How do therapists address shame in ADHD

PostedNovember 3, 2025

UpdatedNovember 5, 2025

ByMy Patient Advice

Author: Harriet Winslow, BSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Shame and self-criticism are common struggles for individuals with ADHD. These emotional challenges often stem from persistent emotional dysregulation, heightened rejection sensitivity, and social stigma, all of which contribute to cycles of self-blame, low self-esteem, and avoidance. Therapists use evidence-based interventions, such as Cognitive Behavioural Therapy (CBT), Compassion-Focused Therapy (CFT), and Schema Therapy, to target these issues. According to NICE guidelines (NG87) and recent clinical studies, these therapeutic approaches are highly effective in reducing shame and improving emotional wellbeing for individuals with ADHD.

Development of shame and self-blame in ADHD

Emotional dysregulation and rejection sensitivity make individuals with ADHD more vulnerable to experiencing shame and self-blame. These factors, often present from a young age, contribute to intense reactions to criticism and perceived exclusion. As highlighted by Psychology Today, these reactions are exacerbated by societal misunderstandings about ADHD, leading many to internalise negative beliefs and struggle with self-doubt. Over time, the ongoing struggle to meet expectations can reinforce a sense of inadequacy and self-criticism.

Therapeutic approaches for shame in ADHD

Therapists use several strategies to address shame in ADHD:

Cognitive Behavioural Therapy (CBT): CBT is a widely used approach that helps individuals challenge self-critical thoughts, develop adaptive emotional coping skills, and reframe negative beliefs. Studies in PubMed and NICE guidelines suggest that CBT significantly improves emotional regulation, particularly when shame and low self-esteem are prominent.

Compassion-Focused Therapy (CFT): CFT focuses on building self-compassion, normalising struggles, and balancing self-criticism with kindness. Evidence in PMID shows CFT is particularly effective for reducing shame and increasing emotional resilience.

Schema Therapy: This therapeutic approach helps modify deep-seated patterns, such as feelings of defectiveness or unworthiness, often seen in individuals with ADHD. Recent research supports its efficacy in treating persistent shame-related issues.

Evidence from recent studies (2022–2025)

Recent clinical studies confirm that these therapies significantly reduce self-criticism and shame in ADHD. A 2025 study on CFT showed substantial improvements in self-compassion and reductions in external shame, with benefits maintained at follow-up. Similarly, schema therapy and CBT are consistently linked to better emotional wellbeing, with improved self-worth and adaptive functioning.

Key takeaway

Therapists play a vital role in addressing shame and self-criticism in ADHD. Evidence from NICE and recent studies shows that therapeutic approaches such as CBT, CFT, and Schema Therapy can reduce shame, improve self-esteem, and foster emotional resilience. These interventions are key components of a holistic treatment plan for individuals with ADHD, helping them navigate emotional challenges and achieve better psychological wellbeing.

Harriet Winslow, BSc

Author

Harriet Winslow is a clinical psychologist with a Bachelor’s in Clinical Psychology and extensive experience in behaviour therapy and developmental disorders. She has worked with children and adolescents with ADHD, autism spectrum disorder (ASD), learning disabilities, and behavioural challenges, providing individual and group therapy using evidence-based approaches such as CBT and DBT. Dr. Winslow has developed and implemented personalised treatment plans, conducted formal and informal assessments, and delivered crisis intervention for clients in need of urgent mental health care. Her expertise spans assessment, treatment planning, and behavioural intervention for both neurodevelopmental and mental health conditions.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.