Tool Module: Anxiety Disorders and Psychoanalysis: Extinguishing Conditioned Fears by “Rewiring” the Brain

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 work.