Exploring the efficacy of dialectical behaviour therapy and methylphenidate on emotional comorbid symptoms in adults with attention Deficit/Hyperactivity disorder: Results of the COMPAS multicentre randomised controlled trial

Carlos López-Pinar; Benjamin Selaskowski; Niclas Braun; Victoria Fornés-Ferrer; Rebekka Euscher; Swantje Matthies; Thomas Jans; Ludger Tebartz van Elst; Christian Jacob; Michael Huss; Esther Sobanski; Wolfgang Retz; Michael Roesler; Petra Retz-Junginger; Barbara Alm; Bernhard Kis; Mona Abdel-Hamid; Michael Colla; Mathias Berger; Silke Lux; Alexandra Philipsen

doi:10.1016/j.psychres.2023.115610

Exploring the efficacy of dialectical behaviour therapy and methylphenidate on emotional comorbid symptoms in adults with attention Deficit/Hyperactivity disorder: Results of the COMPAS multicentre randomised controlled trial

Psychiatry Res. 2023 Dec:330:115610. doi: 10.1016/j.psychres.2023.115610. Epub 2023 Nov 18.

Authors

Carlos López-Pinar¹, Benjamin Selaskowski², Niclas Braun², Victoria Fornés-Ferrer³, Rebekka Euscher², Swantje Matthies⁴, Thomas Jans⁵, Ludger Tebartz van Elst⁴, Christian Jacob⁶, Michael Huss⁷, Esther Sobanski⁸, Wolfgang Retz⁹, Michael Roesler¹⁰, Petra Retz-Junginger¹⁰, Barbara Alm¹¹, Bernhard Kis¹², Mona Abdel-Hamid¹³, Michael Colla¹⁴, Mathias Berger⁴, Silke Lux², Alexandra Philipsen²

Affiliations

¹ Department of Psychobiology and Basic Psychology, University of Valencia, Valencia, Spain; Department of Psychology, European University of Valencia, Valencia, Spain. Electronic address: carloslopez.pinar@universidadeuropea.es.
² Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.
³ Tau Analytics, Statistics, Data Science and Bio-computing. Valencia, Spain.
⁴ Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Germany.
⁵ Centre of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany.
⁶ Department of Psychiatry and Psychotherapy, Medius Hospital of Kirchheim, Kirchheim unter Teck, Germany.
⁷ Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
⁸ Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany; Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
⁹ Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany; Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Mainz, Germany.
¹⁰ Institute for Forensic Psychology and Psychiatry, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
¹¹ Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
¹² Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth Hospital Niederwenigern, Contilia Group, Hattingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
¹³ Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
¹⁴ Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Switzerland.

PMID: 37992514
DOI: 10.1016/j.psychres.2023.115610

Abstract

This study evaluated the efficacy of dialectical behaviour group therapy (GPT) vs. individual clinical management (CM) and methylphenidate (MPH) vs. placebo (PLB) on emotional symptoms in adults with ADHD. This longitudinal multicentre RCT compared four groups (GPT+MPH, GPT+PLB, CM+MPH, and CM+PLB) over five assessment periods, from baseline to week 130. Emotional symptomatology was assessed using SCL-90-R subscales. Of the 433 randomised participants, 371 remained for final analysis. At week 13, the GPT+MPH group showed smaller reductions in anxiety symptoms than the CM groups, but the differences disappeared at subsequent assessments. Improvements in emotional symptom were significantly predicted by reductions in core ADHD symptoms in all groups except the GPT+MPH group. The unexpected lack of between-group differences may be explained by a "floor effect", different intervention settings (group vs. individual), and psychotherapy type. Multiple regression analyses suggest a more specific effect of combined interventions (GPT+MPH). Implications for clinical practice are discussed. Clinical trial registration: ISRCTN54096201 (Current Controlled Trials).

Keywords: Adult ADHD; Comorbidity; Emotional disorders; Psychotherapy; Stimulant medication.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / drug therapy
Central Nervous System Stimulants* / pharmacology
Central Nervous System Stimulants* / therapeutic use
Dialectical Behavior Therapy*
Double-Blind Method
Emotions
Humans
Methylphenidate* / pharmacology
Methylphenidate* / therapeutic use
Treatment Outcome

Substances

Central Nervous System Stimulants
Methylphenidate