CBT was developed by psychologist Aaron Beck and others in the 1960s and is based on the idea that ineffective and self-defeating behavior is caused by “automatic thoughts,” or what Beck defined as inappropriate and irrational thinking patterns. When you react to automatic thoughts, you're responding to your own imagined or distorted version of reality instead of to what's actually happening or being said.

In CBT, you learn how to change automatic thoughts that result in distorted views by examining what you consider real and valid. Your therapist uses a process called cognitive restructuring to help you cross-examine these thoughts.

Some adults with ADHD have so many “automatic beliefs” that their core beliefs are flawed and negatively impact their ability to function effectively. In cases like these, therapists must work from the ground up to help patients establish new ways of thinking and behaving, a process that can take years to kick in.

How CBT Works

If you have adult ADHD, you may be convinced you have a constellation of traits that make you unlovable, unpleasant, difficult to live with, impossible to work with, and hard to get along with. You may withdraw from society because you believe it's easier to remain alone than struggle to get along with others.

CBT therapists generally work on one behavioral trait at a time. Let's say you're a single man with adult ADHD who assumes women don't want to be around you because you're overly blunt and sloppy — two traits that are very common among adult men with ADHD.

Your therapist would put your basic assumption to the test by asking you to name some women friends and family members who enjoy being around you and who have not abandoned you because you speak your mind and sometimes forget to comb your hair or change your shirt.

By showing you that there are women in your life who like you and who haven't deserted you, your therapist can expose your irrational assumption that “no woman wants to be around me because I'm blunt and sloppy.” This gives you a new model of thought so you can change your previous thought pattern to one that sounds something like this: “I'm a likable and lovable guy who many women love to be around, despite the fact that I can be overly blunt and am sometimes sloppy. Therefore, though not all women will respond to me, I expect to be able to find women to go out with. Things are not as bad as I thought.”

While CBT sessions are usually held in a therapist's office or clinic, it's also possible to arrange for group sessions. Your therapist should be licensed in your state for independent practice; have specialty training in CBT; and be a psychologist with a PhD, PsyD, or EdD, a clinical social worker with an MSW, DSW, or LSW degree, or a psychiatrist with an MD. Your best bet is a licensed PhD-level psychologist.

CBT Techniques

Your therapist is likely to use a variety of different techniques during the course of therapy to help you transform flawed assumptions into valid ones. Here are some popular strategies used by CBT therapists.

• Validity testing. Your therapist will ask you to prove your mistaken thought or belief about yourself. If you can't offer concrete evidence to show your belief is correct or accurate, he exposes your “fact” as a falsehood you've been repeating to yourself.

• Cognitive rehearsal. Your therapist asks you to describe a difficult situation in the past that you responded to in an inappropriate or ineffective way. Then, using suggestions provided by your counselor, you role play the right response until it becomes habit. The next time the problem arises in your life, you can use your rehearsed behavior to cope with it more effectively.

• Guided discovery. Just as geologists use topographic maps to find earthquake faults, your therapist asks you a series of questions designed to help you uncover a cognition distortion or falsehood you've been assuming about yourself or your life.

• Journal writing. Your therapist will ask you to write down a detailed account of situations that come up in everyday life, along with how you were thinking, feeling, and behaving at the time. By reviewing your journal, you and your therapist can find patterns of distorted thinking that may be leading to your faulty thoughts and behavior.

• Reinforcing through homework. To help you continue uncovering the falsehoods you've been telling yourself in your daily life and to reinforce concepts you've learned in therapy, your therapist may give you a variety of simple homework assignments. They may range from taking notes during therapy and transcribing them into your journal after the session to reading books and articles that shed additional light on CBT or the specific issues you're dealing with. Homework may also involve practicing a new way of dealing with a problem and recording the results for discussion during the next therapy session.

• Modeling your therapist. Your therapist will role play appropriate responses to problematic situations so you can copy her response in the event the situation arises.

• Systematic reinforcement and punishment. To reduce negative behavior patterns, your therapy may deliberately with- hold reinforcement using a method called extinction. For example, if you have a habit of interrupting conversations with her, she may ignore what you're saying every time you butt in, pretend she didn't hear you, or simply leave the room.

• Aversive conditioning. This technique borrows principles of basic conditioning to diminish the appeal of a behavior that's difficult for you to change because it's ingrained or very rewarding. During aversive conditioning, you'll be exposed to unpleasant stimulus while you're thinking about the negative behavior in question or actively engaged in that behavior. Eventually you'll come to associate the unpleasant stimulus with the activity itself and stop doing it. Aversive conditioning has been tried to help alcoholics stop drinking and to help obese people avoid some of their favorite snacks. For instance, nausea-inducing medication is administered with alcohol so a person with an alcohol problem develops an aversion to the taste and smell of alcohol. In time, the person associates alcohol with unpleasant feelings of nausea.

• Counterconditioning. This technique weakens a negative behavior by strengthening an opposite response by teaching you techniques that directly reduce panic and fear and replace them with feelings of calm and tranquility. This method is often used to treat phobias and has been very successful in programs for fearful flyers.