Combining Psychodynamic Treatments With Medication

Although some anxious patients wish to start medication quickly to diminish the discomfort they experience, there remains a core of highly anxious patients who are too frightened of medication to consider taking it (Cross-Na- tional Collaborative Panic Study 1992; Hofmann et al. 1998). Although medication should be considered and discussed as an efficacious treatment option with patients, in many cases it may not be necessary. Evidence suggests that for many patients, psychodynamic psychotherapy for panic disorder can be an effective treatment alone (Mil- rod 1995; Milrod and Shear 1991; Milrod et al. 1996, 2000, 2007b; Renik 1995; Stern 1995). In the PFPP efficacy study (Milrod et al. 2007b), subjects who entered the study agreed to keep medication doses constant, and the use of medication (by 18% of patients) showed no effect on outcome in either treatment condition.

Psychodynamic treatments can be effectively combined with antianxiety medication (Milrod and Busch

1998; Wiborg and Dahl 1996). In more severe cases, in which patients feel too impaired by anxiety to be able to think clearly, medication can aid psychotherapy by re- lieving severe anxiety, thus permitting patients to more productively explore the underlying significance of the symptoms. In psychoanalytically based treatments, therapist and patient should discuss emotional mean- ings of taking medication (Milrod and Busch 1998).

Conclusion

Despite a wealth of theoretical and clinical conceptions concerning anxiety, professionals in the fields of psy-

choanalysis and psychoanalytic therapy have been slow to undertake efficacy studies to determine the effect of psychodynamic interventions, alone or in combination with other treatments, on anxiety disorders. We remain hopeful that the recent outcome study demonstrating the efficacy of PFPP for panic disorder will encourage more randomized, controlled trials of psychodynamic treatments to better assess the appropriate place of psychodynamic psychotherapy among the available treatments for anxiety disorders. Understanding for whom a treatment works and its mechanisms of change can lead to the development of more specific interventions for individual patients.

Key Clinical Points

• Psychodynamic models conceptualize anxiety disorders as developing from wishes, feelings, and fantasies, often unconscious, that are experienced as fright- ening or intolerable.

• In psychodynamic psychotherapy, therapist and patient work to identify and re- appraise emotional conflicts, rendering them less threatening.

• Psychodynamic approaches, though widely used, have received little in the way of systematic assessment, but psychoanalytic clinicians have increasingly realized the importance of undertaking such studies.

• A manualized psychodynamic approach to panic disorder has demonstrated efficacy when compared with a less active treatment.

• Further studies will help to determine the role of psychodynamic psychotherapy among the available treatments for anxiety disorders.

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Evolutionary Concepts

In document Textbook Anxiety Disorders Second Edition (1) (Page 149-154)

Combining Psychodynamic Treatments With Medication

Conclusion

Key Clinical Points

References

Recommended Readings

Evolutionary Concepts