Adding talk therapy to meds may ease adult ADHD

NEW YORK (Reuters Health) - Adults with attention deficit hyperactivity disorder (ADHD) who still have symptoms despite taking medications might benefit from "talk therapy," also known as cognitive behavioral therapy, or CBT, according to a study released Tuesday.

Among a group of adults whose ADHD symptoms were not adequately controlled with medication, those who were treated with one-on-one CBT reduced their symptoms more than those who had sessions in relaxation and ADHD education, researchers found.

The results support another recent study in which a similar type of group-based therapy also helped adults with ADHD (see Reuters Health story of March 31, 2010: Behavioral therapy may aid adult ADHD).

About 4.4 percent of adults in the United States have ADHD, the authors note in the study, which is published in the Journal of the American Medical Association. The most common treatment for adult ADHD is medications like Adderall and Ritalin. But medication isn't always enough.

"Meds are effective in turning the volume down on symptoms, however usually they don't do everything," Dr. Steven Safren, the lead author on the study from Massachusetts General Hospital in Boston told Reuters Health. His team wanted to see if adding therapy to a patient's medication regimen would help patients deal with those lingering symptoms.

CBT is based on the idea that "what we think and how we interpret our environment affects our behavior (and) affects how we act and how we feel," Dr. John Piacentini, a psychiatrist at the University of California, Los Angeles who was not involved in the study, told Reuters Health.

CBT helps patients break down problems that otherwise might seem overwhelming into small steps, and encourages them to recognize negative thoughts and feelings and rethink how they're approaching a situation, he said.

Safren and his colleagues divided 86 adults with ADHD symptoms that had persisted despite medication into two groups. Patients in one group went to 12 individual CBT sessions over about 3 months, while patients in the other group had 12 treatment sessions that focused on relaxation techniques, education about ADHD, and support.

Over the course of the study, patients regularly filled out self-reports about their symptoms. They also met with a member of the research team who rated their symptoms before and right after treatment, as well as 3 and 9 months later.

These evaluations showed that between half and two-thirds of patients getting CBT improved over the course of the 12 therapy sessions, compared to one-third or less of the group getting relaxation and education therapy.

Adults in both groups maintained the improvements they had made 9 months after treatment ended.

That shows that teaching people with ADHD to change their way of thinking and their behavior can help them make real changes in their lives, Piacentini said.

"The medication only works while you're taking it," he explained. "The benefits of CBT are that the patients in the study were learning techniques that they can use lifelong."

The findings "represent a huge step forward in the psychosocial treatment research for adults with ADHD," Dr. J. Russell Ramsay, the associate director of the University of Pennsylvania School of Medicine's ADHD Treatment and Research Program, told Reuters Health.

The study shows that CBT can help patients when medication doesn't improve some of the symptoms that interfere with their daily functioning, such as poor organization and time management skills, he noted.

Ramsay, who was not involved in the study, added that now that researchers have evidence that CBT on top of medication can help adults with ADHD, it's time to see if patients who don't take medication can also benefit. That's important because some people either prefer not to treat their ADHD with drugs or are unable to take medications, he said.

For now, Safren says that people with ADHD can apply his team's results to their own lives. "If you are an adult and you have ADHD and you're prescribed medications and you still have symptoms," he said, "you should ask your provider to look into using this or a similar cognitive behavior approach to help you get even better."

SOURCE: http://link.reuters.com/xyg86n JAMA/Journal of the American Medical Association, August 25, 2010.