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The POSE study - panic control treatment versus panic-focused psychodynamic psychotherapy under randomized and self-selection conditions: study protocol for a randomized controlled trial.

Sandell, Rolf LU ; Svensson, Martin LU ; Nilsson, Thomas LU ; Johansson, Håkan LU ; Viborg, Gardar LU and Perrin, Sean LU (2015) In Trials 16(130).
Abstract
Background: Panic Disorder with or without Agoraphobia is a commonly occurring disorder affecting 2-3% of the population in Sweden. Untreated, panic disorder is a chronic condition that significantly increases the risk for psychiatric comorbidity, morbidity and mortality, employment difficulties, and healthcare utilization. Cognitive behavioural approaches are the recommended first-line treatment for panic disorder, however many patients in routine care receive another evidence-based psychotherapy, including psychodynamic therapy. Allowing patients to choose among evidence-based approaches to panic disorder may improve outcomes and reduce overall health costs. Trials involving comparing the gold standard treatment for panic disorder to... (More)
Background: Panic Disorder with or without Agoraphobia is a commonly occurring disorder affecting 2-3% of the population in Sweden. Untreated, panic disorder is a chronic condition that significantly increases the risk for psychiatric comorbidity, morbidity and mortality, employment difficulties, and healthcare utilization. Cognitive behavioural approaches are the recommended first-line treatment for panic disorder, however many patients in routine care receive another evidence-based psychotherapy, including psychodynamic therapy. Allowing patients to choose among evidence-based approaches to panic disorder may improve outcomes and reduce overall health costs. Trials involving comparing the gold standard treatment for panic disorder to other evidence based psychotherapies are needed, and also trials which can separate patient preferences for treatment from randomization effects on outcome, disability and healthcare utilization in the longer-term.

Methods/Design: A phase 2/3 doubly-randomized controlled trial carried out in routine care with 216 adults (aged 18-60 years) with a primary diagnosis of DSM-IV Panic Disorder (with or without Agoraphobia). Within each clinic, patients are randomized to self-selection, random assignment of treatment, or wait-list. Patients choose or are randomly assigned to either Panic Control Treatment or Panic Focussed Psychodynamic Psychotherapy. Primary outcomes are changes in panic symptom severity, occupational status, and sickness-related absences from work at 6, 12 and 24 months post-treatment. Secondary outcomes include changes in agoraphobic avoidance, psychiatric comorbidity, disability, and healthcare utilization. The study also employs elements of an effectiveness trial as therapist and service-related effects on outcome will be estimated. Putative change mechanisms for CBT and PF-PP are also assessed.

Discussion: CBT and psychodynamic therapy are evidence-based approaches that are routinely offered to panic disorder patients in Sweden. However little is known about the relative effectiveness of these two approaches for panic/agoraphobia, work-related disability and healthcare utilization over the longer-term. The current trial (POSE) also addresses the important but understudied issue of whether patient preference for a particular therapeutic approach (CBT or psychodynamic therapy) moderates outcome. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Randomized Preference Trial, Panic Disorder, CBT, Psychodynamic Therapy, Health Economics
in
Trials
volume
16
issue
130
publisher
BioMed Central
external identifiers
  • pmid:25873067
  • wos:000352590000001
  • scopus:84926612706
ISSN
1745-6215
DOI
10.1186/s13063-015-0656-7
language
English
LU publication?
yes
id
93ec5ecb-e857-4d8d-aac3-cf1a7419406d (old id 5142443)
date added to LUP
2015-03-02 14:33:29
date last changed
2017-01-01 06:25:10
@article{93ec5ecb-e857-4d8d-aac3-cf1a7419406d,
  abstract     = {Background: Panic Disorder with or without Agoraphobia is a commonly occurring disorder affecting 2-3% of the population in Sweden. Untreated, panic disorder is a chronic condition that significantly increases the risk for psychiatric comorbidity, morbidity and mortality, employment difficulties, and healthcare utilization. Cognitive behavioural approaches are the recommended first-line treatment for panic disorder, however many patients in routine care receive another evidence-based psychotherapy, including psychodynamic therapy. Allowing patients to choose among evidence-based approaches to panic disorder may improve outcomes and reduce overall health costs. Trials involving comparing the gold standard treatment for panic disorder to other evidence based psychotherapies are needed, and also trials which can separate patient preferences for treatment from randomization effects on outcome, disability and healthcare utilization in the longer-term.<br/><br>
Methods/Design: A phase 2/3 doubly-randomized controlled trial carried out in routine care with 216 adults (aged 18-60 years) with a primary diagnosis of DSM-IV Panic Disorder (with or without Agoraphobia). Within each clinic, patients are randomized to self-selection, random assignment of treatment, or wait-list. Patients choose or are randomly assigned to either Panic Control Treatment or Panic Focussed Psychodynamic Psychotherapy. Primary outcomes are changes in panic symptom severity, occupational status, and sickness-related absences from work at 6, 12 and 24 months post-treatment. Secondary outcomes include changes in agoraphobic avoidance, psychiatric comorbidity, disability, and healthcare utilization. The study also employs elements of an effectiveness trial as therapist and service-related effects on outcome will be estimated. Putative change mechanisms for CBT and PF-PP are also assessed. <br/><br>
Discussion: CBT and psychodynamic therapy are evidence-based approaches that are routinely offered to panic disorder patients in Sweden. However little is known about the relative effectiveness of these two approaches for panic/agoraphobia, work-related disability and healthcare utilization over the longer-term. The current trial (POSE) also addresses the important but understudied issue of whether patient preference for a particular therapeutic approach (CBT or psychodynamic therapy) moderates outcome.},
  articleno    = {130},
  author       = {Sandell, Rolf and Svensson, Martin and Nilsson, Thomas and Johansson, Håkan and Viborg, Gardar and Perrin, Sean},
  issn         = {1745-6215},
  keyword      = {Randomized Preference Trial,Panic Disorder,CBT,Psychodynamic Therapy,Health Economics},
  language     = {eng},
  number       = {130},
  publisher    = {BioMed Central},
  series       = {Trials},
  title        = {The POSE study - panic control treatment versus panic-focused psychodynamic psychotherapy under randomized and self-selection conditions: study protocol for a randomized controlled trial.},
  url          = {http://dx.doi.org/10.1186/s13063-015-0656-7},
  volume       = {16},
  year         = {2015},
}