Talk Therapy Curbs Panic Disorder

Study Shows Improvement in Anxiety and Other Panic Disorder Symptoms

By Denise Mann
WebMD Health News

Reviewed By Louise Chang, MD

Jan. 17, 2008 -- A 12-week course of talk therapy may help curb the often debilitating symptoms of panic disorder -- including intense fear, chest pain, heart palpitations, and shortness of breath.

The new findings were presented at the annual meeting of the American Psychoanalytic Association in New York City and published in the American Journal of Psychiatry.

The psychodynamic psychotherapy regimen used in the study was so successful that the American Psychiatric Association is in the process of changing its guidelines to reflect the new findings, according to researcher Barbara Milrod, MD. Milrod is an associate attending physician at New York-Presbyterian Hospital/Weill Cornell Medical Center and an associate professor of psychiatry at Weill Cornell Medical College in New York City.

The twice-weekly sessions are focused on the symptoms of panic disorder as well as garnering insight about the various unconscious factors that may have caused the panic disorder to develop in the first place. Such focus on the unconscious is the basic underpinning of psychoanalysis.

In the new study of 49 people with panic disorder, more than 70% of those in the talk therapy group showed significantly less anxiety and other panic symptoms as measured by a standard scale assessing panic symptoms. By contrast, just 39% of those participants who received applied relaxation training showed an improvement in their symptoms.

"People really got better -- not just a little better," Milrod says. Now a large study is under way comparing psychodynamic psychotherapy to cognitive behavior therapy (CBT) in people with panic disorder, she says.

Comparing Therapies

CBT is also time-limited and aims to change negative thought processes and modify behaviors. It tends to rely on exposure to triggers and a set of exercises to help offset attacks. Psychodynamic psychotherapy is aimed at helping people understand the underlying emotional meaning of their panic while minimizing the accompanying symptoms.

Other treatments for panic disorder include medication such as selective serotonin reuptake inhibitors. Medication and therapy can be used together.

"Panic disorder is a treatable condition, and people shouldn't give up hope just because one of the treatments doesn't work," Milrod says.  "It doesn't mean they won't get better because there are lots of effective treatments out there."

Chicago-based psychoanalyst Mark Smaller, PhD, the director of the Neuro-Psychoanalysis Foundation, has seen very good results using psychotherapy to treat panic disorder.

"Psychodynamic psychotherapy is a step to diffuse the really intense and debilitating symptoms of panic disorder, and you need that in order for someone to do more in-depth work or work on issues that contributed to the symptoms in the first place," he says.

SOURCES: Annual meeting of the American Psychoanalytic Association, New York City, Jan. 16-20, 2008. Milrod, B. American Journal of Psychiatry, February 2007; vol 164: pp 265-272. Barbara Milrod, MD, associate attending physician, New York-Presbyterian Hospital/Weill Cornell Medical Center; associate professor of psychiatry, Weill Cornell Medical College. Mark Smaller, PhD, psychoanalyst, Chicago; director, Neuro-Psychoanalysis Foundation.

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