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

Serena Z Chen; Nili Solomonov; Mary V Minges; Kevin S McCarthy; Fredrik Falkenström; Dianne L Chambless; Barbara Milrod; Jacques P Barber

doi:10.1002/cpp.70081

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

Clin Psychol Psychother. 2025 May-Jun;32(3):e70081. doi: 10.1002/cpp.70081.

Authors

Serena Z Chen¹, Nili Solomonov², Mary V Minges³, Kevin S McCarthy⁴, Fredrik Falkenström⁵, Dianne L Chambless⁶, Barbara Milrod³, Jacques P Barber⁷

Affiliations

¹ Department of Psychology, The Pennsylvania State University, State College, Pennsylvania, USA.
² Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA.
³ Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.
⁴ Department of Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA.
⁵ Department of Psychology, Linnaeus University, Växjö, Sweden.
⁶ Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁷ Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA.

PMID: 40488450
DOI: 10.1002/cpp.70081

Abstract

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.

Keywords: cognitive behavioral therapy; defense mechanisms; panic disorder; psychodynamic psychotherapy; therapeutic techniques.

MeSH terms

Adult
Cognitive Behavioral Therapy* / methods
Defense Mechanisms*
Female
Humans
Male
Middle Aged
Panic Disorder* / psychology
Panic Disorder* / therapy
Psychotherapy, Psychodynamic* / methods
Treatment Outcome

Grants and funding

MH/NIMH NIH HHS/United States