Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial

Carlos López-Pinar; Helena Rosen; Benjamin Selaskowski; Christian Staerk; Thomas Jans; Wolfgang Retz; Petra Retz-Junginger; Michael Roesler; Esther Sobanski; Michael Huss; Swantje Matthies; Ludger Tebartz van Elst; Mathias Berger; Christian Jacob; Bernhard Kis; Michael Colla; Barbara Alm; Mona Abdel-Hamid; Sonia Martínez-Sanchís; Enrique Carbonell-Vayá; Silke Lux; Alexandra Philipsen

doi:10.1159/000532043

Exploring the Relationship between Adherence to Therapy, Treatment Acceptability, and Clinical Outcomes in Adults with Attention-Deficit/Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial

Psychother Psychosom. 2024;93(1):46-64. doi: 10.1159/000532043. Epub 2023 Dec 22.

Authors

Carlos López-Pinar^{1

2}, Helena Rosen³, Benjamin Selaskowski³, Christian Staerk⁴, Thomas Jans⁵, Wolfgang Retz^{6

7}, Petra Retz-Junginger⁶, Michael Roesler⁶, Esther Sobanski^{6

7}, Michael Huss⁷, Swantje Matthies⁸, Ludger Tebartz van Elst⁸, Mathias Berger⁸, Christian Jacob^{9

10}, Bernhard Kis^{11

12

13}, Michael Colla¹⁴, Barbara Alm¹⁵, Mona Abdel-Hamid^{13

16}, Sonia Martínez-Sanchís¹, Enrique Carbonell-Vayá¹, Silke Lux³, Alexandra Philipsen³

Affiliations

¹ Departments of Basic Psychology and Psychobiology, University of Valencia, Valencia, Spain.
² Department of Psychology, European University of Valencia, Valencia, Spain.
³ Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.
⁴ Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany.
⁵ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.
⁶ Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
⁷ Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
⁸ Department of Psychiatry and Psychotherapy Medical Center, University of Freiburg, Faculty of Medicine University of Freiburg, Freiburg im Breisgau, Germany.
⁹ Clinic for Psychiatry and Psychotherapy, Medius Clinic, Kirchheim, Germany.
¹⁰ Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
¹¹ Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany.
¹² Department of Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany.
¹³ Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
¹⁴ Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland.
¹⁵ Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
¹⁶ Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.

PMID: 38142690
DOI: 10.1159/000532043

Abstract

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.

Keywords: Acceptability; Adherence; Adult attention-deficit/hyperactivity disorder; Cognitive behavioral therapy; Dialectical behavior therapy.

Publication types

Randomized Controlled Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / drug therapy
Cognitive Behavioral Therapy*
Humans
Methylphenidate* / therapeutic use
Retrospective Studies
Treatment Outcome

Substances

Methylphenidate