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Does Brief Dynamic Psychotherapy Reduce the Relapse Rate of Panic Disorder?

Does Brief Dynamic Psychotherapy Reduce the Relapse Rate of Panic Disorder? Abstract Background: Although panic disorder can be effectively alleviated by drug treatment, the relapse rate is high. By adding brief dynamic psychotherapy focused on the Psychosocial vulnerability of patients with panic disorder to an established drug treatment regimen, we hypothesized that this would result in a lower relapse rate after pharmacotherapy. Methods: Patients with panic disorder (defined by DSM-III-R) were randomized to treatment with either clomipramine for 9 months (n=20), or clomipramine for 9 months combined with 15 weekly sessions of brief dynamic psychotherapy (n=20). Measures of anxiety and depression were collected at intake and at regular intervals. The patients had blind follow-up interviews at 6, 12, and 18 months after beginning treatment. Results: All patients in both groups became free of panic attacks within 26 weeks of the start of treatment. On termination of pharmacotherapy, the relapse rate was significantly higher in the clomipramine-only group during the follow-up period. There were significantly lower scores for most anxiety measures in the clomipramine plus psychotherapy group at the 9-month follow-up. Conclusion: The addition of brief dynamic psychotherapy to treatment with clomipramine significantly reduces the relapse rate of panic disorder compared with clomipramine treatment alone. References 1. Klein DF, Gorman JM. A model of panic and agoraphobia development . Acta Psychiatr Scand Suppl . 1987;335:87-95.Crossref 2. Sheehan DV. Tricyclic antidepressants in the treatment of panic and anxiety disorders . Psychosomatics . 1986;27( (suppl 11) ):10-16.Crossref 3. Sheehan DV. The Anxiety Disease . New York, NY: Bantam Books Inc; 1986. 4. Ballenger JC. Overview of the pharmacotherapy of panic disorder. In: Wolfe BE, Maser JD, eds. Treatment of Panic Disorder: A Consensus Development Conference. Washington, DC: American Psychiatric Press; 1994:59-72. 5. Ballenger JC. Efficacy of benzodiazepines in panic disorder and agoraphobia . J Psychiatr Res . 1990;24( (suppl 2) ):15-25.Crossref 6. Sheehan DV. Benzodiazepines in panic disorder and agoraphobia . J Affect Disord . 1987;13:169-181.Crossref 7. Noyes R, DuPont RL, Pecknold JC, Rifkin A, Rubin RT, Swinson RP, Ballenger JC, Burrows GD. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial, II: patient acceptance, side effects, and safety . Arch Gen Psychiatry . 1988;45:423-428.Crossref 8. Liebowitz MR, Fyer AJ, Gorman JM, Campeas R, Levin A, Davies SR, Goetz D, Klein DF. Alprazolam in the treatment of panic disorder . J Clin Psychopharmacol . 1986;6:13-20.Crossref 9. Beauclair L, Fontaine R, Annable L, Holobow N, Chouinard G. Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response . J Clin Psychopharmacol . 1994;14:111-118.Crossref 10. Zitrin CM, Klein DF, Woerner MG, Ross DC. Treatment of phobias, I: comparison of imipramine hydrochloride and placebo . Arch Gen Psychiatry . 1983;40:125-138.Crossref 11. Noyes R, Garvey MJ, Cook BL. Follow-up study of patients with panic disorder and agoraphobia with panic attacks treated with tricyclic antidepressants . J Affect Disord . 1989;16:249-257.Crossref 12. Noyes R, Garvey MJ, Cook BL, Suelzer M. Controlled discontinuation of benzodiazepine treatment for patients with panic disorder . Am J Psychiatry . 1991;148:517-523. 13. Shear MK, Maser JD. Standard assessment for panic disorder research . Arch Gen Psychiatry . 1994;51:346-354.Crossref 14. Mavissakalian M, Michelson L, Dealy RS. Pharmacological treatment of agoraphobia: imipramine versus imipramine with programmed practice . Br J Psychiatry . 1983;143:348-355.Crossref 15. Telch MJ, Agras WS, Taylor CB, Roth WT, Gallen CC. Combined pharmacological and behavior treatment for agoraphobia . Behav Res Ther . 1985;23:325-335.Crossref 16. Marks IM, Swinson RP, Basoglu M, Kuch K, Noshirvani H, O'Sullivan G, Lelliot PT, Kirby M, McNamee G, Sengun S, Wickwire K. Alprazolam and exposure alone and combined in panic disorder with agoraphobia: a controlled study in London and Toronto . Br J Psychiatry . 1993;162:776-787.Crossref 17. Telch MJ, Lucas RA. Combined pharmacological and psychological treatment of panic disorder: current status and future directions. In: Wolfe BE, Maser JD, eds. Treatment of Panic Disorder: A Consensus Development Conference. Washington, DC: American Psychiatric Press; 1994:177-197. 18. Cohen SD, Monteiro W, Marks IM. Two-year follow-up of agoraphobics after exposure and imipramine . Br J Psychiatry . 1984;144:276-281.Crossref 19. Mavissakalian M, Michelson L. Two-year follow-up of exposure and imipramine treatment of agoraphobia . Am J Psychiatry . 1986;142:1032-1036. 20. Faravelli C. Life events preceding the onset of panic disorder . J Affect Disord . 1985;9:103-105.Crossref 21. Faravelli C, Pallanti S. Recent life events and panic disorder . Am J Psychiatry . 1989;146:622-626. 22. Roy-Byrne PP, Geraci M, Uhde TW. Life events and course of illness in patients with panic disorder . Am J Psychiatry . 1986;143:1033-1035. 23. Roy-Byrne PP, Geraci M, Uhde TW. Life events and the onset of panic disorder . Am J Psychiatry . 1986;143:1424-1427. 24. Roy-Byrne PP, Geraci M. Uhde TW. Life events obtained via interview: the effect of time of recall on data obtained in controls and patients with panic disorder . J Affect Disord . 1987;12:57-62.Crossref 25. Roy-Byrne PP, Uhde TW. Exogenous factors in panic disorder: clinical and research implications . J Clin Psychiatry . 1988;49:56-61. 26. Modigh K, Westberg P, Eriksson E. Superiority of clomipramine over imipramine in the treatment of panic disorder: a placebo-controlled trial . J Clin Psychopharmacol . 1992;12:251-261.Crossref 27. Spitzer RL, Williams JBW. Revised diagnostic criteria and a new structured interview for diagnosing anxiety disorder . J Psychiatr Res . 1988;22:55-86.Crossref 28. Hyler SE, Rieder RO. PDQ-R: Personality Diagnostic Questionnaire-Revised . New York, NY; New York State Psychiatric Institute: 1987. 29. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised . Washington, DC: American Psychiatric Association; 1987. 30. Davanloo H, ed. Basic Principles and Techniques in Short-Term Dynamic Psychotherapy . New York, NY: Spectrum; 1978. 31. Malan D. The Frontier of Brief Psychotherapy . New York, NY: Plenum Medical Books; 1976. 32. Malan D. The Frontier of Brief Psychotherapy: An Example of the Convergence of Research and Clinical Practice . New York, NY: Plenum Press; 1976. 33. Malan D. Individual Psychotherapy and the Science of Psychodynamics . London, England: Butterworth; 1979. 34. Strupp HH, Binder JL. Psychotherapy in a New Key: A Guide to Time-Limited Dynamic Psychotherapy . New York, NY: Basic Books Inc Publishers; 1984. 35. Derogatis LR. SCL-90: Administration Scoring and Procedures Manual-1 For the (Revised) Version . Baltimore, Md: Clinical Psychometrics Research Unit, John Hopkins University School of Medicine; 1977. 36. Spielberger C, Gorsuch A, Lushene R. The State-Trait Anxiety Inventory . Palo Alto, Calif: Consulting Psychologist Press; 1970. 37. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry . 1976;33:766-771.Crossref 38. Guy W. ECDEU Assessment Manual for Psychopharmacology . Rockville, Md: National Institute of Mental Health; 1976. Publication 76-338. 39. Hamilton M. The assessment of anxiety by rating . Br J Med Psychol . 1959;32:50-55.Crossref 40. Sheehan DV. The Anxiety Disease . New York, NY: Bantam Books; 1986. 41. Panic Disorder: Patient's Status. Kalamazoo, Mich; The Upjohn Co: 1990. Reference 94-1557-41 01/90. Self-report questionnaire. 42. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-62.Crossref 43. Panic Disorder: Medical Events Checklist. Kalamazoo, Mich; The Upjohn Co: 1990. Reference 94-1557-37 01/90. Interview-based questionnaire. 44. Hamre P, Dahl AA, Malt U. Public attitudes to the quality of psychiatric treatment, psychiatric patients, and the prevalence of mental disorder . Nord Psychiatr J . 1994;48:275-281.Crossref 45. Ursano RJ, Sonnenberg SM, Lazar SG. Psychodynamic Psychotherapy . Washington, DC: American Psychiatric Press; 1991;102. 46. Clark DB, Taylor CB, Roth WT, Hayward C, Ehlers A, Margraf J, Agras WS. Surreptitious drug use by patients in a panic disorder study . Am J Psychiatry . 1991;36:130-138. 47. Millrod B, Shear MK. Psychodynamic treatment of panic: three case histories . Hosp Community Psychiatry . 1991;42:311-312. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Does Brief Dynamic Psychotherapy Reduce the Relapse Rate of Panic Disorder?

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1996.01830080041008
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Abstract

Abstract Background: Although panic disorder can be effectively alleviated by drug treatment, the relapse rate is high. By adding brief dynamic psychotherapy focused on the Psychosocial vulnerability of patients with panic disorder to an established drug treatment regimen, we hypothesized that this would result in a lower relapse rate after pharmacotherapy. Methods: Patients with panic disorder (defined by DSM-III-R) were randomized to treatment with either clomipramine for 9 months (n=20), or clomipramine for 9 months combined with 15 weekly sessions of brief dynamic psychotherapy (n=20). Measures of anxiety and depression were collected at intake and at regular intervals. The patients had blind follow-up interviews at 6, 12, and 18 months after beginning treatment. Results: All patients in both groups became free of panic attacks within 26 weeks of the start of treatment. On termination of pharmacotherapy, the relapse rate was significantly higher in the clomipramine-only group during the follow-up period. There were significantly lower scores for most anxiety measures in the clomipramine plus psychotherapy group at the 9-month follow-up. Conclusion: The addition of brief dynamic psychotherapy to treatment with clomipramine significantly reduces the relapse rate of panic disorder compared with clomipramine treatment alone. References 1. Klein DF, Gorman JM. A model of panic and agoraphobia development . Acta Psychiatr Scand Suppl . 1987;335:87-95.Crossref 2. Sheehan DV. Tricyclic antidepressants in the treatment of panic and anxiety disorders . Psychosomatics . 1986;27( (suppl 11) ):10-16.Crossref 3. Sheehan DV. The Anxiety Disease . New York, NY: Bantam Books Inc; 1986. 4. Ballenger JC. Overview of the pharmacotherapy of panic disorder. In: Wolfe BE, Maser JD, eds. Treatment of Panic Disorder: A Consensus Development Conference. Washington, DC: American Psychiatric Press; 1994:59-72. 5. Ballenger JC. Efficacy of benzodiazepines in panic disorder and agoraphobia . J Psychiatr Res . 1990;24( (suppl 2) ):15-25.Crossref 6. Sheehan DV. Benzodiazepines in panic disorder and agoraphobia . J Affect Disord . 1987;13:169-181.Crossref 7. Noyes R, DuPont RL, Pecknold JC, Rifkin A, Rubin RT, Swinson RP, Ballenger JC, Burrows GD. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial, II: patient acceptance, side effects, and safety . Arch Gen Psychiatry . 1988;45:423-428.Crossref 8. Liebowitz MR, Fyer AJ, Gorman JM, Campeas R, Levin A, Davies SR, Goetz D, Klein DF. Alprazolam in the treatment of panic disorder . J Clin Psychopharmacol . 1986;6:13-20.Crossref 9. Beauclair L, Fontaine R, Annable L, Holobow N, Chouinard G. Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response . J Clin Psychopharmacol . 1994;14:111-118.Crossref 10. Zitrin CM, Klein DF, Woerner MG, Ross DC. Treatment of phobias, I: comparison of imipramine hydrochloride and placebo . Arch Gen Psychiatry . 1983;40:125-138.Crossref 11. Noyes R, Garvey MJ, Cook BL. Follow-up study of patients with panic disorder and agoraphobia with panic attacks treated with tricyclic antidepressants . J Affect Disord . 1989;16:249-257.Crossref 12. Noyes R, Garvey MJ, Cook BL, Suelzer M. Controlled discontinuation of benzodiazepine treatment for patients with panic disorder . Am J Psychiatry . 1991;148:517-523. 13. Shear MK, Maser JD. Standard assessment for panic disorder research . Arch Gen Psychiatry . 1994;51:346-354.Crossref 14. Mavissakalian M, Michelson L, Dealy RS. Pharmacological treatment of agoraphobia: imipramine versus imipramine with programmed practice . Br J Psychiatry . 1983;143:348-355.Crossref 15. Telch MJ, Agras WS, Taylor CB, Roth WT, Gallen CC. Combined pharmacological and behavior treatment for agoraphobia . Behav Res Ther . 1985;23:325-335.Crossref 16. Marks IM, Swinson RP, Basoglu M, Kuch K, Noshirvani H, O'Sullivan G, Lelliot PT, Kirby M, McNamee G, Sengun S, Wickwire K. Alprazolam and exposure alone and combined in panic disorder with agoraphobia: a controlled study in London and Toronto . Br J Psychiatry . 1993;162:776-787.Crossref 17. Telch MJ, Lucas RA. Combined pharmacological and psychological treatment of panic disorder: current status and future directions. In: Wolfe BE, Maser JD, eds. Treatment of Panic Disorder: A Consensus Development Conference. Washington, DC: American Psychiatric Press; 1994:177-197. 18. Cohen SD, Monteiro W, Marks IM. Two-year follow-up of agoraphobics after exposure and imipramine . Br J Psychiatry . 1984;144:276-281.Crossref 19. Mavissakalian M, Michelson L. Two-year follow-up of exposure and imipramine treatment of agoraphobia . Am J Psychiatry . 1986;142:1032-1036. 20. Faravelli C. Life events preceding the onset of panic disorder . J Affect Disord . 1985;9:103-105.Crossref 21. Faravelli C, Pallanti S. Recent life events and panic disorder . Am J Psychiatry . 1989;146:622-626. 22. Roy-Byrne PP, Geraci M, Uhde TW. Life events and course of illness in patients with panic disorder . Am J Psychiatry . 1986;143:1033-1035. 23. Roy-Byrne PP, Geraci M, Uhde TW. Life events and the onset of panic disorder . Am J Psychiatry . 1986;143:1424-1427. 24. Roy-Byrne PP, Geraci M. Uhde TW. Life events obtained via interview: the effect of time of recall on data obtained in controls and patients with panic disorder . J Affect Disord . 1987;12:57-62.Crossref 25. Roy-Byrne PP, Uhde TW. Exogenous factors in panic disorder: clinical and research implications . J Clin Psychiatry . 1988;49:56-61. 26. Modigh K, Westberg P, Eriksson E. Superiority of clomipramine over imipramine in the treatment of panic disorder: a placebo-controlled trial . J Clin Psychopharmacol . 1992;12:251-261.Crossref 27. Spitzer RL, Williams JBW. Revised diagnostic criteria and a new structured interview for diagnosing anxiety disorder . J Psychiatr Res . 1988;22:55-86.Crossref 28. Hyler SE, Rieder RO. PDQ-R: Personality Diagnostic Questionnaire-Revised . New York, NY; New York State Psychiatric Institute: 1987. 29. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised . Washington, DC: American Psychiatric Association; 1987. 30. Davanloo H, ed. Basic Principles and Techniques in Short-Term Dynamic Psychotherapy . New York, NY: Spectrum; 1978. 31. Malan D. The Frontier of Brief Psychotherapy . New York, NY: Plenum Medical Books; 1976. 32. Malan D. The Frontier of Brief Psychotherapy: An Example of the Convergence of Research and Clinical Practice . New York, NY: Plenum Press; 1976. 33. Malan D. Individual Psychotherapy and the Science of Psychodynamics . London, England: Butterworth; 1979. 34. Strupp HH, Binder JL. Psychotherapy in a New Key: A Guide to Time-Limited Dynamic Psychotherapy . New York, NY: Basic Books Inc Publishers; 1984. 35. Derogatis LR. SCL-90: Administration Scoring and Procedures Manual-1 For the (Revised) Version . Baltimore, Md: Clinical Psychometrics Research Unit, John Hopkins University School of Medicine; 1977. 36. Spielberger C, Gorsuch A, Lushene R. The State-Trait Anxiety Inventory . Palo Alto, Calif: Consulting Psychologist Press; 1970. 37. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry . 1976;33:766-771.Crossref 38. Guy W. ECDEU Assessment Manual for Psychopharmacology . Rockville, Md: National Institute of Mental Health; 1976. Publication 76-338. 39. Hamilton M. The assessment of anxiety by rating . Br J Med Psychol . 1959;32:50-55.Crossref 40. Sheehan DV. The Anxiety Disease . New York, NY: Bantam Books; 1986. 41. Panic Disorder: Patient's Status. Kalamazoo, Mich; The Upjohn Co: 1990. Reference 94-1557-41 01/90. Self-report questionnaire. 42. Hamilton M. A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;23:56-62.Crossref 43. Panic Disorder: Medical Events Checklist. Kalamazoo, Mich; The Upjohn Co: 1990. Reference 94-1557-37 01/90. Interview-based questionnaire. 44. Hamre P, Dahl AA, Malt U. Public attitudes to the quality of psychiatric treatment, psychiatric patients, and the prevalence of mental disorder . Nord Psychiatr J . 1994;48:275-281.Crossref 45. Ursano RJ, Sonnenberg SM, Lazar SG. Psychodynamic Psychotherapy . Washington, DC: American Psychiatric Press; 1991;102. 46. Clark DB, Taylor CB, Roth WT, Hayward C, Ehlers A, Margraf J, Agras WS. Surreptitious drug use by patients in a panic disorder study . Am J Psychiatry . 1991;36:130-138. 47. Millrod B, Shear MK. Psychodynamic treatment of panic: three case histories . Hosp Community Psychiatry . 1991;42:311-312.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Aug 1, 1996

References