Tool Module: Anxiety
Disorders and Psychoanalysis: Extinguishing Conditioned Fears by “Rewiring”
Freud gave the name “neuroses” to the
conditions that reflect a state of anxiety and the defence mechanisms surrounding
it (repression, displacement, etc.). Today’s psychiatrists use the term
“anxiety disorders” instead, to avoid implying that anxiety symptoms
necessarily reflect Freudian defence mechanisms.
In the Freudian model,
anxiety symptoms reflect unconscious conflicts, and the purpose of psychoanalytic
therapy is to resolve them. In contrast, in the behavioural model, anxiety symptoms
result from simple conditioned responses. But in both cases, the anxiety disorders
that prevent people from functioning normally are always associated with memories
of traumatic experiences and hence are the result of learning. Thus, in both models,
traumatic memories and the mechanism of conditioned fear are believed to play
an important role in anxiety disorders.
The approaches to treating anxiety
disorders on the basis of these two models are quite different, however. Psychoanalysis
attempts to make patients aware of their inner conflicts, while behavioural therapies
try to relieve patients of the symptoms of anxiety, often through the process
of extinction. The advantages of these two approaches, as well as those of the
more recently developed “cognitive” therapies, are still being debated
vigorously. Some authors even argue that the psychoanalytic approach may actually
make significant use of the process of extinction, through the climate of trust
developed by the therapist. Thus psychoanalysis itself can be seen as another
means of “rewiring” the brain, and in particular of strengthening
certain neural pathways that influence the amygdala.
Since emotional memories
seem to be etched into the amygdala indelibly, the best one can hope for is to
exercise some control over their expression. And the best way to do that is to
marshall the rational capabilities of the cortex to calm the emotions of the amygdala.
A better understanding of the phenomenon of extinction, which involves a control
exercised by the medial prefrontal cortex over the amygdala, will surely contribute
to a better understanding of how the various treatments for anxiety disorders