A look at “Group dialectical behavior therapy skills training versus group cognitive behavioral therapy for adults with ADHD: a randomized controlled trial” by Li-Qian Zhang, Mei-Rong Pan, Min Dong, Xin Kong, Zi-Yan Yu, Shi-Yu Zhang, Hai-Mei Li, Lu Liu, Yu-Feng Wang and Qiu-Jin Qian (2026)
In one corner, CBT (cognitive behavioural therapy), the reigning champion of adult ADHD therapy, with a solid track record for helping with organisation, planning and unhelpful thinking. In the other corner, DBT (dialectical behaviour therapy), the challenger, with its focus on mindfulness, emotion regulation and distress tolerance. Given how central emotions are to many people’s experience of ADHD (see “Big Feelings, Busy Brains: Emotions and Adult ADHD”), could DBT be just as helpful, or even better? This Chinese trial put them head to head.
What they found
The researchers randomly assigned 98 adults with ADHD to 12 weeks of either group DBT skills training or group CBT, with 49 people in each. Participants could be unmedicated or on stable medication. They were assessed regularly during treatment and for six months afterwards on a wide range of outcomes: ADHD traits, anxiety, low mood, emotion regulation, quality of life, functioning and executive function. That included both questionnaires and computer-based thinking tasks.
The headlines:
- Both therapies helped. People in both groups improved on core ADHD traits and many other outcomes, and the gains lasted through six months of follow-up.
- There was little to choose between them. Differences between DBT and CBT were small across most measures.
- CBT had a slight edge on one thinking task, a test of spatial working memory.
- But we can’t say they’re equivalent. The trial wasn’t able to show that DBT is “as good as” CBT. The results are compatible with small differences in either direction.
The authors conclude that DBT is a potentially useful option for adults with ADHD, while calling for larger trials.
A grain of glitter ✨
This is a well-designed randomised trial with a good range of outcomes and a decent follow-up, and it’s refreshingly honest about what it can and can’t conclude. But there are notable limitations.
There was no “no therapy” control group, so we can’t be sure how much improvement came from the therapy rather than time, expectations or medication. Only one pair of therapists delivered each therapy, so differences between the two approaches are entangled with differences between therapists. Participants mostly had relatively high IQs, and people with more complex or unstable conditions were excluded. That isn’t a typical clinical population. And it’s set in China, so cultural factors may influence how each approach is received.
Why this matters
If you’re an adult with ADHD, this study offers reassurance that there’s more than one helpful path. If your biggest struggles are with emotions, such as overwhelm, intensity or rejection sensitivity, a DBT-informed approach may feel like a natural fit. If organisation and planning are your main battles, CBT-based approaches have a strong track record. Many therapists blend the two, tailoring to what you need.
In the great unicorn therapy contest, the result was a friendly draw. Both contestants trotted off with rosettes.