Table 1.

Relationship between Psychodynamic Theory and Interventions for Anxiety in CAPP

Anxiety Disorder Features	Psychodynamic Theory in CAPP	Target Symptoms and CAPP Strategies
Social Phobia	Extreme self consciousness and fears of embarrassing oneself are linked to conflicted wishes to be the center of attention and laced with guilt and self-punishment; normal desire for attention feels unacceptably aggressive	Explore defenses against wishes to stand out, conflicted patients’ overly critical evaluation of others as entrée to connections with uncomfortable competitive wishes and conflicted, unacceptable aggression. This raises SSRF.
GAD	Extreme inability to relax, hypervigilance, and dread of many life situations arises from conflicts related to personal meanings of curiosity and exploration of new and novel situations; normal curiosity and desire for exploration is associated with feeling dangerously out of control and overwhelmed.	Focus on terror of internal urges, including aggression and desire for autonomy. Emerging fantasies actively connected with symptoms and persistence of anxiety. This raises SSRF.
Separation Anxiety	Severe, developmentally inappropriate separation distress arises from conflicts between normal strivings for autonomy and concerns about hurting or infuriating the emotionally-needed parent. Clinging to parent leads to anger at parent and self; normal strivings for autonomy are associated with feeling unacceptably lonely and frighteningly rejecting of the parent.	Explore transference, an emotionally vibrant paradigm for understanding and altering separation fears. Intensity (2×/week) and brevity (12 weeks) are key CAPP aspects making emotional significance of termination central to the final third of treatment. This raises SSRF.
Anxiety re. establishing age appropriate autonomy, common to these disorders	Conflicts and fears about normal autonomy (i,e. growing wish to manage by oneself, curiosity and independence) common in SP. GAD, and SAD patients emerge in transference. Assertiveness (seeking attention, exploring and attempts at independence), perceived as destructive anger, creating conflict.	CAPP focus on transference highlights conflicts about autonomy, especially as incorporated into fantasies of bodily harm; sense of inadequacy is experienced as physical anxiety and symptoms.
Comorbid major depression-when present	Conflicted aggression leads to guilt and negative self-evaluation, depressive symptoms, and somatic anxiety	CAPP focus on conflicted aggression detoxifies and helps patient redirect it, improving autonomous function and assertion. Mitigates guilt, with improvement in autonomy, negative views of self improve.