Is the Fear of Death Behind Your Health Anxiety?

Death anxiety, or thanatophobia, has been shown to play a prominent role in a wide range of psychological disorders. Although death anxiety is transdiagnostic (presents itself across a wide variety of disorders), it is a particularly salient feature of health anxiety. And this isn’t exactly surprising. After all, aside from being a victim of violence or in an accident of some kind, the majority of deaths are due to illness-related causes, right? Thus, it makes logical sense that many people struggle with both health anxiety and death anxiety.

Now, most people don’t love the idea of death. But, although it is disconcerting, they can accept to some degree that death is an inevitable part of life and they, more or less, leave it at that. For those of us that live with severe death anxiety, however, it is not so simple. This fear can be all-consuming and begin to take over life. In these cases, it is essential that we address it.

What's the worst that can happen?

A key Socratic question used in CBT is, "What is the worst that can happen?" Now, when used to challenge other types of anxious thoughts, this question can be a slam dunk in terms of reducing anxiety. It highlights the irrationality of the fear, particularly when the worst thing that can happen is you stutter during a speech or someone thinks your idea is stupid.

With health anxiety, however, the answer to this question isn’t so comforting. Because what is the worst that can happen when your health goes south? Uh, you die. And if death is your biggest fear, this only further reinforces your perceived need to ensure that you are as healthy as possible, even if it is just to keep this whole death business at bay a little longer.

You, me, and everyone else on the planet will all be dead at some point in the future. Therefore, the critical question isn’t about the probability of your death happening but about the cost or “badness” of your death when it does happen. And that, my friends, is what needs to be addressed in treatment. So, let's discuss how we use CBT to improve death anxiety.

Common death-related fears

Many of my clients become overwhelmingly anxious when I begin to initiate conversations around death and dying. Of course, as with anything, and true to the very nature of exposure therapy, this fear tends to lessen the more we talk about it. Death has not been an easy topic for me either. I remember talking about death with a friend one night at dinner and then crying the whole drive home because I was so devastated by the idea of leaving loved ones behind. Today, I can talk about it like I'm reading my grocery list.

Now, let’s unpack this fear. In my practice experience, I have noticed some patterns in the fear of death. Generally speaking, my clients (and I) have feared death for several different reasons:

• Fears about the dying process
• Fears about leaving loved ones behind
• Fears about the "final destination" or what happens to you after you die

One or more of these reasons might resonate with you. And no judgment if it’s all three (it was for me). Every one of these reasons have had me hanging on for dear life at various points in my own journey. It is important to tailor cognitive and behavioral interventions to fit each of these different reasons for fearing death. But the overall goal is the same: to help you learn that death is likely not going to be as bad as you think it will be, whether your concern is for you or your loved ones.

CBT strategies to tackle fears

The process of helping clients reduce their fear of death varies greatly from person to person. Each individual's death anxiety is shaped by unique core fears that may differ significantly from someone else's. Below, I outline several common CBT techniques designed to explore and address these underlying fears related to death and dying.

Tackling fears about the dying process

• Identifying and reshaping assumptions about the dying process (e.g., breaking down, analyzing, and reconsidering the core fears, discussing benefits of hospice and palliative care and other programs/services, discussing experiences that challenge assumptions).
• Engaging in imaginal exposure exercises about the dying process.
• Engaging in in-vivo/situational exposure exercises to systematically desensitize one from fears of the dying process (e.g., watching movies or reading fiction about scenes of dying, discussing how you would want your dying process to be, to the extent you have control, reading about and participating in activities related to the concept of death and dying).

Tackling fears about leaving loved ones behind

• Breaking down assumptions and specific fears or beliefs about leaving children, partners, or other loved ones behind.
• Engaging in an "examine the evidence" exercise in which we specifically explore evidence for certain assumptions/thoughts (e.g., my children will not be okay if I die) and then challenge potentially biased/inaccurate assumptions.
• Discuss the extensive research on post-traumatic growth.
• Identify thinking errors and explore assumptions about loved ones' well-being with Socratic dialogue.
• Engage in imaginal and in-vivo exposures to desensitize one to their specific fears about leaving loved ones behind.

Tackling fears about what happens after death

• Breaking down assumptions and specific fears around what happens after death, and examining those through a critical lens to identify more helpful ways of seeing it.
• Discussing fears related to losing consciousness and not existing anymore, and exploring what that process would be like.
• Discussing fears related to going to hell or some "non-heavenly" place, and examining those assumptions through the lens of one's spiritual beliefs/faith/ideological underpinnings of their religion.
• Using imaginal and in-vivo exposure exercises to grow more comfortable with specific fears.

Next steps...

The fear of death can make it difficult to enjoy the life you are so intent on protecting. If this is you, it's worth it to put in the effort to improve it. All of the strategies I listed are based on cognitive behavioral therapy (but this is by no means an exhaustive list). CBT is one evidence-based intervention to improve death anxiety.

If you decide to seek therapy for this, I recommend asking potential therapists about the specific interventions they use to improve death anxiety. Many therapists offer a free consultation phone call, which gives the opportunity to ask these types of questions. Use the strategies I listed as a reference.

The ultimate goal of using CBT to address death anxiety is to evaluate and reshape unhelpful beliefs and assumptions about death while gradually building tolerance through systematic desensitization. The aim isn't to make you like the idea of death—it’s okay not to. Rather, it’s about reducing the debilitating fear that can overshadow the beautiful life you have right now.

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To find a therapist, visit the Psychology Today Therapy Directory.