Psychodynamic Therapy for Panic Disorder

Posted with permission from Psychotherapy Networker magazine, copyright, Psychotherapy Network, Inc.

 

Several decades ago, when the demands that psychotherapy provide empirical proof of its effectiveness first started, Cognitive behavioral therapy (CBT) bolted into the lead among empirically supported. Short-term therapies, while psychodynamic therapy wandered over to the grass and started grazing. But reports of psychodynamic therapy’s demise proved greatly exaggerated.

 

Now quantitative research on psychodynamic therapy is growing since researchers began developing manualized treatments, specific measurement instruments, and more concrete goals with which to measure its effectiveness. The recent Psychodynamic Diagnostic Manual, which brings an alternative perspective to the DSM’s classification system, concludes with 150 pages reviewing evidence-based research for psychodynamic therapies for conditions that include major depression, PTSD, and eating and personality disorders.

A study reported in the February, 2007 American Journal of Psychiatry, led by psychiatrist Barbara Milrod of Cornell University’s Weill Medical College, is another example of psychodynamic therapy’s progress in the empirically supported therapy field. In the first controlled clinical trial of a psychodynamic therapy for any DSM-IV panic disorder (PD), the study finds that a 24-session, 12 week psychodynamic therapy successfully treated 73 percent of the subjects. Only 39 percent of the comparison group, treated with applied relaxation training, met the criteria for response.

The psychodynamic treatment eschewed the tried-and-true CBT techniques of exposure therapy and homework. That may help explain the psychodynamic group’s surprisingly low attrition rate. Only two of the 26 subjects dropped out (beating the relaxation training group’s attrition rate of 8 out of 23), and it’s a lower attrition rate than that of many CBT studies. It may be that psychodynamic therapy feels less difficult to undergo than CBT techniques like exposure. Instead, clients were encouraged to explore such things as the personal meanings they attributed to their attacks and how the attacks were related to underlying dynamics–separation problems, difficulties with autonomy, and conflicted anger—and to the way these themes emerged within the therapeutic relationship.

Milrod stresses that her small study of 49 subjects doesn’t suggest that psychodynamic therapy’s more effective than CBT. Although the study’s success rate is higher than CBT’s 49 percent success in the largest controlled study of CBT on panic disorder, conducted by David Barlow is 2000, the completely different study designs make any direct comparisons impossible. Direct comparisons with CBT will have to come from a head-to-head study.

That match-up is coming soon. With funding by the National Institute of Mental Health, Milrod is beginning a study of 223 people with panic disorder that will compare psychodynamic therapy, relaxation training and CBT.

 

References:

Milrod, Barbara (2007). “A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder,” in American Journal of Psychiatry, 164 (2), 265-272

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