At some point in life, we all find ourselves wondering: What is the meaning of all this? Death, the fleeting nature of existence, the possibility of losing those we love, or the absence of a transcendent purpose can trigger a deep and silent form of anxiety: existential anguish.
It’s not a disorder, but it can hurt like one. It may manifest as a vague fear of death, inner emptiness, a sense of disconnection, or a crisis of meaning. Fortunately, psychotherapy has begun to embrace powerful tools to address this very human experience. One of them is Acceptance and Commitment Therapy (ACT).
What Is Existential Anxiety?
Existential anxiety goes beyond fear of dying. It’s the unease that arises when we confront life’s ultimate truths: uncertainty, existential loneliness, lack of control, or the feeling that nothing really matters. This form of anxiety often intensifies after major losses, life transitions, aging, or serious illness.
It can appear as tightness in the chest, repetitive thoughts, emotional numbness, or the paralyzing feeling that “none of this truly matters.” It may block our decisions, distance us from what we care about, and send us searching for impossible certainties.
The Fear of Death: How Does It Affect Us?
The fear of death is universal. Sometimes it takes a concrete form (fear of illness, loss of control, the disappearance of the self), other times it’s more abstract (awareness of mortality, the irreversible passage of time).
Often, we avoid it through routine, distractions, compulsive control, or even spiritual overcompensation. Sometimes, it sneaks in disguised as panic attacks, generalized anxiety, or deep existential crises.
Acceptance and Commitment Therapy: A Radical Shift
ACT doesn’t aim to eliminate distress—it aims to transform our relationship with it. Instead of running from or overanalyzing existential fear, it invites us to open up to the pain that comes with being alive, while reconnecting with what truly matters to us.
ACT is based on six core processes that can help us respond to existential anxiety:
- Cognitive defusion: Learning to step back from our thoughts without automatically believing them. For example: “My mind says nothing has meaning, but that doesn’t make it true.”
- Acceptance: Willingly making space for discomfort instead of fighting it. Fear of death isn’t the problem—how we relate to it is.
- Present moment contact: Grounding ourselves in the here and now. The mind often drifts toward future fears or past regrets. Presence brings anchoring.
- Self-as-context: Developing an observing self beyond our thoughts and emotions. We are not our fears; we are the space where those fears appear.
- Values: Reconnecting with what gives life meaning—love, kindness, curiosity, creativity, freedom.
- Committed action: Taking steps aligned with our values, even when fear or doubt are present.
How Is This Worked on in Therapy?
An ACT-based intervention for existential anxiety begins by normalizing the experience: you are not broken—you are awake and aware. The work continues by identifying patterns of avoidance (rumination, control, dissociation, digital numbing) and replacing them with mindful openness and value-guided actions.
Therapy helps people identify their existential values: connection, freedom, expression, legacy, compassion. Then, it supports them in taking action consistent with those values, even with fear in the background.
Clients also learn to observe fearful thoughts without becoming entangled in them. For example, if the thought “I will die and that’s unbearable” arises, ACT teaches us to recognize it as a mental event—not an ultimate truth. This creates space and reduces its grip.
Living with the Awareness of Death
Death is real—but it can also serve as a compass. It reminds us that time is limited, that what we delay may never come, that every moment is a choice toward vitality or disconnection.
ACT invites us to build a life of meaning, not a life free of fear. Paradoxically, when we stop struggling against fear, its power fades.
“It’s not about eliminating the fear of death, but learning to live with it—holding its hand while walking toward what we love.”
Final Reflection
If you’re going through a crisis of meaning, feeling overwhelmed by fear or emptiness, perhaps you don’t need a perfect answer—you need a path. That path may begin by facing what you fear, opening to what hurts, and choosing to live again.
Acceptance and Commitment Therapy doesn’t promise certainty, but it offers tools to live a meaningful life—even with fear, even with anguish. Because, as Viktor Frankl said: “He who has a why to live can bear almost any how.”