Bidirectional Associations Between Defense Mechanisms and Therapeutic Techniques in Psychotherapies for Panic Disorder.

OBJECTIVE

The current study investigated bidirectional associations between defense mechanisms and therapeutic techniques in two different psychotherapies for panic disorder (PD). Identifying how technique use facilitates and is facilitated by change in defenses might guide adaptation and improvement of therapies.

METHOD: Patient defense mechanisms and use of therapeutic techniques were measured at early, mid, and late-treatment for 101 patients receiving panic-focused psychodynamic psychotherapy (PFPP) and cognitive behavioral therapy (CBT). Time-lagged associations between use of techniques and psychological defenses were examined using random-intercept cross-lagged panel models.

RESULTS

In PFPP, less-organized defense use at mid-treatment predicted higher therapist focus on the patient's moment-to-moment experience and affect at late-treatment. In CBT, greater therapist focus on the patient's thoughts and cognitions at early-treatment predicted use of more adaptive defenses at mid-treatment.

CONCLUSION

Results underscore differential treatment effects in the relationship between techniques and change in defensive functioning over time.

KEY MESSAGES: In cognitive behavioral therapy, therapists could focus on patients' thoughts and cognitions to foster adaptive defensive functioning like intellectualization and rationalization. In panic-focused psychodynamic psychotherapy, therapists might increase affect-focused interventions to target when patients persist in using lower adaptive defenses. Broadly, therapists can also be aware that their use of therapeutic interventions may be influenced by their patient's defensive functioning.