[Psychodynamics and psychotherapy of anxiety disorders]

Three main concepts in the development of anxiety are important in psychoanalysis: 1. the conflict model assuming that anxiety is initiated by the Ego in dangerous situations, when usual coping strategies fail, 2. the structural model that essentially describes that with general weakness of the adaptive Ego-functions even common conflicts cannot be mastered adequately and, therefore, anxiety as an affect arises quickly, and 3. the ethological model assuming that anxiety is closely connected with ethologically founded needs of binding: with threat of loss of binding, the child reacts anxiously, mobilising care impulses of the parents and, thus, counteracting this threat. It is essential for the psychotherapy of anxiety disorders whether the patient exhibits an Ego-structural weakness requiring an active strengthening of the coping abilities of the Ego, or whether a more conflictual genesis of his anxiety should be assumed-in this case, the disclosure of the frequently unconscious background of the conflicts promises to be successful. Altogether, a more active and encouraging attitude of the therapist is preferable for the psychotherapeutic treatment of anxiety disorders to motivate the patient to directly confront himself with his anxiety symptoms.