Anxiety

Developed in the 1960s by Canadian psychiatrist Habib Davanloo, ISTDP is an evidence-based, emotion-focused therapy designed to access and process unconscious emotional conflicts that result in anxiety and the unconscious ways we try to cope with anxiety. Rather than simply teaching coping techniques, ISTDP can help you understand and experience the buried feelings that drive anxiety in the first place.

 

Understanding Anxiety Through a Dynamic Lens

In ISTDP, anxiety is seen as a signal—an alarm generated by the nervous system when difficult emotions rise toward awareness. ​You may have learned early in life that certain emotions—such as anger, sadness, guilt, or even love—are unsafe or unacceptable. These emotions may have been met with criticism, neglect, or punishment. As a result, your mind developed defenses to keep these feelings out of awareness.​

 

Using ISTDP, I help you identify this sequence:

1. Trigger in the present

2. Unconscious emotion activated

3. Anxiety rises

4. Defensive behaviors appear

 

By understanding this pattern, therapy begins to target the true source of distress.

 

The Role of Defenses in Maintaining Anxiety

A central concept of this therapy is the idea of defenses. Defenses are seemingly automatic psychological strategies used to avoid painful emotions. Common defenses include:

• Overthinking or rumination

• Avoidance or vagueness

• People-pleasing

• Perfectionism

• Emotional numbness

• Self-criticism

• Helplessness

• Humor or intellectualization

 

While defenses initially protect us, they often keep us stuck. For example, someone with social anxiety might avoid gatherings to prevent embarrassment. Avoidance reduces anxiety temporarily but reinforces fear in the long term. Using ISTDP, I gently but directly help you recognize these defenses in real time. I help you see how these patterns contribute to ongoing anxiety. This moment-to-moment focus is one of ISTDP’s distinguishing features. Therapy is active, collaborative, and experiential rather than purely reflective.

 

How ISTDP Reduces Anxiety

1. Regulating the Physiological Experience of Anxiety

ISTDP pays close attention to how anxiety manifests in the body. Anxiety can discharge through different channels:

• Striated muscles (tension, headaches)

• Smooth muscles (stomach pain, nausea)

• Cognitive-perceptual disruption (confusion, dissociation)

 

I help you observe these physical signals and build tolerance for rising emotion without becoming overwhelmed. As you develop the capacity to experience emotion safely, anxiety no longer needs to spike so dramatically. This process is sometimes described as building “affect tolerance.” Your nervous system learns that intense feelings are survivable.

 

2. Accessing and Processing Core Emotions

At the heart of ISTDP is emotional experiencing. Many individuals with chronic anxiety have suppressed powerful feelings—often anger toward loved ones, grief over unmet needs, or guilt about past conflicts. Because these emotions feel dangerous, they are blocked by defenses and converted into anxiety.

​

In therapy, when defenses are lowered and anxiety is regulated, these underlying emotions can be experienced directly. This is not about venting; it is about feeling the emotion fully and understanding its origin. When these emotions are processed, the internal conflict dissolves. Without the need to suppress emotion, anxiety decreases naturally.

 

3. Resolving Unconscious Guilt and Conflict

An important component of ISTDP is identifying unconscious guilt and self-punitive patterns.

Sometimes anxiety persists because a person unconsciously believes they deserve to suffer. This can stem from childhood dynamics where anger toward caregivers felt dangerous or morally wrong. The result may be harsh self-criticism or self-sabotage.

ISTDP helps clients confront and re-evaluate these unconscious beliefs. As guilt becomes conscious and examined, it often loses its grip. Self-compassion grows, and anxiety symptoms reduce accordingly.

 

What Makes ISTDP Different?

Many anxiety treatments emphasize symptom management. ISTDP differs in that it focuses less on changing thoughts and more on transforming emotional experience at its core. Instead of challenging a thought like “I’m going to embarrass myself,” ISTDP asks: What feeling makes this situation so threatening?

​

By resolving the emotional engine beneath anxious thinking, cognitive symptoms often shift spontaneously.

Another distinctive feature is intensity. Sessions are focused and active. I may gently yet directly point out subtle defenses in real time. This allows for meaningful breakthroughs in shorter time frames compared to some traditional therapies.

 

Research and Effectiveness

Research over the past several decades has shown that ISTDP can be effective for:

• Generalized anxiety disorder

• Panic disorder

• Social anxiety

• Somatic symptom disorders

• Treatment-resistant anxiety

 

Studies indicate that many patients experience not only symptom reduction but also long-term personality change and improved emotional resilience. By targeting root causes rather than surface symptoms, ISTDP often produces enduring results.

 

The Emotional Courage of Change

Reducing anxiety through ISTDP requires courage. It helps you to face emotions you may have avoided for decades. However, the payoff can be profound. Clients frequently report:

• A greater sense of internal calm

• Increased emotional clarity

• Improved self-esteem

• More authentic relationships

• Reduced physical symptoms

• Freedom from chronic worry

 

Anxiety shifts from being an overwhelming force to a meaningful signal—one that can be understood rather than feared.

 

Books I Recommend for Anxiety/Panic Attacks:

Facing Panic and Don't Panic - both by Reid Wilson

​

Effective Care Can Be Yours

Anxiety doesn’t have to rule your life. I’ll help you understand what’s driving your anxiety and restore confidence — whether you work with me in person or online. Aren't you tired of carrying it alone? Working with me will be:​

• Private

• Compassionate

• Evidence-based

​

Book your first session today.