Implementing Panic-Focused Psychodynamic Psychotherapy into Clinical Practice

• Published in: Canadian journal of psychiatry Vol. 58; no. 6; pp. 326 - 334
• Main Authors: Beutel, Manfred E, Scheurich, Vera, Knebel, Achim, Michal, Matthias, Wiltink, Jörg, Graf-Morgenstern, Mechthild, Tschan, Regine, Milrod, Barbara, Wellek, Stefan, Subic-Wrana, Claudia
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.06.2013; Canadian Psychiatric Association; SAGE PUBLICATIONS, INC
• Subjects: Adult; Adult and adolescent clinical studies; Agoraphobia - diagnosis; Agoraphobia - psychology; Agoraphobia - therapy; Anxiety disorders. Neuroses; Awareness; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cardiovascular disease; Clinical medicine; Clinical trials; Cognitive Therapy - methods; Combined Modality Therapy; Comorbidity; Executive Function; Female; Follow-Up Studies; Germany; Humans; Implosive Therapy - methods; Individual psychotherapy; Inservice Training; Intervention; Male; Manuals as Topic; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - psychology; Mental Disorders - therapy; Middle Aged; Panic attacks; Panic disorder; Panic Disorder - diagnosis; Panic Disorder - psychology; Panic Disorder - therapy; Psychiatry; Psychoanalytic Therapy - education; Psychoanalytic Therapy - methods; Psychology. Psychoanalysis. Psychiatry; Psychometrics - statistics & numerical data; Psychopathology. Psychiatry; Psychotherapies. Psychological and clinical counseling; Surveys and Questionnaires; Therapists; Therapy; Treatments; Germany; effectiveness; follow-up; cognitive-behavioural therapy; agoraphobia; panic-focused psychodynamic psychotherapy; panic disorder; Panic; Analytical psychotherapy; Cognitive therapy; Agoraphobia; Anxiety disorder; Implementation; Treatment; Follow up study; Behavior therapy
• ISSN: 0706-7437; 1497-0015
• DOI: 10.1177/070674371305800604

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)