CBT Strategies for Rejection Sensitive Dysphoria

CBT Toolkit

Chapter 2 · Rewiring Long-Term Patterns

INTRODUCTION

Introduction to Rewiring Patterns

Changing long-standing behavioral patterns is about shifting the automatic ways we react to triggers. CBT offers a structured, evidence-based approach to identify negative thought cycles and replace them with more adaptive responses.

Rejection Sensitive Dysphoria (RSD), often experienced by individuals with ADHD, presents unique challenges. People with RSD can experience intense emotional pain from perceived or actual rejection, leading to avoidance behaviors and diminished self-esteem.

One key technique within CBT is cognitive restructuring — identifying and challenging irrational or unhelpful thoughts. For example, someone might automatically think, "I'm always going to be rejected." Cognitive restructuring helps examine the evidence for and against this belief, often revealing a more balanced perspective.

Behavioral activation involves engaging in activities that improve mood and decrease avoidance. Gradually exposing yourself to feared situations in a controlled, supportive way builds resilience and reduces anxiety.

Emotional regulation techniques — deep breathing, progressive muscle relaxation, mindfulness — manage physiological anxiety symptoms and create calm, making it easier to approach challenging situations.

Exercises

REFLECT

Describe one automatic pattern or reaction you notice in yourself when you sense possible rejection. What triggers it, and what do you typically do?

PRACTICE — Cognitive Restructuring

Write down a negative automatic thought you have about rejection. Now list 3 pieces of evidence AGAINST that thought.