Hacker News Reader

Comment by kuerbel | Hacker News Reader

>But cognitive behavioral therapy does not work by itself for ADHD.

But it does exactly that. There have been enough studies about this. CBT and medication combined improved faster, but CBT alone catches up in a few months. E.g. https://journals.sagepub.com/doi/abs/10.1177/108705471667119... or this study here: https://pubmed.ncbi.nlm.nih.gov/31280035/

>Stimulants are the gold standard treatment.

I'm not arguing that they don't help, but CBT also increases other metrics, e.g. self esteem, acceptance, self-efficacy, and so on.

View on HN

> I'm not arguing that they don't help, but CBT also increases other metrics, e.g. self esteem, acceptance, self-efficacy, and so on.

I was recently diagnosed, and am on stimulants, which are definitely helpful.

That being said, I'd been going to therapy for about six years (currently winding that down), and I have to say that the therapy alone definitely helped with lots of the emotional/childhood stuff that I don't think would have been helped by medication alone.

I would be prone to believe that both therapy & medication are effective, and indeed my prescribing doctor called this out (although she focused on CBT, which is the easy one to test with controlled trials).

Therapy helps everyone. Everyone should do therapy. I expect that any study comparing ADHD with therapy to ADHD without, will find much better outcomes with therapy. Because therapy works at improving general life outcomes.

But does therapy help alleviate ADHD symptoms specifically? I doubt that very much.

Experientially I agree with you, but therapy is a really really bad fit for controlled trials, as the active ingredient appears to be the patient provider relationship.

Yeah that's a part of it for sure. Experience varies and replication is really difficult.

The reasons for my expectation that therapy doesn't address ADHD symptoms generally (I know it didn't for me) is more fundamental though: therapy is helpful in making conscious changes. The whole point of ADHD is that you're not consciously aware of the decisions you make. Any therapy that tries to address the root cause of ADHD issues boils down to "try to remember to not do that" when the f'ing point is that I will not remember, and I can't control that. Stimulants fix this. No amount of therapy makes it better.

Where therapy is helpful is learning to live with the disability and to prevent or contain the worst outcomes that can result. Therapy helps manage symptoms, not address the root cause. Which is good because even stimulants are not perfect, and usually by the time you're seeking help there's a lot of damage already. But they're not addressing the same thing.

On the dumbass reactions amc distractions I completely agree, medication is much more helpful here.

For all the guilt and shame associated with the consequences of those stupid reactions, therapy is incredibly helpful.

That's a much more succinct way to put it, thank you.

In my case my marriage was falling apart, among other things, due to problems that ultimately stemmed from my ADHD. Therapy helped me fix my marriage, but only medication corrected the behaviors that led to that situation & kept me from repeating the same mistakes.

CBT helps to an extent, however it can't replace meds for things such as long drives or reading unstimulating things (in my case, law or math). Also it requires a lot of routine and discipline (=energy) which can be hard to achieve consistently.

The first psychiatrist I saw told me to do CBT alone, but I also needed to change jobs to a complete different field as doing boring excels would never be possible for me. I mean, it's true but not very practical and quite risky as a life path.

Reply on news.ycombinator.com