A study demonstrating efficacy of a psychoanalytic psychotherapy for panic disorder: Implications for psychoanalytic research, theory, and practice

Probably not a substantial claim: may not pass S3 (load-bearing).

The therapists' concern about adherence standards decreased once their treatments were found to be highly adherent.

“Their concern about meeting adherence standards eased as their treatments were found in fact to have a high degree of adherence.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Therapists without psychoanalytic training have since learned PFPP, participated in a subsequent study, and conducted the treatment well.

“Although the therapists in the studies reported here were all psychoanalysts, therapists without psychoanalytic training have since learned PFPP, have participated in a subsequent study, and have been able to conduct the treatment well.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study's psychoanalytic therapists initially worried that using a manual would restrict flexibility and that they might not meet adherence standards.

“The psychoanalytic therapists in our study initially expressed concern over whether use of a manual would limit their flexibility and whether they could meet adherence standards (Busch et al. 2001).”

• cites Busch et al. 2001 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Four independent expert psychoanalysts judged the manual to closely match their own clinical work.

“All four felt the manual closely approximated their own psychoanalytic clinical work, suggesting that operationalizing these approaches need not create a rigid or nonpsychoanalytic treatment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The therapists' clinical impression was that manualization and adherence standards did not disrupt the psychoanalytic process.

“However, once they were engaged in study therapies, their clinical impression was that neither manualization nor adherence standards were disruptive of the psychoanalytic psychotherapeutic process.”

May combine two claims.

In the open trial, patients also showed significant improvement in psychosocial function, non-panic anxiety, and depression.

“In addition to a significant reduction in symptoms of panic disorder, the patients demonstrated significant improvement in measures of psychosocial function, anxiety unrelated to panic, and depression.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The therapists viewed their study participation positively, and many experienced a research 'cathexis' that they felt improved their treatments.

“Despite their initial concerns, the therapists regarded their participation in the study in a positive light. Indeed, many experienced a research “cathexis,” an intensity of focus on their work that they felt improved their treatments.”

May combine two claims.

A 24-session course of PFPP reduced panic disorder symptoms and improved psychosocial functioning.

“Our study found that a course of twenty-four sessions of PFPP was effective in treating panic disorder and improving psychosocial function.”

May combine two claims.

In those interviews, patients described their parents as variously temperamental, critical, frightening, demanding, and controlling, and reported difficulty acknowledging and expressing angry feelings.

“They described their parents as variously temperamental, critical, frightening, demanding, and controlling, and they reported difficulty acknowledging and expressing angry feelings.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A widespread view held that psychoanalytic concepts and interventions are too complex to study systematically, and this view contributed to limiting research.

“a widespread view that psychoanalytic concepts and interventions are too complex to study in a systematic manner (Green 1996, 2000)”

• cites Green 1996, 2000Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Many psychoanalysts believed that clinical experience already sufficiently demonstrated the effectiveness of psychoanalytic treatments, and this belief contributed to limiting systematic research.

“a belief that clinical experience can demonstrate the effectiveness of psychoanalysis, rendering systematic research unnecessary”

• Also stated in: § Abstract · plain

  “a belief among many psychoanalysts that psychoanalytic treatments have already adequately demonstrated effectiveness based on clinical experience (Busch 2006; Kernberg 2006b)”

• cites Busch 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Kernberg 2006bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

Focusing on psychiatric symptoms can yield rich information about patients' unconscious lives and can be a fruitful way to understand the patient.

“The manual describes, as Freud (Breuer and Freud 1895) did, that focusing on psychiatric symptoms, as opposed to the more contemporary psychoanalytic focus on character, can provide a wealth of information about patients’ unconscious lives, and can be a fruitful route to understanding the patient.”

• cites Breuer and Freud 1895Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The defense of undoing is considered an important mechanism by which many panic patients modulate conflicted anger.

“the defense of “undoing,” which is considered an important mechanism whereby many panic patients modulate conflicted anger”

• cites Milrod et al. 1997Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Bailey et al. (1998) found that process notes from taped sessions contained only one third of the material, with analyst comments omitted more often.

“For example, Bailey et al. (1998) found that supposedly exhaustive process notes taken from sessions that were also tape-recordred contained only a third of the material, with a greater rate of omission of the analyst’s comments (Bucci 2001).”

• cites Bailey et al. (1998)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Bucci 2001 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All study therapists received a twelve-hour training course on conducting PFPP according to the manual, initial cases were closely supervised, monthly group supervision with videotape review occurred, and all therapists had additional individual supervision.

“All study therapists were given a twelve-hour therapist training course that focused on how to conduct PFPP in accord with the treatment manual. Initial cases were closely supervised. Monthly group supervisory meetings were held that included discussion of particular cases, with review of videotapes. All the therapists availed themselves of additional, individual supervision.”

Not yet classified.

Vinnars et al. (2005) found no significant outcome difference between manualized time-limited supportive-expressive psychotherapy and nonmanualized community-delivered psychodynamic psychotherapy for personality disorder patients; both reduced the number meeting personality disorder criteria and the severity of personality disorders and psychiatric symptoms.

“The authors did not find a significant difference in outcome between the two treatment conditions, and both led to reductions in the number of patients who met the criteria for personality disorder diagnoses, and in the severity of personality disorders and psychiatric symptoms.”

• cites Vinnars et al. 2005 sourceNot checked — no full text of the source

May combine two claims.

In the efficacy study, treatments were matched in number and frequency of sessions and in therapist experience, making the trial conservative and less likely to show differences between conditions.

“In the efficacy study, treatments were designed to match in number and frequency of sessions and in the degree of therapist experience, making this treatment trial a conservative one, less likely to show differences between treatment conditions.”

Probably not a substantial claim: may not pass S2 (checkable).

With anxious patients, a comparison psychotherapy group is needed to determine whether improvement results from therapist care and attention rather than the specific therapeutic intervention.

“Particularly with anxious patients, it is important to determine whether they improve simply as a result of the therapist’s care and attention, rather than as a result of the specific therapeutic intervention—hence the need for a comparison psychotherapy group.”

May combine two claims.

PFPP is efficacious for panic disorder, a DSM-IV Axis I condition.

“adherents of evidence-based medicine must recognize that psychoanalytic treatment is efficacious with panic disorder.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The treatment's 'music' did not appear to be impaired by using a manual, though this was not systematically studied.

“Thus, while this question was not systematically studied, the “music” of the treatment did not appear to be impaired by use of a manual.”

Classified as probably not a substantial claim.

Successful adherence rating requires a simple, operationalized description of psychoanalytic psychotherapy that lets independent raters obtain similar results for the same session.

“Successful adherence rating entails the development of a simple, operationalized description of psychoanalytic psychotherapy, the use of which allows independent raters to obtain similar results when rating the same session (see below).”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

The authors' clinical impression was that time-limited psychoanalytic psychotherapy may intensify the transference and thereby lead to faster symptom improvement.

“Our clinical impression is that time-limited psychoanalytic psychotherapy may have intensified the transference, potentially leading to more rapid symptomatic gains.”

Probably not a substantial claim: may not pass S2 (checkable).

Adherence rating instruments are essential in contemporary psychotherapy outcome research.

“Adherence rating instruments are essential tools in contemporary psychotherapy outcome research (Gerber et al. 2006).”

• cites Gerber et al. 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Adherence rating instruments concretely show that clinicians are delivering the treatment being studied.

“They provide concrete demonstration that treating clinicians are actually delivering the treatment being studied.”

May combine two claims.

Head-to-head trials of therapies presumed equally active, such as CBT and PFPP, require enough subjects to provide statistical power to distinguish between them, each with a high response rate; because expected response rates are high, the needed number of subjects would be unfeasibly large.

“Head-to-head trials of therapies presumed to be equally active, such as CBT and PFPP, require enough subjects to provide the statistical power to distinguish between the two therapies, each with a high response rate. Because of the high response rates expected with CBT and PFPP, the number of subjects needed would be unfeasibly large.”

May combine two claims.

Applied relaxation training was chosen as the comparison because it is a credible and efficacious treatment for panic disorder but is less efficacious than CBT.

“ART was chosen as a comparison therapy because it has been shown to be a credible and efficacious treatment for panic disorder (Öst and Westling 1995), yet it is less efficacious than CBT (Beck et al. 1994; Craske, Brown, and Barlow 1991).”

• cites Öst and Westling 1995 sourceNot checked — no full text of the source
• cites Beck et al. 1994 sourceNot checked — no full text of the source
• cites Craske, Brown, and Barlow 1991 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

No concurrent treatments were permitted during the open trial, and patients on ineffective anti-panic medications were tapered off to gain study access.

“No concurrent treatments were permitted during this clinical trial, and patients who presented on ineffective anti-panic medications (i.e., who met symptomatic study entrance criteria while taking pharmacological agents) were tapered off of their medication regimens in order to gain access to the study.”

May combine two claims.

Although brief psychotherapy restricts exploration of conflicts, this limitation does not reduce its usefulness for these patients.

“Although brief psychotherapy limits the exploration of conflicts, this does not detract from the utility of this approach for these patients.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The PFPP manual was constructed around a psychodynamic formulation of panic disorder that incorporated psychoanalytic theorists and clinicians and information from psychological studies of panic patients, including parental perceptions, premorbid personality traits, and defense mechanisms.

“The formulation incorporated the work of psychoanalytic theorists and clinicians (e.g., Freud 1926; Deutsch 1929), as well as information derived from psychological studies of patients with panic disorder—e.g., parental perceptions, premorbid personality traits, defense mechanisms (Arrindell et al. 1983; Parker 1979; Kleiner and Marshall 1987; Busch et al. 1995).”

• cites Busch et al. 1991 sourceNot checked — no full text of the source
• cites Shear et al. 1993 sourceNot checked — no full text of the source
• cites Milrod 1995 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the authors' studies, symptom focus may have helped relieve panic, but this was not specifically evaluated.

“Yet in our studies, symptom focus may have contributed to panic relief, though this was not specifically evaluated.”

• AssumptionRests on an assumption: Focus on panic symptoms is a crucial component of PFPP's effectiveness.

Classified as probably not a substantial claim.

To accomplish adherence rating, the therapy's specific essential components must be clearly articulated.

“To accomplish this, specific essential components of the therapy must be clearly articulated.”

Probably not a substantial claim: may not pass S2 (checkable).

The PFPP studies demonstrate the value of research on psychoanalytic treatments.

“The studies of Panic-Focused Psychoanalytic Psychotherapy described below provide a demonstration of the value of such research.”