درمان شناختی-رفتاری – روشی که مهارت های مقابله با چالش های زندگی و تغییر الگوهای افکار منفی را می آموزد – در کنار درمان های دارویی تاثیر چشمگیری در کنترل عارضه های اختلال کاستی توجه و بیش فعالیADHD در بزرگسالان داشت. این مطلب را پژوهشگران بیمارستان عمومی ماساچوست در مقاله ای که در شماره 25 آگوست "ژورنال اف آمریکن مدیکال اسوسییشن" انتشار یافت گزارش کردند.
دکتر استیون سفرن ... مدیر پزشکی رفتاری در بخش روان پزشکی بیمارستان عمومی ماساچوست که این مطالعه را هدایت کرد توضیح داد: "داروها در پایین آوردن فتیله عوارض ADHD خیلی موثر است، اما داروها مهارت ها را به افراد یاد نمی دهد." او افزود: "این مطالعه نشان می دهد که روش مبتنی بر مهارت ها می تواند به بیماران کمک کند تا بیاموزند چگونه با مشکل های توجهی مقابله کرده و این اختلال مهم و از کار اندازنده را تحت کنترل بیاورند."
بیش از 4 درصد بزرگسالان در ایالات متحده مبتلا به ADHD هستند و در حالی که محرک ها و دیگر داروهای روان پزشکی درمان اولین و اصلی محسوب می شود، نویسندگان این مطالعه توجه می دهند که تعداد قابل توجهی از بیمارانی که از داروها مصرف کرده و جواب می گیرند هنوز با عارضه های ادامه دار مشکل دارند. مطالعه های معدودی درمان روان-اجتماعی برای ADHD را مورد پژوهش قرار داده و اگرچه بعضی از آنها پیشنهاد کرده است که درمان شناختی-رفتاری برای ADHD مفید است، آن مطالعه ها کوچک و کوتاه مدت بوده است.
... این مطالعه از افرادی ثبت نام کرد که مبتلا به ADHD بوده و در حالی که از دارویی برای بیماری خود استفاده می کردند از عوارض کاهش یافته اما هنوز چشمگیر ADHD رنج می بردند. شرکت کنندگان که به طور تصادفی به یکی از دو روش درمانی فرستاده شده بودند در 12 جلسه هفتگی انفرادی با یک روانشناس یا همکار روانشناس شرکت کردند. گروه کنترل آموزش هایی در مورد شل کردن عضله ها و دیگر تکنیک های آرمیدگی، آموزش در مورد کاربرد آرمیدگی در ADHD ، و روان درمانی حمایتی دریافت کرد. نشست های درمان شناختی رفتاری شامل آموزش مهارت هایی در زمینه هایی مانند سازماندهی، و ایجاد افکار سازگارانه در پاسخ به موقعیت های استرس آور بود. ...
Cognitive Behavior Therapy Improves Symptom Control in Adult ADHD
Main Category: ADHD
MNT | Article Date: 27 Aug 2010 - 4:00 PDT
Adding cognitive behavioral therapy -- an approach that teaches skills for handling life challenges and revising negative thought patterns -- to pharmaceutical treatment for attention-deficit hyperactivity disorder (ADHD) significantly improved symptom control in a study of adult patients. The report from Massachusetts General Hospital (MGH) researchers appear in the August 25 Journal of the American Medical Association.
"Medications are very effective in 'turning down the volume' on ADHD symptoms, but they do not teach people skills," explains Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry, who led the study. "This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder."
More than 4 percent of adults in the U.S. have ADHD, and while stimulants and other psychiatric medications are the primary first-line treatment, the study authors note that a significant number of patients who take and respond to these medication are still troubled by continuing symptoms. A few studies have investigated psychosocial treatment for ADHD, and although some have suggested benefits from cognitive behavioral therapy, they were small and short-term. The current study is believed to be the first full-scale randomized, controlled trial of the effectiveness of an individually-delivered, non-medication treatment of ADHD in adults.
The study enrolled adults diagnosed with ADHD who reported reduced but still significant symptoms while taking an ADHD medication. Randomly assigned to one of two therapeutic approaches, participants attended 12 weekly one-on-one counseling sessions with a psychologist or psychology fellow. The control group received training in muscle relaxation and other relaxation techniques, education on how to apply relaxation to ADHD symptoms, and supportive psychotherapy. The cognitive behavioral therapy sessions included skills training in areas such as organization and planning, setting priorities and problem solving, coping with distractions, and developing adaptive thought responses to stressful situations.
"Sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit," Safren says. "The treatment is half like taking a course and half like being in traditional psychotherapy."
Symptom assessments conducted at the end of the 12-week treatment period revealed that participants receiving cognitive behavioral therapy had significantly better symptom control than did those receiving relaxation training, benefits that were maintained three and nine months later. A standard rating scale for ADHD symptoms showed a 30 percent reduction in symptoms in more than two thirds of the cognitive behavioral therapy group but in only one third of the relaxation group.
"We know that ADHD medications are effective for patients who can take them, and without medications it would be harder to learn the skills taught in this study," Safren adds. "But we have shown that learning self-management skills can help reduce symptoms even further. Now we need to determine the best ways to train clinicians in this approach and the best time to introduce this treatment, along with exploring other ways to help patients who did not benefit." Safren is an associate professor of Psychology in the Harvard Medical School Department of Psychiatry.
Additional co-authors of the study, which was supported by a grant from the National Institute of Mental Health, are Susan Sprich, PhD, Matthew Mimiaga, ScD, MPH, Craig Surman, MD, Laura Knouse, PhD, and Meghan Groves -- all of MGH Psychiatry -- and Michael Otto, PhD, formerly of MGH Psychiatry and now at Boston University.
Source: Massachusetts General Hospital