Evaluating Effects of Group-based CBT for Emotion Regulation in Adult ADHD (GEARS)

June 3, 2026 updated by: Elinor Eskilsson Strålin, Karolinska Institutet

Group-based Emotion Regulation Skills Training for Adults With ADHD: GEARS, a Quantitative and Qualitative Investigation of Treatment Effects

This study will evaluate if a specific treatment for emotion regulation in ADHD, GEARS, effectively reduces symptoms of emotional dysregulation. GEARS will be evaluated through a randomized controlled trial (RCT) and a qualitative interview study.

This project aims to investigate two main questions:

  1. Is GEARS an effective treatment for emotion regulation difficulties in adult ADHD patients?
  2. How do participants perceive the impact of completing the GEARS treatment? Study 1 investigates research question 1 through an RCT comparing GEARS to a passive control group. Data are collected using validated measures before and after treatment/waiting period, as well as at six and 12 months follow ups.

Sample size: 150 participants, ensuring sufficient statistical power to detect significant between-group differences, even with some attrition.

Study 2 examines the patients' perspectives on the treatment by interviewing 15-20 participants about their experience with GEARS. The interviews focus on GEARS' perceived impact. Interviews will be recorded, transcribed, and analyzed using thematic analysis to identify key recurring themes.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

The trial will evaluate the GEARS manual. ADHD is one of the most common psychiatric diagnoses, with a growing demand for psychological treatment. Many adults seek help for impaired emotion regulation, yet evidence-based treatments are lacking. GEARS has shown promising results and addresses a critical need in psychiatric outpatient care. If proven effective in controlled studies, it could be widely implemented, enhancing functional outcomes in work and family life. Given the negative impact of emotion dysregulation, establishing evidence for this clinically developed and tested method is essential. Participants Inclusion criteria; (1) being diagnosed with ADHD according to DSM criteria, (2) age 18 years orabove, and (3) having identified problems with emotion regulation difficulties. Exclusion criteria: (1) diagnosis of intellectual disability, (2) diagnosis of autism (3) substance abuse, (4) severe mental illness (e.g., severe depression, anorexia) or comorbidity requiring clinical priority, (5) difficulties allocating time to participate due to social, academic or occupational circumstances hindering engagement in treatment, (6) other ongoing psychotherapy, and (7) difficulties accepting the group setting.

Treatment will take place within psychiatric outpatient clinics in regular care in Stockholm. Participants will be randomized to either start the intervention or to waitlist control. The GEARS is conducted in groups of around 8 participants led by two skilled therapist experienced in CBT and ADHD.

Inclusion criteria Treatment Method: GEARS is a new manual-based group treatment consisting of 14 weekly 2-hour sessions with eight participants and two group leaders. The group leaders, who are licensed psychologists or psychotherapists with CBT training and experience with this patient group, undergo training in the GEARS protocol prior to the start of treatment. The protocol is based on CBT with elements of DBT, ACT, and research on emotion theory and affect dysregulation in ADHD. The treatment is adapted to the needs of individuals with ADHD and designed to provide support so that executive difficulties do not become an obstacle to benefiting from the treatment.

In addition to the group sessions, each participant receives 30-60 minutes of coaching every other week with a group leader. The purpose is to support homework assignments, the application of treatment strategies in relation to individual challenges, and to strengthen the therapeutic process. Coaching sessions can take place on-site, via telephone, or via video.

The GEARS manual gives a clear agenda for the 14 group sessions and provides PowerPoint presentations, worksheets, and texts designed to increase understanding, acceptance, and regulation of emotions. The 14 sessions of the treatment are organized to cover the following themes:

Week 1: Introduction

Week 2: Mindfulness I + Acceptance

Week 3: Mindfulness II + The Normal Function of Emotions

Week 4: Mindfulness III + Emotional Awareness

Week 5: Primary and Secondary Emotions

Week 6: Self-reinforcement of Emotions / "Finished Behavior Analysis"

Week 7: Self-reinforcement of Emotions / "Finished Behavior Analysis"

Week 8: Impulse Control

Week 9: Emotional Control and Avoidance vs. Willingness and Acceptance

Week 10: Communication Skills

Week 11: Regulating Emotions Without Avoiding Them

Week 12: Valued Directions I + Relapse Prevention

Week 13: Valued Directions II

Week 14: Relapse Prevention / Termination

Measurements: Measures of emotion regulation and symptoms of ADHD, depression, anxiety and quality of life will be used to evaluate effects of treatment. Participants will be assessed pre, post and follow up at 6 and 12 months after treatment completion.

Study Type

Interventional

Enrollment (Estimated)

150

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • being diagnosed with ADHD according to DSM criteria,
  • age 18 years or above, and
  • having identified problems with emotion regulation difficulties.

Exclusion Criteria:

  • diagnosis of intellectual disability,
  • diagnosis of autism
  • substance abuse,
  • severe mental illness (e.g., severe depression, anorexia) or comorbidity requiring clinical priority,
  • difficulties allocating time to participate due to social, academic or occupational circumstances hindering engagement in treatment,
  • other ongoing psychotherapy, and
  • difficulties accepting the group setting.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: GEARS intervention group
Group Therapy for Improving Emotional Acceptance and Regulatory Skills in Adults with ADHD (GEARS)
Other: Group Therapy for Improving Emotional Acceptance and Regulatory Skills in Adults with ADHD (GEARS)
The GEARS protocol is the first CBT based group therapy protocol describing an intervention designed specifically to treat emotion regulation in ADHD.
No Intervention: Control
Participants will wait for treatment for six months and provide data assessed at the same time points as the intervention group. Participants will receive treatment and be assessed after their treatment is completed but not at the follow ups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Barkley Deficits in Executive Functioning Scale (B-DEFS) Deficits in emotion regulation subscale (DEFS-LF) : Self-regulation of Emotion using the subscale from the
Time Frame: From pre-treatment to post treatment and follow up at 6 and 12 months past treatment end.
Measures emotion regulation difficulties through 13 items rated from 1 ("Never or rarely") to 4 ("Very often") range: 13-52
From pre-treatment to post treatment and follow up at 6 and 12 months past treatment end.
Difficulties in Emotion Regulation Scale (DERS)
Time Frame: Assessment at pretreatment to post treatment at 15 week and after follow up at week 25. Follow up assessments at 6 and 12 months pat treatment end.
Measures symptoms of emotion regulation difficulties through 36 items rated in a five point scale, from 1(1= almost never) to 5, (5 = almost always) range 36-180.
Assessment at pretreatment to post treatment at 15 week and after follow up at week 25. Follow up assessments at 6 and 12 months pat treatment end.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The Hospital Anxiety and Depression Scale (HADS)
Time Frame: From pretreatment to end of treatment at 25 weeks
Measuring symptoms of anxiety and depression through 14 questions, rated 0-3, range 0-42.
From pretreatment to end of treatment at 25 weeks
ASRS
Time Frame: From pre-treatment to post treatment and follow up at 6 and 12 months past treatment end.
Measuring ADHD symptoms, 18 items rated 0 (0= never) to 4 (4= very often) range 0-72
From pre-treatment to post treatment and follow up at 6 and 12 months past treatment end.
Adult ADHD Quality of Life Scale (AAQoL)
Time Frame: From pre-treatment to post treatment and follow up at 6 and 12 months past treatment end.
Measures different aspects of everyday life functioning through 21 questions, rated from 1 (not at all) to 5 (very much), range 21- 105.
From pre-treatment to post treatment and follow up at 6 and 12 months past treatment end.
Barkley Deficits in Executive Functions Scale Short Form (BDEFS-SF)
Time Frame: up to 6 and 12 months past treatment end.
Measures executive functions in ADHD through 20 items rated from 1 (1= never or rarely) to 4 (very often) range 20-80.
up to 6 and 12 months past treatment end.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Karolinska Institutet

Investigators

  • Principal Investigator: Elinor Eskilsson Strålin, PhD, Department of Clinical Neuroscience, Karolinska Institutet (KI)

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 22, 2026

Primary Completion (Estimated)

June 1, 2029

Study Completion (Estimated)

June 1, 2029

Study Registration Dates

First Submitted

May 22, 2026

First Submitted That Met QC Criteria

May 22, 2026

First Posted (Actual)

May 29, 2026

Study Record Updates

Last Update Posted (Actual)

June 4, 2026

Last Update Submitted That Met QC Criteria

June 3, 2026

Last Verified

June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2023-06542-01
  • 2024-04400-02, 2026-01733-02 (Other Identifier: Swedish Ethical Review Authority)

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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