Charles Darwin (1809-1882), an English scientist, observed that the structures that produce panic distress in humans derive from the same evolutionary roots as a rat’s “fight or flight” reaction, which leads many to believe that anxiety, despite all philosophy and psychology, is also a biological phenomenon that does not seem to differ much between animals and humans (Stossel, 2014).
The psychotherapist and novelist Barry E. Wolfe, noted in his book “Understanding and Treating Anxiety Disorders (2005) that: “No one who has been tormented by prolonged bouts of anxiety doubts its power to paralyze action, stimulate flight, annihilate pleasure, and imbue thought with a catastrophic bias… The experience of chronic or intense anxiety is, above all, a profound and disconcerting confrontation with pain.”
Therefore, when we reduce anxiety to its physiological components, we lose the true meaning of this symptomatology, since human beings react to events such as death, consciousness, guilt, despair, and daily life, whereas an animal cannot worry about the symptoms it presents or interpret them in any way; that is, an animal cannot be a hypochondriac, for example (Stossel, 2014).
Anxiety is the fear of future suffering; the apprehensive anticipation of an unbearable catastrophe that one, as a person, cannot prevent. More deeply, it is a sign that usual defenses against certain unbearably painful events for the individual are failing.
In consultation, many patients, before facing the reality that their marriage is failing, that their professional career has not turned out as they expected, that they are approaching death or even, that they are going to die, generate defensive distraction symptoms, transforming psychic tension into panic attacks or generalized anxiety, and even developing phobias in which they project their internal tension (Stossel, 2014).
S.S. is a patient who presents numerous phobias. Due to this, imaginal exposure techniques have begun to be used in psychotherapy sessions. Previously, a hierarchy of feared situations was established, and then a simulated deconditioning was performed in which the patient had to represent certain images while doing relaxation exercises to reduce the anxiety they produced.
Although the patient was safe in the office and even had the freedom to interrupt the exercise at any time, the simple act of imagining the feared situations represented a torment of anxiety. The simplest and most unreal images (seeing oneself shaken by airplane turbulence and getting dizzy, for example) generated sweat and hyperventilation in S.S., who sometimes left the office to breathe and calm down.
Throughout the sessions, the patient was asked to concentrate and think about what exactly generated anxiety for them. S.S. found it very difficult to answer the question and only insisted that when they were in front of the phobic stimulus, they could not concentrate because they felt such terror that the only thing they thought about was “fleeing from the horror, from their consciousness, from their life, and from their body.”
After five sessions applying imaginal exposure, S.S. found that when trying to confront the phobia, a feeling of sadness distracted them, and their mind began to wander aimlessly. When asked what they felt, the patient replied, “I feel a certain sadness,” and burst into tears. The therapist reassured them by saying, “We have found something.”
These outbursts of sadness were repeated in subsequent sessions, and S.S. began to feel relatively less anxious, and even happier. The therapist commented that they “had reached the heart of the wound.” The patient asked why anxiety was stronger than sadness and “afflicted” them more frequently. The therapist concluded with a reflection: “No matter how much a wound makes you cry, it is less unpleasant than the terror you feel when flying through turbulence.”
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