New psychotherapeutic approaches in adult ADHD - acknowledging biographical factors

Caroline Lücke

doi:10.29245/2572.942x/2017/7.1138

Abstract

Cognitive behavioral therapy (CBT) is the standard form of psychotherapy currently used in adult attention deficit hyperactivity disorder (ADHD). However, biographical factors, such as chronic negative feedback in childhood, which may likely play a role in ADHD as a developmental disorder, are usually not substantially addressed by CBT. In recent years, schema therapy has received increasing attention as an effective therapy approach for chronic psychiatric disorders. A core feature of schema therapy is the identification and targeting of early maladaptive schemas, which are dysfunctional patterns and beliefs resulting from childhood experiences. Recently, two studies have demonstrated an increased prevalence of maladaptive schemas in adult ADHD. Thus, schema therapy might constitute a potentially promising approach in the treatment of ADHD, especially with regard to secondary problems such as poor coping strategies or impaired self-perception. However, randomized controlled clinical studies are needed to support that theory. Here, we provide an overview on the topic of biography-oriented therapy approaches in relation to adult ADHD, summarize current literature and discuss implications for future research.

Highlights

Current practice of psychotherapy in attention deficit hyperactivity disorder (ADHD)Attention deficit hyperactivity disorder (ADHD) is a chronic psychiatric disorder, starting in early childhood and often continuing into adult age
In the development of psychotherapeutic approaches, most programs have been based on the principle of cognitive behavioral therapy (CBT)[5,6] and there is evidence that these are effective in reducing ADHD symptoms, at least with regard to self-reported symptom evaluation[7]
The general idea of targeting childhood traumas is not new, and is an important factor in traditional psychoanalysis, the idea to combine and integrate this focus with behavioral-based approaches is a relatively young development. One of these promising approaches is Cognitive Behavioral Analysis System of Psychotherapy (CBASP)[9], which is already widely used in clinical practice, this program has been developed for the treatment of chronic depression and, to our knowledge has not been adapted for use in other psychiatric conditions

Summary

Background

Attention deficit hyperactivity disorder (ADHD) is a chronic psychiatric disorder, starting in early childhood and often continuing into adult age. The general idea of targeting childhood traumas is not new, and is an important factor in traditional psychoanalysis, the idea to combine and integrate this focus with behavioral-based approaches is a relatively young development One of these promising approaches is Cognitive Behavioral Analysis System of Psychotherapy (CBASP)[9], which is already widely used in clinical practice, this program has been developed for the treatment of chronic depression and, to our knowledge has not been adapted for use in other psychiatric conditions. An alternative study approach could be the usage of more generalized outcome measurements such as the Clinical Global Impression scales (referring to a patient’s overall psychiatric morbidity) or measurements of health-related quality of life and daily functioning, which may improve in patients with different maladaptive schemas by targeting their specific combination in therapy. More standardized attempts on schema therapy have already been developed, such as the manual on group schema therapy for borderline personality disorder by Farrell and Shaw[27] and these may be adapted for the use in ADHD

Conclusions

Conflicts of Interest

Association AP