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

      1 , * , 2

      Cognitive Behaviour Therapist

      Cambridge University Press

      COVID-19, death anxiety, existential, transdiagnostic

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          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.

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          Most cited references 34

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          Two decades of terror management theory: a meta-analysis of mortality salience research.

          A meta-analysis was conducted on empirical trials investigating the mortality salience (MS) hypothesis of terror management theory (TMT). TMT postulates that investment in cultural worldviews and self-esteem serves to buffer the potential for death anxiety; the MS hypothesis states that, as a consequence, accessibility of death-related thought (MS) should instigate increased worldview and self-esteem defense and striving. Overall, 164 articles with 277 experiments were included. MS yielded moderate effects (r = .35) on a range of worldview- and self-esteem-related dependent variables (DVs), with effects increased for experiments using (a) American participants, (b) college students, (c) a longer delay between MS and the DV, and (d) people-related attitudes as the DV. Gender and self-esteem may moderate MS effects differently than previously thought. Results are compared to other reviews and examined with regard to alternative explanations of TMT. Finally, suggestions for future research are offered.
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            Why do people need self-esteem? Converging evidence that self-esteem serves an anxiety-buffering function.

            Three studies were conducted to assess the proposition that self-esteem serves an anxiety-buffering function. In Study 1, it was hypothesized that raising self-esteem would reduce anxiety in response to vivid images of death. In support of this hypothesis, Ss who received positive personality feedback reported less anxiety in response to a video about death than did neutral feedback Ss. In Studies 2 and 3, it was hypothesized that increasing self-esteem would reduce anxiety among individuals anticipating painful shock. Consistent with this hypothesis, both success and positive personality feedback reduced Ss' physiological arousal in response to subsequent threat of shock. Thus, converging evidence of an anxiety-buffering function of self-esteem was obtained.
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              Stereotypes and terror management: evidence that mortality salience enhances stereotypic thinking and preferences.

              If stereotypes function to protect people against death-related concerns, then mortality salience should increase stereotypic thinking and preferences for stereotype-confirming individuals. Study 1 demonstrated that mortality salience increased stereotyping of Germans. In Study 2, it increased participants' tendency to generate more explanations for stereotype-inconsistent than stereotype-consistent gender role behavior. In Study 3, mortality salience increased participants' liking for a stereotype-consistent African American and decreased their liking for a stereotype-inconsistent African American; control participants exhibited the opposite preference. Study 4 replicated this pattern with evaluations of stereotype-confirming or stereotype-disconfirming men and women. Study 5 showed that, among participants high in need for closure, mortality salience led to decreased liking for a stereotype-inconsistent gay man.

                Author and article information

                Cogn Behav Therap
                Cogn Behav Therap
                Cognitive Behaviour Therapist
                Cambridge University Press (Cambridge, UK )
                11 June 2020
                : 13
                [1 ]School of Psychology, University of Sydney , Sydney, Australia
                [2 ]Graduate School of Health, University of Technology Sydney , Sydney, Australia
                Author notes
                [* ]Corresponding author. Email: rmen9233@
                © British Association for Behavioural and Cognitive Psychotherapies 2020

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                References: 69, Pages: 11
                Invited Paper

                transdiagnostic, existential, death anxiety, covid-19


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