Humanistic and Existential Approach

    Background

Humanistic psychology is a psychological perspective that arises in the mid-20th century in answer to the confines of Sigmund Freud‘s psychoanalytic theory and B. F. Skinner‘s behaviorism. With its roots running from Socrates through the Renaissance, this approach highlights individuals’ inherent drive towards self-actualization, the process of realizing and expressing one’s own capabilities and creativity.

One of humanistic psychology’s early foundations was the work of Carl Rogers, who was strongly influenced by Otto Rank. Rogers’ focus was to ensure that the developmental processes led to healthier, if not more creative, personality functioning. The term ‘actualizing tendency’ was also coined by Rogers, and was a concept that eventually led Abraham Maslow to study self-actualization as one of the needs of humans. Rogers and Maslow presented this positive, humanistic psychology in response to what they viewed as the overly pessimistic view of psychoanalysis. The other sources of inspiration include the philosophies of existentialism and phenomenology.

Conceptual origins

  • The humanistic approach was introduced in the 1940’s in the United States. It can be traced to Abraham Maslow as the founding father, but through time has become closely associated with Carl Rogers.
  • The humanistic and existential approach distinguishes itself from other therapeutic styles by including the importance of the client’s subjective experience, as well as a concern for positive growth rather than pathology.
  • The main aspects of humanistic psychotherapy contained genuineness, empathy and unconditional positive regard, the major themes of existential therapy are the client’s responsibility and freedom.
  • Humanistic and existential approaches share a belief that clients have the capacity for self-awareness and have freedom of choice.
  •  The humanistic perspective views human nature as basically good, with a potential to maintain healthy, meaningful relationships and to make choices that are in the best interest of oneself and others.
  • The existentialist, on the other hand, is more interested in guiding clients to find logical meaning while they face anxiety. This is done by exploring the importance of choosing to think and act realistically and responsibly.

Other Humanistic and Existential Therapies

Client-Centered Therapy

Carl Rogers’ client-centered therapy assumes that the client can openly discover and test his/her own reality, with genuine understanding and acceptance from the therapist. Therapists must create three conditions that help clients change:

  1. Unconditional positive regard
  2. A warm, positive, and accepting attitude that includes no evaluation or moral judgment
  3. Accurate empathy, whereby the therapist conveys an accurate understanding of the client’s world through skilled, active listening

Core Beliefs

  • Each individual exists in a private world of experience in which the individual is the central focus.
  • The most basic striving of an individual is toward the maintenance, enhancement, and self-actualization.
  • An individual reacts to situations in terms of the way he perceives them, in ways consistent with his self-concept and self-awareness about the world.
  • An individual’s inner tendencies are toward health and wholeness that motivates a person to behave in a rational and constructive ways and chooses pathways toward personal growth and self-actualization (Carson, 1992).

Gestalt Therapy

Gestalt therapy can be roughly translated to ‘whole’ and focuses on the whole of an individual’s experience, including their thoughts, feelings and actions. Gaining self-awareness in the ‘here and now’ is a key aspect of gestalt therapy. In a therapeutic setting, this approach opposes the notion that human beings can be understood entirely through a rational, mechanistic, scientific process. Gestalt therapy claim that the empirical world of a client can be understood only through that individual’s direct involvement and description.

According to Gestalt theory

  • The organism should be seen as a whole (physical behavior is an important element, as is a client’s mental and emotional life).
  • Being in the “here and now” (i.e., being aware of present experience) is of primary importance.
  • How is more important than why (i.e., causes are not as important as results).
  • The individual’s inner experience is central.

Transpersonal Therapy

Transpersonal psychology developed as a “fourth force” in psychology in the late 1960s and has strong roots in humanistic and existential psychologies. A transpersonal approach highlights development of the individual beyond, but including, the ego. It acknowledges the human spiritual pursuit and recognizes the human striving for unity, ultimate truth, and intense freedom. This approach also recognizes the potential for growth inherent in “peak” experiences and other shifts in consciousness.

Core Beliefs

  • Transpersonal psychotherapy is an approach to healing and growth that recognizes the centrality of the self in the therapeutic process.
  • Transpersonal psychotherapy values wholeness of being and self-realization on all levels of the spectrum of identity (i.e., egoic, existential, transpersonal).
  • Transpersonal psychotherapy is a process of awakening from a limited personal identity to broad universal knowledge of self.
  • Transpersonal psychotherapy makes use of the healing uplifting nature of subjective awareness and intuition in the process of awakening.
  • In transpersonal psychotherapy, the therapeutic relationship is a vehicle for the process of awakening in both client and therapist.

Psych synthesis

Psychosynthesis is a therapeutic approach that derives from psychoanalysis. It was developed in the early 20th century by Italian psychiatrist, Roberto Assagioli. Psychosynthesis explores and supports the ways in which people harmonise various aspects of their personal self in order to grow and develop. Psychosynthesis is a conscious attempt to cooperate with this natural process of personal development in order to foster awareness, self-healing, and a greater connection to the ever-changing nature of human life.

Core Beliefs

According to theoretical framework

  • The practice of psychosynthesis is based on the idea that every person only uses a small part of their potential and that we are all capable of leading fulfilling lives.
  • In order to uncover a person’s inner wisdom, psychosynthesis counselling will focus on the exploration of feelings, thoughts, sensations and spirit in order to uncover any internal conflicts and blocks. 
  • Psychosynthesis is the belief that out of every crisis or challenge, something new is seeking to emerge that will lead us on to the path of growth and transformation. 
  • Psychosynthesis therapists believe that while we cannot always control what comes our way, we do have a choice about how we respond and relate to these events. They aim to help clients find a new sense of direction that provides a source of empowerment.  

Reality therapy

Reality therapy is a person-centered approach that focuses on the here and now rather than issues from the past. Developed by William Glasser in the 1960s, it promotes problem-solving and making better choices in order to achieve specific goals.

Core Beliefs

Central to reality therapy is the idea that mental distress is not the result of a mental illness. Instead it is the result of a socially universal human condition that occurs when an individual has not had their basic psychological needs met. These are:  

  • love and belonging
  • power and achievement
  • Survival (nourishment and shelter etc.)
  • freedom and independence
  • Fun (enjoyment and pleasure).

According to Glasser, we are all the time acting to meet these needs. While we may struggle to choose our feelings and physiology, we are able to directly choose our thoughts and actions. Sometimes however, we don’t act effectively, and this can have negative consequences for our health and well-being.

  • Reality therapy is therefore considered to find ways of meeting a person’s basic needs, while facilitating clients to become aware of, and change negative thoughts and actions.
  • Reality therapists take the view that changing what we do is key to changing how we feel and to getting what we want.

Transactional Analysis

Transactional analysis (TA) is a widely acknowledged form of modern psychology Founded by Eric Berne in the late 1950s that involves a set of practical conceptual tools designed to promote personal growth and change. It is considered an important therapy for well-being and for helping individuals to reach their full potential in all facets of life. It is commonly recognized as a brief and solution-focused approach, transactional analysis can also be applied as an effective long-term, in-depth therapy.

Core Beliefs

TA therapy is based on the theory that each person has three ego states: parent, adult and child. These are: 

  • Parent ego-state – A set of thoughts, feelings and behaviours learnt from our parents and other important people. This part of our personality can be supportive or critical.
  • Adult ego-state – Relates to direct responses in the ‘here and now’ that are not influenced by our past. This tends to be the most rational part of our personality.
  • Child ego-state – A set of thoughts, feelings and behaviours learnt from our childhood. These can be free and natural or strongly adapted to parental influences. 
  • The TA therapist will work directly on here and now problem solving behaviours, whereas helping clients to develop day-to-day tools for finding constructive creative solutions. The ultimate goal is to ensure clients regain absolute autonomy over their lives.

Solution-Focused Brief Therapy

Solution-focused brief therapy is also known as solution-focused therapy – is an approach to psychotherapy based on solution-building rather than problem-solving. Although it acknowledges present problems and past causes, it primarily explores an individual’s current resources and future hopes and helping them to look forward and use their own strengths to achieve their goals.

Core Beliefs

  • Solution-focused therapy concentrates solely on an individual’s strengths and possibilities to help them move forward.
  • It works by helping those overcome problems without confronting them – using the solution-building concept to substitute change and help individuals to develop a set of clear, brief and realistic goals.
  • It is the role of a solution-focused therapist to help stimulate and implement these solutions through a series of discussions.
  • The therapist will help individuals to imagine a clear and detailed picture of how they see their future and how things will be better once changes are made. They will also encourage them to explore past experiences and times when they were as happy as they see themselves in their future vision.

Conclusion

Existential-Humanistic psychology helps in the development of higher self-esteem in an individual and make social contributions to the community and society that they live in. Improving one’s self-esteem can be achieved with the help of others (existential therapies, transpersonal psychology, positive psychology, or interpersonal psychodynamic therapy or by self-reflection (mindfulness/meditation). Individuals with higher self-esteem are happier, have better academic performance, and are more aware of the interconnectedness of humans, societies, and countries. This awareness motivates them to make a contribution to others who are not that fortunate and to appreciate the gifts of kindness and compassion shown by others towards them. Life is justly an ever increasing spiral – the more you give the more you will feel better about yourself and improve your self-esteem. It is important to note that social change begins with the individual. From the individual it can extend to the immediate family and community, eventually leading to global change.

ANXIETY DISORDER

            Across the globe, there are many treatments available but mainly the most actual and relieving treatments include antidepressant, cognitive-behavioral psychotherapies, relaxation and unstructured therapy techniques (Byrne, Wingero & Dager, 1993).Many researches are conceded to make a comparison between the effectiveness of various techniques in the treatment of anxiety disorder worldly. In Pakistan, there is very little attention has given to this issue. The focus of the present study is an effort to assess the efficacy of two techniques named as progressive muscular relaxation and physical exercise in the treatment of anxiety disorder. These techniques were chosen because Pakistan is listed in under established countries where limited health care resources or facilities are available. These mediations are economically affordable and its effectiveness in the treatment of anxiety disorders are well recognized in other parts of the world (Carek, Laibstain , & Carek, 2011; Nickel et al., 2006 ; Tordeurs, Janne, Appart, Zdanowicz, & Reynaert, 2011). These types of interventions also helps to reduce the issues related to stigma associated with the visit of mental health services, and help to deal with anxiety disorders by self-management programs instead of seeking treatment services on regular basis. Therefore, this study aimed to provide evidence on the effectiveness of a PMR and physical exercise in patients with anxiety disorder in Pakistan.

Everyone feels anxiety from time to time. Optimistically, anxiety is a normal phenomenon which is experienced by every living organism and is essential for survival and adaptation. It is not always harmful or risky, typically short-lived and is also useful in daily performances. Moreover, few people get over a week without some anxious tension or a feeling that something is not going to be well. In general, people may feel anxiety when they are facing an important affair, such as an exam or job interview, or when they perceive some threat or danger, such as awake due to strange sounds in the night etc. However, an important point to remember, such everyday anxiety is generally occasional, mild and brief, while if anxiety felt by the person with an anxiety disorder  frequently then it is more intense, and lasts longer for hours, or even days.

Anxiety is one of the increasing psychological disorder effecting approximately 40 million people around the world (Anxiety Disorders Association of America, 2010; Park, 2011). Anxiety is defined as feeling of discomfort and distress related to future uncertainties and doubts which approaches feelings of nervousness, extreme fear resulting due to specifically disturbing event (Webster, 2001).

Anxiety disorders are one of the major disorder which is rapidly growing as it was projected that lifetime prevalence of anxiety disorder is approximately 30%, 12-month prevalence is approximately 20% for all types of anxiety disorders (Kessler, Chiu, Demler, Merikangas, &  Walters, 2005). Kessler and colleagues (2005) appraised that 18.1% of the general population are effected from anxiety disorder. On the other hand, one systematic review found 28 epidemiological studies found anxiety symptoms or disorders, in older adults: 19 in community samples, and nine in clinical samples. The range of anxiety disorder prevalence estimates in those studies varied markedly, ranging from 1.2% to 15% in public samples and from 1% to 28% in medical settings. The occurrence of clinically significant anxiety symptoms ranges from 15% to 52% in community samples and 15% to 56% in medical settings (Bryant, Jackson, & Ames, 2008).

Anxiety disorders are one of the common occurring in society which have an extensive negative impact on daily functioning and excellence of human life. It is discovered that anxiety disorders effect the cognitive, physical and behavioral response systems simultaneously to humans across the lifetime. For instance, if a person is spending a lot of time suspecting about finances (cognitive), he  possibly feel himself on verge and nervousness (physical) which results disturbing his patterns and he may spend quite a bit of time in checking household budget or investments (behavioural). As far as students are concerned, if a student is preparing for an important exam, he may fear about his performance or result in exams (cognitive), resulting he will feel tension and maybe even have “butterflies in stomach” (physical), to handle with this tension, he may initially avoid studying and then cram at the last minute (behavioural).

These examples clearly emphasizing the deterioration in human functioning and behavioral changes on all levels are related to, or significance of anxiety disorder. Due to its deleterious effect, there is emergent interest to advance knowledge about epidemiology, course and treatment of anxiety disorders. However, in Pakistan, scarce attention has given to different important aspects of anxiety disorders like management and treatment. The current study is design to observe how physical exercise (PE) is effective in reducing physical illness and progressive muscle relaxation (PMR) is effective in decreasing the symptoms of anxiety among patients.

Normal anxiety

Whenever the sympathetic nervous system arouses, fight or flight response is activated by danger, either real or illusory, it leads to changes in three “systems of functioning”: the way one thinks and feels (cognitive), the way one’s body feels and works (physical), and the way one acts (behavioural). These three systems change differ, depending on the person and the context like; (1) cognitive: attention shifts immediately and automatically to the potential threat. The influence on a person’s thinking can range from mild worry to severe terror. (2) physical: effects include heart tremoring or increased heart rate, shallow breathing, trembling or shaking, sweating, dizziness or lightheadedness, feeling “weak in the knees,” freezing, muscle tension, shortness of breath and nausea. (3) behavioral: people engage in certain behaviors and refrain from others as a way to guard themselves from anxiety (e.g., taking self-defense classes or avoiding certain streets after dark).

An anxiety disorder may make people feel apprehensive most of the time or for brief intense episodes, which may occur for no obvious reason. People with anxiety disorders may have anxious feelings that are so uncomfortable that they avoid daily routines and activities that might cause these feelings. Some people experienced occasional anxiety attacks so intense that they are terrified or immobilized. People with anxiety disorders are usually aware of the unfounded and extreme nature of their fears. When they come for treatment, many say, “I know my fears are unreasonable, but I just can’t seem to stop them.”

As demonstrated in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5:  American Psychiatric Association, 2013) excessive fear, anxiety and behavioral problems are collective features of anxiety disorder. Individuals with anxiety disorders anticipate threat in future as a result become fearful with real or perceived threat, experience physical symptoms and want to get escape from anxiety (DSM–5, 2013). It can turn into a serious disorder when it becomes excessive and uncontrollable, when there does not appear to be any purpose behind it.Larson and colleagues (2010) depict anxiety as a foreseen conviction of a psychological distress which is a consequence of viewing a distressing and possibly unsafe occasion. 

TYPES OF ANXIEY DISORDER

Following are the types of anxiety disorder:

Generalized anxiety disorder: It concerns of having excessive, beyond reality and tension that has no possible reason.

Panic disorder: in this you have unexpected, intense fear that carries on a panic attack. The symptoms include chest pain, heart palpitations, and heavy sweating. Sometimes it may feel that you are choking or experiencing a heart attack.

Social anxiety disorder: in this you have excessive worry about daily social situation and an exaggerated worry about self-consciousness. One can have a fear of being judged by the society.

Specific phobias: in this one have intense fear experience about an object or any situation such as heightened areas or flying. This will make you avoid most of the ordinary situations.

Agoraphobia: in this one feel trapped in a situation where they consider it is hard to get escape in emergency situations. It may include having a panic situation on airplane, public conveyance or in crowd.

Separation anxiety: it not only concerns little kids but ones that have feeling of anxiousness and loved ones. Anyone can get separation anxiety disorder. It occurs when any person who lose their loved ones will feel anxious or fearful. It is a constant feeling that something will happen bad to our close ones.

Selective mutism: it includes specific anxiety which occurs who easily talks to their family members but cannot speak in front of public more likely at school.

Medication-induced anxiety disorder: in this there is a use of some specific medications or any drugs that are not legal, having withdrawal symptoms from some drugs, can activate the symptoms of anxiety disorder.

TREATMENT

Progressive Muscular Relaxation (PMR)

Relaxation is a state of being free from physical and mental tensions, in other words, it is a homeostatic condition which led to physical and psychological well-being. Currently, number of relaxation techniques has been designed to get escape from anxiety, stress and bring state of ease and mental/physical comfort. PMR is one of the most basic technique developed by Jacobson in 1934. It requires a skill to discriminate between the skeletal muscle tension and relaxation (Jacobson, 1938). The technique is based on the conception that anxiety-provoking thoughts and events produce physiological distress. The technique involves progressively tensing and relaxing muscles in different parts of the body, leading to a reduction in physiological tension, (Davis, Eshelman, & Mckay, 2000). Since its origin, different types of PMR have developed, for instance, in 1973 Bernstein and Brokovec considered modifications to the technique to make it suitable to cognitive behavioral stress management. Today mostly versions are relatively shorter in length than Jacobson’s original program (Bernstein, Carlson, & Schmidt, 2007). There is general consensus that relaxation comprises of three core processes namely: muscular responding, autonomic responding and cognitive responding (Poppen, 1998).

Physical exercise (PE)

Physical excersise is considered an important intervention for the treatment of mental and physical illnesses. Physical exercise is related to bodily movements which involves individual’s muscular exercises and requires more energy than resting and generally bring up to movement that increases health (US Surgeon General, 2008). Health- related physical activity consists of body configuration, cardiovascular fitness, flexibility, muscular endurance and strength (Corbin, Pangrazi, & Frank, 2000). Physical activity or exercise is closely linked with fitness determined by physical activity patterns (Blair, Cheng, & Holder, 2001). Walking, abrupt walk, jogging, dancing, swimming, aerobics, yoga etc are main examples of physical activity. The latest standards for exercise training for encouraging and maintaining health. It is recommended that exercise training includes at least five days a week for 30 to 60 minutes at time, depending of the intensity of the exercise and resistance training for the main muscle groups for two to three times a week, 30 to 40 minutes (Fletcher, Ades, Kligfield, Arena, Balady, Bittner, & Williams, 2013).

Individuals who are fit but they withdraw exercise temporarily are more prone to experience increase anxiety (Morris, Steinberg, Sykes, & Salmon,1990). A physically active and proper lifestyle has also been associated with good psychological health in the elderly, along with intellectual stimulation, avoidance of smoking and healthy eating (Flicker, Lautenschlager, & Almeida, 2006). It is also initiate that aerobic exercise training have anxiolytic like impacts on healthy volunteers (Long, & Satvel 1995). Thirlaway and Benton (1992) found that fitness associated with PE habits to such an extent that the fit subjects who don’t exercise had worse psychological well-being status than the rests.

Cognitive behavioral therapy (CBT):  this therapy can teach you how to get away from negative perceptions, panic situations and behaviors and turn into positive ones. It will give some coping strategies to individuals facing anxiety and help them run their daily functioning. It may include individual and family sessions once in a week.

TAKE AWAY

Anxiety is not a medical condition but it comes naturally and is necessary for survival when any individual is triggered or feel themselves in an emergency situation. There are several types of anxiety disorder like panic, social, agoraphobia, and social anxiety. Treatment includes Progressive muscle relaxation (PMR), Exercises and cognitive behavior therapy (CBT) that is good for maintaining individual conditions.