A comparison of efficacy between cognitive behavioral therapy (CBT) and CBT combined with medication in adults with ADHD

A comparison of efficacy between cognitive behavioral therapy (CBT) and CBT combined with medication in adults with ADHD

Pan MR, Huang F, Zhao MJ, Wang YF, Wang YF, Qian QJ.

Psychiatry Res. 2019 Jun 29;279:23-33.

doi: 10.1016/j.psychres.2019.06.040.

Commentary* by Dr. Margaret Weiss: Core symptoms of ADHD improved with CBT for adult ADHD with and without medication, but executive function improved more in those who had CBT and medication than those who had CBT without medication. Improvement in executive function may require both improvement in symptoms and skills-based training.

ABSTRACT

The study aimed to explore whether cognitive behavioral therapy (CBT) combined with medication is superior to CBT alone in core symptoms, emotional symptoms, self-esteem as well as social and cognitive functions of adult attention-deficit/hyperactivity disorder (ADHD) patients.

Samples from a previous RCT study and outpatient participants were all included. A total of 124 patients received 12 weeks of manualized CBT sessions, either with (n = 57) or without (n = 67) medication. Efficacy variables were evaluated at baseline and each week. Mixed linear models (MLM) were used to compare differences between the two groups in all of the above domains. Within-group comparisons showed that both groups had robust improvements in core ADHD symptoms, emotional symptoms and social functional outcomes.

The CBT + M group presented more domains of improvement in executive functions than the CBT group. However, comparisons between groups didn’t indicate the superiority of CBT + M in core symptoms, emotional symptoms and self-esteem. Instead, the CBT group showed a greater improvement in the physical domain of the WHOQOL-BREF than the CBT + M group. This study further indicated that CBT is an effective treatment for adults with ADHD. A combination of CBT and medication presented broader improvements in executive functions, but not in clinical symptoms, than CBT alone.

* Abstracts are selected for their clinical relevance by Dr. Margaret Weiss, Director of Clinical Research, Child Psychiatry, Cambridge Health Alliance, Harvard University. Her commentary reflects her own opinion, is not approved, or necessarily representative, of the opinion of the CADDRA board.