DBT can help individuals with ADHD manage emotional dysregulation, impulsivity, and interpersonal difficulties.
By teaching skills such as mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, DBT can help those with ADHD better cope with their symptoms and improve overall functioning, making it a valuable complementary treatment approach although alternative management methods should be considered.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent symptoms of inattention, hyperactivity, and impulsivity that interfere with daily functioning, according to the American Psychiatric Association.
While pharmacological treatments are often the first-line approach for managing ADHD symptoms, psychosocial interventions can provide additional support and help individuals develop coping strategies.
Dialectical Behavior Therapy (DBT) is one such intervention that has shown promise in addressing the challenges faced by individuals with ADHD.
What is Dialectical Behavior Therapy?
DBT is a cognitive-behavioral treatment originally developed by Marsha Linehan for individuals with borderline personality disorder.
The therapy combines cognitive-behavioral techniques with mindfulness and acceptance strategies to help individuals regulate their emotions, tolerate distress, and improve interpersonal relationships.
Key components of DBT include:
- Mindfulness: Learning to be present in the moment and non-judgmentally observe thoughts, feelings, and sensations.
- Distress tolerance: Developing skills to cope with difficult situations and emotions without making them worse.
- Emotion regulation: Understanding and managing intense emotions more effectively.
- Interpersonal effectiveness: Communicating assertively, setting boundaries, and maintaining healthy relationships.
How Can DBT Be Applied to ADHD?
While DBT was not specifically designed for ADHD, many of its principles and strategies can be adapted to address the challenges associated with the disorder and help manage ADHD symptoms.
Common difficulties experienced by individuals with ADHD that DBT can target include:
- Emotional dysregulation: Many individuals with ADHD struggle with managing their emotions, leading to impulsivity, mood swings, and interpersonal conflicts. DBT skills such as mindfulness, emotion regulation, and distress tolerance can help individuals better understand and cope with their emotions.
- Impulsivity: Impulsive behavior is a core symptom of ADHD and can lead to negative consequences in various domains of life. DBT’s emphasis on mindfulness and distress tolerance can help individuals pause before acting on impulses and make more thoughtful choices.
- Interpersonal difficulties: ADHD can impact social functioning, leading to challenges in maintaining relationships and communicating effectively. The interpersonal effectiveness skills taught in DBT can help individuals navigate social situations more successfully.
Examples of DBT Strategies for ADHD
Below are some examples of DBT strategies that could be used to help someone manage their symptoms of ADHD:
Mindfulness exercises
Practicing mindfulness through activities such as deep breathing, body scans, or guided meditations can help individuals with ADHD focus their attention, reduce stress, and manage impulsivity.
Behavior chain analysis
This DBT technique involves identifying the sequence of events, thoughts, and feelings leading up to a problematic behavior (e.g., an impulsive outburst).
By understanding these patterns, individuals can develop alternative coping strategies.
Opposite action
When faced with intense emotions that may lead to impulsive behaviors, DBT encourages individuals to act opposite to their emotional urges.
For example, if feeling angry and wanting to lash out, the opposite action might be to take a break and engage in a calming activity.
DEAR MAN
This acronym represents a set of skills for effective interpersonal communication: Describe the situation, Express your feelings, Assert your needs, Reinforce the positive consequences of getting what you want, stay Mindful, Appear confident, and Negotiate if needed.
Effectiveness of DBT for ADHD
Research on the use of DBT for ADHD is still emerging, but several studies have shown promising results:
- A randomized controlled trial found that adults with ADHD who received a 14-week DBT-based group treatment had significantly greater improvements in executive functioning, ADHD symptoms, and quality of life compared to those receiving treatment as usual. These improvements were maintained at a 6-month follow-up.
- A study explored moderators of long-term treatment outcomes in adolescents with ADHD who participated in a DBT-based skills training group. It was found that participants with elevated symptoms of hyperactivity/impulsivity, conduct problems, and emotional dysregulation benefited more from the DBT-based intervention than from a psychoeducational control group.
- A pilot randomized controlled trial investigated DBT group skills training for college students with ADHD. While the study had a small sample size, results indicated improvements in self-reported ADHD symptoms, quality of life, and executive functioning.
Limitations and Considerations
While the research on DBT for ADHD shows promise, there are some limitations and considerations to keep in mind:
- Limited research: More large-scale, well-controlled studies are needed to establish the effectiveness of DBT for ADHD across different age groups and presentations of the disorder.
- Adaptation of DBT: DBT was originally developed for borderline personality disorder, and adaptations for ADHD are still being refined. More research is needed to determine which specific DBT skills and strategies are most effective for individuals with ADHD.
- Complementary treatment: DBT should not be considered a replacement for other evidence-based treatments for ADHD, such as medication management. Instead, it can be used as a complementary approach to address specific challenges and improve overall functioning.
- Access to trained providers: DBT requires specialized training, and not all mental health professionals may be adequately prepared to deliver the treatment. Individuals seeking DBT for ADHD should look for providers with experience in both DBT and ADHD.
Conclusion
Dialectical Behavior Therapy offers a promising approach for addressing the emotional, behavioral, and interpersonal challenges often experienced by individuals with ADHD.
By teaching skills such as mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, DBT can help individuals with ADHD better manage their symptoms and improve their overall functioning.
While more research is needed to establish the effectiveness of DBT for ADHD, the existing evidence suggests that it can be a valuable addition to a comprehensive treatment plan.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425787
Fleming, A. P., McMahon, R. J., Moran, L. R., Peterson, A. P., & Dreessen, A. (2015). Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. Journal of attention disorders, 19(3), 260-271. https://doi.org/10.1177/1087054714535951
Halmøy, A., Ring, A. E., Gjestad, R., Møller, M., Ubostad, B., Lien, T., Munkhaugen, E. K., & Fredriksen, M. (2022). Dialectical behavioral therapy-based group treatment versus treatment as usual for adults with attention-deficit hyperactivity disorder: a multicenter randomized controlled trial. Bmc Psychiatry, 22(1), 738. https://doi.org/10.1186/s12888-022-04356-6
Hirsch, O., Chavanon, M., Riechmann, E., & Christiansen, H. (2018). Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD). Journal of affective disorders, 232, 41-47. https://doi.org/10.1016/j.jad.2018.02.007
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Meyer, J., Zetterqvist, V., Unenge Hallerbäck, M., Ramklint, M., & Isaksson, J. (2022). Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD: who benefits more from DBT-based skills training?. BMC psychiatry, 22(1), 767. https://doi.org/10.1186/s12888-022-04435-8
Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent health, 46(3), 209-217.https://doi.org/10.1016/j.jadohealth.2009.09.009
