PANIC DISORER STUDY - FREE SHORT TERM THERAPY

With several other clinicians in Washington, Maryland and Virginia, I am participating in a free clinical trial of the efficacy of short term, psychoanalytical psychodynamic psychotherapy (PPT) for the treatment of panic disorder. For more information about the study, please contact Pavel Snejnevski at 202-459-4556 or myself at 703-389-2047.


Psychoanalytic Research: A Paradigm Shift?

By Pavel Snejnevski, Kate Rickard, and Claudette Pilger

Psychoanalytic (Psychodynamic) Psychotherapy is the most widely used approach to treatment of mental illnesses. Surprisingly, it is also the least defined. Psychoanalysts think of it as "second best" or "psychoanalysis-with-parameters", and Cognitive-Behavioral therapists in their research studies often refer to it as "treatment-as-usual". It doesn't improve the self-esteem of psychoanalytic psychotherapists that reviews of comparative studies of effectiveness of Psychoanalytic Psychotherapy (PP) to other therapies usually demonstrate its only moderate effectiveness. PP is usually found to be more effective than placebos and less effective than or equal to other therapies, especially CBT.

There are reasons to believe that since most of the research comparing PP with other treatments was done by non-analytically trained researchers, its effectiveness may have been undervalued as a result of poor definition and a lack of adequate quality control [1]. However, the disadvantage in which the psychoanalytic community finds itself is of its own doing and mostly stems from reluctance to clearly define what PP is and to subject PP to vigorous testing by research. This reluctance is understandable historically, but in current conditions is inexcusable. Thankfully, the situation is slowly changing and lately, we see an increasing number of impressive research projects conducted by analysts belonging to psychoanalytic societies all over the world [2]. Perhaps the recent review pointing to the greater effectiveness of long term, intensive, psychodynamic treatment, published in JAMA, will further fuel this trend [3].

A real sea change in the area of PP research, in our opinion, was the development and publication of the "Manual of Panic-Focused Psychodynamic Psychotherapy" by B. Milrod, F. Bush, A. Cooper, and T. Shapiro from Cornell University Medical College [4]. The PFPP manual offers a unique opportunity to define psychoanalytic treatment and to control its delivery in a research setting. Using the Manual B. Milrod et al [5] have demonstrated the superiority of 12 weeks of twice per week manualized Panic-Focused Psychodynamic Psychotherapy (PFPP) performed by highly trained psychotherapists to Applied Relaxation Training (ART is a recognized behavioral therapy for Panic Disorder). This work is ground-breaking. For the first time, a study performed according to externally-recognized clinical trial standards has shown that a psychodynamic intervention is statistically effective compared to a control intervention.

Does this study constitute a very promising beginning of a revival, or a last flame of a dying fire of the old "treatment-as-usual" approach? The authors of this article are trying to prove the former. In an effort to replicate and extend the Milrod et al results, we started a clinical trial of effectiveness of Panic-Focused Psychodynamic Psychotherapy delivered in the private practice setting. It is funded by AB Foundation for Medical Research, co-sponsored by Baltimore-Washington Center for Psychoanalysis, and is conducted in collaboration with Dr. B. Milrod. We are looking for support and, possibly, participation from the members of the psychotherapeutic community in the Washington Metropolitan Area. Currently, the most pressing issue for us is finding patients appropriate for the Study, to whom we offer free treatment. To qualify, patients will have to have a primary diagnosis of Panic Disorder with or without Agoraphobia. Comorbid disorders like Depression or Personality Disorders do not automatically disqualify from participation in the study. We will not accept patients who are currently suicidal or abusing substances. Everyone interested in the study or wishing to refer a patient for free treatment is welcome to visit www.DCPanicTreatmentStudy.com, call (202) 459-4556, or contact one of us directly.

References:

1. Ablon JS, Jones EE. Validity of controlled clinical trials of psychotherapy: findings from the NIMH treatment of depression collaborative research program. Am J Psychiatry 2002 159; 775-783.

2. Fonagy, Ed. An open door review of outcome studies in psychoanalysis. International Psychoanalytical Association. 2002

3. Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-analysis Leichsenring and Rabung. JAMA.2008; 300: 1551-1565.

4. Milrod, Busch, Cooper, Shapiro. Manual of Panic-Focused Psychodynamic Psychotherapy. American Psychiatric Press, Inc. 1997.

5. Milrod, Leon, Busch, Rudden, Schwalberg, Clarkin, Aronson, Singer, Turchin, Klass, Graf, Teres, Shear. A Randomized Controlled Clinical Trial of Psychoanalytic Psychotherapy for Panic Disorder. Am J Psychiatry. 2007; 164:265-272.