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Child Psychiatrist /Adult Psychiatrist

Dialectical Behavior Therapy Demonstrates Long-Term Acceptability for Adult ADHD

For adults with ADHD, DBT as a treatment strategy demonstrated superior acceptability to clinical management with placebo.

A randomized controlled study published in Psychotherapy and Psychosomatics found that dialectical behavior therapy (DBT) demonstrated acceptability as a treatment strategy for adults with attention-deficit/hyperactivity disorder (ADHD), even in the long term. However, future interventions should target treatment adherence to maximize clinical outcomes.

When ADHD persists in adulthood, symptoms can affect educational attainment and social and occupational functioning. Adults with ADHD have reported that cognitive behavioral therapy (CBT) and DBT are useful interventions, but few studies have focused on acceptability and adherence to treatment.

Adults with ADHD

The Comparison of Methylphenidate and Psychotherapy in Adult ADHD Study (COMPAS; ISRCTN54096201) was a 4-arm study conducted between 2007 and 2013 that compared DBT-based group therapy plus methylphenidate (GBT+MPH) with DBT-based group therapy plus placebo (GBT+PLB), clinical management plus methylphenidate (CM+MPH), and clinical management plus placebo (CM+PLB). The DBT intervention comprised 12 weekly sessions followed by 10 monthly sessions lasting 120 minutes that covered mindfulness, behavior analysis, emotional regulation, impulse control, stress management, and self-respect modules, among others. The clinical management intervention was delivered in 15- to 20-minute individual sessions following the same schedule as DBT and involved supportive counseling to encourage patients to develop coping skills. For this study, researchers evaluated self-reported efficacy of the treatment and adherence, measured by session attendance.

The researchers randomly assigned participants to receive GBT+MPH (n=107), GBT+PLB (n=109), CM+MPH (n=110), and CM+PLB (n=107). These cohorts comprised 47.7%, 45.9%, 50.9%, and 54.2% women; were 34.9, 35.6, 35.6, and 34.9 years of age on average; 62.6%, 51.4%, 53.6%, and 62.6% had combined ADHD; and 50.5%, 53.2%, 50%, and 52.3% had used medication treatments for their ADHD, respectively.

At week 52, the researchers found that the overall self-reported effectiveness of treatment was significantly greater for CM+MPH than CM+PLB (P <.001), for GPT+PLB than CM+PLB (P <.001), and for GPT+MPH than CM+PLB (P <.001). The patients who received methylphenidate reported significant effects from medication compared with placebo recipients at weeks 52 and 130 (all P £.019). Notably, recipients of DBT with or without active pharmacotherapy reported significant effects from the therapy intervention compared with CM+PLB at week 52 (both P £.002).

Among the DBT recipients, self-reported use of skills was associated with significant improvements in Clinical Global Impression (CGI) scores (P <.001), Conners’ Adult ADHD Rating Scale (CAARS) total scores (P <.05), and CAARS ADHD index scores (P <.05).

However, the researchers observed no significant group differences in subjective adherence to or effectiveness of overall skills between the GPT+MPH and GPT+PLB groups (all P ³.061).

Additionally, the number of unexcused absences from treatment sessions was higher for GPT+PLB than CM+MPH (P =.013) and CM+PLB (P =.028). Consequently, the researchers found that the number of unexcused absences was negatively correlated with the use of skills overall (r = -0.212) and the use of mindfulness (r = -0.194), emotional regulation (r = -0.174), impulse control (r = -0.181), and relationship/self-esteem (r = -0.173) skills.

Study authors concluded, “These findings suggest that improving adherence to therapy skills could enhance treatment response.”

These study findings may be limited, as the patients who were lost to follow-up were younger and had more severe illness than those who remained in the study.

This article originally appeared on Psychiatric Times

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