A Randomized Controlled Clinical Trial of Psychoanalytic Psychotherapy for Panic Disorder

Milrod, Barbara; Leon, Andrew C.; Busch, Fred; Rudden, Marie G.; Schwalberg, Michael D.; Clarkin, John; Aronson, Andrew; Singer, Meriamne B.; Turchin, Wendy; Klass, Emily; Graf, Elizabeth; Teres, Jed J.; Shear, M. Katherine

doi:10.1176/foc.6.4.foc496

Cited by 49 publications

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“…Only a few studies have evaluated psychodynamic psychotherapy in panic disorder. In one study, psychodynamic therapy was superior to ''applied relaxation'', a relaxation technique (Milrod et al 2007). Some patients received additional SSRI treatment in this trial.…”

Section: Monoamine Oxidase Inhibitors (Maoi)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

699

406

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Section: Monoamine Oxidase Inhibitors (Maoi)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

699

406

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“…In their RCT, Milrod et al 6 demonstrated efficacy of PFPP, a brief, time-limited psychodynamic intervention specifically devised for treatment of panic disorder, with or without agoraphobia. After completion of 12 weeks of this twiceweekly intervention, the reduction of panic severity was significantly greater, compared with patients treated with applied relaxation training, a behavioural intervention shown to be effective in patients with panic disorder.…”

Section: Limitationsmentioning

confidence: 99%

Implementing Panic-Focused Psychodynamic Psychotherapy into Clinical Practice

Beutel¹,

Scheurich²,

Knebel

et al. 2013

Can J Psychiatry

Self Cite

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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

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“…The model for this approach was in part derived from panic-focused psychodynamic psychotherapy, which has demonstrated efficacy as a twice-weekly, 24-session intervention in the treatment of panic disorder (Milrod 1997(Milrod , 2007. Treatment has three phases.…”

Section: Psychodynamic Approaches To Depressionmentioning

confidence: 99%

Anger and depression

Busch¹

2009

Adv. psychiatr. treat

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SummaryA series of psychoanalytic theorists and clinicians have suggested that conflicts about anger play a central role in the development of depression. Research data have supported the notion that patients struggle with the experience and expression of angry feelings. Anger in people with depression often stems from narcissistic vulnerability, a sensitivity to perceived or actual loss or rejection. These angry reactions cause intrapsychic conflicts through the onset of guilt and the fear that angry feelings will disrupt relationships. These conflicts lead to anger being directed inwards, further lowering self-esteem, creating a vicious cycle. Defence mechanisms that are triggered, including passive aggression, reaction formation, denial and identification with the aggressor, are ineffective at managing these conflicts and further prevent the appropriate expression of anger. This article discusses how to identify and detoxify angry feelings and fantasies using a psychodynamic approach.

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A Randomized Controlled Clinical Trial of Psychoanalytic Psychotherapy for Panic Disorder

Cited by 49 publications

References 0 publications

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Implementing Panic-Focused Psychodynamic Psychotherapy into Clinical Practice

Anger and depression

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