Individual defenses against death anxiety

Early deprivation experiences, trauma, separation anxiety, and the corresponding development of psychological defenses set the stage fm an individual's method of coping with death anxiety. Thereafter, people accommodate to the fear of death to varying degrees, through the withdrawal of energy and emotional investment in life-affirming activities and close, personal relationships. The author proposes that death anxiety is related to the degree of individuation and self-actualization. Concerns about death increase as people relinquish defenses, reach new levels of differentiation of self, and expand their lives and persanal power Therapeutic progress poses an existential dilemma an that it increases one's feeling and investment in life and enlarges one's perception, freedom of choice, and personal experience. However simultaneously, one experiences the poignant pain surrounding the anticipated loss of a life that has become me meaningful and valuable.     

Encounters with offspring help terminally ill adult patients cope with death anxiety

This overview of recent work drawing on the theories of terror management and symbolic immortality suggests practical ways of helping the terminally ill to cope with death anxiety and its potential effects. The literature review shows that parenthood can act as an anxiety buffer mechanism against the fear of death but that individual differences, including attachment avoidance, moderate this association. Encounters with adult patients’ offspring may help minimize fear of death, improve coping, and increase quality of life and emotional well-being. Practical suggestions for psychologists, social workers and physicians are presented.     

A concept analysis of decision regret in women with breast cancer

The aim of this article is to understand the components of decision regret for women making breast cancer treatment decisions. Patient-centered care models encourage women to become more active in the decision-making process, inadvertently exposing them to the risk of experiencing decision regret. Enhancing the understanding of the concept of decision regret can offer insight into ways to mitigate this phenomenon. The Walker and Avant method was used to analyze this concept. Using PubMed, CINAHL, ERIC, Academic Search Complete, PsychINFO, SocINDEX, Joanna Briggs Institute of EBP Database, and an online dictionary, articles from 2011 to 2021 were analyzed to identify concept uses, attributes, antecedents, and consequences. Decision regret in women making breast cancer healthcare decisions is a negative cognitive-emotional response to a treatment decision that involves counterfactual thinking with three targets of regret: outcome regret, chosen option regret, and process regret. Experiencing decision regret can reduce a woman's quality of life, inflict psychological distress, and impact future decision-making. Unfavorable outcomes, decision uncertainty, and breakdowns in the decision-making process can lead to decision regret. Findings provide information on identifying women experiencing decision regret and illustrate opportunities to address causative factors through patient education and support to promote optimal patient outcomes.     

Deathbed scene narratives: a construct and linguistic analysis

The present study explored temporal and self/other dimensions of death attitudes among young adults. One hundred seventy-two undergraduate students were randomly assigned to 1 of 4 conditions: writing about one's death (age unspecified), one's death as a young adult, the death of another (age unspecified), or the death of other as a young adult. Results indicated that the death of another, but not of oneself, was associated with more realistic considerations of death (e.g., pain, negative emotions). In addition, participants who wrote about death at an early age were less likely to describe their own deaths with negative emotion or to discuss physiological aspects of death and were less likely to express romanticized notions of death. Implications of these results for death anxiety research are discussed.     

Death anxiety in brain tumour patients and their spouses

When a person is diagnosed with a severe disease, it seems plausible that existential questions and death anxiety are easily intensified. The aims of this study were to explore whether this is the case, to what extent patients and their next of kin experience death anxiety, and how these experiences are expressed. Following a purposive sampling technique, 20 patients with brain tumours and 15 of their next of kin took part in interviews. A content and context analysis were performed using a hermeneutic approach, in order to identify and analyse main categories. Six main categories common to patients and their next of kin emerged during the process: (1) emotional reactions that could be related to death anxiety and included general anxiety, anguish, sadness, hope and despair; (2) existential fear, existential anxiety and existential pain; (3) contradictions; (4) trigger situations; (5) coping strategies related to death anxiety; and (6) new values for life. Besides these categories, a further category emerged, experiences characteristic of the next of kin. The study shows that both the patients and their next of kin are preoccupied with existential thoughts and death anxiety. The problems are easily overlooked as the death anxiety is not always expressed directly. Staff need to be more aware of these situations in order to provide existential support.     

Coping, anxiety and quality of life after coronary artery bypass graft surgery

Title. Coping, anxiety and quality of life after coronary artery bypass graft surgery Aim. This paper is a report of a study to explore the relationship between ways of coping, anxiety level and quality of life for patients after coronary artery bypass grafting. Background. Coronary artery bypass grafting requires appropriate coping strategies to achieve successful adaptation. In Taiwan, the incidence of this surgery is increasing, but research on adaptation following surgery is limited, with no research examining outcomes for women, who often have poorer adaptation outcomes than men. Methods. An integrated research design, based on Lazarus and Folkman’s transaction coping theory, was used. The research employed convenience sampling with four instruments: the Revised Ways of Coping Checklist, State‐Trait Anxiety Inventory, Short Form 36‐Health Survey, and a demographic questionnaire, sent to 50 men and 50 women who were recruited from a medical centre in Taiwan. Additionally, qualitative data from interviews with three men and three women, who had completed the instruments, were analysed. Findings. Better quality of life was associated with lower anxiety level, greater use of problem‐focused coping strategies and those who had more gender role responsibility. Women scored lower on the physical dimensions of quality of life, used more self‐blaming coping strategies and experienced slightly higher levels of anxiety compared to men. The qualitative analysis supported the conclusions of the quantitative analysis. Conclusion. The results will help nurses design specific interventions intended to lower anxiety levels, promote the use of problem‐focused strategies and identify patients’ values, necessary to achieve optimal quality of life.     

Coping with mortality: An essay on self-mourning

The idea of “self-mourning” can be extended to shed light on the existential challenge of coping with life in the shadow of death. Coming to terms with personal finiteness and mortality can be understood as a grieving process. Just as grieving the death of another is an extremely complex and multifaceted experience with emotional, physical, spiritual, intellectual, and social impacts challenging the very integrity of the grieving person, so confrontation with and coming to terms with one's own finiteness (self-mourning in the extended sense proposed) has a similar range of impacts and poses a comparable challenge to personal integrity. Just as grieving persons coping with the death of another must work through the tasks of grieving, so persons coping with their own mortality must work through similar tasks. The extended concept of self-mourning illuminates the potentially lifelong struggle to cope with the finiteness, impermanence, uncertainty, and vulnerability that mortality entails. In conclusion, implications of these findings for death education are sketched.     

Social support and end-of-life issues for small town Japanese elderly

Abstract Social support for Japanese elderly people living in small towns is the focus of this paper. Specifically, it explores the relationship between selected aspects of self‐reported social support, religion, end‐of‐life issues, and death anxiety. A total of the 1956 men and women responded to a questionnaire including a scale of social support they received in their home. The major findings showed that an increased level of perceived social support is not a predictor of decreased death anxiety but correlated with image of death and coping style of death anxiety, for which those who reported greater support tend to use more human relationships and fewer religious beliefs. Early in the next century 25% of Japan's population will be 65 years of age or older. Elderly Japanese have benefited from the traditional values of family care giving which historically provided great social support. How do these elderly respond to questions about the end of their lives when their reported social support varies?     

Mortality Anxiety as a Function of Intrinsic Religiosity and Perceived Purpose in Life

Fear of dying and death may be universal, but individuals differ in their emotional reactions to dying and death. The present study included a sample of 133 Chinese university students who were Christians. The authors tested a mediation model which posited that intrinsic religiosity, but not extrinsic religiosity, lowered anxiety toward the dying and death of self and someone close through fostering perceived purpose in life. Structural Equation Modeling results supported a partial mediating role of purpose in life. Moreover, participants were more anxious toward the dying and death of someone close than those of themselves. Discussion focuses on the protective role of intrinsic religiosity on dying and death anxiety.     

The relationship among young adult college students' depression, anxiety, stress, demographics, life satisfaction, and coping styles

Recent research indicates that young adult college students experience increased levels of depression, anxiety, and stress. It is less clear what strategies college health care providers might use to assist students in decreasing these mental health concerns. In this paper, we examine the relative importance of coping style, life satisfaction, and selected demographics in predicting undergraduates' depression, anxiety, and stress. A total of 508 full-time undergraduate students aged 18-24 years completed the study measures and a short demographics information questionnaire. Coping strategies and life satisfaction were assessed using the Brief COPE Inventory and an adapted version of the Brief Students' Multidimensional Life Satisfaction Scale. Depression, anxiety, and stress were measured using the Depression Anxiety and Stress Scale-21 (DASS-21). Multiple regression analyses were used to examine the relative influence of each of the independent variables on depression, anxiety, and stress. Maladaptive coping was the main predictor of depression, anxiety, and stress. Adaptive coping was not a significant predictor of any of the three outcome variables. Reducing maladaptive coping behaviors may have the most positive impact on reducing depression, anxiety, and stress in this population.     

A Web‐based approach to blood donor preparation

BACKGROUND: Written and video approaches to donor education have been shown to enhance donation attitudes and intentions to give blood, particularly when the information provides specific coping suggestions for donation‐related concerns. This study extends this work by comparing Web‐based approaches to donor preparation among donors and nondonors. STUDY DESIGN AND METHODS: Young adults (62% female; mean [±SD] age, 19.3 [±1.5] years; mean [range] number of prior blood donations, 1.1 [0‐26]; 60% nondonors) were randomly assigned to view 1) a study Web site designed to address common blood donor concerns and suggest specific coping strategies (n = 238), 2) a standard blood center Web site (n = 233), or 3) a control Web site where participants viewed videos of their choice (n = 202). Measures of donation attitude, anxiety, confidence, intention, anticipated regret, and moral norm were completed before and after the intervention. RESULTS: Among nondonors, the study Web site produced greater changes in donation attitude, confidence, intention, and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for moral norm and anxiety. Among donors, the study Web site produced greater changes in donation confidence and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for donation attitude, anxiety, intention, and moral norm. CONCLUSION: Web‐based donor preparation materials may provide a cost‐effective way to enhance donation intentions and encourage donation behavior.     

The Relationship among Young Adult College Students’ Depression,Anxiety, Stress,Demographics, Life Satisfaction,and Coping Styles

Recent research indicates that young adult college students experience increased levels of depression, anxiety, and stress. It is less clear what strategies college health care providers might use to assist students in decreasing these mental health concerns. In this paper, we examine the relative importance of coping style, life satisfaction, and selected demographics in predicting undergraduates’ depression, anxiety, and stress. A total of 508 full-time undergraduate students aged 18–24 years completed the study measures and a short demographics information questionnaire. Coping strategies and life satisfaction were assessed using the Brief COPE Inventory and an adapted version of the Brief Students’ Multidimensional Life Satisfaction Scale. Depression, anxiety, and stress were measured using the Depression Anxiety and Stress Scale-21 (DASS-21). Multiple regression analyses were used to examine the relative influence of each of the independent variables on depression, anxiety, and stress. Maladaptive coping was the main predictor of depression, anxiety, and stress. Adaptive coping was not a significant predictor of any of the three outcome variables. Reducing maladaptive coping behaviors may have the most positive impact on reducing depression, anxiety, and stress in this population.     

Coping and health outcomes in spouse caregivers of persons with dementia

The effects of different coping patterns on the physical health, depression, and anxiety experienced by 60 spouse caregivers of persons with dementia were examined, using Lazarus and Folkman's cognitive model of stress and coping. In addition to coping, the model included the following predictors: severity of the patient's memory and behavior problems, caregiver's appraisal of the stressfulness of those problems, and caregiver's appraisal of their options for managing caregiving. The predictors did not explain a significant amount of the variance in caregivers' physical health, but they did explain 43% of the variance in both depression and anxiety. The only coping pattern that added to the explanations was Wishing-Emotive coping, which consisted of the coping subscales of escape-avoidance, confrontive coping, and accepting responsibility. Caregivers' appraisal of stress was a significant predictor of depression and anxiety, but neither the severity of the patients' problems nor caregivers' appraisal of options was a significant predictor of any of the health outcomes.     

The impact of education and experience on death anxiety in new graduate nurses

Anecdotal evidence suggests that new graduate nurses are ill prepared for their experiences with death. This study explores death anxiety and coping skills in registered nurses during their first year of practice. Participating nurses were undertaking a transition support program; the subject group attended a Death Issues Workshop while the control group did not receive any formal education on death issues during their program. Data collection was by semi-structured interviews and use of the Nurses' Attitude to Death Scale, a questionnaire developed by the researchers. Results indicate that the control group showed a greater reduction in death anxiety while the subject group demonstrated better coping skills in caring for themselves and their colleagues and were better equipped in providing care to patients and relatives. Recommendations are made for death issues to be explored more extensively during both undergraduate and postgraduate nurse education.     

Intimacy-sexuality needs of the bereaved: An exploratory study

Using standardized, open-ended questions, 18 widows were individually interviewed to investigate how they coped with the many facets of widowhood, including intimacy-sexuality loss. Availability of family and/or friends as a source of support was found to be most important for satisfactory coping. Loneliness, isolation, loss of former friendships, and ostracism by former intimate friends were some of the perceptions of the widows.

Sexual problems, especially frustration, were evident among many widows. Adaptation to sexual frustration included sexual affairs with men who would not ordinarily be considered a partner, such as the married or one's physician. All widows reported that the sexual relationship was salubrious, which has implications for counselors and therapists comforting the widowed or providing death education. Each widow's individual personality and life events affected coping. Increased mental and physical ailments after the death of their spouse, especially in the first year of bereavement were reported by 15 of the 18 widows.     

Moving on: recovering from the death of a spouse.

Grieving is a complex multidimensional process in response to loss. The grief work involved in coping with a loved one's death does not end when the loved one dies. Rather, the grief work continues through a series of recovery stages. Six stages of recovery--loss, protest, searching, despair, reorganization, and reinvestment--are illustrated and discussed using a case study that highlights a wife's recovery from the death of her husband. Recognition of the stages of grief recovery after a death are significant for health care professionals so that bereavement support may be provided throughout the entire recovery process.     

Predictors of anxiety and resilience in adolescents undergoing cancer treatment

Aims. To report a study examining the relationships among coping, anxiety and resilience and to identify predictors of anxiety and resilience in adolescents undergoing cancer treatment. Background. Anxiety is the main psychological disturbance in adolescents with cancer, but predictors in the context of anxiety related cancer treatments have not been investigated. Design. Cross‐sectional study. Methods. Adolescents (n = 131) recruited from three medical centres between 2010–2011. The eligible participants were diagnosed with cancer, without mental disease and receiving chemotherapy. Participants were assessed with the paediatric cancer coping scale, revised children’s manifest anxiety scale, second edition, and the Haase adolescent resilience in illness scale. Results. Over 20% of participants scored high on worry. The most commonly used coping strategy was cognitive coping, followed by problem‐oriented coping and finally by defensive coping. There was a statistically significant correlation between defensive coping and level of worry. Resilience was positively correlated with cognitive coping and problem‐oriented coping. The cognitive coping and defensive coping were found to predict anxiety and resilience significantly by a step‐wise multiple regression analysis and accounted for 40·9% and 46·5% of total variance, respectively. Conclusions. Cognitive coping and defensive coping are predictors for the level of anxiety and resilience in adolescents undergoing cancer treatment. Health providers should evaluate coping behaviour in patients and work towards a cognitive and problem‐oriented coping style that will benefit the patient’s mental health during treatment.     

Should the current DSM‐IV‐TR definition for PTSD be expanded to include serial and multiple microtraumas as aetiologies?

Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops from events that are interpreted as traumatic. It may be secondary to witnessing trauma to someone close, an event that threatens one's life or childhood sexual trauma. Resultant feelings can be fear, helplessness or horror. Thresholds at which traumatic events cause PTSD, the individual's coping ability and support systems help determine occurrence and severity of symptoms. According to DSM-IV-TR (DSM) definition, PTSD can occur after childhood sexual abuse or a single trauma threatening life or safety. However, it is becoming clearer that symptoms of PTSD can arise from multiple less severe traumas ('microtraumas'), which can be a consequence of a history of longstanding emotional neglect, humiliation or inaccurate attribution of blame. The DSM should consider modifying the criteria to include multiple microtraumas that can lead to PTSD symptoms and may even be more destructive to psychological health.     

Interactive grief and coping in the marital dyad

Experiencing the death of one's child has been described as one of the most traumatic events that can occur in adult life. This qualitative study examined the grief resolution process of 27 marital couples after the fetal or infant death of their child. Interactive dynamics in the couples' relationship and ways in which they coped with the effects of the death on themselves individually and as a part of a dyadic system were of central importance. The central focus of this article is on the dyadic context, in which marital partners attempt to meet relational responsibilities as well as their own needs. The pressures of being in a system in which both partners are coping with strong and frequently unfamiliar thoughts and emotions are described. Those factors that lead to conflict and stress during this time are discussed as well as other factors that minimize conflict and reduce stress. Finally, implications of these findings for those working with bereaved parents are presented.