An Open Pilot Study of Interpersonal Psychotherapy for Panic Disorder(IPT-PD)


Abstract:Interpersonal psychotherapy (IPT)is a time-limited psy-
chotherapy initially developed to treat depression.It has yetto be
studied systematically fortreatment of panic disorder. We modified
IPT forthe treatment of panic disorder and tested this treatmentin
an open clinicaltrial with 12 patients seeking treatment of DSM-IV
panic disorder. Patients were assessed before during and after
treatment. At completion oftreatment, nine patients (75%) were
independently categorized as responders (i.e.,rated as much im-
proved or very much improved on the Clinical GlobalImpression-
Change Scale). Substantialimprovement was found for panic symp-
toms, associated anxiety and depressive symptoms, and physical and
emotional well-being. Degree of change in this sample approxi-
mated that obtained in studies using established treatments such as
cognitive behavioraltherapy. Results,though preliminary, suggest
thatIPT may have efficacy as a primary treatment of panic disorder.
Further study is warranted.
Key Words: Panic,IPT, anxiety,interpersonal, psychotherapy
(J Nerv Merit Dis 2006;194: 440-445)

Extensive empirical evidence demonstrates the efficacy of
cognitive behavioraltherapy (CBT)fortreatment of panic
disorder(Barlow et al., 2000; dark et al.,1999; Klosko et al.,
1990). However, many patients with panic disorder are not
helped by CBT, and questions remain aboutthe long-term
efficacy of CBT (Milrod and Busch,1996; Nadiga et al.,
2003). Also of concern is the limited dissemination of CBT
beyond specific specialty clinics. Surprisingly,individuals
with panic disorderreport being treated with CBT less often
than with othertherapies, such as supportive therapy (Gois-
man et al.,1993; Rowa et al., 2000; Taylor et al.,1989). This
is the case even though these othertherapies lack scientific
evidence of efficacy for panic disorder. Between 1987 and
1999.the proportion ofindividuals with panic disorder who
received psychotherapy actually decreased (Olfson et al.,
Columbia University, Department of Psychiatry, Anxiety Disorders Clinic
New York State Psychiatric Institute, New York, New York.
This project was supported by NIMH award #K08-MH1575 to Dr. Lipsitz
Send reprintrequests to Joshua Lipsitz, PhD,1051 Riverside Drive, Unit 69
New York, NY 10032.
Copyright @ 2006 by Lippincott Williams & Wilkins
ISSN: 0022-3018/06/19406-0440
2004). While efforts toward better dissemination of CBT
must be emphasized (e.g., Aせdis, 2002),it seems importantto
considerthe potential utility of alternative psychotherapy
approaches fortreatment of panic disorder.
Only a handful of studies have systematically studied
psychotherapy approaches otherthan CBT fortreatment of
panic disorder, and these have yielded mixed results. Shear et
al.(1994)found that a controltreatment of “nonprescriptive”
therapy,focusing on currentlife stressors, achieved results
comparable to those obtained by CBT. However, anothertrial
found nondirective therapy to be inferiorto CBT for panic
disorder(Craske et al.,1995). Shear and Weiner(1997)
developed and tested another non-CBT therapy for panic
disorder, called emotion-focused therapy (EFT). EFT focuses
on interpersonaltriggers for panic attacks and works on ways
of controlling negative emotions that are thoughtto trigger
panic attacks. However,in a controlled comparison study of
EFT,this treatment was found to be less effective than CBT
for panic disorder;its benefits approximated those produced
by placebo (Shear et al., 2001).
Psychodynamic therapy was first studied systematically
for panic disorder as an adjunctto medication treatment
(Wiborg and Dahl,1996). Patients who received clomipra-
mine plus 15 weekly sessions ofinterpersonally focused
psychodynamic psychotherapy were less likely to relapse
aftertermination of medication treatment. Recently, Milrod et
al.(2001) developed and tested a 24-session psychodynamic
therapy as a primary treatment of panic disorder. KCsults of
an open trial supportthe potential efficacy ofthis therapy,
with 16 of 21 patients treated achieving remission of panic
and agoraphobia. A potential challenge to broader application
ofthis psychodynamic therapy is thatitrequires twice-
weekly visits for12 consecutive weeks, a frequency W打ich
may not be feasible for some patients and which may be
difficultto implementin some settings. Furthermore,the
study by Milrod et al.(2001) was conducted using highly
trained psychoanalysts who may be in short supply outside of
major metropolitan centers.

Interpersonal Psychotherapy

Interpersonal psychotherapy (IPT)is a time-limited
psychotherapy first developed by Klerman et al.(1984)for
treatment of depression (Weissman et al., 2000). Similarto
the psychodynamic treatments described above,IPT focuses
on the patient’s interpersonal contextratherthan symptoms
per se. However,IPT differs from most psychodynamic
treatments in that(1)itincludes a formal psychoeducational
component aboutthe disorder,(2)it calls for an active
therapist stance to maintain a focus and structure the phases
oftherapy,(3)it does notfocus on transference, and (4)it
focuses immediately and pragmatically on improving actual
relationships in the here and now ratherthan by analyzing
internal conflicts orrepresentations that may impact on these.
IPT,though structured and manualized,is user-friendly and
can be effectively adapted fortherapists and patients from
varied professional backgrounds (Bolton et al., 2003; Mufson
et al., 2004) and diverse cultures (Bolton et al., 2003).
Interpersonal psychotherapy has demonstrated efficacy
fortreatment of depression in several controlled trials (Bolton
et al., 2003; Elkin et al.,1989; Markowitz et al.,1994).It has
also been shown effective fortreatment of eating disorders
such as bulimia (Fairbum et al.,1991) and binge eating
disorder(Wilfley et al., 2002). A few studies have begun to
examine the potential application ofIPT for anxiety disor-
ders. Lipsitz et al.(1999) modified IPT fortreatment of social
phobia and found preliminary positive results in a small open
trial. However,results of a subsequentrandomized controlled
trial did not show superiority ofIPT over supportive therapy
(Lipsitz, 2002). KCcently,two studies examined IPT for
treatment of PTSD in open trials with encouraging results
(Bleiberg and Markowitz, 2005; Krupnick,1999); no con-
trolled studies have been conducted.

この論文はIPTをPanic に使ったらどうなるのかという話

IPT for Panic Disorder

Several studies suggestthat panic disorder may be a
promising targetforIPT. Panic patients report a high rate
ofinterpersonal stressors in the months preceding panic
onset(Faravelli and Pallanti,1989; Roy-Byrne and Uhde,
1988). These include loss of and separation from a loved
one, othertransitional events such as the birth of a baby,
and stress at work or school(Doctor,1982; Last et al.,
1984). Recently, Milrod et al.(2004)reported that 24 of 51
(47%) panic disorder patients assessed had experienced
onset of panic disorder within 6 weeks after a significant
interpersonalloss.Individuals with agoraphobia and panic
disorder have been found to have high levels of marital
distress (Last et al.,1984; Marcaurelle et al., 2003). They
also report more chronic interpersonal difficulties such as
feelings ofinadequacy relative to others, dependency,fear
of abandonment, and feelings of discomfortin the presence
of conflict(Busch et al.,1991,1995; Goldstein and
Chambless,1978; Shear et al., 2001).
Considering the range of interpersonal problems expe-
rienced by patients with panic disorder, several traditional
foci of IPT seemed potentially applicable. We therefore
modified IPT fort reatment of panic disorder(IPT-PD), adapt-
ing IPT procedures to make this treatment directly applicable
for panic disorder. We then tested this modified treatment
with 12 patients who sought treatment of DSM-IV panic
disorder. We hoped thatfindings would shed light on the
feasibility of using IPT with this population and on whether
initial efficacy would justify further study.