Psychotherapy for panic disorder shows positive long-term effects

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Psychotherapy for panic disorder produces good results, and the effects are lasting. That is the result from a large long-term study from Lund University in Sweden. Two years after treatment were 70 per cent of the patients clearly improved and 45 per cent were remitted.

Panic disorder is one of the most common causes of mental illness in Sweden and worldwide. Approximately 2 per cent has panic disorder. When untreated, the condition is associated with emotional distress and social isolation. Panic attacks often debut in adolescence or early adulthood and many of those affected drop out of education, jobs, and can’t fulfil their life dreams.

“Many people adapt to their panic disorder by various restrictions in their daily living”, says psychologist Thomas Nilsson, who conducted the study, with 221 participants over 10 years, together with research colleague Martin Svensson.

“Treatment is crucial as the disorder often leads to a downward spiral in which the margin for everyday life activities becomes increasingly narrow.”

The researchers studied not only the short and long-term effects of therapy but also how treatment outcome was affected by offering the patients to choose their treatment. The options were two forms of therapy, specifically designed to treat panic disorder – a psychodynamic psychotherapy (PDT) and a cognitive behavioural therapy (CBT). One half of the patients were allowed to choose their form of therapy and the other half were randomly assigned to one or the other.

The researchers’ hypothesis was that the patients offered a choice between two validated treatments would benefit from receiving their chosen form of therapy. In previous research this has been the case, and psychologists generally take patient preferences into account in treatment decision. Therefore, the researchers were surprised by the result: patients’ who had chosen PDT tended to have better outcomes than those who were randomly assigned to the same treatment. However, the exact opposite applied to patients in CBT: those who were randomly assigned to CBT tended to have better outcomes than those who had actively chosen that form of treatment. So far the researchers can only speculate on the reasons for this.

“Perhaps those who chose psychodynamic therapy had a more accurate perception of what they needed”, says Svensson, while pointing out that more studies are required.

However, the most important finding from the study was that both treatments had both positive and lasting results. Two years after treatment 70 per cent of the patients was clearly improved and 45 per cent were remitted.

“The patients felt better in many ways. For instance depressive symptoms, that often accompany panic disorder, were significantly reduced and quality of life improved”, says Svensson.

These findings are impressive given that both treatments were as brief as 12 weeks.

Publication in Psychotherapy and Psychosomatics: The Effect of Patient’s Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial

Panic disorder:

Panic disorder: If four or more of the symptoms listed below occurs simultaneously in an intense bodily attack, followed by at least one month’s persistent anxiety about it happening again.

  • Pounding heart or accelerated heart rate
  • Sensations of shortness of breath or smothering
  • Feeling of choking
  • Chest pain or discomfort
  • Dizziness or instability
  • Sweating
  • Trembling or shaking
  • Chills or heat sensations
  • Numbness or tingling sensation
  • Nausea or abdominal distress
  • Feelings of unreality or being detached from oneself
  • Fear of losing control or going crazy
  • Fear of dying

Contact:

Martin Svensson
Department of Psychology, Lund University
martin [dot] svensson [at] psy [dot] lu [dot] se
+ 46 70 481 17 30

Thomas Nilsson
Department of Psychology, Lund University
thomas [dot] nilsson [at] psy [dot] lu [dot] se
+ 46 70 143 13 43

About the study:

The randomised controlled trial (RCT) was carried out at 15 outpatient psychiatry, primary health care and youth guidance clinics within public healthcare in Skåne, Halland and Småland. Treatments were delivered by 50 therapists and supervisors. 221 patients were included in the study. One half of the patients were assigned to choose between psychodynamic therapy and cognitive behavioural therapy for panic disorder while the other half were randomly assigned to one of the two treatments. Assessments interviews with patients were conducted before and after treatment and then again at 6-, 12- and 24 months after treatment.