Monthly files: April 2014
Anxiety is one of the most common symptoms seen by psychologists in Madrid, and everywhere in the world for that matter, along with depression. It has the fundamental function of alerting the person to an emotional danger and can appear in a vast array of different circumstances. It is often accompanied by physiological symptoms such as rapid heartbeat, sweating, muscle tension and insomnia.
It is important not to confuse anxiety with a diagnosis in itself since anxiety is just one manifestation of something much more complex. Anxiety is the emotional equivalent to having a bodily fever: having a fever can be a symptom of a common cold, of an infection or of cancer –– or of everything in between. In much the same way, having anxiety can be a due to a relatively benign examination situation, but it can be also be a result of obsessive doubt or it can be a symptom of schizophrenia, or any number of other things. Thus, when a patient presents with anxiety, it is vital to see what the entire situation is and to create a hypothesis of what may be causing the anxiety before coming to a diagnosis.
One or two anxieties?
It is interesting to note that at the beginning of the 20th century the creator of psychoanalysis and one of its pioneers ––Freud, then Klein–– postulated, in different ways, the existence of two different kinds of anxiety. Freud’s initial idea of anxiety was that it expressed an excess of unreleased libidinal tension; then he came to think of it as a signal of unconscious emotional danger. As for Klein, she started to think of anxiety as related to the fear of annihilation, of being harmed in some way; she then later conceived of another kind of anxiety that is related to the fear of losing someone/something important.
Roughly 100 years later, neuroscientists such as Panksepp and Yovell have discovered that there are, indeed, two distinct anxiety systems in the brain that have separate neuro-anatomies, are regulated by different neurotransmitters and respond to different psychotropic drugs. They function as warning systems of dissimilar dangers and it is interesting to observe that the fear of being harmed system is older on an evolutionary scale than the fear of losing someone/something system.
There are numerous general therapeutic factors, common to all schools of psychotherapy, that are well known: the psychotherapist’s empathy, his/her authentic wish to help the patient, the patient feeling that he/she is accepted the way he/she is, to be listened to carefully, the regularity in contact with another person, etc.
There are many other therapeutic factors, specific to psychoanalysis; some have been well known for a long time, other are still insufficiently clear and need to be studied further in order to understand them. Recently we have acquired greater knowledge of one of these therapeutic factors.
Sometimes the input of another discipline, such as the neurosciences, for instance, allows us to find a parallel between brain functioning and a psychoanalytic theory of therapeutic action that had been observed many times, had been abundantly theorized but whose brain mechanisms had remained mysterious. Such is the case of what happens during what neuroscientists call memory reconsolidation, which is particularly relevant for psychoanalysis in the case of traumatic memories. The first intuition of memory reconsolidation was Freud's in 1896 in a letter to Fleiss. Neuroscientific research began in the 1960s and was developped by Nader et al in 2000. Recently, Alberini (2013) has published a book on the subject.
Let us begin, then, with the psychoanalytic thesis on this. We know that we all have the tendency to repeat, in the present, behavioral patterns and experiences that we learned unconsciously within the context of important relationships during childhood and that left traces in our implicit memory. This manifests itself clearly throughout our lives in the way that we establish relationships with others, both positive and negative. Now, there is an essential difference to the way positive and negative unconscious behavioral patterns are repeated.