CBT Through Internet and Smartphones for Adults With ADHD - a Randomized Controlled Trial
Condition: ADHD
MeSH terms: Attention Deficit Disorder with Hyperactivity
Study type: Interventional

Summary: 
      The purpose of this study is to further evaluate the treatment for adults with ADHD used in
      our previous study (clinicaltrials.gov ID NCT01659164). It will now be converted to therapist
      supported, internet-delivered cognitive behavioral therapy (iCBT) with an additional
      smartphone application and evaluated through a randomized controlled trial during 12 weeks.
      The patients will be randomized to one of three conditions

        -  an active treatment group where the intervention is based on cognitive - and dialectical
           behavioral therapy (CBT and DBT) and the mobile app.

        -  an active ICBT-treatment based on psychoeducation, a CBT stress-reduction program and
           Applied Relaxation, and

        -  treatment as usual (TAU) / waiting list.

      The main objective of the study is to evaluate if both of the treatment conditions will show
      better outcomes than TAU regarding decreased ADHD symptoms and increased functioning and life
      quality.

      Another objective is to evaluate if the group receiving the active iCBT treatment (based on
      CBT and DBT) will show better outcomes in comparison to the control group regarding ADHD
      symptoms, overall functioning and life quality.
    

Detailed description: 
      Approximately one-third of children with ADHD continue to be fully symptomatic into adulthood
      and many of the remainders often retain some residual problems that require treatment. Thus
      ADHD is a prevalent and chronic disabling disorder. Drugs provide first line treatment for
      adults with ADHD but are not enough for everybody, while we still lack proper evidence for
      promising psychological treatment. In addition to core symptoms of ADHD including regulatory
      difficulties of attention, activity level and impulses, difficulties with emotional
      regulation are common.

      Follow-up studies of adults with ADHD have shown that only a few patients were offered
      sufficient treatment and support after the neuropsychiatric assessment and testing. The
      majority of adults diagnosed with ADHD are offered pharmacological treatment (stimulant
      medication) as the sole treatment. However, stimulant medication is not effective for up to
      20-50 percent of adults as they may not experience symptom reduction or they are unable to
      tolerate the medication.

      Consequently, the possible benefits of identifying and treating individuals with ADHD are
      extensive. Treatment of ADHD is preferably multimodal, i.e. consisting of more than one
      intervention.

      Although literature regarding psychological treatment is relatively limited, studies of
      cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) show that
      structured short-term therapies are promising in reducing ADHD related symptoms and
      increasing life quality. The main treatment focus is to enhance executive and organizational
      skills, improvement of consequence thinking and impulse control as well as emotion regulation
      skills. However, the range of trained psychologist in this field is rather limited. Using
      internet for delivering evidence-based psychological treatment can therefore be a innovative
      treatment alternative in order to make inaccessible treatment available to a large group of
      patients with ADHD.

      The actual treatment project aims to evaluate if adults with ADHD can benefit from
      psychological treatment delivered through Internet. About 150-200 patients will be recruited
      through several outpatient clinics in Stockholm. They will be randomized to one of three
      conditions - active psychological treatment (based on CBT and DBT), an active alternative
      treatment where they undergo a psychoeducational support program (based on CBT) or to
      treatment as usual (TAU) / waiting list. The patients in the treatment conditions will have a
      personal contact via the internet with a psychologist within the 12 week treatment period.
      Assessments will be done before, during and after treatment, and after 3 and 12 months. The
      patients in the TAU condition will be offered iCBT treatment after they have filled out the
      post assessments (after 12 weeks and at 3rd month after treatment).
    

Intervention name(s): iCBT for Adults with ADHD; Internet stress-reduction; Treatment as usual (TAU)/waiting list
Intervention type(s): Behavioral; Behavioral; Other
Intervention description(s): A skill training internet-based treatment program based on CBT and DBT interventions .; Internet-based psychoeducation, stress-reduction, and Applied Relaxation based on CBT (control group); Treatment as usual (usually medications for ADHD), will be offered treatment after the FU3 (week 24)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cognitive Behavioral Therapy; Dialectical Behavioral Therapy; Applied Relaxation; Stress-reduction; Smartphone application; ADHD; Randomized controlled trial; Psychological treatment; Efficacy