How does cognitive behavioural therapy address RSD in ADHD? 

Many people with ADHD find that even small rejections or criticisms can trigger overwhelming emotions. This reaction, often described as Rejection Sensitive Dysphoria (RSD), is not a recognised medical diagnosis, but it reflects the real emotional dysregulation that affects many people living with ADHD. According to NICE guidance (NG87), therapy is a key part of ADHD management, and cognitive behavioural therapy (CBT) is one of the most effective approaches for improving emotional regulation and self-awareness. 

How CBT works in ADHD and emotional sensitivity 

CBT helps people recognise how their thoughts, emotions, and behaviours interact. In ADHD, emotional responses can be fast and intense, often driven by impulsivity or negative self-talk. CBT teaches people to identify these automatic thoughts, challenge unhelpful beliefs, and develop new coping patterns. 

For someone with RSD-like experiences, CBT can help by: 

• Recognising emotional triggers linked to criticism or perceived rejection 

• Reframing self-critical thoughts to reduce shame and self-blame 

• Developing problem-solving and communication skills to handle social stress more confidently 

• Building mindfulness and grounding strategies to reduce emotional reactivity in the moment 

A 2024 UK study published in Frontiers in Psychiatry found that adapted CBT for ADHD significantly improved emotional control and self-acceptance. Participants benefited most when therapy included psychoeducation, acceptance training, and time-structuring tools to manage daily frustration and rejection sensitivity. 

Why adaptation matters 

Traditional CBT may not always meet the needs of people with ADHD, who can struggle with attention, working memory, and emotional intensity. Clinicians now recommend ADHD-specific CBT, which integrates elements of mindfulness, acceptance, and self-compassion to help sustain progress. 

The NHS England ADHD Taskforce (2025) supports combining CBT with coaching and behavioural skills training, helping people turn emotional insight into daily resilience and better self-management. 

Combining CBT with other supports 

CBT is most effective when integrated with other interventions such as medication, mindfulness-based therapy, or behavioural coaching. Services like Theara Change are developing programmes that combine CBT-informed strategies with practical emotional regulation and self-coaching support. This blended approach reflects NICE’s emphasis on holistic ADHD care. 

Takeaway 

Cognitive behavioural therapy does not treat RSD as a separate condition but targets the emotional dysregulation at its core. By helping people recognise thought patterns, reframe rejection, and strengthen emotional control, CBT offers practical tools for resilience and self-acceptance in everyday life with ADHD.