What is Anxiety?

Anxiety can be defined in various ways depending on the context and the source. Here are some definitions from different sources:

1. American Psychological Association (APA): (APA)The APA defines anxiety as an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune.
2. World Health Organization (WHO):WHO defines anxiety as a feeling of unease, such as worry or fear, that can be mild or severe. It can be a normal response to stress, but when it becomes excessive, it may be considered an anxiety disorder.
3. Cambridge Dictionary:Cambridge Dictionary defines anxiety as an uncomfortable feeling of nervousness or worry about something that is happening or might happen in the future.

These are just a few examples, but they all generally describe anxiety as a feeling of unease, worry, or fear that can vary in intensity and interfere with daily life when it becomes excessive.

Anxiety from an Existential Psychology Point of View

Existential philosophers posit anxiety as an inherent part of human existence, stemming from the confrontation with the unknown and the uncertainty of our being in the world and it is linked with our desire for security, perfection and certainty. It is also a fundamental aspect of freedom and responsibility, as anxiety arises from the awareness of one's freedom to choose among alternatives and the attendant responsibility for making those choices.

Anxiety is not solely a source of suffering but also a source of potential growth and creativity which can inspire us to transcend our limitations, take risks, and pursue authentic ways of being in the world. Anxiety serves as a potent force that propels us towards deeper introspection and exploration of our place in the world. In this sense, anxiety is an essential aspect of the human experience that propels us toward self-realization, self-actualization and authentic living.

When does anxiety become problematic?

Many existential psychologists differ between normal anxiety and neurotic anxiety. Normal Anxiety is a natural response to everyday situations like starting a new job, being threatened, or getting lost. It is proportionate to the cause and can be constructive by helping individuals address the underlying dilemma. For instance, imagine a student feeling nervous before a big exam. This anxiety is a natural reaction to the perceived threat of performing well academically. It motivates the student to study harder and prepare adequately, ultimately leading to improved performance.

In another scenario, consider a person feeling anxious about an upcoming job interview. This anxiety is a normal response to the uncertainty of the situation and the desire to make a good impression. It prompts the individual to rehearse answers, research the company, and dress appropriately, all in an effort to increase their chances of success.

Normal Anxiety can transform into Neurotic Anxiety if the individual cannot confront the experience effectively. It is a reaction to threats that is disproportionate to the objective danger and involves repression and intrapsychic conflict. It is managed through various forms of avoiding or soothing mechanisms.

For example, imagine a person experiencing intense anxiety about attending social gatherings. Despite knowing that these events are relatively safe and enjoyable for most people, this individual feels overwhelming fear and discomfort at the thought of interacting with others. This neurotic anxiety may stem from underlying insecurities or past negative experiences, leading the person to avoid social situations altogether, which ultimately hampers their social life and personal growth.

Similarly, consider someone who becomes consumed by anxiety about their health after reading about rare diseases online. Despite having no symptoms, they constantly worry about being seriously ill, excessively monitor their body for signs of illness, and seek reassurance from doctors. This neurotic anxiety may significantly impact their quality of life, leading to unnecessary medical tests, missed opportunities, and strained relationships.

Neurotic anxiety is also experienced when an individual decides to conform and accepts the conditions of worth of others, and gives up possible personal growth, all in the name of safety and security.

Existential psychology views neurotic anxiety as a byproduct of avoiding or displacing the deeper, more profound anxiety stemming from the existential givens of being a human.

Below are some of the existential givens that lie beneath the surface of the neurotic anxiety symptoms.

- Difficulty in accepting that our life will come to an end one day and we cannot know when and how

- Difficulty in accepting the inevitability of experiencing loss (people, money, career, health, identity, relationships, etc) in life

- Difficulty in accepting personal responsibility for our thoughts, feelings, and actions

- Difficulty in accepting the inevitability of experiencing emotional pain and difficulty in tolerating it.

- Difficulty in facing that we are ultimately on our own in facing life’s challenges.

- Difficulty in facing that we are the ones who need to create or find a meaning in life, while there’s no inherent meaning.

- Difficulty in accepting that we always choose among alternatives and by every choice we make, we give up on an alternative.

- Difficulty in accepting that no matter how hard we try we will disappoint our loved ones in some way.

- Difficulty in accepting that a significant aspect of life’s meaning may have changed or no longer exist.

- The conflict over our desire to know for sure who we are but that we can never be certain.

- The conflict over whether to trust or distrust loved ones and people in general.

- The fear of committing one’s life to another human being.

- The conflict between the desire of being free and simultaneously striving for emotional security.

- The conflict over whether to authentically express who we are and what we think or stifle them in the quest for approval or in order to maintain the security of a highly valued relationship.

Existential psychologist Rollo May saw the exacerbation of anxiety in today’s world as deeply intertwined with the fabric of modern Western society. He believed that several aspects of modernity contributed to the prevalence of anxiety:

- Technological Advancements: May noted that while technological progress has brought numerous benefits, it has also created new sources of anxiety. The rapid pace of technological change can leave individuals feeling overwhelmed and uncertain about the future. Additionally, the constant connectivity afforded by technology can lead to information overload and a sense of never being able to fully escape from the demands of work and social media.

– Individualism:Modern Western society places a strong emphasis on individualism and self-reliance. While this can foster a sense of autonomy and personal freedom, it can also contribute to feelings of isolation and alienation. The pressure to succeed and "make it on one's own" can lead to a heightened sense of anxiety, as individuals feel the weight of responsibility for their own success or failure.

– Consumer Culture:May observed that modern Western societies are often characterized by a consumer-driven culture that prioritizes material wealth and external success. This focus on materialism can lead to a constant striving for more, as individuals seek to attain the latest gadgets, fashion trends, or status symbols. However, this pursuit of external validation can leave people feeling empty and unfulfilled, fueling feelings of anxiety and existential angst.

– Loss of Meaning and Purpose:May argued that modern Western society has seen a decline in traditional sources of meaning and purpose, such as religion, community, and family. As a result, many individuals struggle to find a sense of direction or significance in their lives. This lack of existential grounding can leave people feeling adrift and uncertain, leading to heightened feelings of anxiety and despair.

How does Anxiety differ from Fear?

Fear is a reaction to a specific, identifiable threat, while anxiety stems from ambiguity and uncertainty. It is easier to encounter fear than anxiety because fear arises from specific, identifiable threats that prompt clear, actionable responses, whereas anxiety stems from abstract, ambiguous sources. The clarity of fear often prompts specific, targeted responses, such as fight, flight, or protective measures, making it easier to manage and fosters in us a sense of control. In contrast, the vague and pervasive nature of anxiety makes it harder to pinpoint and manage.

According to the existential view, there is an interrelation between fear and anxiety. Underneath every fear is an existential anxiety that we strive to overcome by attaching it to fear, so that we make it more manageable, as fear’s specificity provides us clearer paths for coping.

Symptoms of Anxiety

Anxiety is a complex and multifaceted emotional experience that can manifest in various ways. While it is a natural response to stress or perceived threats, excessive or persistent anxiety can interfere with daily functioning and quality of life. Here are some common symptoms of excessive and dysfunctional anxiety.

Excessive Worry and Apprehension:

Persistent and excessive worry or apprehension about various aspects of life, such as work, relationships, health, or finances, often disproportionate to the actual threat posed by the situation. While occasional worry is normal, excessive worry that persists over time and interferes with daily functioning may indicate an anxiety disorder.

Psychological Distress:

Feelings of fear, dread, or impending doom, along with irritability, agitation, or a sense of being on edge. While it's normal to experience occasional feelings of fear or unease, persistent psychological distress that interferes with daily functioning or causes significant distress may suggest an anxiety disorder.

Physical Symptoms:

Muscle tension, restlessness, trembling, sweating, palpitations, sleep disturbance, changes in appetite, sex drive and gastrointestinal distress, which may arise in anticipation of or during anxiety-provoking situations. While some physical symptoms are a natural part of the body's stress response, persistent or severe physical symptoms that occur without an apparent trigger may indicate excessive anxiety.

Cognitive Symptoms:

Difficulty concentrating, racing thoughts, and intrusive worries or fears that disrupt the ability to focus on tasks or engage in daily activities. While occasional racing thoughts or difficulty concentrating may occur during periods of stress, persistent cognitive symptoms that interfere with functioning may signal excessive anxiety.

Individuals grappling with anxiety often employ a variety of coping mechanisms to navigate the complex terrain of their inner turmoil. These mechanisms, while initially serving as shields against overwhelming emotions, ultimately contribute to the perpetuation of their anxiety.

Avoidance of Anxiety Provoking Situations:

This involves actively steering clear of situations, places, or people that trigger anxiety. It's a proactive strategy aimed at minimizing distress. For example, someone with social anxiety might avoid social gatherings or public speaking engagements altogether.

Escaping or Distracting Behaviors:

This involves a range of strategies aimed at escaping or distracting oneself from anxiety and alleviating distress through soothing or pleasurable activities. These can include behaviors such as alcohol or substance use, excessive screen time, compulsive shopping. eating, sexual activity. On many occasions these behaviors are followed by feelings of guilt and self-blame that feed into anxiety.

Safety Behaviors:

Safety behaviors are specific actions or rituals individuals engage in to reduce anxiety or prevent feared outcomes. Unlike avoidance, safety behaviors are often performed within anxiety-provoking situations to provide a sense of control or security. For instance, someone with obsessive-compulsive disorder might repeatedly check door locks to alleviate anxiety about intruders.

Impression Management:

This coping mechanism revolves around presenting a carefully curated image or facade to others to conceal feelings of anxiety or inadequacy. While similar to safety behaviors in seeking to control perceptions and alleviate social discomfort, impression management primarily focuses on managing others' perceptions rather than directly addressing internal anxiety.

Emotional Constriction:

Emotional blunting involves suppressing or numbing emotions to avoid discomfort or overwhelm. While this can temporarily alleviate anxiety, it differs from avoidance behaviors in that it pertains specifically to emotional experiences rather than external situations or stimuli.

While occasional worry or stress is a natural part of life, persistent or excessive anxiety that interferes with daily functioning may be a call to ask for professional help to address underlying issues.

Anxiety Disorders

The concept of anxiety disorders began to take shape in the late 19th and early 20th centuries with the development of psychiatry and psychoanalysis. Sigmund Freud, often regarded as the father of psychoanalysis, contributed to the understanding of anxiety through his work on neuroses and defense mechanisms. Freud's conceptualization of anxiety as an unconscious response to repressed conflicts laid the groundwork for later theories and diagnostic criteria.

However, it wasn't until the mid-20th century that anxiety disorders were officially recognized and classified within the field of mental health. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA) in 1952, included a category for "Anxiety Reaction" under the broader classification of "Neurotic Disorders." This marked a significant step in formally acknowledging anxiety as a distinct diagnostic entity.

Subsequent revisions of the DSM, expanded and refined the classification of anxiety disorders, introducing specific categories such as generalized anxiety disorder (GAD), panic disorder, phobias, and others.

Below is a list of most common anxiety disorders that are present in the latest DSM-5:

Generalized Anxiety Disorder (GAD)

It is characterized by excessive, uncontrollable worry about various aspects of daily life (e.g., work, health, social interactions) that persists for at least six months. Individuals often experience restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances​.

Panic Disorder

Involves recurrent, unexpected panic attacks—sudden periods of intense fear or discomfort that peak within minutes. Symptoms include palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills or hot flushes, numbness, and fear of losing control or dying. Persistent concern about having more attacks or behavioral changes to avoid them is also common​.

Specific Phobias

Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, injections, blood) that is out of proportion to the actual danger posed. This fear or anxiety is persistent, typically lasting six months or more, and leads to avoidance behavior or significant distress and impairment in functioning​.

Social Anxiety Disorder (Social Phobia)

Intense fear or anxiety about one or more social situations in which the individual may be scrutinized by others (e.g., social interactions, being observed, performing in front of others). Individuals fear they will act in a way or show anxiety symptoms that will be negatively evaluated. This fear or anxiety is persistent, typically lasting six months or more, and causes significant distress or impairment​.

Agoraphobia

It is characterized by marked fear or anxiety about two or more situations such as using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, or being outside the home alone. Individuals avoid these situations because they believe escape might be difficult or help might not be available in the event of panic-like or other incapacitating symptoms. The fear, anxiety, or avoidance is persistent, typically lasting six months or more, and causes significant distress or impairment​.

Separation Anxiety Disorder

Excessive fear or anxiety concerning separation from attachment figures, which is developmentally inappropriate. Symptoms include distress when anticipating or experiencing separation, worry about losing attachment figures or about unfortunate events causing separation, reluctance or refusal to go out or sleep away from home, nightmares about separation, and physical symptoms when separation occurs or is anticipated. This condition is particularly noted in children but can be diagnosed in adults​ as well.

Apart from these above, it is worth mentioning about Obsessive Compulsive Disorder (OCD) as well as it involves a strong component of anxiety. While OCD used to be under the anxiety disorders within DSM in the past, today it is under a separate headline.

Obsessive-Compulsive Disorder (OCD)

as per the DSM-5, is characterized by the presence of obsessions, compulsions, or both. Obsessions are recurrent, persistent, and intrusive thoughts, urges, or images that cause significant anxiety or distress. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules. These behaviors or mental acts are aimed at preventing or reducing distress or preventing a feared event or situation, but they are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. Engaging in compulsions only provides temporary relief and tends to reinforce the cycle of obsessions and compulsions. OCD symptoms can cause significant impairment in social, occupational, or other areas of functioning.

While OCD has a strong anxiety component, it has unique features that differentiate it from other anxiety disorders, such as the specific focus on intrusive thoughts and the compulsive behaviors performed in response to these thoughts.

Please note that the descriptions provided above are solely for informational purposes. Refrain from any attempt at self-diagnosis and consult a qualified mental health professional for further information.

Existential integrative approach to psychotherapy of anxiety disorders

The existential integrative approach to therapy of anxiety disorders combines existential principles with techniques from various therapeutic modalities to provide a comprehensive and personalized therapy experience.

This approach recognizes the existential dimensions of anxiety while drawing upon a range of therapeutic tools to address individual needs and preferences.

A prevalent existential fear that often triggers anxiety is the fear of death. Individuals with anxiety disorders, ranging from generalized anxiety disorder to specific phobias, may find themselves engulfed in panic when confronted with the reality of mortality, whether it be their own or that of a loved one. Additionally, the fear of loss looms large, encompassing not only the fear of losing loved ones but also the fear of losing cherished dreams, aspirations, and identities.

Moreover, many anxiety sufferers grapple with conflicting desires for freedom and security. This inner conflict manifests in intense feelings of uncertainty and anxiety about the future, as individuals struggle to strike a balance between the autonomy they crave and the stability they seek. Similarly, the fear of commitment often traces back to past experiences of betrayal or control, rendering individuals hesitant to trust and form meaningful connections.

A person with panic disorder may uncover that their panic attacks are not merely random occurrences but are intimately tied to a deeply ingrained fear of aging and the inevitability of mortality. Similarly, another individual struggling with obsessive-compulsive disorder might come to realize that their obsessive thoughts and compulsive behaviors stem from a profound terror of inadvertently causing harm to their loved ones. These revelations underscore how existential fears—pertaining to mortality, personal responsibility, and the unpredictability of life—underpin various anxiety disorders.

Here's an overview of how existential integrative therapy approaches anxiety disorders:

Acceptance and Validation:

Existential integrative therapy emphasizes acceptance and validation of the client's experience. The therapist creates a safe and nonjudgmental space where the client feels heard and understood, allowing them to express their anxiety without fear of criticism or rejection. By validating the client's emotions and experiences, the therapist fosters a sense of trust and collaboration, laying the groundwork for therapeutic exploration and growth.

Exploration of Existential Themes:

Existential integrative therapy explores the existential themes underlying the client's anxiety. This may involve examining issues such as the search for meaning, freedom, isolation, and mortality. Exploration of these existential concerns help the client gain insight into the deeper roots of their anxiety and develop a deeper understanding of themselves and their values.

Identification of Maladaptive Patterns:

In conjunction with exploring existential themes, existential integrative therapy helps the client identify maladaptive patterns of thinking, feeling, and behaving that contribute to their anxiety. This may involve techniques from cognitive-behavioral therapy (CBT), such as cognitive restructuring and behavioral experiments, to challenge negative beliefs and develop more adaptive coping strategies.

Cultivating Presence:

Mindfulness practices are often integrated into existential therapy to help the client cultivate present-moment awareness and acceptance of their anxiety. By practicing mindfulness techniques, client learns to observe their thoughts and feelings without judgment, reducing reactivity and enhancing emotional regulation. Mindfulness also fosters a sense of presence and connection to the present moment, allowing the client to engage more fully in their lives despite their anxiety.

Exploration of Values and Meaning:

Η υπαρξιακή-συνθετική θεραπεία ενθαρρύνει το θεραπευόμενο να εξερευνήσει τις αξίες του και τις πηγές νοήματος εν μέσω του άγχους.  Η/Ο θεραπεύτρια/ης  βοηθάει τα θεραπευόμενο να διευκρινίσει τις βασικές αξίες του και να εντοπίσει δραστηριότητες και σχέσεις που το φέρνουν πληρότητα και σκοπό στη ζωή του. Εναρμονίζοντας τις δράσεις του με τις αξίες του, το θεραπευόμενο μπορεί να μειώσει τις υπαρξιακές συγκρούσεις και να βελτιώσει την αίσθηση νοήματος και ευημερίας.

Promotion of Existential Courage:

Central to existential integrative therapy is the cultivation of existential courage – the willingness to face life's uncertainties and challenges with authenticity and resilience. The therapist helps the client develop the courage to confront their anxiety head-on, empowering them to take proactive steps toward growth and self-discovery. Through the cultivation of existential courage, the client can find strength and resilience in the face of anxiety, ultimately leading to greater fulfillment and well-being.

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