Dittner Antonia J, Rimes Katharine A, Russell Ailsa J, Chalder Trudie
BMC Psychiatry. 2014 Sep 3;14:248. doi: 10.1186/s12888-014-0248-1.
ADHD is prevalent in adults and frequently associated with impairment and distress. While medication is often the first line of treatment a high proportion of people with the condition are not fully treated by medication alone, cannot tolerate medication or do not wish to take it. Preliminary studies suggest that psychosocial approaches are a promising adjunctive or alternative treatment option. To date, individual cognitive-behaviour therapy (CBT) has been found to be efficacious in three randomized controlled trials (RCTs). There is a need for more RCTs to be carried out in order to replicate these results in different sites, to further investigate the acceptability and feasibility of CBT in this population and to further develop CBT approaches based on a psychological model. This randomized controlled trial investigates the efficacy of individual, formulation-based CBT when added to treatment-as-usual as compared with treatment as usual alone.
METHODS/DESIGN: Sixty patients with a diagnosis of adult ADHD attending a specialist clinic are randomly allocated to 1 of 2 treatments, 'Treatment as Usual' (TAU) or TAU plus 16 sessions individual CBT (TAU + CBT). In the TAU + CBT, the first 15 sessions take place over 30 weeks with a 16th 'follow-up' session at 42 weeks. Outcomes are assessed at 30 weeks and 42 weeks following randomization. The two primary outcomes are self-rated ADHD symptoms and functioning (occupational and social). Secondary outcomes include distress, mood, ADHD-related cognitions, ADHD-related behaviours and informant-rated ADHD symptoms. The primary analysis will include all participants for whom data is available and will use longitudinal regression models to compare treatments. Secondary outcomes will be analysed similarly.
The results of the study will provide information about a) whether CBT adds benefit over and above TAU for ADHD and, b) if CBT is found to be efficacious, potential mechanisms of change and predictors of efficacy.
Current Controlled Trials ISRCTN03732556, assigned 04/11/2010.
注意力缺陷多动障碍(ADHD)在成年人中很常见,且常与功能损害和痛苦相关。虽然药物治疗通常是一线治疗方法,但很大一部分患有该疾病的人仅靠药物无法得到充分治疗,无法耐受药物治疗或不愿服用药物。初步研究表明,心理社会方法是一种有前景的辅助或替代治疗选择。迄今为止,在三项随机对照试验(RCT)中发现个体认知行为疗法(CBT)是有效的。需要开展更多的随机对照试验,以便在不同地点重复这些结果,进一步研究CBT在该人群中的可接受性和可行性,并基于心理模型进一步开发CBT方法。这项随机对照试验研究了与单纯常规治疗相比,在常规治疗基础上增加基于方案制定的个体CBT的疗效。
方法/设计:60名在专科诊所被诊断为成人ADHD的患者被随机分配到两种治疗中的一种,即“常规治疗”(TAU)或TAU加16节个体CBT(TAU + CBT)。在TAU + CBT组中,前15节在30周内进行,第16节“随访”在42周时进行。在随机分组后30周和42周评估结果。两个主要结果是自我评定的ADHD症状和功能(职业和社交)。次要结果包括痛苦、情绪、与ADHD相关的认知、与ADHD相关的行为以及他人评定的ADHD症状。主要分析将包括所有可获得数据的参与者,并将使用纵向回归模型比较治疗方法。次要结果将进行类似分析。
该研究结果将提供有关以下方面的信息:a)对于ADHD,CBT是否比TAU有额外益处;b)如果发现CBT有效,潜在的变化机制和疗效预测因素。
当前受控试验ISRCTN03732556,于2010年11月4日分配。