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Skills Classes

Transdiagnostic and Therapeutic Processes

Skills Class 28 - Working with Existential Anxiety in CBT: Fear, Uncertainty, and Meaning

Saturday, June 27, 2026
4:00 PM - 5:30 PM PDT
Location: Yerba Buena Salon 13, B3 Level
Earn 1.5 Credit
Keywords: Change Process / Mechanisms, Case Conceptualization / Formulation, Distress Tolerance
Level of Familiarity: All
Recommended Readings: Syfret, W. (2021). The sunny nihilist: How a meaningless life can make you truly happy. Hachette Books.,   Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. Jossey-Bass.,   Hayes, S. C. (2019). A liberated mind: How to pivot toward what matters. Avery.,   ,  
Mental health professionals are increasingly working with clients experiencing fear, confusion, and loss of control rooted in uncertainty about the future. In these contexts, distress is often realistic, collective, and unresolved, rather than the result of distorted thinking. While CBT offers effective tools for structure, agency, and behavioral grounding, it can fall short when applied narrowly to experiences that are fundamentally existential in nature.

This workshop explores how existential and philosophical perspectives can be thoughtfully integrated into CBT practice to support clients facing pervasive uncertainty, instability, and lack of control. Rather than positioning existential distress as something to be corrected or reassured away, the session emphasizes making space for fear, ambiguity, and limits while maintaining therapeutic direction. The workshop focuses on how clinicians can distinguish between cognitive distortions and existential truths, avoiding over-pathologizing realistic distress while still supporting meaningful change.

Using applied case examples, participants will examine how existential themes such as uncertainty, responsibility, meaning, and finitude can be incorporated into CBT case conceptualization. The workshop highlights change processes and mechanisms relevant to this work, including cognitive flexibility, values-guided action, and distress tolerance. Emphasis is placed on helping clients relate differently to uncertainty rather than attempting to eliminate it, and on using CBT tools without defaulting to premature reassurance.

The session situates this integrated approach within a broader social and cultural context characterized by instability, polarization, and ongoing threat perception. Participants will leave with practical strategies for conceptualizing and responding to existential distress within CBT frameworks, supporting ethical, sustainable practice when certainty is unavailable and distress is an understandable response to real conditions

Learning Objectives:

  • Distinguish existential distress from cognitive distortions in clients facing uncertainty and loss of control.
  • Describe limitations of traditional CBT when distress reflects realistic, unresolved threats.
  • Integrate existential perspectives into CBT case conceptualization without abandoning structure or direction.
  • Apply ACT principles to support values-based action when certainty and reassurance are unavailable.
  • Use distress tolerance strategies to help clients remain engaged with fear rather than avoid or suppress it.
  • Identify change processes that support psychological flexibility in conditions of instability and ambiguity.
  • Conceptualize therapeutic goals when symptom reduction is not immediately possible or appropriate.