Psychoanalysis and Treatment of Generalized Anxiety Disorder

“Personality is an abstraction used to describe and explain the coherent patterning over time and space of affects, cognitions, desires and the resulting behaviors that an individual experiences and expresses” (Revelle & Condon, 2015). Personality theory can be defined as a system of concepts or ideas that we use to explain and understand personality and its variation among individuals. There are several theories in studying personality, and they include psychoanalytic, neo-psychoanalytic, biological, behavioral, and cognitive. This paper will compare and contrast the fundamental theories established by Sigmund Freud and Alfred Adler. Psychoanalytic theory is one of the first big theories in personality psychology, developed by Sigmund Freud in the 19th century.

According to reports, the Freudian theory is the most cited work in psychology and it gave an in-depth into understanding the roots of behaviors and personalities. Freud’s thoughts on mental life included dream interpretation, the unconscious mind, ego/id/superego, free association, and trauma. The purpose of Freud’s theory was to prove the events we experience in our childhood had an impact on us as an adult (Schultz & Schultz, 2016). The psychoanalytic theory states that our childhood experiences and unconscious desires influence behavior (Kenny, 2016). According to Freud, everyone goes through five psychosexual stages of development. These stages are oral, anal, phallic, latency and genital stage (Schultz & Schultz, 2016). He presumed mental illness/abnormality occurred when a stage is not successfully completed. According to Freud, the unconscious minis things outside our conscious awareness and they include things that are unpleasant or socially unacceptable.

Freud explained the structure of the mind and stated the mind is made up of the Id, Ego, and Superego (Lapsley & Stey, 2012). Each of these structures of personality emerges at different points in life and they all interact to form a whole. According to Freud, the id is the unconscious part of the mind making up most of the mind (Schultz & Schultz, 2016). The id is the oldest part of the psyche; it develops right after birth and demands immediate gratification (Lapsley & Stey, 2012). The Id is the irrational component of personality, the reservoir of basic instinctual drives, and it is ruled by the pleasure principle (Lapsley & Stey, 2012). The ego is the second aspect of personality and spans between the conscious and unconscious mind; it is involved in our perceptions, decision-making, thoughts, and judgment (Schultz & Schultz, 2016). The ego is influenced by the external world and regulates libidinal drive (Lapsley & Stey, 2012). The superego is the last structure to form, and it serves as a moral compass and our conscience (Schultz & Schultz, 2016). The superego is formed from parental and environmental rules. These three elements work together to create complex behaviors and have a strong influence on our personality.

Neo-psychoanalytic theories consist of various psychologists. In this research paper, we will be focusing on Adler’s theory of individual psychology. Adler’s goal was to understand what made up the human personality and understand why humans behaved the way we did. His quest led to the development of what is known as the inferior complex (Schultz & Schultz, 2016). According to Adler to understand why a person behaves as they do, we must first recognize that humans have a tendency to strive after self-created goals (Goodluck & Gabriel, 2017). Adler assumed that social relatedness formed the foundation of human motivation and not sex. According to Adler, self-ideal formation begins in early childhood and our self-ideal shapes our life (Goodluck & Gabriel, 2017). He believed that a man’s sense of helplessness at birth causes them to feel inferior and in turn propels them to strive and achieve great heights (Goodluck & Gabriel, 2017). He also presumed that birth order and our view of the future shape our personality and behaviors. Freud believed people are motivated by sex and aggression, while Adler believed people are motivated by social influences and striving for superiority or success (Schultz & Schultz, 2016). In comparison to Freud who split the personality into components, Adler believed individuals should be studied as a whole. Adler also believed that the conscious and unconscious worked together and not separate entities as suggested by Freud (Goodluck & Gabriel, 2017). Both psychologists used their theories to explain the development of anxiety, which will be discussed later in the paper.

Generalized Anxiety Disorder

Generalized Anxiety disorder (GAD) is one of the most common mental disorders and is characterized by persistent and excessive worrying. GAD affects approximately 6.8 million adults in the U.S (Maron & Nutt, 2018). Anxiety can lead to depression, suicide, and can severely affect an individual’s entire life functioning. Cognitive, behavioral and physical symptoms include: subtle avoidance, anxious thoughts, dry mouth, rapid heartbeat, muscle tension, and the list go on. Studies show GAD has a biological factor associated with its development, as well as social and psychological factors (Maron & Nutt, 2018). This paper will further explore Freud and Adler’s perspective theories on GAD.

Psychoanalytic Perspective on Generalized Anxiety Disorder

The psychoanalytic theory proposes that we are all driven by the pleasure principle, which inclines us toward an easy physical and emotional reward. Freud strong interest in understanding anxiety led to the development of three phases. The first phase is known as the toxic theory. Freud stated, “Anxiety arises from the transformation of accumulated tension” (Freud Museum London, 2018). He believed that anxiety was closely linked to sexuality than thoughts or ideas (Freud Museum London, 2018). Years after, his views on anxiety shifted leading to the development of phase two known as anxiety as a result of repression. Freud stated, “anxiety arises out of libido by the process of repression” (Freud Museum London, 2018). He explained that this anxiety arises because ideas connected to sexual urges are pushed back into our unconsciousness when in conflict with social norms (Freud Museum London, 2018). Over the years Freud eventually abandoned his earlier anxiety theories leading to the final phase called anxiety as a signal. Freud states, “The ego is the actual seat of anxiety” (Freud Museum London, 2018). From this phase of anxiety, Freud considered three types of anxiety. Objective anxiety results from threats in the physical world to our wellbeing (Schultz & Schultz, 2016). Moral anxiety “results from a conflict between the id and the superego” and occurs when ones feel their internal value is about to be compromised (Schultz & Schultz, 2016). Neurotic anxiety results from the ego being overwhelmed by the id (Schultz & Schultz, 2016).

As stated earlier the mind is made up of the id, ego, and superego. Freud describes that due to conflicting demands, conflict can occur between these three mental structures of our mind leading to anxiety. Conflict among these structures and our effort to find balance determines our behavior and how we approach the world. According to Freud, anxiety arises because the ego is unable to deal with the demands of the id and the superego (Schultz & Schultz, 2016). Freud used the term “neurosis” to reflect a state of anxiety. The id wants instant gratification and while the ego is trying to please the id, it also has to take the superego into consideration. The ego acts as a mediator between the other two mental structures, and in order to reduce anxiety, the ego employs various defense mechanisms (Schultz & Schultz, 2016).

In Freud’s view, we humans seek to reduce anxiety through defense mechanisms. Some of these defense mechanisms are denial, displacement, projection, and rationalization (Schultz & Schultz, 2016). When we experience anxiety, we either dive into problem -solving mode or defense mechanisms are triggered. Psychoanalysis is used in the treatment of depression and anxiety disorders. The Psychoanalytic therapy approach is to bring unconscious thoughts or feelings to the conscious mind, and help patients deal with early conflicts in life as they release repressed emotions and experiences. (University of Michigan Health System, 2012). Using this theory, the therapist focuses on psychological problems that result from issues lodged in the unconscious mind. The aim is to assist the clients in focusing less on fear but instead recognizing and controlling their id.

Neo-Psychoanalytic Perspective on Generalized Anxiety Disorder

According to Adler, we all strive for superiority by seeking to actualize our self-ideal (Schultz & Schultz, 2016). As individuals we know what behaviors and patterns get us closer to our self - ideal and what hinders us from achieving our goals. Anxiety occurs when the weak points of our lifestyle frustrate us in our pursuit of superiority and triggers feelings of inferiority (Watts, 2013). Our inferiority feelings are triggered when we are not successful at achieving our goal. Adler discovered the importance for humans to feel a sense of belonging in this world and he attributed symptoms of anxiety as fear of failing, lack of social connection and childhood upbringing (Journal Psyche, 2009). He believed that children who are neglected or experienced improper parenting styles would more anxious in all aspect of life. He assumed incomplete adjustment to the feeling of inferiority and maladaptive responses to genetics and environment caused anxiety. He also thought social interest was associated with mental health. High social interest is associated with good mental health and low social is associated with low mental health such as anxiety (Clark, 2017). In Adler’s perspective, anxiety occurs due to a perceived threat preventing one from achieving their goals (Rasmussen & Dover, 2006), and the element of neurosis was due to feeling inferior and not having the adequate tools to handle the threat.

A critical aspect of understanding anxiety is how one deals with anxiety. Adler suggested there are two ways people deal with feelings of inferiority; we either confront the challenges by using coping mechanisms or we see the situation as a problem to be avoided (Rasmussen & Dover, 2006). He believed anxiety serves as a tool to safeguard one’s self-esteem, so people tend to adopt safeguarding techniques. Safeguarding techniques consist of using illness to avoid problem and distant seeking (Mitchell, n.d.). A person who adopts distance seeking tends to procrastinate or take little steps towards their goals and reverts back to their comfort zone. Adler’s viewed those who adopt safeguarding techniques as pitiful as they are only trying to escape life duties. Addressing issues head-on allows us to continue our pursuit of the goal and achieve success (Rasmussen & Dover, 2006). However, success is only short-lived till the next set of challenges occur and the cycle continues. Similar to the present understanding of anxiety disorder, some either identify the triggers; find ways to cope with the triggers or some adopt avoidance/ denial. According to (Corey, 2009) “Encouragement is the most powerful method available for changing a person's beliefs, for it helps clients build self-confidence and stimulates courage” The Adlerian therapy was developed to help people cultivate a more courageous attitude. He thought courage is the willingness to engage in risk-taking behavior regardless of the consequences. Life challenges never cease so according to Adler we should all cultivate a courageous attitude and learn to co-exist with uncertainty.

Critical Opinion

The discipline of psychoanalysis and neo-psychoanalysis greatly benefited the understanding of personality. Both theories guided us in understanding how anxiety arises; however, in comparison to the current understanding, we have of GAD both theories have their limitations. The biopsychosocial model explains GAD is caused by a combination of biological, social and psychological factors. Factors that contribute to the development of GAD include genes, environment, parenting styles, and traumatic events (Newman, Llera, Erickson, Przeworski, & Castonguay, 2013). Freud’s theory did a good job of analyzing anxiety from the biological perspective and identifying how childhood trauma can contribute to the development of the disorder. Freud’s theory also had its pitfalls in explain anxiety. He fails to address the impact environment, upbringing, and culture could have on developing GAD.

Data contradicts Freud’s theory on childhood and anxiety as many people with GAD report having a normal childhood. Although childhood traumas could play a role in developing anxiety, there are individuals who have not experienced childhood trauma and still developed the disorder. Freud theorized that mental abnormality is assumed to occur if one of the psychosexual stages is not completed successfully. However, if this was accurate, then each stage should have its own unique condition for anxiety because, if we presume that each psychosexual stage was not fully completed in a person, that individual should be exhibiting 5 different unique symptoms of anxiety for each stage. He placed too much emphasis on sexual desires and the idea of underdeveloped sexuality and developing GAD is difficult to fathom. Freud’s theory had no scientific basis and was not supported experimentally. Most of Freud’s studies were conducted himself, and had no inclusion of cultural variation, making it difficult to make a generalization on anxiety development on the entire population.

In comparison to Freud’s theory, Adler’s theory was a lot less biological in the analysis of anxiety, and he factored in how social environment and culture influence the development of anxiety. From an Adlerian perspective, anxiety stems from fear of defeat and not being good enough to belong. As we know from current studies, GAD can be caused by stress, hormonal imbalance, and traumatic life events. Anxiety is not necessarily only caused by individual failures, however, individual failures can cause stress, depression, and other health issues associated with anxiety. Although Adler included other factors that might have contributed to anxiety, in my opinion, his theory lacked in certain areas when explaining anxiety.

According to Adler, we are not victims of biology or circumstances, but our anxiety is as a result of our maladaptive responses to genetics and environment. This statement as we know is very wrong as we know biology also contributes to the development of GAD and not only inferior feelings. Inferior feelings are not the only challenges one experiences in life that causes anxiety. Adler believed people are not sick but discouraged however, we all at some point have been discouraged and not responded appropriately to environmental pressures, but that does not mean we would all develop anxiety. Both theories did great at outlining defense mechanisms used when anxiety occurs. Research supports the theorists, as people with GAD are likely to use defense mechanisms to deal with the disorder (Newman, Llera, Erickson, Przeworski, & Castonguay, 2013).

Treatment of GAD consists of pharmacological treatments, relaxation techniques, and counseling (Newman, Llera, Erickson, Przeworski, & Castonguay, 2013). Both Freud’s and Adler’s therapy do well at addressing the counseling aspect of treatment. Psychoanalysis therapy helps people identify their triggers by retrieving traumatic memories in the unconscious that could have contributed to the development of the disorder. Although Freud’s psychoanalysis is effective in promoting long term emotional growth, it has its own set of limitations. The one flaw with this theory is when clients are attempting to retrieve repressed memories, how does the counsellor know what memories are real or false memories.

Our memories are malleable so when trying to retrieve things from our past, we do not have a perfect recording of the event. This makes it difficult, as a counselor identifying what memories must have contributed to anxiety. Adlerian therapy also helps the individual to identify triggers and also develop effective strategies in addressing the disorder. However, just like Freud’s therapy, they are only treating the disorder with counseling. No solid evidence proves that Freud or Adler’s therapy is helpful in the treatment of GAD. As stated earlier so many factors contribute to the development of GAD, so only using one treatment is not always effective at helping a person with the disorder. Their therapies might be beneficial in conjunction with other treatment methods.

The blend of both Freud and Adler’s theory gives a better explanation of the causes of anxiety such as childhood experiences/ traumas, and our views and responses to environmental pressures. Although they have flaws in comparison to our present knowledge of GAD, they did contribute to the current knowledge we have.