title: Implementing panic-focused psychodynamic psychotherapy into clinical practice.
abstract: OBJECTIVE
  To determine the effectiveness of manualized panic-focused psychodynamic psychotherapy (PFPP) in routine care in Germany.
  
  
  METHODS
  German psychoanalysts were trained according to the PFPP manual. Fifty-four consecutive outpatients with panic disorder (with or without agoraphobia) were randomly assigned in a 2:1 ratio to PFPP or cognitive-behavioural therapy (CBT) plus exposure therapy. Subjects (female 57.4%; mean age 36.2 years) had high rates of psychiatric (68.5%) and somatic (64.8%) comorbidity, and previous psychiatric treatments (57.4%). Assessments were performed pre- and posttreatment and at 6-month follow-up. The primary outcome measure was the Panic Disorder Severity Scale.
  
  
  RESULTS
  Both treatments were highly effective. In patients randomized to PFPP, remission was achieved in 44.4% at termination and by 50% at follow-up (CBT 61.1% and 55.6%, respectively). No significant differences were found. Emotional awareness, a posited moderator of good outcome in psychotherapies, was significantly higher in the CBT group at baseline. It was found to be a strong moderator of treatment effectiveness in both treatments. After adjusting for initial Levels of Emotional Awareness Scale (LEAS) scores, effect sizes (ESs) for the primary outcome were Cohen d = 1.28, from pre- to posttreatment, and d = 1.03, from pretreatment to follow-up, for PFPP, and d = 1.81 and 1.28 for CBT, respectively.
  
  
  CONCLUSIONS
  PFPP was implemented effectively into clinical practice by psychoanalysts in the community in a sample with severe mental illness with large ESs. Assessment of LEAS may facilitate the identification of patients suitable for short-term psychotherapy. (
  
  
  BACKGROUND
  German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111-1112-4245).
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Mainz, Germany. manfred.beutel@unimedizin-mainz.de
authors.forename: Manfred E
authors.initials: ME
authors.lastname: Beutel
authors.forename: Vera
authors.initials: V
authors.lastname: Scheurich
authors.forename: Achim
authors.initials: A
authors.lastname: Knebel
authors.forename: Matthias
authors.initials: M
authors.lastname: Michal
authors.forename: Jörg
authors.initials: J
authors.lastname: Wiltink
authors.forename: Mechthild
authors.initials: M
authors.lastname: Graf-Morgenstern
authors.forename: Regine
authors.initials: R
authors.lastname: Tschan
authors.forename: Barbara
authors.initials: B
authors.lastname: Milrod
authors.forename: Stefan
authors.initials: S
authors.lastname: Wellek
authors.forename: Claudia
authors.initials: C
authors.lastname: Subic-Wrana
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001364:Awareness; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D015897:Comorbidity; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D007318:Inservice Training; D008297:Male; D008370:Manuals as Topic; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011575:Psychoanalytic Therapy / Q000193:education / Q000379:methods*; D011594:Psychometrics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: agoraphobia; cognitive-behavioural therapy; effectiveness; follow-up; panic disorder; panic-focused psychodynamic psychotherapy