Attention Deficit Hyper Activity Disorder (ADHD) is a commonly controversial and misunderstood disorder in the mental health world. One that many don’t take seriously, even among medical and mental health professionals. The name itself, as argued by Russell Barkley, Ph.D., tends to trivialize the true nature of the complex challenges of ADHD, leaving ADHD adults bereft of getting the help they need to live effectively. On the other hand, Russell Barkley and Thomas Brown, what we call ADHD is better conceived of as a matrix of deficits and dysregulation in executive functions, such as working memory, frustration tolerance, emotion activation as well as the more familiar sustained effort and attention, only to mention a few.
My Own Journey
I first began to investigate how DBT might be an appropriate treatment for adult ADHD after receiving my ADHD diagnosis at around age thirty and as an intensively trained DBT practitioner. Making this early connection between DBT and my ADHD, I found core mindfulness practices to be helpful with self-acceptance, opening paths within me to become a more integrated person, as I cultivated acceptance and self-compassion, I felt less anxious about ADHD and began to soften my efforts to project a “Super Scott” facade to those around me. No one was buying that facade, by the way. More recently, my relationship with my wife Mariah, an ADHD therapist and certified coach, inspired me to learn more about ADHD per see, and to more rigorously explore adapting DBT for ADHD adults. Together, we have begun to develop Wise Mind for the Distracted Mind. We have found that the DBT skills modules do address the array of ADHD-related problems.
Core Mindfulness and Beyond
Core mindfulness is a framework for the practice of paying attention to present moment experiences with gentle and open curiosity that helps us to connect with our respective wise mind, a state of deep knowing in which we experience the balance of reason and emotion, and we connect with our intuition. We cultivate wise mind with the whats and hows of mindfulness. Mindfulness informs all the other skills and immediately germane to adult ADHD, mindfulness helps us increase sustained attention, task initiation, and completion, and even offset the pangs of Rejection Sensitive Dysphoria (RSD), become less subject to the negative effects of criticism or perceived criticism. Mindfulness entails a whole-person awareness, and shouldn’t be conceptually relegated to a strictly discursive or cognitive practice that takes place in the skull. As we learn mindfulness, we connect more fully with our whole selves, we cultivate mindsight as described by Daniel J. Siegel, MD. We become more integrated, relating more directly with our embodied lives, bodily sensations, thoughts, and emotions. More about this in future blogs.
Willingness and Befriending Emotions
Emotion regulation skills are the tools we can use to befriend our emotions, build general resilience, and reduce emotional vulnerability. The skill of opposite action helps us put the breaks on impulses or generate emotion we need to engage with tasks and activities. As we become more skilled in labeling our emotions and living into and with them, we come to know them as simply given, requiring no explanation to self or others. This is a path to increased internal coherence and trust in our inborn neurobiology that guides us toward effective action and connects us with safe and meaningful relationships. We learn how to avoid avoiding and bring to bear the behavioral strategies of shaping, reinforcement, acquisition, and generalization, and we grow into an increasing facility with willingness with which we return to our skills and goals, tenderly and gently, finding an ever-unfolding yes to Life as it finds us.
Interpersonal effectiveness provides us a set of skills that can help us become more clear about what we want from others at home, school, work, and love. We learn to make clear our objectives, and we learn how to enhance and nurture our present relationships which we cherish, and how to let go of toxic relationships. And we learn how to communicate with others in a way that we can retain or improve our sense of self-respect by taking responsibility for our thoughts, feelings, and desires by telling the truth, and living into what we truly value, and finding principles for living a good and human life.
DBT is well suited to meet the complexities of ADHD challenges, as established by preliminary research data (see sources below) as mentioned above. As we continue to build on that research, and our ongoing assessment of what works with our clients here at NorthStar Therapy, we continue to modify our approach, seeking what works. And we will continue to share with you our ongoing adventures in this very important work.
Scott Spradlin, LPC, LMAC is a DBT provider in Wichita, KS. Scott started his career in DBT at The Portland DBT Program, now The Portland DBT Institute, and he completed his DBT intensive training with Marsha Linehan, Ph.D., and Linda Dimeff, Ph.D. in Seattle, WA in 2000 and he is the author of Don’t Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control (New Harbinger, 2003).
Dimeff, L. A., Koerner, K. E. (2007). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. New York, NY: Guilford.
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
Moritz, G. R., Pizutti, L. T., Cancian, A., Dillenburg, M. S., de Souza, L., Lewgoy, L. B., Basso, P., Andreola, M., Bau, C., Victor, M. M., Teche, S. P., Grevet, E. H., Philipsen, A., & Rohde, L. (2021). Feasibility trial of the dialectical behavior therapy skills training group as add-on treatment for adults with attention-deficit/hyperactivity disorder. Journal of clinical psychology, 77(3), 516–524. https://doi.org/10.1002/jclp.23049
Philipsen, A; Richter, Harald; Peters, J; Alm, B; Sobanski, E; Colla, M; Münzebrock, M; Scheel, Corinna N; Jacob, C; Perlov, E; Tebartz van Elst, L; Hesslinger, B (2007). Structured group psychotherapy in adults with attention deficit hyperactivity disorder: Results of an open multicenter study. Journal of Nervous and Mental Disease, 195(12):1013-1019.