Have you ever wondered what treatments are available for anxiety disorders? One that isn’t medication? Psychodynamic therapy may be the answer. It is a form of talk therapy that focuses on your childhood experiences, and how this may affect your anxiety today. 

Understanding anxiety disorders

Everyone may experience anxiety from time to time for different reasons including money, health, work, etc. However, for people with anxiety disorders, there is a constant worry and they find that their anxiety may get worse over time. These symptoms of anxiety can interfere with their daily lives, affecting their performance in jobs or school, and even affecting their relationships. There are many types of anxiety disorders, with symptoms varying depending on the type. Listed below are the different types, with their corresponding symptoms.¹

Generalised anxiety disorder (GAD)

GAD involves feelings of anxiety or fear persistently, interfering with daily life. People with GAD live with this constant anxiety for long periods, sometimes even years. 

Symptoms include

• Feeling fatigued easily
• Difficulty concentrating
• Insomnia
• Restless and irritable
• Headaches/ muscle aches/ stomach aches

Panic disorder

This type of anxiety disorder can cause frequent and unexpected panic attacks, causing discomfort and intense fear even if there is no danger. This causes worry in people about when another panic attack could occur, making them avoid certain places and situations. These panic attacks can be very frequent, varying from person to person. 

Symptoms include

• Racing heart
• Trembling
• Chest pain 
• Sweating 
• Feelings of no control

Social anxiety disorder

This disorder is an extreme fear of being watched and judged by people. It may affect one’s ability to go out in public, for example, to work or school. 

Symptoms include

• Racing heart
• Stomach aches
• Sweating 
• Inability to make eye contact
• Feelings of self-consciousness

Phobia-related disorders

A phobia is an intense fear of a specific object or situation. The fear caused by these phobias may be irrational and out of proportion to the actual danger posed by said object/ situation. There are several types of phobia-related disorders including simple phobias towards heights, animals, or blood. 

People with phobias may

• Actively avoid the feared object/ situation
• Experience extreme anxiety when encountering the feared object/ situation
• Excessively worry about possibly encountering the feared object/ situation

What is psychodynamic therapy? 

Psychodynamic therapy is a form of talk therapy exploring the connection between a patient’s past experiences and their current mindset. Psychodynamics describes “the psychological and emotional forces that interact in a person’s mind”.²

This approach believes everyone’s unconscious thoughts and perceptions are developed during childhood. These unconscious thoughts are thought to affect a person’s current behaviours and thoughts. As this therapy helps you to recognise and understand your true, deep-rooted feelings, it allows you to resolve them and move on from these negative feelings.

One of the key aspects of psychodynamic therapy is the relationship between the therapist and the patient. For therapy to be effective, trust needs to be established and the patient should feel unconditional acceptance, further encouraging them to open up.³

The core principles of psychodynamic therapy are:

• Bring the unconscious to the conscious
• Explore the impact of early life/ childhood
• Uncover defence mechanisms used to avoid painful feelings/ experiences
• Explore feelings and patterns in relationships with others, including therapist

Techniques used in psychodynamic therapy

Psychodynamic therapy promotes self-expression and insight into your deep-rooted feelings through various techniques. It relies on personal interactions between the therapist and patient to reveal the unconscious, their deepest fears and thoughts, and defences. 

Therapeutic alliance refers to promoting trust between the patient and therapist, so the patient feels empowered to open up on more emotionally painful topics. This is key for psychodynamic therapy to work.

Free association is often involved in this therapy. The patient is encouraged to talk about whatever comes to mind, which may include events in their week, past conflicts, dreams, nightmares, or fears. They are supported by the therapist to talk about anything they want, about themselves or their experiences. 

Transference is when patients place their feelings, resentments, or fears they may have for real people in their lives onto the therapist. This is done unconsciously. The patient transfers their feelings for the original person onto their therapist as an object for those feelings. When transference occurs, the therapist can make the connection and help the patient understand where those emotions have come from. This often involves people representing unresolved conflicts, or misplaced guilt and shame. 

Clarification and interpretation are two ways the therapist can respond to the communication from the patient. The therapist can clarify through feedback for both parties to understand better what has been discussed at the conscious level. The therapist is then able to interpret things that have emerged from the unconscious, which reveals the patient’s repressed emotions and memories which are influencing them currently in life, with their anxiety. 

When the therapist correctly interprets these repressed emotions, the patient usually reacts with a noticeable change in their behaviour which often points to the release of said repressed emotion. This is known as catharsis. At this point, the patient may feel some relief from anxiety, anger, and also an increase in trust with their therapist.⁴ 

Depending on the severity of the condition, psychodynamic therapy can be short-term or long-term. It usually lasts around 10-20 sessions but can be spread out over 2 years.² 

Effectiveness and considerations

There is a lot of research to support the efficacy of psychodynamic therapy. One study shows psychodynamic therapy is efficacious in treating social anxiety disorder, however cognitive behavioural therapy (CBT) was significantly better. The response rate to psychodynamic therapy was found to be comparable to pharmacotherapy and cognitive behavioural group therapy.⁵

A meta-analysis was conducted to examine the controlled effects of psychodynamic therapy for anxiety disorders. The therapy was found to be significantly more effective than control conditions, and just as effective as other active treatments.⁶ 

Psychodynamic therapy is also viewed as cost-effective compared to CBT. Overall, there are many studies out there to show how well psychodynamic therapy works for the treatment of anxiety disorders. However, individual differences must also be accounted for. What works for someone may not work for someone else. 

FAQs 

How long does psychodynamic therapy take to work?

It depends on the patient. Some may see results in weeks, while others may take over a year to see results. 

Is CBT a psychodynamic therapy?

No, they are two different forms of therapy. CBT aims to manage the problems you are facing now by changing your thoughts and behaviours. However, psychodynamic therapy identifies and addresses underlying problems in the unconscious which are influencing your current behaviours. 

Summary

It is important to understand the differences between everyday anxiety a person may face, and a diagnosed anxiety disorder stopping a person from living their life. There are a few options out there for the treatment of this, but psychodynamic therapy is considered to be one of the best. While medication may treat the symptoms, it does not treat the cause. Psychodynamic therapy does, whilst also being cost-effective and helping a person understand their innermost feelings and thoughts.