title: 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: BACKGROUND
  Panic 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
  A 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.
  
  
  CONCLUSIONS
  Cognitive 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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01606592 (registered 19 March 2012).
authors: Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden. rolf.sandell@psy.lu.se.
authors: Rolf
authors: R
authors: Sandell
authors: Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden. Martin.A.Svensson@regionhalland.se.
authors: Martin
authors: M
authors: Svensson
authors: Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden. Thomas.K.Nilsson@skane.se.
authors: Thomas
authors: T
authors: Nilsson
authors: Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden. hakan.johansson@psy.lu.se.
authors: Håkan
authors: H
authors: Johansson
authors: Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden. gardar.viborg@psy.lu.se.
authors: Gardar
authors: G
authors: Viborg
authors: Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden. sean.perrin@psy.lu.se.|Institute of Psychiatry, Psychology and Neurosciences, Box PO77, King's College London, 16 DeCrespigny Park, London, SE5 8AF, UK. sean.perrin@psy.lu.se.
authors: Sean
authors: S
authors: Perrin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000150:complications; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy; D006801:Humans; D008875:Middle Aged; D016584:Panic Disorder / Q000150:complications / Q000628:therapy*; D010358:Patient Participation; D064889:Psychotherapy, Psychodynamic; D055815:Young Adult