The Latest on Panic Attacks

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland.

Hot on the heels of a blog I posted on January 20 last, in which I referred to new research in the States that showed very positive outcomes for long term psychoanalytic therapy, comes another survey from the same neck of the woods.

This time, however, it is research that shows how modified and shortened psychoanalytic therapy of 12 weeks duration works for panic disorder.

It might seem like just another piece of research but in the field of psychoanalysis the existence of research is a quite a rarity. That’s why a recent report in the New York Times is interesting. A team of New York analysts published the first scientifically rigorous study of a short-term variation of analytic therapy for panic disorder, a very common form of anxiety. The study was small, the report said, but the therapy proved to be surprisingly effective in a group of severely disabled people.

The research paper appeared in American psychiatry’s premium journal, The American Journal of Psychiatry. The therapy it tested, unlike traditional psychoanalysis, focused on relieving symptoms quickly, and was time-limited. Previous studies had found that other therapies — including exposure techniques such as Cognitive Behavioural Therapy, in which people learn to diffuse their anxieties by facing them one small step at a time — can relieve panic attacks in half to two-thirds of patients, depending on the severity and type of anxiety.

In the new experiment, Dr. Barbara L. Milrod, a psychiatrist at Weill Medical College of Cornell University, led a team of therapists who treated 49 men and women with a variety of anxieties. Some were agoraphobic, unable to ride the subway or visit certain parts of town. Others had symptoms of depression or of personality problems, like a disabling dependency on other people or an avoidance of social situations.
Half of the group received a form of relaxation training, in which they learned how to moderate their arousal by tensing and relaxing specific muscle groups. The other half received psychodynamic therapy, working with their therapist in two weekly sessions to understand the underlying meaning of their symptoms — when the reactions first started and how they might be linked to loss, broken relationships or childhood experiences that unconsciously haunted their current lives.
After 12 weeks, 39 percent of those working with relaxation techniques improved significantly on standard measures of anxiety and reported fewer panic-related problems in their relationships and work. But almost three-quarters of those receiving psychodynamic therapy reported similar benefits.
So, again the principles of psychoanalysis have been tested and found to be robust. Granted the above study modified the therapy, thus satisfying the need for speed that is a hallmark of modern living, but the underlying principles held fast. It might not be enough to re-train behaviours and thoughts on the basis that new habits help us overcome old ones. What the outcome is saying is that there has to be fundamental change in the person’s understanding of what is going on, why it is happening, how that fits in with the entirety of their lives to date and how new possibilities can emerge in place of old, unhelpful solutions.
The only thing that should be added, and I fall on the side of traditionalists in this regard, is that the race to do things quicker is not always better. In most areas of human endeavour you will see an example of this: the food industry has given us fast food but has it improved our nutrition? Banking raced to speed up ways to give us large wads of cash. It led to an inevitable crash. Technology has speeded up our access to great vistas of knowledge and entertainment. But has it freed up our time to be more human and build better communities?
In this regard, the current study has an interesting quote from one of its authors. “This is best response rate I’ve seen in a controlled trial for panic,” Dr. Barbara Milrod said. “And the therapy was time-limited. I don’t think anyone would care if psychoanalysis cured panic in six years — snore. We wanted to know that what we were doing worked, that it wasn’t malpractice.”
Note the word ‘snore’. That is not the language of classical psychoanalysis, not because it is against someone coming for 12 weeks or even 6 and then finishing. The fact is, they do. No, it is because 12 weeks does not suit everyone and to suggest it does is misleading. When people come for therapy, some want to be out as quick as possible but others don’t. And for those who don’t, that choice has to be there.
To assume there is nothing other than a panic disorder sitting in one’s consulting room is the ultimate disrespect. Panic disorder is a symptom, a sign that many other things are operating at an unconscious level for the client. Putting a short term focus on the symptoms runs the risk that deeper issues get ignored.
Yes, it is good to see positive results appearing in respected medical journals about psychoanalysis. But let’s not forget that psychoanalysis is different because it invests time - in the person who presents for therapy, in the human complexity that person represents and in the person behind the person telling us their story.