Learning to Focus Without Medication: People with ADHD often rely on stimulants like Adderall, but behavioral techniques can be just as effective in dealing with distraction

Excerpt – In a study published in the journal Psychiatry Research in 2019, researchers divided 124 participants with ADHD into two groups. One group received 12 weekly sessions of cognitive behavioral therapy (CBT) alone, while the other received CBT paired with medication. CBT focuses on breaking down long-term goals into workable steps and also on self-motivation, stress management and thinking more adaptively. The study found that the CBT-only group experienced the same significant improvement in ADHD symptom as the group that had also received medication.

“Pills don’t teach skills,” said Dr. J. Russell Ramsay, a professor and co-director of the University of Pennsylvania’s Adult ADHD Treatment and Research program. Behavioral treatments focus on “reverse engineering procrastination,” helping patients take a closer look at how and why they have trouble completing important tasks. Common problems include not having a clear and practical plan, struggling with uncomfortable thoughts like “This will take forever,” and negative emotions like anxiety and boredom.

People with ADHD may even catch themselves believing overly optimistic thoughts like “I’m good at doing things at the last minute” or “I thrive under pressure,” observes Dr. John Mitchell, a clinical psychologist at the Duke University ADHD Program. Once you’re attuned to the subtle details that derail you, it’s easier to generate specific ways to pivot at each juncture, including more constructive thinking, such as “I don’t have to be in the mood to get going.” Brief mindfulness practices, such as routinely focusing on your breath for five minutes, can also help you more readily observe your distracting thoughts and behaviors so you can refocus, Dr. Mitchell says.

Another common challenge is “procrastivity”: engaging in lower-priority and less stressful tasks, like responding to emails, in order to avoid starting a more pressing project. While procrastivity isn’t unique to people with ADHD, the condition makes it more frequent, Dr. Ramsay says. He encourages patients to develop a set of steps to move from being “off task” to “on task,” which includes breaking down daunting projects into actionable steps at specific times. [..]

In striving to boost attention, don’t underestimate the impact of good habits in sleeping, eating and exercising, advises psychiatrist Dr. Sasha Hamdani, author of “Self-Care for People with ADHD.” While healthy routines may appear obvious, they can feel harder to implement for individuals who struggle with executive functioning. Dr. Hamdani says that she took stimulant medications beginning in the 4th grade, but since completing her residency she has relied solely on behavioral strategies. When she was younger, “I’d never prioritize sleeping at a normal time…I would get into these bursts of hyperfocus so I wasn’t hungry, and then I would fall into a hypoglycemic mess,” she recalls.

When it comes to planning to get things done, Dr. Hamdani recommends experimenting with what works for you personally, whether that means getting the most daunting items on your to-do list out of the way first thing or starting with an easier task that feels more manageable. Given the effect that attention impairments can have on relationships, Dr. Hamdani recommends discussing your challenges with loved ones, to reduce the likelihood that behaviors like forgetfulness or appearing uninterested will seem offensive. [..]

“Being able to focus isn’t the biggest issue in the world. There are bigger issues,” Mr. [journalist and author of “Stolen Focus: Why You Can’t Pay Attention—and How to Think Deeply Again” Johann] Hari acknowledges. But “If we don’t get this right, we won’t get anything right. Because the person who can’t pay attention is drastically less effective at everything they’re trying to achieve.”

Full essay, J Taitz, Wall Street Journal, 2023.4.27