A meta-analysis of the intervention effect of cognitive behavioral therapy on adult ADHD
Abstract
Objective This meta-analysis systematically evaluated the efficacy of Cognitive Behavioral Therapy (CBT) for adult Attention-Deficit/Hyperactivity Disorder (ADHD). Methods A systematic search was conducted across PubMed, Medline, and the Cochrane Library to identify relevant randomized controlled trials (RCTs). Methodological quality assessment and statistical analysis were performed using Review Manager 5.3 in accordance with Cochrane guidelines. Results Analysis of 14 RCTs selected from 949 identified records showed significant benefits of CBT for core ADHD symptoms (SMD = -0.45, P < 0.00001), depressive mood (SMD = -0.23, P = 0.001), anxiety/stress (SMD = -0.24, P = 0.003), and executive function (SMD = -0.43, P = 0.001). No significant effects were observed for quality of life (SMD = 0.12, P = 0.47) or self-evaluation (SMD = -0.30, P = 0.22). Prespecified subgroup analyses revealed distinct efficacy profiles. By treatment composition, pure CBT demonstrated superior effects on core symptoms (SMD = -0.51, P < 0.00001) and executive function (SMD = -0.56, P < 0.0001), while CBT combined with medication showed greater efficacy for quality of life (SMD = 0.34, P = 0.02) and anxiety/stress (SMD = -0.53, P = 0.0004). By delivery mode, efficacy varied symptom-specifically: group-based formats (Group CBT, Specialized Skills Training) showed stronger effects on core symptoms, whereas Individual CBT was most effective for improving emotional outcomes (depressive mood, anxiety/stress) and quality of life. Conclusion CBT demonstrates efficacy for core and associated symptoms of adult ADHD, with the optimal intervention strategy varying meaningfully by outcome and modality. A symptom-guided, stepped-care approach is supported: group-based CBT formats are preferable for targeting core symptoms and executive function, while individual CBT better addresses emotional dysregulation and quality of life. The combination of CBT with medication offers added benefit for anxiety and quality of life. The consistent lack of effect on self-evaluation highlights a critical unmet therapeutic need.
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- Authors
- Liu, Y., Zhu, F., Yu, Y., Song, Y., Luo, H., Xu, B., Lin, S., Ha, Z., Kuang, D., Xie, Y., Chen, Z., & Ren, Y.
- Affiliations
- Beijing Normal University (CN)
- North China Institute of Science and Technology (CN)
- Corresponding author
- Ren, Yuanchun
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2026-04
- Volume
- 399
- Pages
- 121107
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W7117980530
- Cited by
- 4
- References
- 29
- Citations by year
- 2026: 4
- FWCI
- 5.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Education (21YJA890025)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Keywords
- cognitive behavioral therapy, adult ADHD, executive function, depressive mood, stress and anxiety, quality of life, self-assessment, group versus individual therapy, stepped care, treatment efficacy
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Humans, Quality of Life, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Executive Function
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