Therapy for anxiety Therapy for anxiety
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Implications for Treatment, psychological treatment of anxiety.
Psychodynamic theory continues to influence the psychological treatment of anxiety. In particular, psychodynamic theory has revealed the intricate elationship among thoughts, feelings, images, and behavior.
Among the important observations derived from psychodynamic theory are the following:
(1) anxiety is a universal emotion;
(2) people can appear anxious and be unaware of it;
(3) people can feel anxious and not understand what causes it;
(4) emotions besides anxiety, urges, thoughts, feelings, images, and fantasies can all generate anxiety;
(5) the occurrence of anxiety during therapy often signals important information about the patient.
Many assumptions derived from psychoanalytic theory remain unproven, however, and may even be therapeutically counterproductive.
The psychoanalytic theory of anxiety prescribes a treatment designed to produce insight into those unconscious processes that are believed to generate the symptoms, on the assumption that such insight can bring about improvement in the patient’s condition.
To quote Michels, Frances, and Shear (1985), “The psychoanalytic exploration of symptomatic anxiety . . . involves identifying the danger, the wish, the pattern of defense used in constructing the symptom, and
the developmental history of each of these” (p. 608). Yet such insight may be of little benefit to the patient who is not helped in other ways to overcome symptoms of anxiety.
This is illustrated in a case presented recently by Wallerstein (1986) of a “phobic woman.” Wallerstein cites it as one of eight cases with a “clear-cut very good treatment outcome” from a study of 42 patients in psychoanalysis.
In the beginning of treatment the patient was unable to go to the movies or to a restaurant, to ride elevators, or visit friends. In other words, she was severely agoraphobic.
The patient was in analysis for four years and nine months (1,012 hours). The analyst’s goals were to “conduct a thorough analysis.” By the end of treatment, the patient came to believe that the cause of her symptoms related to sexual feelings toward her father and aggressive strivings in general.
She apparently felt that she both understood such feelings and could control them. Wallerstein reports, “By the end of analysis, the patient had made substantial major changes in remission of symptoms and in enhanced scope and style of life”.
Yet, at termination the patient was still unable to ride in automatic elevators or to drive alone on the freeway. She felt least constrained in Topeka where the analysis occurred, but a good deal more constrained elsewhere.
She also said, “The minute the sun goes down there’s more anxiety; all the awful
sexual things that I was always taught can happen to you when you walk around the streets in the dark” .
She was still apprehensive when alone and required the presence of others to accomplish many tasks outside of her home.
One concept of psychoanalysis that has impeded the development of more effective treatments is that of symptom substitution.
Symptom substitution posits that the elimination of one symptom will usually result in another, unless
the underlying conflicts are resolved. Extensive empirical studies of symptomfocused treatments have proven that this is not the case.
