Instinctual Refinement Therapy for Panic Disorder: A Single-Case Study of Childhood Relational Trauma and Dissociation

Background: This proof-of-concept single-case study (N=1) investigated the efficacy of Instinctual Refinement Therapy (IRT)—an integrative framework synthesizing drive theory with predictive processing—for treating panic disorder rooted in childhood relational trauma and dissociation. The participant, Mr. KA, was a 34-year-old married male who presented with recurrent panic attacks, hypervigilance toward cardiac sensations, avoidance of physical intimacy, sleep disturbances, and significant functional impairment. His panic symptoms began four years prior following the sudden death of his father from a heart attack, which activated unresolved childhood trauma involving emotional neglect and insecure attachment. Method: A comprehensive multi-method assessment battery was administered pre-treatment, post-treatment, and at 3- and 6-month follow-ups over 50 sessions. Measures included the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), Dissociative Experiences Scale (DES-II), SWAP-200, DMRS-Q, and standardized self-reports of anxiety, depression, and interpersonal functioning. Results: Results demonstrated significant structural reorganization across all domains. The participant achieved complete remission of panic attacks, marked reduction in pathological personality traits, and maturation of defensive operations (Overall Defensive Functioning improved from 3.4 to 5.7). Clinically significant improvements were also observed in dissociative symptoms, interpersonal functioning, and self-esteem, with gains maintained at 6-month follow-up. Conclusions: This case provides preliminary evidence that IRT can facilitate profound structural, symptomatic, and functional change for panic disorder with dissociative features rooted in childhood relational trauma. Findings extend the evidence base for IRT to trauma-related anxiety disorders and highlight its potential utility across diverse cultural contexts. Ethics & Data Sharing: All patient data have been rigorously de-identified. The participant provided informed consent for the publication of de-identified case material. The full de-identified dataset, assessment protocols, treatment manual, and supplementary materials are available within this OSF project. This project is intended for researchers, clinicians, and educators in clinical psychology and behavioral sciences.