Anxiety

According to Freud, anxiety is the root of most if not all mental maladies and central to any understanding of the human mind: ‘There is no question that the problem of anxiety is … a riddle whose solution would be bound to throw a flood of light on our whole mental existence.’

LeDoux traces the modern centrality of anxiety in psychopathology to Freud’s foundational claim that anxiety is the root of mental disorder and the defining ‘something felt’ — objectless dread distinct from fear.

LeDoux, Joseph, Anxious: Using the Brain to Understand and Treat Fear and Anxiety, 2015thesis

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When the state in question involves worry about something that is not present and may never occur, then the state is anxiety… To experience anxiety is to worry about whether future threats may harm YOU.

LeDoux establishes the canonical neuroscientific distinction between fear and anxiety as one between present-threat and absent-or-uncertain threat, with self-involvement as the defining phenomenological feature of both.

LeDoux, Joseph, Anxious: Using the Brain to Understand and Treat Fear and Anxiety, 2015thesis

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anxiety relates to the condition and ignores the object, whereas in the word fear attention is directed to the object… anxiety is a protection against fright.

Freud elaborates the structural distinction between anxiety (objectless, preparatory), fear (object-directed), and fright (unprepared encounter with danger), positioning anxiety as a psychic protective signal.

Freud, Sigmund, Introductory Lectures on Psycho-Analysis, 1917thesis

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Anxiety, again like fear, is not directly the result of the activation of a survival circuit. It is a cognitive interpretation that sometimes, but not always, depends on survival circuit activity in generating autonoetic conscious feelings.

LeDoux argues that anxiety is a higher-order cognitive interpretation — not a hard-wired output of the amygdala — and that existential anxieties can arise entirely independently of defensive survival circuits.

LeDoux, Joseph, Anxious: Using the Brain to Understand and Treat Fear and Anxiety, 2015thesis

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Anxiety is still a puzzle being unraveled, but one thing seems certain: it is yet another disorder of prediction and prediction error across these two networks.

Barrett reframes anxiety as a disorder of predictive processing across interoceptive and control networks, explicitly rejecting the triune-brain model of amygdala overactivity versus prefrontal failure.

Barrett, Lisa Feldman, How Emotions Are Made: The Secret Life of the Brain, 2017thesis

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Even defensive maneuvers that successfully ward off severe anxiety, prevent growth and result in a constricted and unsatisfying life. Many existential theorists have commented upon the high price exacted in the struggle to cope with death anxiety.

Yalom argues that psychopathology is fundamentally a set of defensive maneuvers against death anxiety, and that even successful defenses exact a developmental cost by constricting the individual’s life.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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In that in the face of which one has anxiety, the ‘It is nothing and nowhere’ becomes manifest. The obstinacy of the ‘nothing and nowhere within-the-world’ means as a phenomenon that the world as such is that in which one has anxiety.

Heidegger’s ontological analysis reveals anxiety’s unique structure: its ‘object’ is nothing within the world but the world as such, making anxiety the fundamental attunement that discloses Dasein’s groundlessness.

Heidegger, Martin, Being and Time, 1962thesis

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persecutory anxiety very quickly interferes with progress in integration, and experiences of depressive anxiety, guilt and reparation can only be of a transitory nature.

Klein distinguishes persecutory anxiety from depressive anxiety as structurally different defensive positions, arguing that persecutory anxiety obstructs the ego-integration necessary for mourning and reparation.

Klein, Melanie, Envy and Gratitude and Other Works 1946-1963, 1957thesis

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It’s not the presence of anxiety that creates an anxiety disorder. After all, anxiety is a normal human emotion that we all experience. At the core of any anxiety disorder lies excessive experiential avoidance.

Harris advances the ACT thesis that anxiety disorders are not caused by anxiety itself but by experiential avoidance — the sustained effort to eliminate anxiety — which paradoxically amplifies and entrenches the symptom.

Harris, Russ, ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy, 2009thesis

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separation anxiety is the fundamental anxiety; and other sources of anxiety, including the fear of death, acquire emotional significance by equation with separation anxiety.

Yalom critically reviews Bowlby’s claim that separation anxiety is the primal anxiety from which death anxiety derives, arguing against reducing existential dread entirely to object-relational dynamics.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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Here I am concerned with the effects of death anxiety on the internal dynamics of the individual. I shall argue that the fear of death is a primal source of anxiety.

Yalom positions death anxiety as the primal source from which individual psychodynamics are organized, framing the existential encounter with mortality as the foundational anxiety underlying clinical presentations.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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anxiety — fear itself — is a universal, instinctive response to a threat to one’s body or social status and is therefore critical for survival. Anxiety signals a potential threat.

Kandel grounds anxiety in evolutionary biology, emphasizing its universal, cross-species character as a survival signal, thereby providing the neurobiological rationale for animal models of anxiety states.

Kandel, Eric R., In search of memory the emergence of a new science of mind, 2006supporting

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A heightened sense of threat detection occurs in people who have generalized anxiety, which includes mostly everyone with a fear/anxiety disorder. In extreme cases nearly anything can be threatening and trigger defensive behavior.

LeDoux enumerates six neural-cognitive processes characteristic of anxiety disorders, with hypervigilance — the global overestimation of threat — as the most pervasive feature across all fear and anxiety conditions.

LeDoux, Joseph, Anxious: Using the Brain to Understand and Treat Fear and Anxiety, 2015supporting

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Worry is the cognitive equivalent of behavioral avoidance… Worriers, Borkovec explains, escape from fearful images by thinking about the future in abstract verbal terms.

Drawing on Borkovec, LeDoux frames worry as cognitive avoidance — the verbal-abstract suppression of feared imagery — establishing a structural parallel between cognitive and behavioral manifestations of anxiety.

LeDoux, Joseph, Anxious: Using the Brain to Understand and Treat Fear and Anxiety, 2015supporting

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the fact that a connection exists between sexual restraint and anxiety conditions is no longer disputed… the more inclination for sexual intercourse and capacity for satisfaction, a woman has, the more certainly will she react with anxiety manifestations.

Freud argues from clinical evidence for an etiology of anxiety-neurosis rooted in blocked libidinal discharge, demonstrating a direct somatic-economic link between sexual frustration and anxiety symptoms.

Freud, Sigmund, Introductory Lectures on Psycho-Analysis, 1917supporting

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Many of the objects and situations feared are rather sinister, even to us normal people, they have some connection with danger; and these phobias are not entirely incomprehensible to us, although their intensity seems very much exaggerated.

Freud begins a taxonomy of phobic anxiety by distinguishing universally recognized dangers from irrationally magnified situational fears, establishing the spectrum from realistic to neurotic anxiety.

Freud, Sigmund, Introductory Lectures on Psycho-Analysis, 1917supporting

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higher trait anxiety in adolescence is associated with a lower likelihood of accidental death in early adulthood, which suggests that anxiety may serve as a protective function by promoting avoidance of potentially harmful situations.

Lench presents epidemiological evidence for the adaptive functionality of anxiety, demonstrating that moderate-to-high trait anxiety reduces mortality risk by promoting harm-avoidant behavior.

Lench, Heather C., The Function of Emotions: When and Why Emotions Help Us, 2018supporting

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Post-traumatic stress disorder is another form of severe anxiety… in which anxiety-related symptoms emerge weeks, months, or even years after the frightening events that caused them.

Dayton surveys the clinical spectrum of anxiety disorders — generalized, panic, phobic, and post-traumatic — linking PTSD explicitly to anxiety’s temporal displacement from its originating traumatic cause.

Dayton, Tian, Emotional Sobriety: From Relationship Trauma to Resilience and Lasting Fulfillment, 2007supporting

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These processes are inextricably linked with instinctual development, and with the anxieties to which instinctual desires give rise.

Klein ties the genesis of anxiety to early ego-splitting processes driven by instinctual conflict, positioning anxieties as inseparable from the structural development of the ego under the pressure of the death drive.

Klein, Melanie, Envy and Gratitude and Other Works 1946-1963, 1957supporting

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Rollo May… proclaimed in 1977 that ‘[a]nxiety has certainly come out of the dimness of the professional office into the bright light of the market place.’

LeDoux documents the cultural-historical mainstreaming of anxiety as a concept, tracing the path from Freudian clinical theory to Kierkegaardian existentialism and ultimately to popular discourse.

LeDoux, Joseph, Anxious: Using the Brain to Understand and Treat Fear and Anxiety, 2015supporting

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the drug did not diminish the anticipatory anxiety associated with the disorder — namely, the fear that an attack might be forthcoming. While the antianxiety agents tested had diminished anticipatory anxiety, they did not diminish the frequency or intensity of the panic attacks themselves.

Panksepp reports Donald Klein’s pharmacological dissociation between anticipatory anxiety and panic attacks, suggesting these represent neurobiologically distinct processes requiring different treatment strategies.

Panksepp, Jaak, Affective Neuroscience The Foundations of Human and Animal, 1998supporting

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fear and anxiety disorders are the most prevalent of all psychiatric problems in the United States, affecting about 20 percent of the population, more than twice the number who suffer from depression.

LeDoux establishes the epidemiological primacy of fear and anxiety disorders and argues for treating them as a unified category in which maladaptive fear and anxiety co-occur across DSM diagnostic boundaries.

LeDoux, Joseph, Anxious: Using the Brain to Understand and Treat Fear and Anxiety, 2015supporting

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Floatation-REST… has recently been found to reduce state anxiety across a diverse clinical sample with high levels of anxiety sensitivity.

Feinstein’s study uses Floatation-REST to investigate the anxiolytic potential of attenuating exteroceptive input, foregrounding anxiety sensitivity as a measurable trait moderating interoceptive and affective responses.

Feinstein, Justin S., The Elicitation of Relaxation and Interoceptive Awareness Using Floatation Therapy in Individuals With High Anxiety Sensitivity, 2018supporting

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a substantial number of empirical studies examining differences across fear and anxiety rely on behavioral responses from individuals with anxiety disorders… as a proxy for studying state anxiety.

Lench identifies a persistent methodological limitation in the fear-anxiety literature — the conflation of dispositional anxiety and acute state anxiety — that complicates empirical differentiation between the two constructs.

Lench, Heather C., The Function of Emotions: When and Why Emotions Help Us, 2018aside

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those individuals who have very high or very low conscious death anxiety tend to dream of death… Very low conscious death anxiety may reflect strong unconscious death anxiety which in the waking state is contained by denial and repression.

Yalom reviews research on death anxiety and dream content, noting a curvilinear pattern that supports the psychodynamic hypothesis of unconscious death anxiety operating beneath measured conscious levels.

Yalom, Irvin D., Existential Psychotherapy, 1980aside

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The traditional Western approach to fear is negative. In keeping with the attitudes of our heroic ego, fear, like many other affects and their images, is first of all regarded as a moral problem, to be overcome.

Hillman situates the Western denigration of fear and anxiety within the heroic-ego tradition, suggesting that archetypal depth psychology demands a re-imagining of these affects rather than their moral or therapeutic suppression.

Hillman, James; Roscher, Wilhelm Heinrich, Pan and the Nightmare, 1972aside

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