Understanding and treating death anxiety
David Veale, Kings College London and (by video) Rachel Menzies, Sydney University
Death anxiety is a term used to describe people’s fear or negative feelings towards death or dying. Some people may focus on their own death, such as ruminating on all the things they will miss out on after they die, or what it will be like to not exist anymore. Some people may experience doubts about the nature of existence itself, such as questioning what will happen to them after death. Others may worry about the process of dying, such as whether their death will be painful, or what their final moments will be like. Some may be distressed at the idea of losing a loved one. They may worry about how they will cope with their loved ones’ death or that they will somehow cause the death of their loved one without meaning to. For some there is a phobic avoidance and fear of anything related to death (e.g. going near cemeteries or funeral parlours). All the experiences above are in many ways part of being human, but death anxiety is a problem when it is either sufficiently time-consuming, distressing or interfering in one’s life. The concept cuts across different diagnoses including some types of Health Anxiety, OCD, specific phobias, and panic disorder. Unfortunately, death anxiety may not be adequately targeted in standard protocols for these disorders and this workshop will try to remedy this with a specific focus on the fears of death and dying. Treatment components will be discussed, centring on CBT, which is the most evidence-based treatment for death anxiety.
Key Learning Outcomes:
By the end of the skills class, participants will
1) Understand the context and phenomenology of death anxiety, and its relationship with relevant diagnoses
2) Be knowledgeable about a cognitive behavioral model and have a understanding of the cognitive processes and behaviours that maintain death anxiety. This includes the intolerance of uncertainty, magical thinking, the awfulness of dying, as well as avoidance, safety seeking and checking behaviours related to death.
3) Develop alternative ways of thinking about common beliefs in death for example thoughts about the awfulness of not existing or the intolerance of not knowing will happen.
4) Use appropriate exposure/ behavioural experiments for death and dying and consider what expectations are being tested. Fifteen different tasks will be discussed from writing out one’s funeral wishes and obituary, painting one’s coffin or collecting “memento mori”.
5) Focus on living life to the full now as an alternative to focussing on death and dying
David Veale is a Consultant Psychiatrist and leads a national outpatient and residential unit service for people with severe anxiety disorders at the South London and Maudsley Trust and the Nightingale Hospital London. He is a Visiting Professor in Cognitive Behaviour Therapies at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. He is a member of the group that revised the diagnostic guidelines for ICD11 for Obsessive Compulsive and Related Disorders for the World Health Organisation. He was a member of the group that wrote the NICE guidelines on OCD and BDD in 2006. He is an Honorary Fellow of the BABCP, a Fellow of the BPS and of the RCPsych. He is a Trustee of charities, OCD Action, the BDD Foundation and Emet Action. He has co-authored a self help book on death anxiety and a book chapter with Rachel Menzies.
Rachel Menzies is a Clinical Psychologist and Postdoctoral Research Fellow at The University of Sydney, Australia. She won the Dick Thompson Thesis Prize for her work on death anxiety and its relationship with OCD. Her article on death anxiety was featured in The Conversation Yearbook 2016, a collection of the top 1% of ‘standout articles from Australia’s top thinkers’. In 2021, Rachel’s PhD thesis exploring death anxiety and its treatment was awarded the Australian Psychological Society (APS) Award for Excellent PhD Thesis.
Menzies, R.E., & Menzies, R.G. (2021). Mortals: How the Fear of Death Shaped Human Society. Sydney: Allen & Unwin. https://www.allenandunwin.com/browse/books/general-books/self-help-practical/Mortals-Rachel-E-Menzies-and-Ross-G-Menzies-9781760879167
Menzies, R.E., & Veale, D. (2021). Free Yourself from Death Anxiety: A CBT Self-Help Guide for a Fear of Dying. Jessica Kingsley Publishers London and Philadelphia
Menzies, R.E., & Veale, D. (2021) Creative approaches to treating the dread of death and death anxiety. In: Existential Concerns and Cognitive-Behavioral Procedures: An Integrative Approach to Mental Health. Menzies, R.G, Menzies, R,E, Dingle, G. (Eds). Springer: New York.
Menzies, R.E., Zuccala, M., Sharpe, L., & Dar-Nimrod, I. (2018). The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials. Journal of Anxiety Disorders, 59, 64-73 . https://doi.org/10.1016/j.janxdis.2018.09.004