Panic disorder (PD) is a prevalent and debilitating condition. Efficacious treatments for this condition exist, including several classes of medication. Cognitive behavioral therapy, (CBT) has been shown to be efficacious for PD. However, over 30% of PD patients decline medication, and nearly one half do not remit from CBT, there is a pressing need for additional nonpharmacologic approaches. We have developed and tested a manualized psychodynamic psychotherapy for panic disorder, Panic Focused Psychodynamic Psychotherapy (PFPP). We have completed treatment development stages I and II and have demonstrated efficacy in 40 patients with DSM-IV primary PD in comparison with Applied Relaxation Training (ART). This application will investigate the indications, overall utility, and mechanisms of action of PFPP. We are conducting this study at two sites with broad inclusion criteria, to recruit sufficient patients, and to increase generalizability. The project has 3 aims: 1. Acute Efficacy. (Primary Aim) To conduct a 12-week randomized controlled trial of Panic-Focused Psychodynamic Psychotherapy (PFPP), and CBT, versus Applied Relaxation Training (ART) in a 2:2:1 ratio of randomization in 233 subjects with primary PD with or without Agoraphobia. 2. To compare the sustained effects of these two treatments in these patients at 12 months post-treatment termination, 3. To test specific mediator and moderator hypotheses for PFPP and CBT. We shall enroll 233 participants, ages 18 to 70, who meet DSM-IV criteria for PD with or without Agoraphobia as their primary diagnosis. All subjects will be randomly assigned to 19-24 sessions over 12 weeks of CBT, PFPP, or ART in a 2:2:1 ratio. Patients will be followed monthly with standard rating instruments for 12 months post treatment termination to compare durability of effects. Subjects in the ART condition will be given their choice of CBT or PFPP (nonrandomized) if they do not respond at treatment termination.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
3R01MH070918-05S1
Application #
8509422
Study Section
Interventions Research Review Committee (ITV)
Program Officer
Pearson, Jane L
Project Start
2006-08-21
Project End
2013-05-31
Budget Start
2012-09-12
Budget End
2013-05-31
Support Year
5
Fiscal Year
2012
Total Cost
$42,250
Indirect Cost
$17,250
Name
Weill Medical College of Cornell University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
060217502
City
New York
State
NY
Country
United States
Zip Code
10065
Milrod, Barbara; Altemus, Margaret; Gross, Charles et al. (2016) Adult separation anxiety in treatment nonresponders with anxiety disorders: delineation of the syndrome and exploration of attachment-based psychotherapy and biomarkers. Compr Psychiatry 66:139-45
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Milrod, Barbara (2015) An Epidemiological Contribution to Clinical Understanding of Anxiety. Am J Psychiatry 172:601-2
Markowitz, John C; Milrod, Barbara L (2015) What to do when a psychotherapy fails. Lancet Psychiatry 2:186-90
Zilcha-Mano, Sigal; McCarthy, Kevin S; Dinger, Ulrike et al. (2015) Are there subtypes of panic disorder? An interpersonal perspective. J Consult Clin Psychol 83:938-50
Busch, Fredric N; Sandberg, Larry S (2014) Unmentalized aspects of panic and anxiety disorders. Psychodyn Psychiatry 42:175-95
Milrod, Barbara; Markowitz, John C; Gerber, Andrew J et al. (2014) Childhood separation anxiety and the pathogenesis and treatment of adult anxiety. Am J Psychiatry 171:34-43
Milrod, Barbara (2013) The Gordian knot of clinical research in anxiety disorders: some answers, more questions. Am J Psychiatry 170:703-6
Busch, Fredric N; Milrod, Barbara L; Thoma, Nathan C (2013) Teaching clinical research on psychodynamic psychotherapy to psychiatric residents. Psychodyn Psychiatry 41:141-62
Sandberg, Larry; Busch, Fredric; Schneier, Franklin et al. (2012) Panic-focused psychodynamic psychotherapy in a woman with panic disorder and generalized anxiety disorder. Harv Rev Psychiatry 20:268-76

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