Supplementary Material for: Exploring the Relationship Between Adherence to Therapy, Treatment Acceptability and Clinical Outcomes in Adults with Attention Deficit Hyperactivity Disorder: Results from the COMPAS Multicenter Randomized Controlled Trial

Introduction: Cognitive behavioral therapy and dialectical behavior therapy (DBT) can be effective in treating adults with ADHD, and patients generally consider these interventions useful. While adherence, as measured by attendance at sessions, is mostly sufficient, adherence to therapy skills has not been assessed. Furthermore, the relationship between patient evaluation of therapy effectiveness, treatment adherence, and clinical outcomes is understudied.
Objective: This study aimed to examine treatment acceptability and adherence in relation to treatment outcomes in a large randomized controlled trial comparing a DBT-based intervention with a nonspecific active comparison, combined with methylphenidate or placebo.
Method: 433 adult patients with ADHD were randomized. Participants reported how effective they found the therapy, and adherence was measured by attendance at therapy sessions and by self-reports. Descriptive, between-groups and linear mixed model analyses were conducted.
Results: Participants rated psychotherapy as moderately effective, attended 78.40% to 94.37% of sessions, and used skills regularly. The best-accepted skills were sports and mindfulness. Groups receiving placebo and/or nonspecific clinical management rated their health condition and the medication effectiveness significantly worse than the psychotherapy and methylphenidate groups. Improvements in clinical outcomes were significantly associated with treatment acceptability. Subjective (self-reported) adherence to psychotherapy was significantly associated with improvements in ADHD symptoms and clinical global efficacy and response to treatment.
Discussion: These results further support the acceptability of DBT for adult ADHD and suggest the need to address adherence to treatment to maximize clinical improvements. Results may be limited by the retrospective assessment of treatment acceptability and adherence using an ad hoc instrument.

引言：认知行为疗法（Cognitive Behavioral Therapy）与辩证行为疗法（Dialectical Behavior Therapy，DBT）在成人注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder，ADHD）的治疗中具有良好疗效，且患者普遍认为此类干预措施具有实用价值。尽管以疗程出席率为衡量指标的治疗依从性整体尚可，但针对治疗技能依从性的相关评估仍未开展。此外，目前针对患者对治疗有效性的评价、治疗依从性与临床结局三者间的关联研究仍较为匮乏。
研究目的：本研究基于一项大型随机对照试验，旨在探究基于DBT的干预方案与非特异性主动对照方案（分别联合哌甲酯（methylphenidate）或安慰剂（placebo））中，治疗可接受性、依从性与治疗结局的关联。
研究方法：本研究共纳入433名成人ADHD患者并进行随机分组。由受试者自行报告对治疗有效性的感知，治疗依从性通过疗程出席记录与自我报告量表进行衡量。本研究采用描述性分析、组间比较分析及线性混合模型分析完成数据统计。
研究结果：受试者评估心理治疗的疗效处于中等水平，疗程出席率介于78.40%至94.37%之间，且能够规律使用治疗技能。其中接受度最高的治疗技能为运动与正念训练。安慰剂组及/或非特异性临床管理组对自身健康状况与药物疗效的评分显著低于心理治疗联合哌甲酯组。临床结局的改善与治疗可接受性呈显著正相关。主观（自我报告）的心理治疗依从性与ADHD症状改善、整体临床疗效提升及治疗应答情况均存在显著关联。
讨论：本研究结果进一步证实了DBT用于成人ADHD治疗的可接受性，同时提示需重视治疗依从性的优化以最大化临床获益。本研究存在一定局限性：采用特设评估工具对治疗可接受性与依从性进行回顾性评估，可能对研究结果造成偏倚。