PS380 Unit 6 Therapy Approaches Comparison Paper Example

Three Ways to Treat a Racing Heart: A PS380 Unit 6 Therapy Approaches Comparison Paper

[Student Name]

Purdue University Global

PS380: Clinical Psychology

Unit 6 Therapy Approaches Comparison Paper

[Instructor Name]

[Date]

The client, the clinic and the treatment course are composite; the theories and trials cited are real.

The Client

Travis, the plant electrician whose intake and second session were described in earlier units, has had panic attacks for seven months. The first came while he was forty feet up a ladder in the plant's crusher building. Since then he has had about two attacks a week, including one that woke him, and two emergency room visits for what he believed were heart attacks. He avoids high work and highway driving and takes his own pulse over and over through the day. At his intake, Dr. Lund, the psychologist at our clinic, recorded a provisional diagnosis of panic disorder. In the second session, motivational interviewing helped him decide to cut back from six or seven beers a night to three.

Travis's father drank hard through his childhood, and his mother lived with anxiety. He describes his father as unpredictable, warm one day and furious the next, and says that as a boy he learned to watch for signs of trouble.

This paper compares three approaches Travis could be offered: cognitive behavioral therapy, psychodynamic psychotherapy and person-centered therapy. For each it describes how the approach would understand and treat his panic, and what evidence supports it. It then considers what all three share and recommends an approach.

Cognitive Behavioral Therapy

Clark (1986) located the engine of panic in the meaning a person gives to ordinary bodily changes. A quickened pulse, read as the first beat of a heart attack, brings fear; fear quickens the pulse further, and the loop tightens into a full attack within minutes. Sitting down, gripping a rail or checking a pulse then feel like the reason the catastrophe was avoided, so the belief that it was coming never gets tested.

Travis's history fits the model closely. On the ladder, height and exertion raised his heart rate, and he read the change as a sign he would pass out and fall. His pulse checking and avoidance of high work are safety behaviors that keep the belief alive. His attack during sleep fits too: he may have noticed a change in his heartbeat as he woke and interpreted it catastrophically.

In the cognitive model, the attack is not caused by the racing heart but by what Travis believes the racing heart means.

Cognitive behavioral therapy for panic teaches the cognitive model, challenges catastrophic interpretations and uses interoceptive exposure, in which clients deliberately produce feared sensations, such as by running in place or breathing through a straw, to learn that they are not dangerous. It also gradually reduces safety behaviors and avoidance. For Travis, that would mean producing a racing heart in the office, then climbing ladders at work in planned steps without checking his pulse.

The evidence is strong. In a large multisite trial, Barlow et al. (2000) compared cognitive behavioral therapy, the antidepressant imipramine, their combination and placebo for panic disorder. Cognitive behavioral therapy outperformed placebo, and its gains tended to hold up better after treatment ended than those from medication alone.

Psychodynamic Psychotherapy

A psychodynamic approach would understand Travis's panic as connected to unconscious conflicts and early relationships. His childhood of watching for signs of his father's anger might have taught him to treat any internal change as a warning of danger. Feelings he could not express as a child, such as anger at his father, might surface as anxiety. The recent increase in his own drinking, and his fear of becoming like his father, could be important themes.

Treatment would explore the circumstances and meanings of his attacks, the feelings that precede them and the ways the relationship with the therapist repeats earlier patterns. Milrod et al. (2007) tested a manualized panic-focused psychodynamic psychotherapy in a randomized trial with 49 adults, comparing it with applied relaxation training over twelve weeks. Significantly more patients responded to the psychodynamic treatment than to relaxation training.

That trial is important but small, and it compared psychodynamic therapy with relaxation rather than with cognitive behavioral therapy. Evidence for psychodynamic treatment of panic is much more limited than for cognitive behavioral therapy.

Person-Centered Therapy

Rogers (1957) proposed that therapeutic change occurs when a client experiences a therapist's congruence, unconditional positive regard and accurate empathic understanding. A person-centered therapist would not target Travis's panic directly. Instead, the therapist would provide a relationship in which Travis could explore his experience, including his fear and his feelings about his father, and move toward greater self-acceptance.

For Travis, the approach would offer acceptance he did not get from his father, and it might reduce his general anxiety. But it does not include exposure to feared sensations, and there is little evidence that person-centered therapy alone resolves panic disorder.

What All Three Share

Wampold (2015) argued that common factors, including the therapeutic alliance, empathy, positive expectations and the therapist's ability to provide a convincing explanation and treatment, explain a large share of why psychotherapy helps, often more than the differences between specific techniques. A synthesis of 295 studies found that clients who rated the working bond with their therapist more highly tended to improve more, by a moderate margin that showed up in every major school of therapy (Flückiger et al., 2018).

These findings matter for Travis. Any approach will work better if he trusts the therapist and believes in the treatment. Rogers's conditions describe that relationship well, and both other approaches depend on it. For a man who grew up watching an unpredictable father, a steady, accepting therapist may be part of what helps.

Recommendation

Cognitive behavioral therapy is the best fit for Travis. It has the strongest evidence for panic disorder, it directly targets the misinterpretations and safety behaviors that maintain his attacks, and it offers a clear explanation he can test against his own experience, which suits a practical electrician. It also works quickly, usually in twelve to fifteen sessions.

Two elements from the other approaches should be included. First, the relationship should reflect what Rogers and the common factors research describe, with particular care because interoceptive exposure asks a frightened client to face what he fears. Second, if his fear of becoming like his father continues to affect his drinking or mood, a later phase of treatment might explore that theme more fully, drawing on psychodynamic ideas.

Conclusion

The three approaches see Travis's panic differently: as a misinterpretation of sensations, as an echo of childhood danger, or as a symptom that will ease in an accepting relationship. The evidence favors cognitive behavioral therapy for panic disorder, but the common factors research shows that the relationship carries much of the benefit in any approach. The best plan combines the strongest specific treatment with the strongest possible alliance.

References

Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283(19), 2529-2536. https://doi.org/10.1001/jama.283.19.2529

Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470. https://doi.org/10.1016/0005-7967(86)90011-2

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340. https://doi.org/10.1037/pst0000172

Milrod, B., Leon, A. C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., Aronson, A., Singer, M., Turchin, W., Klass, E. T., Graf, E., Teres, J. J., & Shear, M. K. (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry, 164(2), 265-272. https://doi.org/10.1176/ajp.2007.164.2.265

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95-103. https://doi.org/10.1037/h0045357

Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270-277. https://doi.org/10.1002/wps.20238