Anger as a primary phenomenon in anxiety and panic symptomatology: a Gestalt-phenomenological psychotherapeutic perspective
Published 2025-12-19
Keywords
- Retroflexed anger, Anxiety, Panic attacks, Gestalt psychotherapy, Phenomenology, Contact cycle.
How to Cite
Copyright (c) 2025 Daniela Cirasino, Stefano Orlando, Marco Schiralli, Angela Verardo, Martina Marano, Elisabetta Macchia, Chiara Zilli, Innocenzo Mangiacavallo, Damiano Conte

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Abstract
This study explores the presence and role of retroflected anger in panic attacks and anxiety disorders, adopting a phenomenological-Gestalt perspective. The central hypothesis is that unexpressed anger may manifest in individuals through anxiety and panic symptoms, functioning as an “internal alarm” triggered by environmental factors or stressors. The research investigates the difficulty individuals experience in recognizing and expressing anger—often replaced, in their narratives, by terms such as “frustration” or “sadness”, which they report within the therapeutic setting. A semi-structured interview specifically developed for this study was administered to a pilot sample, providing preliminary data that indicate the presence of anger—often unacknowledged—in situations where personal expectations or desires were unmet. The observation of results further suggests that once recognized, anger can be transformed into self-affirming awareness and assertive communication. The semantic analysis of the collected data aims to provide a phenomenological description of retroflected anger in anxiety disorders, highlighting the relevance of therapeutic interventions focused on emotional recognition and the effective management of related symptoms.
References
- Yağcılar Dikici, İ., & Zeren, Ş. G. (2025). Gestalt contact disturbances and invalidating childhood environments in predicting romantic relationship satisfaction. Turkish Psychological Counseling and Guidance Journal, 15(78), 659–673.
- Perls, F., Hefferline, R., & Goodman, P. (1994). Gestalt therapy: Excitement and growth in the human personality (Original work published 1951). The Gestalt Journal Press.
- De Lucca, F. (2010). La estructura de la transformación: Teoría, vivencia y actitud en gestalt-terapia a la luz de la sabiduría organísmica. Tiempo de Lectores.
- Lommatzsch, A., Cirasino, D., De Fabrizio, M., Orlando, S., Terzi, C., & Antoncecchi, M. (2024). Working on the emotion of anger in panic disorder: A phenomenological–existential and Gestalt psychotherapy approach. Phenomena Journal: International Journal of Psychopathology, Neuroscience and Psychotherapy, 6(1), 6–11.
- Bueno‑Notivol, J., Gracia‑García, P., Olaya, B., Lasheras, I., López‑Antón, R., & Santabárbara, J. (2021). Global prevalence and determinants of mental health disorders during the COVID‑19 pandemic: A systematic review and meta‑analysis. Journal of Affective Disorders, 283, 131-140.
- Perls, F. (1995). L’io, la fame e l’aggressività: L’opera di uno psicoanalista eretico che vide in anticipo i limiti fondamentali dell’opera di Freud. Franco Angeli.
- Freud, S. (1971). Il disagio della civiltà (Vol. X). Bollati Boringhieri. (Trad. di: S. Freud, 1930, Das Unbehagen in der Kultur.)
- Kepner, J. I. (1987). Body process: A Gestalt approach to working with the body in psychotherapy. Gestalt Journal Press.
- Francesetti, G. (2012). The field perspective in Gestalt therapy: Roots and developments. British Gestalt Journal, 21(1), 20-29.
- Francesetti, G., & Settanni, M. (2020). Panic disorder: Attack of fear or acute attack of solitude? Convergences between affective neuroscience and the phenomenological–Gestalt perspective. Research in Psychotherapy, 23(1), 77-87.
- Denson, T. F., Pedersen, W. C., Ronquillo, J., & Nandy, A. S. (2009). The angry brain: Neural correlates of anger, angry rumination, and aggressive personality. Journal of Cognitive Neuroscience, 21(4), 734-744.
- Bujor, L., & Turliuc, M. N. (2023). Do emotion regulation strategies mediate the relationship of parental emotion socialization with adolescent and emerging adult psychological distress? Healthcare, 11(19), 2620.
- Kohut, H. (1982). The search for the self. Bollati Boringhieri.
- Feldker, K., Heitmann, C. Y., Neumeister, P., Bruchmann, M., Vibrans, L., Zwitserlood, P., & Straube, T. (2016). Brain responses to disorder related visual threat in panic disorder. Human Brain Mapping, 37(12), 4439–4453.
- Horney, K. (1981). Neurosis and the development of personality. Astrolabio.
- Etkin, A., Büchel, C., & Gross, J. J. (2015). The neural bases of emotion regulation. Nature Reviews Neuroscience, 16(11), 693-700.
- Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35(1), 169-191.
- Hewig, J., Hagemann, D., Seifert, J., Naumann, E., & Bartussek, D. (2004). On the selective relation of frontal cortical asymmetry and anger-out versus anger-control. Journal of Personality and Social Psychology, 87(6), 926-939.
- Stewart, J. L., Levin, R. L., Sass, S. M., Heller, W., & Miller, G. A. (2008). Anger style, psychopathology, and regional brain activity. Emotion, 8(5), 701-713.
- Panksepp, J., & Biven, L. (2012). The archaeology of mind: Neuroevolutionary origins of human emotions. W. W. Norton & Company.
- Sorella, S., Lapomarda, G., Messina, I., Siugzdaite, R., Job, R., & Grecucci, A. (2020). Testing the expanded continuum hypothesis of schizophrenia and bipolar disorder: Neural and psychological evidence for shared and distinct mechanisms. NeuroImage: Clinical, 23, 101854.
- Andolfi, M. (1978). Therapy with the family: A relational approach. Raffaello Cortina.
- Mahoney, M. J. (1991). Human change processes. Basic Books.
- Frijda, N. H. (1986). The emotions. Cambridge University Press.
- Cimbolli, P. (2011). Il caso di Giorgia: Un intervento cognitivista sistemico postrazionalista. Rivista di Psichiatria, 46(5), 349-353.
- Eisenberger, N. I., & Lieberman, M. D. (2004). Why rejection hurts: A common neural alarm system for physical and social pain. Trends in Cognitive Sciences, 8(7), 294-300.
- Milrod, B., Busch, F. N., & Shapiro, T. (2007). Panic-focused psychodynamic psychotherapy in a woman with panic disorder and generalized anxiety disorder. Journal of the American Psychoanalytic Association, 55(4), 1339-1343.
- Freud, S. (1925). Inhibition, symptom, and anxiety. In The standard edition of the complete psychological works of Sigmund Freud (Vol. 10).
- Klein, M. (2006). Contribution to the psychogenesis of manic-depressive states. In Writings: 1921–1958 (Italian ed.). Bollati Boringhieri.
- Winnicott, D. W. (1975). From pediatrics to psychoanalysis (Italian ed.). Martinelli.
- Winnicott, D. W. (1970). Emotional development and the environment (Italian ed.). Armando.
- Bastianini, T., & Moccia, G. (2003). Reflections on current developments of the concepts of affect, memory, and therapeutic action. Rivista di Psicoanalisi, 49(3), 529-549.
- Bondi, P. (2021). Panic and suffering of the self: A psychoanalytic perspective. Gli Argonauti, 163, 67-79.
- De Masi, F. (2004). The psychodynamics of panic attacks: A useful integration of psychoanalysis and neuroscience. International Journal of Psychoanalysis, 85, 311-336.
- Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461–470.
- Beck, J. (2013). Cognitive behavioral therapy (Italian ed., edited by A. Montano). Astrolabio-Ubaldini Editore.
- Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). Guilford Press.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
- Merikangas, K. R., & Avenevoli, S. (2000). Aggression and impulsivity in antisocial personality disorder: A review of the literature. Journal of Clinical Psychiatry, 61(12), 907-915.
- Van der Meer, L., Groenewold, N. A., Nolen, W. A., Pijnenborg, M., & Aleman, A. (2011). Inhibit yourself and understand the other: Neural basis of distinct processes underlying theory of mind. NeuroImage, 56(4), 2364-2374.
- Aoki, Y., Inokuchi, R., Nakao, T., & Yamasue, H. (2014). Neural bases of antisocial behavior: A voxel-based meta-analysis. Social Cognitive and Affective Neuroscience, 9(8), 1223-1231.
- Shackman, A. J., & Pollak, S. D. (2014). Impact of early life stress on the development of emotion regulation and aggression: A neurobiological perspective. Developmental Psychopathology, 26(4 Pt 1), 1221-1237.
- Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.
- Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.
- Williams, J. E., Barefoot, J. C., Shekelle, R. B., et al. (2000). Anger expression and incident hypertension in healthy middle-aged men. Psychosomatic Medicine, 62(6), 598-602.
- Husserl, E. (2002). Ideas pertaining to a pure phenomenology and to a phenomenological philosophy (Ideen zu einer reinen Phänomenologie und phänomenologischen Philosophie). Laterza.
- Ajjawi, R., & Higgs, J. (2007). Using hermeneutic phenomenology to investigate how experienced practitioners learn to communicate clinical reasoning. The Qualitative Report, 12(4), 612-638.
- Eatough, V., & Smith, J. (2006). "I was like a wild person": Understanding feelings of anger using interpretative phenomenological analysis. British Journal of Psychology, 97(4), 483-498.
- Merleau-Ponty, M. (2003). Phenomenology of perception (A. Bonomi, Trans.). Bompiani.
- Latner, J. (2000). Gestalt therapy: History, theory, and practice. Psychotherapy, 37(3), 295-302.
- Brownell, P. (2008). The experiential process in Gestalt therapy. Gestalt Review, 12(2), 126-140.
- Perls, F. (1973). Gestalt approach: Eyewitness to therapy. Astrolabio Ubaldini.
- Spagnuolo Lobb, M. (2011). The now for next in psychotherapy: Gestalt psychotherapy narrated in postmodern society. Franco Angeli.
- Perls, F. S. (1969). Gestalt therapy verbatim. Real People Press.
- Polster, E., & Polster, M. (1973). Gestalt therapy integrated: Contours of theory and practice. Brunner/Mazel.
- Clarkson, P. (1999). Gestalt counseling in action (3rd ed.). SAGE Publications.
- Joyce, P., & Sills, C. (2014). Skills in Gestalt counselling & psychotherapy (3rd ed.). SAGE Publications.
- Paivio, S. C., & Greenberg, L. S. (1995). Resolving "unfinished business": Efficacy of experiential therapy using empty-chair dialogue. Journal of Consulting and Clinical Psychology, 63(3), 419-425.
- Melnick, J., & March Nevis, S. (2000). Gestalt therapy. In F. M. Dattilio & A. Freeman (Eds.), Cognitive-behavioral strategies in crisis intervention (2nd ed., pp. 253–270). The Guilford Press.
- Kayyali, Y. J. (2018). Therapist personal and professional experience as predictors of Gestalt therapy contact resistances (Psy.D. thesis, Adler School of Professional Psychology). ProQuest Dissertations & Theses.