Anxiety is a fascinating topic, one that I have learned is integral to the work of therapy. There are many different perspectives upon and ways of understanding anxiety, and I have found the framework provided by psychodynamic psychology in general and ISTDP therapy in particular to be paradigm shifting. What is most important to communicate, I think, at the beginning of therapy, is the difference between fear and anxiety. Fear is a response to an external, clear, and present danger, while anxiety is the activation of this same fear system in response to an internal stimuli. It’s the difference between a tiger jumping out at you and the idea of a tiger jumping out at you. One danger is happening, the other is imagined, predicted, or expected. But our internal reactions in the absence of an external stimuli can be just as powerful – more so, in fact, given that they can perpetuate and effect our bodies in the absence of any clear and present danger out in the world to provoke them. The internal stimuli that cause our individual experiences of anxiety depend very much on how our internal systems are constructed, and this depends upon the things we have experienced. The question is, are we aware of what gets us anxious, and if so, what do we do with that? Developing insight and experience of this is exactly where ISTDP therapy can come in.
Thoughts on Therapy and Mental Health