How can therapy assist with task initiation issues? 

For many people with ADHD, getting started on a task can feel like the hardest step. This difficulty with task initiation is linked to executive function, the mental processes that help us plan, organise, and begin activities. According to the NICE NG87 guideline (2025), structured psychological interventions such as cognitive-behavioural therapy (CBT) are recommended for adults and young people who struggle with these challenges, even when on medication. 

How therapy helps with task initiation 

Therapy gives structure, strategy, and accountability, essential support for the ADHD brain. A 2025 Frontiers in Psychiatry randomised controlled trial tested the CBT for ADHD-Inattentive (CADDI) protocol, designed to tackle procrastination and avoidance. Participants who completed CADDI reported stronger behavioural activation, improved ability to start tasks, and better overall quality of life compared with standard CBT. 

Therapist-guided sessions work because they combine behavioural activation, goal setting, and mindfulness, helping individuals move from awareness to action. A 2024 Frontiers in Psychiatry study found that clients valued structured accountability and adaptive coping plans, which reduced avoidance and improved follow-through on personal goals.Frontiers in Psychiatry (2024) suggests that for adolescents, emotion-regulation CBT incorporating homework reminders and reinforcement between sessions also improved routine and task completion.  

The science behind it 

Therapy does not just teach skills; it changes the brain. Evidence from ScienceDirect (2021) shows that mindfulness and behavioural activation enhance prefrontal-striatal regulation and dopamine-based motivation pathways, which are often underactive in ADHD. These improvements help people shift from “knowing what to do” to “doing it”. 

NHS England’s Independent ADHD Taskforce Report (2025) also highlights that therapy models combining CBT and executive-function coaching provide measurable benefits in real-world self-management supporting focus, planning, and consistent follow-through. 

Where therapy fits into care 

Most people benefit from combining therapy with medication or coaching. Medication supports attention and impulse control, while therapy builds the systems and self-regulation needed to act on goals. Services such as Theara Change integrate therapy-based behavioural coaching for ADHD, helping clients apply skills in everyday contexts through evidence-based frameworks aligned with NICE guidance. 

Takeaway 

Therapy helps transform intention into action. By targeting the root causes of task paralysis, emotional regulation, motivation, and executive control, evidence-based interventions like CBT provide the tools to start, persist, and complete tasks more effectively. As NHS and NICE guidance confirms, when therapy is structured, skills-based, and consistent, it becomes one of the most powerful ways to move from stuck to steady progress.