by DR. IBRAHIM KREPS

In the second part of a series on the psychology of anxiety, Dr. Ibrahim Kreps take a look at various psychoanalytic theories as well as the Cognitive Theory of anxiety

THE PSYCHOLOGICAL DIMENSION

Up until the latter part of the 20th century, most of the discussion about anxiety concerned psychological factors. In medical literature at least, the biological and social domains were largely ignored, let alone the spiritual ones. With the explosion of scientific technology and the promulgation of multi-dimensional models of disease, the panorama has changed and our horizons have expanded.

We will divide our discussion of the psychology of anxiety into two sections—one on Psychodynamics (the psycho-analytic view) and the other on the Cognitive Theory of anxiety (the source of cognitive-behavioral therapy).

THE PSYCHODYNAMICS OF ANXIETY

Although anxiety has existed since the beginning of time, serious reflection on this phenomenon began with the work of Sigmund Freud and the psychoanalytic movement. Freud worked with two basic models of the psyche:

1) The topographical model, which looks at the mind as having various levels—the unconscious, preconscious and conscious.

The unconscious uses primary process thinking in which there is an absence of the principle of contradiction and ordinary logic. Both affirmation/negation and time (before and after) are absent. Effect may precede cause and “short” may represent “tall.” In dream interpretation, one of the means to the unconscious, “condensation,” is an important principle. This refers to the idea that one dream symbol may contain several meanings. As well, “displacement,” is another important concept, in which one object may contain characteristics that belong to another object or we may see our own characteristics represented in another person. In contemporary parlance we may refer to this as holistic or right-brain thinking.

The preconscious contains retrievable memories that are derived from the unconscious and may be discovered through free association.

The conscious is what we are normally aware of.

2) The structural model consists of the id, e go and superego.

The id is the mental structure that contains the representations of the drives—similar to instincts in animals. The id operates according to primary process and acts in accordance with the pleasure principal.

The ego is the seat of conscious and unconscious defense mechanisms. It functions according to logic and reasonableness; it is based primarily on “secondary process” thinking and negotiates the relationship between internal and external reality.

The superego is the part of the mind identified with moral and ethical values.

Freud’s first theory of anxiety was known as the “toxic theory.” He proposed that anxiety was the result of repressed libidinal impulses (unconscious sexual drives). This repressed libido is converted into anxiety by reappearing either as free-floating anxiety or as an anxiety equivalent—for example a physical symptom such as a headache or chest pain. The underlying image here is one of elementary physics in which pressure is applied to a closed container incrementally. Something has to give, and the tension in this system is called anxiety.

Freud’s second theory of anxiety is the “signal theory,” which emerges from the structural model of the psyche. In this model, the ego perceives a danger signal (coming from the id) and produces anxiety to alert the organism to the threat. Repression then occurs to push the anxiety further from consciousness. Among the symptoms of signal anxiety may be apprehension about the loss of relationship, castration anxiety or superego anxiety with guilt. This theory focuses attention on the role of intra-psychic conflict among the entities of the id, ego and superego.

A 30-year-old patient of English-Canadian origin and mother of two young children comes to consult for problems related to her marriage. Although she believes her husband is kind and well intentioned, she feels more and more distant and estranged from him. As our sessions get underway, her anxiety increases until it reaches panic-like intensity. Then she starts having flashbacks and realizes that she was repeatedly sexually abused by her father at a young age. Her anxiety attacks were a signal of unconscious conflict. The abuse was buried deep in her unconscious and was now emerging into the preconscious and consciousness. By the time she realized what was happening, she began to feel more in control.

The American psychoanalyst Glen Gabbard hypothesized a hierarchy of anxiety, which begins with the most primitive level, disintegration anxiety (the anxiety of being annihilated or losing one’s sense of identity), and goes up to superego anxiety (being in conflict with one’s own set of values).