FOCUS TV at the Angstambulanz: “From Ten Years of Anxiety Disorder to Treatment Success in Ten Hours”

What Has Not Improved in a Quarter of a Century

The following report documents the findings of the year 2001: a representative study by the Technische Universität Dresden with more than 20,000 patients showed that two thirds of generalized anxiety disorders went unrecognized by general practitioners and that the remaining third was almost exclusively mistreated. The mean duration of therapy was over 40 hours for behavioral therapy, over 70 hours for depth-psychology-based methods, and over 120 hours for analytic ones. On average, those affected reached a suitable psychotherapist only after seven to ten years.

And today? Switzerland affords itself the highest density of psychiatrists in the world with an average treatment duration of around 60 months, the number of psychotherapy practices has doubled since 2022, and the costs of outpatient psychotherapy borne by basic health insurance have risen to more than 900 million Swiss francs a year — while the mental strain on the population and the number of invalidity pensions granted for mental illness keep growing.^1,2 The psychotherapy researcher Klaus Grawe had already proven in 1994 that cognitive psychotherapy is “highly significantly” more effective than psychoanalysis and client-centered psychotherapy³ — the psychoanalysts and client-centered psychotherapists responded with a “flood of indignant reactions” and went on practicing as before.

The present supplies the punch line: what Volker G. documented on camera in 2001 - the cure of a ten-year anxiety disorder in ten hours - was denounced as “misleading” by the Assoziation Schweizer Psychotherapeutinnen und Psychotherapeuten (ASP), the Association of Swiss Psychotherapists, in a formal complaint in 2025⁴ — although the NICE guidelines for anxiety disorders recommend cognitive behavioral therapy of seven to fourteen hours in total.⁵ The profession's progress thus consists not in finally delivering the rapid cure, but in having its mention prohibited. That Swiss parliamentarians are simultaneously demanding that “psychotherapies be removed from the benefits catalog again”⁶ is the logical receipt.

The Angstambulanz: An Impossible, Because Unwanted, Institution

That no one except the anxiety sufferer himself has an interest in the elimination of his anxiety is not a conspiracy theory but one of the oldest insights of political theory. Niccolò Machiavelli answered the question whether a ruler is better loved or feared, in his book “The Prince,” printed in 1532, with disarming sobriety:

“It is far safer to be feared than loved if one must choose between the two. [...] For love is held by a bond of obligation which men, because they are wicked, tear apart at every opportunity that serves their own advantage; fear, however, is held by a dread of punishment that never abandons you.”

Niccolò Machiavelli Il Principe (The Prince). Written in 1513, first printed in 1532.⁷

The love of the citizens depends on the goodwill of the citizens; their fear the rulers can generate and dose themselves. What Machiavelli described for the principality, H. L. Mencken transferred to modern democracy in 1918: the whole aim of practical politics, he wrote, is “to keep the populace alarmed (and hence clamorous to be led to safety) by an endless series of hobgoblins, most of them imaginary.”⁸

In this web of interests, an Angstambulanz that corrects anxiety disorders in ten hours is an anomaly foreign to the business. It works against the government, which needs fear as an instrument of steering; against physicians, clinics, and the pharmaceutical industry, which profit from the rich symptom spectrum of anxiety; and against those psychotherapists whose business model is designed for 40, 70, or 120 hours. The most precise analysis of this economy comes from a patient whose question is quoted in the interview below: “Mr. Luchmann, how can you make a living from psychotherapy if you need only ten hours per patient?” It is Machiavelli's insight in economic translation. The only one with a vital interest in the elimination of an anxiety is its bearer: the patient. In this system, an Angstambulanz is therefore not a matter of course but an impossible - because unwanted - institution.

Against this background, to the question of the FOCUS TV editor whether the anxiety states triggered by terrorist attacks needed to be treated, there was only one realistic answer in 2001:

“If it is of use to the government to generate anxiety in its citizens, it will hardly really want those anxiety states to be treated successfully.”

Twenty years later, NATO declared the human mind the sixth domain of warfare⁹ — Machiavelli's doctrine for princes, carried forward as military doctrine. Whoever wants to understand why a system does not heal anxiety but uses and cultivates it will find the key here.

Attentive readers will further notice that the text of 2001 already describes the way of working that declares therapist-accompanied practice components dispensable, because purely cognitive work enables patients to accomplish the relearning in everyday life on their own — the position that clearly distinguishes cognitive behavioral therapy from cognitive psychotherapy¹⁰ and today forms the basis of Written Cognitive Psychotherapy (WCP).

Terror in the Mind: “From Ten Years of Anxiety Disorder to Treatment Success in Just Ten Hours”

Editorial report on the visit of FOCUS TV on October 12, 2001, to the Angstambulanz at the Institute for Cognitive Psychotherapy, Stuttgart

Zeitschrift PSYCHOTHERAPIE
December 19, 2001

They suffer for ten years on average, often ruin their lives, and cost the German economy between 50 and 100 billion euros a year — people with anxiety and panic disorders. Responsibility for this scandalous situation lies with physicians who let this illness drag on in their patients for years, although anxiety and panic disorders can be treated successfully within ten to 15 hours — without medication, with cognitive behavioral therapy alone. Volker G. is one of those affected — one of some 12 million Germans. For more than ten years, anxiety destroyed his life — until, in ten hours of psychotherapy, he found the way out of his anxiety. Talking to FOCUS TV, he described his painful experience of the perfectly ordinary horror of the German healthcare system.

Volker G., a client of the Angstambulanz, talking to editor Sabine Kreyssig of FOCUS TV in one of the consulting rooms of the Angstambulanz at the Institute for Cognitive Psychotherapy in Stuttgart, October 12, 2001.

It was his final session at the Angstambulanz when FOCUS TV approached the Institute for Psychotherapy in Stuttgart for a feature on the subject of “anxiety.” Volker G., 26, had been suffering for more than ten years from an anxiety and panic disorder that had increasingly restricted his freedom of movement and capacity to act and had cost him many opportunities for personal development and career. His cognitive behavioral therapy, which led him to “tangible changes” and gave him back his freedom of movement and action, cost only around 1,500 euros.

G. was glad to speak about the development of his anxiety and the futile treatment attempts that preceded it, in order to spare other people with anxiety and panic disorders a similar history of suffering. In the interview with editor Sabine Kreyssig of FOCUS TV on October 12, 2001, he reported on his successful psychotherapy with the psychologist and psychotherapist Dietmar Luchmann and on the preceding decade-long anxiety and panic “career” that better information would have spared him.

The Patient

Volker G.: “It is only for a little more than three months now that I have known the exact name of an illness that influenced and lastingly shaped my life for more than a decade: anxiety and panic disorder.”

“Only by a lucky coincidence did a specialist book on the subject fall into my hands in a bookstore. In all those years, no physician had recognized this illness — and God knows I saw the general practitioner, the neurologist, the internist, the psychotherapist often enough [...]”

“Triggered by breathing difficulties caused by a pollen allergy, I developed a panic-stricken fear of a possible asthma attack during puberty. From then on, this fear of suffocation appeared more and more often in new, unfamiliar situations. As the symptoms of the anxiety disorder intensified, so grew the fear of the next anxiety attack, the so-called ‘fear of fear.’”

“Six years have now passed since my Abitur. The price of this illness: an abandoned university course and two study places never taken up in the later attempts to overcome the anxiety after all [...]”

“These ‘ruptures’ in my life were ultimately all closely connected with the fear of panic attacks, of living in big cities, and of contact with people who did not know or understand my problems with anxiety.”

“After successfully completing a commercial apprenticeship last year, I decided to start a degree once again. Unfortunately, the anxieties I had long believed overcome flared up anew.”

“My general practitioner talked me round (as so often before), prescribed a ‘modern anxiety-relieving medication,’ and advised me to take up the study place. In terms of confronting the anxiety, the latter was not even wrong, but after years of an anxiety career it was completely useless advice. The neurologist told me (as he had six years earlier) that I was perfectly healthy, needed no medication, and should ‘find a new girlfriend as quickly as possible’ at my place of study, and then everything would sort itself out!!!”

“My bitter realization: apparently, in Germany you only need to read a short scientific paper on the current state of anxiety and panic research, and you already know more about the illness and the treatment methods than a general practitioner or a neurologist with additional psychotherapeutic training!”

“The search for a suitable anxiety therapist finally proved more difficult than expected. Useful outpatient or inpatient short-term therapy hardly seems to exist for people with statutory insurance — at least, it appears, not at the insurer's expense. Psychotherapists in private practice immediately ask on the phone ‘private or statutory?’ and have no free appointment for statutory patients for months. Two ‘behavioral therapists’ I consulted worked without any recognizable concept for anxiety patients. With one of them, you seemed to get help only once you had become a ‘regular insurance customer’ after five sessions, i.e. once the health insurer had approved a course of therapy exclusively with him [...]”

“I was in poor mental and physical condition when I turned to Mr. Luchmann in July 2001. The anxiety was now almost permanently present; I hardly drove my car alone anymore, and driving on the autobahn was impossible for me. At that point I was extremely neurotic and depressed. I felt unable either to begin my studies or to look for a job.”

“It even went so far that I could no longer carry out the simplest tasks, such as writing an e-mail, because I no longer trusted myself to write reasonably good, error-free German!!! This ‘writer's block’ was successfully ‘dissolved’ at the start of the cognitive psychotherapy with Mr. Luchmann.”

“After that I needed about ten more hours of therapy, in which Mr. Luchmann taught me the instruments for changing my self-destructive ways of thinking and behaving. The first successes soon appeared: at the beginning of the treatment, for example, I still took the train to Stuttgart; after just a few hours of therapy I managed the journey by car — alone.”

“Having completed the cognitive psychotherapy at the Angstambulanz, I can say that in a few hours I have gained knowledge that is changing my view of life and my way of dealing with anxiety. I will still need some time to change my ingrained thinking and behavior in various areas of life. The most important thing, however, is that I have acquired a new relationship to my anxiety — and that was immediately ‘tangible’!”

The Bottom Line

Volker G., with his decade-long anxiety and panic disorder, is a typical case at the Stuttgart Angstambulanz. Typical is the avoidable suffering, typical are the avoidable costs, and typical is the extremely small therapeutic effort required to end both suffering and costs. G. knows that he will still have to consolidate what he learned in those few hours. In a few weeks he can then have shed the false thought patterns and behaviors practiced over many years. Whether his health insurer will reimburse the comparatively modest costs of the outpatient cognitive psychotherapy is uncertain. The “staggering sums” for medical diagnostics, medication, and hospital stays, on the other hand, are paid — a grotesque situation in a sick healthcare system.

“Given that I had already paid around 30,000 DM elsewhere for my anxiety disorder of several decades' standing, without success, I would have wished to find my way to Mr. Luchmann earlier,” another client wrote on October 16, 2001. Psychotherapist Luchmann received a copy of this letter to the health insurer, in which the client requests reimbursement of “8 sessions with Mr. Luchmann”: “The therapy was worth it and has already changed my life for the better. I wanted to inform you of this. Many thanks,” the letter says.

Luchmann, whose clients include managers as well as students, carefully covers the sender's name on the letter. “Confidentiality is our highest good and limits the references we can give.” He calls it a scandal for the German healthcare system that mental disorders are predominantly mistreated by physicians out of ignorance and greed, and that the health insurers squander enormous sums on pointless psychoanalyses and superfluous psychosomatic clinics.

Those seeking help at the Institute for Psychotherapy who are privately insured or voluntary members of a statutory health insurance fund generally have a legal claim against their insurer for reimbursement of the costs of effective cognitive psychotherapy. Compulsorily insured members of the statutory funds, by contrast, will often have to pay for the program out of their own pockets — or go on suffering in a sick healthcare system. “Health policy has failed completely here. In view of the unimaginable corruption and mistreatment to be observed in the medical business in general and in psychotherapy in particular, the media have a special role to play in public education,” says Luchmann — and turns to the online registrations at the Institute for Psychotherapy: “These people, at least, we can help.”

Ways Out of the Psychological Trap of Anxiety and Panic: What the Psychotherapist Recommends

The questions were put by Sabine Kreyssig of the FOCUS TV editorial team to Dietmar Luchmann, psychologist, psychotherapist, and head of the Angstambulanz at the Institute for Cognitive Psychotherapy, Stuttgart.

The Interview

Sabine Kreyssig: What exactly is anxiety, is there a definition?

Dietmar Luchmann: Anxiety is the name given to an emotional state, experienced as unpleasant, that signals danger or threat. An anxiety disorder arises when, in dealing with the states of arousal of one's own body, a person does not make expedient use of his reason but lets himself be guided by feelings. That is why the most successful instruments for correcting anxiety disorders are those of cognitive behavioral therapy. They start at cognition, at thinking, and correct those errors of thinking that lead to anxiety and its many disorders.

A considerable proportion of employees, for example, fear for their jobs. Millions dread bullying by colleagues or superiors. Private circumstances such as family problems, illness, or other risks of life can also generate anxiety. With their reporting, the media of the information society frequently feed and sharpen the perception of these real and supposed dangers and threats. The individual awareness of existential and life risks conveyed in this way can become increasingly distorted and exaggerated and lead to persistent, subliminal anxiety. More and more people are driven by this latent anxiety into a state of chronic tension that hollows out their physical and mental capacity over many years.

In a broader sense, the term anxiety often also covers those anxiety states that amount to illness. At the onset of an anxiety disorder, however, many people are unable to recognize the resulting physical symptoms as the expression of an anxiety that, though pathological, is easily treatable by psychotherapy. Fixated on organic medicine, and given the pronounced reluctance in Germany to consult psychotherapists, they drag out their phobic illness, their anxiety and panic disorder, often for many years.

How differently do anxiety states manifest themselves, what are the symptoms?

Luchmann: Anxiety often arises from the repetition of unpleasant physical sensations that those affected perceive in themselves. The physical symptoms range from tension through dizzy spells and trembling to sweating, a racing heart, and shortness of breath in a panic attack. As a rule, however, these symptoms are not associated with anxiety. The perceived bodily reactions are explained by seemingly natural causes: overexertion, too much coffee, a meal too small or too long ago, trivial annoyance, or simply everyday stress. That in the process one's thinking about these changes in well-being and bodily symptoms itself changes goes regularly unnoticed for lack of knowledge. Thus, unnoticed, a phobic and anxiety-laden observation and perception develops, of one's own body as well as of one's surroundings. The typical development of an anxiety disorder begins when, in certain situations or in a specific context, the anxiety-laden perceptions and the symptoms reinforce one another.

What stages are there, from mild anxiety states up to panic attacks?

Luchmann: In anxiety and panic disorders the spectrum is so broad and multiform that it exceeds ordinary imagination. For anxieties there is therefore no meaningful scale like that of Saffir-Simpson, which categorizes hurricanes, or that of Charles Richter, which classifies the intensity of earthquakes. The transitions from mild anxiety states to panic attacks are fluid and are often determined by factors that are not apparent at first glance but that lead decisively to different outcomes. The concrete form an anxiety takes is influenced, for example, by the manner - regularly unknown to those affected themselves - of their phobic thinking, feeling, and behavior. This typically includes avoidance behavior, which can develop to a greater or lesser degree depending on the specific problem situation. Let us consider two examples to illustrate the range of phobic developments:

Example one: a perceptive and sensitive woman, a scientist, who has been doing her job satisfactorily for years with the same employer and has grown organically into her current leadership position as head of a laboratory with a medium-sized team. If, in her role as a superior, this woman is now confronted or rejected more and more critically and disrespectfully by younger staff, she may succeed for a very long time in sidestepping the unpleasant situations, in avoiding them. All the same, her tension and latent stress will probably increase continuously. The first physical stress symptoms will appear. Thus there gradually develops - perhaps over years - a fear of failure, a fear of criticism and rejection, which leads not only to exhaustion but, at some point, given a triggering stressful event, to physical collapse. Whether with or without an accompanying panic reaction will hardly make a difference. The path to the general practitioner will probably lead to inpatient admission to a clinic — with the probable diagnosis of depression. In reality, behind these events lies a concealed development of anxiety, of “mild anxiety states” that were never recognized as such but that in consequence have almost completely used up this woman's physical and mental resources. To lead such a client out of the desolate end state of a long-lasting stage of “mild anxiety” requires correcting phobic thinking that has been deeply ingrained over many years and overcoming the resulting profound exhaustion.

Consider as a second example the case of an equally perceptive and sensitive young woman who, on some occasion or other, has drunk too much black tea, which then presses on her bladder more strongly than she finds comfortable. This inconvenience strikes her in a situation with other people in which she cannot relieve herself. The stronger the pressure in her bladder becomes, the more her tension rises and the greater grows her worry of being exposed to a great embarrassment if she loses control of herself or of her bladder. Thoughts such as “Oh my God” or “I hope I can still make it” will presumably then arise; her imagination will drown in horror fantasies of her own loss of control; and finally these thoughts and images will begin to rotate in her brain — until they are literally racing through every nerve cell of her body. She will become increasingly cramped, breathe in gasps, get goose bumps or break out in sweat, and begin to tremble. Hot flushes will chase through her body, and she will have the feeling that she could faint at any moment. Although the woman may manage to conceal her condition from others, we can call it panic. What matters in this example is that this experience of panic has burned itself so firmly into the young woman's emotional memory that later, at the slightest perception of her bladder, she is seized by the fear of wetting herself, and her thinking begins to orient itself toward the search for a toilet. Since the bladder is controlled by the brain, this worry about wetting herself acts in turn, as a mental stressor, to activate the bladder, and consequently leads to a self-reinforcing process of anxiety development. Visits to the cinema or the theater become difficult or impossible; moving about in public - using bus and train, for example, shopping, and going for walks - becomes more complicated. In her fear of not making it to the next toilet, she will use every opportunity along the way to visit a toilet purely as a precaution. She will eventually develop elaborate movement patterns for “hopping” from toilet to toilet in public. If she is lucky, this behavior will begin to annoy her partner so much that she is prompted to come to us. Then this incipient anxiety development is stopped at the outset. If she is less lucky, or has no partner, her thoughts, directed at finding toilets and avoiding potentially problematic situations, will probably take up more and more space and imperceptibly drive the young woman into an anxiety development that restricts her life more and more.

At the end of such a phobic process, which can be filled with a thousand different anxiety contents, there often stand a broken career or even the loss of one's job, the loss of friends, and social isolation. The examples make clear that anxiety careers can develop completely unnoticed over a long time before any visible eruption of anxiety or a first panic attack occurs at all. But anxiety careers can also - as in the second example - start with a more or less random and banal anxiety attack and then enter a long developmental stage of chronic anxiety. To these are added those people who - as in social phobia - learned and internalized their anxiety in earliest childhood. From this we see: anxiety is always highly individual and usually very complex.

When should a patient seek treatment?

Luchmann: As quickly as possible, of course. The whole misery is that almost all providers in the healthcare system to whom a patient with an anxiety disorder may come will work through their range of services on the colorful symptom spectrum of anxiety. The two examples described offer the highest exploitation potential in this respect. If the young woman - who has merely learned to fear wetting herself, without ever actually having wet her pants - takes her supposed bladder problem to a urologist who certifies a nervous or irritable bladder, captures her as a permanent patient, and then, with the aggravated diagnosis of an overactive bladder or urge incontinence, offers her drug treatment and surgery, then a few errors of thinking after a few cups of black tea easily become a ruined life. Statistically, the probability is high that this young woman will have her anxiety - objectively easy to correct, but now falsely misunderstood as a bodily defect and medically confirmed - nursed and mistreated in the medical-pharmaceutical complex for a long time. Our patient Volker G., too, described this, albeit with a different anxiety content, as his own painful experience.

There are those apt words of the German poet Eugen Roth: “What robs the doctor of his bread? a) good health, b) being dead. And so the doctor, that he may live, keeps us suspended between the two.” That, unfortunately, is closer to reality than we like to believe. The mean duration of therapy in Germany is over 40 hours for behavioral therapy, over 70 hours for depth-psychology-based psychotherapy, and over 120 hours for analytic psychotherapy. Years ago, a patient therefore asked me: “Mr. Luchmann, how can you make a living from psychotherapy if you need only ten hours per patient?” That was a clever question. Intelligent patients know about the economic interests of the medical and pharmaceutical mafia and question much of it critically. That helps to shorten the search for treatment success. As a matter of principle: the faster a development escalates, the earlier it is perceived as a problem and help is sought. Early treatment retains its value, however, only if it is at the same time the right treatment.

What can treatment look like? Are there differences between the various fields, e.g. cognitive therapy, medication, sport?

Luchmann: According to the state of science, the demonstrably best therapy for anxiety and panic disorders, phobias, and depression is cognitive psychotherapy. Very good psychotherapists now lead their patients to the therapeutic goal with exclusively cognitive work. That is, the practice components accompanied by the psychotherapist, formerly typical of behavioral therapy for anxiety and panic disorders as well as compulsions, can today often be dispensed with. With cognitive therapy, patients are enabled to accomplish the practice part of every psychotherapy - the practicing relearning of their thinking and behavior in everyday life, in the family, and at work - on their own. That lowers the cost of therapy considerably.

On medication there is a perfectly clear answer: psychoactive drugs have no place in a clean cognitive psychotherapy or behavioral therapy of anxiety. They lastingly impair the cognitive-therapeutic effect or, in the end, cancel it out completely. This applies to all psychoactive substances, including those with anxiety-relieving, sedative, or antidepressant effects. Those seeking help should not deceive themselves, or let themselves be deceived, with psychotropic drugs in the treatment of anxiety. The mental damage done by anxiety-relieving medication is immense and absolutely underestimated.

Sport, strictly speaking, is not an instrument in the psychotherapeutic inventory. But sport, as we know, is not only healthy; it is also a helpful supplement in reducing the tension that is frequently elevated in people with anxieties. And moreover, it has been scientifically proven that sport is often a better and, in the long term, more effective antidepressant than the one from the pharmacy.

How many people suffer from generalized anxiety?

Luchmann: From that specific form of generalized anxiety in the sense of the “International Statistical Classification of Diseases” which Volker G. described, around four percent of people suffer in the course of their lives. That is, conservatively estimated, more than three million Germans. If, on the other hand, one includes all anxiety disorders, then in Germany, again conservatively estimated, there are at least ten million mostly younger people whose lives are impaired by anxiety of a clinically treatable severity.

What is the difficulty in recognizing anxiety patients?

Luchmann: Anxiety patients have a primarily mental disorder that manifests itself, however, mainly in physical symptoms. From this follow one general and one particular difficulty. The first, general difficulty for those affected is, against the background of the social devaluation of mental problems, to allow the thought of a mental disorder at all. The idea of being mentally ill is unjustifiably often linked with being insane. Consequently, this possibility is indignantly rejected or suppressed in horror. That many mental disorders, correctly treated, are easier and quicker to correct than many physical disorders is, by contrast, largely unknown.

The particular difficulty consists, in addition, in recognizing the concrete anxiety as such in the patient. Those affected themselves regularly see only their physical symptoms. They speak of feeling constantly tense and unwell, of no longer being able to breathe in and out freely, of dizzy spells up to the feeling of fainting, of feeling their heart beat more distinctly or faster up to sudden palpitations, of sweating more, blushing, or suffering hot flushes, of a feeling of numbness and tingling in fingers and toes, of sleeping badly and having nightmares, of tiring and becoming exhausted more quickly, and, on top of all this stress, of perhaps being tormented by various other complaints such as head, neck, and back pain. No patient ordinarily comes along and says he is having anxious thoughts.

Is there something like an “anxiety test” so that patients can be recognized more easily?

Luchmann: Certainly. Psychologists have developed tests for many things - tests which at times even measure what they claim to measure. The problem is a different one: the patient who does not even begin to suspect that he might be suffering from an anxiety disorder will not be able to use an “anxiety test.” And the providers in the healthcare system, whose turnover and profit would be drastically reduced by a clean anxiety diagnosis followed by efficient cognitive short-term psychotherapy, will not want to use an “anxiety test.”

Whoever among your viewers or readers finds at least half of the bodily symptoms listed here in himself and, on honest self-examination, also perceives his anxious thoughts and the fear of losing control, no longer needs an “anxiety test.” There the anxiety is presumably already proliferating.

How many patients go unrecognized?

Luchmann: We know from the relevant studies that the overwhelming majority of anxiety illnesses are not recognized in time. From this result millions of individual tragedies of people whose anxiety prevents them from living their lives freely and developing their potential. Particularly tragic consequences follow from the mistaken assumption of receiving help from physicians for this illness. This finding is not only tragic but bitter, because anxiety illnesses mostly begin at a young age and, untreated, usually take a chronic course. In their years- and decades-long course of suffering, those affected, through the use of medical services resulting from their chronic anxiety disorder, unintentionally feed the medical cartel. In the extreme case, at the end of such long anxiety careers stands invalidity.

A highly representative study recently presented by the Technische Universität Dresden, with more than 20,000 patients and more than 500 medical practices, showed that two thirds of generalized anxiety illnesses were not recognized by the general practitioners at all. The remaining third was almost exclusively mistreated. In assessing these shattering results, the practiced self-interest of physicians must be taken into account. Patients with anxiety, panic, or a phobia represent, by virtue of their rich physical symptomatology - one cannot stress this often enough - an invitation to years of copious money-making that many physicians cannot resist.

For society, too, this amounts to a tragedy: anxieties, panic disorders, and phobias can today, as a rule, be treated with lasting success by cognitive behavioral therapy within less than 15 hours. Nevertheless, on average, those who fall ill reach a suitable psychotherapist only after seven to ten years.

Another study, by the Fachhochschule Köln, determined the gigantic losses caused to the German economy alone by the anxiety of its employees. Anxiety and anxiety disorders cause 50 to 100 billion euros in costs and damage per year. That is value-creation potential which could largely be preserved for the national economy through workplace prevention and suitable treatment offerings!

Can anyone become ill with anxiety?

Luchmann: Yes - provided that, in conjunction with the presence of stress, the person in question commits a series of typical errors of thinking that promote the development of an anxiety and panic disorder or a phobia.

How high is the risk of mistreatment?

Luchmann: If one takes the aforementioned study by the Technische Universität Dresden with more than 20,000 patients as a basis, it must rather be regarded as a rare stroke of luck not to be mistreated with an anxiety illness.

Anxiety, depression, trauma - where do the differences lie, are there connections?

Luchmann: Diagnostically, one can distinguish between anxiety, depression, burnout, and trauma. These are specific weightings that matter for statistics, administration, and reimbursement. Therapeutically, by contrast, it is more important to grasp the individual web of cause and effect, of thinking, feeling, and behavior, in all its complexity. In ordinary everyday life, anxieties, depression, trauma, and exhaustion are frequently very strongly interwoven. I recall the first example, the laboratory head who feared the criticism within her team. In our example she has been given the diagnostic label of depression. In reality, however, what contributed essentially to her collapse, taken as a whole, were the anxiety and the exhaustion arising from the fight against the anxiety, together perhaps with anxiety-promoting influences in her biography. To uncover this individual web of effects and make it manageable for those affected is the core component of good psychotherapy.

In clinical practice, by contrast, the diagnosis is frequently chosen with a view to exploitation potential. In the example of the laboratory head, admission to a clinic under the diagnosis of depression will typically be accompanied by the administration of strong but not essentially necessary medication, which severely clouds mental alertness and the capacity to think. Although her collapse came about essentially through her exhaustion, the laboratory head, who under the medication now for the first time also experiences herself as mentally absent, will in this way be easy to convince that she has a severe mental illness requiring very protracted treatment. The connection you ask about between anxiety, depression, and trauma would, in line with the results of the Technische Universität Dresden, probably present itself in our example as follows: the original small anxiety leads in the long run to exhaustion, which is clinically misdiagnosed as severe depression, and only then does the hospital treatment cause a lasting trauma, which delivers the laboratory head up to maximum exploitation in the medical-pharmaceutical complex, all the way to her completely unnecessary invalidity. It is the treatment experience that often traumatizes. That is the almost classic connection between anxiety, depression, and trauma on which the sick healthcare system feeds so splendidly.

Are there people who develop anxiety states as a result of the terrorist attacks?

Luchmann: Of course. Above all, they can become anxious if they begin to think about things in a correspondingly self-damaging way. In 1993, I was myself on the observation deck of the World Trade Center in New York with a patient. The terrorist attack affected me. But it did not frighten me. Terrorist attacks and suicide bombers have been known instruments of asymmetric warfare since antiquity. People who let terrorists take away their freedom and drive them into anxiety and panic do not deserve their freedom.

Do these anxiety states have to be treated, or do they resolve on their own?

Luchmann: When a society slides into terror - whether its source is external, internal, or in its own government - it has far greater problems than the treatment of individual anxiety states. One must see this realistically: if it is of use to the government to generate anxiety in its citizens, it will hardly really want those anxiety states to be treated successfully.

Is there timely prevention, so as not to become ill with anxiety in the first place?

Luchmann: Yes, naturally. To live healthily and happily in harmony with one's own nature and the nature that surrounds us - physically, mentally, and spiritually — in an intact family and social community, where public spirit counts for more than modern egoism and where the security and mutual help of the community make the psychotherapist largely superfluous.

Photo: © 2001 Angstambulanz, Institute for Cognitive Psychotherapy, Stuttgart.

First published December 19, 2001.

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