Therapy for anxiety Therapy for anxiety
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Theories of Anxiety
The origins and meaning of anxiety and fear have preoccupied many of the great experimental and clinical theorists of the 20th century. Freud was concerned with the problem of anxiety throughout his career and revised his theory at least four times.
Much of the history of learning theory has been devoted to understanding and treating simple fears and anxiety. Extensive work by neuroscientists has been devoted to characterizing the biological nature of
anxiety.
Interest in anxiety is keener today than ever before, and the resulting investigations have enhanced our efforts to treat most anxiety disorders. Yet, despite effective treatment, the nature of anxiety remains elusive. No one theory accounts for all the behavioral, biological, psychological, and physiological
aspects of anxiety.
Among the impediments to developing an integrated theory of anxiety is its multifaceted nature. Anxiety and fear can be observed and/or experienced in a number of dimensions—subjective, cognitive, behavioral, physiologic—and these dimensions largely determine how “the problem” is
defined. In addition, the field is in transition.
Five years ago we largely endorsed a leaming-theory view of anxiety; that is, we assumed that most anxiety disorders were learned. But recent biologic and pharmacologic studies provide a much richer and more complex view of the origins of anxiety.
There is evidence that genes, development, cognition, behavior, learning, physiology, and biochemistry interact to some extent in all patients with anxiety disorders. The patient’s family, culture, work, and social
environment are also important.
The septo-hippocampus, thalamus, locus coeruleus, and their afferents and efferents, and various neurotransmitters are clearly involved with anxiety. We believe the informed clinician needs to be
aware of recent findings in these areas.
We will discuss three major perspectives on anxiety: psychodynamic, learning, and biological. In doing so, we outline the major publications, events, or research efforts in each of these perspectives. Because of the influence of psychodynamic theory on developmental studies, we include these two in the same section.
The theories we discuss apply, for the most part, to all the anxiety disorders discussed in this book. In chapters on the different anxiety disorders we will discuss theories specific to them.
