depression introspection

The NYT published a story on Feb. 6 about how talk therapy aids panic disorders.

The study seems interesting. The psych world is excited because of its promising results. The results do seem hopeful but give the sample size, it's too early to tell.

"A team of New York analysts published [in The American Journal of Psychiatry] the first scientifically rigorous study of a short-term variation of the therapy for panic disorder, a very common form of anxiety. The study was small, but the therapy proved to be surprisingly effective in a group of severely disabled people… The brand of therapy tested relies on core tenets of analysis, like the search for the underlying psychological meaning of symptoms. But unlike traditional psychoanalysis, it focused on relieving symptoms quickly, and was time-limited. Previous studies of similar approaches have shown some promise for other disorders, like depression."

Perhaps Dr. David H. Barlow, a psychologist at Boston University, had the best insight:

"[He] said… that the study was too small to be conclusive but that 'the authors should be congratulated for actually  taking the first step in doing the hard work of beginning to evaluate treatments” that are widely used without good supportive evidence.

The researchers tested a pared-down version of analysis tailored specifically for panic attacks, the breathless, paralyzing dread that strikes some 1 percent to 2 percent of people, seemingly out of nowhere. Previous studies had found that other kinds of therapy — including exposure techniques, 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."

The article doesn't mention where the estimated "some 1 percent to 2 percent of people" comes from so I'll probably do some digging around to find out how many people are estimated to suffer from anxiety disorders and panic attacks. It's also interesting to note that studies used a form of psychological behavioral therapy to help patients manage their symptoms.

"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."

Relaxation techniques — don't Ativan and Klonopin achieve the same result except much faster?

"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. "

Thirty-nine percent of 49 patients equals about 19 patients who "improved significantly." It's not brain science, but you've left with another 30 who didn't. However, nearly 75 percent of the sample size "reported similar benefits" from psychodynamic therapy. Perhaps it wasn't revealed in the American Journal or it's a shoddy article thrown together at the last minute, but I'd like to know what "similar benefits" the study is speaking of.

Also, isn't 12 weeks longer than most clinical trials funded by drug companies? Perhaps I'm thinking that's just the first phase of a clinical trial…?

"One former patient treated with this therapy began to have panic attacks after witnessing a young woman die of an illness, said her doctor, Fredric N. Busch, a Cornell psychiatrist and a co-author of the new study.

The patient, who was not a part of the study, described the death as deeply unfair, and in sessions explored perceptions of unfairness in her work and her life, including her childhood. “Once she was able to understand this pattern, the panic became less frightening, she felt safer and was eventually able to get rid of the symptoms,” Dr. Busch said."

I'm no doctor, but this sounds more like Post-Traumatic Stress Disorder. This example makes PTSD sound less like a mental illness and more like a behavior to be unlearned. Perhaps it's true? How do events "trigger" a mental illness? Is it inherited or can it be acquired? What a debatable topic. Oy.

"The researchers said that even if this approach was not for everyone, it appeared to be especially beneficial for a particular group. In an analysis of individual patient’s responses, the researchers found that those who also had a personality disorder, like avoidant personality, showed significantly greater improvement than those whose symptoms were related solely to anxiety. Patients with multiple diagnoses are usually more difficult to treat. "

It's nice to think that these techniques could replace anti-anxiety meds. But alas, they won't; Big Pharma wouldn't allow it. But a girl can dream, can't she?

(The boss won't let me skip lunch and leave early so… here are your updates…)