Death Anxiety

Worries about dying or losing a loved one are a normal part of life, but if your thoughts about death (or dying) are extremely distressing, time-consuming, or stop you from doing important things, you might be experiencing death anxiety.

Death anxiety (or ‘thanatophobia’) is a common fear that anyone can experience. Research suggests that up to 10% of people experience death anxiety, and around 3% have an intense fear of death ^[1,2]. These concerns might relate to your own death, someone else’s death, the process of dying, or what happens after death.

Death anxiety can lead to difficulties with your mental health and can affect how you function in your daily life. It can also play a role in other problems including anxiety disorders (such as health anxiety or obsessive-compulsive disorder), depression, and eating disorders. The good news is that cognitive behavioral therapy (CBT) is an effective treatment for death anxiety.

What is death anxiety?

Fear of death is normal, and it shapes how we think and behave in subtle ways ^[3].

But what if your fear of death is so severe that it stops you from enjoying your life? When concerns about death and dying are extremely distressing, time-consuming, or get in the way of doing things, people are said to struggle with ‘death anxiety’. While death anxiety isn’t a psychiatric diagnosis, it can lead to serious problems.

People experience death anxiety in different ways. If you struggle with death anxiety, you might worry about:

The process of dying (e.g., “Dying will be painful”).
What happens after dying (e.g., “What if I go to hell after I die?”).
The consequences of dying (e.g., “My death will make my family suffer”).
Other people dying (e.g., “I won’t be able to cope when my partner dies”).
Death overall (e.g., “Why is death so cruel and unfair?”).

Some of the key signs of death anxiety include:

Death anxiety can be an isolated issue or part of another mental health difficulty ^[4]. In fact, some psychologists believe that fear of death might underlie most (if not all) mental health problems ^[5].

What is it like to struggle with death anxiety?

Ron’s fear of death was linked to concerns about his health.

Looking back, I think I’ve been afraid of dying since I was a boy. When I was ten years old, my grandma died from a sudden heart attack. It hit me hard because we were close, and the idea of an ‘attack’ sounded scary. My parents explained that it was normal for old people to die, but I couldn’t shake off the idea that dying was painful and totally unpredictable.

After my grandma passed away, I worried a lot about my parents dying. As time went on, I became more and more obsessed with my own health. Every ache or pain in my chest would send me into a panic, and I worried that any unusual physical sensation might be a sign of heart disease. I would spend hours researching my symptoms online, convinced that I had some rare heart problem my doctors had missed. I even avoided doing any exercise in case it put too much strain on my body. The thought of dying was always there and made me highly aware of everything going on inside my body.

After countless tests and medical checkups showing there was nothing wrong with my heart, my doctor referred me to a therapist. We talked about my health worries, and I felt less anxious for a while, but soon after treatment, my fears started to come back. Nothing seemed to have changed.

I didn’t want to go back into therapy again, but my doctor persuaded me to give it a try. I thought my new therapist would want to talk about my health worries again, but she wondered if fear of dying might be the real issue. I think she’s right. Looking back, I think my obsession with my health became a way of coping with the anxiety I’d felt about dying for so long.

Understanding Death Anxiety CBT Psychoeducation Guide (Featured Image)

Do I have death anxiety?

Most people feel a bit anxious about death and dying, so it’s sometimes hard to know when it becomes a serious problem. Death anxiety can also be difficult to spot when it overlaps with other issues like health worries, depression, or general anxiety. Some people are so fearful and avoidant of death that simply acknowledging it is an issue can be tough for them.

Answering the questions below can give you an idea of whether it is worth arranging a professional assessment.

Do you spend a lot of time worrying about your death or the death of a loved one?	Yes	No
Are you frightened about what happens after you die?	Yes	No
Do you feel scared of what dying will be like?	Yes	No
Are you very concerned about the suffering your death will cause others?	Yes	No
Do distressing mental images about death or dying often pop into your mind?	Yes	No
Does the idea of death or dying make you feel very sad or guilty?	Yes	No
Have thoughts about death interfered with your relationships, work, or enjoyment of life?	Yes	No
Do you avoid things that remind you about death, such as places (e.g., cemeteries or hospitals), people (e.g., health professionals), or types of entertainment (e.g., stories, TV shows, or films featuring death)?	Yes	No
Have you often found yourself looking for information or seeking reassurance about your health, the health of others, or what happens after you die?	Yes	No
Do you feel compelled to do things that might reduce the risk of dying (e.g., exercising excessively, checking for signs of illness or danger, or other repetitive ‘rituals’ that help you feel safe)?	Yes	No
Have your concerns about death stopped you from doing important end-of-life tasks like preparing a will or discussing funeral preferences?	Yes	No

You might be struggling with death anxiety if you answered ‘yes’ to most of these questions. If so, you might find it helpful to speak to your family doctor or a mental health professional about how you feel.

What causes death anxiety?

Death anxiety doesn’t have a single cause, but some things make people more likely to experience it.

Human evolution. Humans have a unique understanding of death. Evolutionary theories suggest that awareness and avoidance of death helped humans survive in dangerous environments ^[6,7]. However, this doesn’t really explain why only some people develop an extreme fear of death.
Your life experiences. Certain experiences might make you more likely to develop an extreme fear of death ^[8]. For example, having anxious, overprotective, or unprotective parents might teach you that danger is ever-present, so you should be vigilant for things that might harm or kill you. Alternatively, you might remember loved ones talking about death in very negative ways. Other experiences that could make you fearful of death include being exposed to death at a young age (e.g., suddenly losing someone close to you), having a traumatic experience (e.g., witnessing an accident or being involved in a war), or experiencing serious harm or illness as a child.
Your personality. Some psychologists believe that death anxiety is a trait – an aspect of your personality or character ^[9].
Your religious beliefs. Research suggests that people who are very religious or unreligious tend to feel less anxious about death. However, people who are slightly religious or unsure of their beliefs tend to experience more fear of death ^[10]. This suggests that having strong beliefs about death and what happens after dying protects people from death anxiety. Some religions also promote confusing or scary ideas about death (e.g., that you might be damned or suffer forever), which can contribute to death anxiety ^[8].
Your culture. The environment in which you live can also influence your attitude toward death ^[11]. In some cultures, death is celebrated and openly talked about. In others, death and dying are treated as taboo subjects. Some people believe that Western cultures try to ‘hide’ death, sickness, and ageing from public view, which can make these experiences seem frightening ^[12].
Genetic factors. Research suggests that your genetics may make you more likely to experience some emotional problems, and the same might be true of death anxiety. However, your experiences in life are likely to play a much bigger role.

What keeps death anxiety going?

Death anxiety can be looked at in different ways. It can be seen as an existential issue, an emotional issue, or the result of a particular understanding of death. All these factors can be relevant sometimes.

Research studies indicate that cognitive behavioral therapy (CBT) is an effective treatment for death anxiety ^[13]. CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. If they can work out what keeps a problem going, they can treat the problem by interrupting the cycles that maintain it.

CBT models of death anxiety describe some of the ‘parts’ that keep death anxiety going ^{[8, 14, 15]}. These include:

Treatments for death anxiety

Psychological treatments for death anxiety

There are several therapies that can help with death anxiety, including Existential Psychotherapy and individual (one-to-one) cognitive behavioral therapy (CBT) ^[13].

CBT is a popular form of talking therapy. Unlike some other therapies, it is often quite structured. After talking things through so your therapist understands your problem, you can expect to set goals so you both know what you are working toward. At the start of most sessions, you will set an agenda together so you can agree on what that session will focus on. It is best to seek a therapist with specialist training and experience in working with death anxiety.

Some of the ‘ingredients’ of effective CBT for death anxiety include ^{[8, 14, 15]}:

Assessing the symptoms of death anxiety you are struggling with.
Creating a shared understanding or ‘formulation’ of what is keeping your death anxiety going, which is usually drawn out as a diagram.
Developing a realistic understanding of death and dying (‘psychoeducation’).
Exploring alternative ways of thinking about death (‘cognitive restructuring’).
Facing your death-related fears in a gradual and prolonged way (‘exposure’).
Testing your negative death-related beliefs and experimenting with using fewer safety behaviors (‘behavioral experiments’).
Engaging in normal death-related activities (e.g., writing a will).
Building a meaningful, values-driven life (‘behavioral activation’).
Creating a plan that helps you maintain your progress and avoid setbacks in the future (‘relapse prevention’).

Medical treatments for death anxiety

Medical treatments are not typically used to treat death anxiety. However, they might be used to address the problems that sometimes accompany it, such as depression.

References

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About this article

This article was written by Dr Matt Pugh and reviewed by Dr Matthew Whalley, both clinical psychologists. It was last reviewed on 2023/08/16.