A Problem-Focused Psychodynamic Approach to Panic Disorder |
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Panic attacks are often triggered by unconscious fears involving separation, dependency, and anger.
People with panic disorder commonly struggle with avoidance, unassertiveness, and fears of expressing needs.
Panic-focused psychodynamic psychotherapy addresses unconscious emotional conflicts that contribute to panic.
Although medications and cognitive behavioral therapy (CBT) can treat panic attacks and panic disorder, many people respond only partially, or not at all, to these treatments. Many patients also suffer from recurrent episodes of panic, and panic disorder can be highly disruptive to people’s lives and functioning (Ziffra, 2021).
Some people with panic disorder also suffer from Cluster C personality traits and disorders, which often include difficulties with dependency, fears of assertiveness, and tendencies toward avoidance (Friborg et al., 2013). They become frustrated in their interpersonal relationships, as they have difficulty addressing their needs with others. CBT and medication only indirectly address these associated problems.
For these reasons, my colleagues and I worked to develop a psychodynamic approach that focused on the treatment of panic disorder, which we call Panic Focused Psychodynamic Psychotherapy (PFPP) (Busch et al., 2012). This is another in the series of focused psychodynamic interventions that I have been describing in other blog posts.
Although traditional psychoanalytic treatments address panic attacks when the patient brings them into treatment, they are typically not the primary target of therapy. In PFPP, the therapist focuses on panic attacks and their associated dynamics, psychological factors that contribute to panic disorder.
In our psychoanalytic exploration of panic disorder, we identified certain core fears that these individuals struggle with (Busch et al., 1991). One is an insecurity about the safety of their relationships with close attachment figures. That is, they feel these relationships can be easily disrupted, often based on something they have felt, thought, or done. Furthermore, because of this “fearful dependency,” they believe that their angry feelings are particularly dangerous, at high risk of causing this disruption. These fears of dependency and conflicts about anger,........