Anxiety pathways in ISTDP: self-reported symptom clusters in patients with persistent physical symptoms

Although case studies support the notion of three anxiety pathways in Intensive Short-Term Dynamic Psychotherapy (ISTDP), empirical research remains scarce, highlighting the need to investigate how somatic symptoms cluster in line with ISTDP’s anxiety pathway theory using validated measures. This study therefore explored the clustering of self-reported somatic symptoms in 550 patients with persistent physical symptoms (PPS) from three previous randomized controlled trials, examining their potential alignment with the theory of unconscious anxiety and its discharge pathways, as proposed in ISTDP. Using the Patient Health Questionnaire-15 (PHQ-15), an exploratory factor analysis identified three symptom clusters—musculoskeletal, gastrointestinal, and cardiopulmonary—that together explained 40.1% of the variance. This three-factor structure, validated through confirmatory factor analysis, partially aligned with ISTDP’s conceptual anxiety pathways, though limitations were noted in capturing cognitive-perceptual disturbances. These findings suggest that self-reported symptom assessment can complement clinician-led methods in identifying anxiety-related symptom clusters, warranting further development of self-report tools within psychodynamic assessment frameworks.