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Randomized Controlled Trial
. 2023 Dec:330:115610.
doi: 10.1016/j.psychres.2023.115610. Epub 2023 Nov 18.

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  1 , Benjamin Selaskowski  2 , Niclas Braun  2 , Victoria Fornés-Ferrer  3 , Rebekka Euscher  2 , Swantje Matthies  4 , Thomas Jans  5 , Ludger Tebartz van Elst  4 , Christian Jacob  6 , Michael Huss  7 , Esther Sobanski  8 , Wolfgang Retz  9 , Michael Roesler  10 , Petra Retz-Junginger  10 , Barbara Alm  11 , Bernhard Kis  12 , Mona Abdel-Hamid  13 , Michael Colla  14 , Mathias Berger  4 , Silke Lux  2 , Alexandra Philipsen  2
Affiliations
Randomized Controlled Trial

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 et al. Psychiatry Res. 2023 Dec.

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.

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Conflict of interest statement

Declaration of Competing Interest CL-P, VF-F, RE, PR-H, BA, and SL declare no competing financial interests. BS, NB reported receiving funding by BONFOR. SM reported having been involved in clinical trials conducted by Janssen and Lundbeck outside the submitted work. LTvE reported serving on advisory boards, delivering lectures, and receiving travel grants within the last 3 years from Eli Lilly and Co, Janssen-Cilag, Novartis, Shire, UCB, GlaxoSmithKline, Servier Laboratories, Janssen, and Cyberonics. MC reported serving on the advisory boards of Eli Lilly and Co, Janssen, and Novartis; receiving speaker honoraria from Eli Lilly and Co and Novartis; and participating in phase 3 studies with Eli Lilly and Co and Novartis outside the submitted work. CJ received speakers’ fees from Shire, Novartis and Medice and was a member of the adult ADHD Advisory Board of the latter company. CJ received speakers’ honoraria from Janssen, Novartis, Shire and Medice, and has been member of the adult ADHD Advisory Board of the two latter companies. ES is scientific advisor for Takeda Germany. MAH reported being the author and editor of diagnostic instruments published by the Hogrefe publishing group. MR reported serving as a member of the advisory boards of Medice, Eli Lilly and Co, and Janssen; serving as a member of the speakers’ bureaus of Medice, Eli Lilly and Co, Shire, and Novartis; and performing clinical studies for Medice. WR reported receiving honoraria from Medice; serving as a member of the advisory board of Medice; and participating in clinical trials sponsored by the Federal Ministry of Education and Research, Novartis, and Medice. BK reported receiving honoraria from Medice, Servier Laboratories, and Eli Lilly and Co; serving as a member of the advisory boards of Medice, Servier Laboratories, and Shire; receiving personal fees and nonfinancial support from Medice, Eli Lilly and Co, and Han-Huber publishers; and being the author and editor of book chapters on ADHD psychopathology and diagnostic instruments published by the Hogrefe publishing group. AP reported serving on the advisory board for Shire/Takeda, Boehringer, Janssen-Cilag, and Medice Arzneimittel; receiving honoraria from Takeda, Medice; receiving travel support from Janssen-Cilag; and delivering lectures, participating in phase 3 studies, and receiving travel grants from Eli Lilly and Co, Janssen-Cilag, Medice, Novartis, Shire, Boehringer; and being the author of books and articles on psychotherapy published by Elsevier, Hogrefe, Schattauer, Kohlhammer, and Karger publishers. All other authors declare no conflict of interests.

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