Cognitive behavioral therapy for anxiety symptoms in ADHD: A systematic review and meta-analysis with dose-response...

To synthesize randomized evidence on the effect of cognitive-behavioral therapy (CBT) on anxiety symptoms in individuals with attention-deficit/hyperactivity disorder (ADHD), and to explore whether intervention dose parameters moderate effects.

A PRISMA-guided systematic review searched PubMed, Web of Science, PsycINFO, and the Cochrane Library to June 15, 2025. Multilevel random-effects models pooled Hedges' g, and subgroup/meta-regression analyses examined the effects of comparator type and intervention dose.

Thirteen RCTs (n = 744). Relative to control conditions, CBT-based interventions reduced anxiety at post-treatment (t(10.00) = -2.97, SMD = -0.29, 95% CI -0.52 to -0.06, P = 0.014) and follow-up (t(6.34) = -4.40, SMD = -0.42, 95% CI -0.71 to -0.13, P = 0.004). Effects were more apparent in adults; pediatric evidence was sparse. Exploratory nonlinear dose-response analyses suggested more favorable estimated effects around 2 sessions/week, ∼50 min/session, over ∼6 weeks (∼5-9 total hours), although these study-level associations should be interpreted cautiously.

CBT-based interventions were associated with small-to-moderate reductions in anxiety relative to control conditions in individuals with ADHD, sustained into follow-up. Future large RCTs and meta-analyses should test dose-related hypotheses and evaluate comparative specificity against other bona fide psychotherapies and medication management.