ADHD and CBT

After diagnosis, it’s normal to start thinking about what comes next. Ongoing treatment, coping strategies, and how to use the insight in a practical way.

Not everyone takes the same route. Some explore ADHD-specific medication straight away. Some don’t. Some want to see what changes simply from having more understanding and headspace.

In my case, I decided not to take ADHD-specific medication at that stage. I wanted to see what impact the extra headspace would have on its own. I was still experiencing anxiety and stress, though, and I had access to therapy through my work employee assistance programme.

Pressure

Context matters with anxiety. Sometimes it’s less about your personality and more about what your nervous system is responding to.

At the time, my organisation was making significant layoffs. My role wasn’t obviously in jeopardy, but the manner in which things were being done was anxiety-inducing. Without going into details, I felt as though any influence or agency had been removed from me. That sense of powerlessness is unsettling for anyone.

It was against that backdrop that I had my first appointment with a therapist over Teams, around May or June.

Cynicism

A lot of people meet therapy with a mix of hope and scepticism. If you’ve never experienced a technique working for you, it can be hard to imagine it will.

When my therapist said we were going to use Cognitive Behavioural Therapy, I felt underwhelmed. Part of that was cynicism about whether you could “think yourself better”, which was really just me not understanding CBT properly. I’d tried reading CBT for Dummies about ten years earlier and dismissed it as unrealistic.

My interest-based ADHD brain was also doing what it does when it smells something dry. It was trying very hard not to engage.

But the sessions were free, and I was feeling anxious. That made it easy enough to give it a fair try. There was also something quietly significant about it being the first time I’d gone into any kind of treatment while explicitly talking about my neurodiversity. It felt like a new frontier.

Method

CBT is commonly used for anxiety. The basic idea is straightforward. You identify the thoughts and beliefs that are driving stress, and then you challenge them using evidence, so they gradually lose their grip.

A simple example is presentation anxiety. You can be an experienced presenter and still feel a spike of stress. CBT encourages you to work backwards to the belief underneath the feeling.

That belief might be something like “I’m not a good presenter and I’m going to get found out.” Sometimes it helps to keep questioning until you hit the underlying belief, using something like the “five whys” approach.

Once you have the belief, you treat it as something to test rather than something to obey. You look for evidence supporting it, and evidence against it. Often you find that the “for” evidence is thin and the “against” evidence is extensive.

Then you develop a more realistic belief. Something like “I’m an experienced presenter who has done this many times.” The goal isn’t forced positivity. It’s accuracy.

Fit

It’s also fair to ask how ADHD fits into this.

If your brain is hyperactive and tends not to stop, and you are a divergent thinker, your capacity to invent new things to worry about can be higher than average. If your filters are lower, more things register as stimulus, and your nervous system has more opportunities to latch onto something and spin it.

Like many ADHD traits, this has upsides and downsides.

The upside is planning. You can “war game” scenarios. You can think ahead. You can anticipate risks.

The downside is that you can make yourself miserable. Your mind can generate threat narratives faster than you can soothe them.

For me, that showed up partly because of work stress and partly because I would get stressed whenever I needed to set boundaries. I’m a people pleaser by nature. I can manage that for work, but I can’t keep it up all the time.

Effect

What surprised me was how effective CBT became over time. It didn’t instantly remove stress, but it gradually defused it in situations that would normally trigger me.

One technique in particular stuck. The idea of putting beliefs “on trial” made my mind imagine a courtroom. I found myself watching a trial of my beliefs in my head, with evidence being presented on both sides. It sounds odd, but it worked.

Being a visual person helped. I suspect that, combined with repetition, made the method stick faster. The volume of times I was using it meant I got reasonably good at it quickly.

Routine

Once something proves useful, the next question is how to make it repeatable.

I now have a daily planning routine, and I’ve built the CBT method into it. In the morning, I think about the beliefs I might bump into during the day, and I pre-emptively challenge the ones I know will trigger stress.

I’ve also started collecting the more helpful beliefs in a document so I can refer back to them. They’ve become a useful reference point when I’m feeling uncertain or under pressure.

Value

If you struggle with anxiety and you’re an ADHD person, CBT is worth trying. Not because it makes you a different person, but because it can give you a structured way of separating what your mind is saying from what is actually true.

It’s not always easy, because ADHD people aren’t blessed with as much space between stimulus and reaction. But for me, it helped reduce the back-pressure. It didn’t remove complexity from life, but it made my relationship with anxious thoughts calmer and more manageable.

It might be worth looking at anyway.