Commentary on “Integrating the Psychoanalytic and Neurobiological Views of Panic Disorder”

Alexander, Feigelson, & Gorman have sought to create a bridge between varying perspectives on panic disorder. The anchoring for one side of the bridge is the post-1926 psychoanalytic structural model, and the anchor from the other side of the bridge is a series of observations from the neuroscientific literature which center around the amygdala and its relationships to other brain structures and activities. The span is offered in the form of classical conditioning, whereby psychoanalytic and neuroscientific constructs can be understood within a conditioning paradigm, and panic and anxiety disorders can be more richly elucidated within this paradigm. The authors state: “We are proposing a theoretical overlap between classical conditioning and the psychodynamic theory of panic disorder”. Classical conditioning has also been used extensively to study fear conditioning in the neurosciences. “We postulate that classical conditioning could serve as a link between the psychodynamic and neurobiological understanding of anxiety.” Beyond the grand effort of an integration, the authors do provide us with a summary of important findings of the functioning of the amygdala and an interesting review of classical conditioning. Others can comment upon the amygdalocentric focus in the authors' analysis of the neurobiological research; I shall attend more to matters of integrating.

Integrating models and clinical strategies have the benefit of informing novel clinical interventions and research programs from neighboring disciplines. Several authors over the past 30 years have sought to bring analytic thought into closer proximity to conditioning models, such as the work of Wachtel (1981) and Cooper (1992). It has been proposed by many that the transference-countertransference working through in the analytic process is a form of exposure and extinguishing of traumatic memories, relearning new possible outcomes to feared situations, and unlearning failed strategies of the past. For the p