Anxiety, Panic Attacks, and Phobias

Anxiety has been important in shaping psychodynamic therapy. Sigmund Freud’s efforts to understand anxiety led him to explore how hidden fears and emotions affect our thoughts, feelings, and relationships. Today, anxiety and panic attacks are still among the main reasons people look for therapy.

Although anxiety, panic attacks, and phobias are often spoken about together, they are not the same experience. Understanding the differences may help you make sense of what you are going through and reduce confusion, fear, or self-blame.

Anxiety

Anxiety is a normal response to uncertainty or possible danger. It is how our mind and body try to protect us. When we sense danger, whether physical or emotional, our nervous system prepares to act. Fear usually happens when there is real danger, but anxiety often comes from expecting something bad to happen. The body reacts as if there is a threat, even if there isn’t one. So, anxiety is often about what could happen, not what is happening.

In psychodynamic therapy, anxiety is not just seen as something to get rid of. It can be a sign of hidden emotional conflict or a signal that something important needs attention. Worrying about the future, though uncomfortable, can help us be creative, reflect, and make decisions. Sometimes, we find solutions by imagining what might happen. A little anxiety can also help us question ourselves, grow, and adapt. In small amounts, it can make us more alert, careful, or motivated. Problems start when anxiety becomes too strong or happens too often.

Anxiety is usually a steady, ongoing feeling instead of a sudden event. It can show up as constant worry, overthinking, feeling tense or restless, trouble relaxing, poor sleep, or mental fatigue.

Anxiety is not a sign of weakness, personality flaws, or lack of ability. Even people who seem calm or confident may struggle inside. Anxiety can affect anyone, children or adults, people in relationships or alone, and at any stage of life, especially during stress, change, or loss.

For example, in The Queen’s Gambit, Beth Harmon’s anxiety shows up as intense pressure to succeed, fear of losing control, and using self-reliance and substances to cope with strong feelings. Even though she is very talented, she still feels unsettled inside. Winning only gives her short relief before the anxiety comes back.

Panic Attacks

Panic attacks are more common than many people realise. Many people will have at least one panic attack in their lives. For some, it happens during a stressful time. For others, panic attacks keep happening and become part of ongoing anxiety.  During a panic attack, the body’s fear system suddenly and powerfully activates, even when there is no immediate danger. The fear feels very real because the body reacts as if life is under threat. Although terrifying, panic attacks usually last only a short time.

During a panic attack, people might feel short of breath or like they are choking, dizzy, shaky or sweaty, have chest tightness, and fear losing control, dying, or that something awful will happen.

Unlike anxiety, panic attacks are sudden and not ongoing. Many people feel calm between attacks but worry about when the next one will happen.

A strong example is in The Sopranos. Tony Soprano has repeated panic attacks that come without warning and sometimes make him collapse. These attacks are a main reason he starts therapy. His panic attacks do not happen during clear danger, but when he is stressed or vulnerable, often without knowing it. His body shows what is too hard for him to face emotionally.

Phobias

Phobias are some of the most common anxiety problems. A phobia is a strong and lasting fear of a certain object, situation, or experience. The fear feels much bigger than the real danger, but it is very real to the person. Phobias are not habits that can just be turned off.

People with phobias often know their fear is stronger than it should be, but knowing this does not make it go away. Fear leads to avoiding what is scary. Avoiding the feared thing brings short-term relief, which teaches the brain that avoidance is needed to stay safe. Over time, this makes the phobia stronger, and the fear feels even more real.

Common phobias include fear of certain animals, flying, heights, tight or crowded spaces, and social situations.

For example, in Finding Nemo, Marlin becomes afraid of the open ocean after a traumatic loss. His constant worry and avoidance show how fear can come from wanting to protect what matters most.

Another form of phobia is agoraphobia, which is often misunderstood as a fear of open spaces. In reality, it is a fear of being in situations where escape might feel difficult or help may not be available, such as crowded places, public transport, shopping centres, queues, or being far from home. This fear is frequently associated with panic attacks and can lead to increasing avoidance and isolation over time.

A Psychodynamic Perspective

Psychodynamic therapy is about looking a bit deeper, rather than just trying to stop the symptoms. Anxiety, panic attacks, and phobias are seen as responses that make sense in the context of someone’s life, often shaped by earlier experiences that still have an influence today.

In therapy, fear, worry, and avoidance are looked at together in a safe and supportive space. As people begin to understand what is happening to them, symptoms often feel less frightening and easier to live with, making day-to-day life feel less restricted.