Pathways of anxiety (adapted from Coughlin Della Selva, 2004). Part of an intensive short-term dynamic psychotherapeutic approach.
Anxiety signals to the body that emotions are being processed and acted upon. When emotions arise, they must be processed instead of suppressed. Coughlin Della Selva provideda list of anxieties and theirlocations in the body. Anxiety can be aStriatedMuscle presenting anxiety. Striated muscles are skeletal muscles that are striped and voluntary.
How can this present? It can present as Hand clenching and tension in arms, neck, shoulders,head and other body parts. Shortness of fast breath might happen. One may start to get agitated. The legs and feet may feel tense. The abdomen might clutch. Smooth Muscle Anxiety. Smooth muscles are involuntary and present in internal organs. Some may feel an urgency to urinate, and this is smooth muscle anxiety. People present with IBS. These are gastrointestinal smooth muscles presenting with anxiety. Headaches or pain can be a presentation of anxiety. Asthma can be a presentation of smooth muscle anxiety. Cognitive-Perceptual Disruption. Thiscan confuse, or sometimes, vision might become blurred. Becoming dizzy or fainting might occur.
Dissociation can happen with a break from the conscious surroundings as a result of the cognitive presentation of anxiety. Defence mechanisms are ways in which people deal with unpleasant emotions, anxiety and experiences. It can be in non-verbal ways. Anxiety can be combated by defences such as avoiding eye contact with people. Arms and legs tightened and in a closed crossed position. They are emotionally becoming labile, showing up as temper and anger. Defence mechanisms can be verbal, including becoming sarcastic or argumentative, changing the rate and speed of speech, changing the topic, and not answering the question immediately. People might repress their emotions and anxiety by rationalising it. They could minimise the effects and the seriousness of the situation. They could intellectualise it or displace it onto others. They could repress their emotions as a defence mechanism. This may be done by being in denial, projection, or presenting physical somatic symptoms.
The Central Dynamic Sequence (adapted from Davanloo, 2001) includes the first step as INQUIRY. By letting the person talk, we can sense the conflicts between their experiences, anxiety and how the defence mechanisms work. Build rapport and get to the crux of the problem after the patient consents to therapy. If the patient is vague, we ask more specific questions that break the defence mechanisms. The second step is the INVITATION TO FEEL. Many people have defences built up so much that when asked, “What are your emotions to your husband’s death?” the feelings would be a defence reaction to the primary feelings of sadness or anxiety.
By gently encouraging, genuine emotion can be invited to be experienced. The next step is BREAKING THE DEFENCES. “How did you feel when your husband cheated on you?” “ I was surprised that a woman liked him”. This is sarcasm, which is a defence mechanism of intellectualisation. It is not the actual emotion. By asking questions, we break through to the crux of the emotion. Breakthrough into the feelings will be frightening for the patient, but you will be supported. Next, summing up and writing down the cycle of experiences, thoughts, emotions and defences, you understand better. The final step is self-compassion, which has been discussed in earlier blogs.
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