Talk Therapy for treating ADHD

Michael Uram, MA, LMFT

Licensed Marriage and Family Therapist BBS #45428Michaeluram.com

About Michael Uram, MA, LMFT

• I attended Pepperdine University’s Graduate School of Education and Psychology. I am a licensed Marriage and Family Therapist in Private Practice in Costa Mesa, CA. I specialize in treating individuals and families that have one person diagnosed on the Autism Spectrum, Asperger’s and ADHD.

• I am a Faculty Member at the University of Phoenix. I facilitate courses in their Graduate School as well as the Bachelors Level Courses in the College of Social Sciences.

• I counsel abused children, some are diagnosed on the spectrum, through Childhelp Group Homes through the use of Trauma Focused Cognitive Behavioral Therapy.

What is Talk Therapy?

• Talk Therapy or Psychotherapy, particularly Cognitive Behavioral Therapy, is the process of discussing a concern with the expectation that changing thoughts and behaviors will change feelings and decrease symptoms of ADHD.

• Below are a few of the symptoms that I have seen change the most using talk therapy for ADHD.

Forgetfulness

Distractedness

Inattention

Goal Incompletion

Poor Prioritization

Impulsiveness

Does it Cure ADHD?

• It depends on what you mean by cure…

• ADHD patterns do not fully disappear, but they can be greatly reduced to the point that they don’t interfere with your daily life.

• The ADHD diagnosis of “In Remission” means that the symptoms no longer meet clinical significance, which means you could no longer meet criteria for having ADHD, while still having a few symptoms of it.

So, how do you treat it?• First, you have to see specifically how a person

presents symptoms and we develop a plan to treat the symptoms one at a time.

• Second, based on your age and cognitive development, we choose a method

• Adults – Cognitive Behavioral Therapy (CBT) works well, with gestalt and Object relations theories techniques being occasionally utilized.

• Adolescents – A combination of CBT and Collaborative Problem Solving (CPS) works rather well.

• Children – Due to not having the cognitive abilities of adults, CBT has not been shown to be effective. I use behavior modification and self- awareness training techniques.

Piaget’s Stages of Cognitive Development

https://figures.boundless.com/20638/full/ve-development-examples-i8.gif

What is CBT?• Cognitive Behavioral

Therapy was originated by Aaron Beck. He now runs the Beck Institute, a great resource for CBT materials and training. A simplified description of the process that he developed is called the Cognitive Triad.

• Our thoughts affect our behaviors which influence our feelings which influence our thoughts which influence…

Behaviors

Feelings

Thoughts

The CBT Treatment process• Identify one behavior to change at a time and

develop a pattern of improvement such as:

• Treatment Process:

• 1. build motivation to change.

• 2. Identify and challenge distorted thoughts

• 3. Replace unhealthy behaviors with healthy ones.

• 4. Build awareness of feelings and our body’s response, leading to practicing body regulation to control intensity of feelings.

Give me an example…• ADHD Criteria 1a. Often fails to give close attention

to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

For this example• 1. My client identifies how much it frustrates themselves and

others when they make a careless mistake, like after working four hours at night to complete a report and forgetting to email it to everyone, then missing the deadline. They state that they do not like the reputation that this gives them and they state that they do not want this to continue.

• 2. The distorted thought is overgeneralization. They believe this behavior to be a never ending pattern of defeat. They have always made this mistake, so they always will continue to make it. In reality, when we feel like a failure, we avoid thinking about our mistakes, when we avoid thinking about our mistakes, we are bound to repeat them. When we focus on repairing the mistakes often, the mistakes rarely make another appearance. This takes a lot of confidence and dedication.

•

CBT Treatment• 3. They now replace the unhealthy behavior of

procrastinating by identifying that the project has a definite beginning and end rather than not clearly planning or under budgeting the time that the task will take.

• 4. They identify when they are starting to drift off or get distracted and refocus themselves, through using reminders, phone alarms or “external frontal lobes.”

• 5. On the occasion that the behavior does repeat, they view it as a hiccup rather than a never ending pattern. They learn from this mistake and have a good rest of their day.

Why this may not work…• Russell Barkley has a great summary of why, in his

article: http://www.russellbarkley.org/factsheets/ADHD_EF_and_SR.pdf

• “Once per week counseling without efforts to insert accommodations at key points of performance in natural settings is unlikely to succeed with the patient with deficient EF. This is not to say that extensive training or retraining at the instrumental level of EF, as with working memory training, may not have some short-term benefits. Such practice has been shown to increase the likelihood of using EF/SR and of boosting the SR resource pool capacity in normal individuals.”

What is EF and SR?• Again from Barkley (this guy is amazing BTW)

• The term “self-regulation” in psychology has a relatively specific definition. While it is often considered the means by which an individual manages themselves in order to attain their goals, it can be thought of as having at least three components. Self-regulation involves (1) any action an individual directs at themselves so as to (2) result in a change in their behavior (from what they might otherwise have done) in order to (3) change the likelihood of a future consequence or attainment of a goal.

So what is EF?• “A commonly used definition in the field of ADHD

has been to refer to EF as “those neuropsychological processes needed to sustain problem-solving toward a goal.” Now we can begin to see a potential relationship between EF and self-regulation, because they share a similar if not identical definition. Both involve goal-directed, future-oriented actions. Both involve sustaining actions over time to achieve one’s goals. And both include problemsolving as part of those goal-directed actions. Moreover, when we look at a list of the mental processes most often listed as being part of the notion of EF, they include: inhibition, resistance to distraction, self-awareness, working memory, emotional self-control, and even self-motivation.”

Okay, I now get that, but I still am not aware of what my patterns are to begin with…

• To identify patterns, we have to go another route:

• We have to train our abilities to be more aware of patterns and to be a great detective.

• Tracking behaviors: • Keep a log• Ask our spouses, friends, coworkers to identify times that

we may need to improve our focus, impulsivity, etc.• Prioritize this list and determine how much we do not want

this behavior to continue.• Identify the stages of change and understand that it is a

process.

What do you mean by patterns

• Between David Burns and Sigmund Freud, they identified the most common patterns of unhealthy thoughts and behaviors that we often use.

• I give clients a copy of the handouts that I am giving you today. We review them and explore possible patterns of behavior that may be interfering with their life.

• Let’s use the example from before again…

Treatment Process• First, I would identify a situation where you frequently

would have difficulty paying attention to details or making careless mistakes.

• Second, we figure out a pattern that is consistently leading you to make this careless mistake.

• We get to the core belief about the task that it leading you to not prioritize it, care about it, or value it.

• We would “Slow down to go faster.” Often, when we are careful, the same mistakes do not occur. This is often referred to as a part of mindfulness training. When we don’t have to fix mistakes, our work output increases.

• We see if sometimes you would not view a task as complete when all of the parts are done, rather than just the challenging ones or the sections that matter.

Using an automatic thought record

• The Thought Record, adapted from the Workbook Mind Over Mood in conjunction with the Plan B guide helps the client and their family identify cognitive distortions and stuck patterns of behavior in a time efficient and documented manner.

• The thought record describes the emotions that we have when we have not worked out the concern, discuss all thoughts that support or do not support the thought, then develop a balanced view of the situation, the Plan B template then takes the balanced view and gives the family a method to try to see if they can adapt it to their problem.

Common Questions

• How many sessions does treatment last? Usually 10 – 20, sometimes much longer.

• Who should come to the first appointment? Parents and Child.

• Is every session with the entire family? It is usually balanced between individual and family, sometimes the parents observe an individual session.

• What does this cost? $125 per 50 minute session, sliding scale and some insurances are accepted.

• What research is available? The best resource for research is livesinthebalance.org for Collaborative Problem Solving and the Beck Institute for Cognitive Therapy.

Resources - Books

• Russell Barkley – Virtually everything that he has written regarding ADHD, videos referencing Executive functioning.

• Mind Over Mood – Christine Padesky and Dennis Greenberger

• The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children - Ross Greene

• Everything that Edward Hallowell has written – Driven to Distraction

Crowd Participation• Identify one of the criteria of ADHD that you would

like to work on and how much it is impacting your life.

• Guess what pattern of behavior is leading you to continue that symptom.

• Identify what would motivate you to change the symptom.

• Use one of the techniques outlined.

• Determine whether your core belief has changed.

And Remember…

There is no major secret to treatment. I gave you the most important tools that I use everyday.

Contact Information

• 949-777-6694 2900 Bristol St., Suite G-201Costa Mesa, CA 92626michaeljuram@gmail.comhttp://www.MichaelUram.com