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The purpose of this study was to determine the efficacy of panic-focused psychodynamic psychotherapy relative to applied relaxation training, a credible psychotherapy comparison condition. Despite the widespread clinical use of psychodynamic psychotherapies, randomized controlled clinical trials evaluating such psychotherapies for axis I disorders...
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Context 1
... evaluators, blinded to subject condition and therapist orientation, assessed subjects at baseline, treatment termination, and at 2, 4, 6, and 12 months posttreatment termi- nation ( Figure 1). The primary outcome measure was the Panic Disorder Severity Scale (19) (Figure 2), a clinician-administered instrument monitoring the number of panic attacks, limited symptom attacks, agoraphobic avoidance, and somatic sensitiv- ity. The Panic Disorder Severity Scale was analyzed as a continu- ous measure, although the criterion for "response" that has be- come standard (9)-a 40% reduction from the baseline Panic Disorder Severity Scale score-is determined categorically. Other measures included the Sheehan Disability Scale (20), a measure of psychosocial impairment; the Hamilton Depression Rating Scale (HAM-D); and the Hamilton Anxiety Rating Scale (HAM-A), a measure of nonpanic ...
Similar publications
A new 13-item scale has been developed for measuring severity of illness in patients with panic disorder and agoraphobia, the Panic and Agoraphobia Scale (P & A). The scale has five subscales covering the main factors that reduce quality of life in panic disorder patients (panic attacks, avoidance, anticipatory anxiety, disability and worries about...
Citations
... The committee refused to consider additional evidence demonstrating the noninferiority of PDT to CBT and ultimately declined to revise their decision (Abbass et al., 2017). Lastly, the US National Institute for Mental Health excluded PDT altogether from their 2017 treatment recommendations for depression, anxiety disorders, and borderline personality disorder despite strong evidence that was available at the time which supports PDT as an effective treatment option for each of these diagnoses (e.g., Abbass et al., 2008;Driessen et al., 2015;Keefe et al., 2014;Leichsenring, 2005;Milrod et al., 2007). ...
... The empirical literature on psychodynamic theory and therapy is dense as it is diverse. Outcome studies have shown that PDT is at least as effective as other evidence-based psychotherapies, such as CBT (e.g., Driessen et al., 2015;Keefe et al., 2014;Leichsenring, 2001;Steinert et al., 2017), and more effective than others, such as solution-focused therapy and some varieties of CBT (Crits-Christoph et al., 2005;Knekt et al., 2008a;Milrod et al., 2007). ...
Psychodynamic theory and therapy is widely misunderstood by students, clinicians, and researchers at all levels of the mental health profession. This is an unfortunate consequence of bias and misinformation, which run rampant in academic and clinical environments alike. Despite the publication of numerous empirical research volumes and evidence-based treatment manuals over the past two decades, many students and professionals persist in their belief that the modality is ineffective and obsolete.
After identifying several sources of bias and misinformation, Psychodynamic Theory, Therapy, and Research: A Reintroduction presents a detailed overview of key developments in theory and technique. Readers will then be introduced to the clinical, developmental, and neurobiological domains of evidence which establish the validity of psychodynamic models and the efficacy of psychodynamic therapies. Each chapter also provides topical reading lists for those who wish to explore the literature in more depth.
... − In einer Studie war AR besser als eine Warteliste, aber weniger wirksam als KVT (Arntz u. van den Hout, 1996). − Bei einer Studie war AR war auf der PDSS (dem Haupteffizienzmaß) weniger gut wirksam als psychodynamische Therapie, während die HAMA Gleichwirksamkeit zeigte (Milrod et al., 2007a). − In einer weiteren Studie war eine um Expositionsübungen ergänzte AR wirksamer als eine Warteliste, aber weniger wirksam als KVT bzw. ...
... In eine Netzwerk-Metaanalyse (Pompoli et al., 2016) wurden nur zwei psychodynamische Studien eingeschlossen Milrod et al., 2007a), wobei bei Beutel et al. offenbar die korrigierten Effektstärken in die Berechnung mit eingingen und nicht die Rohwerte. Die Autoren schreiben: "In the only two studies available that explored PD (psychodynamic treatment), this treatment showed promising results, although further research is needed in order to better explore the relative efficacy of PD with respect to CBT. … PD and CBT, were directly compared in only one study , which suggested a superiority of CBT over PD, although the results were not statistically significant either in terms of ST-remission or in terms of ST response (it must be noted that the lack of significance may be due to the relatively small sample size ...
... In light of the inconclusive finding of a meta-regression that tested the potential impact of the year of publication on treatment effect, such a result may be due to the loss of statistical power after removing one 155 of the five RCTs on short-term psychodynamic therapy. 39,105,113,114,155 Despite that, the transitivity assumption appeared to be well preserved. In line with this point, we think the all-encompassing consideration of all the available delivery formats might explain at least part of the statistical heterogeneity detected in the efficacy analysis. ...
Background
Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence.
Aims
To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis.
Method
We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258).
Results
We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive–behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = −0.67, 95% CI −0.95 to −0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI −0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = −0.61, 95% CI −1.15 to −0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54–1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU.
Conclusions
CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.
... • post-partum stress disorders [82]; • panic attacks [83]; ...
Objective
Since the 2000s, “mental health” policies in France have to be based on evidence. A report on various forms of psychotherapy, published by the INSERM (the French National Institute of Health and Medical Research) in 2004, and whose conclusion was that there is no evidence of effectiveness for psychoanalysis, remains an important reference. The aim of this article is to re-examine its scientific value, fifteen years later.
Method
After returning to the context in which this report was written and the controversies surrounding its publication, we propose a review of the efficacy studies that have since evaluated psychoanalysis. This recent literature, mostly international, remains relatively little known in France.
Results
The INSERM's expert report – whose status could in part be promoted at the time of its publication – now appears to be relatively dated, both in terms of methodology and in its conclusions. The majority of current efficacy studies show that psychoanalytical and cognitive-behavioral therapies do not show any significant differences in efficacy for all known disorders.
Discussion
These results give rise to debate. Some scientists believe that they are only due to a lack of rigor in the experimental protocols. Others, on the contrary, maintain that the search for specific factors of efficacy is a dead end and promote studies in natural conditions, in order to assess the cumulative contextual factors of therapeutic effectiveness.
Conclusions
Without prejudging future research orientations and results, it nevertheless appears that the INSERM report can no longer be the dominant reference in France today for recommending psychotherapeutic “good practices.” Research has progressed considerably. In view of the international scientific literature available today, psychoanalysis is one offer of care to be advocated among others – a position to which many countries subscribe.
... Given this psychodynamic overlap, addressing conflicts about anger typically helps with both anxious and depressive symptoms, as well as problems in interpersonal relationships. Notably, treating patients with PFPP has been found to reduce comorbid depressive symptoms, although this reduction did not reach significance (7). ...
Psychoanalytic approaches, although still extensively used by practitioners, have been marginalized in treatment guidelines partly because of limited efficacy research. In recent years, several manualized psychodynamic approaches have been developed that target specific problems or disorders, which can be referred to generally as problem-focused psychodynamic psychotherapies. These treatments offer modified psychodynamic techniques to address dynamics associated with particular disorders and can be used for systematic outcome studies. One of these, panic-focused psychodynamic psychotherapy, has demonstrated efficacy in the treatment of panic disorder. The manuals for these psychotherapies emphasize comprehensibility for training purposes and are more readily transportable to the public health sector. Extensive research will be needed to ascertain which psychotherapies are most effective for various patients and conditions over the short and long term.
... To date PFPP is the only form of PDT having been evaluated specifically for adults identified because of a primary diagnosis of PD/A. PFPP has been shown to be effective at both acute (Milrod et al., 2016;Milrod et al., 2007) and longterm follow-ups (McCarthy et al., 2018), and when delivered in routine clinical practice (Beutel et al., 2013). ...
Patient preferences have drawn considerable attention as a potential moderator of treatment outcome. The Doubly Randomised
Controlled Preference Trial (DRCPT) in which patients are randomised to a choice between two or more treatments or random
assignment to one of these same treatments is considered one of the most rigorous tests of the effects of patient preferences on
outcomes. To date, there have been no DRCPTs involving the choice between two psychological treatments for any psychiatric
disorder. A DRCPT was conducted in which 221 adults with a primary diagnosis of Panic Disorder with or without Agoraphobia
(PD/A) were randomly allocated to choose between Panic Control Treatment (PCT) and Panic Focused Psychodynamic
Psychotherapy (PFPP), or to random assignment to these two treatments. The primary outcome measures were the Panic Disorder
Severity Scale (PDSS), work status and sick leave assessed at post-treatment, 6-, 12-, and 24-month follow-ups. A range of
secondary outcomes were assessed at these same intervals. The DRCPT, titled Project POSE (Psychotherapy Outcome and Selfselection
Effects), was carried out in the southern part of Sweden between 2010 and 2019.
Project POSE, from which this program of PhD research is drawn, had two primary aims: 1) to assess the effects of patient
treatment preferences on the primary and secondary outcomes at post-treatment and follow-up; and 2) to compare outcomes for
PCT and PFPP on the primary and secondary outcomes at post-treatment and follow up. The primary aims of this PhD were: 1)
to assess the effects of patient choice of treatments on the primary outcomes at post-treatment and follow-up; and 2) via qualitative
and quantitative methods to better understand why participants randomised to the choice condition chose either PFPP or PCT;
and 3) to evaluate the validity of the Swedish version of the PDSS, which served as the primary (interview version) and secondary
(patient-report version) measures of PD/A severity in the trial.
Study I identified an important gap in the literature with respect to a need for studies that could experimentally test the role of
patient treatment preferences on outcomes in psychotherapy. Study II established that that the Swedish translations of the PDSS
and PDSS-SR possessed high levels of internal consistency and concurrent validity, as well as a factor structure similar to the
English-language original, suggesting they were valid for use as a primary/secondary measures in the DRCPT. Study III found that
when offered a choice between PCT and PFPP, the resulting choice was primarily a function of the individual’s beliefs about the
chosen therapy, its potential for success, and their own learning style. Contrary to expectation, Study IV found no differences for
the primary and secondary outcomes at post-treatment or long-term follow-up for patients randomised to the treatment choice
and random allocation to treatment conditions. However, a disordinal interaction, albeit non-significant, on the PDSS, suggested
that the effect of treatment preferences on outcomes for PD/A may have been moderated by treatment type (PCT or PFPP).
... Hence, scores below 8 were considered not clinical. Also, patients were regarded as responders when a 40% reduction from baseline to post-test in the PDSS was observed Milrod et al., 2007). In addition, PD sufferers were defined as panic free by a PD clinician severity rating of ≤2 (Craske et al., 1991). ...
Compared to conventional face-to-face psychological treatments, internet-based cognitive-behavioral therapy (iCBT) presents an innovative alternative that has been found to be effective in the treatment of anxiety disorders. The current study provides a meta-analysis investigating the efficacy of disorder-specific guided self-help (Gsh) iCBT compared to various active and inactive control conditions, with focus on adult panic disorder sufferers with or without agoraphobia (PD/A). Systematic literature search yielded 13 randomized controlled trials (RCTs) (N = 1,214) that met the eligibility criteria for this study. We found no statistically significant differences between Gsh iCBT and various active CBT interventions in reducing PD/A symptoms at both post-test (g = 0.015, k = 10) and follow-up (g = 0.113, k = 6) levels. Also, comorbid anxiety and depression were reduced equivalently at post-test (g = 0.004, k = 6) and follow-up (g = 0.004, k = 6). Quality of life was equally improved at post-test (g = -0.100, k = 5) and follow-up (g = 0.074, k = 2). When compared to inactive controls, we found large effect sizes in PD/A (g = -0.892, k = 9) and comorbid anxiety and depression (g = -0.723, k = 9) symptoms, and moderate change in quality of life (g = -0.484, k = 3) at post-test. There was no difference between Guided self-help iCBT and Self-help iCBT in PD/A (g = -0.025, k = 3) and comorbid anxiety and depression (g = -0.025, k = 3) at post-test. Baseline severity, country of original research and adherence to the treatment in form of initial uptake were identified as statistically significant moderators of the iCBT treatment.
... Psychodynamic formulations of panic disorder have also been considered over the last several decades (Busch et al., 1999;Milrod et al., 2007). These theories are based on a neoFreudian conceptualization of panic attacks and panic disorder. ...
... More recent work has shown that anxious attachment is not only related to avoidance when alone more than when accompanied by a safe other,but that anxious attachment also improves during CBT following reductions in anxiety sensitivity and avoidance when alone (Zalaznik et al., 2019). p0375 Treatment evidence indicates that psychodynamic treatment based on the aforementioned principles is more effective than control treatments, such as relaxation (Milrod et al., 2007). However, it's relative efficacy to CBT is unclear, with some studies showing superiority of CBT at posttreatment (one of two sites in Milrod et al., 2016;Svenson et al., 2021), but not at follow-up (McCarthy et al., 2018;Svenson et al., 2021). ...
Panic disorder is characterized by a fear of future panic attacks, or a “fear of fear,” which leads to avoidance and distress. Panic disorder is often comorbid with agoraphobia, or a fear of experiencing anxiety or panic attacks in different situations. Psychological theories of panic have made significant progress since the inception of the diagnosis in the 1980s. These theories focus catastrophic interpretations of bodily sensations, also described as feared associations of bodily sensations with threat. Most psychological theories and treatments (i.e., cognitive behavioral therapies) focus on learning that bodily sensations are not dangerous through experiential exercises often called exposure or behavioral experiments. Multiple studies have demonstrated the efficacy of these interventions, and they are considered recommended, first-line treatments in most of the world. So much progress has been made in these treatments that there are self-help programs, including guided internet-based interventions that incorporate these principles and yield similar efficacy.
... In light of the inconclusive finding of a meta-regression that tested the potential impact of the year of publication on treatment effect, such a result may be due to the loss of statistical power after removing one 155 of the five RCTs on short-term psychodynamic therapy. 39,105,113,114,155 Despite that, the transitivity assumption appeared to be well preserved. In line with this point, we think the all-encompassing consideration of all the available delivery formats might explain at least part of the statistical heterogeneity detected in the efficacy analysis. ...
... Une autre approche psychothérapique recommandée par l'APA est la psychothérapie psychodynamique focalisée sur le trouble panique (PPFP), pour laquelle un essai contrôlé randomisé comparativement à l'utilisation de techniques de relaxation a retrouvé une taille d'effet forte (d = 0,95) en termes de probabilité de réduction d'au moins 40 % du score de sévérité estimé à l'aide de la Panic disorder severity scale [21]. La PPFP consiste en une thérapie brève de 12 semaines, à raison de 2 séances par semaine, et constitue une alternative pour les patients ne répondant pas à la TCC et/ou partiellement à la pharmacothérapie. ...
Panic disorder in the elderly is an understudied disorder, despite being associated with substantial functional impairment, diminished quality of life and increased suicide risk in this population. This disorder is likely to be underdiagnosed and sometimes inadequately treated in the absence of national and international guidelines for this vulnerable population. Few therapeutic trials have specifically focused on the efficacy and tolerability of pharmacologic and psychotherapy treatments for panic disorder in the elderly, and current approaches to detect and manage this disorder are mainly based on experts' opinion or extrapolation from data available in younger adults. This report aims to provide a summary of current knowledge on pharmacologic and psychotherapeutic treatments for panic disorder in the elderly, and to propose a medical treatment algorithm, which should be viewed as a tool that may contribute to the choice of treatment, especially for treatment-resistant older patients with panic disorder. The main results here are the emphasis on antidepressant treatment, like selective serotonin reuptake inhibitor (SSRI), restricted benzodiazepine usage, take care of drug interactions, and importance of psychotherapy like cognitive behavioral therapy (CBT).
