Article
“I’ve had every test. The doctors say I’m fine. But I still feel like I’m falling apart.”
This isn’t a rare story. It’s one told by millions.
If you’ve ever experienced chronic pain, digestive distress, mysterious fatigue, or even seizures—yet had your tests come back “normal”—you know how lonely and frustrating that experience can be. You know what it’s like to search for answers and feel dismissed. And if you’re a mental health professional or a physician, you’ve probably struggled to help patients like this.
A growing body of research, now reviewed in depth by psychiatrists Dr. Allan Abbass and Dr. Behnia Haghiri in their 2025 article, shines a light on a psychotherapy approach that’s offering profound hope for these complex cases: Intensive Short-Term Dynamic Psychotherapy (ISTDP).
What Is ISTDP, and Why Should We Care?
ISTDP isn’t just another talk therapy. It’s a highly focused, emotion-centered approach designed to unlock unconscious emotional conflicts that are often at the root of functional somatic disorders—physical symptoms that lack a clear medical explanation.
These include:
- Chronic pain (fibromyalgia, back pain, migraines)
- Irritable bowel syndrome (IBS)
- Functional neurological disorders (e.g., seizures without epilepsy, paralysis without nerve damage)
- Chronic fatigue
- Medically unexplained symptoms (MUS)
While traditional treatments often involve managing symptoms with medication or behavioral coping strategies, ISTDP goes deeper. It asks:
“What if your body is expressing what your mind isn’t allowed to feel?”
When Feelings Become Symptoms
Dr. Habib Davanloo, the founder of ISTDP, observed that painful feelings—especially those connected to trauma, loss, or disrupted attachment—can become “blocked” from conscious awareness.
But blocked emotions don’t disappear.
Instead, they may show up through anxiety symptoms such as tightness in the chest, gut spasms, memory lapses, headaches, or weakness in the limbs.
The person may feel like they’re sick or dying. But under the surface, something very different is going on: the body is speaking the language of emotion.
Understanding the Four “Anxiety Discharge Channels”
A major insight from ISTDP is the concept of anxiety discharge pathways—how the body reacts when a patient comes close to experiencing repressed emotions. ISTDP therapists are trained to assess these channels early in treatment.
Striated Muscle Tension
Muscle pain, jaw clenching, migraines, fibromyalgia.
Common in patients who can “feel the pressure” but avoid expressing emotion.
Smooth Muscle Activation
IBS, bladder urgency, asthma, heart palpitations.
Often seen in patients who grew up needing to suppress feelings in unsafe environments.
Cognitive-Perceptual Disruption
Brain fog, dissociation, blurry vision, confusion.
A hallmark of fragile patients who need careful pacing and stabilization.
Conversion Symptoms
Non-epileptic seizures, limb weakness, speech issues.
Classic “functional neurological” symptoms—often misunderstood as malingering.
Understanding these patterns allows ISTDP therapists to diagnose and treat the somatic manifestation of psychological conflict—something many therapies overlook.
Why Standard Treatments Often Fail
Let’s be clear: CBT, medications, physical therapy, and dietary changes can help. But in some functional cases, they only go so far. That’s because the root problem isn’t just physical or cognitive—it’s emotional.
When a patient has spent years suppressing rage, grief, guilt, or longing—especially in early relationships—those feelings don’t disappear. They become somaticized.
And ISTDP works because it:
- Helps patients become conscious of unconscious emotions
- Builds tolerance for complex affect
- Dismantles defenses that block emotional closeness or awareness
- Offers a path toward healing, not just coping
Does It Work? What the Research Shows
Abbass and Haghiri’s 2025 review is comprehensive: over 50 studies are analyzed, including randomized controlled trials (RCTs), case series, and process research.
Key findings:
- ISTDP is effective for chronic pain, FND, IBS, and a wide range of somatic symptoms
- In some studies, ISTDP outperformed CBT, particularly in chronic pain
- It is associated with reduced emergency room visits, less medication use, and lower healthcare costs
- ISTDP also improves emotional awareness, self-compassion, and relationship functioning
Even short courses of ISTDP—sometimes just 8 to 12 sessions—can lead to major improvements.
The Human Impact: What Patients Report
Imagine suffering for 10 years with migraines, only to discover they’re connected to unprocessed grief over a parent’s death. Or experiencing seizures for years, until you realize they’re a protective response to overwhelming feelings from the past.
In ISTDP, patients report moments where a wave of rage, sadness, or longing finally breaks through—and the body lets go of the symptom it was holding. These moments are emotional, raw, and deeply human. They’re not about fixing a symptom; they’re about healing a life story that was stuck in the nervous system.
How It Feels to Be Seen Differently
One of the most meaningful aspects of ISTDP is how it respects the intelligence of the body. Instead of pathologizing the patient—“You’re imagining it,” “It’s just stress,” “You’re overreacting”—ISTDP says:
“Your body is doing something important. Let’s listen.”
That shift in stance—from symptom suppression to emotional understanding—can be transformative. Patients often feel deeply seen for the first time.
What This Means for the Future of Healthcare
The authors argue that ISTDP should be considered a first-line treatment for complex somatic presentations—particularly in:
- Primary care settings
- Neurology and gastroenterology clinics
- Emergency departments
- Chronic pain and rehabilitation programs
- Mental health and trauma-informed care teams
With increasing attention to mind-body integration, ISTDP is well-positioned to bridge the gap between medicine and psychotherapy.
What Patients Should Know
If you’re living with chronic, unexplained symptoms, here’s what we want you to take away:
- You are not imagining things
- You are not alone
- Your symptoms may have emotional roots that are treatable
- There is a therapy that takes both your suffering and your body seriously
What Clinicians Should Consider
Whether you’re a psychotherapist, psychiatrist, physician, or allied health professional, ISTDP offers a skillset that can radically change your practice.
- Learn to assess anxiety pathways and defenses
- Integrate psychodiagnostic interviews into your evaluation
- Consider somatic symptoms as meaningful signals, not just obstacles
The research shows that ISTDP is not only effective—it’s efficient, cost-saving, and scalable when applied by trained professionals.
Final Thoughts: Listening to the Body, Listening to Emotion
In a world that still divides mind and body, ISTDP re-integrates them. It asks us to listen to what the body has been saying all along:
“I hurt… but not for the reasons you think.”
By helping patients experience their true feelings—safely, fully, and in connection with another person—ISTDP gives them more than symptom relief. It gives them a chance to reclaim their lives.
And for therapists, it offers a way to sit at the intersection of medicine, emotion, and transformation.
