“Even when there is no particular provocation, I always have an anxious concern that causes me to see and look for dangers where none exist; for me it magnifies to infinity the tiniest vexation and makes association with people most difficult.”
– Irving Yalom, The Schopenhauer Cure

  • Generalized Anxiety Disorder
  • Post Traumatic Stress Disorder
  • Panic attacks and agoraphobia
  • Phobias, including phobias of childhood and adolescence
  • Obsessive-Compulsive Disorder
  • Separation Anxiety Disorder

PictureThis article originally appeared in Practical Psychoanalysis Blog at PsychCentral

Anxiety is one of the most common mental health issues encountered in clinical practice today and probably one of the most misunderstood, often neglected and minimized mental health issue. Just browse any psychotherapy website, and I bet you’ll find anxiety mentioned in every single one of them. But what is anxiety to psychoanalysis? How do we understand it from a psychoanalytic point of view and what can we do to overcome it?

Anxiety defined…

Everyone experiences anxiety to a certain degree. In fact, it is well proven in the field of psychology that moderate levels of anxiety are actually beneficial and foster learning, problem-solving and productivity. However, when the anxiety becomes too high, relative to our resources and abilities to cope with stressors and changes in the environment, it becomes overwhelming and can cause one of three responses – fight, flight or freeze.

Manifestations of anxiety

Anxiety manifests in various forms, some of which are classified in the Diagnostic and Statistically Manual of Mental Disorders (DSM) and some aren’t. Think about what you do when you are “nervous” or “worried,” which is really another way to say that you are anxious. Some people play with their fingers, bite their nails or crack their knuckles, others clean or keep themselves busy; some drink or use substances, while others try to meditate or journal.

We all have established methods to defend against or cope with feeling anxious but sometimes, they are not enough and when that happens, the anxiety manifests itself in what in psychoanalysis we call symptoms. Here are several examples:

  • Panic attacks

Probably the most noticeable and forthright manifestation of anxiety is when you have a panic attack – your heart starts pounding, you cannot breathe, your body starts sweating, your hands are shaking, thoughts start running through your head, you feel like you are having a heart attack or you are about to die and you are absolutely terrified.

  • Inattention and difficulty focusing

Another manifestation of anxiety is difficulty focusing and staying on task at work, school or home. You may find yourself having a hard time starting a project, finishing a project or being easily distracted, unmotivated and unable to get yourself organized.

  • Difficulties with sleep

Struggling with falling asleep and staying asleep is another common manifestation of anxiety. You may find yourself lying in bed, thinking and worrying about various aspects of your life, responsibilities you have, deadlines, money issues, romantic issues, family issues, anything that may be a cause for concern at the moment.

  • Somatic symptoms and complaints

Sometimes, anxiety manifests in the body in the form of stomach troubles, uneasiness, gastrointestinal complaints, headaches, fatigue, etc. In children and adolescents, in addition to somatic and physical complaints, the anxiety may manifests itself in behavioral acting out at home, difficulties at school or problems with social interactions, to name a few.

  • Other diagnosable anxiety disorders

For some people, the anxiety can become as severe as trichotillomania (a compulsive urge to pull out your hair, eyelashes or eyebrows), panic disorder, phobia (fear of certain objects, animals, people or situations, usually very common and normal with young children) or obsessive-compulsive disorder, all of which are your psyche and body’s attempt to cope, unfortunately, unsuccessfully.

Psychoanalytic understanding of anxiety

The question of anxiety is central in psychoanalysis. In his Introductory Lectures on Psychoanalysis, Freud distinguished between two kinds of anxiety: “realistic anxiety“, i.e. fear of actual danger, and what he called “neurotic anxiety,” which stems from internal psychic conflicts. He also said that anxiety can be a stand-in for almost any feeling that transforms itself or discharges into the form of anxiety.

Depending on which school of psychoanalytic thought you ask, you will get different points of view on the matter. However, one thing in common is that as with any other symptom in psychoanalysis, the symptom of anxiety is understood as having an unconscious meaning, specific and unique to the individual, who presents with it.

In psychoanalytic psychotherapy, you can speak about your anxiety and how it manifests itself. From a psychoanalytic point of view, it is only in the context of who you are in relation to your analyst/therapist and where you come from, that you can begin to understand its meaning and overcome your anxiety.

For more articles on common mental health issues, affecting you and your family, subscribe to Mental Health Digest and get the latest issue emailed to you today by leaving your name and email address in the contact form here.

Do you have questions? Found this article helpful? I would love to hear from you.

The #1 Problem that Causes Severe Anxiety


One of the most common reasons why people seek out psychotherapy is because they struggle with anxiety. However, saying that someone has a problem with severe anxiety doesn’t really say much about what is it that the person is really struggling with. In my practice, I work with children, adolescents and adults, who experience anxiety to one degree or another, but the anxiety itself is rarely the main problem. Please, let me explain.

The presenting complaint

Often times in psychoanalysis and psychoanalytic psychotherapy, what we call the “presenting complaint” isn’t always the issue at stake in the treatment. For this reason, when I hear that a new client needs help for anxiety, I am often cautious not to take that statement at face value. As I reviewed in a previous post, from a psychoanalytic point of view “anxiety is the universal currency of affect, in a sense that every emotion can be converted into it” (Bruce Fink). So when I hear anxiety, I pretty much know that we’ll have some digging to do.

Anxiety is a symptom

People come for help because of a certain “symptom” that has been bothering them for awhile, and they’ve come to the point that they cannot deal with it on their own anymore. That symptom can be anything from anxiety and depression, to self-injurious or oppositional and defiant behaviors in kids and adolescents, to substance abuse, hypochondria, promiscuity or difficulty with relationships.

Notice how I frame all of these mental health issues as symptoms. That’s right, from a psychoanalytic point of view, anxiety, which is what we are talking about today, is a symptom, a symptom of something else. What this means is that the anxiety is NOT the problem itself, but rather, it’s a manifestation or a SYMPTOM of the problem.

The real problem

Okay, so what’s the real problem then? I am glad you asked. The real problem is usually something very specific to the individual’s psyche and personal history that is rarely easy to identify. I am saying this because I want to emphasize that it is not as simple as pointing your finger at this or that and saying “That’s the real problem!” It is very important not to put people in predetermined categories and in my opinion, we will be doing a disservice if we did that. The real problem is UNIQUE to every person.

The #1 problem underlying severe anxiety

However, there is one common problem that causes severe anxiety regardless of the specific shape or form it takes. That problem is generally defined as psychological TRAUMA. Oftentimes, people, who have experienced trauma in their past find themselves tormented by recurrent and severe anxiety, difficulty sleeping, fear, worry, uneasiness, difficulty trusting people and maintaining relationships, and occasional or periodic panic attacks.

Of course, anxiety is just one of the symptoms caused by the unbearable affect and emotional pain of traumatic experiences. But it doesn’t come as a surprise that the number one problem often underlying severe anxiety is a history of trauma. In psychoanalytic psychotherapy, once people are able to address the unspeakable, frightening and terrifying events that have lead to the anxiety, they can begin to make changes in their relationships for a happier and more fulfilling life.

I will leave the topic of trauma for another post but if you would like to learn more about common mental health issues affecting you and your family, subscribe to Mental Health Digest and get the latest issue emailed to you today by leaving your name and email address in the contact form here.

Do you have questions? Found this article helpful? I would love to hear from you.

4 Unique Strategies to Successfully Manage Your Anxiety

Anxiety is one of the most commonly encountered problems in the mental health field, yet one of the most misunderstood and complicated ones. If you are struggling with anxiety, regardless of its severity, but you are not quite ready to take the leap and try psychotherapy, here are four unique strategies to successfully manage it by yourself.

Strategy #1. Create a sense of control. The scariest part about feeling anxious or panicky is feeling out of control or on the spot all of the time. In order to get a grip of the situation, you need to gain a sense of control and ownership of your own mind and body, which can be very hard to do if you are hyperventilating, sweating and struggling to focus on one thing at a time.

A simple exercise, I recently learned during one of my psychoanalytic psychotherapy consultation classes with William Gieseke, Ph.D., was to incorporate a relaxation technique of deep diaphragmatic breathing, a visualization of your “happy place” and an intentional exercise of “warming up your hands.” How does it work?

Relaxation technique “warm up your hands”

1) Step #1. Begin by practicing deep diaphragmatic breathing with progressive relaxation of each muscle in your body, starting with your toes and moving your way up your body until you reach you head (squeeze your muscles really hard three times quickly and then release in relaxation, moving one muscle at a time – toes, calfs, thighs, buttons, core muscles, etc. until you squeeze and release all the muscles in your body simultaneously three times).

2) Step #2. Then, imagine your “happy place” – it looks different for everyone but we all have a place that we feel safe, relaxed, taken care of and at peace with ourselves. Imagine your happy place and try to smell the smells around you, see the colors and listen to the sounds that surround you. You are completely safe and at easy with yourself.

Thermometer, Toshiyuki IMAI,
3) Step #3. Now, here’s the interesting part: buy one of those partial immersion thermometers with organic filling, hold it up by the bulb with your thumb, pointer and middle finger, and think about “warming up your hands.” You will notice how the thermometer raises as your hands get warmer and your body and mind relax. It’s awesome, almost like magic!

This will take some practice to master and it is a progressive exercise – you need to have mastered step #1 and #2 before you can do step #3. Once you’ve mastered it, however, you can gain a sense of control whenever you feel anxious or overwhelmed. Some people think of fire in their fingers, others just think about sending all the heat from their body to their fingers but in truth, the more relaxed you are, the warmer your hands become and the less likely it is to have a panic attack or to feel anxious. Quite extraordinary, don’t you think?

Strategy #2. Distraction, distraction, distraction. This is probably the most commonly recommended strategy to manage the symptoms of anxiety and you will probably see it in almost every single self-help post or book out there.

Find a way to get your mind and energy off of the constant thinking, nervousness, self-deprecating or disturbing thoughts, etc. Professionals recommend exercise, yoga, relaxation, mindfulness, journaling, creating lists and strategies (such as this one you are reading right now), cleaning, working, reading, listening to music…really, anything that will get your mind off of the anxiety. Just be careful not to overdo it – you don’t want to get into a manic do-it-all kind of mode either. Ultimately, distraction doesn’t solve the problem but it makes it more manageable.

Strategy #3. Connect to others, who struggle with the same issue. One of the most empowering qualities of the group process or the sense of community is the feeling of “I am not alone in my pain.” There are millions of people out there, who struggle with the same thing. Find a sense of belonging in websites like PsychCentral or communities like Mental Health Digest electronic magazine, where you can connect to people, share your struggles and listen to others, who experience the same difficulty.

Strategy #4. Tap into your creativity and use it to your advantage. Are you an artist, writer, athlete, singer, musician, actor, comedian, scientist, etc.? Do you have a talent for any creative process that can channel all of your anxious energy into a socially productive or acceptable activity? If so, do it! Take advantage of the creative process and if you can, immerse yourself in it. The best way to battle anxiety is through creativity. Don’t be afraid to put yourself out there!

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