Oedipal dynamics in panic disorder

Both research and clinical work have revealed factors that can lead to the onset and persistence of panic disorder. Preoedipal conflicts intensify the danger of oedipal longings for panic patients. Competition with the same-sex parent is linked with angry preoedipal fantasies and associated fears of disruption in attachments. Fantasies or actual successes can thus trigger panic episodes. Regression to a helpless, dependent state such as panic defends against the danger of aggressive, competitive fantasies and actual achievements. However, the regressive state can also be experienced as dangerous, and can be linked with frightening homosexual fantasies. A reactive aggressive oedipal stance can sometimes result, triggering escalating turmoil. The panic episode serves a series of compromise formations in dealing with these conflicted wishes.     

Obscuring Desire: A Special Pattern of Male Adolescent Masturbation,Internet Pornography,and the Flight From Meaning

The sexual development of adolescent boys is closely tied to masturbation. Erotic fantasies are used to work through conflicts concerning sexuality and gender. These fantasies may be extended, enriched, and socialized through a variety of means, including interactions with peers, various cultural means, and pornography. Adolescents also commonly defend against awareness of these conflicts by denying their significance and conceptualizing them as mere stimulants or concomitants of physiologic arousal. Internet pornography provides a particularly powerful means by which some adolescents can disguise or obliterate the meaning of personal masturbation fantasies and so be spared the anxiety associated with the fantasies and their conflicted meaning.     

Das Drama des begabten Kindes und die Suche nach dem wahren Selbst

The clinical material for this study of female fantasies stems from a specific psychoanalytical situation where the analyst and the analysand are pregnant at the same time. The impact of this situation is powerful. The emergence of archaic fantasies is facilitated in transference and countertransference. Fantasies of damage to the baby or to the procreative function may emerge very vividly in the double pregnancy setting and working through these fantasies becomes possible. It is suggested that these fantasies are typical female castration fantasies and manifest the fear of the mother's revenge and punishment for forbidden oedipal wishes. The double pregnancy setting may sensitize the analyst to her pregnant analysand's unconscious communication and yet blind the analyst in some areas to the protection of her own baby. The duality of phallic strivings in the girl's psychosexual development is discussed. They may be employed as a defense against specific feminine anxieties, such as fear of retaliatory attacks on her inner space and its fertility: the female castration anxiety. They may also be constituents of her sexuality, coexisting with inner genital strivings. The co-existence of phallic and inner-genital strivings in the female psyche is always conflictual.     

Delineating generalized anxiety: A preliminary investigation

The present study examined the nature of generalized anxiety, which was defined as the constellation of symptoms listed as diagnostic criteria for generalized anxiety disorder in DSM-III-R. Generalized anxiety was assessed by means of a questionnaire that was especially constructed for this study. Although multidimensional scaling of symptoms reported by a clinically anxious sample produced orthogonal anxiety and panic dimensions, many symptoms were common to both dimensions. Whereas worry was found to be the cardinal feature of generalized anxiety, respiratory symptoms were found to associate closely with panic. These dimensions were replicated in a student sample. It is argued that while generalized anxiety symptoms constitute a unique dimension in the field of anxiety disorders, both panic and generalized anxiety may be linked with a basic anxiety response system. The findings also indicated that worry associated more closely with generalized anxiety than did apprehensive expectations. The heuristic value of the findings are discussed in light of the issue relating to an anxiety-panic continuum.     

Unconscious fantasy in context: The work of Jacob A. Arlow

For Jacob A. Arlow, understanding unconscious fantasies was central to his clinical work. These fantasies are to be found at the core of those eruptions that break without warning into our ordinary lives, whether in the form of hysterical symptoms, daydreams or nightmares. What, however, could an unconscious fantasy be on a theoretical level, beyond a vehicle for discharge? Although partly unconscious, such fantasies are sometimes composed of fixed verbal content with a high degree of internal organisation. Unconscious fantasies therefore pose many challenges to understanding.     

In and out of a daydream: attachment orientations, daily couple interactions, and sexual fantasies

In this study, the authors examined the contribution of attachment orientations to the content of daily sexual fantasies. The two partners of 48 couples independently reported on their attachment orientations and provided daily reports on relationship interactions and sexual fantasies for a period of 21 days. Results showed that attachment anxiety was associated with wishes for intimacy and representations of others as more affectionate in sexual fantasies. Conversely, avoidant attachment was associated with avoidance-related wishes and representations of the self and others as more aggressive and alienated. Negative couple interactions increased habitual attachment-related wishes and self-representations. Specifically, during days characterized by negative couple interactions (relationship-damaging behaviors), attachment anxiety was associated with portrayal of the self as more helpless and avoidant attachment was associated with the expression of more avoidant wishes and portrayal of the self as less helpless. The discussion focuses on the manifestations of attachment-related interpersonal goals in sexual fantasies.     

Beyond the borders of reality: Attachment orientations and sexual fantasies

Two studies examined the associations between attachment orientations and sexual fantasies. In Study 1, 176 participants completed a sexual fantasy checklist. The findings indicated that attachment anxiety was associated with frequent sexual fantasizing (e.g., submission themes). More anxiously attached women were particularly likely to report extrapair fantasies, whereas more anxiously attached men were especially likely to report romantic fantasies. Attachment avoidance was negatively associated with romantic themes, primarily among men. In Study 2, 115 participants described a sexual fantasy in narrative form. Findings paralleled those of Study 1, with the exception that the avoidant effects were more pronounced in women’s sexual fantasies than in men’s. Implications for understanding the interplay of the attachment and sexual behavior systems are discussed.     

ISOLATION: CENTER AND PERIPHERY

Preliminary data from an investigation of children growing up in geographically isolated Norwegian farm families indicate a strong preoccupation with the theme of center vs. periphery, or inside vs. outside, in projective fantasies. What lies outside the circle of home and family seems to provoke anxiety, and return to the farm is a frequent theme. This 'centripetal' tendency may be a basic feature of the perceptual organization as well as general life orientation of such children.     

Emotion- and intrusion-based reasoning in Vietnam veterans with and without chronic posttraumatic stress disorder.

Patients suffering from anxiety disorders other than posttraumatic stress disorder (PTSD) interpret anxiety responses themselves as evidence that threat is impending: "if anxiety, then threat" (Arntz, Rauner, & van den Hout, 1995, Behaviour Research and Therapy, 33, 917-925). This "emotion-based reasoning" (ER) may render a disorder self-perpetuating. Analogous to ER, danger might also be inferred from the presence of intrusions: "intrusion-based reasoning" (IR). The aims of this study were to test whether ER and IR are involved in chronic PTSD. Vietnam combat veterans with or without PTSD or other anxiety disorders rated perceived danger of brief scenarios in which information about objective danger (danger vs safety) and response (anxiety/intrusions vs non-distressing emotion) was systematically varied. Two series were administered: ER-scenarios were non-specific for PTSD and IR-scenarios were specific for PTSD. Relative to control participants, PTSD patients engaged in both ER and IR: whereas veterans without PTSD inferred the danger of scenarios from objective stimulus information, veterans with PTSD also inferred danger from the presence of anxiety or intrusions. Further analyses showed that these effects were largely mediated by perceived uncontrollability.     

Mit Imagination an Albträumen arbeiten

According to Jung fantasies appear during sleep as dreams and while awake, they appear as more or less conscious fantasies. He understood fantasy as an activity of the psyche itself. Fantasy is that which simply occurs without any effort on our part and is always present. Imagination is what we call fantasy when we concentrate on it, i.e. perceive it and do something with it. Due to the close relationship of dreams, fantasies and imagination, the more they are consciously observed and perceived, the more it is possible to use imagination with dreams to better understand them. This is especially true for nightmares so that through imagination helplessness can be overcome and self-efficacy can be stimulated. Steven Starker already proposed using imagination for working on nightmares in 1974 and he also showed how the style of the nocturnal dreams changed as a consequence. In a clinical vignette I show how this technique can be used and what an influence it has. The analyst and analysand are in a communal space of visualization, framed in the beginning by the nightmare. This space is considered as a space of interaction and of potential transformation. The analyst is a part of the process, offering ideas in a symbolic form and reinforcing the analysand’s ideas which lead to stress-reducing behaviour and images that provide an opening for the future. There are pauses in the imaginative work to talk together about the experiences, to link the situation in the imagination to biographical material, and to understand the resources opening up in the material, through the analysand herself. The goal of working with imagination is to ban the anxiety in the dream and to let the dreamer experience the fact that dreams and imagination are not only determined by the anxious feelings but it is also possible to transform these kinds of energy into creative fantasies.     

False Memories,Negative Affects,and Psychic Reality: The Role of Extra‐Clinical Data in Psychoanalysis1

Psychoanalysis as a treatment originated in the idea that neurosis is related to the ways in which individual psychic reality departs from actuality. Psychic reality includes memories, beliefs and their associated affects and fantasies connected with an individual's experience of the inner and outer world. The psychoanalytic determination of what meaningful memories or beliefs are inaccurate, distorted or false ordinarily relies upon principles of intra‐clinical validation. By itself, however, intra‐clinical validation is subject to limitations and pitfalls that conviction alone about what is actual cannot circumvent. Despite this fact, there are remarkably few analytic case reports demonstrating false or signifi cantly distorted memories through the use of data obtained from outside the consulting room. This paucity of reports may be related, at least in part, to the belief that the use of extra‐clinical data is essentially unanalytic or supports resistance. Based on the views that (a) psychic reality cannot be regarded as exclusively subjective or objective but is inherently both; and that (b) a goal of analysis is to achieve a different, acceptable and more accurate view of reality, the authors report a clinical case involving a confi rmably false pivotal memory and its associated negative affects. They discuss theoretical and technical considerations in utilizing extra‐clinical data during the treatment process.     

Unconscious fantasies, structural theory, and compromise formation

Although the existence of unconscious fantasies is an empirical assumption, in the clinical situation unconscious fantasies are treated as if they have a concrete existence. Unconscious fantasies form intermediate links in causal chains of which clinical observations constitute one end, and the components of unconscious conflicts, the other. Like all clinical material, fantasies may be affected by actual experiences; they may also be revised, layered, and can function to alter and disguise other fantasies as well as provide gratification. From a technical standpoint, it is most important to analyze their constituents and to adduce their primary purposes in the clinical situation of the moment. The nature of the evidence that identifies the presence of particular unconscious fantasies is discussed. Although a single analytic session is presented by way of illustration, I am convinced that the analyst's entire understanding of the patient inevitably channels his or her interpretive focus on the associational material of each analytic hour.     

Sadomasochism in the neuroses conceived of as a pathological compromise formation.

Masochistic phenomena in adults are discussed as derivatives of conscious and/or unconscious fantasies. These masochistic fantasies are always associated with conscious and/or unconscious narcissistic and sadistic fantasies. These fantasies, like all fantasies in adults, are conceived of as compromise formations. After a selected review of the literature, analytic data are presented to highlight the clinical advantages of a contemporary elaboration of the structural hypothesis for the understanding of sadomasochistic and sadonarcissistic phenomena.     

Interpretive bias,repressive coping,and trait anxiety

Objectives: According to vigilance–avoidance theory, repressors have an avoidant interpretive bias, i.e., they interpret ambiguous self-relevant situations in a nonthreatening fashion. This study sought to demarcate the range of situations associated with avoidant interpretive bias in repressors. Design: Four groups of participants, representing the four combinations of low- and high-trait anxiety and defensiveness, were identified. Those low in trait anxiety and high in defensiveness were categorized as repressors. Methods: Participants (N = 163) rated their likelihood of making both threatening and nonthreatening interpretations of 32 ambiguous scenarios over four domains: social, intellectual, physical, and health. Half the scenarios were self-relevant and half were other relevant. Brief measures of state anxiety were taken after each likelihood rating. Results: Repressors displayed an avoidant interpretive bias for ambiguous threats in the social and intellectual domains but not the health or physical domains. This was due to repressors' low level of trait anxiety rather than their high defensiveness. Conclusions: Individuals high in trait anxiety are especially sensitive to situations involving social evaluation but not those characterized by danger to their health or physical well-being.     

Fear of fear,trait anxiety and aerobic fitness in relation to state anxiety during adrenalin provocation

Abstract

Psychological explanations of both spontaneous and experimentally induced panic anxiety stress the role of fear of fear, especially fear of bodily symptoms of arousal. Fear of fear is conceptually different from trait anxiety but may be associated with repeated experience of arousal symptoms in fearful situations, while frequent physical exercise may lead to habituation to these symptoms. To test this hypothesis, 44 healthy male volunteers, classified as having high or low trait anxiety and high or low aerobic fitness, underwent a single-dose adrenalin infusion (80 nanogram/kilogram bodyweight/minute). In both groups, during the experiment a significant rise in state anxiety was found; compared to the group with low trait anxiety, subjects with high trait anxiety reported higher levels of state anxiety, which could be attributed to differences in aerobic fitness. In the high-anxious group, subjects showed a greater decrease in state anxiety during the recovery phase. State anxiety during adrenalin was strongly associated with fear of bodily symptoms only in the high-anxious group. Correlations between trait anxiety and somatic anxiety were not significant; state anxiety scores tended to correlate negatively with physical fitness. It is concluded that these results lend support to a fear of fear-model of panic anxiety.     

Dysfunctional Cognitions in Children with Social Phobia, Separation Anxiety Disorder, and Generalized Anxiety Disorder

According to cognitive theories of anxiety, anxious adults interpret ambiguous situations in a negative way: They overestimate danger and underestimate their abilities to cope with danger. The present study investigated whether children with social phobia, separation anxiety disorder, and generalized anxiety disorder have such a bias, compared to a clinical and a normal control group. Children were exposed to stories in which ambiguous situations were described, and asked to give their interpretations, using open and closed responses. Results showed that anxious children reported more negative cognitions than control children. However, anxious children did not overestimate danger on the free responses, but they did judge the situations as more dangerous on the closed responses. Anxious children had lower estimations of their own competency to cope with danger than the control groups on both open and closed responses. The results indicate that children with anxiety disorders have dysfunctional cognitions about ambiguous situations.     

Smoking and social anxiety: the role of false safety behaviors

ABSTRACT

Despite the negative health consequences associated with smoking, most smokers find it difficult to quit. This is especially true for smokers with elevated social anxiety. One factor that may play a role in maintaining smoking with elevated anxiety is false safety behavior (FSB), behaviors geared toward decreasing anxiety short-term but that maintain or increase anxiety long-term. The present study tested whether FSB explained the relation of social anxiety severity with smoking among 71 current smokers. Avoidance-related FSB was the only type of FSB related to cigarettes smoked per day (CPD) and it was robustly related to more CPD. Further, social anxiety was related to CPD indirectly via FSB-Avoidance. Findings suggest that more frequent use of avoidance behaviors to manage anxiety may maintain smoking and may partially explain the high rates of smoking among those with elevated social anxiety. Thus, FSB may be a promising target in smoking cessation interventions, especially among those with elevated social anxiety.     

Impact of fearful expression on danger processing: The influence of the level of trait anxiety

Threat estimation is crucial for the adaptation of behavior to a dangerous situation. In anxiety, a bias to threat has been described as a core feature. Therefore, the sensitivity for threatening information in anxious individuals may have consequences for danger estimation. In this study, we used the affective priming paradigm to test the assumption that fearful expressions would facilitate danger detection in natural scenes in anxious individuals. Twenty-three high trait anxious individuals and 22 low trait anxious individuals participated in the study. They had to detect the potential threat of a target scene (neutral or threatening) following neutral or fearful face primes. High trait anxious participants detected threat more rapidly than low trait anxious participants, consistent with previous reports of emotional hypervigilance in anxiety. Furthermore, this effect was enhanced when the target scene followed a fearful expression: Only in anxious participants were reaction times shorter to detect danger following a fearful prime than a neutral prime. Our results tend to show that in anxiety, the hypervigilance to threat may be of an important value such as increasing the detection of a subsequent potential danger. Implication of attentional processes and attentional control is discussed.