1. What is the effect on comorbid personality disorder of brief panic-focused psychotherapy in patients with panic disorder?
- Author
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John R. Keefe, Robert Gallop, Jacques P. Barber, Barbara Milrod, and Dianne L. Chambless
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Adult ,Male ,050103 clinical psychology ,Adolescent ,Context (language use) ,Comorbidity ,Personality Disorders ,behavioral disciplines and activities ,Article ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,mental disorders ,medicine ,Humans ,0501 psychology and cognitive sciences ,Agoraphobia ,Aged ,Psychodynamic psychotherapy ,Cognitive Behavioral Therapy ,business.industry ,Panic disorder ,05 social sciences ,Panic ,Middle Aged ,medicine.disease ,Personality disorders ,030227 psychiatry ,Clinical trial ,Psychiatry and Mental health ,Clinical Psychology ,Panic Disorder ,Female ,medicine.symptom ,Psychotherapy, Psychodynamic ,business ,Clinical psychology - Abstract
BACKGROUND: No studies of psychotherapies for panic disorder (PD) have examined effects on comorbid personality disorders (PersD), yet half such patients have a PersD. METHODS: In a randomized trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), PersD was assessed pre-to-post treatment with the Structured Clinical Interview for the Diagnosis of Axis-II Disorders (SCID-II). For patients completing therapy (n = 118, 54 with PersD), covariance between panic and SCID-II criteria improvements was analyzed. SCID-II diagnostic remission and recovery were evaluated. Comparative efficacy of PFPP versus CBT for improving PersD was analyzed both for the average patient, and as a function of PersD severity. RESULTS: 37% and 17% of PersD patients experienced diagnostic PersD remission and recovery, respectively. Larger reductions in PersD were related to more panic improvement, with a modest effect size (r = 0.28). While there was no difference between treatments in their ability to improve PersD for the average patient (d = 0.01), patients meeting more PersD criteria did better in PFPP compared to CBT (p = 0.007), with PFPP being significantly superior at 11 criteria and above (d = 0.66; 3 more criteria lost). CONCLUSIONS: PersD presenting in the context of primary PD rarely resolves during psychotherapies focused on PD, and change in PersD only moderately tracks panic improvements, indicating non-overlap of the constructs. Patients receiving panic-focused psychotherapies may require additional treatment for their PersD. PFPP may be superior at improving severe PersD, but replication of this finding is required.
- Published
- 2017
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