认知行为治疗与成人注意缺陷多动障碍:认知模式及情绪症状在治疗中的中介作用

Cognitive Behavioral Therapy in Medicated Adults with Attention-Deficit/Hyperactivity Disorder:The Mediating Role of Changes in Cognitive Patterns and Emotional Symptoms

目的:探讨认知行为治疗(CBT)对成人注意缺陷多动障碍(ADHD)患者核心症状的直接影响,以及认知模式和情绪症状改变的中介作用。方法:研究纳入既往随机对照试验入组的98名成人ADHD患者,对结果进行二次分析,选取治疗前(T1)、治疗12周结束后(T2)及48周随访(T3)时的核心症状、认知模式及情绪症状得分,构建链式中介模型。结果:CBT可通过焦虑、抑郁情绪症状得分变化影响T2及T3时核心症状得分,也可依次通过认知模式(自动思维和功能失调得分)变化及情绪症状变化影响T3时核心症状得分。结论:CBT短期主要通过改善情绪进而改善ADHD核心症状,同时长期可依次通过认知模式的中介作用影响情绪变化,进而影响ADHD核心症状。

Objective:The study was a secondary analysis of previous randomized controlled trial(RCT)study,aiming to explore the direct effects of cognitive-behavioral therapy(CBT)on the core symptoms of ADHD,and the mediating role of changes in cognitive patterns and emotional symptoms with the use of serial multiple mediator models.Methods:98 adult ADHD were randomly allocated to the CBT combined with medication(CBT+M)group or the medication(M)only group.The CBT+M group received CBT for 12 weeks,and the M-only group received stable medication.ADHD core symptoms,cognitive patterns,and emotional symptoms were evaluated in the two groups before treatment(T1),at the end of the12-week CBT(T2),and the follow-up at week 48(T3).Results:The influence of CBT on ADHD core symptoms through emotional symptoms changes was statistically significant at T2 and T3.The effect of CBT on ADHD core symptoms was statistically significant through the changes of cognitive patterns and then the changes of emotional symptom scores at T3 but not immediately at T2.Conclusion:The research indicated that CBT could affect ADHD core symptoms through the reduction of anxiety and depression symptoms both in the short-term and long-term follow-up.Meanwhile,CBT could in turn affect the changes of anxiety and depression through the mediation of cognitive patterns and then affect ADHD core symptoms of in the long-term follow-up.