Review of: Janssen L et al, Psychological Medicine 2018;28:1–11

Medications are the first-line treatment for adult ADHD, and the efficacy of psychosocial therapies is less well-defined. Mindfulness-based therapy showed promise for adult ADHD in a recent meta-analysis, but there were flaws and significant differences between the included studies (Janssen L et al, BMC Psychiatry 2015;doi:10.1186/s12888-015-0591-x).

The current study was a single-blind, randomized controlled study of mindfulness-based cognitive behavioral therapy (MBCT) as an adjunct to treatment as usual (TAU) in 120 patients with adult ADHD. Both groups received TAU, which consisted of various combinations of medication, psychoeducation, and skills training. The intervention group received 8 weekly sessions of MBCT and a 6-hour silent day of mindfulness. Each session was 2.5 hours long and consisted of meditation exercises, cognitive behavioral techniques, psychoeducation, and group discussions. For the silent day, study subjects spent 6 hours completing various meditation activities, eating lunch, and having a tea break. Mindfulness practice was encouraged outside of the sessions for 30 minutes a day.

Patients in the MBCT group had significant reductions in clinician-rated and self-reported ADHD symptoms that persisted for 6 months. Significantly more patients in the MBCT group (27%) experienced a ≥30% reduction in symptoms compared with the TAU group (5%) (p=0.001). The two groups were similar in their utilization of TAU, although those in the mindfulness group were less likely to make changes to their medications.

Although the results are encouraging, the study had several limitations. Participants were not blinded to the treatment, so placebo effects cannot be completely ruled out. No data were collected on patients who were excluded or declined to participate in the study, raising the possibility that the sample was enriched and limiting the generalizability of the results.

TCPR’s TAKE
This study raises the quality of evidence in support of mindfulness therapy in adult ADHD. Mindfulness is reasonable to recommend as an adjunct to medication, and as a solo treatment for patients who cannot tolerate or do not respond to medication.