Introduction

Every clinician knows that anxiety can wear many faces: panic attacks, obsessive thoughts, phobias, social worries, or a vague but relentless sense of dread. While evidence-based treatments like CBT and DBT provide effective strategies for managing symptoms, many clients still feel like they are “fighting the same battles” week after week.

The Deconstructing Anxiety model, developed by Todd Pressman, PhD, takes a different approach. It suggests that beneath every form of anxiety lies one of just five universal fears. By identifying these fears, clinicians can move beyond surface symptoms and help clients address the roots of their suffering.

The Five Universal Fears

1. Abandonment (Loss of Love)

  • Definition: Fear of losing connection, affection, or belonging.
  • Clinical Presentation: Rejection sensitivity, clinginess in relationships, difficulty tolerating separation.
  • Example: A client who constantly worries that loved ones will leave them, even in stable relationships.

2. Loss of Identity

  • Definition: Fear of not being enough, or not knowing who one truly is.
  • Clinical Presentation: Low self-esteem, perfectionism, shame-based patterns.
  • Example: A high-achieving client whose panic intensifies around performance reviews.

3. Loss of Meaning

  • Definition: Fear that life has no inherent value or coherence.
  • Clinical Presentation: Existential anxiety, disconnection, chronic emptiness.
  • Example: A client presenting with depressive symptoms and the recurring question, “What’s the point?”

4. Loss of Purpose

  • Definition: Fear of lacking direction or significance in the world.
  • Clinical Presentation: Burnout, midlife crises, hopelessness.
  • Example: A therapist experiencing compassion fatigue and questioning whether their work matters.

5. Fear of Death

  • Definition: The ultimate existential fear — the end of being.
  • Clinical Presentation: Health anxiety, phobias, avoidance of discussions around mortality.
  • Example: A client with recurring panic attacks triggered by news of illness or accidents.

Why These Fears Matter in Therapy

When clients protect themselves from these fears, they often develop defenses (avoidance, perfectionism, control, distraction). Unfortunately, these defenses, while adaptive in the short term, fuel anxiety in the long run.

By uncovering the core fear driving symptoms, clinicians can:

  • Clarify case conceptualization
  • Guide treatment more effectively
  • Help clients “do the opposite” of their defenses and reclaim freedom

Integrating the Model Into Practice

  • Ask “What would it mean if this fear came true?” to deconstruct presenting symptoms.
  • Explore the “price” of defenses: How much energy is the client spending protecting themselves?
  • Normalize existential fears as part of the human condition.

Conclusion

The five core fears offer a powerful framework for understanding anxiety in its many forms. By looking beneath surface symptoms, clinicians can identify the universal fears that shape suffering — and help clients move toward resilience and meaning.

👉 Want to learn how to uncover and work with core fears in clinical practice? Join Dr. Todd Pressman for a live, 3-hour training on Sept. 20, 2025: [Register Here]