by Arianna Iliff, LMFT | 5 minute read
Everybody deserves the best mental health care possible, and as a person with ADHD it's important to know which style of treatment will give the greatest value of time and energy. Mental health care is full of acronyms and a long history of research, but when it comes to you and your brain, naturally you want to know you're doing what works. I'm here to talk about the research on different therapies for ADHD, explore your ADHD therapy options, and share a little bit about why I love using DBT and EMDR as a dream team for ADHD treatment.
Cognitive Behavior Therapy (CBT) Benefits
CBT targets our thoughts first in order to change our feelings and behaviors
Of all the therapies in all the world, cognitive therapies have been studied the most for ADHD, and Cognitive Behavior Therapy shows good results. Solanto et al. (2010) showed significant improvements in ADHD symptoms with a structured cognitive therapy over the course of twelve weeks, and another randomized controlled trial (the gold standard of research!) reported that patients who completed a cognitive behavioral program versus relaxation saw lasting results, even a year after completing the program. (Safren et al., 2010)
In CBT, you'll learn about the relationship between thoughts, feelings, and actions, and practice questioning distorted thoughts in order to change behaviors. The structure and accountability associated with cognitive therapies (they're often known for their "homework" assignments) can make therapy feel safe and consistent, and learning methods of reframing unhelpful thoughts can support us in slowing down big reactions, and effectively "getting out of our own way."
It's popular to criticize CBT these days, but when used correctly (and not used to invalidate folks' lived experiences), it can be useful to have CBT skills in your mental health toolbox.
CBT Drawbacks and Limitations
But there are some limitations:
Sometimes targeting our thoughts just isn't quite enough.
Cognitive therapies have been around for a long time, meaning there's been lots of time to study them. Cognitive therapies can be provided using a manual as well, which is great for research when we want to control for different variables, but perhaps not so great in the gray area of being a client outside of a psychology lab setting.
CBT concepts have made it into support groups, coaching, apps, and self-help resources, and is an often-accessible treatment style when you're searching for a therapist. If you've been in therapy before, you've probably been exposed to some CBT. I find that many clients are already familiar with questioning distorted thoughts. I hear it all the time: "I know this thought is not actually true, but I can't stop thinking it." Clients are tense and worried, made all the more challenging by the knowledge that the things they believe may not be fully true.
It's a bit of a trend to criticize CBT, and I want to make clear that I don't automatically dislike it. I might sometimes discuss cognitive distortions with folks, for instance, but I don't identify as a CBT therapist. Other modalities have additional things to offer that CBT just doesn't.
Mindfulness is a key part of DBT.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy, or DBT, builds on CBT’s foundation. Historically, cognitive behavior therapy has framed ADHD as mostly about impulse control or cognitive weaknesses, but I feel it’s also important to address emotions, stimulation, and nervous system regulation.
In my opinion, the best part of DBT for ADHD is the inclusion of mindfulness as a core part of the treatment. Mindfulness, in DBT terms, isn't just about meditating at the top of a mountain, but also about how we slow down and purposefully engage in our lives. Observing mindfully is an important part of deciding how we proceed in a given situation, and can be great for combating impulsive action and choosing effective ways to manage emotions. In DBT, mindfulness is called “core mindfulness,” which means it acts as the blueprint for further skill building in emotion regulation, distress tolerance, and interpersonal effectiveness.
DBT honors an individual's experience of ADHD (Champ et al., 2021) and incorporates the idea of dialectics, meaning two opposites that are both true. The idea of dialectics plays well with many of the paradoxes of ADHD life, such as executive dysfunction: "I want to do this task, and also I feel completely incapable of doing this task."
Plus, the data supporting DBT for ADHD is there: one randomized controlled trial of adults with ADHD in a group DBT setting found that after 14 weeks, significant improvements were shown in executive functioning, depressive symptoms, overall ADHD symptoms, and overall quality of life compared to treatment as usual (Halmøy et al., 2022).
I love DBT skills, as they provide a wonderful reference point for ways to handle everyday life. Want to learn more about DBT skills?
Eye Movement Desensitization and Reprocessing (EMDR)
In EMDR, we can learn and integrate new ideas about ourselves!
ADHD has a lot of "cousins," that is to say, co-occurring conditions, and one of them is PTSD. Magdi et. al. (2025) demonstrates how multiple studies have found a strong association between ADHD and PTSD, with ADHD symptoms existing well before a traumatic event happened. EMDR is a newer area of study with adult ADHD, but it seems that initial perspectives about the two together are promising. Learn more about the difference between EMDR and talk therapy here.
Folks with ADHD can have intense traumatic experiences, but there is a type of "little-T" trauma I see over and over among them. After forgetting that deadline, losing track of that important paperwork, or feeling out of place among other people (often repeatedly throughout our lives), we can start to believe that something is deeply, irrevocably wrong with us. Moreover, when we experience negative feedback, embarrassment, or even job loss due to issues with executive functioning, attention, or emotional regulation, the issues are compounded. The bottom line is, ADHD is a condition which can change how we look at ourselves.
EMDR is based on the idea that difficult symptoms now are the result of unprocessed, or inadequately processed information from our past. Much like CBT involves identifying core beliefs that don't work for us, EMDR involves not only identifying and shifting these beliefs to something more reasonable, but also understanding the emotions, sensations, and overall distress which go with them. Therefore, EMDR can provide a clarity and comprehensiveness to how we understand ourselves, without getting lost in harmful thoughts and beliefs. Explore more about EMDR.
Conclusions and recommendations
So what’s the best ADHD therapy for adults? Well, there are a few things to keep in mind: first, ADHD is an organic condition, meaning it's with us from birth and there's no cure for it. ADHD is also a little different with each person: for example, some folks may find they struggle with their working memory the most, and others may find that time blindness is their greatest challenge. Therapists like me strive to understand people on an individual level, and apply therapy models based on specific needs, and not just based on a diagnosis.
The reason I love DBT and EMDR together is because DBT skills address some of the developmental challenges that folks with ADHD can experience, improving cognitive flexibility and self-regulation. DBT skills are an excellent addition to Phase 2 of EMDR, where we build internal resilience before processing difficult events. When these features improve, deep and transformational therapeutic work can be done with EMDR to radically shift how we understand our experiences and ourselves.
If you're interested in a therapy approach that isn't one-size-fits-all and might like to work with me, I'd love to meet you in one of my free 15 minute consultations. Hope to join you soon!
Arianna Iliff, LMFT (they/she) is a licensed therapist and the founder of Inspiration Point Therapy. On their blog, The Reroll, they share helpful information about ADHD, DBT, EMDR, and the wide world of mental health.
Works cited:
Champ, R. E., Adamou, M., & Tolchard, B. (2021). The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review. PLoS ONE, 16(12), e0261247. https://doi.org/10.1371/journal.pone.0261247
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, 738. https://doi.org/10.1186/s12888-022-04356-6
Magdi, H. M., Abousoliman, A. D., Ibrahim, A. M., Elsehrawy, M. G., EL-Gazar, H. E., & Zoromba, M. A. (2025). Attention-deficit/hyperactivity disorder and post-traumatic stress disorder adult comorbidity: A systematic review. Systematic Reviews, 14, Article 41. https://doi.org/10.1186/s13643-025-02774-7
Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010). Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: A randomized controlled trial. JAMA, 304(8), 875-880. https://doi.org/10.1001/jama.2010.1192
Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. M. J., & Kofman, M. D. (2010). Efficacy of meta-cognitive therapy for adult ADHD. American Journal of Psychiatry, 167(8), 958-968. https://doi.org/10.1176/appi.ajp.2009.09081123