探索注意力缺陷/多动障碍成人患者坚持治疗、治疗可接受性与临床结果之间的关系:COMPAS 多中心随机对照试验的结果

IF 16.3 1区 医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2023-12-22 DOI:10.1159/000532043
Carlos López-Pinar, Helena Rosen, B. Selaskowski, Christian Staerk, T. Jans, Wolfgang Retz, Petra Retz-Junginger, M. Roesler, E. Sobanski, Michael Huss, S. Matthies, L. Tebartz van Elst, Mathias Berger, Christian Jacob, Bernhard Kis, Michael Colla, B. Alm, M. Abdel-Hamid, Sonia Martínez-Sanchís, E. Carbonell-Vayá, S. Lux, A. Philipsen
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引用次数: 0

摘要

简介:认知行为疗法和辩证行为疗法(DBT认知行为疗法和辩证行为疗法(DBT)可有效治疗成人多动症,患者普遍认为这些干预措施很有用。虽然根据疗程出勤率衡量的依从性基本足够,但对治疗技能的依从性尚未进行评估。此外,患者对治疗效果的评价、治疗依从性和临床结果之间的关系也未得到充分研究。研究目的本研究旨在通过一项大型随机对照试验,比较以 DBT 为基础的干预方法与非特异性的积极对比方法,以及哌醋甲酯或安慰剂,考察治疗的可接受性和依从性与治疗结果之间的关系。研究方法共有 433 名患有多动症的成年患者接受了随机对照试验。参与者报告了他们认为治疗的有效性,并通过治疗课程的出席率和自我报告来衡量坚持治疗的情况。进行了描述性分析、组间分析和线性混合模型分析。结果显示参与者将心理疗法评为中等有效,参加了 78.40%-94.37% 的疗程,并定期使用技能。接受度最高的技能是运动和正念。接受安慰剂和/或非特异性临床管理的组对其健康状况和药物疗效的评价明显低于心理疗法组和哌醋甲酯组。临床结果的改善与治疗的可接受性密切相关。心理治疗的主观(自我报告)依从性与多动症症状的改善、临床总体疗效和对治疗的反应明显相关。讨论这些结果进一步支持了 DBT 治疗成人多动症的可接受性,并表明有必要解决坚持治疗的问题,以最大限度地改善临床症状。结果可能会受到使用临时工具对治疗的可接受性和依从性进行回顾性评估的限制。
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Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial
Introduction: Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied. Objective: This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo. Method: A total of 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups, and linear mixed model analyses were conducted. Results: Participants rated psychotherapy as moderately effective, attended 78.40–94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms, clinical global efficacy and response to treatment. Discussion: These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.
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来源期刊
Psychotherapy and Psychosomatics
Psychotherapy and Psychosomatics 医学-精神病学
CiteScore
29.40
自引率
6.10%
发文量
46
期刊介绍: Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.
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