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Understanding and Treating Anxiety Disorders: A Psychodynamic Approach

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Clinical Handbook of Anxiety Disorders

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

This chapter seeks to offer an overview of the psychodynamic theory and treatment of anxiety disorders. We begin by tracing psychodynamic conceptualizations of anxiety from Freud to the present day. Next, we describe contemporary psychodynamic models of anxiety disorders. We then review the current research on psychodynamic treatments, which provides empirical support for psychodynamic psychotherapy for anxiety disorders. Finally, we offer recommendations for empirical and theoretical future directions, emphasizing the value of rigorous research methods and the potential benefits of integrating psychodynamic thought and technique with other therapeutic orientations.

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Notes

  1. 1.

    Given the brevity of this chapter, we will necessarily omit substantial theory and theorists that should otherwise be discussed.

References

  1. Freud S. On the grounds for detaching a particular syndrome from neurasthenia under the description ‘anxiety neurosis’. In: Strachey J, et al., editors. The standard edition of the complete psychological works of Sigmund Freud, vol. 3. London: Hogarth Press; 1894. p. 85–115.

    Google Scholar 

  2. Freud S. Interpretation of dreams. In: Strachey J, et al., editors. The standard edition of the complete psychological works of Sigmund Freud, vol. 4. London: Hogarth Press; 1900. p. ix–627.

    Google Scholar 

  3. Freud S. The unconscious. In: Strachey J, et al., editors. The standard edition of the complete psychological works of Sigmund Freud, vol. 8. London: Hogarth Press; 1915. p. 159–215.

    Google Scholar 

  4. Freud S. The Ego and the Id. In: Strachey J, et al., editors. The standard edition of the complete psychological works of Sigmund Freud, vol. 19. London: Hogarth Press; 1923. p. 1–66.

    Google Scholar 

  5. Freud S. Inhibitions, symptoms and anxiety. In: Strachey J, et al., editors. The standard edition of the complete psychological works of Sigmund Freud, vol. 20. London: Hogarth Press; 1926. p. 75–176.

    Google Scholar 

  6. Klein M. Notes on some schizoid mechanisms. Int J Psychoanal. 1946;27:99.

    CAS  PubMed  Google Scholar 

  7. Klein M. A contribution to the theory of anxiety and guilt. Int J Psychoanal. 1948;29:114–23.

    Google Scholar 

  8. Klein M. Some theoretical conclusions regarding the emotional life of the infant. In: The writings of Melanie Klein volume 8: envy and gratitude and other works. London: Hogarth Press; 1952. p. 61–94.

    Google Scholar 

  9. Winnicott DW. The maturational processes and the facilitating environment: studies in the theory of emotional development. New York: International Universities Press; 1965.

    Google Scholar 

  10. Kohut H. The analysis of the self. Chicago: The University of Chicago Press; 1971.

    Google Scholar 

  11. Kohut H. The restoration of the self. New York: International University Press; 1977.

    Google Scholar 

  12. Greenberg JR, Mitchell SA. Object relations in psychoanalytic theory. Cambridge, MA: Harvard University Press; 1983.

    Book  Google Scholar 

  13. Leichsenring F, Klein S, Salzer S. Psychodynamic therapy of anxiety disorders. The Wiley handbook of anxiety disorders: Wiley; 2014. p. 852–64. https://doi.org/10.1002/9781118775349.ch42.

    Chapter  Google Scholar 

  14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  15. Shear MK, Cooper AM, Klerman GL, Busch FN, Shapiro T. A psychodynamic model of panic disorder. Am J Psychiatry. 1993;150:859–86.

    Article  CAS  Google Scholar 

  16. Busch FN, Milrod BL, Singer MB. Theory and technique in psychodynamic treatment of panic disorder. Am J Psychother. 1999;8:234–42.

    CAS  Google Scholar 

  17. Leichsenring F, Beutel M, Leibing E. Psychodynamic psychotherapy for social phobia: a treatment manual based on supportive–expressive therapy. Bull Menninger Clin. Guilford Publications. 2007;71(1):56–84. https://doi.org/10.1521/bumc.2007.71.1.56.

    Article  Google Scholar 

  18. Luborsky L. Principles of psychoanalytic psychotherapy: manual for supportive-expressive treatment. New York: Basic Books; 1984.

    Google Scholar 

  19. Crits-Christoph P, Crits-Christoph K, Wolf-Palacio D, Fichter M, Rudick D. Brief supportive-expressive psychodynamic therapy for generalized anxiety disorder. In: Barber JP, Crits-Christoph P, editors. Dynamic therapies for psychiatric disorders (Axis I). New York: Basic Books; 1995. p. 43–83.

    Google Scholar 

  20. Cassidy J, Lichtenstein-Phelps J, Sibrava NJ, Thomas CL, Borkovec TD. Generalized anxiety disorder: connections with self-reported attachment. Behav Ther. Elsevier BV. 2009;40(1):23–38. https://doi.org/10.1016/j.beth.2007.12.004.

    Article  Google Scholar 

  21. Busch FN, Milrod BL. Generalized anxiety disorder and other anxiety disorders. In: Luyten P, Mayes LC, Fonagy P, Target M, Blatt SJ, editors. Handbook of psychodynamic approaches to psychopathology. New York: Guilford Press; 2015. p. 152–64.

    Google Scholar 

  22. Crits-Christoph P. Psychodynamic-interpersonal treatment of generalized anxiety disorder. Clinical psychology. Sci Pract [Internet]. Wiley. 2002;9(1):81–4. https://doi.org/10.1093/clipsy/9.1.81.

    Article  Google Scholar 

  23. Busch FN, Milrod BL, Singer MB, Aronson AC. Psychoanalytic inquiry book series. Manual of panic focused psychodynamic psychotherapy—eXtended range. New York: Routledge/Taylor & Francis Group; 2012.

    Google Scholar 

  24. Milrod B. Emptiness in agoraphobia patients. J Am Psychoanal Assoc. 2007;55:1007–26.

    Article  Google Scholar 

  25. Barber JP, Luborsky L. A psychodynamic view of simple phobias and prescriptive matching: a commentary. Psychotherapy (Chic). 1991;28:469–72.

    Article  Google Scholar 

  26. Leichsenring F, Steinert C. Towards an evidence-based unified psychodynamic protocol for emotional disorders. J Affect Disord. 2018;232:400–16.

    Article  Google Scholar 

  27. Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol. 2010;65(2):98–109.

    Article  Google Scholar 

  28. Bandelow B, Reitt M, Röver C, Michaelis S, Görlich Y, Wedekind D. Efficacy of treatments for anxiety disorders. Int Clin Psychopharmacol. Ovid Technologies (Wolters Kluwer Health). 2015;30(4):183–92. https://doi.org/10.1097/yic.0000000000000078.

    Article  Google Scholar 

  29. Keefe JR, McCarthy KS, Dinger U, Zilcha-Mano S, Barber JP. A meta-analytic review of psychodynamic therapies for anxiety disorders. Clin Psychol Rev. Elsevier BV. 2014;34(4):309–23. https://doi.org/10.1016/j.cpr.2014.03.004.

    Article  Google Scholar 

  30. Milrod B, Busch F, Leon AC, Aronson A, Roiphe J, Rudden M, et al. A pilot open trial of brief psychodynamic psychotherapy for panic disorder. J Psychother Pract Res. 2001;10:239–45.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Milrod B, Busch F, Cooper A, Shapiro T. Manual of panic-focused psychodynamic psychotherapy. Washington, DC: American Psychiatric Press; 1997.

    Google Scholar 

  32. Milrod B, Leon AC, Busch F, Rudden M, Schwalberg M, Clarkin J, Aronson A, Singer M, Turchin W, Klass ET, Graf E. A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. Am J Psychiatry. American Psychiatric Association Publishing. 2007;164(2):265. https://doi.org/10.1176/appi.ajp.164.2.265.

    Article  Google Scholar 

  33. Milrod B, Chambless DL, Gallop R, Busch FN, Schwalberg M, McCarthy KS, et al. Psychotherapies for panic disorder: a tale of two sites. J Clin Psychiatry. 2016;77:927–35. https://doi.org/10.4088/JCP.14m09507.

    Article  PubMed  Google Scholar 

  34. Leichsenring F, Salzer S, Beutel ME, Herpertz S, Hiller W, Hoyer J, Huesing J, Joraschky P, Nolting B, Poehlmann K, Ritter V, Stangier U, Strauss B, Stuhldreher N, Tefikow S, Teismann T, Willutzki U, Wiltink J, Leibing E. Psychodynamic therapy and cognitive behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. Am J Psychiatry. 2013;170:759–67.

    Article  Google Scholar 

  35. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  36. Clark DM, Wells A. A cognitive model of social phobia. In: Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, editors. Social phobia: diagnosis, assessment, and treatment. New York: Guilford Press; 1995. p. 69–93.

    Google Scholar 

  37. Leichsenring F, Salzer S, Beutel ME, Herpertz S, Hiller W, Hoyer J, et al. Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder. Am J Psychiatry. American Psychiatric Publishing. 2014;171(10):1074–82. https://doi.org/10.1176/appi.ajp.2014.13111514.

    Article  Google Scholar 

  38. Bögels SM, Wijts P, Oort FJ, Sallaerts SJM. Psychodynamic psychotherapy versus cognitive behavior therapy for social anxiety disorder: An efficacy and partial effectiveness trial. Depress Anxiety. [Internet]. Wiley. 2014;31(5):363–73. https://doi.org/10.1002/da.22246.

    Article  Google Scholar 

  39. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. American Psychological Association (APA). 1991;59(1):12–9. https://doi.org/10.1037/0022-006x.59.1.12.

    Article  CAS  Google Scholar 

  40. Johansson R, Hesslow T, Ljótsson B, Jansson A, Jonsson L, Färdig S, et al. Internet-based affect-focused psychodynamic therapy for social anxiety disorder: a randomized controlled trial with 2-year follow-up. Psychotherapy. American Psychological Association (APA). 2017;54(4):351–60. https://doi.org/10.1037/pst0000147.

    Article  Google Scholar 

  41. Crits-Christoph P, Connolly MB, Azarian K, Crits-Christoph K, Shappell S. An open trial of brief supportive-expressive psychotherapy in the treatment of generalized anxiety disorder. Psychotherapy (Chic). American Psychological Association (APA). 1996;33(3):418–30. https://doi.org/10.1037/0033-3204.33.3.418.

    Article  Google Scholar 

  42. Crits-Christoph P, Gibbons MBC, Narducci J, Schamberger M, Gallop R. Interpersonal problems and the outcome of interpersonally oriented psychodynamic treatment of GAD. Psychotherapy (Chic) American Psychological Association (APA). 2005;42(2):211–24. https://doi.org/10.1037/0033-3204.42.2.211.

    Article  Google Scholar 

  43. Leichsenring F, Salzer S, Jaeger U, Kachele H, Kreische R, Leweke F, et al. Short-term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: a randomized, controlled trial. Am J Psychiatry. American Psychiatric Publishing. 2009;166(8):875–81. https://doi.org/10.1176/appi.ajp.2009.09030441.

    Article  Google Scholar 

  44. Salzer S, Winkelbach C, Leweke F, Leibing E, Leichsenring F. Long-term effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalized anxiety disorder: 12-month follow-up. Can J Psychiatry. SAGE Publications. 2011;56(8):503–8. https://doi.org/10.1177/070674371105600809.

    Article  Google Scholar 

  45. Andersson G, Paxling B, Roch-Norlund P, Östman G, Norgren A, Almlöv J, et al. Internet-based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: a randomized controlled trial. Psychother Psychosom. S. Karger AG. 2012;81(6):344–55. https://doi.org/10.1159/000339371.

    Article  Google Scholar 

  46. Hoffart A, Matinsen EW. Exposure-based integrated vs. pure psychodynamic treatment of agoraphobic inpatients. Psychotherapy (Chic). American Psychological Association (APA). 1990;27(2):210–8. https://doi.org/10.1037/0033-3204.27.2.210.

    Article  Google Scholar 

  47. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Rev 3rd ed. Washington, DC: American Psychiatric Association; 1987.

    Google Scholar 

  48. Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol. American Psychological Association (APA). 1998;66(1):7–18. https://doi.org/10.1037/0022-006x.66.1.7.

    Article  CAS  Google Scholar 

  49. Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G. Psychological treatment of generalized anxiety disorder: a meta-analysis. Clin Psychol Rev. Elsevier BV. 2014;34(2):130–40. https://doi.org/10.1016/j.cpr.2014.01.002.

    Article  Google Scholar 

  50. Leichsenring F, Leweke F, Kleine S, Steinert C. The empirical status of psychodynamic psychotherapy–an update: Bambi’s alive and kicking. Psychother Psychosom. 2015;84(3):129–48.

    Article  Google Scholar 

  51. Gerber AJ, Kocsis JH, Milrod BL, Roose SP, Barber JP, Thase ME, et al. A quality-based review of randomized controlled trials of psychodynamic psychotherapy. Am J Psychiatry. American Psychiatric Publishing. 2011;168(1):19–28. https://doi.org/10.1176/appi.ajp.2010.08060843.

    Article  Google Scholar 

  52. Luborsky L, Diguer L, Seligman DA, Rosenthal R, Krause ED, Johnson S, et al. The researcher’s own therapy allegiances: a “wild card” in comparisons of treatment efficacy. Clin Psychol (New York). 1999;6:95–106. https://doi.org/10.1093/clipsy.6.1.95.

    Article  Google Scholar 

  53. de Jong PJ. Implicit self-esteem and social anxiety: differential self-favouring effects in high and low anxious individuals. Behav Res Ther. 2002;40:501–8. https://doi.org/10.1016/S0005-7967(01)00022-5.

    Article  PubMed  Google Scholar 

  54. Jiang J, Bailey K, Xiang L, Zhang L, Zhang Q. Comparing the neural correlates of conscious and unconscious conflict control in a masked Stroop priming task. Front Hum Neurosci. 2016;10:297. https://doi.org/10.3389/fnhum.2016.00297.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Clark LA, Cuthbert B, Lewis-Fernández R, Narrow WE, Reed GM. Three approaches to understanding and classifying mental disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s research domain criteria (RDoC). Psychol Sci Public Interest. 2017;18:72–145.

    Article  Google Scholar 

  56. Leichsenring F, Salzer S. A unified protocol for the transdiagnostic psychodynamic treatment of anxiety disorders: an evidence-based approach. Psychotherapy. American Psychological Association (APA). 2014;51(2):224–45. https://doi.org/10.1037/a0033815.

    Article  Google Scholar 

  57. Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, et al. Unified protocol for transdiagnostic treatment of emotional disorders: Oxford University Press; 2010. https://doi.org/10.1093/med:psych/9780199772667.001.0001.

  58. Cohen JN, McElhaney R, Jensen D. The empirical examinability of psychodynamic psychotherapy: a reply to Hoffart and Johnson. Clin Psychol Sci. 2018;6:458–63. https://doi.org/10.1177/2167702617751887.

    Article  Google Scholar 

  59. Hope DA, Heimberg RG, Turk CL. Managing social anxiety: a cognitive-behavioral therapy approach. New York: Oxford University Press; 2010.

    Google Scholar 

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We would like to thank Matt Gitlin for his editorial assistance.

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Cohen, J.N., Kaplan, S.C. (2020). Understanding and Treating Anxiety Disorders: A Psychodynamic Approach. In: Bui, E., Charney, M., Baker, A. (eds) Clinical Handbook of Anxiety Disorders. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-30687-8_17

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