Efficacy of CBT for Residual ADHD in Adults

CBT 对成人残余多动症的疗效

• 批准号: 6818824
• 负责人: Steven A Safren
• 金额: $ 39.19万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-05 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6818824
• 关键词: adult human (21+); anxiety; attention deficit disorder; audiotape; clinical research; cognitive behavior therapy; combination therapy; depression; functional ability; human subject; human therapy evaluation; interview; longitudinal human study; mental disorder chemotherapy; mental disorder diagnosis; patient oriented research; stimulant /agonist

DESCRIPTION (provided by applicant): This is an amended application for first efficacy trial of a psychosocial intervention to treat Attention Deficit Hyperactivity Disorder (ADHD) in adults. This will be the principal investigator's first independent R01, hence meeting the NIH guidelines for the new investigator designation. The psychosocial intervention is based on our successful pilot study and on current conceptual models of adult ADHD. It is a cognitive-behavioral treatment targeting symptoms of ADHD in adults who remain symptomatic after adequate and stable medication treatment. Ten years of study by our research team and others - including controlled studies of stimulant medications and open studies of tricyclic, monoamine oxidase inhibitor, and atypical antidepressants - reveal that 20-50% of adults are considered nonresponders to psychopharmacotherapy due to insufficient symptom reduction or inability to tolerate side-effects. Moreover, adults who do respond to treatment typically show a reduction in only 50% or fewer of the core symptoms of ADHD. This leaves pharmacologically-treated patients with residual symptoms which cause significant distress and functional impairment. The current application builds on our pilot work, which followed NIMH guidelines for completing stages of psychosocial intervention development necessary before proposing an (R01) efficacy trial. We conceptualized the novel intervention based on theories of ADHD and cognitive behavioral therapy, developed and standardized a CBT treatment manual with expert consultation, and provided evidence for its feasibility, patient acceptability, and clinical utility by conducting a pilot randomized controlled trial of the CBT compared to maintenance psychopharmacology alone. The goal of the pilot was to estimate the effect size of the CBT intervention (versus attempting to find statistically significant improvement in such a small sample). Results revealed large effect sizes that reached clinical and statistical significance. Patients in the CBT condition had greater reductions in global severity as well as in core ADHD symptoms. Endpoints were ratings by a blinded independent assessor and patient self-report data. We propose to build on this work by conducting an adequately-powered efficacy study comparing CBT to a credible, placebo-control psychotherapy.

描述（由申请人提供）：这是对心理社会干预的首次疗效试验的修订申请，以治疗成人注意力缺陷多动障碍（ADHD）。 这将是首席研究员的第一个独立R01，因此符合新调查员指定的NIH指南。社会心理干预基于我们成功的试点研究和当前成人多动症的概念模型。这是一种靶向ADHD症状的认知行为治疗，在适当稳定的药物治疗后仍然有症状的成年人。我们的研究团队和其他人的十年研究 - 包括对刺激药物的受控研究和对三环，单胺氧化酶抑制剂和非典型抗抑郁药的开放研究，发现20-50％的成年人被认为是由于症状减少或无能为力或无能为力或无能为力的心理药物治疗而被认为是无反应的。 耐受副作用。此外，对治疗做出反应的成年人通常仅显示 多动症的核心症状中有50％或更少。这使经过药理学治疗的患者患有残留症状，造成严重的困扰和功能障碍。当前的申请基于我们的试点工作，该申请遵循了NIMH指南，即在提出（R01）疗效试验之前完成了必要的社会心理干预开发阶段。我们根据多动症和认知行为疗法的理论概念化了新的干预措施，并通过专家咨询制定并标准化了CBT治疗手册，并通过进行CBT的Pilot随机对照试验与单独的维护心理药物相比，提供了其可行性，患者可接受性和临床实用性的证据。飞行员的目的是估计 CBT干预的效果大小（与试图在这么小样本中找到统计学上显着改善的相比）。结果表明，具有临床意义和统计显着性的大小大小。处于CBT状况的患者的全球严重程度以及核心多动症症状的降低。终点是盲目的独立评估者和患者自我报告数据的评分。我们建议通过进行充分动力的功效研究来基于这项工作。 CBT进行可信的安慰剂控制心理治疗。