Getting to the Hidden Cause of Anxiety

David Burns on the Origin of His Hidden Emotion Technique

David Burns

I began my career as a biological psychiatrist at the University of Pennsylvania during the early ’70s, the opening years of psychopharmacology’s appropriation of psychiatry. At the drug company presentations at the conferences I attended, I heard that 85 percent of depressed patients could be treated effectively with meds, but soon discovered otherwise. While some of my patients improved a bit, many others continued to suffer, no matter how many drugs I prescribed or how long I listened and supported them with traditional talk therapy.

I began looking for a new and different treatment method to supplement the drugs, and my department chairman suggested I try the relatively new CBT approach, but I was highly skeptical. To my amazement, however, CBT seemed to work a lot better than medications and talk therapy, and clients liked it. Sometimes, the results were fast and spectacular, even with discouraged clients who’d tried years of talk therapy and meds without much success.

It seemed obvious that negative thoughts triggered anxiety, but what caused the negative thoughts? What was it inside a person that made him or her so vulnerable to intense anxiety and insecurity?

Then one day, one of my patients got me to thinking about anxiety in an entirely new way. Margaret was a 25-year-old married woman who came to me because she was struggling with panic attacks at work. She was working as an administrative assistant for a man with a wholesale soda pop distributing company. Her father had helped get her the job through a family friend. Although she was doing good work and got along well with her boss, every time he walked past her desk, she developed feelings of intense nausea and had the urge to vomit.

I felt there must be something else going on, but had no idea what. I asked if she was angry or unhappy with her boss, but Margaret insisted, quite believably, that she admired him greatly. He treated her well, constantly sang her praises, and paid her well. She was happily married and had no conflicts with anybody.

Margaret had been working with the list of cognitive distortions from my book Feeling Good. One day, she asked whether All-or-Nothing Thinking, one of the distortions listed, could apply to family dynamics. When I asked what she was thinking about, she said that when she’d been growing up, she’d always been expected to be a model citizen and perfect lady. She became studious, bookish, and hardworking, getting straight A’s in school. As her parents said repeatedly, she was a “very good girl.”

Margaret went on to explain, however, that she didn’t always want to be such a nice, compliant girl. Then she confessed that she secretly hated her job. She said that ever since she was a little girl, she’d always dreamed about being a dress designer, adding that she was good at art and had a talent for fabrics, color, and fashion.

A possible meaning of Margaret’s symptoms jumped to mind. Could her panic attacks be her way of saying, “This job makes me sick,” or “I can’t stand working here,” but instead of verbalizing her feelings, her symptoms allowed her to play the sick role and say, “I just can’t do this any more.” This idea resonated with Margaret, and she brightened up immediately. She left determined to talk things over with her boss and her husband.

At the start of the next session, much to my shock, a beaming Margaret announced that she’d talked things over with her husband and boss, who both supported her desire to change careers. “And,” she said triumphantly, “I haven’t felt panicky or sick to my stomach even once since telling my boss.” Six months later, Margaret sent me a thank-you note explaining that she’d found a job as an apprentice to a woman who manufactured women’s clothing, had never had another panic attack, and was still doing great.

Exploring the Hidden Cause

At first, I thought that Margaret’s case was just an isolated example, but over time, I began to notice the same pattern with more and more anxious patients who seemed stuck. I started asking them if there was something going on in their lives that they hadn’t told me about—something that was bothering them. At first, they’d all deny it, but after a few sessions, a hidden emotion or problem would emerge. It seemed that these patients were trying to teach me something important about the deeper causes of anxiety, something that wasn’t a part of my CBT training. They were giving me a new tool I decided to call the Hidden Emotion Technique.

The vast majority of these patients were exceptionally nice individuals who felt a strong urge to please others. In fact, most of them seemed to exhibit---beneath their panic attacks, anxieties, and fears—phobias about conflict, anger, or negative emotions of any kind. They seemed to experience a kind of emotional perfectionism, the belief that they should always be happy, pleasant, calm, and totally in control of their feelings, even at the expense of their own desires and emotional needs.

In other words, when anxiety-prone individuals get feelings or urges that don’t seem “proper” or “acceptable,” they sweep them under the rug without realizing they’re doing this. Then they suddenly develop a phobia, a panic attack, or OCD symptoms and completely lose sight of the hidden problem or feeling that triggered the anxiety in the first place.

From my work with large numbers of clients with every conceivable type of anxiety, I’ve learned more about the nature of the hidden problems that trigger the symptoms. Anxiety is a kind of creative poetry that the brain automatically generates, much like dreaming. As a therapist, you have to “listen” to the poem to detect the symbolic meaning.

This blog is excerpted from “Living With the Devil We Know". Read the full article here. >>

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Topic: Anxiety/Depression

Tags: behavioral therapy | cbt | cognitive behavioral | cognitive behavioral therapy | David Burns | depression | drugs | emotion | family | ocd | ocd symptoms | panic attack | panic attacks | parents | psychotherapy | therapist | therapy | networker | Feeling Good

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Sunday, July 5, 2015 2:57:32 PM | posted by Bronah Livingston
Thank you David for sharing great examples of how you uncover the hidden anxiety that fuels resistance. IFS does similar work by having the Self of client validate positive intention of anxious parts. Seeing this through the eyes of CBT further validates the power of "being with" before facilitating change. When the client leads change, lasting change can occur! Thanks for all the ways you share your wisdom...I grow each time I read...and reread...your books and articles.

Sunday, July 5, 2015 1:05:26 PM | posted by Nancy Segelstein
" Talk therapy" about the psychodynamics of ones history of interpersonal relations - the term now has days has a negative connotation. But in my opoinion it's the only therapy that works - eventually everyone ends up there. I hope it's still being taught in our higher learning institutions. I find it hard to believe that this psychiatrist thinks that he just came up with this idea. It's been around a long, long time.