Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study

Svanborg, Cecilia; Bäärnhielm, Sofie; Wistedt, Anna Åberg; Lützen, Kim
January 2008
BMC Psychiatry;2008, Vol. 8, Special section p1
Academic Journal
Background: A better understanding is needed of factors behind the long-term outcome of dysthymic and panic disorders. Combining patients' perceptions of factors that help and hind remission with objective assessments of outcome may give greater insight into mechanisms for maintaining recovery. Methods: Twenty-three dysthymic and 15 panic disorder patients participated in a 9-year follow-up investigation of a naturalistic study with psychotherapy and antidepressants. Degree of remission was determined by reassessments with SCID-I & II interviews, self-reported symptoms and life-charting (aided by case records). Qualitative content analysis of in-depth interviews with all 38 patients was done to examine the phenomenon of enduring remission by exploring: 1) perceived helpful and hindering factors, 2) factors common to and specific for the diagnostic groups, 3) convergence between patients' subjective views on remission with objective diagnostic assessments. Results: About 50% of the patients were in full or partial remission. Subjective and objective views on degree of remission generally converged, and remission was perceived as receiving 'Tools to handle life'. Common helpful factors were self-understanding, enhanced flexibility of thinking, and antidepressant medication, as well as confidence in the therapist and social support. The perceived main obstacle was difficulty in negotiating treatments. Remitted had overcome the obstacles, whereas many non-remitted had problems expressing their needs. Patients with dysthymia and panic disorder described specific helpful relationships with the therapist: 'As a parent' versus 'As a coach', and specific central areas for change: self-acceptance and resolution of relational problems versus awareness and handling of feelings. Conclusion: A general model for recovery from dysthymic and panic disorders is proposed, involving: 1) understanding self and illness mechanisms, 2) enhanced flexibility of thinking, and 3) change from avoidance coping to approach coping; and recognising that a vehicle for this change is a helpful relationship to the health care provider. The perceived needs of specific treatment ingredients suggest that it is essential to differentiate between early-onset dysthymia and secondary depressions. The perceived access problems will be further investigated.


Related Articles

  • Seasonal Affective Disorder. KURLANSIK, STUART L.; IBAY, ANNAMARIE D. // American Family Physician;12/1/2012, Vol. 86 Issue 11, p1037 

    Seasonal affective disorder is a combination of biologic and mood disturbances with a seasonal pattern, typically occurring in the autumn and winter with remission in the spring or summer. In a given year, about 5 percent of the U.S. population experiences seasonal affective disorder, with...

  • The Galway Study of Panic Disorder. III. Outcome at 5 to 6 years. O'Rourke, D.; Fahy, T.J.; Brophy, J.; Prescott, P. // British Journal of Psychiatry;Apr96, Vol. 168, p462 

    Background: The aim was to evaluate long-term outcome of DSM-III-R panic disorder at a mean of 5.3 years following a controlled trial of treatment that included antidepressants and behavioural counselling.Method: Sixty-eight (86%) subjects were evaluated by lengthy...

  • Predictors and Moderators of Internet- and Group-Based Cognitive Behaviour Therapy for Panic Disorder. El Alaoui, Samir; Hedman, Erik; Ljótsson, Brjánn; Bergström, Jan; Andersson, Erik; Rück, Christian; Andersson, Gerhard; Lindefors, Nils // PLoS ONE;Nov2013, Vol. 8 Issue 11, p1 

    Internet-based cognitive behaviour therapy (ICBT) can be equally effective as traditional face-to-face cognitive behaviour therapy (CBT) for treating panic disorder (PD). However, little is known about the predictors and moderators of outcome of ICBT when delivered in psychiatric outpatient...

  • Clinical and Pathophysiological Relations Between Migraine and Mood Disorders. Fasmer, Ole Bernt; Akiskal, Hagop S.; Kelsoe, John R.; Oedegaard, Ketil J. // Current Psychiatry Reviews;2009, Vol. 5 Issue 2, p93 

    No abstract available.

  • Heterogeneity in Patient-Reported Outcomes following Low-Intensity Mental Health Interventions: A Multilevel Analysis. Ali, Shehzad; Littlewood, Elizabeth; McMillan, Dean; Delgadillo, Jaime; Miranda, Alfonso; Croudace, Tim; Gilbody, Simon // PLoS ONE;Sep2014, Vol. 9 Issue 9, p1 

    Background: Variability in patient-reported outcomes of psychological treatments has been partly attributed to therapists – a phenomenon commonly known as therapist effects. Meta-analytic reviews reveal wide variation in therapist-attributable variability in psychotherapy outcomes, with...

  • Benzodiazepine Anti-Anxiety Agents: Prevalence and Correlates of Use in a Southern Community. Swartz, Marvin; Landerman, Richard; George, Linda K.; Melville, Mary Lou; Blazer, Dan; Smith, Karen // American Journal of Public Health;May91, Vol. 81 Issue 5, p592 

    Background: Benzodiazepine anti-anxiety agents are the most widely prescribed psychotherapeutic drugs in the United States today. Recent evidence, however, suggests that their use may be decreasing. Methods: We examine the population prevalence and correlates of use of benzodiazepine anxiolytics...

  • Agomelatine: The evidence for its place in the treatment of depression. Eser, Daniela; Baghai, Thomas C.; Möller, Hans-Jürgen // Core Evidence;2009, Vol. 4 Issue 1, p171 

    Introduction: Depressive disorders are among the main causes of disability due to disease. In spite of recent progress in the pharmacotherapy of depression, there is still a high nonresponse rate of --30% to the first antidepressant treatment. Furthermore, the latency of several weeks until...

  • Better Than I Thought: Positive Evaluation Bias in Hypomania. Mason, Liam; O'Sullivan, Noreen; Bentall, Richard P.; El-Deredy, Wael // PLoS ONE;Oct2012, Vol. 7 Issue 10, Special section p1 

    Background: Mania is characterised by increased impulsivity and risk-taking, and psychological accounts argue that these features may be due to hypersensitivity to reward. The neurobiological mechanisms remain poorly understood. Here we examine reinforcement learning and sensitivity to both...

  • Trastornos del estado de �nimo. Baronet Jordana, Gemma // El Farmac�utico Hospitales;oct2011, Issue 195, p18 

    Mood disorders entail a wide variety of signs and symptoms that affect the individual's behaviour, leading to states of sadness or euphoria. Of all mood disorders, depression is the most common condition, and produces a functional disability that is as severe as the most chronic medical...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics