Acceptability and Experience of Cognitive Behavioural Therapy for Adult ADHD: A Systematic Review With Narrative Synthesis

Objectives: Cognitive behavioural therapy (CBT) is a first-line psychosocial treatment for adults with attention deficit hyperactivity disorder (ADHD). While its clinical efficacy has been the focus of considerable research, the acceptability of CBT for ADHD remains under-studied. This is a critical gap, as core ADHD deficits may impact on acceptability and, therefore, utility. This review evaluates CBT acceptability for adults with ADHD using the Theoretical Framework of Acceptability (TFA). Method: Five databases (Scopus, PubMed, MEDLINE, Web of Science and PsycINFO) were systematically searched in February 2026. Twenty-one studies including randomised controlled trials, pilot, feasibility, qualitative and mixed-methods studies, were included. Data were integrated and mapped to the seven TFA domains. Results: Across studies, CBT acceptability in adults with ADHD most strongly explored the domains of affective attitude, intervention coherence, perceived effectiveness and self-efficacy. Acceptability was driven by skills training, psychoeducation, therapeutic support, accountability strategies, individualisation and diverse materials. Burden was linked to homework, cognitive load and treatment intensity, while opportunity costs and ethicality were rarely reported. Group and digital formats were generally acceptable but dependent on facilitation quality, accessibility and therapeutic presence. CBT for adult ADHD is most acceptable when it enhances affective response, understanding, perceived effectiveness and self-efficacy while minimising burden. Conclusions: Acceptability is optimised through structured, flexible interventions with therapeutic support, accountability, individualisation and engaging delivery. Rather than being determined by intervention format alone, acceptability reflects the combined influence of intervention content, delivery approach and treatment intensity. Future research should use standardised, prospective measures of acceptability and further explore ethicality, burden and opportunity costs. ( J. of Att. Dis.