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Extinction Training During the Reconsolidation Window Prevents Recovery of Fear
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Exploring termination setback in a psychodynamic therapy for panic disorder.

Thomas Nilsson1, Fredrik Falkenström2, Sean Perrin1

  • 1Department of Psychology, Lund University.

Journal of Consulting and Clinical Psychology
|September 30, 2021
PubMed
Summary
This summary is machine-generated.

Termination in psychodynamic therapy (PDT) can cause symptom increases. This study found a termination setback (TS) in PDT, where symptom improvement halted near treatment end, unlike cognitive behavioral therapy. This setback persisted long-term.

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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.