Anxiety

Understanding Anxiety: A Psychodynamic and Practical Perspective

Anxiety is one of the most common reasons people seek therapy. Almost everyone experiences anxiety at some point, but for some, it can feel overwhelming, confusing, or even debilitating. From a psychodynamic perspective, anxiety can tell us something about deeper conflicts or unmet needs. At the same time, cognitive-behavioural (CBT) techniques can provide practical tools for managing its intensity in everyday life.

What Is Anxiety?

At its core, anxiety is our body’s natural response to perceived threat. It’s part of our survival system: a surge of alertness that prepares us to act. This kind of “normal anxiety” helps us perform well in exams, stay safe in risky situations, or prepare thoroughly for an important presentation.

Anxiety becomes problematic when it is too intense, too frequent, or appears in situations where there is no real danger. In these cases, it can interfere with daily life, relationships, and a sense of wellbeing. One useful question to ask is: is the anxiety the problem, or is the problem the problem? For example, feeling anxious before a big deadline is natural—the deadline is the problem. But if anxiety persists even after the deadline, or becomes overwhelming in many areas of life, the anxiety itself may be the problem.

Different Types of Anxiety

Anxiety can appear in different forms, including:

• Generalised Anxiety: a persistent sense of worry or dread about many aspects of life, often without a clear focus.

• Social Anxiety: fear of being judged, embarrassed, or rejected in social situations.

• Panic Attacks: sudden, intense bursts of fear accompanied by physical symptoms like racing heart, breathlessness, or dizziness.

• Phobias: strong, irrational fears of specific objects or situations, such as flying or spiders.

• Health Anxiety: excessive worry about illness or physical symptoms.

• Obsessive-Compulsive Patterns: repetitive thoughts or behaviours aimed at reducing anxiety, even if they cause distress in the long run.

These categories help us name different experiences, but from a psychodynamic point of view, anxiety is often a signal pointing toward something deeper.

A Psychodynamic Understanding of Anxiety

Psychodynamic therapy views anxiety as more than just a symptom—it’s a messenger. Anxiety often arises when feelings, memories, or conflicts from earlier life press on us, even if we’re not consciously aware of them.

For example, if as children we felt unsafe, criticised, or unable to express anger or sadness, those feelings may not simply disappear. Instead, they can resurface later as anxiety, often in situations that unconsciously resemble earlier experiences. In this way, anxiety can reflect an internal struggle: part of us wants to express a need or feeling, while another part fears rejection, punishment, or loss.

The therapeutic task is not simply to get rid of anxiety but to understand what it is trying to communicate. By exploring the origins of these feelings—often rooted in early relationships with parents or caregivers—we can begin to see patterns more clearly. The therapeutic relationship itself becomes a place where these patterns might re-emerge, and where new, healthier ways of relating can be experienced.

How CBT Can Help Manage Anxiety

While psychodynamic therapy helps us understand why anxiety arises, CBT offers practical strategies for managing it in the here and now. CBT is based on the idea that our thoughts, feelings, and behaviours are interconnected. By changing unhelpful thinking patterns and behaviours, we can reduce the intensity of anxiety.

Some CBT strategies include:

• Challenging anxious thoughts: noticing when our mind jumps to worst-case scenarios and testing whether these beliefs are realistic.

• Gradual exposure: facing feared situations step by step, allowing our body and mind to learn that the feared outcome does not happen.

• Breathing and relaxation techniques: calming the body to reduce the physical intensity of anxiety.

• Behavioural experiments: trying out new ways of responding and observing the results, which often reduces fear over time.

These tools don’t always address the deeper roots of anxiety, but they can make symptoms more manageable, allowing clients to live more freely while they do the deeper work.

Normal vs. Problematic Anxiety

It’s important to remember that anxiety itself is not always the enemy. In fact, anxiety can be a sign of growth. For example, feeling anxious before starting a new job or entering a new relationship often reflects the risk inherent in change. In these situations, anxiety is a natural part of moving beyond our comfort zone.

Anxiety becomes problematic when it takes centre stage, making choices for us rather than alerting us to a challenge. If anxiety consistently prevents us from pursuing goals, connecting with others, or enjoying life, then it is worth paying attention to what lies underneath.

From a psychodynamic stance, this often involves asking: what feelings or needs might anxiety be protecting me from? Am I avoiding anger, sadness, or vulnerability that once felt too risky to express? By exploring these questions, therapy helps to transform anxiety from a paralysing force into a guide that points us toward deeper self-understanding.

Integrating Approaches

For many people, a combination of approaches is most effective. Psychodynamic therapy offers the chance to understand the roots of anxiety and make sense of recurring patterns, while CBT provides immediate, practical tools to reduce distress. Together, they help clients not only cope with anxiety but also transform their relationship to it.

Moving Forward

Anxiety does not have to dominate life. With curiosity, compassion, and the right support, it can become a doorway to greater self-awareness and resilience. Therapy provides a space to both relieve the symptoms of anxiety and explore what lies beneath, allowing clients to build a life that feels freer, more grounded, and more authentic.

In summary: Anxiety is part of being human. It can be helpful or problematic depending on its intensity and context. Psychodynamic therapy helps uncover what anxiety is really about, while CBT offers tools for managing it in daily life. By combining insight with practical strategies, therapy helps clients face anxiety with greater understanding and confidence.