Psychiatrist Awarded for Research on Psychoanalytic Therapy

If Barbara Milrod, M.D., had appeared on the television program“ What's My Line?” back in the 1950s and 1960s, one might have guessed that she was a comedian since she makes wry facial expressions and has a dry sense of humor.

In fact, Milrod is a professor of psychiatry at Weill Cornell Medical College, a psychoanalyst on the faculty of the New York Psychoanalytic Society and Institute and the Columbia Psychoanalytic Center for Treatment and Research. She is an expert on the psychotherapeutic treatment of anxiety disorder, and one of the pioneers trying to demonstrate scientifically that psychoanalysis or psychodynamic psychotherapy works.

Or as she quipped at the January meeting of the American Psychoanalytic Association in New York City: “Panic disorder and psychodynamic psychotherapy are what I study. Analysis is what you guys do.”

And to date, the findings that she and her colleagues have made are most encouraging. For this reason, the American Psychoanalytic Association bestowed its Fifth Annual Scientific Paper Prize for Psychoanalytic Research on her at its January meeting.

It all started some 15 years ago, Milrod reported. There was a sense that the clinical syndrome of panic disorder might involve certain psychodynamic conflicts. For example, in her experience and that of some other analysts, panic patients' symptoms often seemed to represent unconscious rage. Panic patients frequently appeared to be furious at someone they loved, and the panic seemed to be a way of expressing their rage while also punishing themselves for feeling it. Panic patients often appeared to have problems with autonomy. Their panic often emerged at times when they felt conflicted about a big event such as college, marriage, or pregnancy. So Milrod and some colleagues decided that they wanted to determine scientifically whether psychodynamic psychotherapy can help panic patients.

They designed a short-term psychodynamic psychotherapy called Panic-Focused Psychoanalytic Psychotherapy (PFPP) to help patients with their panic symptoms. It is a 12-week, 24-session therapy where the therapist discusses the meanings of a patient's panic symptoms as well as why he or she starts to feel better after therapy has commenced.

“The time constraint puts pressure on both patient and therapist to get a lot done quickly,” Milrod explained. “Also, termination is a very important aspect of the treatment because of panic patients' problems with autonomy. As a result, the therapist starts talking about termination with the patient long before that time comes.”

Once Milrod and her colleagues had developed PFPP, they taught some analytically trained psychiatrists to use it. After that, they conducted an open pilot clinical trial to see whether PFPP might help 21 subjects with DSM-IV-diagnosed panic disorder. Sixteen of the 21 responded. Results were published in the October 2001 Journal of Psychotherapy Practice and Research.

In the wake of this encouraging outcome, they undertook a randomized, controlled trial to explore PFPP's efficacy in treating DSM-IV-diagnosed panic disorder. Since there was some evidence that Applied Relaxation Training (ART), which involves progressive muscle relaxation, exposure, and homework, is efficacious for patients with panic disorder, they decided that it would constitute a good comparison psychotherapy condition for PFPP in their randomized, controlled trial. The study was funded by the National Institute of Mental Health.

Out of the 49 subjects who participated in the trial, 26 were randomized to PFPP and 23 to ART. By the study's completion in 2005, both the PFPP group and the ART group had experienced a decrease in panic symptoms as measured by the Panic Disorder Severity Scale, but the former had experienced a significantly greater decrease in such symptoms. The findings were published in the February 2007 American Journal of Psychiatry.

Researchers in Germany and Sweden are now attempting to replicate those results, Milrod noted. She and her colleagues, she added, are now planning to compare the efficacy of PFPP with that of cognitive-behavioral therapy on patients with DSM-IV panic disorder. Their recruitment goal for this trial is 233 subjects.

All of these research efforts by Milrod and her group demonstrate that psychodynamic psychotherapy and psychoanalysis can be subjected to rigorous scientific-outcome research, said Robert Michels, M.D., a professor of psychiatry at Weill Cornell Medical College, at the meeting. Moreover, a number of analysts have been inspired by their success to conduct similar studies, he said. Michels chaired the session where Milrod discussed the research that she and her team have conducted.

Kenneth Levy, Ph.D., an assistant professor of psychology at Penn State University, a previous winner of the association's Annual Scientific Paper Prize for Psychoanalytic Research, and a session discussant, agreed:“ This is big science with a capital 'S.' This is what analysis needs more of if it is going to survive.” ▪