Dialectical Behavior Therapy for ADHD: More Tools for Your Toolbox
By Paula Jones, LCSW
Senior Therapist and Clinical Supervisor, Hallowell Todaro California
DBT, as it is commonly referred to, is a type of behavior therapy that emphasizes the dialectic opposites of acceptance and change. Marsha Linehan, the creator of DBT, spent months in a Zen monastery learning how to be in “acceptance “ so she could teach her clients. The result was one of the core concepts of DBT, Radical Acceptance.
DBT (like Buddhism) teaches that everyone has suffering; it is part of the human condition. We can reduce the degree of our suffering by being mindful and accepting things we can’t change. From a DBT perspective, persons with ADHD must first accept they have a non-neurotypical brain, because in essence, it can’t be changed: “It is what it is.” We can treat the symptoms with medication and psychotherapy, coaching or neurofeedback which help us improve our functioning, but our brain is still non-neurotypical. We still have ADHD.
Someone might see this as “unfair” because having ADHD creates challenges that others don’t have. The DBT perspective is “we should accept that circumstances are often unfair, but we can still create a life worth living.” Your boss might be critical that some tasks take you longer to complete. Your spouse may say “if you really cared you would finish that to-do list.” Your child with ADHD may have difficulty with emotional regulation which creates stress for the family. These are things you need to accept, then you can work to improve what you can.
Marsha Linehan created an extensive handbook of many DBT skills and many of these skills can reduce the distress created by ADHD. She brilliantly summarizes 4 choices when facing a problem.
1) ”solve the problem”
Maybe you chose to solve the boss problem by seeking accommodations for your ADHD from HR or finding a job that requires less in the areas in which you struggle.
2) “tolerate the problem”
You might tolerate the boss problem by not taking it personally that he doesn’t understand ADHD is a real disorder. Instead of focusing on it’s “unfair” how he treats you, radically accept that he is who he is and cope with it.
Maybe to better tolerate your child’s meltdowns, you can alternate which parent handles them or seek coaching to learn ways to manage them more effectively.
3) “feel better about the problem”
You might weigh out the pros and cons of your job and decide the salary and hours make up for many of the negatives. By educating yourself more about ADHD and emotional dysregulation, you may cultivate compassion, recognize your child is doing the best he can, and focus more on his strengths. Joining a support group or sharing with friends often makes you feel better and reminds you that everyone has problems.
Ned Hallowell has written extensively on seeing the gifts in his book “ADHD 2.0” and encourages focusing on what is uniquely positive about having ADHD. Feeling better about the problem goes one step further than “It is what it is” to “It is both good and bad.”
4) “do nothing, stay miserable”
People often deny the problem, get frozen in anxiety, or try to push the problem away. Many ADHD adults now regret that their parents did nothing. Perhaps they could have “solved the problem” or made the problem better with treatment.
Many adults with ADHD carry shame from past jobs, relationships, or school failures. Accept that you have those feelings but move past them to radical acceptance. It is what it is and was what it was. Focus on the present and choose to solve it, tolerate it, or feel better about it. Or maybe a little of each.
Our therapists and coaches are on hand to support children with ADHD and other learning differences.
Contact us to learn more.