Source: Robin Carman 2022
Anxiety is one of the most common psychological complaints, and for good reason. Most psychodynamic theories view anxiety as a necessary feature of human nature that helps us avoid danger and seek safety, prepare for difficult situations and manage our lives with foresight. motivate us to Anxiety is associated with many symptoms and excesses that can interfere with our health and functioning, such as insomnia, upset stomach, elevated blood pressure, weakened immune function, anxious rumination, avoidance of necessary or desirable activities, and depression. It will be a problem if it leads to the vigilance of
Anxiety encompasses a number of conditions, including phobias and PTSD, each of which has its own meaning and may require different approaches, hence the diagnostic term here as Generalized Anxiety Disorder. Addresses the more common free-floating worry known to ( GAD.)
Choosing the Appropriate Treatment for Anxiety
With so many types of treatments that offer solutions for GAD, it can be difficult to know which one to choose. Consider that different treatments may have very different ideas about what causes anxiety and what treatments are best for managing, if not eradicating, anxiety disorders. Here are some of the most common approaches and their similarities and differences. Keep in mind that no two practitioners are the same, and many practitioners change and integrate approaches to suit their own style.
Psychoanalysis and psychodynamic therapy
Psychoanalysis is a less structured form of talking therapy than cognitive-behavioral therapy (CBT) that emphasizes the relationship with the therapist as a context in which change can occur.
There is a complex theoretical history underpinning psychodynamic research, beginning with Freud and including many others who have modified or replaced Freud’s concepts. Most psychotherapists today engage in open, reflective conversations with their patients, exploring the patterns of behavior, thoughts, and feelings that shape their lives, but are well beyond the realm of awareness and control. increase. Psychotherapists help their patients better understand the expectations, fantasies, and fears that drive them, and help them to have new and better experiences with caring, generous, and caring others. Creating space helps the patient let go of the standing aspect within themselves. how to implement them.
So what does psychodynamic theory have to say about anxiety?
Freud, the founder of talk therapy, describes anxiety as a space between the id and the ego, or between our impulses and our consciousness, shaped by practical or social forces that limit our freedom of expression. All that Freud and others said about anxiety could fill a book, but there are a few that shape modern psychodynamic thinking on the subject. It is possible to extract prominent ideas.
First, anxiety is a fundamental human experience, linked to our early feelings of helplessness and dependence, and the danger of losing or hurting our caregivers. It can occur for a number of reasons. It is either our unbearable urges or the fears generated by the environment. For other influential theorists such as Freud and Harry Stack Sullivan later, avoiding anxiety is what motivates our defenses (self-protective behaviors), To understand who we are and what we do.
Moreover, especially for modern psychotherapists, anxiety is seen in the context of relationships. As an adult, you are more likely to become anxious.
Given this framework for understanding anxiety, psychotherapists are likely to focus on exploring early relationship experiences alongside past traumas to make sense of current anxiety behavior. Yes. Like CBT, psychodynamic approaches look at the underlying thoughts and beliefs that cause anxiety, but where those thoughts and beliefs come from and how they survive in their original context. Unlike cognitive-behavioral therapists, psychoanalysts are unlikely to believe that we can change our thoughts and actions at will. Attempting to change behavior without adequate preparation can increase anxiety. Psychotherapists believe that only in the context of a therapeutic relationship that creates sufficient reassurance, insight, and new positive experiences can anxiety begin to diminish and the self-protective behaviors that sustain it can begin to be lost. believe.
cognitive behavioral therapy
Based on the work of Allen Beck and Albert Ellis, CBT combines cognitive and behavioral therapy into a structured, time-limited approach. Cognitive therapy focuses on the automatic thoughts that underlie our behavior, while more behavioral approaches focus on changing the behaviors that contribute to the disorder.
So what does CBT have to say about anxiety?
The basic idea behind the cognitive approach is that thoughts, beliefs, and attitudes directly influence our behavior, often automatically and unquestioningly. This is a belief that can also be found in psychodynamic approaches, but CBT focuses only on this fact and pays less attention to the causes of these thoughts or their relational context. CBT focuses on how to use practical tools and acquired skills to challenge and change the way we think today.
Anxiety is one of the conditions CBT is designed to treat, and its approach is to examine the underlying beliefs of our anxious feelings. Hands and feet are embarrassing. Such negative beliefs are said to be the result of cognitive distortions, and several common mechanisms of distortion are typical of anxious patients, such as emotional thinking. felt It must be true that they think I’m boring.
To help identify cognitive distortions and negative thoughts, CBT practitioners may suggest journaling or other exercises. Another commonly used method to manage anxiety isWorst case/best case/most likely case scenario methodology. Patients imagine situations that cause anxiety in order to get a more realistic picture of possible outcomes. Mindfulness and muscle relaxation exercises, as well as behavioral strategies, are also frequently used with anxious patients. CBT practitioners encourage patients to engage in previously avoided stressful activities and may use a method of systematic desensitization known as exposure therapy.With the aid of relaxation exercises, the patient gradually Being exposed to things or situations that arouse anxiety.
When deciding whether to engage in exposure therapy, it is important to consider that there are some ethical concerns about patients experiencing distress or even retraumatizing. From a dynamic point of view, this danger is largely due to the fact that exposure therapy treats symptoms alone, without considering what function the symptoms serve the individual. If the underlying cause is not addressed, symptoms may recur and other symptoms and psychiatric problems may develop. There is evidence that exposure therapy proves effective, especially in the more targeted treatment of anxiety.
Although the two treatments are different, a recent study found that both CBT and psychotherapy were equally and substantially effective in treating anxiety.
dialectical behavioral therapy
For those seeking a focused and immersive approach, dialectical behavioral therapy may be the right choice. Developed by Marsha Linehan, DBT is a type of CBT originally designed to treat borderline personality disorder. Today, this treatment is more widely applied, including by those who suffer from anxiety disorders.
Like CBT, DBT is skill-based and time-limited, but it incorporates mindfulness teachings drawn from Zen practices while balancing the desire for change and the need for acceptance. DBT has four main components: mindfulness, stress tolerance, emotional regulation, and interpersonal effects.
So what does DBT have to say about anxiety?
When dealing with anxious patients, DBT practitioners use mindfulness techniques to help them focus on the present rather than worrying about what’s to come. Distress tolerance helps an anxious person accept the desire to change a difficult situation rather than ruminating on it. Emotional regulation also helps us manage or tolerate the unpleasant emotions that arise. Interpersonal effectiveness skills are designed to help patients improve communication, create useful boundaries, assert needs, and build trust in relationships. People with anxiety often have emotionally unstable and avoidant relationships, so this is an important step to change the patterns that perpetuate the problem.
Whether DBT is right for you depends on whether you prefer treatment that provides longer, continuous support or treatment with a short but intense time commitment. includes Weekly individual therapy sessions, longer group skills training sessions, homework, and possibly additional coaching. Although there are few studies on DBT as a treatment for anxiety, DBT has proven effective in his PTSD, and some studies suggest it may also be effective in GAD.
To find a therapist, visit Psychology Today’s Therapy Directory.