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.

中文翻译：

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探索成人注意力缺陷/多动症患者的治疗依从性、治疗可接受性和临床结果之间的关系：COMPAS 多中心随机对照试验的结果。


简介 认知行为疗法和辩证行为疗法 (DBT) 可有效治疗成人 ADHD，患者普遍认为这些干预措施有用。虽然通过参加会议来衡量的依从性基本上已经足够，但对治疗技能的依从性尚未得到评估。此外，患者对治疗效果的评估、治疗依从性和临床结果之间的关系尚未得到充分研究。目的 本研究旨在通过一项大型随机对照试验来检查治疗可接受性和依从性与治疗结果的关系，该试验将基于 DBT 的干预措施与联合哌醋甲酯或安慰剂的非特异性积极干预措施进行比较。方法 总共 433 名成年 ADHD 患者被随机分组​​。参与者报告了他们发现治疗的效果如何，并通过参加治疗课程和自我报告来衡量依从性。进行了描述性、组间和线性混合模型分析。结果 参与者将心理治疗评为中等有效，参加了 78.40-94.37% 的课程，并定期使用技能。最受接受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的健康状况和药物疗效明显低于心理治疗组和哌醋甲酯组。临床结果的改善与治疗可接受性显着相关。主观（自我报告）对心理治疗的依从性与 ADHD 症状、临床整体疗效和治疗反应的改善显着相关。 讨论 这些结果进一步支持 DBT 治疗成人 ADHD 的可接受性，并表明需要解决治疗依从性问题，以最大限度地提高临床改善。结果可能会受到使用专门仪器对治疗可接受性和依从性的回顾性评估的限制。