Psychodynamic Psychotherapy for Panic Disorder?

Psychoanalytic psychotherapists have long argued that their therapies are effective for panic disorder, but these claims have hitherto lacked the quality of evidence required by current standards. In this randomized, controlled clinical trial, 49 adults with DSM-IV panic disorder (mean number of Axis I comorbidities, 2; patients on stable antipanic medications, 9) underwent 12-week courses of twice-weekly panic-focused psychodynamic therapy (PFP) or applied relaxation training, a behavioral therapy less elaborate than cognitive-behavioral therapy. PFP involves three phases, addressing different issues: (1) unconscious issues thought to be associated with panic (e.g., separation, autonomy, and unacknowledged anger); (2) salient unconscious conflicts thought to contribute to panic vulnerability; and (3) separation- and anger-related conflicts that may re-emerge with termination.

Response was defined as a 40% decrease in scores on a scale measuring panic disorder severity. PFP was associated with a lower dropout rate than relaxation training (7% vs. 34%), greater reductions in functional impairment, and a higher rate of symptom response (73% vs. 39%), with a strong effect size. Adjustment for antipanic medications did not alter these outcomes.