STRATEGIES AND/OR TECHNIQUES IN COGNITIVE AND CONTEXTUAL THERAPIES FOR THE POSSIBILITY OF MANAGING IMPULSIVITY IN ADULTS WITH ADHD

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, characterized by a delay in neuronal maturation, with onset typically in childhood. Its main symptomatic features include inattention and hyperactivity/impulsivity. Adults with ADHD may experience impairments due to difficulty controlling impulsive behaviors, such as legal problems, substance use, financial mismanagement, unsafe sexual practices, susceptibility to severe injuries, eating problems, traffic accidents, and work-related difficulties. Recent studies suggest the potential of cognitive and contextual therapies (CBTs) for managing impulsivity in adults with ADHD. Strategies and techniques aimed at impulsivity can be classified into two groups: top-down and bottom-up. Top-down techniques act as external supports for deficits in cognitive and executive functions of the prefrontal cortex, contributing to the management of impulsive responses. The bottom-up group, on the other hand, strengthens sensory and emotional pathways associated with the limbic system, promoting an automated reduction in emotional intensity. This study aimed to identify, describe, and summarize the strategies and techniques used to manage impulsivity in adults with ADHD within cognitive and contextual therapies. To achieve this aim, an integrative literature review was conducted using PubMed, the Virtual Health Library (BVS), and the Scientific Electronic Library Online (SCIELO). The results showed that top-down techniques included contingency management, organization, psychoeducation, cognitive restructuring, among others, aiming to reduce mind-wandering, decrease emotional intensity, and increase patient engagement. The bottom-up skill group was more closely linked to contextual approaches, employing techniques such as “cinema screen,” “surfing the emotions,” “three-minute breathing space,” “sitting meditation,” among others. These interventions were grounded in concepts such as acceptance of experience, mindful awareness, and cognitive flexibility. CBTs offer various resources to foster and/or develop effective strategies and techniques for managing impulsivity in adults with ADHD, whether through more “traditional” approaches (first- and second-wave), using techniques such as cognitive restructuring, or through more current approaches (third-wave), which, although also grounded in behavioral principles, emphasize and expand strategies and concepts such as mindfulness, values, acceptance, and flexibility. It is important to consider the implementation of such strategies and techniques within a therapeutic setting, as the experience of a controlled study differs in many aspects from clinical practice. In this sense, integrating evidence-based theoretical contributions may support future clinical studies using an approach that goes beyond the diagnostic model, particularly when considering the significant heterogeneity of ADHD.