Structured Group Psychotherapy in Adults With Attention Deficit Hyperactivity Disorder

Philipsen, Alexandra; Richter, Harald; Peters, Julia; Alm, Barbara; Sobanski, Esther; Colla, Michael; Münzebrock, Mirka; Scheel, Corinna N.; Jacob, Christian; Perlov, Evgeniy; Elst, Ludger Tebartz van; Heßlinger, Bernd

doi:10.1097/nmd.0b013e31815c088b

Cited by 170 publications

(113 citation statements)

References 27 publications

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“…For example, dialectical behaviour therapy has proven efficacy in the treatment of emotional instability in people with borderline personality disorder, (38) and may also have similar effects in ADHD accompanying pharmacological treatments. (39) Further investigations are required using individual patient level data to address these questions.…”

Section: Discussionmentioning

confidence: 99%

Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis

et al. 2017

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. Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis. European Psychiatry, 44,[198][199][200][201][202][203][204][205][206][207] AbstractBackground: Emotional lability (EL) is an associated feature of attentiondeficit/hyperactivity disorder (ADHD) in adults, contributing to functional impairment. Yet the effect of pharmacological treatments for ADHD on EL symptoms is unknown. We conducted a systematic review and meta-analysis to examine the effects of stimulants and atomoxetine on symptoms of EL and compare these with the effects on core ADHD symptoms. Methods:A systematic search was conducted on the databases Embase, PsychInfo, and Ovid Medline ® and the clinicaltrials.gov website. We included randomised, double-blind, placebo-controlled trials of stimulants and atomoxetine in adults aged 18-60 years, with any mental health diagnosis characterised by emotional or mood instability, with at least one outcome measure of EL. All identified trials were on adults with ADHD. A random-effects meta-analysis with standardised mean difference and 95% confidence intervals was used to investigate the effect size on EL and compare this to the effect on core ADHD symptoms.Results: Of the 3,864 publications identified, nine trials met the inclusion criteria for the meta-analysis. Stimulants and atomoxetine led to large mean weighted effect-sizes for on ADHD symptoms (n=9, SMD= -0.8, 95% CI:-1.07 to -0.53). EL outcomes showed more moderate but definite effects (n=9, SMD= -0.41, 95% CI:-0.57 to -0.25). Conclusions:In this meta-analysis, stimulants and atomoxetine were moderately effective for EL symptoms, while effect size on core ADHD symptoms was twice as large. Methodological issues may partially explain the difference in effect size. Reduced average effect size could also reflect heterogeneity of EL with ADHD pharmacotherapy responsive and non-responsive sub-types. Our findings indicate that EL may be less responsive than ADHD symptoms overall, perhaps indicating the need for adjunctive psychotherapy in some cases. To clarify these questions, our findings need replication in studies selecting subjects for high EL and targeting EL as the primary outcome. Funding: None

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Section: Discussionmentioning

confidence: 99%

Effects of stimulants and atomoxetine on emotional lability in adults: A systematic review and meta-analysis

et al. 2017

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“…Skills from the emotion regulation module were included in a larger intervention for adults with ADHD (Philipsen et al 2007) and were among the top three skill areas (along with mindfulness and behavior analysis) in participant-rated effectiveness (Fleming and McMahon 2012). DBT skills 29 were also delivered to eight adults with ADHD in a study by Hesslinger et al (2002), who tested the feasibility of DBT against a waitlist control condition.…”

Section: Dialectical Behavior Therapy Skillsmentioning

confidence: 99%

ADHD and Emotion Dysregulation Among Children and Adolescents

Bunford

Evans

Wymbs

2015

Clin Child Fam Psychol Rev

210

161

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Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.

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“…Taken together, these results suggest that adults with ADHD obtain signifi cant benefi t from the functionally relevant and goaldirected approach of CBT. Signifi cant benefi ts have also been shown for group treatments that included similar underlying principles within a dialectical-behavioral approach (Philipsen et al 2007 ) as well as metacognitive therapy (Solanto et al 2008 ;Solanto et al 2010 ). The development of practical skills in these approaches has the potential to lead to lasting benefi ts by helping individuals cope more effectively with ADHD symptoms in multiple contexts.…”

Section: Cognitive-behavioral Therapy (Cbt)mentioning

confidence: 97%

“…Speaking with experts in the fi eld and reading scientifi cally based materials will help individuals gain an understanding about the impact of ADHD symptoms, and increase insight and empathy into their own experience (Murphy 2005 ). Adults with ADHD have rated this aspect of treatment as particularly helpful (Philipsen et al 2007 ). Ultimately, improved understanding and knowledge about the condition can assist adults with ADHD in developing realistic goals and compensatory strategies to minimize impairment.…”

Section: Psychoeducationmentioning

confidence: 98%