi.ajp.163.4.716CrossRefGoogle ScholarPubMed
Knouse, L. E., Bagwell, C. L., Barkley, R. A., & Murphy, K. R. (2005). Accuracy of self-evaluation in adults with ADHD evidence from a driving study. Journal of Attention Disorders, 8(4), 221–234. doi:10.1177/1087054705280159Google Scholar
Knouse, L. E., & Mitchell, J. T. (2015). Incautiously optimistic: Positively valenced cognitive avoidance in adult ADHD. Cognitive and Behavioral Practice, 22(2), 192–202. doi:10.1016/j.cbpra.2014.06.003Google Scholar
Knouse, L. E., Mitchell, J. T., Kimbrel, N. A., & Anastopoulos, A. D. (2017). Development and evaluation of the ADHD cognitions scale for adults. Journal of Attention Disorders, advance online publication. doi:10.1177/1087054717707580Google Scholar
Knouse, L. E, Zvorsky, I., & Safren, S. A. (2013). Depression in adults with attention-deficit/hyperactivity disorder (ADHD): The mediating role of cognitive-behavioral factors. Cognitive Therapy and Research, 37(6), 1220–1232. doi:10.1007/s10608-013-9569-5Google Scholar
Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clinical Psychology Review, 31(3), 328–341.Google Scholar
Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. Guilford.Google Scholar
Mallott, R., & Shane, J. T. (2016). Principles of behavior (7th ed.). Routledge.Google Scholar
McLeod, B. D., Jensen-Doss, A., & Ollendick, T. H. (Eds.). (2013). Diagnostic and behavioral assessment in children and adolescents: A clinical guide. Guilford.Google Scholar
Mitchell, J. T., Benson, J. W., Knouse, L. E., Kimbrel, N. A., & Anastopoulos, A. D. (2013). Are negative automatic thoughts associated with ADHD in adulthood? Cognitive Therapy and Research, 37(4), 851–859. doi:10.1007/s10608-013-9525-4Google Scholar
Mitchell, J. T., Robertson, C. D., Anastopolous, A. D., Nelson-Gray, R. O., & Kollins, S. H. (2012). Emotion dysregulation and emotional impulsivity among adults with attention-deficit/hyperactivity disorder: Results of a preliminary study. Journal of Psychopathology and Behavioral Assessment, 34(4), 510–519.Google Scholar
Owens, J., Goldfine, M., Evangelista, N., Hoza, B., & Kaiser, N. (2007). A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clinical Child and Family Psychology Review, 10, 335–351. doi:10.1007/s10567-007-0027-3Google Scholar
Pliszka, S. R. (1998). Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: An overview. The Journal of Clinical Psychiatry, 59, 50–58.Google Scholar
Ramsay, J. R. (2015). Psychological assessment of adults with ADHD. In Barkley, R. A. (Ed.), Attention-deficit/hyperactivity disorder: A handbook for diagnosis and treatment (pp. 475–500). Guilford Press.Google Scholar
Ramsay, J. R. (2017). The relevance of cognitive distortions in the psychosocial treatment of adult ADHD. Professional Psychology: Research and Practice, 48(1), 62–69. doi:10.1037/pro0000101Google Scholar
Ramsay, J. R., & Rostain, A. (2015). Cognitive behavioral therapy for adult ADHD: An integrative psychosocial and medical approach (2nd ed.). Routledge.Google Scholar
Ramsay, J. R., & Rostain, A. L. (2016). Adult attention-deficit/hyperactivity disorder as an implementation problem: Clinical significance, underlying mechanisms, and psychosocial treatment. Practice Innovations, 1(1), 36–52. doi:10.1037/pri0000016Google Scholar
Ratey, J. J., Greenberg, M. S., Bemporad, J. R., & Lindem, K. J. (1992). Unrecognized attention-deficit hyperactivity disorder in adults presenting for outpatient psychotherapy. Journal of Child & Adolescent Psychopharmacology, 2, 582–587.Google Scholar
Rees, C. S., McEvoy, P., & Nathan, P. R. (2005). Relationship between homework completion and outcome in cognitive behaviour therapy. Cognitive Behaviour Therapy, 34(4), 242–247. doi:10.1080/16506070510011548Google Scholar
Roth, R. M., Isquith, P. K., & Gioia, G. A. (2005). BRIEF-A: Behavior Rating Inventory of Executive Function – Adult Version: Professional manual. Psychological Assessment Resources.Google Scholar
Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005). Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behavior Research and Therapy, 43(7), 831–842. doi:10.1016/j.brat.2004.07.001Google Scholar
Safren, S. A., Sprich, S. E., Perlman, C. A., & Otto, M. W. (2017). Mastering your adult ADHD: A cognitive-behavioral treatment program therapist guide. (2nd ed.). Oxford University Press.Google Scholar
Sibley, M. H., Pelham, W. E., Molina, B. S. G., Waschbusch, D. A., Gnagy, E., Babinski, D. E., & Biswas, A. (2010). Inconsistent self-report of delinquency by adolescents and young adults with ADHD. Journal of Abnormal Child Psychology, 38, 645–656. doi:10.1007/s10802-010-9404-3Google Scholar
Sobanski, E., Brüggemann, D., Alm, B., Kern, S., Philipsen, A., Schmalzried, H., … & Rietschel, M. (2008). Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment. European Psychiatry, 23(2), 142–149. doi:10.1016/j.eurpsy.2007.09.007Google Scholar
Solanto, M. V. (2011). Cognitive-behavioral therapy for adult ADHD: Targeting executive dysfunction. Guilford Press.Google Scholar
Solanto, M. V, Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J., & Kofman, M. D. (2010). Efficacy of meta-cognitive therapy (MCT) for adult ADHD. The American Journal of Psychiatry, 167(8), 958–968. doi:10.1176/appi.ajp.2009.09081123Google Scholar
Sprich, S., Knouse, L. E., Cooper-Vince, C., Burbridge, J., & Safren, S. A. (2010). Description and demonstration of CBT for ADHD in adults. Cognitive and Behavioral Practice, 17(1), 9–15. doi:10.1016/j.cbpra.2009.09.002Google Scholar
Stickley, A., Koyanagi, A., Ruchkin, V., & Kamio, Y. (2016). Attention-deficit/hyperactivity disorder symptoms and suicide ideation and attempts: Findings from the Adult Psychiatric Morbidity Survey 2007. Journal of Affective Disorders, 189, 321–328. doi:10.1016/j.jad.2015.09.061Google Scholar
Thompson, A. L., Molina, B. S., Pelham, W., & Gnagy, E. M. (2007). Risky driving in adolescents and young adults with childhood ADHD. Journal of Pediatric Psychology, 32(7), 745–759.Google Scholar
Torrente, F., López, P., Prado, D. A., Kichic, R., Cetkovich-Bakmas, M., Lischinsky, A., & Manes, F. (2014). Dysfunctional cognitions and their emotional, behavioral, and functional correlates in adults with attention deficit hyperactivity disorder (ADHD): Is the cognitive-behavioral model valid? Journal of Attention Disorders, 18(5), 412–424. doi:10.1177/1087054712443153Google Scholar
Ward, M. F., Wender, P. H., & Reimherr, F. W. (1993). The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. The American Journal of Psychiatry, 150(6), 885–890.Google Scholar
Weiss, M. D. (2010). The unique aspects of assessment of ADHD. Primary Psychiatry, 17(5), 21–25.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×