Academic journal article Journal of Cognitive Psychotherapy

Death Anxiety: A Cognitive-Behavioral Approach

Academic journal article Journal of Cognitive Psychotherapy

Death Anxiety: A Cognitive-Behavioral Approach

Article excerpt

Over the years, there has been a considerable amount of psychological research focused on death anxiety. However, little attention has been given to clinical aspects of this problem. This paper focuses on a practical approach to assessment and treatment of death anxiety for the clinician. We discuss situations where it is wise to evaluate death anxiety and provide questions to address this topic in a sensitive manner. Death anxiety is clearly a central feature of health anxiety and may also play a significant role in other anxiety disorders. While there is very little specific research on treatment of fear of death, research on the anxiety disorders in general and health anxiety in particular has facilitated the development of an approach we have found useful in treating death anxiety. The main components of this treatment include exposure to feared themes related to death, reduction of safety behaviors, cognitive reappraisal, increased focus on life goals and life enjoyment, and relapse prevention.

Keywords: death anxiety; health anxiety; CBT; exposure

Just as anxiety is a normal emotion, anxiety concerning death is also a normal experience. Death anxiety has been a focus of interest for philosophers and psychologists for many years, and there is extensive research on death anxiety in nonclinical populations. The research on death anxiety in clinical populations, such as individuals with anxiety and somatoform disorders, is also developing and provides important information about how death anxiety cuts across diagnostic categories and should be considered in assessment and treatment.

THEORETICAL PERSPECTIVES ON DEATH ANXIETY

Freud was one of the earliest theorists to discuss death anxiety. He suggested that death-related fears reflected unresolved childhood conflicts rather than fear of death itself, as he was skeptical about our ability to accept mortality. For example, in his paper Thoughts for the Times on War and Death, Freud (1952) noted that "our unconscious does not believe in its own death; it behaves as if immortal" (p. 765). Freud viewed the unconscious as the fundamental source of thought and behavior, and thus he argued that while we pay lip service to the reality of death, "at bottom no one believes in his own death" (p. 761).

Modern theories are more commonly based on Becker's existential view of death (Becker, 1973). He suggested that death anxiety is a real and basic fear that underlies many forms of anxiety and phobia. Becker argued that humans manage this anxiety by living in accord with cultural worldviews that "offer immortality either literally (i.e., belief in an afterlife) or symbolically (i.e., identification with entities greater and longer lasting than an individual life, such as achievement, families, or nations)" (Strachan et al., 2007, p. 1138). Becker's view was that much of people's energy is focused on the denial of death as a strategy to keep death anxiety under control.

Becker's work led to the development of terror management theory (TMT), which proposes that while humans strive for self-preservation, they are also aware of the inevitability of death (Pyszczynski, Greenberg, & Solomon, 1999). According to TMT, when people are reminded of their mortality, their need for structure and meaning increases, and this results in enhanced focus on personally and culturally valued goals. This theory also suggests that those with greater self-esteem will have greater tolerance for death-related situations and that those with lower selfesteem will experience greater death anxiety. TMT has generated extensive research providing substantial experimental support for its basic hypotheses (for reviews, see Bassett, 2007; Solomon, Greenberg, & Pyszczynski, 2004).

Posttraumatic growth theory (PTG), another recent death anxiety theory, suggests that facing a life crisis, in particular death of self or a loved one, can result in positive changes, such as a greater appreciation for life, a shift in priorities toward intrinsic goals, and improved interpersonal relationships (Tedeschi & Calhoun, 1996, 2004). …

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