Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial.
Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial.
复制标题
DOI：
10.1001/jama.2010.1192
复制
发表时间：
2010-08-25
影响因子：
120.7
通讯作者：
Otto, Michael W.
中科院分区：
文献类型：
--
作者：
Safren, Steven A.;Sprich, Susan;Mimiaga, Matthew J.;Surman, Craig;Knouse, Laura;Groves, Meghan;Otto, Michael W.
成年期注意力缺陷/多动障碍（ADHD）是一种普遍存在、令人痛苦且具有损害性的疾病，仅靠药物治疗无法完全治疗，并且缺乏基于证据的心理社会治疗。在接受药物治疗但仍有临床显著症状的成人中测试ADHD的认知行为疗法。一项随机对照试验，评估认知行为疗法对86例已接受药物治疗的ADHD患者的疗效。该研究于2004年11月至2008年6月在美国一家医院进行（随访至2009年7月）。在86例随机化患者中，79例完成治疗，70例完成随访评估。患者被随机分配到12个单独的认知行为治疗或放松教育支持（这是一个注意力匹配的比较）。主要指标是评估者在基线、治疗后以及6个月和12个月随访时评定的ADHD症状（ADHD评定量表和临床总体印象量表）。评估者对治疗条件分配不知情。次要结局指标是ADHD症状的自我报告。认知行为疗法治疗后的临床总体印象量表评分（幅度-0.0531; 95%可信区间[CI]，-1.01至0.05; P=.03）和ADHD评定量表评分（幅度-4.631; 95% CI，-8.30至0.963; P=.02）均低于放松教育支持。在整个治疗过程中，自我报告的症状在认知行为治疗中也得到了显著改善（β=−0.41; 95%CI，−0.64至−0.17; P<0.01），认知行为治疗的临床总体印象量表和（53% vs 23%;比值比[OR]，3.80; 95% CI，1.50 - 9.59; P=.01）和ADHD评定量表（67% vs 33%; OR，4.29; 95% CI，1.74 - 10.58; P=.002）。认知行为治疗条件下的应答者和部分应答者在6个月和12个月内保持了他们的增益。在接受药物治疗的持续ADHD症状的成年人中，使用认知行为疗法与放松教育支持相比，ADHD症状得到改善，并维持在12个月。
Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a prevalent, distressing, and impairing condition that is not fully treated by pharmacotherapy alone and lacks evidence-based psychosocial treatments. To test cognitive behavioral therapy for ADHD in adults treated with medication but who still have clinically significant symptoms. Randomized controlled trial assessing the efficacy of cognitivebehavioraltherapyfor86symptomaticadultswithADHDwhowerealreadybeing treated with medication. The study was conducted at a US hospital between November 2004 and June 2008 (follow-up was conducted through July 2009). Of the 86 patients randomized, 79 completed treatment and 70 completed the follow-up assessments. Patients were randomized to 12 individual sessions of either cognitive behavioral therapy or relaxation with educational support (which is an attention-matched comparison). The primary measures were ADHD symptoms rated by an assessor (ADHD rating scale and Clinical Global Impression scale) at baseline, posttreatment, and at 6- and 12-month follow-up. The assessor was blinded to treatment condition assignment. The secondary outcome measure was self-report of ADHD symptoms. Cognitive behavioral therapy achieved lower posttreatment scores on both the Clinical Global Impression scale (magnitude −0.0531; 95% confidence interval [CI], −1.01 to −0.05; P=.03) and the ADHD rating scale (magnitude −4.631; 95% CI, −8.30 to −0.963; P=.02) compared with relaxation with educational support. Throughout treatment, self-reported symptoms were also significantly more improved for cognitive behavioral therapy (β=−0.41; 95% CI, −0.64 to −0.17; P<001), and there were more treatment responders in cognitive behavioral therapy for both the Clinical Global Impression scale (53% vs 23%; odds ratio [OR], 3.80; 95% CI, 1.50 to 9.59; P=.01) and the ADHD rating scale (67% vs 33%; OR, 4.29; 95% CI, 1.74 to 10.58; P=.002). Responders and partial responders in the cognitive behavioral therapy condition maintained their gains over 6 and 12 months. Among adults with persistent ADHD symptoms treated with medication, the use of cognitive behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms, which were maintained at 12 months.
登录
查看更多内容
影响因子：
4.1
作者：
Safren, SA;Otto, MW;Biederman, J
通讯作者：
Biederman, J
DOI：
10.1176/appi.ajp.2009.09081123
发表时间：
2010-08
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Solanto MV;Marks DJ;Wasserstein J;Mitchell K;Abikoff H;Alvir JM;Kofman MD
通讯作者：
Kofman MD
影响因子：
17.7
作者：
Kessler, RC;Adler, L;Zaslavsky, AM
通讯作者：
Zaslavsky, AM
影响因子：
4.3
作者：
Knouse, Laura E;Cooper-Vince, Christine;Sprich, Susan;Safren, Steven A
通讯作者：
Safren, Steven A
影响因子：
3
作者：
Zylowska, Lidia;Ackerman, Deborah L.;Smalley, Susan L.
通讯作者：
Smalley, Susan L.