Repression, Anxiety & CBT

Sigmund Freud’s “signal theory” of anxiety conceptualizes this emotion as a safeguard protecting us and others from the emergence of threatening intrapsychic and interpersonal material. Freud saw anxiety signaling the presence and press of threatening psychic content – oftentimes aggressive or sexual impulses.

Contemporary evolutionary psychology supports Freud’s formulation. Biopsychosocial analysis considers anxiety a legacy emotion, passed on to us from our early ancestors. As such it serves the same purpose as other legacy emotions like guilt and shame. Human beings are at once the most empathic and the most hostile species on earth. For homo sapiens to survive living with themselves, nature selected these emotions to inhibit acting on violent impulses that would damage individual human beings and our social fabric.

Anxiety deters displays of anger and aggression in a number of ways. First, it reminds us that anger is dangerous and to be avoided. Next, behavioral avoidance, of conflict say, is immediately positively reinforced by feelings of relief. The physiologic concomitants  of anxiety – the freeze portion of the fight/flight/freeze response –  immobilizes us, inhibiting words and behaviors that might lead to our being cast out of our kinship groups.

While anxiety is an effective mechanism for suppressing aggression, it is a maladaptive one. It’s effects, in addition to the experience of this aversive emotion itself, are physically stressful, increasing that wear and tear on our bodies called allostatic load. It’s unsurprising then that anxiety disorders are often comorbid with physical illnesses, including gastrointestinal disease, cardiovascular illness, endocrine disorders, chronic pain, migraines, dementia and Parkinson’s disease. Clearly, finding more adaptive ways of processing angry, hostile emotions could well have a huge upside for any individual.

In this professional consultation session, Matt May MD and I consult with our colleague Agnes Kalwa Ph.D. regarding an anxious patient she is treating. Matt and I first consulted with Agnes on stage at an international congress in Warsaw Poland in August, 2022. This session is a follow-up on that first consult.

About Daniel Mintie

Daniel Mintie is an adjunct professor at Georgetown University's School Of Medicine. He has a private practice in Taos New Mexico, USA and teaches cognitive-behavioral therapy at universities and training centers worldwide.

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