What Are the Guideline Procedures?

Anxiety disorders are well treatable with psychotherapy. Currently, four therapeutic approaches are recognized as "guideline procedures" for the treatment of mental illnesses. They are called guideline procedures because they are scientifically validated, their quality has been tested, and they are deemed medically necessary. As a result, the costs for psychotherapy in the case of mental illnesses are covered by health insurance.

What Are the Guideline Procedures?

The four guideline procedures are:

• Analytical Psychotherapy
• Depth Psychology-Based Psychotherapy
• Behavioral Therapy
• Systemic Therapy

Analytical Psychotherapy

Analytical Psychotherapy (AP) is the oldest therapeutic method and evolved from psychoanalysis. Most of us have probably heard of its founder, Sigmund Freud.

According to Analytical Psychotherapy, mental illnesses are caused by inner conflicts that originated during early childhood. Because the associated feelings and memories were so painful, our psyche repressed them into the unconscious for protection. As a result, we have no conscious access to these memories, even though they continue to influence how we feel, think, and act, potentially hindering healthy psychological development.

In treating anxiety disorders, the goal is to identify the inner conflict from the past that is now causing anxiety in the present. To do this, we are encouraged to freely express everything that comes to mind without judgment. This allows repressed feelings and memories to resurface and be re-experienced. The aim is to resolve the conflict and the anxiety through a deeper understanding of oneself. The therapist serves as a neutral projection surface. To avoid influencing our process, the therapist says very little and only occasionally helps interpret thoughts. In classic AP, the therapist often sits out of sight behind the patient, who lies down during the session.

Analytical Psychotherapy is an intensive long-term therapy, typically occurring 2-3 times per week over several years (160–300 sessions).

Depth Psychology-Based Psychotherapy

Depth Psychology-Based Psychotherapy, often called Depth Psychology or simply DP, also evolved from psychoanalysis and attributes mental illnesses to inner conflicts from the past.

When treating anxiety disorders, the therapy focuses on uncovering past inner conflicts to develop a deep emotional understanding of our fears. Unlike Analytical Psychotherapy, DP has a clearly defined treatment goal. Additionally, it places more emphasis on the function of the anxiety in the present and works to find better ways to manage it. The therapist sits across from the patient during discussions.

The overall treatment duration is less intensive, occurring 1-2 times per week for a total of 25 to 100 sessions.

Behavioral Therapy

Behavioral Therapy (BT) is based on the idea that mental illnesses result from unfavorable learning experiences. Problematic behaviors, combined with stressful experiences, can trigger mental illnesses. Therapy focuses on unlearning these problematic behaviors and developing more helpful ones. An extension of Behavioral Therapy is Cognitive Behavioral Therapy (CBT), which focuses on our perception and thinking (cognition) in addition to behavior. CBT teaches us to question and adapt our perceptions, thoughts, and behavior patterns to our current life situations.

Anxiety disorders are typically treated with exposure therapy (also known as confrontation therapy). The goal is to resolve our anxiety by repeatedly facing anxiety-triggering situations and physical symptoms. This allows the fear center in our brain to adapt and learn that there is no danger.

BT/CBT usually takes place once a week and lasts about 24–80 sessions. Between sessions, homework is often assigned to practice and reinforce new behaviors and skills.

Systemic Therapy

Systemic Therapy (ST) has been recognized as a guideline procedure since July 1, 2020, meaning it has also been proven effective.

The foundational belief of systemic therapists is: "A disturbed psyche reflects a disturbed system." Our system primarily includes family members but also other individuals and institutions, such as colleagues and workplaces. Each of us is also a system within ourselves, with various internal parts. The development and persistence of mental illnesses are always viewed within the context of relational processes and are addressed within this framework. However, individuals involved in the system do not necessarily need to be physically present. It’s like a mobile—if one part moves, the position of others changes too.

In treating anxiety disorders, the anxiety is seen as part of the system. It serves both as an indicator that something is out of balance and as an attempt to restore equilibrium. The aim is first to acknowledge this function of anxiety and then collaboratively develop an alternative solution. The therapist provides impulses to "disrupt" the system—like tapping one figure of the mobile so the entire system shifts. To make systemic structures more tangible and experiential, therapists often use spatial methods. For example, we might position ourselves in relation to our anxiety or another person in our system, change these positions, and observe how it affects us. Systemic therapists also ask many questions that encourage us to adopt others’ perspectives, such as: "How would your partner recognize that your anxiety has lessened?"

Systemic Therapy assumes that change is initiated during sessions but ultimately takes place in daily life within our system. Therefore, sessions are spaced out longer and held irregularly, based on individual needs. ST is intended as a short-term therapy, with 12 to 48 sessions.