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FB67#_!L>!a>q!@$<%)&_!F>!A>q!G!Q2*&30%D_!A>!Q>![+,,\^>!=!6(B&4!&09)*6(%2($*D!0::$7274!):!2!1647#)2*2<4($7! 1647#)(#0%214!:)%!12*$7!&$6)%&0%?!$91<$72($)*6!:)%!1647#)2*2<4($7!%0602%7#_!(#0)%4!2*&!1%27($70>! N">#+@B&"!&,-%& /$%#)?@+&'(A?-"@+@BA,)?&/(("?)@,)"+O&Jb& [-^?!-P-E]b>!! @$<%)&_!F>!A>q!8))10%_!=>q!G!Q#21$%)_!">![-\\d^>! Z@+>@B&"!&'@+)?VQ"?>(%*&'(A?-"*A+@$)?&'(A?-",-%#@:A >! K26#$*D()*_!O8?!=90%$72*!/647#$2(%$7!/%066>! @$<%)&_!F>!A>q!A0)*_!=>!8>q!FB67#_!L>!a>q!5B&&0*_!@>q!Q7#Z2<30%D_!@>q!8<2%M$*_!i>q!=%)*6)*_!=>q!Q$*D0%_!@>q!"B%7#$*_! K>q!I<266_!'>!">q!S%2:_!'>q!"0%06_!i>!i>q!G!Q#02%_!@>!I>![+,,d^>!=!%2*&)9$C0&!7)*(%)<<0&!7<$*$72! /$%#)?@+&N">#+@B&"!&'(A?-)@,#AO&Igl _!+g.h+d+>! W(*&,!>-001(3 ! Systematic research on psychoanalytic treatments has been limited by several factors, including a belief that clinical experience can demonstrate the effectiveness of psychoanalysis, rendering systematic research unnecessary, the view that psychoanalytic research would be difficult or impossible to accomplish, and a concern that research would distort the treatment being delivered. In recent years, however, many psychoanalysts have recognized the necessity of research in order to obtain a more balanced assessment of the role of psychodynamic psychotherapy and psychoanalysis in a contemporary treatment armamentarium, as well as to allow appropriate evaluation and potentially greater acceptance by the broader mental health and medical communities. In this context, studies were performed on psychodynamic treatment, Panic-Focused Psychodynamic Psychotherapy (PFPP), initially in an open trial and then in a randomized controlled trial (RCT) in comparison with a less active treatment, Applied Relaxation Training (ART), for adults with primary DSM-IV panic disorder. The PFPP studies were conducted from 1997 to 2005 at Weill Cornell Medical College, using therapists who were Ph.D. psychologists or M.D.s after psychiatric residency, all of whom completed at least three years of psychoanalytic training in New York City area APsaA-approved psychoanalytic training programs. All study therapists were trained on how to conduct PFPP in accord with the treatment manual. Initial cases were closely supervised. The PFPP manual (Milrod, Cooper, and Shapiro 1997) was constructed around a psychodynamic formulation of panic disorder, which incorporated the work of psychoanalytic theorists and clinicans as well information derived from psychological studies of patients with panic disorder—e.g., parental perceptions, premorbid personality traits, defense mechanisms. Based on these clinical observations and studies, a formulation was developed that outlines a series of dynamics central to panic disorder (Milrod et al., 1997), including ambivalence about autonomy and dependency, fear of anger disrupting needed attachments, narcissistic humiliation surrounding panic, ego deficiencies, and sexual conflicts (find detailed information about the therapeutical focus of the PFPP manual in Milrod et al., 1997). After the first draft of the manual was formulated, it was given to four psychoanalysts, all experts in treating anxiety, who had not been involved in its creation, for comment in an effort to ensure that the manual captured the way psychoanalysts in fact treat patients with panic disorder. 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 . The open clinical trial of PFPP was initially accomplished between 1997 and 2000 and was not an efficacy study, as there was no comparison condition, but was designed to determine whether PFPP could be reliably delivered, and to assess its effects on patients with panic disorder. Twenty-one patients with primary DSM-IV panic disorder signed informed written consent forms and were treated with twenty-four sessions of PFPP over twelve weeks. No concurrent treatments were permitted during this clinical trial, and patients who presented on ineffective anti-panic medications (i.e., who
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