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

Abstract

BackgroundPanic disorder with or without agoraphobia is a commonly occurring disorder affecting 2 to 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 behavioral 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 comparing the ‘gold standard’ treatment for panic disorder to other evidence-based psychotherapies are needed, and also trials that can separate patient preferences for treatment from randomization effects on outcome, disability and healthcare utilization in the longer term.Methods/DesignA phase 2/3 doubly-randomized controlled trial carried out in routine care with 216 adults (aged 18 to 70 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-Focused Psychodynamic Psychotherapy. Primary outcomes are changes in panic symptom severity, occupational status, and sickness-related absences from work at post-treatment and 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 the two treatments are also assessed.DiscussionCognitive behavioral and psychodynamic therapies are both evidence-based approaches that are routinely offered to panic disordered 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 psychotherapeutic approach moderates outcome.Trial registrationClinicalTrials.gov NCT01606592 (registered 19 March 2012).

Preferences for panic control treatment and panic focused psychodynamic psychotherapy for panic disorder – who chooses which and why?

“…Participants in the WL condition were re-randomized to either the Random or Choice conditions after twelve weeks. Details of the trial protocol are available in Sandell et al (2015).…”

“…The present study uses data from the first doubly randomized controlled preference trial (DRCPT) (Sandell et al, 2015) examining whether outcomes for PD/A are superior when patients choose their treatment compared to when the treatment is randomly allocated. The two forms of psychotherapy offered to the participants were a form of CBT called Panic Control Treatment (PCT; Craske & Barlow, 2006) and Panic Focused Psychodynamic Psychotherapy (PFPP;Milrod et al, 1997).…”

Psychometric analysis of the Swedish panic disorder severity scale and its self-report version

“…Treatments were delivered and data were collected between the years 2012 and 2018. A detailed presentation of the procedures in the study can be found in the published trial protocol [24].…”

“…Nordic translations and psychometric analyses of instruments used internationally are important and there are several notable examples of this effort [19][20][21][22][23]. The aim of this study was to evaluate the psychometric properties (including the factor structure) of the PDSS and PDSS-SR in a large, treatment-seeking sample of adults with a DSM-IV diagnosis of PD or PDA who were recruited to a randomized controlled preference trial of cognitive behavioral therapy and brief, panic-focused psychodynamic therapy (Project POSE [24]).…”

Depressed patients’ preferences for type of psychotherapy: a preliminary study

“… 4 There are, to our knowledge, few studies focused on a patient’s choice of psychotherapy. 5 , 6 Psychotherapy includes various types, including Internet psychotherapy; psychotherapy from artificial intelligence; personal development books focused on patient education; conventional forms of psychotherapy such as cognitive psychotherapy; and dynamic, interpersonal, or supportive therapy. 5 , 7 For example, Berle et al made a significant contribution to the issue of patient preferences for treatment or therapy delivered face-to-face or via the Internet.…”