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“Dying” to know more about it: Fear of death

Updated: Oct 5


The fear of death is a common experience that humans have. It can vary from person to person as they respond to the realization of their own mortality and its inevitability in different ways. Some people may react by being more introspective and questioning about life's meaning and values. Others may respond with denial, avoidance, anxiety, or depression. When such fear becomes too intense, occurs frequently and starts to affect one’s daily functioning, like their ability to sleep, pay attention, or engage in meaningful actions, it may be s sign that this fear has now become a problem.


Regardless of whether fearing death has come up in your life or become problematic, it is worth exploring some of its roots as well as the approaches and tools that might help to cope with it if it starts getting in the way.



- How does fear of death show up in mental health conditions?


Interestingly, fear of death is a common thread present in many mental health disorders. These include specific phobias (such as tanaphobia or agoraphobia), certain Obsessive-Compulsive Disorder (OCD) compulsions (like washing hands, checking to make sure you’re safe or you didn’t leave the stove on), health anxiety and panic disorders. Research has shown that although the fear of death is a central component of these conditions, frequently, this fear is not addressed in the treatment. For example, when engaging in exposure exercises derived from Cognitive Behavioural Therapy (CBT), one might tackle the fear of heights by gradually visiting a building and exposing oneself to higher altitudes within the building little by little. Nonetheless, often there are no conversations or exposures around the core fear of dying if they were to fall off the building. Thus, asking yourself the question about what the core fear is and addressing the root of the worries can be very helpful and guide the treatment course toward positive results.


- What helps us face the fear of death and what does not?


Research tells us that there are a few factors that contribute to the fear of dying, including early experiences of death, grief and loss, and intergenerational trauma. There are also certain elements that exacerbate them, such as feelings of meaninglessness and isolation. Generally, engaging in avoidant behaviours related to (a) things that remind us of death, such as cemetery, films, conversations, thoughts, and sleep) or (b) things perceived to have an increased risk of death, such as germs, flying, certain foods, or heights can be problematic. In addition, reassurance seeking, hypervigilance to physical sensations and compulsive behaviours (checking, tapping, rituals or repeating phrases) increases the fear of death.


Research suggests what helps us face the fear of death is to develop a more neutral acceptance of it. Thus, in addition to making room for thoughts and feelings associated with death, we provide you below with some examples of actions you can take to better manage these worries:

1. striving for achievement and self-esteem (through academics, sports or arts)

2. engaging in health-conscious behaviours (like exercising, wearing sunscreen, sleeping well)

3. participating in activities that offer a sense of meaning (such as volunteering or being in nature)

4. being part of a value-driven movement or cause (e.g., related to religion or environmental initiatives)

5. attempting to build a legacy (like creating a photo album or recording a song)


- What are the treatment approaches that work?


CBT has proven to be the most effective intervention to treat fear of death. In particular, exposure work, cognitive restructuring, and acceptance have shown to be the treatment components that have the largest efficacy across studies. Below are some examples of each CBT component:


1. Examples of exposure exercises to help people get used to the fear and maybe leave it in the background:

  • Reading obituaries

  • Discussing end-of-life preferences

  • Pretending to organize your funeral (including a music playlist for that day),

  • Visualizing your death (and maybe writing down a story about it)


2. Examples of cognitive restructuring to help thoughts become more realistic and less scary:

  • Targeting unhelpful thoughts such as: “Death will be painful, lonely and scary”

  • Being aware of those thoughts and identifying the thinking traps in place (e.g., catastrophizing, fortune telling, discounting the positive)

  • Asking some of the following questions to cognitively challenge the thought:

  • What evidence do I have for and against that thought?

  • What would you tell a friend to help them if they had that thought?

  • Are you worrying about an outcome that you can't control? Is there any point in this type of worry?

  • What good things would you gain if you gave up the thought?

  • How would your life be different if you didn't believe the thought?

  • Embracing uncertainty and using coping statements. For example: “I can’t predict nor control how my death will be. Regardless of what happens, I will cope with it in the moment surrounded by the people who love me.”


Acceptance and Commitment Therapy (ACT) also offers some tools to reframe your relationship with death through acceptance. Below are some ideas to help you make room for these thoughts:


  • Normalize death: engage in open conversations about this with people around you, attend a death cafe, listen to podcasts and watch videos or movies related to death.

  • Lighten attitudes towards death: Play games about death, such as death deck or listen to music on this topic.

  • Reframe the death fear as an opportunity to make the most of the “now”: watch videos or do this interesting exercise: draw a line on a piece of paper, with one end representing your birth and the other representing your death. Put an X on the line to mark where you are right now. Reflect on this image.


- Practical tips


  • Focus on creating a meaningful life that is true to your personal values.

  • Remind yourself that the work to overcome death fear isn’t easy.

  • The goal is to create a neutral acceptance of death.

  • Try to make the journey to cope with the fear of death playful and fun!

  • Some of the ways in which this fear can be alleviated are through acceptance, fulfilling relationships, finding or creating meaning, belonging to a larger group (i.e. through religion or sports) or creating a legacy (i.e., writing a book or making a movie).

  • If needed, work with a therapist who can help you gradually face some of these fears and unpack the individual experiences as well as your cultural and personal beliefs that have shaped the way you think of your own mortality.


Thanks for reading this blog. I would like to end it with an inspiring quote about this topic:


“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!”


― Hunter S. Thompson, The Proud Highway: Saga of a Desperate Southern Gentleman, 1955-1967


About the Author: Diana Franco Yamin is a Canadian Certified Counsellor who holds a Master's in Clinical Psychology and has 9 years of clinical experience in community agencies and hospital settings. She received training in CBT)for OCD and anxiety at the OCD Clinic at BC Children’s Hospital, where she also coordinated multiple studies, provided individual and group treatment and supervised Ph.D. students. For more information about Diana, please check out her profile.


References

- Furer, P., & Walker, J. R. (2008). Death anxiety: A cognitive-behavioral approach. Journal of Cognitive Psychotherapy, 22(2), 167–182

- Menzies, R and Menzies R (2023) Workshop on The Relevance, Assessment, and Treatment of Death Anxiety in Mental Health Conditions. Bespoke Canada Mental Health.



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