Effectiveness of mindfulness-based cognitive therapy on inhibitory control and selective attention in adults with attention-deficient/hyperactivity disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) is a psychological disorder that begins in childhood and involves disproportionate levels of development in the areas of inattention, impulsivity, and hyperactivity. The prevalence of this disorder in children is 3.53%. In many cases, it showed that they persist into adulthood, and the prevalence of ADHD in adulthood is 3.4%. This disorder is one of childhood’s most pervasive developmental neurological disorders, which has been shown to be hyperactive, inattentive, or both, and is associated with numerous deficits in cognitive dimensions such as attention and inhibition control. Other cognitive deficiencies in this disorder include attention, controlling, and scheduling problems, indicating that the disorder is in the context of executive functions. Today, due to the side effects of drugs, the compulsion to continue consumption in order to maintain the effects, and weak adherence to drug therapy, non-drug treatments have been welcomed for this disorder. Non-drug treatments such as cognitive therapy based on mindfulness are a combination of cognitive-behavioral therapy and mindfulness and use sustainable attention training methods that include attention regulation, emotional regulation, and physical awareness. Thus, in this study, an attempt is made to improve the dimensions of selective attention and inhibitory control in ADHD by using cognitive therapy based on mindfulness.

The present study is applied in terms of purpose. In terms of control of variables, it is an experimental type with a pretest-posttest design in which the experimental group was exposed to mindfulness-based cognitive therapy training. The control group did not receive any intervention. The statistical population of this study includes all people with ADHD in Rasht. The number of participants in this study was 30 (18-35 years old) males (N: 15 in each group) that were selected in a targeted and accessible way and also through an online call based on the initial diagnosis of a psychologist, clinical interview researcher, and diagnostic test. The inclusion criteria in this study are the presence of ADHD syndrome from childhood. Criteria for exclusion were other psychological disorders (other than ADHD). Mindfulness-based cognitive therapy interventions are based on Segal, Williams & Teasdale treatment program (19). The program consisted of eight 90-minute sessions and 45-minute homework three days a week (February 2021). The post-test was held for all members of the groups after the intervention sessions. A follow-up session was performed after three months to evaluate the durability of the intervention method. Pre-test and post-test data analysis were performed by SPSS statistical calculation software version 25. Instruments include the Connors Adult ADHD Screening Scale, the  Test, and the Go/No-GoTest. In order to analyze the data, in addition to descriptive methods (mean and standard deviation) for inferential analysis of test hypotheses, repeated measures analysis of variance was used.

The mean of pre-test, post-test, and follow-up inhibition control in the mindfulness group was 17.60, 14.47, and 14.40, with a standard deviation of 1.35, 1.95, and 1.50, respectively. The mean of pre-test, post-test, and follow-up inhibition control in the control group is equal to 18.00, 16.87 and 17.20, with a standard deviation of 1.89, 1.52, and 1.85, respectively. The mean of pre-test, post-test, and follow-up selective attention in the mindfulness group are 16, 12.80, and 11.60, with a standard deviation of 1, 0.86, and 0.73, respectively. Also, the mean of pre-test, post-test, and follow-up selective attention in the control group is equal to 16.80, 15.93, and 15.53, with a standard deviation of 1.61, 1.22, and 1.06, respectively. In the mindfulness group, post-test scores, and follow-up inhibition control and selective attention decreased compared to the pre-test (P<0.01), while in the control group, there was no significant difference in the three stages of the test (P<0.05). Therefore, mindfulness therapy has been effective in improving inhibition control and selective attention in the post-test and follow-up stages.

The treatment is a combination of relaxation and mindfulness. The use of relaxation techniques in mindfulness-based cognitive therapy has had a positive effect on reducing impulsivity in patients with ADHD. According to neuroimaging studies, mindfulness exercises cause structural changes in the prefrontal areas and strengthen cognitive mechanisms, including attention located in the prefrontal area. Based on the current study’s findings, it is recommended to perform cognitive therapy on mindfulness in clinics and psychological service centers as an effective intervention method of treatment.