Our Neurodiversity-Affirming Approach to ADHD and Anxiety Therapy

If you've spent years being told to "just try harder," "be more organized," or "stop overthinking" — and watched those instructions fail you over and over — this page is for you.

At Brilla Counseling, we don't treat ADHD and anxiety as character flaws to be willpower-ed away. We treat them as how your nervous system works. Our approach combines three things most therapy practices don't put together in one place: Acceptance and Commitment Therapy (ACT), Peg Dawson's evidence-based executive function skills framework, and a deep focus on the relationship you have with yourself. We work with adults, women, couples, parents, teens, and families — in our East Sacramento office and online throughout California via secure telehealth.

What follows is a clear walkthrough of how we work, why we work that way, and what you can expect when you begin therapy with our team.

What Neurodiversity-Affirming Therapy Means at Brilla

"Neurodiversity-affirming" has become a popular phrase, and we want to be specific about what it actually means in our clinical practice.

A neurodiversity-affirming approach starts from a different premise than traditional ADHD therapy. Traditional models treat ADHD as a disorder to be corrected — a deviation from a "normal" brain that needs to be reshaped to fit a neurotypical world. Affirming therapy treats ADHD and anxiety as natural variations in how human nervous systems are wired. Some of the experiences they create are genuinely difficult and worth treating. Some are differences that, with the right environment and support, become strengths.

In practice, this means our work focuses less on "fixing" you and more on understanding your actual cognitive style, identifying which strategies are already working for you, and building a life that fits your real brain rather than the brain you were told you should have. We use evidence-based interventions — ACT, executive function coaching, exposure work for anxiety, somatic regulation — but we apply them in a way that respects your autonomy, your lived experience, and your self-knowledge.

Neurodiversity-affirming care is also trauma-informed. Many of our adult clients, especially women, come to us carrying years of internalized shame from being misunderstood, misdiagnosed, or asked to perform a version of "functional" that didn't match how they were built. We name that. We work with it directly. Healing the relationship between you and your own mind is part of the clinical work, not a side effect.

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Why ADHD and Anxiety Often Travel Together

Most current research suggests roughly half of adults with ADHD also meet criteria for an anxiety disorder. The overlap is even higher in late-diagnosed women. This isn't a coincidence — it's a pattern with a clear mechanism.

When your executive function system (the brain's organizing, planning, and self-regulation apparatus) is under-supported, daily life requires more conscious effort than it does for neurotypical brains. Forgetting appointments, losing track of time, missing details, blanking on words mid-sentence — each of these creates small moments of stress that accumulate. Over years, that accumulation often shows up as chronic anxiety, worry loops, perfectionism, panic, or persistent low-grade dread.

For many of our clients, anxiety is the symptom that finally drives them to seek help. The ADHD has been there all along — it just got reframed as anxiety because the anxiety was louder and easier to point at. Treating only the anxiety without addressing the underlying executive function strain is a common reason clients tell us, "I've been in therapy for years and nothing really helps."

Our approach treats ADHD and anxiety together. We address the executive function load that's generating the anxiety in the first place, build skills that lower the daily cognitive cost of basic tasks, and work directly with the anxiety patterns themselves. The result is therapy that addresses the whole system rather than chasing one symptom at a time.

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Our Three-Part Clinical Approach

Our clinical model rests on three pillars. Most sessions touch all three; depending on what you're navigating in a given week, one pillar will get more weight than the others.

Acceptance and Commitment Therapy (ACT) for ADHD and Anxiety

ACT is one of the most extensively researched modern therapies. It belongs to the broader family of cognitive-behavioral therapies, but it works differently from traditional CBT. Rather than trying to change the content of your thoughts ("that's an irrational fear, here's a more reasonable one"), ACT teaches you to change your relationship to your thoughts.

For ADHD and anxiety specifically, this matters. People with ADHD often have intrusive, racing, or hyper-focused thoughts that don't respond well to thought-challenging. Telling someone with ADHD-driven worry "just notice the thought is irrational" often makes it worse — they can argue both sides of the irrationality endlessly. ACT teaches a different move: notice the thought is happening, recognize you don't have to obey it, and act in line with what actually matters to you anyway.

ACT also centers values clarification — figuring out what you actually want your life to be about. For people who've spent years performing a version of themselves designed to mask ADHD or quiet anxiety, this can be the most important work. Many of our clients arrive having lost touch with what they want. ACT helps them find it again.

The research base for ACT in adult ADHD and generalized anxiety is strong, with multiple controlled trials showing meaningful improvement in psychological flexibility, mood, and functional outcomes. We use it not as a single technique but as the orienting framework for how we think about change.

Executive Function Skills: The Peg Dawson Framework

Executive function is the umbrella term for the cognitive skills that let humans plan, prioritize, regulate emotion, and follow through. Most ADHD therapy talks about executive function in vague ways. We use the specific framework developed by Peg Dawson, EdD, and Richard Guare, PhD — researchers whose work has shaped modern executive function intervention across schools, clinics, and clinical psychology training programs.

Their framework identifies eleven distinct executive function skills:

• Response inhibition
• Working memory
• Emotional control
• Sustained attention
• Task initiation
• Planning and prioritization
• Organization
• Time management
• Goal-directed persistence
• Flexibility
• Metacognition

Most of our clients are strong in some of these and significantly weaker in others. The pattern of strengths and gaps is highly individual. A client with strong working memory and weak task initiation needs a completely different intervention than a client with strong organization and weak emotional control. Generic "ADHD coaching" that hands the same tools to everyone misses this entirely.

Our work begins with mapping your actual executive function profile — not in a clinical-feeling way, just by paying close attention to where things break down in your real life. From there we build skill by skill, using approaches matched to where you actually struggle. We pair the skills work with environmental design (how to set up your space, calendar, and routines so your weak skills are supported and your strong ones can lead).

We also use this framework with the parents and partners of clients with ADHD, so the people closest to you can understand what's actually happening in your nervous system rather than reading your behavior as character or motivation. This often shifts mixed-neurotype family and couple dynamics in lasting ways.

The Self-Relationship Lens

This is the part of our work that's most distinctively Brilla. Most ADHD therapy focuses outward — productivity, systems, accommodations, communication. Those are necessary. They're not sufficient.

Many of our clients arrive carrying decades of accumulated self-judgment. Years of being late, forgetting things, losing items, missing social cues, being called "lazy" or "spacey" or "too much" — those experiences don't just create practical problems. They shape how you talk to yourself, what you believe you deserve, and what you assume other people think of you. Untreated, this internal landscape becomes a second-order disability that shapes relationships, career choices, and self-trust long after the original ADHD symptoms have been managed.

Our work addresses the self-relationship directly. We name the internalized voices. We trace where they came from — usually a teacher, a parent, a former partner, or the cumulative pressure of a culture that rewards a kind of cognitive performance you couldn't deliver. We slowly, deliberately rebuild the relationship between you and your own mind.

For late-diagnosed clients — especially women — this part of the work is often the most important. ADHD identity work, processing the grief of late diagnosis, and finding language for experiences you didn't have language for before are central to long-term outcomes. We have specific clinical depth in this area, and several of our clinicians have completed advanced training in late-diagnosed adult ADHD.

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What This Looks Like in a Therapy Session

A first session is mostly listening. We want to understand the shape of your life right now — what's working, what isn't, what you've already tried, and what brought you in. We don't expect you to be organized about it. ADHD brains often arrive with a tangle of half-finished stories; that's fine. We'll sort through it together.

After the initial sessions, our work tends to follow a flexible pattern. We check in on the previous week (what you tried, what got in the way, what surprised you), pick a focus for that day's session based on what you're navigating, and end with a small, specific intention for the coming week. Sometimes the intention is behavioral — try this scheduling approach, set up this environmental cue. Sometimes it's relational — notice when you talk to yourself harshly, or practice naming a feeling when it arrives. Sometimes it's nothing. Rest is sometimes the work.

Sessions are 50 minutes. Most clients meet weekly; some prefer biweekly, depending on what your nervous system can integrate without burnout. We work in person at our East Sacramento office (924 57th Street, Sacramento, CA 95819) or online throughout California via secure HIPAA-compliant telehealth.

Between sessions, we encourage small, specific experiments rather than ambitious behavior-change projects. ADHD brains do not respond well to "this week I'll completely overhaul my morning routine." They respond well to "this week I'll try one thing in the morning and notice what happens." Our pacing is built around how change actually happens in ADHD nervous systems — through accumulation of small wins, not through heroic willpower campaigns.

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Who We Work With at Brilla Counseling

Our specialty is ADHD across the lifespan and the conditions that frequently travel with it — anxiety, executive dysfunction, rejection-sensitive dysphoria (RSD), late-diagnosis identity work, and the burnout and exhaustion that build up when you've been white-knuckling through life without the right support.

We particularly welcome women diagnosed later in life, college students navigating coursework and independence, creatives whose work depends on sustainable engagement with their own minds, working professionals who are high-functioning on the outside and depleted underneath, and families with mixed-neurotype dynamics. If you're struggling with procrastination, organizational overwhelm, anxiety, or emotional regulation — and tired of advice that doesn't account for how your brain actually works — you're our population.

We offer individual therapy for adults, specialized therapy for women with ADHD, therapy for parents, and family-based treatment for children and teens. For relationships affected by ADHD, we offer couples therapy for mixed-neurotype partnerships and dedicated support for non-ADHD partners.

Our team includes Lauren Dibble, LMFT (founder and clinical supervisor), Joseph Boyle, LPCC, Kim Schuster, LCSW, Andrea Valle, ASW, and Jocelyn Medrano, AMFT. Every clinician on our team has completed 30 to 60+ hours of ADHD-specific training beyond licensure — a depth of specialty preparation that's unusual in general therapy practices.

If you're not sure which kind of therapy fits your situation, we'll figure that out together in your free consultation.

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Beginning Therapy at Brilla

If this approach resonates with you, the next step is a free, no-obligation 20-minute consultation. The consultation is a conversation — not an intake interview. We want to hear what brought you in, get a sense of whether we're the right fit, and answer any questions you have about how we work. We meet clients in person at our Sacramento office and online throughout California via telehealth.

We're a private-pay practice and provide superbills you can submit to your insurance for potential out-of-network reimbursement. Detailed pricing is on our Rates page.

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We work with a lot of people who have spent a long time being misunderstood by mental health care. Our intention is for therapy with us to feel different from that. If you're ready, we're ready to begin.