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Mindfulness-based cognitive therapy v. treatment as usual in adults with ADHD: a multicentre, single-blind, randomised controlled trial

Published online by Cambridge University Press:  28 February 2018

Lotte Janssen ,
Cornelis C. Kan ,
Pieter J. Carpentier ,
Bram Sizoo ,
Sevket Hepark ,
Melanie P.J. Schellekens ,
A. Rogier T. Donders ,
Jan K. Buitelaar  and
Anne E.M. Speckens
Lotte Janssen*
Affiliation:
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
Cornelis C. Kan
Affiliation:
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
Pieter J. Carpentier
Affiliation:
Reinier van Arkel, ‘s-Hertogenbosch, The Netherlands
Bram Sizoo
Affiliation:
Dimence, Deventer, The Netherlands
Sevket Hepark
Affiliation:
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
Melanie P.J. Schellekens
Affiliation:
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
A. Rogier T. Donders
Affiliation:
Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
Jan K. Buitelaar
Affiliation:
Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
Anne E.M. Speckens
Affiliation:
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
*
Author for correspondence: Lotte Janssen, E-mail: [email protected]
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Abstract

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.

Keywords

ADHD symptomsadult ADHDmental healthmindfulnessmindfulness-based cognitive therapypsychosocial treatmentrandomised controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 1 , January 2019 , pp. 55 - 65
Copyright
Copyright © Cambridge University Press 2018 

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References

Adler, LA, Faraone, SV, Spencer, TJ, Michelson, D, Reimherr, FW, Glatt, SJ et al. (2007) The reliability and validity of self and investigator ratings of ADHD in adults. Journal of Attention Disorders 11, 711–719.Google Scholar
APA (2000) Diagnostic and Statistical Manual-Text Revision (DSM-IV-TRim, 2000). Washington, DC: American Psychiatric Association.Google Scholar
Bachmann, K, Lam, AP and Philipsen, A (2016) Mindfulness-based cognitive therapy and the adult ADHD brain: a neuropsychotherapeutic perspective. Frontiers in Psychiatry 1–7. doi: 10.3389/fpsyt.2016.00117.Google Scholar
Bohlmeijer, E, Peter, M, Fledderus, M, Veehof, M and Baer, R (2011) Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment 18, 308–320.Google Scholar
Boutron, I, Estellat, C and Ravaud, P (2005) A review of blinding in randomized controlled trials found results inconsistent and questionable. Journal of Cinical Epidemiology 58, 1220–1226.Google Scholar
Cairncross, M and Miller, C (2016) The effectiveness of mindfulness-based therapies for ADHD: a meta-analytic review. Journal of Attention Disorders, 1–7. doi: 1087054715625301.Google Scholar
Crane, RS, Kuyken, W, Williams, JMG, Hastings, RP, Cooper, L and Fennell, MJ (2012) Competence in teaching mindfulness-based courses: concepts, development and assessment. Mindfulness 3, 76–84.Google Scholar
Dimidjian, S and Segal, ZV (2015) Prospects for a clinical science of mindfulness-based intervention. American Psychologist 70, 593.10.1037/a0039589Google Scholar
Edel, MA, Hölter, T, Wassink, K and Juckel, G (2017) A comparison of mindfulness-based group training and skills group training in adults with ADHD: an open study. Journal of Attention Disorders 21, 533–539.10.1177/1087054714551635Google Scholar
Faraone, SV and Glatt, SJ (2010) A comparison of the efficacy of medications for adult attention-deficit/hyperactivity disorder using meta-analysis of effect sizes. The Journal of Clinical Psychiatry 71, 754–763.Google Scholar
First, MB and Gibbon, M (2004) The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II).Google Scholar
Fox, KC, Nijeboer, S, Dixon, ML, Floman, JL, Ellamil, M, Rumak, SP et al. (2014) Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neuroscience & Biobehavioral Reviews 43, 48–73.Google Scholar
Gajria, K, Lu, M, Sikirica, V, Greven, P, Zhong, Y, Qin, P et al. (2014) Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder – a systematic literature review. Neuropsychiatric Disease and Treatment 10, 1543.Google Scholar
Gu, Y, Xu, G. & Zhu, Y. (2018) A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for College Students With ADHD. Journal of Attention Disorders 22, 388–399.Google Scholar
Hanley, AW, Abell, N, Osborn, DS, Roehrig, AD and Canto, AI (2016) Mind the gaps: are conclusions about mindfulness entirely conclusive? Journal of Counseling & Development 94, 103–113.Google Scholar
Hepark, S, Janssen, L, de Vries, A, Schoenberg, PLA, Donders, R, Kan, CC et al. (2015) The efficacy of adapted MBCT on core symptoms and executive functioning in adults with ADHD. A preliminary randomized controlled trial. Journal of Attention Disorders, 1–12. doi: 1087054715613587.Google Scholar
Huijbers, MJ, Crane, RS, Kuyken, W, Heijke, L, van den Hout, I, Donders, ART et al. (2017) Teacher competence in mindfulness-based cognitive therapy for depression and its relation to treatment outcome. Mindfulness 8, 960–972.Google Scholar
Jacobson, NS and Truax, P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12.Google Scholar
Janssen, L, De Vries, A, Hepark, S and Speckens, AEM (2017) The feasibility, effectiveness, and process of change of Mindfulness-Based Cognitive Therapy for adults with ADHD: a mixed method pilot study. Journal of Attention Disorders, 1–15. doi: 1087054717727350.Google Scholar
Janssen, L, Kan, CC, Carpentier, PJ, Sizoo, B, Hepark, S, Grutters, J et al. (2015) Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD). BMC Psychiatry 15, 1.Google Scholar
Kabat-Zinn, J (1990) Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: DeltaGoogle Scholar
Kooij, J (2010) Diagnostic Interview for ADHD in Adults 2.0 (DIVA 2.0). Adult ADHD. Diagnostic Assessment and Treatment. Amsterdam: Pearson Assessment and Information BV.Google Scholar
Kooij, SJ, Bejerot, S, Blackwell, A, Caci, H, Casas-Brugué, M, Carpentier, PJ et al. (2010) European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 10, 67.Google Scholar
Lambert, MJ, Burlingame, GM, Umphress, V, Hansen, NB, Vermeersch, DA, Clouse, GC et al. (1996) The reliability and validity of the outcome questionnaire. Clinical Psychology & Psychotherapy 3, 249–258.Google Scholar
Lamers, S, Westerhof, GJ, Bohlmeijer, ET, ten Klooster, PM and Keyes, CL (2011) Evaluating the psychometric properties of the mental health continuum-short form (MHC-SF). Journal of Clinical Psychology 67, 99–110.Google Scholar
Matheson, L, Asherson, P, Wong, ICK, Hodgkins, P, Setyawan, J, Sasane, R et al. (2013) Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study. BMC Health Services Research 13, 184.Google Scholar
Mitchell, JT, McIntyre, EM, English, JS, Dennis, MF, Beckham, JC and Kollins, SH (2017) A pilot trial of mindfulness meditation training for ADHD in adulthood: impact on core symptoms, executive functioning, and emotion dysregulation. Journal of Attention Disorders 21, 1105–1120.Google Scholar
Mitchell, JT, Zylowska, L and Kollins, SH (2015) Mindfulness meditation training for attention-deficit/hyperactivity disorder in adulthood: current empirical support, treatment overview, and future directions. Cognitive and Behavioral Practice 22, 172–191.Google Scholar
Moriyama, TS, Polanczyk, GV, Terzi, FS, Faria, KM and Rohde, LA (2013) Psychopharmacology and psychotherapy for the treatment of adults with ADHD – a systematic review of available meta-analyses. CNS Spectrums 18, 296–306.Google Scholar
NICE (2009) Attention Deficit Hyperactivity Disorder: The NICE Guideline on Diagnosis and Management of ADHD in Children, Young People and Adults. London: The British Psychological Society and the Royal College of Psychiatrists.Google Scholar
NVvP (2015) Richtlijn ADHD bij volwassenen: fase 1 – diagnostiek en medicamenteuze behandeling [guidelines ADHD in adults: phase 1 – diagnostics and pharmacotherapy]. (https://www.nvvp.net/website/nieuws/2015/monodisciplinaire-richtlijn-adhd-bij-volwassenen-fase-1-gepubliceerd) Dutch Association for Psychiatry.Google Scholar
Philipsen, A, Jans, T, Graf, E, Matthies, S, Borel, P, Colla, M et al. (2015) Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder: a randomized clinical trial. JAMA Psychiatry 72, 1199–1210.Google Scholar
Raes, F, Pommier, E, Neff, KD and Van Gucht, D (2011) Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology & Psychotherapy 18, 250–255.Google Scholar
Ramos-Quiroga, JA and Casas, M (2011) Achieving remission as a routine goal of pharmacotherapy in attention-deficit hyperactivity disorder. CNS Drugs 25, 17–36.Google Scholar
Roth, RM and Gioia, GA (2005) Behavior rating inventory of executive function – adult version. Lutz, FL: Psychological Assessment Resources.Google Scholar
Schoenberg, PLA, Hepark, S, Kan, CC, Barendregt, HP, Buitelaar, JK and Speckens, AEM (2014) Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder. Clinical Neurophysiology 125, 1407–1416.10.1016/j.clinph.2013.11.031Google Scholar
Segal, ZV, Williams, JMG and Teasdale, JD (2012) Mindfulness-based Cognitive Therapy for Depression. New York: Guilford Press.Google Scholar
Simon, V, Czobor, P, Balint, S, Meszaros, A and Bitter, I (2009) Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. British Journal of Psychiatry 194, 204–211.Google Scholar
Tang, Y-Y, Holzel, BK and Posner, MI (2015) The neuroscience of mindfulness meditation. Nature Reviews Neuroscience 16, 213–225.10.1038/nrn3916Google Scholar
UMHS (2013) Attention-Deficit Hyperactivity Disorder: Guidelines for Clinical Care Ambulatory. (www.med.umich.edu/1info/FHP/practiceguides/adhd/adhd.pdf)Google Scholar
Van Vliet, I and De Beurs, E (2007) Het Mini Internationaal Neuropsychiatrisch Interview (MINI). Een kort gestructureerd diagnostisch psychiatrisch interview voor DSM-IV en ICD-10 stoornissen [The Mini International Neuropsychiatric Interview (MINI). A short structured diagnostic psychiatric interview for DSM-IV and ICD-10 disorders]. Tijdschrift voor Psychiatrie 49, 5.Google Scholar
Wigal, SB (2009) Efficacy and safety limitations of attention-deficit hyperactivity disorder pharmacotherapy in children and adults. Cns Drugs 23, 21–31.Google Scholar
Young, Z, Moghaddam, N and Tickle, A (2016) The efficacy of cognitive behavioral therapy for adults with ADHD. A systematic review and meta-analysis of randomized controlled trials. Journal of Attention Disorders, 1–14. doi: 1087054716664413.Google Scholar
Zylowska, L, Ackerman, DL, Yang, MH, Futrell, JL, Horton, NL, Hale, TS et al. (2008) Mindfulness meditation training in adults and adolescents with ADHD a feasibility study. Journal of Attention Disorders 11, 737–746.Google Scholar
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