Their premise made perfect sense: Panic-attack patients who are given a choice of psychotherapy treatments will enjoy better results than those given no choice at all. Precedence supported this belief by Swedish researchers heading into a 10-year study. But their results suggested otherwise.
Stats Support Treatments' efficacy
Of the study’s 221 participants, half were allowed to choose between two treatments designed specifically for panic disorder: psychodynamic psychotherapy (PDT) or cognitive behavioral therapy (CBT). The other half was randomly assigned one or the other.
The results? Inexplicably mixed.
Those who chose PDT generally experienced better outcomes than those randomly assigned the same treatment. However, those who chose CBT generally experienced worse outcomes than those randomly assigned the same treatment.
The study also noted that participants who received random treatments "were no less likely to drop out of treatment than those who chose their treatment, in direct contrast to one of the reported benefits of providing patients a choice of their treatment."
Choice or no choice, the study found that both psychotherapy treatments had positive, long-term results. Of the patients participating in the 2011-2017 study, 70% were clearly improved and 45% were remitted two years after treatment.
"The patients felt better in many ways,” says researcher Martin Svensson of Sweden's Lund University department of psychology. “For instance, depressive symptoms that often accompany panic disorder were significantly reduced and quality of life improved,”
Published in the journal Psychotherapy and Psychosomatics, the findings were especially impressive given that the duration of both treatments was as brief as 12 weeks. This aligns with the general move of health services toward shorter - not longer - psychological treatments.
Findings Relevant To Millions of Americans
These findings are especially pertinent in the United States where nearly 2.4 million Americans – or almost 2% of the adult population, ages 18-54 – experience some form of panic disorder at least once a year. The condition is two times more prevalent among women than men.
Panic attacks typically begin during adolescence or early adulthood, and, left untreated, are associated with emotional distress and social isolation. Many drop out of school, out of work, or are simply unable to fulfill their life's dreams.
“Many people adapt to their panic disorder by various restrictions in their daily living,” says researcher Thomas Nilsson. "Treatment is crucial as the disorder often leads to a downward spiral in which the margin for everyday life activities becomes increasingly narrow."
A similar study conducted in 2004-2009 divided PTSD patients into two groups of about 100 each – one group given a choice between psychotherapy and pharmacotherapy treatments, the other randomly assigned one or the other. The study found that “giving patients a choice over treatment yielded significantly lower health costs and more quality-adjusted life years than random assignment to treatment conditions.”
However, the study also found that psychotherapy (in this case, prolonged exposure therapy) was less costly and yielded more quality-adjusted life years relative to the pharmacotherapy (sertraline) when the treatment was assigned rather than chosen.
Researchers: Cost Shouldn't Determine Treatment
During the early stages of their study, the Swedish researchers cited similar concerns about cost as a treatment determinant, noting that "policy-makers would do well not to limit patient choice to the most cost-effective treatment," and that "providing patients access to their preferred (evidence-based) treatment is likely to increase compliance rates, thereby improving outcomes and reducing the overall cost and burden of illness."
At its conclusion, the study noted that "When offered a choice between two evidence-based psychotherapies for (panic disorder), the resulting choice was primarily a function of the patient's beliefs about the chosen therapy, its potential for success, and their preferred learning style."
Attempting to explain the study's conflicting results, Svensson suggested that “perhaps those who chose psychodynamic therapy had a more accurate perception of what they needed,"
It was also suggested that the failure to notably distinguish the benefits of one allocation over another - chosen vs. random treatments - might be attributed to the researchers' choice of psychotherapies (PTD and CBT) used in the study; that one cancelled out the other, and that different evidence-based treatments might have produced different results.
Further studies are required, Svensson says.
Make The Right Choice When Selecting Mental Health Software
As the researchers learned, even when conducting a study on choices, their own choices can be the difference between desired and undesired outcomes. That same idea applies when choosing a mental health EHR software that best sets up your behavioral health practice for success.
With software systems that are customized to meet the specific needs of mental health and substance abuse providers, InSync Healthcare Solutions makes that an easy choice to make.
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