When Your Brain Works Differently: A Real Introduction to DBT for ADHD Minds
Why Traditional Therapy Might Have Left You Feeling Like a Square Peg
If you're reading this, chances are you've sat in a therapist's office at some point, trying to explain why the "simple" homework they've given you feels impossible. Maybe you've attempted thought logs that remained blank, or mindfulness exercises that made your brain feel like it was about to explode from understimulation. Perhaps you've been told to "just notice your thoughts" whilst your mind ricocheted between seventeen different topics in the span of thirty seconds.
You're not broken. The therapy might just not have been designed with your brain in mind.
I've been exploring how Dialectical Behaviour Therapy (DBT) offers something fundamentally different – not because it's a miracle cure (spoiler: nothing is), but because it was originally created for people whose emotions and thoughts don't follow the typical patterns that many therapeutic approaches assume. And here's the thing: ADHD brains rarely follow typical patterns either.
What Actually Is DBT? (Beyond the Acronym)
DBT emerged in the late 1980s when psychologist Marsha Linehan noticed that traditional Cognitive Behavioural Therapy (CBT) wasn't working for some of her clients. These were people whose emotions felt too overwhelming, whose relationships were too chaotic, and whose sense of self felt too unstable for the neat framework of challenging thoughts and changing behaviours.
Sound familiar?
Linehan created something that holds two seemingly opposite truths at once: you are doing the best you can AND you need to do better. This is the "dialectical" part – the ability to hold contradictions without having to resolve them immediately. For ADHD brains that often exist in extremes (hyperfocus or complete distraction, overwhelming emotion or emotional numbness), this philosophy can be revolutionary.
The Four Modules: Your New Toolkit
DBT is structured around four core skill modules. Think of them less as sequential steps and more as different tools in a toolkit – you might need different ones at different times.
1. Mindfulness: But Not the Kind That Makes You Want to Scream
Traditional mindfulness often asks us to sit still, clear our minds, and focus on our breath. For ADHD brains, this can feel like torture. DBT mindfulness is different. It's about:
Observing without immediately reacting (noticing you're angry without immediately sending that text)
Describing what's happening without judgement ("My chest feels tight" rather than "I'm having a panic attack and I'm pathetic")
Participating fully in whatever you're doing (yes, even if you're doing three things at once)
The "what" skills (observe, describe, participate) work alongside "how" skills (non-judgementally, one-mindfully, effectively). And here's the radical part for ADHD folks: one-mindfully doesn't mean you can't fidget whilst doing it. It means bringing your attention back when it wanders, not preventing it from wandering in the first place.
2. Distress Tolerance: When Everything Is on Fire
Sometimes, the goal isn't to feel better – it's to not make things worse. Distress tolerance skills are your emergency toolkit for when your emotional intensity is at a 10/10 and your executive function has left the building.
These include:
TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) – physiological hacks to calm your nervous system
Distraction techniques that actually work with ADHD tendencies rather than against them
Self-soothing through your five senses (and yes, this can include stimming)
Radical acceptance – arguably the hardest but most transformative skill
The beauty of distress tolerance for ADHD brains is that many of these skills are action-oriented. You're not sitting with difficult thoughts; you're doing something to get through the moment.
3. Emotion Regulation: Understanding the Rollercoaster
If you have ADHD, you might experience emotions more intensely than neurotypical folks. A minor disappointment can feel devastating; a small success can trigger euphoria. DBT doesn't try to flatten these experiences but instead offers ways to understand and work with them.
Key concepts include:
Identifying and labelling emotions (harder than it sounds when you feel seventeen things at once)
Understanding the function of emotions (yes, even the inconvenient ones)
Reducing vulnerability to intense emotions through PLEASE skills (treating PhysicaL illness, balancing Eating, avoiding mood-Altering substances, balancing Sleep, and getting Exercise)
Opposite action – acting opposite to your emotional urge when that emotion doesn't fit the facts
The PLEASE skills might seem basic, but for ADHD brains that often forget to eat, sleep erratically, and struggle with consistent self-care, they're foundational.
4. Interpersonal Effectiveness: Navigating Relationships When You're Not Neurotypical
ADHD can make relationships complicated. Maybe you interrupt without meaning to, forget important dates despite caring deeply, or struggle with rejection sensitive dysphoria (RSD) that makes every small conflict feel like the end of the world.
DBT's interpersonal effectiveness skills include:
DEAR MAN – a framework for asking for what you need
GIVE – maintaining relationships even during conflict
FAST – maintaining self-respect in interactions
These acronym-heavy skills might seem cheesy, but for ADHD brains that can go blank under interpersonal stress, having a structured framework can be invaluable.
Why DBT Might Click Where Other Therapies Didn't
It's Structured but Flexible
DBT provides clear frameworks and specific skills – perfect for ADHD brains that thrive with structure. But it also acknowledges that rigidity doesn't work for everyone. You can adapt skills to your needs.
It's Action-Oriented
Rather than spending sessions solely exploring why you feel a certain way, DBT focuses on what you can do about it. This concrete, practical approach often resonates with ADHD minds that prefer doing over discussing.
It Validates Your Experience
DBT starts from the premise that your emotions make sense given your history and neurology. You're not "too sensitive" or "overreacting" – your emotional responses are valid even if they're not always effective.
It Works with Crisis, Not Just Contemplation
Unlike therapies that require a certain level of stability to engage with, DBT was designed for people in active crisis. If your ADHD means you're constantly putting out fires, DBT meets you there.
The Reality Check: What DBT Isn't
Let's be clear about what DBT won't do:
It won't "cure" your ADHD (nothing will – it's how your brain is wired)
It won't make you neurotypical
It won't eliminate all emotional pain
It won't work if you don't practice the skills (the ADHD struggle is real here)
What it might do is give you a set of tools that actually work with your brain rather than against it. It might help you build what Linehan calls "a life worth living" – not a life without problems, but one where the problems feel manageable.
Getting Started: First Steps for ADHD Brains
If you're intrigued, here's how to begin exploring DBT:
Look for DBT-informed therapists who also understand ADHD. The combination matters.
Consider different formats: Full DBT programmes include individual therapy, group skills training, and phone coaching. But DBT-informed therapy or self-help resources can also be valuable.
Start with one skill: Don't try to master everything at once. Pick one skill that addresses your most pressing need.
Adapt freely: If a skill doesn't work as written, modify it. DBT is about effectiveness, not perfection.
Track what works: Your ADHD brain might forget what helped. Keep notes (voice memos count!) about which skills actually make a difference.
Building Your Personal Practice
The reality of learning DBT with ADHD is that it won't be linear. You might hyperfocus on one module and completely forget another exists. You might use a skill successfully once and then forget about it for months. This is normal and okay.
What matters is building a personalised toolkit over time. Maybe you'll never use half the skills, but the ones that stick might be transformative. Maybe you'll modify everything beyond recognition, creating your own ADHD-adapted version. That's not just acceptable – it's encouraged.
What's Coming Next
This is the beginning of a deeper exploration. In upcoming posts, we'll dive into:
Specific DBT skills adapted for ADHD brains
Managing RSD (rejection sensitive dysphoria) with DBT techniques
The intersection of executive dysfunction and emotion dysregulation
Creating ADHD-friendly skill practice routines
Real stories from ADHDers using DBT
We'll also explore the challenges honestly – because pretending this is easy helps no one.
The Invitation
If you've made it this far (congratulations – I know long-form reading with ADHD is its own achievement), you're probably wondering if DBT is worth trying after previous therapy disappointments.
Here's my take: DBT offers something unique – a framework that assumes intensity, chaos, and contradiction as starting points rather than problems to be fixed. For ADHD brains that have been pathologised, misunderstood, or forced into neurotypical boxes, this can be profound.
You don't have to commit to a full programme immediately. Start by learning about one skill. See if the philosophy resonates. Notice if the validation inherent in the approach feels different from what you've experienced before.
Your brain works differently. Maybe it's time your therapy did too.
Join me next week as we explore the concept of "wise mind" and why ADHD folks might need to reimagine what this looks like when your mind contains seventeen simultaneous threads of consciousness. We'll also tackle the practical question of how to practice skills when your executive function has other plans.
Remember: you're already doing something remarkable by seeking support. That's a radical act of self-care, especially when previous attempts haven't worked. Keep going.
My neurodivergent brain saw the title of this piece and immediately thought “Deep Brain Thrombosis”.