Introduction: It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. Objective: To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. Methods: In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. Results: At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, –0.64; 95% confidence interval, CI, –1.02 to –0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27–0.98). There was no allocation by treatment type interaction (SMD –0.57; 95% CI –1.31 to 0.17). Conclusions: Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.
Psychother Psychosom

中文翻译：

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患者选择认知行为或心理动力学疗法对惊恐障碍结果的影响：一项双重随机对照偏好试验

简介：目前尚不清楚为精神病患者提供首选治疗是否会影响症状水平的结果。目的：评估为伴有/不伴有广场恐怖症 (PD/A) 的恐慌症患者在 2 种心理疗法之间进行选择是否比随机分配产生更好的结果。方法：在一项双随机对照偏好试验 (DRCPT) 中，221 名患有 PD/A 的成年人被随机分配到：选择以恐慌为中心的心理动力学疗法 (PFP​​P) 或恐慌控制疗法 (PCT；一种认知行为疗法)；随机分配到 PFPP 或 PCT；或等候名单控制。主要结果是治疗后评估的 PD/A 严重程度、工作状态和缺勤。使用分段多级线性增长模型评估治疗后评估、6、12 和 24 个月随访的结果。结果：在治疗后评估中，选择和随机条件优于控制的恐慌严重程度，但不是工作状态/缺勤。在主要结局的治疗或随访期间，选择条件和随机条件没有差异。对于恐慌的严重程度，治疗期间 PCT 优于 PFPP（标准化平均差，SMD，–0.64；95% 置信区间，CI，–1.02 至 –0.25）；在随访期间，PFPP 优于 PCT（SMD 0.62；95% CI 0.27–0.98）。没有按治疗类型相互作用进行分配（SMD –0.57；95% CI –1.31 至 0.17）。结论：以前的研究发现，为患者提供他们喜欢的治疗会产生小到中等的效果，但没有采用可以严格测试偏好效果的设计。在 2 项循证心理治疗的首个 DRCPT 中，允许 PD/A 患者选择其首选治疗与改善结果无关。需要进一步的 DRCPT。
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