8 - Panic-focused psychodynamic psychotherapy–extended range

Abstract

Panic-focused psychodynamic psychotherapy (PFPP) is a 24-session, twice weekly, 12-week manualized psychotherapy that has demonstrated efficacy in randomized controlled trials for the treatment of panic disorder with or without agoraphobia. The treatment has been better articulated and modified to include approaches for patients with an extended range of DSM 5 anxiety disorders, cluster C personality disorders, and posttraumatic stress disorder. The manual describes dynamic factors that contribute to anxiety and panic onset, persistence, and recurrence, including intrapsychic conflicts about separation, autonomy, anger and ambivalent attachment, and guilt. The treatment targets patients’ understanding of the meanings of their anxiety and panic attacks through identification of the feelings and circumstances surrounding their symptoms. In addition, the therapist works to identify relevant intrapsychic conflicts, developmental factors, and transference. The termination of treatment is utilized as a central experience in working through emotions and conflicts related to separation, autonomy, and ambivalent attachments. This chapter describes a psychodynamic formulation of panic disorder, the framework of PFPP, and clinical research on PFPP. A case example is provided.