La psicoterapia psicodinamica nel trattamento integrato del disturbo di panico : esiti a tre anni di uno studio clinico osservazionale

Aim. Many trials suggested that the combination of pharmacotherapy and cognitive behavioral therapy (CBT) might be more effective than single treatment to reduce in short term the panic symptoms: CBT has been found to maintain treatment gains for 1 year at least. Despite these data, about 30% of patients remain symptomatic and 50% relapse. Some authors suggest that a psychodynamic approach, integrated with other treatments, can be more effective than single treatment in achieving the reduction or disappearance of panic symptoms and allows to maintain the results achieved over time. According to these studies we organized a model of integrated treatment combining pharmacological therapy (SSRI), cognitive-behavioural group therapy (G. Andrews Model) and short-term psychodynamic oriented psychotherapy. We focused the attention on the effectiveness of integrated therapy to early reduction of panic symptoms, to improve the global functioning and at long-term to reduce relapsing. Methods. In this study we analysed the results of 36 months follow-up of 89 patients with panic disorders (DSM IV Criteria) recruited after a clinical and instrumental assessment, and treated with the integrated therapy. Results. Pharmacotherapy combined with CBT confirm in this study its effectiveness at short-term to reduce panic and avoidance, but the integrated therapy (drug, CBT and dynamic psychotherapy) seems to become more effective in long-term follow-up, during the third year, reducing relapse and improving physical, emotional and social functioning more than the combined therapy (pharmacotherapies and CBT). Conclusion. The preliminary data obtained in this study, even if they need to be confirmed with a greater case series, allow only a cautious positive response for long-term better results in patients treated with integrated treatments.