Terror Mismanagement: Evidence That Mortality Salience Exacerbates Phobic and Compulsive Behaviors

The Psychopathological Predictors and Effects of Death Anxiety

Death anxiety has been linked to several psychopathological conditions. However, the causes, comorbidity, and differential diagnosis of death anxiety is unexplored. This paper stands out by identifying common predictors of death anxiety and exploring the potential of death anxiety as a predictor for other psychological conditions. The paper reports the findings of four consecutive studies that involved a total of 2291 conveniently selected participants including 861 men and 1430 women. We focused on clarifying both the predictors of death anxiety and the psychopathological consequences emerging from it. Our findings established depression, anxiety, stress, fear of aging, and reduced life satisfaction as predictors of death anxiety. Psychosocial illness, sleep disturbances, aggression, and daily hassles were established as the adverse outcomes of death anxiety. Fear of aging was the most significant predictor of death anxiety and daily hassles emerged as the most significant adverse consequence of death anxiety.

Starving off death: Mortality salience impacts women's body image and disordered eating

From a Terror Management perspective, the pursuit of thinness that characterizes eating disorders (EDs) is arguably a culturally endorsed way to mitigate death anxiety. In the present studies, we used the mortality salience (MS) paradigm to examine whether priming death increases ED symptoms. We recruited two samples of women from undergraduate (Study 1, N = 120), and clinically relevant (Study 2, N = 154) populations. After priming, participants completed measures of potential confounds (e.g., neuroticism, affect). Next, we assessed ED attitudes and behavior using a portion size estimation task, and measures of body dissatisfaction and eating intention. Study 1 findings were inconsistent with the claimed role of death anxiety in ED related behavior. However, in Study 2, MS priming led to increased dissatisfaction with current thinness and smaller portion sizes for high-fat compared to low-fat food. Overall, the results suggest that death anxiety may, at least partially, drive ED symptoms.

Dressing up social psychology: Empirically investigating the psychological functions of clothing using the example of symbolic protection

Clothing behaviour remains an understudied research area within social psychology. Through the present research, we aim to anchor attire as an empirical research subject by investigating the psychological properties of one of its functionalities, namely, to provide protection. We argue that attire's undisputed role in shielding humans from environmental hazards may extend to the psychological level and protect them from the incorporeal consequences of existential threats symbolically. In this Registered Report, a mixed-methods approach links an ecologically valid field study of self-presentation in social media posts during Russia's war on Ukraine (Study 1; N = 248) with supraliminal priming of mortality salience in an online experiment (Study 2; N = 248). Across both studies, we expect that mortality concerns let people accentuate the physically protective attributes of clothing (e.g. more layers of clothing) and resort to more in-group prototypical dress styles (i.e. more gender-stereotypical). Findings show that people adjust their clothing preferences in response to existential threats, favouring in-group prototypical clothing (more gender-typical for both women and men in Study 1) and physically protective attire (higher in women and lower in men in Study 2) during high (vs. low) levels of existential threat. By positioning clothing as a research area within social psychology, our goal is to stimulate a wave of research on its profound role for humankind. Furthermore, we provide a dynamic and robust methodological approach to researching terror management theory.

The effect of gratitude on death anxiety is fully mediated by optimism in Lebanese adults following the 2023 earthquake

BACKGROUND

Exploring the levels of death anxiety and factors that can undermine its impact are crucial for the Lebanese nationals. Even though studies have shown various relationships between death anxiety and several factors, very few to no research has been done to show the relationship of death anxiety, gratitude and optimism. Therefore, the objectives of our study were to assess the mediating role of optimism in the association between gratitude and death anxiety, along with investigating the validity and reliability of the Arabic version of the Death Anxiety Scale.

METHODS

A one-time-point online survey was conducted among Arabic-speaking community adults from the general population of Lebanon (N = 601; mean age 29.91 ± 12.61; 62.7% females). The following scales were used: Scale of Death Anxiety, Optimism-Pessimism Short Scale-2, and Gratitude Questionnaire-Six-Item Form.

RESULTS

The results of the mediation analysis showed that optimism fully mediated the association between gratitude and death anxiety. Higher gratitude was significantly associated with more optimism; higher optimism was significantly associated with less death anxiety. Finally, higher gratitude was not directly associated with death anxiety.

CONCLUSION

Our study reveals the relationship between gratitude and death anxiety and the mediating role of optimism. Our results need to be confirmed in a longitudinal study, but point to the importance of assessing optimism in prevention and management of persons with death anxiety.

Death Anxiety in Obsessive-Compulsive Disorders

Objective: Death anxiety has long been attributed a role as a psychopathologically decisive factor in the development of mental illnesses such as obsessive-compulsive disorder (OCD). For example, patients with washing compulsions associate their behavior with a fear of life-threatening diseases or patients with control compulsions report that the constant checking is driven by the fear of fatal or deadly consequences for the occupants.Method: The Bochum Questionnaire to Assess Death Anxiety and Attitudes Towards Death (BOFRETTA) was administered to 31 patients with OCD and 31 healthy volunteers within a semi-structured interview using broad psychometry.Results: OCD patients showed increased death anxiety and negative attitute to death in comparison to healthy volunteers. A significant correlation was found between BOFRETTA-anxiety and the currently present religious obsessive thoughts.Conclusions: Our investigation provides further findings on the role of death anxiety and the problematic attitude towards death in OCD patients.

Examining terror management theory in Ukraine: impact of air-raid alarms and explosions on mental health, somatic symptoms, and well-being

Objective

This study sought to evaluate Terror Management Theory (TMT) assumptions about death awareness and its psychological impact in the context of a real-world war situation with high external validity. We examined if factors such as habituation to war circumstances and psychological resilience could buffer the effects on civilians' anxiety, physical and mental health, and affect.

Method

We implemented a pre-registered smartphone-based experience sampling method study over four weeks, with 307 participants (k = 7,824) living in war-affected areas in Ukraine whereby participants were regularly exposed to war situations, including air-raid alarms, explosions, and infrastructural problems.

Results

The data indicated that war situations significantly increased anxiety, negatively impacting mental health, and raising somatic symptom severity. While habituation showed a mild buffering effect on these impacts, resilience did not.

Conclusion

This real-world investigation supports TMT's fundamental assumptions about death awareness and its psychological implications. However, even amidst the presence of real, life-threatening situations, the buffering effects of habituation were surprisingly minimal. This suggests that further exploration of TMT's buffering factors in real-world scenarios is warranted.

A meta-analysis of systematic reviews and meta-analyses to evaluate the psychological consequences of COVID-19

BACKGROUND

Several meta-analysis studies have been reported in the literature on the incidence of psychopathological conditions resulting from the COVID-19 pandemic. This investigation aims to compile and analyze the findings of previously published meta-analysis research, as shown by the present meta-analysis of previous meta-analysis studies.

METHODS

The PubMed and Scopus databases were searched from 1 January 2019 to 30 May 2022. The procedure was carried out according to the PRISMA flow chart and the qualities of the identified studies were analyzed using AMSTAR 2. Heterogeneities and risk of bias were assessed using the Meta-MUMS tool. The corresponding results, forest and funnel plots of the psychological consequences of COVID-19 were synthesized.

RESULTS

Eleven meta-analysis studies were included. Random-effects meta-analysis of anxiety and depression showed (ER = 0.318 p-value < 0.001, ER = 0.295 p-value < 0.001) high heterogeneities (I2 = 99.70%, I2 = 99.75) between studies. Random-effects meta-analyses of sleep difficulties and insomnia were shown (ER = 0.347 p-value < 0.001, ER = 0.265, p-value < 0.001) along with heterogeneities (I2 = 99.89, I2 = 99.64). According to the random meta-analysis of post-traumatic stress syndrome (PTSS) and post-traumatic stress disorder (PTSD) (ER = 0.246, p-value = 0.001, ER = 0.223 p-value < 0.001) with heterogeneities (I2 = 99.75, I2 = 99.17). Random-effects meta-analyses of somatic and fear symptoms have been shown (ER = 0.16 p-value < 0.001, ER = 0.41, p-value = 0.089) with high heterogeneities (I2 = 99.62, I2 = 98.63). Random-effects meta-analysis of obsessive-compulsive symptoms and distress (ER = 0.297 p-value = 0.103; ER = 0.428, p-value = 0.013) with high heterogeneity, as I2 = 99.38%. Subgroup analysis of all symptoms and Egger's tests for detecting publication bias were also assessed.

CONCLUSION

The data from the current meta-analysis showed different psychological disorders of COVID-19 during the pandemic. Clinicians should be aware of the prevalence with which COVID-19-infected patients experience emotional distress, anxiety, fatigue, and PTSD. About half of the included systematic reviews (SRs)/meta-analyses (MAs) suffered from poorer methodological quality and increased risk of bias, reducing confidence in the findings. There must be more SRs/MAs and high-quality clinical trials conducted to confirm these findings.

Death Anxiety in the Context of Religion, Personality and Life Meanings

Previous studies on the context between death anxiety and religion do not provide any clear evidence regarding "anxiety buffer" function. In this explorative study, death anxiety and attitude to death were determined in the context of mood, personality and meaning of life among groups of Muslims (n = 60) and Christian Protestants (n = 60). Death anxiety and attitude to death were assessed using the Bochum questionnaire for recording death anxiety and attitudes to death. Death anxiety was mild to moderate in our healthy Participants of Muslim and Christian faith. Attitude towards death was therefore much more pronounced among Muslim members than Christians. The influence of religious beliefs on the fear of death does not appear to be direct and linear. Sources that provide meaning in life and emotional stability can contribute to a reduction in death anxiety and a less problematic attitude towards death.

Death anxiety in connection to anxiety and depressive disorders: A meta-analysis on emotional distress in clinical and community samples

Awareness of one's mortality bears noteworthy implications on psychological functioning, proposing death anxiety as a transdiagnostic construct, with connections to psychopathology. The present meta-analysis investigates the relationship between death anxiety, depression, and anxiety disorders, as well as in symptomatology labeled as emotional distress. A random-effects model was used for extracting the effect size from 105 selected studies, comprising both clinical and community samples (N = 11,803). Results revealed a large overall effect size, g = 1.47 (95% CI [1.27; 1.67]), and a higher effect size favoring anxiety disorders. The instruments evaluating death anxiety and the presence of chronic conditions moderated the relationship. A higher effect size was observed for instruments other than Templer's Death Anxiety Scale, and for participants with chronic/terminal illness compared to healthy samples. Overall, the results highlight the need for a transdiagnostic perspective on death anxiety, as well as for reaching a consensus regarding its conceptualization and measurement.

A Systematic Review and Meta-Analysis on Death Anxiety During COVID-19 Pandemic

This systematic review was conducted to estimate the pooled score of death anxiety during the COVID-19 pandemic. All eligible articles from January 2020 to May 2022 reporting the death anxiety score were included in the analysis b.y searching the Scopus, PubMed, Embase, and ISI databases. The standard score of death anxiety in the COVID-19 pandemic was 50%. The highest score of death anxiety was related to patients with COVID-19 (59.4%), other chronic patients (58.9%), and the elderly (56.4%). The lowest death anxiety score was related to the general population (42.9%) and health care workers (48.2%). The death anxiety score in the studies whose data was collected in 2020 and 2021 was 51% and 62%, respectively. During the COVID-19 pandemic, people experienced high death anxiety, which had terrible effects on their lives. Therefore, it seems necessary to provide training courses to deal with death anxiety for other possible pandemics.

Stigmatization, panic disorder, and death anxiety among patients of Covid-19: Fourth wave of pandemic in Pakistan

BACKGROUND

In Pakistan, the fourth wave of COVID-19 is causing an increasing number of positive cases. This fourth wave may be a risky aspect of mental health issues for COVID-19 patients. This quantitative study is designed to understand the stigmatization, and panic disorder and to explore the mediating role of death anxiety among patients of COVID-19 during the fourth wave of novel coronavirus.

METHODS

The study was conducted using a correlational research design. The survey was carried out by utilizing a questionnaire with a convenient sample technique. The sample of the study was comprised of 139 patients with COVID-19. Data were collected through Stigma Scale for Chronic Illnesses (SSCI), The Panic Disorder Severity Scale (PDSS), and Death Anxiety Inventory.

RESULTS

Results show that stigma is significantly positively related to panic disorder and death anxiety. Furthermore, panic disorder is also significantly positively related to death anxiety. Results also indicate that stigmatization is a significant positive predictor for death anxiety and panic disorder. Moreover, results indicate that death anxiety has a mediating role in the relationship between stigmatization and panic disorder with age and gender as covariates.

CONCLUSION

This study would be helpful for people around the world to understand this threatening contagious virus so they wouldn't stigmatize infected ones. Additional research is required for the sustainable improvement of anxiety over time.

Death anxiety and mental health: Requiem for a dreamer

Recently, there has been an increased interest in the role of death anxiety in a broad range of mental health disorders. It has been argued that the fear of death may be a transdiagnostic variable contributing to the development and maintenance of many chronic mental health problems. Further, it has been suggested that death anxiety may be responsible for relapse and the emergence of new disorders in patients that have received successful treatment for earlier conditions in their lives. Given this, the purpose of the present selective review is to: (1) explore contemporary theoretical accounts of the role of death anxiety in a broad range of human behaviours; (2) examine evidence for death anxiety as a key variable in mental health disorders; (3) examine evidence on the treatment of death anxiety in both non-clinical and clinical populations; (4) describe the limitations of the current literature, and; (5) provide a detailed description of the critical future directions for this field.

"Life's too short to be small": An experimental exploration of the relationship between death anxiety and muscle dysmorphia symptoms

Growing research demonstrates that death anxiety is strongly associated with numerous mental health conditions. It is possible that death anxiety may similarly contribute to behaviours associated with muscle dysmorphia (MD). The current pre-registered study examined this possibility in 322 young men with an interest in health and fitness. The mortality salience paradigm was used to experimentally examine whether reminders of death increased behaviours relevant to MD. Measures of MD symptoms and death anxiety were also completed by participants. Contrary to expectations, reminders of death did not significantly increase willingness to trial workout supplements, or dissatisfaction with current muscularity. Participants reminded of death reported lower intention to exercise in the near future, compared to the control condition. Moreover, death reminders did not lead to significantly larger portion sizes being chosen. However, in post-hoc analyses, men with high, but not low, MD symptoms did choose larger portions after being primed with death. Lastly, positive correlations were found between self-report measures of MD symptoms and two measures of death anxiety. Cumulatively, these results suggest that while fears of death may be associated with self-reported MD symptoms, they may not drive excessive exercise, nor body dissatisfaction in men.

A systematic review of the relationship between death anxiety, capability for suicide, and suicidality

This systematic review aimed to examine the relationship between death anxiety and suicidality in adults, and the impact of death anxiety interventions on the capability for suicide and suicidality. MEDLINE, PsycINFO, PubMed, and Web of Science were extensively searched using purpose-related keywords from the earliest to July 29th, 2022. A total of 376 participants were included across four studies which met inclusion. Death anxiety was found to relate significantly and positively with rescue potential, and although weak, negatively with suicide intent, circumstances of attempt, and a wish to die. There was no relationship between death anxiety and lethality or risk of lethality. Further, no studies examined the effects of death anxiety interventions on the capability for suicide and suicidality. It is imperative that future research implements a more rigorous methodology to establish the relationship between death anxiety and suicidality and establish the impacts of death anxiety interventions on the capability for suicide and suicidality.

Reduced death anxiety as a mediator of the relationship between acute subjective effects of psychedelics and improved subjective well-being

Research over the past several decades suggests that meaningful psychedelic experiences can engender long-term effects on subjective wellbeing. However, less research has investigated the psychological mechanisms through which these effects may emerge. In the present study, participants (N = 201) completed an online survey that retrospectively measured the acute effects of a meaningful psychedelic experience, as well as changes in subjective well-being and death anxiety. Reductions in death anxiety significantly mediated the effects of mystical experience on satisfaction with life, positive affect, and negative affect. Reductions in death anxiety did not mediate any of the effects of psychological insight. Although correlational, the findings are consistent with the hypothesis that some of the benefits of psychedelic-induced mystical experiences on subjective well-being may emerge due to reductions in death anxiety. Nevertheless, further research is needed to establish a causal effect of reduced death anxiety on well-being in the context of psychedelic experiences.

Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care

Background: Death anxiety is powerful, potentially contributes to suffering, and yet has to date not been extensively studied in the context of palliative care. Availability of a validated Death Anxiety and Distress Scale (DADDS) opens the opportunity to better assess and redress death anxiety in serious illness. Objective: We explored death anxiety/distress for associations with physical and psychosocial factors. Design: Ancillary to a randomized clinical trial (RCT) of Dignity Therapy (DT), we enrolled a convenience sample of 167 older adults in the United States with cancer and receiving outpatient palliative care (mean age 65.9 [7.3] years, 62% female, 84% White, 62% stage 4 cancer). They completed the DADDS and several measures for the stepped-wedged RCT, including demographic factors, religious struggle, dignity-related distress, existential quality of life (QoL), and terminal illness awareness (TIA). Results: DADDS scores were generally unrelated to demographic factors (including religious affiliation, intrinsic religiousness, and frequency of prayer). DADDS scores were positively correlated with religious struggle (p < 0.001) and dignity-related distress (p < 0.001) and negatively correlated with existential QoL (p < 0.001). TIA was significantly nonlinearly associated with both the total DADDS (p = 0.007) and its Finitude subscale (p ≤ 0.001) scores. There was a statistically significant decrease in Finitude subscale scores for a subset of participants who completed a post-DT DADDS (p = 0.04). Conclusions: Findings, if replicable, suggest that further research on death anxiety and prognostic awareness in the context of palliative medicine is in order. Findings also raise questions about the optimal nature and timing of spiritual and psychosocial interventions, something that might entail evaluation or screening for death anxiety and prognostic awareness for maximizing the effectiveness of care.

The development and validation of the Death Anxiety Beliefs and Behaviours Scale

OBJECTIVES

Research spanning the fields of clinical, social and health psychology suggests that death anxiety is an important construct. However, no comprehensive, psychometrically adequate measure of the construct exists. The current studies outline the development of a new measure of death anxiety, the Death Anxiety Beliefs and Behaviours Scale (DABBS), which is the first measure to specifically assess unhelpful beliefs and behaviours that may underlie fears of death.

METHODS

In Study 1, items were piloted in a large community sample (N = 505). In Studies 2A and 2B, exploratory and confirmatory factor analyses were performed using a treatment-seeking (N = 200) and non-treatment-seeking sample (N = 200). These analyses resulted in the final 18-item scale.

RESULTS

The DABBS demonstrated good construct validity, criterion validity, internal consistency and test-retest reliability. In Study 3, the DABBS effectively distinguished participants with clinically significant death anxiety and distress from those without, demonstrating excellent discriminant validity.

CONCLUSIONS

The present data indicate that the DABBS is a valid and reliable measure of affect, beliefs and behaviours relating to death anxiety, in a community sample of adults and among those seeking mental health treatment. Given the increasing recognition of the importance of death anxiety, the DABBS offers a useful research and clinical tool.

The Impact of Death Anxiety, Meaning and Coping on Posttraumatic Stress Disorder and Psychiatric Co-Morbidity Among Iraqi Civilians Exposed to a Car Bomb Attack A Latent Class Analysis

Much has been documented that the experience of a bombing is associated with posttraumatic stress disorder and psychiatric co-morbidity. Whether the co-existing relationship between death anxiety, meaning in life and coping styles would influence the aforementioned association is unknown. The present study aimed to identify latent classes of victims with different levels of death anxiety, meaning in life and coping styles, and to examine whether the severity of PTSD and co-morbid psychiatric symptoms differed between classes. One hundred and eighty-five victims who had experienced the first car bombing completed a demographic page, the Posttraumatic Stress Diagnosis Scale, General Health Questionnaire-28, Multidimensional Fear of Death Scale, Meaning in Life Questionnaire and Coping Responses Inventory. The results showed that 82% and 18% of the victims met the criteria for PTSD and no-PTSD, respectively. Four classes of victims were identified: Class 1 victims were approach copers with low levels of death anxiety and meaning. Class 2 victims were minimal copers with high levels of death anxiety and meaning. Class 3 victims were approach copers with a high level of death anxiety and meaning. Class 4 victims were avoidance copers with high levels of death anxiety. Individuals in Class 1 reported significantly lower levels of PTSD and psychiatric co-morbidity than the other three classes. Class 3 victims also reported significantly lower levels of psychiatric co-morbidity than Class 2 victims. To conclude, victims exposed to a car bombing were likely to exhibit posttraumatic stress symptoms in addition to other psychological symptoms. The severity of these symptoms tended to be lower among those who had little fear of death, did not search for meaning in life and approached their distress proactively.

The Impact of Mortality Salience, Negative Emotions and Cultural Values on Suicidal Ideation in COVID-19: A Conditional Process Model

As suicides incurred by the COVID-19 outbreak keep happening in many countries, researchers have raised concerns that the ongoing pandemic may lead to "a wave of suicides" in society. Suicidal ideation (SI) is a critical factor in conducting suicide intervention and also an important indicator for measuring people's mental health. Therefore, it is vital to identify the influencing factors of suicidal ideation and its psychological mechanism during the outbreak. Based on the terror management theory, in the present study we conducted a social media big data analysis to explore the joint effects of mortality salience (MS), negative emotions (NE), and cultural values on suicidal ideation in 337 regions on the Chinese mainland. The findings showed that (1) mortality salience was a positive predictor of suicidal ideation, with negative emotions acting as a mediator; (2) individualism was a positive moderator in the first half-path of the mediation model; (3) collectivism was a negative moderator in the first half-path of the mediation model. Our findings not only expand the application of the terror management theory in suicide intervention but provide some insights into post-pandemic mental healthcare. Timely efforts are needed to provide psychological interventions and counseling on outbreak-caused negative emotions in society. Compared with people living in collectivism-prevailing regions, those living in individualism-prevailing regions may be more vulnerable to mortality salience and negative emotions and need more social attention.

Death Obsession, COVID-19-Related Fear and Religiosity in People Living with Type 2 Diabetes

Patients diagnosed with type 2 diabetes were included among high-risk groups for more severe manifestations in case of COVID-19 infection and higher risk of mortality. The current study aims to (1) examine the relationship between death obsession, religiosity, and fear of COVID-19 among type 2 diabetes patients, and (2) assess if religiosity moderates the relationship between death obsession and fear of COVID-19. This cross-sectional online survey involved 306 type 2 diabetes patients. We found that 35.6 % of the participants were overweight and 14.6 % were suffering from obesity. Results showed that death obsession was positively associated with fear of COVID-19 and more religious individuals experience higher levels of fear. The overall level of religiosity did not moderate the relationship between death obsession and fear of COVID-19 but only the preoccupation with God dimension of the religiosity scale. The practical implications of these findings are discussed.

Big Data Analysis of Terror Management Theory's Predictions in the COVID-19 Pandemic

The current study aimed to address the limitations of the terror management theory literature by using big data analysis to examine the theory's predictions in the COVID-19 pandemic. Specifically, Google Trends were examined before and after the first COVID-19 case was identified in Singapore. The results showed that there was a significant increase in mortality salience, intergroup conflict, and prosocial behavior, and a significant decrease in materialism after the first COVID-19 case was identified. However, no significant differences were found for anxiety. Limitations include the assumption that search terms reflect intentions that would eventually lead to a relevant behavior and the lack of data from other sources to corroborate with the results from Google Trends. Future research could use data from other sources to examine the effects of COVID-19 on theoretically relevant behaviors.

OCD, death anxiety, and attachment: what's love got to do with it?

BACKGROUND

Death anxiety has been empirically implicated in obsessive compulsive disorder (OCD). Research has shown that secure attachments appear to protect against fear of death, and are also associated with reduced risk of mental illness. However, few studies have investigated the moderating effect of attachment style in the relationship between death anxiety and OCD.

AIMS

The present study sought to explore whether attachment style moderates the relationship between death anxiety and OCD symptoms among a treatment-seeking sample of individuals diagnosed with OCD.

METHOD

Following a structured diagnostic interview, a number of measures were administered to 48 participants. These included the Multidimensional Fear of Death Scale, Vancouver Obsessive Compulsive Inventory, and Experiences in Close Relationships-Revised.

RESULTS

As expected, death anxiety was a strong predictor of OCD severity, and other markers of psychopathology. However, contrary to hypotheses, neither anxious nor avoidant attachment style moderated the association between fear of death and OCD severity.

CONCLUSIONS

The current findings add further support to the role of death anxiety in OCD. Given the absence of a moderating effect of attachment between death fears and OCD severity, it is possible that this proposed buffer against death anxiety may potentially be insufficient in the presence of this disorder. Further research is needed to clarify whether attachment style may moderate the relationship between death anxiety and symptom severity in other disorders.

The role of death anxiety on marksmanship performance: a virtual reality simulator study

Despite the well-established relationship between state anxiety and marksmanship performance, few efforts have examined the individual differences that affect the extent to which individuals experience state anxiety in combat situations. Thus, further studies are needed to increase the probability of mission accomplishment, which could ultimately serve to safely bring soldiers home. The present study examined how death anxiety, a trait-based difference affects state anxiety, which in turn affects shooting performance on a battlefield. In particular, we used a virtual reality simulator to create a realistic engagement setting in which simulated death anxiety is salient. On a sample of 99 active-duty enlisted men in the Republic of Korea Army, we found that death anxiety, and not trait anxiety, increased state anxiety, which in turn decreased marksmanship performance. Overall, the current findings highlight the role of death anxiety in combat situations. The practical implications and avenues for future research are also discussed.

The Thought of Death in a Pandemic Era: Can Anxiety Determine the Nexus between the Accessibility, Availability and Use of Personal Protective Equipment (PPE) for COVID-19 and Work Behaviour among Aviation Workers?

Since the emergence of COVID-19, the aviation sector has been one of the numerous industries which have been affected the most. In this present paper, the thought of death among aviation workers as an indicator of anxiety at a time when the availability, access to, and use of Personal Protective Equipment (PPE) remains paramount to the survival of work in the line of duties and its influence on different work behaviors was assessed. The theoretical foundation of the study was built on the process efficiency theory, attentional interference theory, and the terror management theory (TMT), which focuses on both the psychological and emotional responses exhibited by people due to fear or worry about a specific situation. The study adopted an exploratory study design that incorporates a cross-sectional and self-reported survey among 646 frontline workers across 12 international airlines and the Ghana Airport Company Limited (GACL), Accra, Ghana using simple random sampling and convenient sampling techniques. After all the preliminary tests were performed, the path analysis estimated by Structural Equation Modelling (SEM) indicated that anxiety has a significant influence on workers’ stress-adaptive performance and task performance, but recorded no significant causal link with interpersonal performance. The findings indicated that all three proxies of employee work behaviours, which focus on both adaptive and task performance, were significantly related to workers’ access, availability, and use of PPE (APPE). The association between anxiety and APPE was also found to be significant. Bootstrapping mediation analysis shows that anxiety partially mediates the influence APPE has on both stress-adaptive performance and task performance, but did not show any mediating effect on the association between APPE and interpersonal performance. Among the three dimensions of death anxiety, both the fear of death (FDE) and death intrusion (DINT) indicated a significant partial mediating effect on the influence APPE has on all three multidimensional constructs of work behaviours. The findings literally prove that worrying about the fatality risk associated with COVID-19 is highly predictive.

Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.

Death Anxiety and Loneliness among Older Adults: Role of Parental Self-Efficacy

Death anxiety and loneliness are major issues for older people. The present study aimed to broaden the understanding of factors that are linked with increased loneliness in old age by examining the association between death anxiety and loneliness, and the role of an unexplored variable among older adults, namely, parental self-efficacy. A convenience sample of 362 Israeli parents over the age of 65 was recruited through means of social media. Participants completed self-reported questionnaires, which included background characteristics, death anxiety, parental self-efficacy, and loneliness measures. The findings showed that death anxiety was positively associated with loneliness among older adults. The findings also confirmed that parental self-efficacy moderated this association in this population. We concluded that the combination of death anxiety and low parental self-efficacy identified a group of older adults that are at higher risk of developing increased loneliness levels. Mental health professionals should consider intergenerational relationships as a fundamental component of older adults' daily lives, focusing on parental self-efficacy in old age, as this appears to be a resilience resource.

Overcome Death Anxiety: The Development of an Online Cognitive Behaviour Therapy Programme for Fears of Death

Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although cognitive behaviour therapy (CBT) has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Furthermore, there is a growing need for accessible, scalable and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based programme which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet individualised online treatment. The present study outlines the development and structure of this programme using responses from four users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical sample.

Death Anxiety and Attitudes towards Death in Patients with Multiple Sclerosis: An Exploratory Study

Background: Death and the anxiety of it becomes more apparent when confronted with a chronic disease. Even though multiple sclerosis (MS) is a treatable condition today, it is still accompanied by a multitude of impairments, which in turn may intensify of death anxiety. Objective: The aim of this study is to explore the relationship between depression, anxiety and death anxiety in individuals with MS. Methods: Fifty-six MS patients were recruited at the Department of Neurology of the University Clinic in Basel. Death anxiety was assessed using the Bochumer Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0). Results: Scores of death anxiety towards it in MS patients were low. Only disability (EDSS) was moderately correlated with death anxiety. Depression in MS was significantly correlated with fatigue and disability, but not with the BOFRETTA 2.0. Conclusion: Scores of death anxiety and the attitude towards death are low in this MS cohort. It was shown that both psychopathological and neurological deficits impact the subject of death with respect to multiple sclerosis.

Death Anxiety and Related Factors in Schizophrenia Patients: Controlled Study

The aim of the study was to investigate the level of death anxiety and related sociodemographic and clinical variables in schizophrenia patients. One hundred and ninety schizophrenia patients and 110 healthy controls were included the study. Death anxiety measured with Templer Death Anxiety Scale (TDAS). The patients were also evaluated with scales in terms of depression, anxiety, obsessive-compulsive symptoms, and suicide. The death anxiety level in patients with schizophrenia was significantly higher than the healthy controls. The severity of depressive and psychotic symptoms were related to the level of death anxiety. Patients with schizophrenia may need more protection and psychosocial interventions about death related themes.

Are anxiety disorders a pathway to obsessive-compulsive disorder? Different trajectories of OCD and the role of death anxiety

OBJECTIVES

A body of research has demonstrated high rates of comorbidity among individuals with obsessive-compulsive disorder (OCD). Further, recent empirical evidence has demonstrated the relevance of death anxiety in OCD. Given that the trajectory towards OCD remains unclear, the current study aimed to examine which disorders individuals typically experience prior to the onset of this disorder. Further, the study aimed to explore the role of death anxiety in the developmental pathways to the disorder.

METHODS

The present study involved administering a measure of death anxiety and conducting structured diagnostic interviews among a treatment-seeking sample of 98 individuals with OCD.

RESULTS

First, the findings revealed a number of anxiety-related disorders commonly experienced prior to the development of OCD, the most frequent of which were separation anxiety disorder, specific phobias, and generalised anxiety disorder. Second, consistent with hypotheses, individuals with higher death anxiety experienced more disorders prior to the onset of OCD. Conversely, those with lower fears of death were significantly more likely to develop OCD as their first disorder.

CONCLUSIONS

These findings support the argument that death anxiety may influence the trajectory towards OCD, and the comorbidity among anxiety-related disorders. However, further research is needed to clarify whether death anxiety plays a causal role in this trajectory.

The role of mortality concerns in separation and connection effects: comment on Lee and Schwarz

Using terror management theory and research findings, we expand the framework provided by Lee and Schwarz to highlight the potential link between separation and connection effects to existential, death-related concerns. Specifically, we address how death awareness may motivate separation and connection behaviors and how engaging in these behaviors may serve a protective terror management function.

Death Anxiety, Religiosity and Culture: Implications for Therapeutic Process and Future Research

Death anxiety is a common phenomenon that humans experience. It is multidimensional. There has been an upsurged interest around the discussion on death anxiety across the globe, however, much of the literature focuses on the concept of death anxiety, religiosity, and its role in mental health conditions. Further, studies on death anxiety are scattered and at times disconnected. It is important to review existing literature to get an overview of the current direction in research and understand its relevance to facilitate therapeutic processes. In this scoping review, literature was searched in databases such as PubMed, Scopus, and PsychINFO using key words such as “death anxiety”, “fear of death”, religion”, “culture”, and “psychopathology” combined with Boolean operators to narrow down the search results. The initial search yielded 614 records, of which 546 records were removed based on title review (363), abstract review (94), and full-text review (89). Finally, 68 articles were appraised, narratively synthesized, and thematically presented. Major themes revealed in the literature were theoretical frameworks of death anxiety, religiosity, universality, psychological effects of death anxiety, psychopathology, and religious coping strategies. There is a need to assess client’s death anxiety and address them using religious rituals and coping mechanisms.

COVID-19 in the geriatric population

OBJECTIVES

The global COVID-19 pandemic has caused rapid and monumental changes around the world. Older people, who already experience higher rates of social isolation and loneliness, are more susceptible to adverse effects as a result of the social distancing protocols enacted to slow the spread of COVID-19. Based on prior outbreaks, we speculate the detrimental outcomes and offer solutions.

METHODS

Reviewing the literature on the detrimental effects of social isolation and loneliness and higher mortality in the older population. Utilizing psychological study outcomes from prior major outbreaks such as in SARS, Ebola, H1N1 influenza, and Middle East respiratory syndrome offer predictions and the susceptibility in the geriatric age group.

RESULTS

Organizations such as the WHO, Centers for Disease Control, and American Association of Retired Persons have put measures in place to provide networking on a local, regional, and national level. These efforts are designed to start mitigating such detrimental effects. A necessary follow-up to this pandemic will be gathering data on unique populations such as the geriatric community, to better mitigate adverse outcomes given the certainty that COVID-19 will not be the last global viral outbreak.

CONCLUSIONS

The results of worsened social isolation and loneliness is associated with significantly increased morbidity and mortality in the geriatric population. Various solutions including virtual interactions with loved ones, engaging in physical activity, continuing any spiritual or religious prayers remotely, and community services to provide aid for the older population are all efforts to minimize social isolation and loneliness.

Preliminary evidence of the effectiveness of acceptance and commitment therapy for death anxiety in Iranian clients diagnosed with obsessive-compulsive disorder

The authors investigated the effectiveness of acceptance and commitment therapy (ACT) for the treatment of death anxiety and obsessive-compulsive disorder (OCD) with eight adult women in Iran. The ACT protocol was conducted in weekly solo sessions with each participant for 8 weeks (45 minutes each). The results were analyzed by visual analysis method and improvement percentage. ACT resulted in a 60%-80% decrease in death anxiety and a 51%-60% decrease in obsessive-compulsive symptoms, thereby indicating promise for ACT as a treatment for OCD and death anxiety.

Death anxiety and attitude to death in patients with schizophrenia and depression

Attitude to death and death anxiety in patients with severe psychiatric disorders have been studied rarely so far, although this is an existential perspective for each human being and clinically seems to be changed in patients with depression and schizophrenia. Patients with depression (mean age 46.30 ± 13.39; 12 women, 8 men) and schizophrenia (mean age 38.95 ± 1285; 9 women, 11 men), as well as healthy controls, were included in the study. Death anxiety and attitude to death were assessed using the newly developed and currently validated BOFRETTA scale. Attitude to death was significantly worse in the group of patients with schizophrenia, especially in those with prominent negative symptoms. Concerning death anxiety, patients with schizophrenia and also those with depression exhibited higher mean values compared with healthy controls in the same age range. These results suggest that there are specific similarities and differences concerning attitude to death and death anxiety in patients with psychotic and affective disorders. It can be concluded that existential aspects such as death and meaningful life should also be considered within the treatment of patients with severe mental disorders.

The hierarchical structure of fear of personal death: from the general factor to specific forms

Purpose

In the present study, we aimed to integrate unidimensional and multidimensional perspectives of the construct of the fear of personal death (FOPD). It has been assumed that (a) there is one general factor of FOPD, reflecting the unidimensional perspective and that (b) FOPD assumes a hierarchical structure reflecting the multidimensional perspective.

Methods

We administered the Death and Dying Anxiety Inventory (FVTS, Ochsmann, 1993) to 1217 Polish participants (602 women and 615 men) aged between 18 and 89 (M_Age = 31.13; SD_Age = 12.65).

Results

The results of the bi-factor model of the confirmatory factor analysis proved the existence of a FOPD general factor. Using the bass-ackwards approach, we provided evidence on the hierarchical structure of FOPD, which stresses that specific types of FOPD distinguished in the FVTS, which, on a higher level, make up the factors of threats to self-fulfilling existence, threats to well-being and threats of physical destruction, which in turn depend on the subject’s perspective: the physical self and/or the symbolic self.

Conclusion

The current study demonstrates that unidimensional and multidimensional approaches to FOPD do not necessarily exclude one another. The unidimensional approach to FOPD seems to be most appropriate for studying the intensity of FOPD, while the multidimensional approach seems to be more suitable for studying the individual differences in how people give meaning to FOPD.

Death anxiety in the time of COVID-19: theoretical explanations and clinical implications

The recent COVID-19 pandemic has triggered a surge in anxiety across the globe. Much of the public's behavioural and emotional response to the virus can be understood through the framework of terror management theory, which proposes that fear of death drives much of human behaviour. In the context of the current pandemic, death anxiety, a recently proposed transdiagnostic construct, appears especially relevant. Fear of death has recently been shown to predict not only anxiety related to COVID-19, but also to play a causal role in various mental health conditions. Given this, it is argued that treatment programmes in mental health may need to broaden their focus to directly target the dread of death. Notably, cognitive behavioural therapy (CBT) has been shown to produce significant reductions in death anxiety. As such, it is possible that complementing current treatments with specific CBT techniques addressing fears of death may ensure enhanced long-term symptom reduction. Further research is essential in order to examine whether treating death anxiety will indeed improve long-term outcomes, and prevent the emergence of future disorders in vulnerable populations.

Key learning aims

(1)To understand terror management theory and its theoretical explanation of death anxiety in the context of COVID-19.(2)To understand the transdiagnostic role of death anxiety in mental health disorders.(3)To understand current treatment approaches for directly targeting death anxiety, and the importance of doing so to improve long-term treatment outcomes.

Specific Phobias: Maintaining Control in the Face of Chaotic Threats

Introduction: Drawing on existential psychology we examine the possibility that specific phobias can serve a psychological function. Specifically, we propose that phobic objects allow individuals to focalize anxieties about haphazard existential threats into a more manageable form, reducing perceptions of risk and bolstering control.

Method: We tested this by assessing perceived control among participants with varying levels of spider fear who were reminded of chaotic hazards (or not) and exposed to spiders images (or not).

Results: Study 1 (N = 940) found that among those high in spider fear, salient uncontrollable threats (vs. controllable threats or uncontrollable non-threats) reduced feelings of control unless participants were exposed to their phobic object. Similarly, exposure to spider (vs. non-spider) images bolstered perceived control in the face of salient hazards, but only for those high in spider fear. A second preregistered study (N = 1349) found that the palliative effects of focusing on a phobic object were partially explained by a decreased concern with haphazard harms.

Discussion: This supports the premise that phobic objects help to maintain control by narrowing the source of disordered risks, creating a more controllable conception of reality.

Anxiety Buffer Disruption: Self-Evaluation, Death Anxiety, and Stressor Appraisals Among Low and High Posttraumatic Stress Symptom Samples

Objective: Research driven by terror management theory suggests sociocultural anxiety-buffer systems typically protect against existential anxiety, whereas anxiety buffer disruption theory suggests traumatic experiences may disrupt that process.

Method: Following posttraumatic stress (PTS) symptom screening (n = 4097), individuals with low (n = 149) and high (n = 120) PTS engaged in either negative or positive self-evaluations, then reported death anxiety and appraised life's stressors as negative/threatening or positive/challenging.

Results: When low PTS participants contemplated their worst (vs. best) selves, they experienced moderately heightened death anxiety yet appraised life's stressors as more positive/challenging than harmful/threatening, reflecting effective existential anxiety buffers. However, high PTS participants reported high death anxiety in both the best-self and worst-self conditions—indicating anxiety buffer disruption—and the worst-self (vs. best self) prompt increased their appraisal of life's stresses as a harmful threat and decreased appraisal as positive/challenging opportunities for growth and well-being.

Discussion: Theoretical and clinical implications are discussed.

Editorial Foreword: Applying Existential Social Psychology to Mental Health

Human existence is characterized by some rather unique psychological challenges. Because people can reflect on their lives and place in the world, they are regularly confronted with a variety of existential concerns: death and mortality; the burdens of freedom; uncertainty regarding one's identity; isolation from others; and indeterminate meaning in life. Existential social psychology (Greenberg, Koole, & Pyszczynski, 2004; Vail & Routledge, 2020) investigates whether and how such existential concerns shape everyday life and, as highlighted in the present special issue, how such processes impact mental health and social functioning.

To the Victors Go the Existential Spoils: The Mental-Health Benefits of Cultural Worldview Defense for People WHO Successfully Meet Cultural Standards and Valued Goals

Introduction: Research in support of terror management theory suggests that mortality concerns will activate symbolic defenses associated with cultural worldviews, and when these defenses are activated, mental health will benefit. However, no study to date has examined this process in full. We filled this gap, while testing the moderating effect of feeling successful vis-à-vis cultural value-standards.

Method: In two studies, we hypothesized that participants who feel successful at meeting cultural standards would engage cultural worldview defense (WVD) following mortality salience (MS), and as a consequence of their defensiveness, would experience greater mental health.

Results: In Study 1, MS increased pro-American WVD only among relatively wealthy participants, which in turn reduced death-thought accessibility. In Study 2, MS increased pro-American WVD only among participants primed with felt success (vs. failure), which in turn reduced anxiety and depression.

Conclusions: Culture can relieve death-related distress and promote mental health to the extent that it provides feelings of success.

Embedding existential psychology within psychedelic science: reduced death anxiety as a mediator of the therapeutic effects of psychedelics

Psychedelic therapies can engender enduring improvements in psychological well-being. However, relatively little is known about the psychological mechanisms through which the salutary effects of psychedelics emerge. Through integrating extant research on psychedelics with contemporary existential psychology, we present a novel hypothesis that reduced death anxiety may be a key mechanism underpinning the therapeutic effects of psychedelics. In developing this hypothesis, we also provide a complementary review of mechanisms through which psychedelics may reduce death anxiety. We conclude that an awareness of the role of death anxiety in psychopathology has the potential to guide future research into psychedelic therapies.

A systematic review of the psychometric properties of death anxiety self-report measures

Recent research suggests that the transdiagnostic construct of death anxiety may be a basic fear underlying a range of anxiety disorders. Although the investigation of death anxiety in clinical populations is relatively recent, the death anxiety literature as a whole has a longer history evidenced by the number of instruments developed to measure this construct. This systematic review aimed to evaluate the evidence supporting the psychometric properties of self-report death anxiety measures. Relevant studies were identified via a systematic search of four electronic databases in addition to reference list searches. Two independent reviewers evaluated relevant studies using the established Terwee et al. quality appraisal tool. Of the 1831 studies identified, 89 met inclusion criteria. These studies investigated the psychometric properties of 21 self-report scales of death anxiety as well as six subscales. No measure was found to possess evidence of adequacy on all evaluated quality criteria. The Templer Death Anxiety Scale, Concerns about Dying Instrument and Death Concern Scale were found to possess the most evidence supporting their validity and reliability. Overall findings suggest that additional research is needed to establish the psychometric adequacy of death anxiety instruments, especially given increased utilization of these measures in both clinical and research settings.

Heldentum gegen Todesangst und Psychopathologie: “Selbstwert” als protektiver Faktor in der ambulanten Psychotherapie

<b><i>Hintergrund:</i></b> Die Befunde der bisherigen Untersuchungen legen nahe, dass die Angst vor dem Tod ein wichtiger Faktor bei der Entstehung psychischer Erkrankungen ist. Insbesondere die Terror-Management-Theorie geht davon aus, dass Menschen zwei verschiedene Strategien anwenden, um mit Todesangst umzugehen: (1) Sie versuchen, ihren Selbstwert zu steigern; (2) sie halten die Werte ihrer Kultur hoch. <b><i>Patienten und Methoden:</i></b> Im Rahmen einer prospektiven Studie wurden 56 ambulante Psychotherapie-Patienten (29 Frauen, Alter 42,8 Jahre, SD 13,8) vornehmlich mit depressiven Störungen mittels Interview/Fragebögen u.a. zu Angst vor dem Tod (BOFRETTA) sowie Religiosität untersucht. <b><i>Ergebnisse:</i></b> Die Angst vor dem Tod korrelierte signifikant mit der Schwere der psychischen Symptomatik (BDI), Neurotizismus (NEO-FFI) sowie dem Hochhalten kultureller Werte (LeBe). Erwartungsgemäß zeigte sich ein signifikanter negativer Zusammenhang von Selbstwert und Angst vor dem Tod. Dieser zeigte sich nicht bei Vergleichsvariablen wie Lebenssinn, Religiosität und Spiritualität. <b><i>Diskussion und Schlussfolgerungen:</i></b> Die Angst vor dem Tod spielt bei der Entstehung und Aufrechterhaltung psychischer Probleme eine wesentliche Rolle. Ein wichtiger protektiver Faktor gegen diese scheint das Selbstwertgefühl zu sein. Es lässt sich vermuten, dass das Hochhalten kultureller Werte zwar ein unbewusster Versuch ist, gegen die Angst vor dem Tod (und die psychische Symptomatik) vorzugehen, dieser allerdings nicht wirksam ist.