Existential Distress

As human beings, many people have a deeply rooted and often repressed anxiety about death, also called death anxiety.

We create defenses and ways of coping with this anxiety, which also often comes with a serious illness.

Note

Due to the nature of this topic, some may find this module triggering. We encourage you to take breaks as much as you need as you work through this content. Please reach out to training@numinus.com if you need support.

When faced with chronic or serious illness (CSI), clients can become distressed and need additional support to enhance mental and emotional wellbeing and quality of life. At the heart of existential distress is the broad theme of existentialism and the common feeling of demoralization.

Video: What is Existentialism?

2:46

If you’re unfamiliar with the philosophy of existentialism, please watch this brief video to help you better understand existential distress within the context of existentialism. Existentialism as a philosophy has applications that extend far beyond the confines of therapy; however, this brief overview will provide us with some important context as we look more deeply at existential distress and psychedelic-assisted therapy.

Similarities Between Depression and Demoralization

Demoralization is a common realization of existential distress and is a normal response to an overwhelming circumstance where someone experiences helplessness, hopelessness, confusion, or subjective incompetence to varying degrees (Griffith & Gaby, 2005). Depression and demoralization can sometimes present in similar ways. For example, common symptoms like:

Disturbance of sleep
Disturbances to appetite
Low energy
Suicidal ideation

Differences Between Depression and Demoralization

As a result, health professionals working with clients who have a chronic or serious illness should be aware of the key differentiating symptoms of demoralization. Demoralization is different from depression because:

The responsivity of the client’s mood preserved
If the adversity was to cease (be it relief of pain or emotional relief), it would restore the client’s capacity to feel enjoyment or hope
Uncertainty and fear can cause clients to develop an apathy or paralysis towards others and their life
The client won’t respond to anti-depressant medications (Griffith & Gaby, 2005)

General Hopes and Fears

Clients with a chronic or terminal illness may experience a wide array of emotions, thoughts, hopes, and fears.

Please ensure that you read through all examples before proceeding by using the arrow keys on your keyboard or using the navigation buttons at the bottom of each slide.

Example

The absence of relationships or an adequate social support network leads to a greater likelihood of the individual experiencing existential distress, which can be exacerbated through unresolved trauma.

Example

Clients attempt to seek what's most important to those who are closer to death:

Comfort
Feeling unburdened and unburdening to those they love
Existential peace
Sense of wonderment and spirituality

Example

Clients may be fearful for their family and loved ones they are leaving behind.

Example

Clients might not want to be in this experience alone. They want their loved ones to understand and support their psychedelic journey and learnings. The experience can be very scary and isolating.

Imagine a “floodlit room lined with tubes and beeping machines and blinking lights. Cleaning crew swoops in, the body's whisked away, and it all feels as though that person had never really existed”

— BJ Miller (2015).

Self-Care

In order to help combat existential distress, health professionals can work with clients to engage in self-care. Some opportunities for self-care include:

Stress Relief

Clients may use healthy and unhealthy coping strategies to decrease stress in the present moment. Naturally, clients should be guided towards healthy stress relief activities like exercise and mindfulness rather than unhealthy ones (such as alcohol consumption or substance use).

Stress Reduction

Clients can also make lifestyle choices and practice stress relief skills which allow them to reduce the amount of stress in their lives. This ultimately expands their window of tolerance which we discussed in Fundamentals of Psychedelic-Assisted Therapy.

Stress Resilience

Clients can work to build stress resilience so that they can navigate stressful events without too much negative impact on their day-to-day lives.

Learn More

Existential distress is a large topic which goes beyond the scope of this course. If you would like to learn more about existential distress, please watch these videos.

References

Griffith, J. L., & Gaby, L. (2005). Brief psychotherapy at the bedside: countering demoralization from medical illness. Psychosomatics, 46(2), 109–116.

Miller, B. J. (2015). What really matters at the end of life [Video]. Ted.