Hoffmann S O, Bassler M
Klinik für Psychosomatische Medizin, Universität Mainz.
Z Arztl Fortbild (Jena). 1995 May;89(2):127-32.
Three main concepts in the development of anxiety are important in psychoanalysis: 1. the conflict model assuming that anxiety is initiated by the Ego in dangerous situations, when usual coping strategies fail, 2. the structural model that essentially describes that with general weakness of the adaptive Ego-functions even common conflicts cannot be mastered adequately and, therefore, anxiety as an affect arises quickly, and 3. the ethological model assuming that anxiety is closely connected with ethologically founded needs of binding: with threat of loss of binding, the child reacts anxiously, mobilising care impulses of the parents and, thus, counteracting this threat. It is essential for the psychotherapy of anxiety disorders whether the patient exhibits an Ego-structural weakness requiring an active strengthening of the coping abilities of the Ego, or whether a more conflictual genesis of his anxiety should be assumed-in this case, the disclosure of the frequently unconscious background of the conflicts promises to be successful. Altogether, a more active and encouraging attitude of the therapist is preferable for the psychotherapeutic treatment of anxiety disorders to motivate the patient to directly confront himself with his anxiety symptoms.
在精神分析中，焦虑发展的三个主要概念很重要：1. 冲突模型，该模型假定焦虑是自我在危险情况下、常规应对策略失效时引发的；2. 结构模型，该模型本质上描述了随着适应性自我功能普遍薄弱，即使是常见冲突也无法得到充分掌控，因此焦虑作为一种情感会迅速产生；3. 习性学模型，该模型假定焦虑与基于习性学的依恋需求密切相关：面对依恋丧失的威胁，儿童会产生焦虑反应，调动父母的关爱冲动，从而应对这种威胁。对于焦虑症的心理治疗而言，关键在于患者是表现出需要积极增强自我应对能力的自我结构弱点，还是应假定其焦虑有更多基于冲突的成因——在这种情况下，揭示冲突通常无意识的背景有望取得成功。总体而言，治疗师采取更积极且鼓励的态度对焦虑症的心理治疗更为可取，以激励患者直接面对自己的焦虑症状。
