Failure Causes Fear: The Effect of Self-Esteem Threat on Death-Anxiety

A possible anti-anxiety effect of appetitive aggression and a possible link to the work of Donald Winnicott

Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations.

The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult.

In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.

Death anxiety among advanced cancer patients: a cross-sectional survey

PURPOSE

This study aimed to investigate death anxiety in advanced cancer patients and identify associated factors in the context of Chinese culture.

METHODS

Participants (N = 270) with advanced cancer in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of a Likert-type Templer-Death Anxiety Scale, Rosenberg's Self-esteem Scale, Medical Coping Modes Questionnaire, the Social Support Rating Scale, and Connor-Davidson Resilience Scale. Data were analyzed in SPSS using descriptive statistics, Student's t test, Pearson correlation test, and linear regression.

RESULTS

Respondents returned 252 (93.33%) of the 270 questionnaires. The total CL-TDAS score was 39.56 ± 10.20. The top three items were "I fear dying a painful death" (3.59 ± 1.41), "I often think about how shortly life really is" (3.11 ± 1.33), and "1 am not particularly afraid of getting cancer" (3.09 ± 1.35). Associated factors of death anxiety (R² = .333, F = 15.756, p < .001) were the medical coping mode (resignation, confronce), self-esteem, the participants' adult children, the patient-primary caregivers' relationship, resilience, and the level of activity of daily living.

CONCLUSIONS

Our results demonstrate high levels of death anxiety in advanced cancer patients. Generally, patients with adult children, high self-esteem and resilience had low death anxiety. Conversely, patients with low levels of activity of daily living and high coping mode (resignation, confrontation) reported high death anxiety. We determined that associated factors contributed to reduce death anxiety. Social interventions are recommended to improve the end-of-life transition for patients and caregivers.

The positive effect of social support on psychological distress among Chinese lung cancer patients: The mediating role of self-esteem

AIM

To investigate the effect of social support on psychological distress among Chinese lung cancer patients and clarify the mediating role of self-esteem.

DESIGN

A cross-sectional descriptive correlational survey of 441 Chinese lung cancer patients was designed.

METHODS

Self-esteem was supposed to play a mediating role in the association between social support and psychological distress. We collected demographic information, the Distress Thermometer, Multidimensional Scale of Perceived Social Support and Rosenberg Self-Esteem Scale.

RESULTS

Our revised model demonstrated an acceptable fit to the data (χ²  = 37.489, comparative fit index (CFI) = 0.965, Tucker-Lewis index (TLI) = 0.926, root mean square error of approximation [RMSEA] = 0.099). Social support had a direct effect on self-esteem and psychological distress, and self-esteem had also a direct effect on psychological distress. Meanwhile, self-esteem also partially mediated the relationship between social support and psychological distress among Chinese lung cancer patients.

Death anxiety, self-worth, and exposure to human donor remains: A longitudinal study of Irish medical students

This study aimed to investigate the relationship between death anxiety levels at pre-exposure to human donor remains, post-exposure self-worth, and post-exposure death anxiety levels, among a sample of Irish medical students. A multi-wave prospective study was conducted, using questionnaires administered at six time-points. Path analysis was used to investigate the effect of pre-exposure death anxiety levels and post-exposure self-worth on post-exposure death anxiety levels. Baseline death anxiety was found to predict post-exposure death anxiety. Furthermore, self-worth at one month of exposure was found to mediate the relationship between pre-exposure death anxiety levels and death anxiety levels at six months.

Age is not just a number: age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms among older adults

Objectives: Humans often hold structured generalizations about themselves, which include attributes of qualities or characteristics they consider as important to their personal self-definitions. In this regard, holding one's age as an important defining personal category (high age awareness) was demonstrated to be connected with increased distress in older adults. However, little is known about the manner by which this connection is affected by individuals' perceptions regarding how close they are to their death on the one hand, and their personal resources on the other hand. Accordingly, the current research examined whether the connection between age awareness and depressive symptoms is mediated by subjective nearness-to-death, and whether this mediation is moderated by self-esteem.Method: A convenience sample of 386 older adults was collected using an online panel survey (age range 60-97, M = 71.62, SD = 6.88). Participants were requested to fill out scales assessing age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms, as well as various sociodemographic scales.Results: Age awareness was associated with increased subjective nearness-to-death and depressive symptoms. In line with the hypotheses, subjective nearness-to-death mediated the age awareness-depressive symptoms connection, and this mediation was moderated by self-esteem.Conclusion: Age awareness is an important concept in old age, and is connected with increased depressive symptoms. We discuss this issue in line with Terror Management Theory, and emphasize the relevance of personal resources, such as feeling far from death and holding a positive view of oneself, in this regard.

Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan

Among several forms of miseries experienced by cancer patients, one of the significant experiential problems is the inevitable fear of death. The present study aimed at exploring the relationship between death anxiety, perceived social support, and different demographic variables. A sample of 80 breast cancer patients was recruited from different departments of oncology in Pakistan. Research findings revealed that death anxiety was negatively associated with social support. Moreover, it was found that education and marital status were associated with death anxiety among patients with breast cancer. Results suggest that social support assist in reducing death anxiety and enhance their recovery course.

Demoralization and death anxiety in advanced cancer

OBJECTIVE

The circumstances of advanced cancer can cause considerable psychological distress, including death anxiety and demoralization. Although these states of existential distress have a negative impact on the quality of life of patients with advanced cancer, they are rarely evaluated as outcomes or targets of interventions in this population. In an effort to improve understanding of existential distress, a structural model of relationships among death anxiety, demoralization, symptom burden, and social relatedness was tested in patients with advanced cancer.

METHODS

A total of 307 patients with advanced cancer completed baseline measures including the Death and Dying Distress Scale, the Demoralization Scale, the modified Experiences in Close Relationships Scale, the Life Completion subscale of the Quality of Life Evaluation-Cancer scale, the Memorial Symptom Assessment Scale, and Karnofsky Performance Status. A structural equation model of protective and risk factors for demoralization and death anxiety was tested.

RESULTS

The final model had good fit (SRMR = 0.061; RMSEA = 0.077; CFI = 0.927; NNFI = 0.902) in which death anxiety was positively associated with demoralization (β = 0.71), and demoralization was positively associated with symptom burden (β = 0.31) and negatively associated with social relatedness (β = -0.74).

CONCLUSIONS

The findings of this study suggest that demoralization and death anxiety are closely linked in patients with advanced cancer. The contribution of both symptom burden and low social relatedness to demoralization suggests that an integrated intervention addressing both physical and psychosocial disease factors may be most effective at alleviating such states of existential distress.

Death Anxiety, Perfectionism and Disordered Eating

Recently, death anxiety, or dread of death, has been proposed as a key transdiagnostic process underlying the anxiety disorders, depressive disorders, somatic disorders, and trauma and stressor-related disorders. In fact, it has been argued that death anxiety underlies all psychopathology, and is more fundamental than perfectionism, a process which was previously considered the root of mental illness. However, there has been a paucity of research examining the relationship between death anxiety and the eating disorders, although these conditions have been found to be strongly related to perfectionism. The present study therefore aimed to examine whether death anxiety is related to disordered eating, and whether death anxiety is a better predictor of disordered eating than perfectionism. A sample of 164 participants (132 female), average age 33.55 years (SD= 15.45 years), completed an online survey comprising background questions (age, sex, diagnosed psychiatric disorder), the Eating Attitudes Test — 26 item version (EAT-26), the Almost Perfect Scale — Revised (APS-R), the Rosenberg Self-Esteem Scale (RSES), and the Death Anxiety Scale (DAS). The findings of a hierarchical multiple regression analysis with EAT-26 as the dependent variable, age entered at Step 1, the RSES and APS-R entered at Step 2, and the DAS entered at Step 3 showed that only death anxiety and self-esteem were independent predictors of disordered eating at Step 3. A simultaneous multiple regression analysis was subsequently run with age and the APS-R alone as predictors of EAT-26 scores. This analysis showed that perfectionism was only a predictor of disordered eating when death anxiety and self-esteem were not included in the regression model. Death anxiety and self-esteem both appear to be important transdiagnostic processes.