i Mastering Your Adult ADHD ii TREATMENTS THAT WORK Editor-I n-C hief David H. Barlow, PhD Scientific Advisory Board Anne Marie Albano, PhD Gillian Butler, PhD David M. Clark, PhD Edna B. Foa, PhD Paul J. Frick, PhD Jack M. Gorman, MD Kirk Heilbrun, PhD Robert J. McMahon, PhD Peter E. Nathan, PhD Christine Maguth Nezu, PhD Matthew K. Nock, PhD Paul Salkovskis, PhD Bonnie Spring, PhD Gail Steketee, PhD John R. Weisz, PhD G. Terence Wilson, PhD iii TREATMENTS THAT WORK Mastering Your Adult ADHD A Cognitive- Behavioral Treatment Program Second Edition THERAPIST GUIDE STEVEN A . SAFREN SUSAN E. SPRICH CAROL A . PERLMAN MICHAEL W. OT TO 1 iv 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2017 First Edition published in 2005 Second Edition published in 2017 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. CIP data is on file at the Library of Congress ISBN 978–0 –1 9–0 23558–1 9 8 7 6 5 4 3 2 1 Printed by WebCom, Inc., Canada v About TREATMENTS THAT WORK Stunning developments in healthcare have taken place over the last several years, but many of our widely accepted interven- tions and strategies in mental health and behavioral medicine have been brought into question by research evidence as not only lacking benefit, but perhaps, inducing harm (Barlow, 2010). Other strategies have been proven effective using the best current standards of evidence, resulting in broad-based recommendations to make these practices more available to the public (McHugh & Barlow, 2010). Several recent develop- ments are behind this revolution. First, we have arrived at a much deeper understanding of pathology, both psychological and physical, which has led to the development of new, more precisely targeted interventions. Second, our research method- ologies have improved substantially, such that we have reduced threats to internal and external validity, making the outcomes more directly applicable to clinical situations. Third, govern- ments around the world and healthcare systems and policy- makers have decided that the quality of care should improve, that it should be evidence based, and that it is in the public’s interest to ensure that this happens (Barlow, 2004; Institute of Medicine, 2001; McHugh & Barlow, 2010). Of course, the major stumbling block for clinicians everywhere is the accessibility of newly developed evidence-based psycho- logical interventions. Workshops and books can go only so far in acquainting responsible and conscientious practitioners with the latest behavioral healthcare practices and their applicability to individual patients. This series, Treatments ThatWork, is devoted to communicating these exciting new interventions to clinicians on the frontlines of practice. v vi The manuals and workbooks in this series contain step-by-step detailed procedures for assessing and treating specific problems and diagnoses. But this series also goes beyond the books and manuals by providing ancillary materials that will approximate the supervisory process in assisting practitioners in the imple- mentation of these procedures in their practice. In our emerging healthcare system, the growing consensus is that evidence-based practice offers the most responsible course of action for the mental health professional. All behavioral healthcare clinicians deeply desire to provide the best possible care for their patients. In this series, our aim is to close the dissemination and information gap and make that possible. This Therapist Guide and the companion Workbook for cli- ents address the treatment of adult attention-deficit/hyperac- tivity disorder (adult ADHD). ADHD is prevalent in adults but under recognized and undertreated. With its characteristic symptom picture of hyperactivity, impulsivity, and difficulties focusing attention, adult ADHD can be as impairing as it is in children. Mastering Your Adult ADHD was the first evi- dence-based treatment for adult ADHD from a leading group of clinical investigators. After years of research, and with sup- port from the National Institute of Mental Health, this team developed a treatment that directly attacks the symptoms of ADHD in a collaborative framework with patients. Now in its second edition, the clinical components of this pro- gram have been updated based on the research team’s experi- ences and on the most current strategies in cognitive behavioral therapy (CBT). The intervention includes use of technology (such as using smart phones), and optional strategies that help with organization and planning. Optional sessions with a part- ner or spouse of someone with adult ADHD have more focus on providing education about ADHD, which can reduce dis- harmony in the relationship. Either as a complement to medica- tion, or for the cases where medication is relatively ineffective, vi vii every practitioner treating this very common disorder will want to incorporate this intervention into their armamentarium. David H. Barlow, Editor- in- Chief, Treatments ThatWork Boston, MA References Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59, 869– 878. Barlow, D. H. (2010). Negative effects from psychological treatments: A per- spective. American Psychologist, 65(2), 13–20. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. McHugh, R. K. & Barlow, D. H. (2010). Dissemination and implementation of evidence-based psychological interventions: A review of current efforts. American Psychologist, 65(2), 73–84. vii viii Accessing Treatments ThatWork Forms and Worksheets Online All forms and worksheets from books in the TTW series are made available dig- itally shortly following print publication. You may download, print, save, and digitally complete them as PDF’s. To access the forms and worksheets, please visit http://www.oup.com/us/ttw. viii ix Contents Introductory Information for Therapists  xi Module 1 Psychoeducation, Organizing, and Planning Session 1 Psychoeducation and Introduction to Organization and Planning 3 Session 2 Informational Session with Spouse, Partner, or Family Member (if applicable) 15 Session 3 Organization of Multiple Tasks 21 Session 4 Problem- Solving and Managing Overwhelming Tasks 29 Session 5 Organizational Systems 37 Module 2 Reducing Distractibility Session 6 Gauging the Client’s Attention Span and Teaching Distractibility Delay 47 Session 7 Modifying the Environment 55 Module 3 Adaptive Thinking Session 8 Introducing a Cognitive Model of ADHD 65 Session 9 Adaptive Thinking 83 Session 10 Rehearsal and Review of Adaptive Thinking Skills 99 ix