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Mindfulness vs psychoeducation in adult ADHD: a randomized controlled trial

  • E. Hoxhaj
  • C. Sadohara
  • P. Borel
  • R. D’Amelio
  • E. Sobanski
  • H. Müller
  • B. Feige
  • S. Matthies
  • Alexandra Philipsen
Original Paper

Abstract

Background

Mindfulness training is a promising treatment approach in adult ADHD. However, there has not yet been a randomized controlled trial comparing mindfulness to an active control condition. In this study, we assessed the efficacy of a mindfulness training program (MAP) compared to structured psychoeducation (PE).

Methods

After randomization 81 medication-free adult ADHD patients participated either in an 8-week MAP or PE group program. At baseline (T1), after 8 weeks (T2) and after 8 months (T3), severity of ADHD and associated symptoms (depression, general psychopathology, quality of life) were measured with the Conner’s ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Brief Symptom Inventory (BSI) and the SF-36 by self and blind observer ratings.

Results

Both groups showed significant pre–post improvements in observer-rated Inattention scale (p < .001, partial η2 = 0.18) and in associated symptomatology, which persisted through 6 months of follow-up. There were no significant differences regarding symptom reduction between the treatment groups. Women benefited more compared to men irrespective of treatment group. Men showed the most pronounced changes under MAP.

Conclusions

In the current study, MAP was not superior to PE regarding symptom reduction in adult ADHD. Both interventions, mindfulness meditation and PE, were efficacious in reducing symptom load in adult ADHD. Furthermore in exploratory post hoc tests the study provides evidence for a potential gender-specific treatment response in adult ADHD.

Keywords

Adult ADHD Mindfulness Psychoeducation Psychotherapy Gender 

Notes

Compliance with ethical standards

Conflict of interest

E. Hoxhaj, C. Sadohara, P. Borel, B. Feige and H. Müller declare that they have no conflicts of interest. R. D’Amelio has authored books and articles on adult ADHD published by Kohlhammer and Elsevier. S. Matthies received a speakers’ fee from Janssen-Cilag and was involved in clinical trials conducted by Janssen-Cilag and Lilly as a study physician in years 2007–2009. She has no conflicts of interest since that time. E. Sobanski has served on advisory boards of MEDICE Arzneimittel Pütter GmbH and Co. KG, Eli Lilly and Co and Shire. A. Philipsen has served on advisory boards, given lectures, performed phase 3 studies, or received travel grants within the last 5 years from Eli Lilly and Co, Janssen-Cilag, MEDICE Arzneimittel Pütter GmbH and Co KG, Lundbeck, Novartis, Servier and Shire; and has authored books and articles on psychotherapy published by Elsevier, Hogrefe, Schattauer, Kohlhammer, Karger, Springer, and Oxford Press.

Supplementary material

406_2018_868_MOESM1_ESM.pdf (102 kb)
Supplementary material 1 (PDF 102 KB)

References

  1. 1.
    Willcutt EG (2012) The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9(3): 490–499CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    de Zwaan M, Gruß B, Müller A, Graap H, Martin A, Glaesmer H, Hilbert A, Philipsen A (2012 Feb) The estimated prevalence and correlates of adult ADHD in a German community sample. Eur Arch Psychiatry Clin Neurosci 262(1):79–86CrossRefPubMedGoogle Scholar
  3. 3.
    Volkow ND, Swanson JM (2013) Clinical practice. Adult attention deficit-hyperactivity disorder. N Engl J Med 369(20):1935–1944CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    National Institute for Health and Care Excellence (2017). Attention deficit hyperactivity disorder: diagnosis and management (NG 72). https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/attention-deficit-disorder. Accessed 2017
  5. 5.
    Wilens T, Spencer T, Biederman J (2002 Mar) A review of the pharmacotherapy of adults with attention-deficit/hyperactivity disorder. J Atten Disord 5(4):189–202CrossRefPubMedGoogle Scholar
  6. 6.
    Knouse LE, Safren SA (2011) Psychosocial treatment of adults with attention deficit hyperactivity disorder. In: Evans SW, Hoza B (eds) Treating attention deficit hyperactivity disorder: assessment and intervention in development context. Civic Research Institute, Kingston, pp 12-1–2-21Google Scholar
  7. 7.
    Philipsen A (2013) Gruppenpsychotherapie bei Aufmerksamkeitsdefizit Hyperaktivitätsstörung im Erwachsenenalter. J Neurol Neurochir Psychiatr 14(2):69–75Google Scholar
  8. 8.
    Zylowska L, Ackerman DL, Yang MH, Futrell JL, Horton NL, Hale TS et al (2008) Mindfulness meditation training in adults and adolescents with ADHD. J Atten Disord 11(6): 737–746CrossRefPubMedGoogle Scholar
  9. 9.
    Krisanaprakornkit T, Ngamjarus C, Witoonchart C, Piyavhatkul N (2016) Meditation therapies for attention deficit/hyperactivity disorder (ADHD). Cochrane Database Syst Rev 16(6):CD006507Google Scholar
  10. 10.
    Gu Y, Xu G, Zhu Y (2016) A randomized controlled trial of mindfulness-based cognitive therapy for college students with ADHD. J Atten Disord.  https://doi.org/10.1177/1087054716686183 PubMedCrossRefGoogle Scholar
  11. 11.
    Mitchell JT, Mclntyre E, Joseph E, Dennis M, Beckham J, Kollins SH (2013) A pilot trial of mindfulness meditation training for ADHD in adulthood: impact on core symptoms, executive functioning, and emotion dysregulation. J Atten Disord.  https://doi.org/10.1177/1087054713513328 CrossRefPubMedGoogle Scholar
  12. 12.
    Philipsen A, Richter H, Peters J, Alm B, Sobanski E, Colla M et al ( 2007) Structured group psychotherapy in adults with attention deficit hyperactivity disorder—results of an open multicentre study. J Nerv Ment Dis 195(12):1013–1019CrossRefPubMedGoogle Scholar
  13. 13.
    Schoenberg PL, Hepark S, Kan CC, Barendregt HP, Buitelaar JK, Speckens AE (2014) Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder. Clin Neurophysiol 125(7):1407–1416CrossRefPubMedGoogle Scholar
  14. 14.
    Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U (2011) How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. ‎Perspect Psychol Sci 6(6):537–559.  https://doi.org/10.1177/1745691611419671 CrossRefPubMedGoogle Scholar
  15. 15.
    Shapiro SL, Carlson LE, Astin JA, Freedman B (2006) Mechanisms of mindfulness. J Clin Psychol 62(3):373–386.  https://doi.org/10.1002/jclp.20237 CrossRefPubMedGoogle Scholar
  16. 16.
    Barkley RA (2010) Deficient emotional self-regulation is a core component of attention-deficit/hyperactivity disorder. J ADHD Relat Disord:5–37Google Scholar
  17. 17.
    Barkley RA, Fischer M (2010) The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry49(5):503–513.  https://doi.org/10.1016/j.jaac.2010.01.019 PubMedCrossRefGoogle Scholar
  18. 18.
    Chiesa A, Serretti A (2011) Mindfulness-based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Res 187(3):441–453.  https://doi.org/10.1016/j.psychres.2010.08.011 CrossRefPubMedGoogle Scholar
  19. 19.
    Fjorback LO, Arendt M, Ornbol E, Fink P, Walach H (2011) Mindfulness-based stress reduction and mindfulness based cognitive therapy: A systematic review of randomized controlled trials. Acta Psychiatr Scand 124(2):102–119.  https://doi.org/10.1111/j.1600-0447.2011.01704.x CrossRefPubMedGoogle Scholar
  20. 20.
    Hofmann SG, Sawyer AT, Witt AA, Oh D (2010) The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 78(2):169–183.  https://doi.org/10.1037/a0018555 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Alm B, Sobanski E (2010) Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenalter. In: Laux G, Möller HJ, Kapfhammer HP (eds) Psychiatrie und Psychotherapie. Springer, Berlin, pp 2437–2464Google Scholar
  22. 22.
    Jha AP, Krompinger J, Baime MJ (2007) Mindfulness training modifies subsystems of attention. Cogn Affect Behav Neurosci 7(2):109–119CrossRefPubMedGoogle Scholar
  23. 23.
    Bachmann K, Lam AP, Philipsen AP (2016) Mindfulness-based cognitive therapy and the adult ADHD brain: a neuropsychotherapeutic perspective. Front Psychiatry 7:117.  https://doi.org/10.3389/fpsyt.2016.00117 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lattimore P, Fisher N, Malinowski P (2011) A cross-sectional investigation of trait disinhibition and its association with mindfulness and impulsivity. Appetite 56(2):241–248CrossRefPubMedGoogle Scholar
  25. 25.
    Chambers R, Lo BCY, Allen NB (2008) The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cogn Ther Res 32(3):303–322.  https://doi.org/10.1007/s10608-007-9119-0 CrossRefGoogle Scholar
  26. 26.
    D’Amelio R, Retz W, Philipsen A, Rösler M (2009) Psychoedukation und Coaching ADHS im Erwachsenenalter. Manual zur Leitung von Patienten und Angehörigengruppen. Urban & Fischer Elsevier, MünchenGoogle Scholar
  27. 27.
    Vidal R, Bosch R, Nogueira M, Gómez-Barros N, Valero S, Palomar G et al (2013) Psychoeducation for adults with attention deficit hyperactivity disorder vs. cognitive behavioural group therapy: a randomised controlled pilot study. J Nerv Ment Dis 201(10):894–900CrossRefPubMedGoogle Scholar
  28. 28.
    Hirvikoski T, Waaler E, Lindström T, Bölte S, Jokinen J (2015) Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): an open clinical feasibility trial. Atten Defic Hyperact Disord 7(1):89–99.  https://doi.org/10.1007/s12402-014-0141-2 CrossRefPubMedGoogle Scholar
  29. 29.
    Wiggins D, Singh K, Getz HG, Hutchins DE (1999) Effects of brief group intervention for adults with attention deficit/hyperactivity disorder. J Ment Health Couns 21(1):82–92Google Scholar
  30. 30.
    Wittchen HU, Zaudig M, Fydrich T (1997) Strukturiertes klinisches Interview für DSM-IV. Hogrefe, GöttingenGoogle Scholar
  31. 31.
    Retz-Junginger P, Retz W, Blocher D, Weijers HG, Trott GE, Wender PH, Rösler M (2002) Wender Utah Rating Scale (WURS-k). Die deutsche Kurzform zur retrospektiven Erfassung des hyperkinetischen Syndroms bei Erwachsenen. Nervenarzt 73(9):830–838CrossRefPubMedGoogle Scholar
  32. 32.
    Conners CK, Erhardt D, Sparrow EP (1999) Technical manual for the conners’ adult ADHD rating scales (CAARS). Multi Health Systems, North TonawandaGoogle Scholar
  33. 33.
    Lehrl S (2005) Manual zum MWT-B. Spitta-Verlag, BalingenGoogle Scholar
  34. 34.
    Ebert D, Krause J, Roth-Sackenheim C (2003) [ADHD in adulthood—guidelines based on expert consensus with DGPPN support]. Nervenarzt 74(10):939–946PubMedGoogle Scholar
  35. 35.
    Derogatis LR (1975) Brief symptom inventory. Clinical Psychometric Research, BaltimoreGoogle Scholar
  36. 36.
    Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-second edition. Manual. The Psychological Corporation, San AntonioGoogle Scholar
  37. 37.
    Bullinger M, Kirchberger I, Ware J (1995) Der deutsche SF-36 Health Survey. Übersetzung und psychometrische Testung eines krankheitsübergreifenden Instruments zur Erfassung der gesundheitsbezogenen Lebensqualität. Z Gesundh Wiss 3:21–36.  https://doi.org/10.1007/BF02959944 CrossRefGoogle Scholar
  38. 38.
    Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S et al (2008) Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment 15(3):329–342.  https://doi.org/10.1177/1073191107313003 CrossRefPubMedGoogle Scholar
  39. 39.
    Kabat-Zinn J (1990) Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press, New YorkGoogle Scholar
  40. 40.
    Segal Z, Williams JMG, Teasdale JD (2002) Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. Guilford Press, New YorkGoogle Scholar
  41. 41.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Psychology Press, New YorkGoogle Scholar
  42. 42.
    Grossmana P, Niemann L, Schmidt S, Walach H (2004) Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 57(1):35–43CrossRefGoogle Scholar
  43. 43.
    Baer RA (2003) Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract 10(2):125–143CrossRefGoogle Scholar
  44. 44.
    de Vibe M, Bjørndal A, Tipton E, Hammerstrøm KT, Kowalski K (2012) Mindfulness based stress reduction (MBSR) for improving health, quality of life and social functioning in adults. Campbell Syst Rev.  https://doi.org/10.4073/csr.2012.3 CrossRefGoogle Scholar
  45. 45.
    Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V et al (2013) Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev 33(6):763–771CrossRefPubMedGoogle Scholar
  46. 46.
    Ivanovski B, Malhi GS (2007) The psychological and neurophysiological concomitants of mindfulness forms of meditation. Acta Neuropsychiatr 19(2):76–91CrossRefPubMedGoogle Scholar
  47. 47.
    Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L (2006) Using self-report assessment methods to explore facets of mindfulness. Assessment 13 (1):27–45CrossRefPubMedGoogle Scholar
  48. 48.
    Cash M, Whittingham K (2010) What facets of mindfulness contribute to psychological well-being and depressive, anxious, and stress-related symptomatology?. Mindfulness 1:177–182.  https://doi.org/10.1007/s12671-010-0023-4 CrossRefGoogle Scholar
  49. 49.
    Peeping CA, O’Donovan A, Davis PJ (2013) The positive effects of mindfulness on self-esteem. J Posit Psychol 8(5):376–386.  https://doi.org/10.1080/17439760.2013.807353 CrossRefGoogle Scholar
  50. 50.
    Ogrodniczuk JS, Piper WE, Joyce A (2004) Differences in men’s and women’s response to short term group psychotherapy. Psychother Res 14:231–243CrossRefGoogle Scholar
  51. 51.
    Katz D, Toner B (2013) A systematic review of gender differences in the effectiveness of mindfulness-based treatments for substance use disorders. Mindfulness 4(4):318–331.  https://doi.org/10.1007/s12671-012-0132-3 CrossRefGoogle Scholar
  52. 52.
    de Vibe M, Solhaug I, Tyssen R, Friborg O, Rosenvinge JH, Sørlie T, Bjørnda A (2013) Mindfulness training for stress management: a randomised controlled study of medical and psychology students. BMC Med Educ 13:107.  https://doi.org/10.1186/1472-6920-13-107 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Solanto MV, Marks DJ, Wasserstein J, Mitchell K, Abikoff H, Alvir JM,et al (2010) Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry 167(8):958–968CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Ogrodniczuk JS, Piper WE, Joyce A, McCallum M (2001) Effect of patient gender on outcome in two forms of short-term individual psychotherapy. J Psychother Pract Res 10(2):69–78PubMedPubMedCentralGoogle Scholar
  55. 55.
    Sobanski E, Brüggemann D, Alm B, Kern S, Philipsen A, Schmalzried H et al (2008) Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment. Eur Psychiatry 23(2):142–149CrossRefPubMedGoogle Scholar
  56. 56.
    Jacob CP, Romanos J, Dempfle A, Heine M, Windemuth-Kieselbach C, Kruse A et al (2007) Comorbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. Eur Arch Psychiatry Clin Neurosci 257(6):309–317CrossRefPubMedGoogle Scholar
  57. 57.
    Cumyn L, French L, Hechtman L (2009) Comorbidity in adults with attention-deficit hyperactivity disorder. Can J Psychiatry 54(10):673–683CrossRefPubMedGoogle Scholar
  58. 58.
    Williams ED, Reimherr FW, Marchant BK, Strong RE, Halls C, Soni P et al (2010) Personality disorder in ADHD Part 1: assessment of personality disorder in adult ADHD using data from a clinical trial of OROS methylphenidate. Ann Clin Psychiatry 22(2):84–93PubMedGoogle Scholar
  59. 59.
    Matthies S, van Elst LT, Feige B, Fischer D, Scheel C, Krogmann E et al (2011) Severity of childhood attention-deficit hyperactivity disorder—a risk factor for personality disorders in adult life?. J Pers Disord 25(1):101–114CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • E. Hoxhaj
    • 1
  • C. Sadohara
    • 1
  • P. Borel
    • 1
  • R. D’Amelio
    • 2
  • E. Sobanski
    • 3
    • 4
  • H. Müller
    • 5
  • B. Feige
    • 1
  • S. Matthies
    • 1
  • Alexandra Philipsen
    • 1
    • 5
  1. 1.Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
  2. 2.Institute for Forensic Psychology and PsychiatrySaarland University Faculty of MedicineHomburg/SaarGermany
  3. 3.Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Clinical Faculty MannheimUniversity of HeidelbergMannheimGermany
  4. 4.Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Medicine MainzMainzGermany
  5. 5.Medical Campus University of OldenburgSchool of Medicine and Health Sciences, Psychiatry and Psychotherapy-University HospitalBad ZwischenahnGermany

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