Effects of Group Psychotherapy, Individual Counseling, Methylphenidate, and Placebo in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder

Philipsen, Alexandra; Jans, Thomas; Graf, Erika; Matthies, Swantje; Borel, Patricia; Colla, Michael; Gentschow, Laura; Langner, Daina; Jacob, Christian; Groß-Lesch, Silke; Sobanski, Esther; Alm, Barbara; Schumacher-Stien, Martina; Roesler, Michael; Retz, Wolfgang; Retz-Junginger, Petra; Kis, Bernhard; Abdel‐Hamid, Mona; Heinrich, V.; Huß, Michael; Kornmann, Catherine; Bürger, Arne; Perlov, Evgeniy; Ihorst, Gabriele; Schlander, Michael; Berger, Thomas; Elst, Ludger Tebartz van

doi:10.1001/jamapsychiatry.2015.2146

Cited by 148 publications

(173 citation statements)

References 47 publications

(36 reference statements)

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“…In adults with ADHD, two single studies on methylphenidate added on highly structured group CBT versus non-specific clinical management, provided discordant results 49 50. However, there is no evidence from systematic reviews, so that this issue needs to be further explored 38 41 51…”

Section: Resultsmentioning

confidence: 99%

Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review

Crescenzo

Cortese

Adamo

et al. 2016

Evid Based Mental Health

109

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Attention-deficit/hyperactivity disorder (ADHD) is characterised by a persistent and impairing pattern of inattention and/or hyperactivity/impulsivity and it is one of the most common neuropsychiatric conditions. Evidence about interventions of adults with ADHD is growing rapidly and clinicians need a reliable summary of all the best available information in order to better inform their daily practice. We searched MEDLINE, PubMed, PsycINFO and Cochrane databases until 31 May 2016 for systematic reviews about pharmacological and non-pharmacological treatments in adults with ADHD and carried out a meta-review to address clinically relevant questions. We identified a total of 40 papers. Psychostimulants-such as methylphenidate, dexamphetamine, mixed amphetamine salts and lisdexamfetamine-and non-psychostimulants-such as atomoxetine-were the most studied agents. Overall, pharmacological treatments were significantly more efficacious than placebo (standardised mean difference (SMD) 0.45, 95% CI 0.37 to 0.52), albeit less well accepted (OR 1.18, 95% CI 1.02 to 1.36) and tolerated (OR 2.29, 95% CI 1.97 to 2.66). The effects of pharmacological treatment for individuals with co-occurring ADHD and substance use disorder are still uncertain. The evidence for the efficacy and effectiveness of non-pharmacological treatments of ADHD in adults, as well as the combination of pharmacological and non-pharmacological strategies, is only preliminary. In conclusion, while available evidence addressed mainly the efficacy and tolerability of psychostimulants and nonpsychostimulants for ADHD core symptoms in the short term, we still need further empirical support for the non-pharmacological and multimodal treatments. A comprehensive evidence-informed hierarchy of ADHD drugs based on their efficacy and tolerability is not yet available but it should be the next research priority in the field. INTRODUCTIONAttention-deficit/hyperactivity disorder (ADHD) is one of the most common neuropsychiatric conditions, 1 with a pooled worldwide prevalence estimated at about 5% in school-aged children and persistence of impairing symptoms in adulthood in up to 65% of cases.1 The pooled estimated prevalence of ADHD (as categorical diagnosis) in adults is around 2.5%.

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Section: Resultsmentioning

confidence: 99%

Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review

Crescenzo

Cortese

Adamo

et al. 2016

Evid Based Mental Health

109

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“…29,30 Treatments were allocated with a 1:1:1:1 ratio, stratified by centre. 31 Patients and therapists were blinded for medication, but were aware of the assignment to either GPT or CM. However, the observers rating the symptoms of ADHD (using the Conner Adult ADHD Rating Scale [CAARS], the Diagnostic checklist for diagnosis of ADHD in adults and the Clinical Global Impressions Scale) were blind to the allocation of treatment.…”

Section: Randomization and Maskingmentioning

confidence: 99%

“…29,30 The results of the clinical trial are published elsewhere. 31 Neuro imaging measurements were obtained at baseline (week 0), after 3 months (week 13) and after 1 year (week 52).…”

Section: Introductionmentioning

confidence: 99%

The effect of methylphenidate intake on brain structure in adults with ADHD in a placebo-controlled randomized trial

Elst¹,

Maier²,

Klöppel³

et al. 2016

jpn

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“…In a randomized controlled trial with 419 patients, cognitive behaviour group treatment (GPT) was compared to clinical management (CM) for twelve weeks and thereafter every month for nine months. In addition, patients in the study received either central stimulants or a placebo (Philipsen et al, 2015). The results showed that pharmacological treatment was effective for core symptoms of ADHD and after three months, CM appeared superior to the structured group treatment, but long-term effects favoured GPT, especially when measuring patients´ general wellbeing, coping skills, self-esteem and acceptance.…”

Section: Psychotherapy For Adhdmentioning

confidence: 99%

“…Evidence for usefulness of psychosocial treatment in adult ADHD is inconclusive (Philipsen et al, 2015) but in combination with pharmacological medication there is evidence of efficaciousness (Skokauskas, McNicholas, Masaud, & Frodl, 2011). In a randomized controlled trial with 419 patients, cognitive behaviour group treatment (GPT) was compared to clinical management (CM) for twelve weeks and thereafter every month for nine months.…”

Section: Psychotherapy For Adhdmentioning

confidence: 99%

Psychotherapy for Substance Use Disorders – the importance of affects

Frankl¹

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Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options.The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia.In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test -a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affectfocused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design.In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cutoff between the clinical and the university student sample were calculated -3 -and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In ...

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Effects of Group Psychotherapy, Individual Counseling, Methylphenidate, and Placebo in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder

Cited by 148 publications

References 47 publications

Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review

Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review

The effect of methylphenidate intake on brain structure in adults with ADHD in a placebo-controlled randomized trial

Psychotherapy for Substance Use Disorders – the importance of affects

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