Within the past twelve months, the Fund for Psychoanalytic Research approved and recommended for funding three outstanding proposals. In this issue we describe one of these: “Psychodynamic Psychotherapy of Panic Disorder.” In this new column, we will report on other new proposals and new important results of proposals that have been supported by the Fund.
In December 1996, we awarded Barbara Milrod, an Assistant Professor of Psychiatry at Cornell University Medical College, a two-year grant to study the nature and effectiveness of psychodynamic psychotherapy for panic disorder. Working with Milrod are Catherine Shear, Associate Professor of Psychiatry at the University of Pittsburgh Medical Center, and John Docherty, Professor and Vice-Chair of the Department of Psychiatry at Cornell University Medical College.
Substantial advances have occurred in methods for conducting psychotherapy outcome studies. Research programs in this area have already had a strong impact both on psychotherapy and on psychiatric residency education and reimbursement patterns. Yet the application of these increasingly powerful methods to psychoanalysis and psychodynamic psychotherapy has been woefully limited, despite much clinical evidence supporting the efficacy of psychodynamic treatments. Milrod warns that in the current health-care climate, if these methodologies are not applied to psychoanalysis and psychodynamic therapies, there is a risk that “these treatments will not obtain their proper place in the accepted therapeutic guidelines for specific disorders, in psychiatric education, or in reimbursement systems.”
Although much clinical evidence — including case studies and systematic case reviews — suggests that psychodynamic psychotherapy and psychoanalysis can be effective treatments for panic disorder, there have been no reported controlled prospective studies to date. This is an important gap in the literature, since controlled clinical trials are the scientific standard for efficacy research.
Milrod and her colleagues will be pursuing two key goals in their current project. The first is to discover whether psychoanalytically trained clinicians can be taught to reliably follow a treatment manual for short-term psychodynamic psychotherapy of panic. In collaboration with Fred Busch, Arnold Cooper, and Theodore Shapiro, Milrod has written “A Manual of Panic-Focused Psychodynamic Treatment.” She and her colleagues have carried out several pilot studies as steps preceding the construction of the final treatment manual. These pilot studies also contributed further information about the role of predisposing psychological factors in vulnerability to panic and to meaningful life events connected with the onset of panic.
The second central goal of the project is to assess the effectiveness of time-limited psychodynamic psychotherapy of panic disorder, or agoraphobia with panic attacks, in an open field trial. The investigators who will be taking part in this study are graduate analysts with extensive clinical experience in treating panic disorders through psychoanalysis and psychodynamic psychotherapy. Milrod and her colleagues expect that success in their two goals will lay the groundwork for an extensive program of work whose centerpiece will be a controlled clinical trial, funded through large-scale new grant support.
Milrod's project is a pilot project. The Fund has had marked success in supporting pilot projects. When the pilot studies have been systematically carried out and achieved meaningful results, the researches have had impressive success in pursuing their primary project, obtaining greater funding from private foundations and the National Institute of Mental Health. The three reviewers of Milrod's project were enthusiastic about the planned studies. We consider the work to be an outstanding application. We look forward to hearing about its results in the near future and following its trajectory on to systematic larger clinical trials of psychoanalytic psychotherapy.
Stuart T. Hauser is co-chair of the Fund for Psychoanalytic Research.