1.Psychological causes of anxiety
Anxiety is the core concept of psychoanalytic theory, and psychoanalysis has the most systematic and in-depth research on anxiety. Yunyun Liu, Department of Neurology, The Sixth Hospital of Sun Yat-sen University
1.1 Freud’s theory of anxiety
Freud. Freud Sigmund (1856-1939) successively proposed two theories of anxiety. His early theory believed that anxiety was transformed by the repressed Libido and that the ego was the source of anxiety. Later, he proposed a later theory of anxiety based on the triadic theory of the personality of the ego, self, and superego. At this point he argued that the root of anxiety was not in the ego but in the self, and that anxiety was a danger signal and a function of the ego (ego). In contrast, Freud divided anxiety into three types: (1) realistic anxiety; (2) neurotic anxiety; and (3) moral anxiety.
The rational side of Freud’s anxiety theory is that, first, he recognized that internal and external stimuli threaten the ego as the root cause of anxiety. Secondly, he has recognized the involvement of cognition in the occurrence of anxiety.
The unreasonable side of Freud’s anxiety theory is that, first, he always believed that anxiety is determined by instinctive processes. Second, his view that anxiety arises due to threats to functional organization does not reveal the true nature of anxiety production.
1.2 Horney’s theory of anxiety
Karen Horney Karen Horney (1885-1952) criticized Freud’s instinctive determinism and believed that social contradictory tendencies were the cultural basis of individual internal conflicts and the social and cultural basis of individual anxiety.
Horney’s theory of anxiety breaks away from Freud’s instinctual determinism and explores the root causes of anxiety from the social culture. Of course, Horney’s anxiety theory also has shortcomings, mainly in: first, the understanding of the role of sociocultural factors on anxiety is incomplete. Second, Horney’s understanding of the psychological mechanisms of anxiety has a tendency to be simplistic.
1.3 Sullivan’s theory of anxiety
Harry. Stack. Haryy Stack Sullivan (1892-949) started from interpersonal relationships and elaborated on the socio-cultural roots of anxiety, overcoming both Freud’s instinctual determinism and Horney’s tendency to simplify socio-culture. Sullivan argues that the roots of anxiety lie in the threatening effects of social stimuli that affect a person’s self-esteem and self-confidence when anxiety arises.
Sullivan’s understanding of anxiety is indeed profound in that, first, he clearly states that the root cause of anxiety lies in the threatening effect of social stimuli. Second, it is clear that the factor of self-esteem plays a central role in the occurrence of anxiety. Third, it overcomes Horney’s tendency to dissipate the richness of interpersonal relationships and to weaken the role of social culture.
However, Sullivan’s understanding of the anxiogenesis process also has shortcomings, mainly in that he ignores the role of the factor of cognitive evaluation in anxiogenesis.
1.4 Jacobson’s Anxiety Theory
Roman Jakobson Roman Jakobson (1896-1982) critically inherited Freud’s theory of the personality structure of the ego, self and superego, and believed that the impairment of individual autonomy is the cause of anxiety, and that the external environment is also a factor that causes anxiety. The following insights can be drawn from her theory of anxiety: First, anxiety arises from the ego’s inability to adopt its favorite behavior. Second, the external environment is also a factor in the creation of anxiety. The shortcomings of Jacobson’s theory include: it still considers anxiety as an instinctive release, which is obviously influenced by Freud’s early anxiety theory; secondly, the understanding of the mechanism of anxiety still stays at the stage of Freud’s psychological metaphysics, and there is no new breakthrough.
1.5 Summary: Anxiety stems from the threat to self-esteem
In summary, if we were to summarize the psychoanalytic theory of anxiety, we could summarize it as follows: anxiety is an emotional experience that arises when an individual anticipates that internal and external stimuli threaten his or her self-esteem and feels that he or she is incapable of coping with them; and the judgment of whether internal and external stimuli threaten self-esteem and whether he or she is capable of coping with them is determined by cognitive evaluation.
2.Etiology of anxiety disorders (psychosocial factors)
It is now generally believed that anxiety disorders are the result of a combination of biological factors (genetic factors, biochemical factors) and psychosocial factors.
Behaviorist theory believes that anxiety is a conditioned reflex formed by the fear of certain environmental stimuli. Psychodynamic theory believes that anxiety originates from internal psychological conflicts, which are suppressed in the subconscious during childhood or adolescence and are activated in adulthood, thus forming anxiety.
3.Psychotherapy of anxiety disorders
After a long debate, it is now recognized that both psychosocial factors and biology play an important role in the development of anxiety disorders. This article focuses on the psychological treatment of anxiety disorders.
Since the 1980s, non-pharmacological treatment of anxiety disorders has made great progress, and many psychotherapies, such as supportive psychotherapy, cognitive therapy, and Morita therapy, can be used to treat anxiety disorders.
3.1 The therapeutic relationship
Rogers believed that the therapeutic relationship has a much greater impact on the change of the visitor’s personality than the role of therapeutic techniques, and that the subjective attitude of the therapist influences the quality of the therapeutic relationship. in 1957 Rogers proposed six conditions for constructive personality change. His students later further summarized them into 3 conditions, all of which are reflected in the therapist’s attitude toward the visitor.
3.1.1 Empathy (empathic understanding)
Empathy is the therapist’s attitude and ability to empathize with the visitor’s internal world. “Put yourself in the place of the visitor and empathize.” The therapist’s attitude and understanding of empathy for the visitor can be expressed in two ways: (1) nonverbal behavior (body posture, facial expressions, tone of voice, eye contact with the visitor); and (2) verbal communication.
3.1.2 Sincere congruence
Sincerity: The sincerity of the therapist. The therapist is required to be a consistent and sincere person within the context of the therapeutic relationship. According to Rogers, “sincerity leads to trust”. Sincerity, along with other therapeutic conditions, creates a safe, non-threatening atmosphere in which the client can explore himself or herself without fear.
3.1.3 Unconditional positive regard
Because the therapist adopts a completely accepting attitude toward the visitor, and because the therapist is able to reach a level of empathy and understanding for the visitor, the visitor sees the therapist as someone who listens to and accepts his thoughts and feelings, and he has a little bit of inner communication below himself, reorganizing experiences or experiences that were completely excluded from consciousness in the past. And no matter how incredible the content of what the visitor is expressing, the therapist always shows attention and understanding to it. The visitor will gradually treat himself or herself in the same way and will be able to express himself or herself more openly.
3.2 Supportive Psychotherapy
Supportive psychotherapy, also called health education, is the most widely used psychotherapy and the easiest to use, and is also widely used to treat various anxiety disorders. Listening carefully to the patient’s narrative can make the patient feel that the doctor cares about them and pays careful attention to their condition. Early in treatment, the doctor should explain to the patient what the anxiety disorder is all about and tell the patient what steps can be taken to manage the symptoms. This can improve the patient’s cooperation with the physician, help the patient adhere to the treatment plan, and make the patient realize that their symptoms fit a known pattern and that there are treatment techniques available that can lead to a directed recovery from the disorder.
3.3 Cognitive therapy
Patients with anxiety disorders have a number of distorted perceptions of things that contribute to the persistence of the illness. After a thorough assessment of the patient, the therapist has to help the patient to change the bad perceptions or perform cognitive reconstruction.
The cognitive therapy approach is highly stereotypical and specific in that it helps patients reshape their maladaptive views about the world so that they adopt a more positive attitude toward it. Conclusive research on the effectiveness of this approach for treating anxiety disorders is lacking, but there has been some evidence that it can be helpful for operational anxiety and social phobia.
3.4 Behavioral therapy
Behavior therapy is a type of psychotherapy that uses experimental psychological methods to change an individual’s symptoms and behavior; this approach is also known as behavior modification or behavior psychotherapy. Behavioral therapy usually uses the following training and therapies.
3.4.1 Breathing Training
Deep, slow breathing has a relaxing effect on the body and also exhales too much carbon dioxide, thus avoiding causing certain anxiety disorder symptoms. This is one of the simplest methods of relaxation, and the easiest to practice.
Controlled breathing, such as belly breathing and slow breathing, not only has a “first aid” effect, but can also reduce your overall anxiety level, but belly breathing and slow breathing require regular training.
3.4.2 Relaxation training
The simplest behavioral treatment for anxiety disorders is relaxation training. Relaxation training, also known as “relaxation therapy,” is a practical and effective method of basic and psychological training used in a variety of psychotherapies, and was founded by Jacobson in 1938.
The scope of application and role of relaxation therapy: ① prevention and treatment of neurosis; ② treatment of a variety of psychosomatic diseases; ③ correction and treatment of various psychosocial maladjustment syndrome, such as examination syndrome, school maladjustment syndrome and school phobia; ④ widely used in psychological training, correction and treatment of various psychological deficiencies, enhance the psychological defense function and mental potential; ⑤ cultivate psychological self-control; ⑥ treatment of insomnia and other sleep disorders.
Commonly used relaxation therapy: ① breathing relaxation training method; ② imagination relaxation training method; ③ self-referral relaxation training method. It is also called “self-command method”.
3.4.3 Exposure therapy
The so-called exposure therapy is to insist on direct or indirect exposure to objects, places or situations to be feared or avoided, so as to reduce or eliminate the fear of objects, places or situations and avoidance behavior. Exposure therapy is used primarily for the treatment of phobias, but also for the treatment of obsessive-compulsive disorders. Exposure therapy alone can be very effective in treating specific phobias; for social and situational phobias, the effect is checked alone and usually needs to be combined with cognitive therapy.
Exposure therapy can be carried out in different ways: in the clinic or treatment room by helping the patient to realistically imagine the feared object, place or situation so as to experience the kind of intense anxiety or fear that occurs in a real situation, which is called imaginal exposure therapy. Imaginal exposure therapy is a gradual process that begins with imagining scenarios that cause mild anxiety and progresses to imagining scenarios that cause more intense anxiety, also known as imaginal desensitization therapy. This is also called real-life exposure therapy. Sudden exposure to a scenario that triggers severe anxiety is called shock therapy, and step-by-step exposure therapy is called step-by-step exposure therapy.
3.5 Morita therapy
Morita therapy is a unique, self-contained theory and method of psychotherapy based on an Eastern cultural background, founded around the 1920s by Morita Shoma, PhD, a Japanese psychiatrist.
3.5.1 Characteristics of Morita Therapy
(1) Focus on the present without asking about the past. The treatment adopts the “reality principle”, which does not pursue past life experiences, but guides patients to focus on the present, encouraging them to start from the present and make real life vibrant.
(2) Do not ask about symptoms, but focus on action. Treatment focuses on guiding patients to take positive action, “action transforms character” and “act like a healthy person, and you can become a healthy person.
(3) Guidance in life, change in life. Morita therapy does not use any apparatus or special facilities, and advocates living like a normal person in actual life, while changing the patient’s bad behavior patterns and cognition.
(4) Cultivate character and build on strengths and avoid weaknesses. Morita therapy believes that character is not fixed, and any character has both positive and negative sides. It should be honed through positive social life to bring out the strengths and suppress the weaknesses in character.
3.5.2 Principles of Morita Therapy
The use of Morita therapy in the treatment process generally follows the following basic principles.
(l) Let nature take its course. Morita believes that when symptoms appear, one should take a carefree attitude toward them, let nature take its course, accept them as a special problem, and treat them with a normal mind.
(2) Endure the pain and do what is necessary. Patients must do no matter how painful it is, they should do what they should do to put up with the pain and do what they should do, so that they can get better without realizing it.
(3) Purpose-oriented, action-oriented. Morita therapy advocates that the patient should abandon the attitude of living by emotion as the guideline, and should instead take behavior as the guideline.
(4) Overcome low self-esteem and maintain self-confidence. When hovering between doing and not doing, one should be bold enough to act, even if one is not confident or may fail. Success is possible with effort.
3.6 Psychoanalytic therapy
Just like other forms of psychotherapy, the theory and techniques of psychoanalytic therapy require systematic learning and training. Learning and training include three aspects: theoretical learning, case practice, and the experience of the self being analyzed. For example, a traumatized neurotic patient can easily elicit deep sympathy from the analyst with his or her difficult experiences, and the ensuing understanding and concern shown back to the patient will inspire gratitude, trust and dependence on the analyst. In this process, the patient’s emotional response to the analyst is called empathy, and the analyst’s emotional response to the patient is called counter-empathy.
In addition to the use of empathy and counter-empathy as analytical tools, psychoanalysis has more techniques and contents, such as the analysis of dreams, the processing of impedance, etc., but all these techniques are linked to empathy and counter-empathy in the therapeutic relationship.
4. Pharmacotherapy versus psychotherapy
We emphasize that the treatment of anxiety disorders begins with proper psychological analysis, and on the basis of psychological analysis and psychotherapy, anti-anxiety and depression drugs with few side effects are given, and patients with extreme neurological weakness are given treatment to nourish brain nerves and improve microcirculation. During the treatment process, we should first correctly analyze the psychological and somatic symptoms that exist in patients, give them proper explanations and analysis, help them identify the psychological triggers and family and social triggers that trigger the disease on this basis, and help solve the psychological confusion that exists in patients from the perspective of psychology. Cognitive and behavioral therapies, including exposure therapy, cognitive reconstruction, and social skills training, are the main methods used.