Treating Anxiety

All theories of anxiety disorders attempt to explain and organize what is

known about fear and anxiety. Some of the theories, including the ones described

here, also have been applied in developing treatments for anxiety

disorders. As might be expected, clinical psychologists with very different

ideas about the cause of anxiety will recommend very different treatments

to eliminate it.

In the case of Little Hans, Freud thought that his anxiety about horses was

caused by repressed sexual impulses toward his mother and hatred of his father.

From this, it follows that these repressed impulses would need to be

brought out into the open and resolved before his anxiety about horses

would diminish. This was the basic goal of the psychoanalytic therapy Freud

recommended for Hans.

On the other hand, if Hans’s parents had taken him to a behaviorally oriented

therapist, the therapist would have assumed that the child’s fear

stemmed from a fright he suffered in the presence of a horse. In fact, Freud

stated that the phobia began when Hans saw a horse fall while pulling a bus.

Further, the therapist would assume that now Hans was rewarded for avoiding

horses by anxiety reduction and by getting extra attention from his parents.

Treatment would involve having the boy gradually think about, look at,

and even pet horses, and it would include being rewarded for approaching

(rather than avoiding) horses.

Given these vastly different theories and treatments, a question arises as

to which one is right. The theoretical issues are still debated, but it is clear

that treatments based on a behavioral model of anxiety are much more successful

in reducing fear than are treatments based on the theories of Freud

or his followers.