A new study suggests that the most common form of psychotherapy — cognitive behavioral therapy (CBT) — is more effective than relaxation therapy and education about attention deficit hyperactivity disorder (ADHD).
Researchers at Massachusetts General Hospital studied the effects of these two kinds of psychosocial treatments fin 86 adults with attention deficit disorder between 2004 and 2008. All patients who entered the study were already being treated for their ADHD with medication, but still had clinically significant symptoms.
Of the original 86 patients who entered the study, 79 completed treatment. Of those 79, 70 completed follow-up assessments in the study. Study participants were randomized to one of two treatment groups — either cognitive behavioral therapy (CBT) or relaxation therapy with educational support.
The researchers found that after the treatment was completed, patients who received cognitive behavioral therapy had significantly better ADHD rating scale scores and Clinical Global Impression scale scores than those who were assigned to relaxation with educational support. Also, there was a greater proportion of responders in the cognitive behavioral therapy condition compared with the relaxation condition, using criteria from both the Clinical Global Impression scale (53 percent vs. 23 percent) and the ADHD rating scale (67 percent vs. 33 percent).
Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy. Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months.
“This study suggests that cognitive behavioral therapy for ADHD in adults appears to be a useful and efficacious next step strategy for adults who show continued symptoms despite treatment with medication,” said Steven A. Safren, Ph.D., A.B.P.P., one of the researchers of the new study.
“Medications have been the primary treatment,” noted the researchers. “However, many adults with ADHD cannot or will not take medications while others show a poor medication response. Furthermore, those considered responders to medications (i.e., 30 percent symptom reduction) may continue to experience significant and impairing symptoms. Thus, there is a need for alternative and next-step strategies.”
Cognitive behavioral therapy included sessions that focused on psycho-education about ADHD and training in organizing and planning; learning skills to reduce distractibility; cognitive restructuring (learning to think more adaptively in situations that cause distress); and relapse prevention. ADHD symptoms were rated by an assessor using an ADHD rating scale and Clinical Global Impression scale at the beginning of the trial, at the end of treatment, and at 6- and 12-month follow-up.
The researchers add that further study is required to examine whether this cognitive behavioral therapy intervention may be useful for individuals who may be unwilling or unable, for medical reasons, to take medication for ADHD.
“Additionally, because the only other tested treatment is a group intervention, further investigation is needed to examine whether different patients or settings may be more receptive or conducive to an individual vs. a group approach.”
“Generally, the treatment was well tolerated, with very low drop-out rates, and had positive and sustained effects on ADHD symptoms. Clinical application of these strategies to patients in need is encouraged,” concluded the researchers.
According to the study, approximately 4.4 percent of adults in the United States have attention deficit disorder. ADHD is characterized by impairing levels of inattention, hyperactivity, and impulsivity, and can occur and be diagnosed in both children and adults.
The study is published in the August 25 issue of JAMA.