Cognitive-Behavioural Therapy for ADHD in Adolescents and Adults: A Psychological Guide to Practice

318 Pages·2012·3.1 MB·English

by  Susan Young

COGNITIVE-BEHAVIOURAL THERAPY FOR
ADHD IN ADOLESCENTS AND ADULTS
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COGNITIVE-BEHAVIOURAL
THERAPY FOR ADHD IN
ADOLESCENTS AND ADULTS
A PSYCHOLOGICAL GUIDE
TO PRACTICE
SECOND EDITION
Susan Young and Jessica Bramham
A John Wiley & Sons, Ltd., Publication
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This edition first published 2012
© 2012 John Wiley & Sons, Ltd.
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Library of Congress Cataloging-in-Publication Data
Young, Susan, 1957–
Cognitive-behavioural therapy for ADHD in adolescents and adults : a psychological guide to practice /
Susan Young and Jessica Bramham. – 2nd ed.
p. cm.
Rev. ed. of: ADHD in adults / Susan Young, Jessica Bramham. 2007.
Includes bibliographical references and index.
ISBN 978-1-119-96074-4 (hardback) – ISBN 978-1-119-96073-7 (paper)
1. Attention-deficit disorder in adults–Treatment. 2. Attention-deficit disorder in adolescence–
Treatment. 3. Cognitive therapy. I. Bramham, Jessica. II. Young, Susan, 1957– ADHD in
adults. III. Title.
RC394.A85Y68 2012
616.85′89–dc23
2011053429
A catalogue record for this book is available from the British Library.
Set in 10/12pt Times by SPi Publisher Services, Pondicherry, India
1 2012
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CONTENTS
List of Figures, Tables and Boxes vii
About the Authors x
Foreword by Margaret Weiss xi
Foreword by Sam Goldstein xviii
Preface xxi
Acknowledgements xxiii
I BACKGROUND AND TREATMENT 1
1 Introduction 3
2 Delivering the Young-Bramham Programme 21
II CORE SYMPTOM MODULES 37
3 Attention Module 39
4 Memory Module 54
5 Organization and Time-Management Module 64
6 Impulsivity Module 91
III COMORBID AND ASSOCIATED PROBLEM MODULES 109
7 Problem-Solving Module 111
8 Interpersonal Relationships Module 129
9 Anxiety Module 153
10 Frustration and Anger Module 182
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vi CONTENTS
11 Low-Mood and Depression Module 203
12 Sleep Module 221
13 Substance Misuse Module 243
IV THE FUTURE MODULE 267
14 Preparing for the Future Module 269
References 285
Index 294
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LIST OF FIGURES, TABLES AND BOXES
Figures
1.1 A cognitive behavioural model of ADHD in adults 12
2.1 Stages of change 28
3.1 The spiral of anxiety and attentional control 46
4.1 Memory systems 55
4.2 Working memory model 56
5.1 Example of breaking down goals into steps 74
5.2 Prioritization methods 76
7.1 Example of brainstorming solutions 119
8.1 How to communicate effectively 138
9.1 Anxiety spiral 160
9.2 Thought bubble anxiety spiral 162
9.3 The three-legged anxiety table 162
9.4 The three-legged anxiety table: Coping with negative thoughts 165
9.5 Bodily reactions to anxiety 171
9.6 The three-legged table: Controlling feelings of anxiety 173
9.7 The three-legged table: Changing behaviour 176
10.1 Physical, cognitive and behavioural aspects of anger 191
10.2 Dealing with insults and criticisms 199
11.1 Cognitive model of depression in ADHD 207
12.1 Dysfunctional sleep cycle 223
12.2 The sleep cycle 232
13.1 Context of substance misuse for people with ADHD 244
13.2 The sequence of thoughts and beliefs during cravings and urges 261
13.3 Dysfunctional beliefs that can maintain substance misuse 262
14.1 Steps towards goals 275
Tables
3.1 DSM-IV checklist of symptoms 42
3.2 Examples of attentional impairments 44
3.3 External strategies to improve attentional control 48
3.4 Internal strategies to improve attentional control 49
4.1 Memory problems log 59
4.2 External strategies to improve memory 60
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viii LIST OF FIGURES, TABLES AND BOXES
4.3 Internal strategies to improve memory 61
5.1 Time-management evaluation 67
5.2 Importance of punctuality evaluation 68
5.3 Diary activity log 69
5.4 Time-estimation exercise 79
5.5 Time plan 81
5.6 Example of diary activity plan 83
6.1 Typical impulse control problems experienced by people
with ADHD 93
6.2 The IMPULSE method for identifying and monitoring
behaviours 98
6.3 The process of CONTROL 102
6.4 Distraction techniques 104
7.1 Common domains of problems in ADHD 117
7.2 Understanding the problem 118
7.3 Example of a pros and cons list 122
8.1 Social skills questionnaire 132
8.2 Characteristics of ADHD speech and suggestions for improvement 134
8.3 Conversational skills 134
8.4 Listening skills 135
8.5 Emotions and facial expressions 137
9.1 Anxiety checklist 157
9.2 Example of a thought diary 163
9.3 Example of negative challenges in a thought diary 164
9.4 Cognitive techniques and the process of anxiety 165
9.5 Thinking errors 167
9.6 Examples of negative thoughts and challenges 168
10.1 Measure of assertion 190
11.1 Typical thinking errors of people with ADHD 209
11.2 Examples of negative thoughts and challenges 213
11.3 Diary activity plan 217
12.1 Sleep diary 227
12.2 Stages of sleep 231
12.3 Factors which may affect sleep in people with ADHD 234
12.4 Behavioural sleep strategies 236
13.1 The five stages of substance use 249
13.2 Problems associated with substance misuse 250
13.3 Substance, stage and motivation 251
13.4 Decisional balance sheet 256
13.5 Distraction and replacement techniques 260
13.6 Addictive beliefs 262
14.1 Review of successful strategies 277
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LIST OF FIGURES, TABLES AND BOXES ix
Boxes
1.1 The Young-Bramham programme structure 15
5.1 Six steps to making a time plan 73
5.2 List components 75
5.3 Priority task list 77
5.4 Organizing a repeat prescription 78
6.1 ‘Double-check’ questions 103
7.1 Define the Problem 116
9.1 Anxiety chart: What happens to you when you become anxious? 159
9.2 Positive self-statements 169
9.3 Ten rules for coping with panic 172
9.4 Breathing exercises 174
9.5 Progressive muscle relaxation 175
9.6 Overcoming avoidance and increasing confidence 177
9.7 Example of stage 1: List of situations avoided 177
9.8 Example of stage 2: Grading of list of situations avoided (0–10) 178
9.9 Example of stage 3: Ranking list of situations avoided (0–10)
and choosing rewards 178
10.1 The ADHD formula 195
11.1 Thinking errors exercise 209
11.2 Brainstorming Techniques 212
11.3 Exercise: Challenging negative thinking 212
11.4 Replacing negative thoughts 213
11.5 Making a task list 214
11.6 Example of a task list for activity scheduling 216
12.1 Examples of the thoughts, feelings and behaviours that mediate
sleeplessness 239
12.2 Mood-related sleep strategies 240
13.1 Risk domain exercise 252
13.2 Five stages of seeking help 254
13.3 The problem of change 255
13.4 Weighted advantages/disadvantages worksheet 257
13.5 Distraction techniques 260
13.6 Flashcards of self-reinforcement 263
14.1 Top ten achievements 275
14.2 Future goals 275
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ABOUT THE AUTHORS
Susan Young is a Senior Lecturer in Forensic Clinical Psychology at the Institute of
Psychiatry, King’s College London and an Honorary Consultant Clinical and Forensic
Psychologist at the high security Broadmoor Hospital. In 1994 Susan set up the
clinical psychology service at the Maudsley Hospital’s National Adult ADHD
Service and has extensive clinical experience in the assessment and psychological
treatment of youths and adults with ADHD. Susan participated in the British
Association of Psychopharmacology Consensus Meeting (2007) to develop
guidelines for management of transition for ADHD adolescents to adult services.
She was a member of the National Institute for Health and Clinical Excellence
(NICE) ADHD Clinical Guideline Development Group (2009); her main contribution
being to provide expert guidance on psychological treatment of children and adults
with ADHD. Susan is Vice President of the UK Adult ADHD Network (UKAAN),
which aims to support practitioners establish adult ADHD clinical services. Susan
has published articles in scientific journals, three psychological intervention
programmes and has authored two books. She is currently leading a research group,
supported by the Department of Health, which aims to develop projects that will
establish the evidence base on ADHD and offenders and approaches to their
management in the criminal justice system.
Jessica Bramham is a Lecturer in Clinical Neuropsychology in the School of
Psychology, University College Dublin. She leads the Adult ADHD Service at
St Patrick’s University Hospital Dublin. She previously coordinated the National
Adult ADHD Service at the Maudsley Hospital in London and was a Clinical Lecturer
at the Institute of Psychiatry, King’s College London. Jessica has a doctorate in
Clinical Psychology and PhD from the Institute of Psychiatry and a MA from
Cambridge University. Neuropsychological assessment is a particular interest. She is
involved in researching cognitive functioning and the presentation of comorbid
disorders in adults with ADHD.
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FOREWORD BY MARGARET WEISS
‘The journey started with the words “You have ADHD”. To the client these words
were not just a diagnosis, but a framework for self-understanding.’ These words
taken from the authors’ module on terminating therapy are a statement of the central
thesis of this book. This is a clinically driven manual for understanding and helping
adults with ADHD. The strength of this manual is that it is clinically driven. The
authors are not constrained by a particular view of how change occurs, the structures
of the DSM or ICD, the ideology of a particular method of therapy, or a narrow arena
of functional impairment.
Young and Bramham define three ways in which change may occur. Biological
change may occur either through maturation or as a result of taking medication, in
which case one observes a direct improvement in symptoms. Environmental change
can occur when the patient’s milieu is modified in such a way as to minimize the
impact of symptoms or optimize the visibility of strengths. Psychological change
occurs through the use of cognitive, behavioral, psychoeducational and interpersonal
techniques that provide a scaffolding for building skills that were not previously
present. The authors further simplify this schema for understanding change by noting
that it can occur from the outside in, as well as from the inside out.
Psychiatrists who prescribe medication and CBT therapists are most interested in
change from the inside out. The focus of these authors is not on any one direction of
change. Instead they have focused on the dialectic between symptoms and function-
ing that is unique to this particular group of patients. This is a book by clinicians who
have learned about ADHD from their patients. The result is a practical manual that
can be as easily referenced in individual, group or workshop formats. The instrumen-
tal tools that accompany each module are made available to the reader on a website
for ease of presentation.
What emerges from this perspective is clinical wisdom. One can see and feel both the
patient and the therapy. Sometimes the authors sound almost simplistic in stating the
obvious ‘Achievement is a strong reinforcer’, ‘Self monitoring can increase a skill’,
‘Recognizing and preparing for problematic tasks makes a difference’. Yet each one
of these statements represents tasty therapeutic spice.
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