Psychological defenses against death anxiety: integrating Terror Management Theory and Firestone's Separation Theory

Attitudes towards the dying and death anxiety in acute care nurses - can a workshop make any difference? A mixed-methods evaluation

OBJECTIVES

In Singapore, the core curriculum for end-of-life (EOL) care used in nurse training courses is limited. Only 45% of nurses indicated familiarity with inpatient palliative care. Nurses who lack skills in palliative care may develop anxiety and negative attitudes towards caring for dying patients. We explored whether a two-day, multimodal EOL care workshop could reduce nurses' death anxiety and improve nurses' skills, knowledge, and attitude towards palliative care.

METHODS

Forty-five nurses participated in the workshop. At baseline before and at six weeks after, a 20-item knowledge-based questionnaire and the Death Attitude Profile-Revised (DAP-R) were administered. Six weeks post-workshop, in-depth interviews were conducted. We employed descriptive statistics, student paired samples t-test and inductive thematic analysis.

RESULTS

There was a significant improvement in nurses' knowledge score (p < 0.01) and reduction in their death anxiety score (p < 0.01). Fear of Death (p = 0.025) and Death Avoidance (p = 0.047) sub-scores decreased significantly. However, the remaining domains such as Neutral Acceptance, Approach Acceptance, and Escape Acceptance did not show any significant difference, although Escape Acceptance showed a trend towards a reduced score (p = 0.063). After the workshop, more nurses adopted the Neutral Acceptance stance (76.2%), and none of them fell into the Fear of Death subdomain. Most nurses interviewed reported a positive change in their knowledge, attitudes, and practice even after the workshop.

SIGNIFICANCE OF RESULTS

The multimodal palliative care workshop was useful in improving nurses' EOL knowledge and reducing their anxiety towards death. The positive change in nurses' attitudes and practices were noted to be sustained for at least six weeks after the intervention.

Factors Associated with Death Anxiety Among Rural Chinese Older Adults: The Terror Management Perspective

OBJECTIVES

The aim of this study was to examine how the factors suggested by the Terror Management Theory are associated with death anxiety among rural Chinese older adults.

METHOD

Data were derived from a longitudinal survey of older adults aged 60 and above, had at least one living child, and were living in rural areas of Anhui Province. The working sample included 1,362 older adults. Two-level random effects models were used.

RESULTS

Children's financial support was negatively related to death anxiety, whereas emotional closeness with children was positively related to death anxiety. Older women reported more death anxiety than older men. Functional limitations were positively associated with death anxiety, and the widowed reported less death anxiety than the married. We did not find a significant association between religious belief and death anxiety.

DISCUSSION

The study highlights the importance of culture in shaping death anxiety among older adults in rural China.

Social curiosity as a way to overcome death anxiety: perspective of terror management theory

Social curiosity has been found to have great benefits in human life, especially in fostering interpersonal relationships. Nevertheless there is indication of other benefit of social curiosity that have not yet been explored, namely overcoming the anxiety of death. This indication is based on previous research which found a positive relationship between anxiety and social curiosity. In this study, social curiosity is framed as representation of symbolic immortality, which people use to overcome the terror of death. To support this conjecture, two studies were conducted using the Terror Management Theory (TMT) framework. Study 1 (N = 352, M age = 19.39) found a positive relationship between death anxiety and social curiosity. In Study 2 (N = 507, M age = 20.68) it was found that intolerance of uncertainty and desire for self-verification mediated the relationship between death anxiety and social curiosity. The results of this study indicate that increasing interest in obtaining information about how other people think, feel, or act is a form of mechanism used by people to control anxiety related to death.

Basic Tenets of Separation Theory

This article outlines the basic tenets of separation theory, including the fantasy bond and the voice process. The fantasy bond is a unifying concept explaining how human beings seek security in fantasies of fusion in an attempt to heal the fracture related to interpersonal trauma compounded by death anxiety. Painful elements in parent–child interactions are incorporated in the form of a negative thought process or “voice,” creating a division in the personality between the self and the anti-self. My colleagues and I developed a methodology called “voice therapy” to expose and contend with people’s destructive attitudes and attacks on themselves. The article also describes the evolution of a group of more than 100 associates and friends who have lived in close proximity and shared their innermost feelings in an ongoing group experience for more than 40 years. These people contributed significantly to the evolution of separation theory. Together, we developed an implicit set of values based on understanding factors that hurt people in their psychological development. The article specifies the concepts learned from observing the reference population and delineates findings from research in the neurosciences, attachment theory, and terror management theory that validate the key concepts of separation theory.

Death Anxiety From Quality of Life and Emotional Impact of Event: A Case Study of Proximate Earwitnesses of Dana Air Crash in Nigeria

The study investigated the traumatic impact of the Dana 2012 plane crash in Lagos, Nigeria. Using a cross-sectional survey, the roles of quality of life (QoL) and impact of event were examined against death anxiety of the proximate inhabitants of the crash site. Result showed significant influence of QoL on death anxiety, with higher QoL participants manifesting higher levels of death anxiety. However, impact of the crash event and demographic indicators such as age, sex, pilot preference, and belief-in-life after death did not influence death anxiety of participants. It can be concluded from these results that the perception of higher QoL has a profound influence on death anxiety of people reminiscing mortality reminders no matter their age, sex, beliefs, and life preferences. It is recommended that anxious death-related experiences be prevented in all spheres of life in pursuit of safety and sound mental health of the people.

The Ultimate Resistance

Although resistance takes many forms, this article elucidates the primary source of resistance in psychotherapy as well as the fundamental resistance to leading a fulfilling life. The ultimate resistance to change, in both cases, originates in the anticipatory fear of arousing existential angst. To varying degrees, most individuals retreat from life and adopt defense mechanisms in an attempt to avoid reawakening suppressed feelings of terror and dread they experienced as children in early separation experiences, and, in particular, when they first learned about death. As clients dismantle their defenses during therapy and move toward increased individuation and self-fulfillment, these unconscious fears threaten to emerge into conscious awareness, and core resistances come into play. Certain events and circumstances, both positive and negative, arouse or intensify latent death anxiety, whereas other circumstances and defenses relieve it. There are numerous defenses that help ameliorate the core anxiety including the fantasy bond—an illusion of connection or fusion with another person, persons, groups, or causes—addictions, microsuicidal behavior, and literal and symbolic methods of denying one’s eventual demise. Although these defenses provide a measure of security and a sense of immortality, they adversely affect one’s psychological adjustment, emotional well-being, and interpersonal relationships.

A Sociocultural Analysis of Death Anxiety among Older Japanese Urbanites in a Citizens' Movement

By examining the experiences of death anxiety and attitudes toward personal deaths among members of a citizens' movement, the Grave-Free Promotion Society (GFPS), this study considers the applicability of the view that culture and high self-esteem serve as defenses against death anxiety in Japan's changing society. The GFPS promotes the scattering of ashes over the conventional interment of cremated remains in a family grave. GFPS members often lack descendants to care for a family grave, the neglect of which is thought to endanger the deceased's peaceful rest. By returning the dead to nature through ash scattering, the GFPS provides an alternative strategy of managing its members' posthumous well-being. GFPS members often report that their choice of ash scattering has reduced their anxiety about their personal deaths and improved the quality of their lives. Based upon these findings, this study offers some suggestions for increasing cultural sensitivities of test instruments commonly used to examine death anxiety among older persons for use in a Japanese context.