正念认知疗法与 ADHD 成人的常规治疗相比：一项多中心、单盲、随机对照试验。
Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial.
机构信息
Department of Psychiatry,Radboud University Medical Centre,Nijmegen,The Netherlands.
Reinier van Arkel,'s-Hertogenbosch,The Netherlands.
出版信息
Psychol Med. 2019 Jan;49(1):55-65. doi: 10.1017/S0033291718000429. Epub 2018 Feb 28.
BACKGROUND
There is a high need for evidence-based psychosocial treatments for adult attention-deficit hyperactivity disorder (ADHD) to offer alongside treatment as usual (TAU). Mindfulness-based cognitive therapy (MBCT) is a promising psychosocial treatment. This trial investigated the efficacy of MBCT + TAU v. TAU in reducing core symptoms in adults with ADHD.
METHODS
A multicentre, single-blind, randomised controlled trial (ClinicalTrials.gov: NCT02463396). Participants were randomly assigned to MBCT + TAU (n = 60), an 8-weekly group therapy including meditation exercises, psychoeducation and group discussions, or TAU only (n = 60), which reflected usual treatment in the Netherlands and included pharmacotherapy and/or psychoeducation. Primary outcome was ADHD symptoms rated by blinded clinicians. Secondary outcomes included self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. Outcomes were assessed at baseline, post-treatment, 3- and 6-month follow-up. Post-treatment effects at group and individual level, and follow-up effects were examined.
RESULTS
In MBCT + TAU patients, a significant reduction of clinician-rated ADHD symptoms was found at post-treatment [M difference = -3.44 (-5.75, -1.11), p = 0.004, d = 0.41]. This effect was maintained until 6-month follow-up. More MBCT + TAU (27%) than TAU participants (4%) showed a ⩾30% reduction of ADHD symptoms (p = 0.001). MBCT + TAU patients compared with TAU patients also reported significant improvements in ADHD symptoms, mindfulness skills, self-compassion and positive mental health at post-treatment, which were maintained until 6-month follow-up. Although patients in MBCT + TAU compared with TAU reported no improvement in executive functioning at post-treatment, they did report improvement at 6-month follow-up.
CONCLUSIONS
MBCT might be a valuable treatment option alongside TAU for adult ADHD aimed at alleviating symptoms.
背景
成人注意力缺陷多动障碍（ADHD）除了常规治疗（TAU）外，还需要有循证的心理社会治疗。基于正念认知疗法（MBCT）是一种很有前途的心理社会治疗方法。本试验旨在研究 MBCT+TAU 与 TAU 相比，在减少成人 ADHD 核心症状方面的疗效。
方法
这是一项多中心、单盲、随机对照试验（ClinicalTrials.gov：NCT02463396）。参与者被随机分配到 MBCT+TAU（n=60）组，即每周一次的小组治疗，包括冥想练习、心理教育和小组讨论，或仅接受 TAU（n=60）组，这反映了荷兰的常规治疗，包括药物治疗和/或心理教育。主要结局是由盲法临床医生评定的 ADHD 症状。次要结局包括自我报告的 ADHD 症状、执行功能、正念技能、自我同情、积极心理健康和一般功能。在基线、治疗后、3 个月和 6 个月随访时进行评估。检验了治疗组和个体水平的治疗后效果和随访效果。
结果
在 MBCT+TAU 患者中，治疗后临床医生评定的 ADHD 症状显著减轻[M 差值=-3.44（-5.75，-1.11），p=0.004，d=0.41]。这种效果一直持续到 6 个月的随访。与 TAU 组（4%）相比，更多的 MBCT+TAU 组（27%）患者 ADHD 症状改善≥30%（p=0.001）。与 TAU 组相比，MBCT+TAU 组患者在治疗后报告 ADHD 症状、正念技能、自我同情和积极心理健康方面有显著改善，且这种改善一直持续到 6 个月的随访。虽然 MBCT+TAU 组患者在治疗后与 TAU 组患者在执行功能方面没有改善，但他们在 6 个月的随访时报告了改善。
结论
MBCT 可能是成人 ADHD 除 TAU 以外的一种有价值的治疗选择，旨在减轻症状。
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