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Exploring termination setback in a psychodynamic therapy for panic disorder

Nilsson, Thomas LU ; Falkenström, Fredrik ; Perrin, Sean LU orcid ; Svensson, Martin LU ; Johansson, Håkan LU and Sandell, Rolf LU (2021) In Journal of Consulting and Clinical Psychology 89(9). p.762-772
Abstract
Objective: Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during treatment to determine whether such setbacks are in fact common in PDT. Methods: In a doubly randomized clinical preference trial, 217 adults (female = 163; M age = 34.8 (12.6)) with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale-Self Report (PDSS-SR) weekly during treatment (weeks 1-12), and 6, 12 and 24 months after... (More)
Objective: Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during treatment to determine whether such setbacks are in fact common in PDT. Methods: In a doubly randomized clinical preference trial, 217 adults (female = 163; M age = 34.8 (12.6)) with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale-Self Report (PDSS-SR) weekly during treatment (weeks 1-12), and 6, 12 and 24 months after treatment. Using piecewise latent growth curve modeling we tested the trajectories of change focusing on the termination phase in PFPP. Results: Week-to-week improvement on the PDSS-SR stopped (a termination setback [TS]) in PFPP during weeks 10-12, whereas PCT participants continued to improve. Larger symptom reductions up to week 10 in PFPP predicted a more severe TS. Less avoidant attachment and less severe interpersonal problems also predicted more severe TS. The TSs tended to last, as evidenced by inferior outcomes, up to the 12-month follow-up. Conclusions: This study provides evidence of a TS in PDT. Resurgence of symptoms as termination approached was more common in PFPP than in PCT. Studies involving weekly assessment of primary and comorbid symptoms, as well as qualitative analyses of the patient experiences of the therapeutic process during termination, in different forms of PDT, are warranted. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Termination setback, Psychodynamic short-term psychotherapy, Cognitive behavioral therapy, randomized clinical trial, panic disorder
in
Journal of Consulting and Clinical Psychology
volume
89
issue
9
pages
11 pages
publisher
American Psychological Association (APA)
external identifiers
  • scopus:85117483086
  • pmid:34591549
ISSN
0022-006X
DOI
10.1037/ccp0000678
project
Long-Term Outcomes of Adults Treated with Panic-Focussed CBT and Psychodynamic Psychotherapies
language
English
LU publication?
yes
id
2311c270-ee52-42c0-b86d-e23987eb4327
date added to LUP
2021-08-20 10:02:10
date last changed
2023-12-07 15:46:02
@article{2311c270-ee52-42c0-b86d-e23987eb4327,
  abstract     = {{Objective: Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during treatment to determine whether such setbacks are in fact common in PDT. Methods: In a doubly randomized clinical preference trial, 217 adults (female = 163; M age = 34.8 (12.6)) with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale-Self Report (PDSS-SR) weekly during treatment (weeks 1-12), and 6, 12 and 24 months after treatment. Using piecewise latent growth curve modeling we tested the trajectories of change focusing on the termination phase in PFPP. Results: Week-to-week improvement on the PDSS-SR stopped (a termination setback [TS]) in PFPP during weeks 10-12, whereas PCT participants continued to improve. Larger symptom reductions up to week 10 in PFPP predicted a more severe TS. Less avoidant attachment and less severe interpersonal problems also predicted more severe TS. The TSs tended to last, as evidenced by inferior outcomes, up to the 12-month follow-up. Conclusions: This study provides evidence of a TS in PDT. Resurgence of symptoms as termination approached was more common in PFPP than in PCT. Studies involving weekly assessment of primary and comorbid symptoms, as well as qualitative analyses of the patient experiences of the therapeutic process during termination, in different forms of PDT, are warranted.}},
  author       = {{Nilsson, Thomas and Falkenström, Fredrik and Perrin, Sean and Svensson, Martin and Johansson, Håkan and Sandell, Rolf}},
  issn         = {{0022-006X}},
  keywords     = {{Termination setback; Psychodynamic short-term psychotherapy; Cognitive behavioral therapy; randomized clinical trial; panic disorder}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{762--772}},
  publisher    = {{American Psychological Association (APA)}},
  series       = {{Journal of Consulting and Clinical Psychology}},
  title        = {{Exploring termination setback in a psychodynamic therapy for panic disorder}},
  url          = {{http://dx.doi.org/10.1037/ccp0000678}},
  doi          = {{10.1037/ccp0000678}},
  volume       = {{89}},
  year         = {{2021}},
}