Existential Therapy can help with Anxiety and Fear of Death

A lot of anxiety comes from trying to hold together things that are ultimately not fully holdable. We try to guarantee outcomes, prevent loss, make the future certain. I think this is partly why anxiety can persist even when life externally looks good. Even when we’re successful, loved, productive, or supposedly resting, there can still be this anxiousness beneath the surface. Because underneath many forms of anxiety is a confrontation with something much deeper: the vulnerability of being alive.

Existential therapy helps us turn toward that vulnerability instead of endlessly trying to outrun it. At its core, existential therapy asks us to wrestle honestly with the realities of being human: our mortality, our uncertainty, our loneliness, our freedom, and the responsibility of creating meaning in a life where nothing is guaranteed.

I remember one vacation in particular where this hit me deeply. It was one of those trips that was supposed to be restful. I had escaped the cold Utah winter to get away somewhere warm with my family. Nothing was actually wrong, externally. Yet internally, I was distracted with anxiety for the first few days. I had a mental to-do list constantly running in the background. Work and bills and future planning. Mentally searching for something I might be forgetting or messing up. I kept trying to tell myself I shouldn’t be anxious, which of course only made me more anxious.

One night, I stepped outside alone after my family had gone to sleep. I could see the stars. And I remember finally deciding to stop fighting what I was feeling. Instead of distracting myself, I let myself become fully mindful of the anxiety in my body.

I followed it downward.

Underneath the anxiety was fear.

And underneath the fear was something even deeper: a confrontation with my basic powerlessness.

Not in a dramatic way. In a deeply human way.

The full acknowledgment that I cannot fully control life. I cannot guarantee anything. I cannot secure myself against loss- in fact, I could lose everything. Uncertainty, change, disappointment, or death were not off the table no matter what. And oddly, when I stopped resisting that truth and merged with it instead, something softened. The anxiety lost some of its usual franticness.

There was grief in it, vulnerability in it, but also relief. Because so much of anxiety is the exhausting attempt to mentally outmaneuver uncertainty.

Psychiatrist and existential therapist Irvin Yalom wrote extensively about what he called the “ultimate concerns” of existence: death, freedom, isolation, and meaninglessness. These are not problems to solve once and for all. They are realities to consciously relate to.

Most of us spend enormous energy trying to avoid them. We distract ourselves from mortality. We search for certainty. We cling to externally assigned identities and expectations. We avoid loneliness by abandoning authenticity. We search for prescribed meaning- for answers-rather than creating it ourselves.

But existential therapy suggests that freedom exists on the other side of facing these truths honestly.

One of the ultimate goals of therapy, in my view, is helping people recognize that they are free. Not free from pain or vulnerability, but free in a deeper sense: free to choose how they relate to life. Free to decide what matters to them. Free to create meaning rather than waiting for it to be handed to them. Free to live authentically instead of unconsciously following scripts about who they should be.

The perception of lack of freedom is one of the biggest prisons we place ourselves in psychologically.

Freedom can feel terrifying at first because freedom also means responsibility. If there is no universally assigned meaning to our lives, then we must participate in creating meaning ourselves. If there is no guaranteed certainty, then we must learn to live anyway. This is also why existential therapy often brings us face to face with mortality. The most ultimate expression of our powerlessness is the reality that we die. Most of us unconsciously avoid this truth constantly. We stay busy. Distracted. Numb. We operate as though death is theoretical rather than inevitable. But there is profound psychological value in turning toward mortality rather than away from it.

When we genuinely face the fragility of life, something often awakens. Gratitude becomes more immediate. Presence becomes more available. Petty concerns lose some of their dominance; we get clear about what’s truly important to us. We become more motivated to live authentically because we realize our time is finite.

Pema Chödrön writes, “Only to the extent that we expose ourselves over and over to annihilation can that which is indestructible be found in us.”

Another quote of hers that deeply reflects existential work is: “The most fundamental aggression to ourselves, the most fundamental harm we can do to ourselves, is to remain ignorant by not having the courage and the respect to look at ourselves honestly and gently.”

Existential therapy asks us to do exactly that. To face uncertainty without collapsing, acknowledge loneliness without abandoning connection, recognize mortality without becoming numb, and accept powerlessness while still claiming agency. And what often emerges on the other side is not despair. We move through the inherent vulnerabilities of being human toward something surprisingly resilient: the ability to live consciously despite uncertainty. We begin to realize that courage is not the absence of fear. It is the willingness to remain present in the face of it.

Perhaps freedom is not found in controlling life, but in fully participating in life, though we can’t control it.