What Do We Already Know About Anxiety?

Let us do a stock take on what we know about anxiety.

What is anxiety?

Anxiety is a feeling we have when we get worried, tense and afraid about something that is related to our future. It is a human condition that happens when we sense that we are unsafe, exposed, vulnerable, unprotected or under threat.

What does anxiety feel like?

Everyone experiences anxiety in their own unique way. This experience could present itself through our thoughts, feelings or bodily symptoms. Some of the common experiences include:

Bodily symptoms

  • Butterflies in the stomach
  • Indigestion and/or feeling full even though you have not eaten much
  • Pins and needles
  • Aches and pains
  • Rapid breathing
  • Sweating or hot flushes
  • Insomnia or disrupted sleep
  • Nausea
  • Panic attacks
  • Restlessness and nervousness
  • Rapid heartbeats

Effects on thoughts and feelings

  • Sense of dread or fearing the worst
  • Catastrophizing
  • Uncontrolled replaying of worst possible scenarios that could happen
  • Worrying about having another panic attack
  • Worrying a lot about the future
  • Avoiding daily activities that trigger anxiety
  • Feeling that people are judging you because of your anxiety
  • Feeling that your body and mind are no longer yours
  • Feeling that the world is unreal
  • Contemplating death to end the pain

When does anxiety become a serious mental health issue?

Sometimes, it feels like these anxiety symptoms have a life of their own. Anxiety comes and goes when we least expect it. At other times, it stays and does not seem to go away. It becomes a mental health issue when it starts impacting on your day-to-day functioning. Some of the signs that prevent you from living your life to the fullest include:

  • Your worries about what could happen interferes with your daily activities (sleep, school, work and social life)
  • An overwhelming sense of worry that becomes hard for you to focus
  • Experiencing feelings of depression that nothing is working, and turning to alcohol and drugs to cope
  • Finding it hard to do things you enjoy and slowly, you are participating in fewer activities.

What causes anxiety?

Multiple factors can explain the cause of anxiety. They include:   

  • past traumatic experiences
  • life transitions
  • underlying physical and mental health issues
  • medications
  • genetics

This is what we may know so far about anxiety. All true and real. However, there is another form of anxiety that I would like to bring our attention to.

There is a thing called existential anxiety

Existential anxiety is the feeling of restlessness about ourselves and our position to this world when we:

  • question our purpose in life (e.g. who am I? what is my purpose in life? why are we here?)
  • realise that nobody can tell us how to live our life except for ourselves
  • realise that our freedom to make choices comes with a responsibility for ourselves and others
  • are reminded of how our time on earth is finite

Existential anxiety is probably the deepest form of anxiety. It can get triggered in us when we find ourselves at crossroads where we realise that our choice for one path means we have to give up others. We experience an overwhelming sense of uncertainty and fear that we are making the wrong choices.

‘My mind is just full of “what ifs”' and I can’t stop thinking ' what if I chose this and I regret it?’

You can read more about existential anxiety and how it comes about in this article.

There's No One Way to Live

You may be thinking, where did existential therapy come from? The philosophy of existentialism has the face of gloomy and depressing post-World War II France and Gauloises- smoking intellectuals furtively discussing the meaninglessness of existence. Many people also associate it with such concepts as nihilism, angst, atheism and death.

Existential ideas themselves have a lineage that ‘can be traced far back in the history of philosophy and even into man’s pre-philosophical attempts to attain some self-understanding’ (Macquarrie, 1972: 18). Existential ideas, questions and ways of philosophising have been identified in the teachings of such notable figures as Socrates, Jesus and the Buddha (Macquarrie, 1972), as well as in such ancient philosophical systems as Stoicism (van Deurzen, 2002a).  Existentialists place great emphasis on in-the-world-with-others nature of human existence. They reject individualism and subjectivism that is inherent in more humanistic approaches.  

The roots of existential psychotherapy lie in philosophy from the 1800s, and more importantly with philosophers whose work dealt with human existence. The philosophers most commonly associated with existential therapy are Søren Kierkegaard, Friedrich Nietzsche, Heidegger and Sartre. However, Halling and Nill write, existential therapy ‘cannot be traced to a single authoritative source’, and so unlike other therapies, this approach does not have a common theoretical and practical basis.

You must remember that existential philosophers are diverse themselves. Some are deeply religious (Kierkegaard, Buber, Victor Frankl, Marcel), others are atheistic (Sartre, Nietzsche and camus). Some emphasise individuality (Kierkegaard and Nietzsche), others emphasise the need for relationship (e.g. Buber, Marcel and Jaspers). Some consider existence to be meaningless (Sartre and Camus) while others put emphasis on hope (Marcel). So one can only speak of existential philosophers in the loosest sense as a group of thinkers who ponder about what it means to live.  

What is most important is to appreciate the diverse ideas on existence that there is no one single way to live.

We humans are all different. There’s no one way to live.  

Several Rich Tapestries

In this century, psychologists started taking these philosopher’s ideas and use them in therapy.

More popular ones include Viktor Frankl who wrote Man’s Search for Meaning in 1946, and coined logotherapy as a method of creating meaning.

Viktor Frankl - Wikipedia

Rollo May brought this European perspective to America in the 1950s, giving it a more optimistic flair focused on the vastness of human potential, and called it the “existential-humanistic” approach.

In 1980, Irvin Yalom defined the four “givens” of the human condition—death, meaning, isolation, and freedom—that have become the basis for the field.

Today there remain different branches of existential therapy, but they all help clients face existential givens head-on so that they can move toward a more “authentic” and free existence.

All Of Us Are Unique In Our Relatedness

At Encompassing, our guiding principles come from the British school of Existential Analysis.  This was influenced by many existential philosophers such as Kierkegaard, Nietsczhe, Sartre, Buber, Jaspers and Merlaeu Ponty.  

The 3 organising principles in existential therapy are discussed by Professor Ernesto Spinelli, Academic Dean of the School of Psychotherapy and Counselling at Regent’s College, London:

  1. Relatedness argues that everything that exists is always in an inseparable relation to everything else. From this understanding of relatedness, every thought, feeling and action experienced or undertaken by me is said to arise not only from the interaction of systems and components within me but also between self and others and between self and world. Essentially, we are always in relation and with all other beings. All of us are unique in our relatednes. Each being stands out in a wholly unique and unrepeatable way of being and is able to be and do so through a foundational relatedness that is not only shared by all beings but which is also the necessary condition through which individual beings emerge. 
  2. Uncertainty arises as an immediate consequence of relatedness. Uncertainty expresses the inevitable and inescapable openness of possibility in any and all of our reflections upon our existence. I can never fully determine with complete and final certainty or control not only what will present itself as stimulus to my experience, but also how I will experience and respond to stimuli. At any moment, for example, all prior knowledge, values, assumptions and beliefs regarding self, others and the world in general may be open to challenge, reconsideration or dissolution in multiple ways that might surprise or disturb. Common statements of uncertainty include ‘I never thought I would act like that’, or ‘She seemed to turn into someone I didn’t know’
  3. Anxiety is a direct consequence of the first two principles in that it expresses the lived experience of relational uncertainty. It is necessary to note from the outset, however, that existential anxiety is not only an expression of disabling and unwanted levels of unease, nervousness, worry and stress.  It is much more generally a felt experience of incompleteness and perpetual potentiality which is expressive of an inherent openness to the unknown possibilities of life experience. Existential anxiety can be both exhilarating and debilitating, a spur to risk-taking action as well as stimulus to fear-fuelled paralysis. 

This is why, at Encompassing we:

  • Stay with the actuality of the client’s lived experience.  
  • See clients as having ‘problems with living’ rather than having pathological issues that need to be treated.
  • Explore different ways of relating to the world - personal, social, physical and spiritual.  
  • Look at how clients handle paradoxes or polarities. E.g. good vs evil, trust vs distrust, belonging vs isolation, intimacy vs separation, transcendence vs mundanity. Mental wellbeing is found when we are able to be flexible enough to live on both extremes at the same time.
  • A lot of dilemmas can be found when we are fixated on one end and refuse to look at the other end possibly because of a lack of familiarity or with too much uncertainty. Our goal is not to help clients find answer to the dilemmas that they bring into the session, but to help them see and accept that living presents us with many dilemmas. 
  • Focus on choice, responsibility and freedom. For instance: Through such an acceptance, clients can then begin to address the real challenges that face them. For instance, they start to ask questions such as ‘How do I become more authentic to myself even though I know the choices will not make my life easier?’  
  • Challenge taken-for-granted assumptions and are open to a multitude of perspectives.  

The primary value of existential-phenomenological thinking for therapists is that it offers them a way of being which they can come to embody, rather than providing a frame-work by which to understand clients, or as a blueprint for living.  



Spinelli, E. (2015). Practicing existential therapy: the relational world. (2nd ed.). London, SAGE Publications.  

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Reflections: Why Did I Choose To Be An Existential Psychotherapist?

Why did I choose to be an existential psychotherapist? Over the years, I have been asked this question numerous times . After all, this is a less popular field within counseling in Asia, much less Singapore.

Honestly, I have often found it difficult to answer this question. It is not that I do not know how it all happened. I just struggled with how to start. It was not a single moment that decided it. Many things happened that slowly showed me that it was what I wanted to do. And to write it all out will probably take me more than an article.

So I thought I will allow the younger me answer this question.

I picked up the habit of journaling for the last 7 years. For a while now, I have wanted to go back to read my older entries. And I came across an entry back in 2013. At a time when I was seriously contemplating a doctorate in existential psychotherapy versus other modalities.

So here it goes. Unedited.


I’ve always thought that understanding ourselves requires us to go deep within and back to the past to discover why we act a certain way. Well, to a great extent, it is true. But I’m slowly learning that it is only useful insofar as it will help us in our current situation.

Why do I believe in existential psychotherapy much more than other forms of therapy? what do I like about it?

One, it is philosophical in nature. I’ve always been drawn to philosophy. How should one lead a meaningful life? what are some virtues that everyone should possess? These are just some questions that are close to my heart. And I particularly like the focus on freedom and isolation within existential therapy.

Also, unlike Freudian’s model of biological conflict or neo-Freudian’s model of a conflict between oneself and his/her culture or environment, existential psychotherapy focus on the meaning of our existence. Well not that I reject the other two models but I think that the existential model is more holistic. It looks at a person’s life with the use of different lenses. Spiritual, biological, religious and our experience.

The focus on a person’s experience instead of his behaviour alone is what draws me most to existential psychotherapy. We can look at a person from many lenses- diagnostic disorders, behavioural patterns, chemical imbalance, biological defect or cognitive schema etc. But we haven’t studied someone based on his experience.

Shouldn’t that be the most important aspect? Which is more important? Our theories of that person or the person itself?

Yes, science and technology has been advancing at lightning speed. Science has helped us understand our world or bodily phenomenon. But we have been so focused on our left brains and neglecting our right brain functions- subjectivity. It is just as important as all the hard facts and empirical observations.

Existential therapy allows me to do just that- seeing persons not for what they should be but who they really are.

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How Can Psychotherapy Help Me With My Existential Crisis?

These days, we hear many people talk about feeling bored, tired or even anxious in their lives but not knowing why despite having a comfortable lifestyle. The struggle to experience our life as meaningful or to feel we are living other people’s lives rather than on our own terms can be destructive. It negatively affects our relationships with our loved ones, motivation at work and our self-esteem. It makes us question, what is my purpose in living? Where am I going with my life? What would make me feel alive?

These people could even be you.

An existential crisis is not a bad thing

When you start asking questions relating to your freedom to make choices for yourself how your job is contributing to life satisfaction, whether your decisions will lead to regret in the future or why you are often feeling anxious or guilty over decisions you have or have not made,you are facing your existence in the eye. These are signs of an existential crisis. It can be triggered by events like relationship breakdowns, deaths, retrenchment, burnout, life transitions and more.

Some of us have resources to deal with it and others struggle to live with it.  However, an existential crisis is not necessarily a bad thing. Feelings of anxiety or depression could be a sign that we are not living purposefully enough or we are not looking after ourselves emotionally, physically or psychologically. It may spur us to think more creatively about what we want to be remembered for at the end of our lives and subsequently act towards it. It is when we ignore an existential crisis, hoping that it will eventually go away, that would lead to us feeling an intensifying sense of deadness within us.

What you can do

Fortunately, going through an existential crisis is not the end of the road. There are three steps we can take to help us.

1.Acknowledge that the awareness of an existential crisis is a sign that you are getting in touch with what it means to be human. It is part of the human condition to feel anxious around uncertainty and there is nothing wrong with you.

2.Allow yourself to feel the struggle without analysing it in your head. Avoiding it through distraction or denial may only make uncomfortable emotions more intense. At times, if you are able to stay and honour your feelings, answers to what is important to you and the available choices in your life may surface.

3. This process of staying with uncomfortable feelings is not always easy for all of us. This is when, lastly, seeing a counsellor/therapist trained in existential therapy helps. He/she is trained in facilitating a non-prescriptive exploration of your struggles and will help you to build resources so that you can better develop yourself in your personal and professional life.

Other benefits of going through counselling include: 1. identifying and better accepting the inevitable paradoxes in our lives; 2. learning to accept challenging and limiting circumstances; 3. being able to identify choices and becoming more responsible for ourselves when we feel stuck; and 4. becoming more authentic to ourselves.

In reaping these benefits, it is hoped that you can smile on your deathbed knowing that you have conquered your existential crisis and lived a meaningful life according to your beliefs, values and principles.

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Find out how an existential outlook allows us to be authentic and have a decisive dedication to whatever it is we choose to accomplish in our lives.
Read On

What is Existential Therapy?

Existential Therapy – Finding the Light in the Darkness

You may be thinking, I’ve never heard of existential therapy before. It sounds so negative, dark, heavy, pessimistic and/or depressing. I’m not sure if it will make my life more depressed and anxious than I already am.

While it’s very true that due to the existentialist view that suffering can be embraced as part of the human existence, existential psychology can be read as pessimistic. This is not an encouragement of suffering, though, only recognition of the fact that it is an inescapable part of being human. What existential therapy does do is encourage people to embrace the reality of suffering in order to work through and learn from it. 

Not Advocates of Despair

Existentialists are not advocates of despair. Instead, they campaign for a resolute and courageous attitude that is willing to commit to life's projects despite the inherent absurdity of living. This allows us to be authentic and have decisive dedication to whatever it is we choose to accomplish in our lives

Consider seeing existential anxiety as a teacher and guide rather than something that is considered irrational or pathological – how does that impact your view?

We believe that clients are the experts of their own lives. Having the capacity for self-awareness means that we as humans can reflect and make choices. Existential therapy can help expand your awareness through realising that:

  • we are finite: time is limited
  • we have the potential and the choice to act or not to act
  • meaning is not automatic – we must seek it
  • we are subject to loneliness, meaninglessness, emptiness, guilt and isolation

Facing Distressing Symptoms Instead of Suppressing Them

Existential therapy is different from other therapies in that it grounds itself in a philosophical worldview. We are generally less focused on diagnosing psychopathology and providing rapid symptom relief per se than other forms of therapy. Instead, distressing "symptoms" such as anxiety, depression or rage are recognized as potentially meaningful and comprehensible reactions to current circumstances and personal contextual history. We avoid diagnostically labelling or pathologizing people. We treat people not labels.

As such, existential therapy is primarily concerned with experiencing and exploring these disturbing phenomena in depth: directly grappling with rather than trying to immediately suppress or eradicate them. Its principal aim is to clarify, comprehend, describe and explore rather than analyze, explain, treat or “cure” someone's subjective experience of suffering.

Existential therapy is not directive but directional. The core emphasis of therapy is on the therapeutic relationship and actual experience of the client. The therapist does not impose their worldviews, values, thoughts and feelings onto the clients.  The therapist is committed to exploring their clients’ questions with a receptive attitude, rather than a dogmatic one: the search for truth with an open mind and an attitude of wonder is the aim, not the fitting of the client into pre-established categories and interpretations.

I Don’t Like Philosophy

Therapists use existential philosophy to guide them in their work with the client and allow the client to see your difficulty with a more existential perspective. However, the work in session focuses only on what the client brings in. The therapist strives to stay with whatever material the client brings. Contrary to what you might be thinking, existential therapy isn’t for intellectuals! You won’t be talking about theories or about philosophy in therapy. It is not necessary for a person to be a philosopher or scholar to benefit from the principles of existential therapy, and many people who are actively struggling with mental health issues can also be helped by the approach. 

Existential therapy has slowly been gaining recognition; in 2016, there were 136 existential-therapy institutions in 43 countries across six continents, and existential practitioners in at least 48 countries worldwide. A range of well-controlled studies indicates that certain forms of existential therapy, for certain client groups, can lead to increased well-being and sense of meaning. There is a good deal of evidence indicating that one of the core qualities associated with existential therapy – a warm, valuing and empathic client or patient-therapist relationship — is predictive of positive therapeutic outcomes. Additionally, existential therapy's central emphasis on finding or making meaning has been shown in general to be a significant factor in effective treatment.






Vos, Craig & Cooper, 2014

Norcross & Lambert, 2011

Wampold & Imel, 2015