Efficacy of Cognitive Behavioral Therapy With and Without Medication for Adults With ADHD: A Randomized Clinical Trial

Summary & key facts

This randomized clinical trial tested 12 sessions of manualized group cognitive behavioral therapy (CBT) with individual coaching in 88 adults with ADHD. Participants were randomly assigned to CBT alone (n = 46) or CBT plus medication (n = 42). The combined treatment produced greater improvements in ADHD symptoms, organizational skills, and self‑esteem right after treatment. Differences between the groups became smaller by the 3‑ and 6‑month follow‑ups because the CBT‑alone group kept improving while the combined group kept their gains. Outcomes were based on unblinded self‑reports and observer ratings.

Key facts:

• The study was a randomized clinical trial that included 88 adults with ADHD.
• Participants received 12 manualized group CBT sessions plus individual coaching.
• One group received CBT alone (n = 46). The other group received CBT plus medication (n = 42).
• CBT combined with medication led to greater improvements than CBT alone in ADHD symptoms, organizational skills, and self‑esteem, according to the study abstract.
• Researchers measured outcomes at the end of treatment and again at 3‑month and 6‑month follow‑ups.
• Outcome ratings were unblinded self‑reports and observer ratings, which the authors report and which can be a source of bias.

Abstract

Objective: Recent trials have demonstrated efficacy of cognitive behavioral therapy (CBT) in medicated adults with ADHD. Efficacy of CBT in unmedicated versus medicated adults remains mostly unknown. We evaluated the effects of group CBT alone versus combined with medication on ADHD symptoms and functional outcomes in adult patients. Method: Eighty-eight adults with ADHD received 12 manualized group CBT sessions, accompanied by individual coaching, either without (n = 46) or with (n = 42) medication. Treatment effects were evaluated following treatment and 3-month and 6-month follow-up using un-blinded self-report and observer ratings. Results: CBT + medication resulted in greater improvements than CBT alone in ADHD symptoms, organizational skills, and self-esteem. Group differences diminished over follow-up, as the CBT alone group continued improving, while the combined group maintained the gains. Conclusion: CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.

Topics

Attention Deficit Hyperactivity Disorder Behavioral and Psychological Studies Neural and Behavioral Psychology Studies

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Clinical psychology Coaching Cognition Cognitive behavioral therapy Internal medicine Medicine Physical therapy Psychiatry Psychology Psychotherapist Randomized controlled trial