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Symposia

Adult -ADHD

Advancing Cognitive Behavioral Therapy for Adult ADHD in Japan: Innovations and Cultural Adaptations

1 - (SYM 9) Culturally Adapted Cognitive Behavior Therapy (CBT) for Adults with ADHD

Friday, November 21, 2025
3:06 PM - 3:27 PM CST
Location: Celestin F, Level 3
Keywords: ADHD, Adult, Culture
Recommended Readings: Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005). Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behaviour Research and Therapy, 43(7), 831–842.,   Ramsay, J. R., & Rostain, A. L.(2014). Cognitive Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach (English Edition), Routledge,   Knouse, L. E., Hu, X., Sachs, G., & Isaacs, S. (2022). Usability and feasibility of a cognitive-behavioral mobile app for ADHD in adults. PLOS Digital Health, 1(8),   Takamatsu, N., Nakashima, M., Matsuura, K., Umemoto, I., Ito, M., Kanazawa, J., Tomiyama, H., Kondo, M., Tachimori, H., Nakao, T., Horikoshi, M., & Kuga, H. (2024). A multicenter, single-group, open feasibility study of a new individual cognitive behavioral therapy program for adult Japanese patients with attention-deficit/hyperactivity disorder: A study protocol. Psychiatry and Clinical Neuroscience Reports, 3.,  
Abstract Body

Background
Cognitive behavior therapy (CBT) has been shown to improve symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults. However, since cultural factors influence functional impairments in the diagnostic criteria for ADHD, it is necessary to examine whether programs developed in other countries are also applicable in Japan. The purpose of this study is to develop and test the feasibility of a CBT program adapted to Japanese culture that fits ADHD patients and the medical system.

Methods
First, a survey of ADHD patients revealed difficulties such as procrastination, time management, planning, and taking care of family members. Next, from interviews at medical institutions, difficulties characterized by high dropout rates in ADHD CBT, low homework fulfillment rates, and high levels of tardiness and absences were identified. In addition, it was noted that foreign worksheets are text-based and difficult to use for those who have little reading habit, and that the situations are different from those in daily life in Japan. Based on these surveys, the worksheets for patients were designed to be familiar to Japanese people, who have a cartoon culture, by using colorful illustrations of difficulties in Japanese daily life situations and a structure in which the characters talk to the patients. The worksheets were designed to allow participants to select what they needed from 21 programs based on their difficulties in daily life. A total of 14 ADHD patients underwent 16 CBT sessions.

Results
A preliminary study with a single-arm comparative design was conducted for program validation, involving 14 adult participants diagnosed with ADHD (CAARS-G scores above the clinical threshold). Pre- and post-treatment assessments included ADHD symptom severity (CAARS), quality of life (EQ-5D), and adherence rates. Thirteen of the 14 participants completed the entire intervention, with one participant dropping out due to relocation. The primary endpoint, CAARS total score, showed a significant decrease after treatment (p = .017), with 79% of participants reporting significant symptom improvement.

Discussion
This study demonstrated the feasibility of implementing ADHD CBT adapted to Japanese culture. The format with visual support is well suited to the learning style of the Japanese. Future work includes conducting randomized controlled trials (RCTs) to compare with usual interventions and integrating digital CBT interventions such as chatbot support and smartphone applications to further improve accessibility and engagement.