Effectiveness of Psychodynamic Psychotherapy for Panic Disorder

Psychoanalytic therapies have been in professional use for over a century, but a new study from physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center is the first to show that a classic psychoanalytic talk therapy is efficacious in treating panic disorder.

Panic disorder remains a common, debilitating condition, accounting for more than 20 percent of U.S. hospital emergency room visits. Patients with the condition are plagued by sudden, uncontrolled symptoms such as panic, dizziness, and heart palpitations, as well as chest and abdominal pain.

The small but significant study, involving 49 patients, compared 12 weeks of twice-weekly psychodynamic psychotherapy sessions to another well-known approach, applied relaxation training (ART).

"The psychoanalytic strategy was highly effective, achieving nearly double the level of patient response by the end of treatment as compared to ART," says Dr. Barbara Milrod, the study's lead author and associate attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. She is also associate professor of psychiatry at Weill Cornell Medical College.

The findings are significant because the trial, while preliminary, is among the first to prove clinical efficacy for a psychoanalytic therapy for any major psychiatric disorder, Dr. Milrod says.

Her team published their findings in the American Journal of Psychiatry.

"Right now, two therapies - cognitive behavioral psychotherapy (CBT) and the use of antidepressant or anti-anxiety drugs such as selective serotonin reuptake inhibitors (SSRIs) - are the main forms of treatment for panic disorder in the United States," Dr. Milrod explains.

However, studies suggest that up to half of patients may not respond to either of these approaches. What is more, many patients, such as women during pregnancy, prefer not to take a pharmaceutical therapy, lending urgency to the notion that patients need effective, non-pharmaceutical options in treating panic disorder.

That is why there has been a renewed interest in psychodynamic psychotherapy. "This form of talk therapy has actually been around since the beginning of the 20th century, and it's still practiced by many psychiatrists and psychologists across the U.S. today," Dr. Milrod says.

Unlike CBT - which relies on exposure to panic triggers, and a highly structured set of exercises aimed at easing attacks - psychodynamic psychotherapy has a different focus.

"It's really aimed at getting patients to understand the underlying emotional meaning of their panic, its root psychological causes," Dr. Milrod says. "Once that is achieved, patients can acknowledge previously unacceptable feelings and ideas, which have led to panic, as they arise."

For example, in one case highlighted in the study, a respected professional musician was beset by panic attacks so severe they kept her from performing. During her psychodynamic psychotherapy sessions, she and her doctor traced the source of her panic to her relationship with her highly critical and demanding mother.