ADHD and anxiety are strongly linked, with anywhere between 15% and 35% of ADHD patients also suffering from anxiety. Because the two conditions are so closely related, it’s often hard to tell whether symptoms such as restlessness and avoidance are coming from ADHD or anxiety.

The strong connection between ADHD and anxiety means that treatment must address both issues – and cognitive behavioural therapy (CBT) is one of the best options for this. At The ADHD Centre, we help people with ADHD and anxiety navigate the complexities of their conditions using evidence-based CBT coping strategies. 

In this article, we’ll explore the connection between ADHD and anxiety in more depth, and explain how cognitive behavioural therapy techniques can effectively treat ADHD and anxiety.

Understanding ADHD and Anxiety

Insights Into ADHD

ADHD (attention deficit hyperactivity disorder) is a neurological condition that includes symptoms of inattention, hyperactivity and impulsivity. These symptoms are caused by an imbalance of dopamine and noradrenaline, the neurotransmitters that affect attention regulation. According to ADHD UK, 2.6 million people in the UK are living with ADHD.

 A child or adult living with ADHD typically has a short attention span and has difficulty performing executive functions like planning, organisation and time management. To an outsider, a person with ADHD might appear restless, unable to concentrate and impulsive. Symptoms of ADHD can impact work/school, relationships, and overall quality of life. 

ADHD is often diagnosed in childhood but can persist into adulthood. Many people fail to realise they have ADHD until diagnosed by an CBT therapist. 

What is Anxiety?

Anxiety disorders are characterised by excessive fear or worry that interferes with daily activities. Anxiety can manifest as generalised anxiety, panic attacks, social anxiety or specific phobias. 

Due to the range of ways anxiety can manifest, it’s a very common condition. In the UK, it’s estimated that 8 million people at any given time are living with an anxiety disorder. Anxiety is in part caused by heightened activity in the amygdala, the brain’s fear centre, and is associated with disturbances in serotonin.

How ADHD and Anxiety Disorders Co-occur

ADHD and anxiety often occur together, especially in children and adults who have difficulty regulating their thoughts and emotions. 

When these two conditions occur together, it can be hard to differentiate between the two. But in general, attention disorders like ADHD are associated with difficulty concentrating, controlling impulses and organising daily tasks, while anxiety is a fear or worry about the future. 

Anxiety and ADHD do share some core symptoms, including:

• Excessive worry: People with anxiety and ADHD tend to experience persistent and overwhelming worry about school or work performance, relationship stability and personal achievements.
• Restlessness: ADHD and anxiety can both cause restlessness and can make a person feel constantly on edge.
• Procrastination: A person with ADHD may procrastinate due to concentration issues or difficulty with planning and organisation. On the other hand, someone with anxiety may procrastinate due to fear of future consequences (eg., failure).
• Avoidance Behaviours: ADHD and anxiety can both lead to avoidance behaviours. ADHD makes it hard to commit to overwhelming tasks and anxiety makes people consciously avoid certain situations.

ADHD and anxiety often feed into each other as well. For example, concentration issues at work can make a person anxious about their work performance, due to fear of missing deadlines. On the other hand, excessive worry caused by anxiety can make it even harder for people with ADHD to concentrate.

When ADHD and anxiety occur together, individuals often feel trapped in a loop where the inattention and impulsivity of ADHD increases anxious thoughts, and in turn, this anxiety makes it harder to focus and complete important tasks.

Fortunately, CBT for ADHD and anxiety can provide children and adults with the tools they need to break this cycle. 

Challenges in Dual Diagnosis and Treatment

One of the biggest challenges in managing both ADHD and anxiety is diagnosing each condition. Since ADHD and anxiety share so many common symptoms and feed into each other, it can be hard for therapists to determine when a patient is experiencing symptoms of anxiety or ADHD.

For example, hyperactivity, restlessness and racing thoughts are common in both ADHD and anxiety, making it difficult for clinicians to distinguish where one condition ends and the other begins. 

For children with ADHD and anxiety, dual diagnosis can also be particularly challenging. Children may struggle to express their worries or explain why they’re feeling overwhelmed, making it harder to know whether their condition stems from ADHD or anxiety.

Fortunately, cognitive behavioural therapy is effective for treating both ADHD and anxiety together. CBT offers patients a structured way to understand their emotions and develop coping strategies. Through CBT, children and adults with ADHD and anxiety can get a deeper insight into whether they are experiencing ADHD or anxiety symptoms in certain situations. 

Medication management is another important aspect of treating ADHD and anxiety together. Some medications can treat ADHD, but at the same time, may increase anxiety symptoms. On the other hand, some medications for anxiety can have sedative effects that may worsen ADHD symptoms. This makes finding a balanced medication treatment approach crucial.

The overlap between anxiety and ADHD can make diagnosis and treatment challenging. However, the expert team at The ADHD Centre has the skills and experience to make the proper diagnosis and design an effective ADHD treatment plan.

Strategies for Treating Anxiety and ADHD with CBT

ADHD CBT is one of the best ways to improve the quality of life of children and adults with ADHD and anxiety. Cognitive therapy is a forward-looking and outcome-orientated treatment option focused on helping patients understand their cognitive processes, reframe cognitive distortions and change unhelpful behavioural patterns. 

In a CBT session at The ADHD Centre, a CBT therapist helps clients learn the tools and strategies they need to stay organised, maintain focus and be on time in their daily lives, while also helping them change problematic behaviours that don’t align with their values and goals. 

Cognitive Restructuring

Cognitive restructuring is one of the main techniques used in CBT programs. With cognitive restructuring, a CBT therapist will help the patient identify unhelpful or distorted thoughts. After identifying these negative aspects of thinking, a person can replace them with more realistic, positive thoughts.

For individuals with ADHD, cognitive distortions often involve feelings of failure or inadequacy. For example, a person might carry the belief that they will never be able to focus. Anxiety can further intensify this ‘all or nothing’ thinking, leading to a spiral of self-criticism and stress. 

Cognitive restructuring can help a person break this cycle by questioning the validity of these automatic thoughts. Using cognitive behavioural therapy techniques, a CBT therapist can work with their clients to examine evidence for and against their negative beliefs, and to create new, healthier ways of thinking. This kind of mental filtering can reduce the intensity of anxious feelings and boost confidence in managing ADHD and anxiety.

Behavioural Therapy

Behavioural techniques in CBT focus on changing habits and behaviour patterns that contribute to or worsen ADHD and anxiety. For ADHD, behavioural techniques could include:

• Time management strategies
• Breaking down large tasks into smaller, more manageable pieces
• Calendars or task lists

By learning these new skills, children and adults with ADHD can learn to better manage their time, set more realistic goals and complete tasks, which can improve daily functioning and increase self-esteem.

For anxiety, a common behavioural technique is an exposure task. People with anxiety are more likely to avoid situations that make them anxious, which only increases their fear and avoidance of the situation. With an exposure task, a person with anxiety confronts a situation that makes them anxious, helping to remove negative emotions associated with the situation and reducing their avoidance and anxiety.

Another common behavioural technique for anxiety is pattern tracking, which is where a person keeps a log of their thoughts, emotions, circumstances and behaviours to analyse their anxiety. This can help a person identify the causes of anxiety, such as negative thoughts, and feel more in control of how they react.

Relaxation techniques such as mindfulness and deep breathing can help a person regain control over their emotional responses. Mindfulness meditation can help a person stay grounded in the present moment, reducing the impulsivity of ADHD and easing the worry that comes with anxiety.  

Success Stories of ADHD CBT

Overcoming Common Obstacles 

Behaviour therapy is one of the most effective treatments for anxiety and ADHD. Here are some real-life success stories that show how The ADHD Centre uses CBT to help people overcome ADHD and anxiety: 

Brad: The care and support from Dr Ankur Kumar and The ADHD Centre team is second to none. I spent a lot of time reading into medications, coaching etc, which pointed towards combinational therapy being the most effective; so we discussed this as an option and opted for both medication and coaching.

The change has been incredible. I can work, sleep, read and be present when talking with friends/family. I am conscious of the fact that I sound like an advertisement here, but I am amazed by the impact that treatment has had on me.

Faye: Thank you so much for today and your time and making it a very productive session. I’ve come away with lots of ideas but more importantly for me a focus on implementing the steps towards change. Very much appreciated and feel much more positive about gaining some control back and the whole giving myself permission. You sent me away with the start of a toolkit that I can dip into and that will help me achieve step by step.

Leanda: I am really grateful for the coaching support I received through the ADHD Centre. I found that the medication helped me a lot with being able to stay focussed and not zoning out the whole time, but the coaching really helped with my ability to properly plan my day and actually get things done on time. The combination of treatments was just what I needed.

Achieving Balanced Mental Health

While CBT is an effective treatment for ADHD, it can be used to treat a range of mental conditions. 

Here are some stories of how The ADHD Centre has helped patients improve their mental health issues through CBT combined with other treatments: 

Anonymous: After a lifetime of struggles with all that comes along with ADHD, I booked an adult ADHD assessment at the beginning of April. After booking, I received a few forms to fill out, including registration forms and child/adult collateral. They do all of this through an online system.

The initial assessment was 1 1/2 hours, which was with Dr Ankur Kumar, where we discussed some of the struggles I’d had, shared school reports, and talked through the day-to-day parts of life. I was extremely apprehensive before the consultation, but soon became more comfortable. At the end of the session, based on the collateral forms, school reports and discussion we had, the diagnosis was given. When asked about my thoughts on the diagnosis, I was a mix between frustrated at schools historically missing the signs, and relieved that I had a new language to explore the issues I was having. I am aged 27, so there was a thought of what life could have been if this was discovered sooner.

Anonymous: The real challenges of staying focused, setting and meeting long-term goals completely autonomously are the antithesis of anyone with ADHD. At this point in my life I had built a mountain of coping mechanisms and strategies to deal with the symptoms that came with ADHD. Living with an impaired reward system takes away a lot of joy in living and I had a comorbid condition of depression as a result.

The ADHD centre has a wealth of experienced professionals who cut no corners and have a myriad of connections and tools available to patients. It’s a HUGE step in life and I’m glad I chose to take it with such a group of professionals. The difference is night and day. It’s like having been blind my whole life and being given sight overnight.

Integrating ADHD CBT into Daily Life

CBT doesn’t end when you leave the therapist’s office. CBT sessions help ADHD and anxiety, but patients must incorporate CBT tools and strategies into their day to day life as well.

Practical Application Tips

Here are some practical tips to apply CBT techniques in your daily life:

Make a routine: A consistent daily routine can help reduce the confusion that comes with ADHD. Creating a schedule that includes set times for waking up, meals and work/school can help you stay on task. 

Use checklists and planners: CBT therapists often suggest keeping tools like checklists and planners to manage tasks and meet important deadlines. A checklist can help you prioritise tasks, and as you check off completed tasks you can get a sense of reward that helps you stay focused on work or school.

Break tasks into smaller chunks: Large tasks can be overwhelming, often leading to procrastination. Dividing tasks into smaller, more manageable steps can help you stay focused on one task at a time.

Practice mindfulness: Mindfulness exercises can help you stay in the present moment and become aware of your internal state. This can improve focus, help you deal with negative thoughts and reduce impulsivity. Practising mindfulness is also one of the best ways to reduce anxiety. 

Apply cognitive restructuring to day to day life: To get the most out of CBT for ADHD, it's essential to integrate the new skills learned in therapy into daily life. Throughout your daily routine, take some time to identify any limiting thoughts, evaluate the validity of these thoughts and replace them with more constructive ones. 

Maintaining Progress Over Time

Seeing the benefits of CBT takes time, and ADHD CBT typically lasts 8 to 12 sessions. And the CBT work doesn’t stop after the first few sessions are over – patients must take the lessons they learned from CBT and apply them to their daily lives to see progress over time. 

One way to maintain progress over time is to set short and long-term goals that align with your unique challenges; goals can help you stay on track and give you a sense of reward that will keep you moving forward on your journey. Regular check-ins with a therapist can be helpful in maintaining progress over time, especially when you feel you’ve forgotten some of the lessons of CBT or are going through challenging times. 

For parents of children with ADHD and anxiety, it's crucial to establish a supportive environment at home. Parents should encourage the daily use of the tools learned in CBT and provide positive reinforcement when children use these techniques. Tackling ADHD and anxiety as a family can help children develop the resilience and confidence needed to live with the condition.

Final Thoughts: The Future of CBT For ADHD and Anxiety

CBT has proven to be a highly effective treatment option for individuals struggling with ADHD and anxiety, as it provides a clear framework for understanding and managing these conditions. Research into ADHD and anxiety continues to grow and as we understand how strategies like mindfulness can help with these conditions, our capacity to treat them will only increase.

At The ADHD Centre, we stay at the forefront of advances in ADHD CBT, ensuring our patients receive the most up-to-date and effective treatments available.

Whether you are an adult facing the challenges of working with ADHD and anxiety, or a parent supporting your child, our team of skilled specialists at The ADHD Centre is here to help. 

Book an assessment with The ADHD Centre today to gain control over your ADHD and anxiety.

Additional Resources and Support

Managing ADHD and anxiety can be challenging, but with the right support and resources, there is plenty of reason for hope and optimism.  You can find extensive information on ADHD and CBT through The ADHD Centre’s blog or through organisations such as ADHD UK or the Attention Deficit Disorder Association. 

FAQ: Anxiety and ADHD CBT

Should I Treat Anxiety or ADHD Symptoms First?

It’s difficult to know whether to treat ADHD or anxiety first, therefore it’s typically best to address both issues together. 

CBT sessions can be useful in treating anxiety and ADHD together, as CBT can help children and adults with ADHD gain insight into their anxiety and ADHD symptoms, and develop tools and strategies to help them deal with both. Treating ADHD and anxiety together also requires medication that treats both conditions without increasing the symptoms of either condition.

Can ADHD Cause Panic Attacks?

While ADHD itself does not cause panic attacks, the stress associated with managing ADHD symptoms can trigger anxiety and panic attacks in some people. For example, failure to finish tasks caused by ADHD might cause anxiety about the consequences of missing a deadline. This anxiety, together with other stresses caused by ADHD, may cause panic attacks.