According to Intensive Short-Term Dynamic Psychotherapy (ISTDP), anxiety is not simply a cognitive thought or fear of loss, and is rather understood as a bio-physiological pattern of activation in the body. In ISTDP, anxiety is considered to be a result of the activation of the fear system inherited from mammals through evolution. When anxiety arises, it triggers the activation of both the somatic and autonomic nervous systems.
The somatic nervous system, responsible for controlling skeletal muscles, becomes tense and prepared for action in response to anxiety. This tension can manifest physically, such as muscle tightness or restlessness. Meanwhile, the autonomic nervous system, which comprises the sympathetic and parasympathetic branches, also becomes activated. The sympathetic branch leads to physiological responses such as increased heart rate, rapid breathing, and heightened blood pressure, preparing the body for a "fight or flight" response. Conversely, the parasympathetic branch can lead to decreased heart rate, slower breathing, and lowered blood pressure, facilitating relaxation and recovery.
In ISTDP, anxiety is viewed as a somatic experience, meaning it is felt in the body rather than just as a cognitive or emotional state. This perspective emphasizes the importance of addressing both the physiological and emotional aspects of anxiety in therapy. By understanding anxiety as a bio-physiological response, ISTDP aims to help individuals regulate their anxiety and develop healthier coping mechanisms to manage it effectively. When anxiety arises, our somatic and autonomic nervous systems become activated. The somatic nervous system, which controls skeletal muscles, becomes tense and prepared for action, while the autonomic nervous system branches into sympathetic and parasympathetic systems, leading to physiological responses like increased heart rate and breathing (sympathetic activation) or decreased heart rate and breathing (parasympathetic activation).
Davanloo's research identified three unconscious pathways for anxiety discharge: striated muscles, smooth muscles, and cognitive perceptual disruption. Patients may manifest anxiety through tension in striated muscles, resulting in sighs when discussing emotionally charged topics. Others may experience anxiety discharged into smooth muscles, leading to symptoms like migraine headaches or upset stomachs, while some may experience cognitive perceptual disruptions such as dizziness or dissociation. Understanding these pathways is crucial in tailoring therapy to individual needs.
Assessing patients' anxiety involves exploring their feelings in therapy to observe where in the body the anxiety is discharged. This helps gauge the patient's capacity for affect tolerance and informs how therapy should be tailored. Patients with anxiety discharged into smooth muscles or cognitive perceptual disruption may require more focus on anxiety regulation to build their capacity to tolerate emotional experiences. ISTDP offers tailored treatments for different patient groups based on factors like affect tolerance, patterns of anxiety discharge, defenses used, resistances, and self-observing capacity, emphasizing the importance of individualized care in psychotherapy.
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