Implementing Panic-Focused Psychodynamic Psychotherapy into Clinical Practice

Abstract

Objective: To determine the effectiveness of manualized panic-focused psychodynamic psychotherapy (PFPP) in routine care in Germany.Method: German psychoanalysts were trained according to the PFPP manual. Fifty-four consecutive outpatients with panic disorder (with or without agoraphobia) were randomly assigned in a 2:1 ratio to PFPP or cognitive-behavioural therapy (CBT) plus exposure therapy. Subjects (female 57.4%; mean age 36.2 years) had high rates of psychiatric (68.5%) and somatic (64.8%) comorbidity, and previous psychiatric treatments (57.4%). Assessments were performed pre-and posttreatment and at 6-month follow-up. The primary outcome measure was the Panic Disorder Severity Scale.Results: Both treatments were highly effective. In patients randomized to PFPP, remission was achieved in 44.4% at termination and by 50% at follow-up (CBT 61.1% and 55.6%, respectively). No significant differences were found. Emotional awareness, a posited moderator of good outcome in psychotherapies, was significantly higher in the CBT group at baseline. It was found to be a strong moderator of treatment effectiveness in both treatments. After adjusting for initial Levels of Emotional Awareness Scale (LEAS) scores, effect sizes (ESs) for the primary outcome were Cohen d = 1.28, from pre-to posttreatment, and d = 1.03, from pretreatment to follow-up, for PFPP, and d = 1.81 and 1.28 for CBT, respectively.Conclusions: PFPP was implemented effectively into clinical practice by psychoanalysts in the community in a sample with severe mental illness with large ESs. Assessment of LEAS may facilitate the identification of patients suitable for short-term psychotherapy.(Clinical Trial Registration Number: German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111-1112-4245) W W W Mise en oeuvre de la psychothérapie psychodynamique axée sur la panique dans la pratique clinique Objectif : Déterminer l'efficacité de la psychothérapie psychodynamique axée sur la panique (PPAP), pratiquée d'après un manuel, dans les soins courants en Allemagne.Méthode : Les psychanalystes allemands ont été formés en conformité avec le manuel de PPAP. Cinquante-quatre patients ambulatoires consécutifs souffrant de trouble panique

The Empirical Status of Psychodynamic Psychotherapy - An Update: Bambi's Alive and Kicking

“…No additional RCTs fulfilling the inclusion criteria were identified by our search. In a recent RCT, no differences in outcome between PDT and CBT in panic disorder were found [76]. Remission rates at termination and follow-up were 44 and 50% for PDT and 61 and 56% for CBT.…”

Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder.

“…Some writers have theorized that patients with higher pretreatment insight may fare better in psychodynamic therapy than their low insight counterparts (see Barber, Muran, McCarthy, & Keefe, 2013). Indeed, Beutel et al (2013) found that patients with panic disorder who were higher in emotional awareness fared better in treatment. Closely related to the concepts of insight and emotional awareness, reflective functioning (RF) is defined as the ability to understand one's own and others'; behavior in terms of mental states (desires, intentions, feelings, and beliefs) (Fonagy, Target, Steele, & Steele, 1998).…”

“…In a small randomized, controlled trial (RCT), PFPP outperformed applied relaxation training (ART) in the reduction of panic symptoms and improvement in psychosocial functioning (Milrod, Leon, Busch, et al, 2007). Other supportive evidence of PFPP's efficacy comes from a study of its effectiveness in clinical practice (Beutel et al, 2013). …”

A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design

“…In a direct comparison with CBT Beutel et al 2013), CBT was superior in some specific outcome parameters at the end of treatment. Longer follow-up studies for short-term psychodynamic psychotherapy are still lacking.…”