met symptomatic study entrance criteria while taking pharmacological agents) were tapered off of their medication regimens in order to gain access to the study. Four patients dropped out, and at termination sixteen of the remaining seventeen met “response” criteria, a greater than 40 percent reduction in the Panic Disorder Severity Scale (PDSS). 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. Notably, comorbid major depression, present in eight of twenty-one patients, remitted with PFPP as well. Clinical improvements were maintained at six-month follow-up, without intervening treatment. Following the open trial, our group proceeded with a randomized controlled trial (Milrod et al. 2007) in which PFPP was compared with a less active psychotherapy, applied relaxation training (ART), to assess efficacy. ART was chosen as a comparison therapy because it has been shown to be a credible and efficacious treatment for panic disorder. 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. Nonetheless, a significantly greater reduction in a broad range of panic symptoms was observed after PFPP, compared with ART, as assessed by the Panic Disorder Severity Scale, the primary outcome measure. Using the a priori definition of “response”, PFPP demonstrated a significantly higher rate of response compared with ART: 73% vs. 39% ( p = .017). PFPP also led to significantly greater improvement in psychosocial function, as measured on the Sheehan Disability Scale (SDS): p = .014. The SDS is a self-report instrument using a visual analog scale in which the patient rates himself from 0 (not at all impaired) to 10 (extremely impaired) by symptoms in each of three areas: work or school, social life, and family life/home responsibilities. In addition, the PFPP studies assessed adherence with a well- operationalized scale demonstrated excellent interrater reliability (ICC [intraclass correlation coefficient] = .92), indicating that independent raters assessing the same sessions or therapeutic treatment obtain very similar results. Most of the study therapists have easily met adherence standards (Milrod et al. 2007). @)15-1.*$# The PFPP efficacy study is part of a small but increasing effort to introduce psychoanalytic psychotherapy into the era of evidence-based medicine, in that it is the first psychoanalytic psychotherapy for a primary DSM-IV Axis I anxiety disorder to have demonstrated efficacy. We can expect that nonpsychoanalytic colleagues, and institutions that monitor clinical practice (the American Psychiatric Association, the Institute of Medicine, the National Institute for Health and Clinical Excellence in the UK), will show a new respect for psychoanalytic psychotherapy for panic disorder. This study should give pause to those within our own ranks who maintain that psychoanalysis and psychoanalytic psychotherapy cannot be empirically studied. G$#.1/.\!
Prof. Fredric N. Busch, Weill Cornell Medical College Columbia Center for Psychoanalytic Training and Research. Email: fnb80@aol.com, Website: www.weill.cornell.edu
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