Dialectical Behavior Therapy for Adult Attention Deficit Hyperactivity Disorder: A Narrative Review

Abstract

Due to the multifaceted psychosocial problems of adults with ADHD and the low level of functionality in different areas such as education, work and family life, the search for psychotherapeutic treatment other than pharmacological approaches has increased in the last decade. This study aims to evaluate the clinical contributions of Dialectical Behavioral Therapy (DBT)-based interventions and the controlled studies in which DBT were tested. This study is a qualitative narrative review. This review included the controlled studies reached by searching the DDT and Adult ADHD as keywords in Medline, Pubmed, Science Direct and EBSCO Psychology & Behavioral Sciences Collection databases until 2021. A total of 12 research articles and 1 short report were identified, but only 9 studies met the inclusion criteria and controlled study conditions. In all studies, it was seen that the skills training mode of DBT was used or adapted. Although the results of the studies reviewed in this review are not consistent, DBT Skills Training shows promise in controlling ADHD symptoms and increasing other psychosocial skills of adults. However, there is a need for more controlled studies on the effectiveness of DBT Skills Training in different experimental research designs.

Keywords

• Adult attention Deficit Hyperactivity Disorder
• Controlled Trials
• Dialectical Behavior Therapy
• Dialectical Behavior Therapy Skills Training

Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu İçin Diyalektik Davranış Terapisi: Bir Narativ Derleme

Öz

DEHB’li yetişkinlerin çok yönlü psikososyal problemleri ve eğitim, iş, aile hayatı gibi farklı alanlarda görülen düşük işlevsellik düzeyleri nedeniyle farmakolojik yaklaşım dışında psikoterapötik tedavi arayışları son on yılda artış göstermiştir. Bu çalışmada Diyalektik Davranış Terapisi (DDT) temelli müdahalelerin sınandığı kontrollü çalışmaların ve geliştirilen DDT müdahalelerinin klinik anlamda katkılarının değerlendirilmesi amaçlanmaktadır. Bu çalışma nitel bir naratif derlemedir. Çalışmaya DDT ve Erişkin DEHB anahtar kelimelerinin İngilizce karşılıklarının Medline, Pubmed, Science Direct ve EBSCO Psychology&Behavioral Sciences Collection veritabanlarında 2021 yılına kadar taranmasıyla ulaşılan kontrollü çalışmalar dahil edilmiştir. Toplam 12 tane araştırma makalesi ve 1 kısa rapor tespit edilmiş ancak dahil etme kriterlerini ve kontrollü çalışma şartlarını yalnızca 9 çalışma karşılamıştır. Tüm çalışmalarda DDT’nin beceri eğitiminin kullanıldığı veya uyarlandığı görülmüştür. Derlemede incelenen çalışmaların sonuçları tutarlı olmamakla birlikte DDT Beceri Eğitimi’nin yetişkinlerin DEHB belirtilerini kontrol etmede ve diğer psikososyal becerilerini artırmada umut vaat ettiğini göstermektedir. Ancak çalışmaların sınırlı sayıda olması nedeniyle DDT Beceri Eğitimi’nin etkililiğine yönelik farklı deneysel araştırma desenlerinde daha fazla kontrollü çalışmaya ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• diyalektik davranış terapisi
• diyalektik davranış terapisi beceri eğitimi
• erişkin dikkat eksikliği hiperaktivite bozukluğu
• kontrollü çalışma

Kaynakça

1. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demle OR et al. (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry, 163:716-723.
2. Able SL, Johnston JA, Adler LA, Swindle RW. (2007) Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychol Med, 37:97-107.
3. Asherson P, Akehurst A, Sandra Kooij JJ, Huss M, Beusterien K, Sasané R et al. (2012) Under diagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord,16:20-38.
4. Baer RA (Ed.) (2015) Mindfulness-based treatment approaches: Clinician's guide to evidence base and applications, Elsevier.
5. Barra S, Grub A, Roesler M, Retz-Junginger P, Philipp F, Retz W (2021) The role of stress coping strategies for life impairments in ADHD. J Neural Transm,128:981–992.
6. Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM et al. (2006) “Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study” Psychol Med, 36:167-179.
7. Bjerrum MB, Pedersen PU, Larsen P (2017) Living with symptoms of attention deficit hyperactivity disorder in adulthood: a systematic review of qualitative evidence. JBI Evid Synth, 15:1080-1153.
8. Bodalski EA, Knouse LE, Kovalev D (2019) Adult ADHD, emotion dysregulation, and functional outcomes: Examining the role of emotion regulation strategies J Psychopathol Behav Assess, 41:81-92.

9. Bohus M, Dyer AS, Priebe K, Krüger A, Kleindienst N, Schmahl C et al. (2013) Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial. Psychother Psychosom, 82: 221-233.
10. Brod M, Pohlman B, Lasser R, Hodgkins P (2012) Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes, 10:1-17.
11. Courbasson C, Nishikawa Y, Dixon L (2012) Outcome of dialectical behaviour therapy for concurrent eating and substance use disorders. Clin Psychol Psychother, 19: 434-449.
12. Calvo N, Lara B, Serrat L, Pérez-Rodríguez V, Andión Ò, Ramos-Quiroga JA et al. (2020) The role of environmental influences in the complex relationship between borderline personality disorder and attention-deficit/hyperactivity disorder: review of recent findings. Borderline Personal Disord Emot Dysregul, 7:1-7.
13. Canela C, Buadze A, Dube A, Eich D, Liebrenz M (2017) Skills and compensation strategies in adult ADHD–A qualitative study” PloS One, 12, e0184964
14. Conejero I, Jaussent I, Lopez R, Guillaume S, Olié E, Hebbache C et al. (2019) Association of symptoms of attention deficit-hyperactivity disorder and impulsive-aggression with severity of suicidal behavior in adult attempters. Sci Rep, 9:1-8.
15. Creswell JW (2021) Karma Yöntem Araştırmalarına Giriş (Çeviri Ed. Mustafa Sözbilir) (3. Baskı). Ankara, Pegem Akademi.
16. Davids E, Gastpar M (2005) Attention deficit hyperactivity disorder and borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry, 29:865-877.
17. Ek A, Isaksson G (2013) How adults with ADHD get engaged in and perform everyday activities. Scand J Occup Ther, 20:282-291.
18. Edel MA, Hölter T, Wassink K, Juckel G (2014) A comparison of mindfulness-based group training and in adults with ADHD” J Atten Disord, 21: 533-539.
19. Edel MA, Juckel G, Brüne M (2010) Interaction of recalled parental ADHD symptoms and rearing behavior with current attachment and emotional dysfunction in adult offspring with ADHD. Psychiatry Res, 178:137-141.
20. Faraone SV, Spencer T, Aleardi M, Pagano C, Biederman J (2014) Meta-analysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol, 24: 24-29.
21. Ferrari R (2015) Writing narrative style literature reviews. Medical Writing, 24:230-235.
22. Fleming AP, McMahon RJ, Moran LR, Peterson AP, Dreessen A (2015). Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. J Atten Disord, 19: 260-71.
23. Fossati A, Gratz KL, Borroni S, Maffei C, Somma A, Carlotta D (2015) The relationship between childhood history of ADHD symptoms and DSM-IV borderline personality disorder features among personality disordered outpatients: the moderating role of gender and the mediating roles of emotion dysregulation and impulsivity” Compr Psychiatry, 56:121-127.
24. Gold AL, Yaptangco M (2019) Getting unstuck: Dialectical strategies to reduce suffering and build a life worth living. The Brown University Child and Adolescent Behavior Letter, 35:1-6.
25. Goldstein TR, Fersch-Podrat RK, Rivera M, Axelson DA, Merranko J, Yu H, Brent DA, Birmaher B (2015) Dialectical behavior therapy for adolescents with bipolar disorder: Results from a pilot randomized trial. J Child Adolesc Psychopharmacol, 25$ 140-149.
26. Green BN, Johnson CD, Adams A (2006) Writing narrative literature reviews for peer-reviewed journals: secrets of the trade, J Chiropr Med, 5:101-117.
27. Gülpınar Ö, Güçlü AG (2013) How to write a review article? Turk J Urol, cilt:44-48.
28. Harley R, Sprich S, Safren S, Jacobo M, Fava M (2008) Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. J Nerv Ment Dis,196:136-143.
29. Hesslinger B, van Elst LT, Nyberg E, Dykierek P, Richter H, Berner M et al. (2002) Psychotherapy of attention deficit hyperactivity disorder in adults: A pilot study using a structured skills training program. Eur Arch Psychiatry Clin Neurosci, 252:177–184.
30. Hill DM, Craighead LW, Safer DL (2011) Appetite‐focused dialectical behavior therapy for the treatment of binge eating with purging: A preliminary trial. Int J Eat Disord, 44: 249-261.
31. Hirsch O, Chavanon M, Riechmann E, Christiansen H (2018) Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD). J Affect Disord, 232:41-47.
32. Hirvikoski T, Waaler E, Alfredsson J, Pihlgren C, Holmström A, Johnson A et al. (2011) Reduced ADHD symptoms in adults with ADHD after structured skills training group: Results from a randomized controlled trial. Behav Res Ther, 49: 175-185.
33. Jennings JL, Apsche JA (2014) The evolution of a fundamentally mindfulness-based treatment methodology: From DBT and ACT to MDT and beyond. International Journal of Behavioral Consultation and Therapy, 9:1-3
34. Kliem S, Kröger C, Kosfelder J (2010) Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling. J Consult Clin Psychol, 78:936.
35. Langer S, Greiner A, Koydemir S, Schütz A (2013) Evaluation of a stress management training program for adults with ADHD: A pilot study. Journal of Cognitive Psychotherapy: An International Quarterly, 27:96-110.
36. Lee CS, Ma MT, Ho HY, Tsang KK, Zheng YY, Wu ZY (2017) The effectiveness of mindfulness-based intervention in attention on individuals with ADHD: A systematic review. Hong Kong J Occup Ther, 30:33-41.
37. Linehan M (1993) Cognitive-Behavioral Treatment of Borderline Personality Disorder, New York, The Guilford Press.
38. Linehan M (2015) DBT Skills Training Manual, New York, The Guilford Press.
39. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, McDavid J, Comtois KA, Murray-Gregory AM (2015) Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry, 72: 475-482.
40. Linehan MM, Comtois KA, Murray AM, Brown MZ, Gallop RJ, Heard HL, Korslund KE, Tutek DA, Reynolds SK, Lindenboim N (2006) Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry, 63: 757-766.
41. López-Pinar C, Martínez-Sanchís S, Carbonell-Vayá E, Fenollar-Cortés J, Sánchez-Meca J (2018) Long-term efficacy of psychosocial treatments for adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Front Psychol, 9:638.
42. Lynch TR, Cheavens JS, Cukrowicz KC, Thorp SR, Bronner L, Beyer J (2007) Treatment of older adults with co‐morbid personality disorder and depression: A dialectical behavior therapy approach. Int J Geriatr Psychiatry, 22: 131-143.
43. Lynch TR, Morse JQ, Mendelson T, Robins CJ (2003) Dialectical behavior therapy for depressed older adults: A randomized pilot study. Am J Geriatr Psychiatry, 11: 33-45.
44. Matthies S, Philipsen A, Lackner HK, Sadohara C, Svaldi J (2014) Regulation of sadness via acceptance or suppression in adult Attention Deficit Hyperactivity Disorder (ADHD). Psychiatry Res, 220:461-467.
45. McKay M, Wood JC, Brantley J (2019) The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance, Oakland, New Harbinger Publications.
46. Minde K, Eakin L, Hechtman L, Ochs, E, Bouffard R, Greenfield B et al. (2003) The psychosocial functioning of children and spouses of adults with ADHD. Journal of Child Psychology and Psychiatry, 44:637-646.
47. Morgensterns E, Alfredsson J, Hirvikoski T (2016) Structured skills training for adults with ADHD in an outpatient psychiatric context: an open feasibility trial. Atten Defic Hyperact Disord, cilt 8: 101–111.
48. Neacsiu AD, Eberle JW, Kramer R, Wiesmann T, Linehan MM (2014) Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behav Res Ther, 59: 40-51
49. Nasri B, Castenfors M, Fredlund P, Ginsberg Y, Lindefors N, Kaldo V (2017) group treatment for adults with adhd based on a novel combination of cognitive and dialectical behavior ınterventions: a feasibility study. J Atten Disord, :1-13.
50. Oerbeck B, Overgaard K, Pripp AH, Aase H, Reichborn-Kjennerud T, Zeiner P (2019) Adult ADHD symptoms and satisfaction with life: Does age and sex matter? J Atten Disord, 23:3-11.
51. Öztürk O, Uluşahin A (2015) Ruh Sağlığı ve Bozuklukları (15. baskı), Ankara, Nobel Tıp Kitabevleri.
52. Panos PT, Jackson JW, Hasan O, Panos A (2014) Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Res Soc Work Pract, 24: 213-223.
53. Philipsen A (2006) Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults. Eur Arch Psychiatry Clin Neurosci, 256:42-46.
54. Philipsen A, Jans T, Graf E, Matthies S, Borel P, Colla M et al. (2015) Effects of group psychotherapy, individual counseling, methylphenidate, and placebo in the treatment of adult attention-deficit/hyperactivity disorder: a randomized clinical trial. JAMA Psychiatry, 72:1199-1210.
55. Poissant H. Moreno A, Potvin S, Mendrek A (2020) A meta-analysis of mindfulness-based interventions in adults with attention-deficit hyperactivity disorder: Impact on ADHD Symptoms, depression, and executive functioning. Mindfulness, 11:2669-2681.
56. Prada P, Hasler R, Baud P, Bednarz G, Ardu S, Krejci I et al. (2014) "Distinguishing borderline personality disorder from adult attention deficit/hyperactivity disorder: a clinical and dimensional perspective" Psychiatry Res, 217:107-114.
57. Rodriguez D, Tercyak KP, Audrain-McGovern J (2008) Effects of inattention and hyperactivity/impulsivity symptoms on development of nicotine dependence from mid adolescence to young adulthood. J Pediatr Psychol, 33:563-575.
58. Safer DL, Joyce EE (2011) Does rapid response to two group psychotherapies for binge eating disorder predict abstinence? Behav Res Ther, 49:339-345.
59. Skirrow C, Ebner-Prieme U, Reinhard I, Malliaris Y, Kuntsi J, Asherson P (2014) “Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability. Psychol Med, 44:3571-3583.
60. Telch CF, Agras WS, Linehan MM (2001) Dialectical behavior therapy for binge eating disorder. J Consult Clin Psychol, 69: 1061.
61. Torrente F, López P, Prado DA, Kichic R, Cetkovich-Bakmas M, Lischinsky A et al. (2012) Dysfunctional cognitions and their emotional, behavioral and functional correlates in adults with attention deficit hyperactivity disorder (ADHD): Is the cognitive-behavioral model valid? J Atten Disord, 18:412-424.
62. Turner RM (2000) Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cogn Behav Pract, 7: 413-419.
63. Valentine SE, Bankoff SM, Poulin RM, Reidler EB, Pantalone DW (2015) The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literatüre. J Clin Psychol, 71:1–20.
64. Verheul R, Van Den Bosch LM, Koeter MW, De Ridder MA, Stijnen T, Van Den Brink W (2003) Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182: 135-140.
65. Weafer J, Milich R, Fillmore MT (2011) Behavioral components of impulsivity predict alcohol consumption in adults with ADHD and healthy controls. Drug Alcohol Depend, 113:139-146.
66. Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E et al. (2018) Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord, 226: 85-91.
67. Weiner L, Perroud N, Weibel S (2019) Attention deficit hyperactivity disorder and borderline personality disorder in adults: a review of their links and risks. Neuropsychiatr Dis Treat, 15:3115-3129.
68. Wilens TE, Biederman J, Faraone SV, Martelon M, Westerberg D, Spencer TJ (2009) Presenting ADHD symptoms, subtypes, and comorbidity disorders in Clinically Referred Adults with ADHD. J Clin Psychiatry, 70:1557-1562.