Why Uncertainty Feels So Difficult: The Hidden Psychology of Existential Anxiety

Why do clients struggle with uncertainty? This article explores the existential roots of anxiety and suggests practical therapeutic approaches for helping clients live with life’s unknowns.

Related articles: When Work Changes: Supporting Clients Through Career Transitions, Helping Clients Navigate Death Anxiety, Understanding Money Trauma and Financial Anxiety.

Introduction

A client asks whether they are making the right career decision. Another worries constantly about their relationship and seeks repeated reassurance that everything is going to be okay. A third spends hours researching health symptoms despite receiving multiple medical opinions that nothing serious is wrong. Although the content of these concerns differs, they often share a common theme: an intense discomfort with uncertainty.

Most mental health professionals encounter this pattern regularly. Clients may seek certainty about their future, their relationships, their health, their identity, or the consequences of important decisions. They often hope that if they can gather enough information, make the perfect choice, or eliminate every possible risk, their anxiety will finally subside. Yet certainty remains elusive. New questions emerge, fresh doubts appear, and the cycle begins again.

From a clinical perspective, uncertainty intolerance has been linked to a range of psychological difficulties, including anxiety disorders, obsessive-compulsive presentations, health anxiety, and excessive worry (Carleton, 2016a). However, existential perspectives suggest that uncertainty is not simply a symptom trigger or cognitive distortion. Rather, it reflects a confrontation with one of the most fundamental realities of human existence: life offers no guarantees (May, 1950; Yalom, 1980).

This distinction has important implications for therapeutic practice. If uncertainty is viewed solely as a problem to eliminate, therapy may inadvertently become another form of reassurance seeking. If, however, uncertainty is recognised as an unavoidable aspect of being human, the therapeutic task begins to shift. The goal becomes less about helping clients achieve certainty and more about helping them develop the capacity to live meaningfully in its absence.

This article explores the existential roots of uncertainty, why certainty-seeking often fails to resolve distress, and how therapists can support clients in building a healthier relationship with life’s inevitable unknowns.

The human need for certainty

Before exploring existential perspectives, it is worth considering why uncertainty feels so uncomfortable in the first place.

Human beings are meaning-making creatures who continuously attempt to understand, predict, and navigate their environments. From an evolutionary perspective, the ability to anticipate potential threats offered obvious survival advantages. Knowing where danger might arise, recognising patterns, and preparing for future challenges increased the likelihood of survival. Uncertainty, by contrast, often signalled potential risk.

Modern life may be considerably safer than many ancestral environments, but the human nervous system remains highly sensitive to ambiguity and unpredictability. Research increasingly suggests that uncertainty itself can be experienced as stressful, even when no immediate danger is present (Carleton, 2016a). Faced with uncertainty, individuals often experience heightened vigilance, increased information seeking, reassurance seeking, rumination, or attempts to regain a sense of control.

Yet not all uncertainty is the same. Some forms are practical and potentially solvable. A person may be uncertain about which treatment option to pursue, how to navigate a workplace conflict, or whether to relocate to a new city. Gathering information and weighing alternatives can often reduce uncertainty in these situations.

Existential uncertainty is different. It concerns questions that cannot be fully resolved because they arise from the nature of life itself. Human beings cannot know with complete certainty what the future holds. Relationships cannot be guaranteed against loss or change. Health cannot be perfectly protected. Outcomes cannot be entirely controlled. Even the most carefully constructed plans remain vulnerable to circumstances beyond our influence (Yalom, 1980; van Deurzen, 2012).

This reality creates a dilemma. People naturally seek certainty because certainty feels safe. Yet many of the concerns that matter most deeply – love, purpose, mortality, meaning, identity, and the future – exist within domains where complete certainty is ultimately unattainable. As a result, individuals may find themselves pursuing guarantees that life itself cannot provide.

For some clients, this pursuit becomes exhausting. The more they attempt to eliminate uncertainty, the more attention uncertainty demands. Therapy may therefore involve helping clients recognise not only how they respond to uncertainty, but also the possibility that uncertainty itself is not the true enemy. The struggle to eliminate it may be the greater source of suffering.

When uncertainty becomes existential

Not all uncertainty is practical. Some uncertainty reaches into the deepest concerns of human life. Clients may worry about whether a relationship will last, whether their health will remain stable, whether they have chosen the right career, whether they are living meaningfully, or whether they will look back later with regret. Beneath these concerns often sit larger existential questions about mortality, freedom, responsibility, identity, change, and loss (Yalom, 1980).

Existential uncertainty differs from ordinary decision-making uncertainty because it cannot be fully answered through information alone. A person can research a career path, seek medical advice, or discuss a relationship with trusted friends, yet still be left with questions that no amount of evidence can resolve completely: What if things change? What if I choose wrongly? What if I waste my life? What if I lose what I love?

A brief therapeutic exchange may illustrate this shift:

• Client: “If I just knew this relationship would work out, I could relax.”
• Therapist: “That makes sense. It sounds exhausting to feel suspended between hope and fear.”
• Client: “Exactly. I just need certainty.”
• Therapist: “And what if part of the pain here is that relationships matter deeply, but none of us can guarantee what will happen?”
• Client: “That’s what scares me.”
• Therapist: “So perhaps we are not only working with relationship anxiety. We may also be working with the vulnerability of loving someone without being able to control the future.”

This kind of exploration does not dismiss the client’s fear. Rather, it gently widens the frame. The therapist helps the client see that the anxiety is not simply about a single decision or outcome. It is also about the human difficulty of caring, choosing, and committing within uncertainty.

Existential anxiety often intensifies when clients believe they should be able to eliminate uncertainty before living fully. They may postpone decisions, avoid intimacy, over-research options, seek repeated reassurance, or attempt to control situations that are inherently unpredictable. While these strategies may provide temporary relief, they can also narrow the client’s life and reinforce the idea that uncertainty must be resolved before meaningful action is possible.

For therapists, the clinical task is not to argue clients out of uncertainty, nor to provide philosophical lectures about the human condition. Rather, it is to help clients recognise when their distress reflects an encounter with unavoidable realities of life. This recognition can make space for a different therapeutic question: not “How can we remove all uncertainty?”, but “How can this person live meaningfully while uncertainty remains?” (van Deurzen, 2012; Yalom, 1980).

Why reassurance rarely solves the problem

Reassurance is one of the most understandable responses to uncertainty. Clients seek it because they are distressed; therapists, partners, family members, and friends often offer it because they want to help. In many situations, reassurance is compassionate and appropriate. However, when existential uncertainty is the deeper issue, reassurance may provide only temporary relief.

Consider Steven, a 36-year-old senior manager who sought therapy after months of escalating anxiety about whether to leave his job. On paper, he had gathered extensive information. He had spoken to mentors, compared salaries, assessed career pathways, reviewed financial risks, and discussed the decision repeatedly with his partner. Each time someone reassured him that he was capable and would “work it out”, he felt calmer for a few hours. Then the doubts returned.

Steven’s anxiety appeared at first to be about career choice. Yet as therapy progressed, it became clear that the decision had come to represent something larger. He feared wasting his potential, disappointing others, losing security, and discovering too late that he had built a life around the wrong priorities. His question was not simply, “Should I take this job?” It was also, “How do I make choices in a life where I cannot know the outcome in advance?”

This distinction matters clinically. If therapy focuses only on helping Steven make the “correct” decision, it may unintentionally reinforce the belief that anxiety will disappear once certainty is achieved. Yet no decision can provide total protection from regret, change, loss, or future uncertainty. The deeper therapeutic work involves helping Steven tolerate the vulnerability of choosing without guarantees.

Reassurance-seeking can become self-reinforcing. The client feels anxious, seeks certainty, receives reassurance, experiences short-term relief, and then becomes anxious again when doubt returns. Over time, the client may become increasingly dependent on external confirmation rather than developing confidence in their own capacity to act under uncertainty. This pattern is commonly discussed in relation to intolerance of uncertainty and anxiety maintenance (Carleton, 2016b).

Existentially informed therapy does not require therapists to withhold warmth or support. Rather, it asks therapists to notice when reassurance begins to function as avoidance. Instead of answering the same uncertainty-based question repeatedly, the therapist may gently redirect attention toward the client’s relationship with uncertainty itself.

For example, the therapist might ask:

• “What happens inside you when certainty is unavailable?”
• “What are you hoping reassurance will protect you from?”
• “If there were no perfect answer, what values would you want to guide this decision?”
• “What would it mean to trust yourself enough to choose without complete certainty?”

Such questions shift therapy from reassurance provision to capacity-building. The goal is not to leave clients alone with fear, but to help them discover that they can experience uncertainty without allowing it to govern every choice. This is where existential work overlaps strongly with acceptance-based approaches: clients may learn to make room for uncertainty while taking action guided by values, meaning, and commitment (Hayes et al., 2012; Frankl, 1963).

In this sense, therapy does not remove the unknown. It helps clients stop treating the unknown as proof that they cannot live, choose, love, or move forward.

Helping clients develop a different relationship with uncertainty

Once therapists recognise that uncertainty itself is not always the problem, a different therapeutic question emerges: how can clients learn to live effectively when certainty is unavailable?

This shift can be surprisingly powerful. Many clients enter therapy hoping to eliminate uncertainty altogether. They may assume that psychological wellbeing requires confidence about the future, clarity regarding important decisions, or guarantees that painful outcomes can be avoided. Yet therapy often reveals that such guarantees are impossible. No amount of insight can ensure that relationships will last, careers will unfold as planned, health will remain stable, or loss will never occur.

Existential approaches therefore encourage a movement away from certainty-seeking and toward uncertainty tolerance. This does not mean clients must learn to enjoy uncertainty or stop caring about outcomes. Rather, they gradually develop the capacity to acknowledge uncertainty without allowing it to dictate every choice, relationship, or decision (Yalom, 1980; van Deurzen, 2012).

Contemporary acceptance-based approaches echo this principle. Acceptance and Commitment Therapy (ACT), for example, emphasises psychological flexibility: the ability to remain in contact with difficult thoughts and feelings while taking action guided by personal values rather than avoidance (Carleton, 2016b; Hayes et al., 2012; Gloster et al., 2020). From this perspective, uncertainty becomes something to carry rather than something that must first be removed.

In practice, therapists can help clients explore how their lives may have become organised around avoiding uncertainty. Questions such as the following can invite reflection:

• What opportunities have been postponed while waiting for certainty?
• What relationships have been limited by fear of vulnerability or loss?
• What values become difficult to live when uncertainty is treated as intolerable?
• How might life look if meaningful action were possible before certainty arrives?

These conversations often reveal a paradox. The more intensely individuals pursue certainty, the smaller and more constrained their lives can become. Conversely, when clients become willing to tolerate uncertainty, they may discover greater freedom to act, connect, create, and engage.

Importantly, this work requires sensitivity and pacing. Encouraging clients to embrace uncertainty prematurely can feel invalidating, particularly when they are experiencing significant distress. Instead, therapists help clients gradually expand their capacity to remain present with uncertainty while maintaining connection to their values, relationships, and sources of meaning.

Ultimately, helping clients develop a healthier relationship with uncertainty is not about teaching resignation. It is about fostering trust in their ability to navigate life even when outcomes cannot be fully controlled.

Clinical Pearl: The goal is not to make uncertainty comfortable. The goal is to help clients live meaningfully when certainty is unavailable.

Uncertainty as an invitation rather than an obstacle

If uncertainty is unavoidable, what might change when it is no longer viewed solely as a threat?

This question sits at the heart of many existential approaches. While uncertainty undoubtedly generates anxiety, it is also inseparable from many of the experiences that make life meaningful. Love involves uncertainty. Commitment involves uncertainty. Creativity involves uncertainty. Growth, exploration, learning, and personal transformation all require stepping into situations where outcomes cannot be guaranteed.

Seen in this light, uncertainty is not merely the absence of security. It is also the space in which possibility exists.

Consider a client contemplating a significant life transition. They may feel paralysed by the inability to predict the future. Yet the very uncertainty that evokes anxiety is also what makes change possible. A future that could not be altered would offer certainty, but it would offer little freedom, choice, or growth. Existential thinkers have long recognised that uncertainty and possibility are intertwined; one cannot exist without the other (May, 1950; Yalom, 1980).

This perspective does not deny suffering. Uncertainty can accompany grief, illness, relationship difficulties, financial hardship, and profound personal challenges. However, existential approaches suggest that meaningful living does not begin once uncertainty disappears. Meaningful living occurs within uncertainty itself.

Many clients find this idea unexpectedly liberating. Rather than waiting to feel completely certain before acting, they begin asking different questions:

• What kind of person do I want to be in this situation?
• What matters most to me right now?
• How do I want to respond to this uncertainty?
• What values can guide me even when the outcome remains unknown?

These questions shift attention away from prediction and toward participation. The focus moves from controlling the future to engaging with the present.

Frankl (1963/2006) argued that meaning is often discovered through the ways individuals respond to life’s circumstances rather than through complete control over those circumstances. Similarly, contemporary meaning-centred approaches suggest that purpose, connection, and fulfilment emerge not because uncertainty has been resolved, but because individuals continue engaging with life despite uncertainty (Wong, 2010).

For therapists, this perspective offers a valuable reminder. Our role is not to provide certainty where none exists. Rather, it is to help clients develop the courage, flexibility, and self-awareness required to move forward when certainty is unavailable.

In many ways, psychological wellbeing is not the absence of uncertainty. It is the capacity to participate fully in life while uncertainty remains.

Conclusion

Uncertainty is not a problem to be solved once and for all, but an enduring aspect of human existence. While clients often seek certainty as a pathway to safety and relief, therapy may instead help them develop the capacity to engage meaningfully with life despite not knowing what lies ahead. In this way, the goal is not to eliminate uncertainty, but to cultivate the courage, flexibility, and values-based commitment needed to live well within it.

Key takeaways

• Uncertainty is not merely a symptom trigger; it is an unavoidable feature of human existence.
• Many clients seek certainty regarding relationships, health, identity, decisions, or the future, yet complete certainty is rarely attainable.
• Existential anxiety often emerges when individuals confront realities such as mortality, freedom, responsibility, change, and the limits of control.
• Reassurance can provide short-term relief, but repeated certainty-seeking may unintentionally reinforce anxiety and dependence on external validation.
• Therapists can help clients distinguish between practical problems that can be solved and existential uncertainties that must be navigated.
• Psychological flexibility and uncertainty tolerance are often more helpful therapeutic goals than certainty acquisition.
• Values-based action enables clients to move forward meaningfully even when outcomes remain unknown.
• Existential approaches encourage clients to engage with uncertainty rather than organising their lives around avoiding it.
• Uncertainty creates anxiety, but it also creates possibility, choice, creativity, growth, and authentic living.
• Psychological wellbeing is not the absence of uncertainty; it is the capacity to participate fully in life while uncertainty remains.

Questions therapists often ask

Q. How can I tell whether a client’s distress is driven by uncertainty intolerance or by a genuine problem that requires practical action?

A. Both may be present. A useful clinical question is whether additional information or action would realistically resolve the concern. Practical uncertainties often diminish when clients gather information or take appropriate action. Existential uncertainties persist because they involve questions that cannot be fully answered, such as whether a relationship will last, whether a life decision is ultimately correct, or what the future may hold.

Q. Isn’t acceptance of uncertainty simply another word for resignation?

A. No. Resignation involves disengagement and helplessness. Existential acceptance involves recognising that uncertainty exists while continuing to make choices, pursue values, maintain relationships, and engage meaningfully with life. It is an active rather than passive stance.

Q. How can therapists avoid becoming part of a client’s reassurance-seeking cycle?

A. Therapists can remain empathic while gently shifting attention from the content of uncertainty to the client’s relationship with uncertainty itself. Rather than repeatedly answering the same question, clinicians can explore what certainty is expected to provide and how the client might respond if certainty remains unavailable.

Q. Are existential approaches appropriate for clients experiencing significant anxiety?

A. Yes, provided interventions are tailored to the client’s needs and level of functioning. Existential exploration should complement, not replace, sound clinical assessment, evidence-based interventions, and appropriate risk management. Many clients benefit from understanding that some aspects of anxiety arise not from pathology alone but from confronting universal human concerns.

Q. How can I introduce existential ideas without sounding overly philosophical?

A. Start with the client’s lived experience. Most people readily understand concerns relating to uncertainty, change, loss, identity, responsibility, and meaning because they encounter them in everyday life. Existential work is often most effective when it emerges naturally from the client’s own questions rather than through abstract philosophical discussion.

Q. What should clients ultimately learn from therapeutic work around uncertainty?

A. Not that uncertainty will disappear, but that they are capable of living, choosing, loving, creating, and finding meaning even when certainty is unavailable. The aim is not confidence about the future; it is increased capacity to engage with life despite not knowing exactly what the future will bring.

References

• Carleton, R. N. (2016a). Fear of the unknown: One fear to rule them all? Journal of Anxiety Disorders, 41, 5–21. https://doi.org/10.1016/j.janxdis.2016.03.011
• Carleton, R. N. (2016b). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43 DOI:10.1016/j.janxdis.2016.02.007
• Frankl, V. E. (1963/2006). Man’s search for meaning. Beacon Press.
• Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18(1), 181–192. DOI:10.1016/j.jcbs.2020.09.009
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: Guilford Press.
• May, R. (1950). The meaning of anxiety. Ronald Press.
• van Deurzen, E. (2012). Existential counselling and psychotherapy in practice (3rd ed.). Sage.
• Wong, P. T. P. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85–93.
• Yalom, I. D. (1980). Existential psychotherapy. Basic Books.