Anxiety Management: Effective Strategies Combining Adapted CBT, ACT, DBT, and Mindfulness for Individuals with ADHD

By Dr Danielle Baillieu

Understanding Anxiety in ADHD

Anxiety is an increasingly widespread problem for people with ADHD, often complicating their daily functioning and emotional well-being. Studies indicate that nearly 50% of individuals with ADHD experience significant anxiety symptoms. This overlap highlights the urgent need for effective management strategies tailored to the unique challenges faced by this population. A promising treatment approach integrates cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), dialectical behavioural therapy (DBT), and mindfulness practices. By blending these therapeutic modalities, psychologists can address the multifaceted nature of anxiety in ADHDers and foster greater resilience.

The Evidence for Integrated Approaches

The effectiveness of supplementary approaches is well supported in the literature. Mendez (2015) and Palakodeti et al. (2024) highlight that combining different therapeutic techniques enhances treatment outcomes by addressing cognitive, emotional, and behavioural aspects of anxiety. The adaptable nature of these therapies allows professionals to customise interventions based on individual needs and preferences—essential for managing the unique symptoms of ADHD. Additionally, research by Wakelin et al. (2023) and Tarraza (2022) has validated the effectiveness of these integrated treatments in alleviating anxiety, reinforcing the idea that a holistic therapeutic approach can be more beneficial than standalone traditional methods.

12 Effective Strategies for Relieving Anxiety

1. Mindfulness Practices

Mindfulness meditation can be a game-changer for individuals struggling with anxiety and ADHD. This practice encourages focusing attention on the present moment, reducing overwhelming thoughts and emotions. Taking just a few minutes each day to cultivate mindfulness can help individuals observe their anxiety without judgment, fostering a sense of calm and clarity.

2. Cognitive Restructuring

Adapted CBT techniques help individuals challenge negative thought patterns. For example, replacing "I will never be able to manage my time" with "I can learn skills to improve my time management" fosters a more constructive mindset. Recognising, challenging, and changing automatic thoughts are fundamental strategies for reducing anxiety.

3. Emotional Regulation Skills

DBT provides invaluable tools for enhancing emotional awareness. People with ADHD often respond impulsively to emotional triggers, increasing anxiety levels. Skills such as distress tolerance and emotional mindfulness help individuals pause and assess their emotions, leading to better outcomes.

4. Acceptance Techniques

ACT promotes acceptance of thoughts and feelings rather than resisting them. This approach is particularly useful for individuals experiencing anxiety. Instead of seeing anxiety as something to eradicate, embracing its presence with compassion can lead to greater self-awareness and emotional resilience.

5. Behavioural Activation

Engaging in enjoyable activities acts as a powerful counterweight to anxiety. Prioritising activities that bring joy or fulfilment reduces the tendency to spiral into anxious thoughts. Making a list of enjoyable activities and committing to at least one per day can have a significant positive impact.

6. Stress Management Techniques

Deep breathing exercises and progressive muscle relaxation are essential for managing physiological anxiety symptoms. Grounding techniques, such as focusing on breathing or purposefully relaxing muscles, create a physiological shift that relieves stress and anxiety.

7. Time Management Strategies

Implementing structured time management techniques can alleviate anxiety in individuals with ADHD. Creating a clear schedule, setting specific goals, and breaking tasks into smaller parts help reduce overwhelm. This structured approach fosters control and predictability, lowering anxiety levels.

8. Social Support Systems

Building a strong support network plays a crucial role in managing anxiety. Connecting with friends, family, or support groups provides individuals with a space to share experiences and receive validation. Knowing that they are not alone in their struggles offers relief and encouragement.

9. Physical Activity

Regular physical activity benefits both physical and mental well-being. Running, yoga, or dancing are excellent stress relievers. Endorphins released during exercise act as natural mood boosters, making it easier to manage anxiety symptoms.

10. Sleep Hygiene

Quality sleep is vital for mental health, particularly for those with ADHD. Establishing good sleep hygiene—such as maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and limiting screen time before bed—can enhance sleep quality. Better sleep improves focus and reduces anxiety, fostering overall well-being.

11. Routine Implementation

Establishing a structured daily routine acts as an anchor for individuals with ADHD. Anxiety often intensifies in unpredictable environments, but having a predictable schedule minimises chaos and enhances clarity. Simple practices like scheduled meal times, designated work periods, and planned relaxation times contribute to a balanced emotional state (Guo et al., 2022).

12. Regular Check-Ins

Frequent therapeutic check-ins enable adjustments to treatment methods based on evolving needs. This allows individuals to assess which strategies work and make modifications as needed. Continuous communication between patients and professionals reinforces learned skills and fosters accountability in the therapeutic process.

The Role of Psychoeducation

Psychoeducation plays a vital role in anxiety management. It helps individuals and their families understand the complexities of ADHD and its relationship with anxiety. By recognising how ADHD affects thought processes and emotional responses, families can offer greater support, fostering empathy and open communication. Educating individuals about their condition equips them with valuable knowledge, demystifying challenges and empowering them with effective coping mechanisms (Méndez, 2015).

A Holistic Approach to ADHD and Anxiety

These integrated approaches underscore the importance of personalised methods for each individual. Combining group support, structured routines, psychoeducation, and ongoing check-ins acknowledges the unique challenges faced by those with ADHD while addressing underlying anxiety. This holistic approach allows for a comprehensive treatment plan that considers multiple factors influencing mental health. Since responses to strategies vary widely, customisation remains crucial in therapy (Palakodeti et al., 2024; Wakelin et al., 2023).

References

• Mendez, J. (2015). Mind and Emotions: The Effectiveness of an ACT/DBT/CBT Integrative/Transdiagnostic Protocol Targeting Multiple Presenting Emotional Difficulties. The Wright Institute.

• Palakodeti, S. S., Sarangi, A., & Mehta, T. R. (2024). The ADHD Conundrum: A Review of Non-Pharmacological Approaches to Management. Current Developmental Disorders Reports, 12(1), 6.

• Wakelin, C., Willemse, M., & Munnik, E. (2023). A Review of Recent Treatments for Adults Living with Attention-Deficit/Hyperactivity Disorder. South African Journal of Psychiatry, 29(1).

• Tarraza, M. (2022). Integrative Management of Disordered Attention. Advanced Practice Psychiatric Nursing, 379.

• López-Pinar, C., Martínez-Sanchís, S., Carbonell-Vayá, E., Sánchez-Meca, J., & Fenollar-Cortés, J. (2020). Efficacy of Non-Pharmacological Treatments on Comorbid Internalising Symptoms of Adults with ADHD: A Meta-Analytic Review. Journal of Attention Disorders, 24(3), 456-478.

• Guo, C., Assumpcao, L., & Hu, Z. (2022). Efficacy of Non-Pharmacological Treatments on Emotional Symptoms of Children and Adults with ADHD: A Meta-Analysis. Journal of Attention Disorders, 26(4), 508-524.