The relationship of reflective functioning and severity of agoraphobia in the outcome of a psychoanalytic psychotherapy for panic disorder
Item
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Title
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The relationship of reflective functioning and severity of agoraphobia in the outcome of a psychoanalytic psychotherapy for panic disorder
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Identifier
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d_2009_2013:d607739d15fc:10169
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identifier
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10308
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Creator
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Graf, Elizabeth P.,
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Contributor
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Diana Diamond
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Date
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2009
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Language
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English
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Publisher
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City University of New York.
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Subject
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Clinical psychology | agoraphobia | mentalization | panic | psychodynamic | reflective functioning
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Abstract
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This study examined the relationship between reflective functioning and severity of agoraphobia in the context of an outcome study investigating psychoanalytic psychotherapy for panic disorder. The DSM-IV identifies two subtypes of Panic Disorder: Panic Disorder with and without agoraphobia. The agoraphobic syndrome is associated with the most impaired end of the diagnostic continuum, the poorest prognosis, and lower response rates to existing efficacious treatment. A better understanding of the patients who develop severe agoraphobia is important in guiding interventions.;This study involved secondary data analysis drawn from two studies. In the first, Milrod et al. conducted a randomized controlled trial of Panic Focused Psychodynamic Psychotherapy (PFPP) v. Applied Relaxation Therapy (ART) for panic disorder. As part of this larger project, Rudden et al. conducted a pilot study of reflective functioning (RF) in patients enrolled in the Milrod's study. The Reflective Functioning Scale is a validated measure of individuals' abilities to understand mental states in themselves and other people and to link mental states to behavior and symptoms. Impairments in reflective functioning have been associated with a range of psychiatric disturbances, and studies have demonstrated that improvements in RF are related to response to psychotherapy in patients with borderline personality disorder. For this reason, an investigation of the relationship between severe agoraphobia and reflective functioning is an important next step in better understanding this group of patients.;The study participants were 30 patients with panic disorder with or without agoraphobia who completed both studies. This project determined that reflective functioning is not related to severity of agoraphobia. Rather, within this population, there is a large range of RF, suggesting that this is a heterogeneous group. As a secondary aim, this study investigated whether baseline panic specific reflective functioning (PSRF) is associated with poorer response to PFPP and ART. While PSRF did not moderate outcome, this study found that patients with severe levels of agoraphobia did significantly better in PFPP than in ART, the first time a psychodynamic treatment has demonstrated effectiveness in treating agoraphobia.
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Type
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dissertation
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Source
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2009_2013.csv
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degree
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Ph.D.
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Program
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Psychology
