The 2021 version of the S3 guideline recommends the following for anxiety disorders: cognitive behavioral therapy as the first choice. Psychodynamic psychotherapy should be offered if behavioral therapy has not been effective, is not available, or if the informed patient prefers it.
There are two forms.
Signal Anxiety signals an internal conflict: A desire or impulse is incompatible with internal prohibitions, and fear is a warning sign of this. It is directed and can be tied to specific situations.
Diffuse anxiety has no such focus. It occurs when the ability to regulate emotions and calm oneself is underdeveloped, and is often experienced as a sense of being overwhelmed.
When it comes to signal anxiety, the key is to understand and address the underlying conflict.
In cases of diffuse anxiety, a confrontational approach would be misguided. The focus here is on building skills: recognizing emotions, naming them, tolerating them, and being able to calm oneself down.
The specific form of the condition is determined at the outset. In many cases, there is also comorbidity with Depression, which influences treatment planning.
