The POSE study - panic control treatment versus panic-focused psychodynamic psychotherapy under randomized and self-selection conditions: study protocol for a randomized controlled trial.

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Abstract

Background: Panic Disorder with or without Agoraphobia is a commonly occurring disorder affecting 2-3% of the population in Sweden. Untreated, panic disorder is a chronic condition that significantly increases the risk for psychiatric comorbidity, morbidity and mortality, employment difficulties, and healthcare utilization. Cognitive behavioural approaches are the recommended first-line treatment for panic disorder, however many patients in routine care receive another evidence-based psychotherapy, including psychodynamic therapy. Allowing patients to choose among evidence-based approaches to panic disorder may improve outcomes and reduce overall health costs. Trials involving comparing the gold standard treatment for panic disorder to other evidence based psychotherapies are needed, and also trials which can separate patient preferences for treatment from randomization effects on outcome, disability and healthcare utilization in the longer-term.
Methods/Design: A phase 2/3 doubly-randomized controlled trial carried out in routine care with 216 adults (aged 18-60 years) with a primary diagnosis of DSM-IV Panic Disorder (with or without Agoraphobia). Within each clinic, patients are randomized to self-selection, random assignment of treatment, or wait-list. Patients choose or are randomly assigned to either Panic Control Treatment or Panic Focussed Psychodynamic Psychotherapy. Primary outcomes are changes in panic symptom severity, occupational status, and sickness-related absences from work at 6, 12 and 24 months post-treatment. Secondary outcomes include changes in agoraphobic avoidance, psychiatric comorbidity, disability, and healthcare utilization. The study also employs elements of an effectiveness trial as therapist and service-related effects on outcome will be estimated. Putative change mechanisms for CBT and PF-PP are also assessed.
Discussion: CBT and psychodynamic therapy are evidence-based approaches that are routinely offered to panic disorder patients in Sweden. However little is known about the relative effectiveness of these two approaches for panic/agoraphobia, work-related disability and healthcare utilization over the longer-term. The current trial (POSE) also addresses the important but understudied issue of whether patient preference for a particular therapeutic approach (CBT or psychodynamic therapy) moderates outcome.

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Subject classification (UKÄ) – MANDATORY

  • Psychology

Keywords

  • Randomized Preference Trial, Panic Disorder, CBT, Psychodynamic Therapy, Health Economics
Original languageEnglish
Article number130
JournalTrials
Volume16
Issue number130
Publication statusPublished - 2015
Publication categoryResearch
Peer-reviewedYes

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