Exploring termination setback in a psychodynamic therapy for panic disorder.

Area of Science:

• Psychology
• Psychotherapy Research
• Clinical Psychology

Background:

• Termination in psychodynamic therapy (PDT) is a critical phase, often associated with patient conflict and potential symptom exacerbation.
• Previous research has limited data on symptom changes during PDT termination due to infrequent assessments.

Purpose of the Study:

• To investigate the frequency and characteristics of symptom changes during the termination phase of panic-focused psychodynamic psychotherapy (PFPP).
• To compare symptom trajectories during termination between PFPP and panic control treatment (PCT), a cognitive behavioral therapy.

Main Methods:

• A doubly randomized clinical preference trial involving 217 adults with panic disorder.
• Participants received either PFPP or PCT and completed the Panic Disorder Severity Scale Self-Report (PDSS-SR) weekly during treatment and at follow-up.
• Piecewise latent growth curve modeling was used to analyze symptom trajectories during the termination phase of PFPP.

Main Results:

• Symptom improvement stalled in PFPP during the final weeks of treatment (Weeks 10-12), termed a termination setback (TS), while PCT participants continued to improve.
• Greater symptom reduction prior to Week 10 and less avoidant attachment predicted a more severe TS in PFPP.
• Termination setbacks in PFPP were associated with poorer outcomes up to the 12-month follow-up.

Conclusions:

• This study provides empirical evidence for a termination setback (TS) in psychodynamic therapy (PDT).
• Symptom resurgence near termination was more prevalent in PFPP compared to PCT.
• Further research with frequent symptom assessments and qualitative analyses across various PDT modalities is recommended.