Can CBT be tailored for ADHD and anxiety or depression?

PostedNovember 20, 2025

UpdatedNovember 21, 2025

ByMy Patient Advice

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

Cognitive behavioural therapy can be adapted for people who experience ADHD alongside anxiety or depression, and both NHS and NICE recognise this approach. According to the NHS overview of CBT, CBT aims to help people understand and change unhelpful patterns of thinking and behaviour. The NICE ADHD guideline (NG87) also advises that structured psychological interventions can support adults whose ADHD symptoms overlap with low mood or anxiety.

How CBT is adapted for people with ADHD and coexisting anxiety or depression

Therapists often modify CBT to meet the executive functioning needs linked to ADHD. These adaptations help make sessions more predictable and practical. The NICE guidance for depression (CG90) and the NICE guidance for anxiety (CG113) explain that therapies may need adjustments for neurodevelopmental conditions so people can use the techniques more regularly and with less cognitive strain.

Why adaptations are recommended

Traditional CBT can be challenging for people with ADHD because it relies on planning, memory, and sustained focus. By adding shorter sessions, clearer goals, visual prompts and written summaries, therapists reduce cognitive load and make it easier to stay engaged. These adaptations also help individuals apply CBT strategies consistently between appointments.

What adapted CBT looks like

Adapted CBT usually includes organisation tools, practical routines, emotional regulation supports and techniques to manage distractibility. Evidence from a 2023 PubMed review suggests that tailored CBT improves symptoms of anxiety, depression and attention more effectively than unadapted CBT.

Managing mood and anxiety at the same time

For anxiety, adapted CBT may include gradual exposure and structured coping strategies delivered with additional repetition. For depression, behavioural activation is adjusted by breaking tasks into manageable steps. The NHS and NICE both support combining these approaches when ADHD overlaps with anxiety or low mood.

Evidence gaps to be aware of

Although evidence is strong for ADHD with anxiety or depression, long term follow up and research in older adults remain limited.

Key takeaway

CBT can be adapted to support people with ADHD and coexisting anxiety or depression by combining practical ADHD strategies with established CBT techniques. This approach is supported by NHS and NICE guidance and is linked with improvements in emotional wellbeing and daily functioning.

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.