The effect of patient's choice of cognitive behavioural or psychodynamic therapy on outcomes for panic disorder: a doubly randomised controlled preference trial
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INTRODUCTION: It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. OBJECTIVE: To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. METHODS: In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. RESULTS: At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, -0.64; 95% confidence interval, CI, -1.02 to -0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27-0.98). There was no allocation by treatment type interaction (SMD -0.57; 95% CI -1.31 to 0.17). CONCLUSIONS: Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.
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In a recent double-randomized controlled preference trial, there were no between-group differences in primary outcomes for symptom reduction, absence from work, nor employment status at the end of treatment nor at the 2-year follow-up assessment.
“Results showed no between-group differences in primary outcomes for symptom reduction, absence from work, nor employment status at the end of treatment nor at the 2-year follow-up assessment.”
From Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized controlled trial (2021) · cites this paper as Svensson et al., 2021
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Experimental — accuracy not yet measuredParticipants randomized to a treatment were no less likely to drop out than participants who were able to choose the treatment they preferred.
“participants randomized to a treatment were no less likely to drop out than the participants who were able to choose the treatment they preferred (Svensson et al., 2021).”
From Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized controlled trial (2021) · cites this paper as Svensson et al., 2021
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- Authors
- Svensson, M., Nilsson, T., Perrin, S., Johansson, H., Viborg, G., Falkenström, F., & Sandell, R.
- Affiliations
- Lund University (SE)
- Linköping University (SE)
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2020-11-23
- Volume
- 90
- Issue
- 2
- Pages
- 107-118
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W3104129843
- Cited by
- 17
- References
- 27
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 4
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychotherapy and Psychosomatics (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DiVA (Linkoping University) (submittedVersion, other-oa)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Stiftelsen Lindhaga
- Vetenskapsrådet
- Försäkringskassan
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- panic disorder, agoraphobia, patient preferences, treatment selection, cognitive behavioral therapy, psychodynamic psychotherapy, preference effects, treatment outcomes, employment status, absenteeism
- MeSH terms
- Adult, Agoraphobia, Cognition, Humans, Cognitive Behavioral Therapy, Panic Disorder, Patient Preference
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