Need to know
Are you troubled by the thought that life is just too short? Would you feel deeply uncomfortable walking through a cemetery? Have you ever experienced a jolt of panic upon realising a celebrity has died? Does the thought of death itself often cause you significant distress?
If the answer to any of these questions is ‘yes’, you are not alone. Having negative feelings in response to thoughts and reminders of death is something all humans must grapple with from a young age – and it is more intense for some people than for others. The term ‘death anxiety’ is commonly used to refer to the negative emotions one might have about death. It includes anxious feelings, of course, but these might coexist with feelings of dread, sadness or anger.
Just as people’s emotions about death can vary, so too does the specific focus of those emotions. For example, some people might be worried about their own death, while others are far more concerned about the eventual death of a loved one. One person might fear the concept of non-existence, whereas another might be terrified that dying will be painful. All of these different responses to death can be considered examples of death anxiety.
The strong aversion to death has been wired into humans through millions of years of evolution, a way of helping to keep us safe and protect the species. As a result, it is normal to have some anxiety about the idea of death. You can think of death anxiety as existing on a spectrum, with very low anxiety at one end and very high anxiety at the other. Each of us will find ourselves sitting somewhere on this spectrum, and a number of things are predictive of where someone will sit. For example:
- Age is one of the biggest factors related to death anxiety, although perhaps not in the way that you might imagine. People are often surprised to learn there is evidence that older adults tend to be less fearful of death. The fear of death seems to typically start in early childhood and peak in early adulthood.
- Religiosity has a somewhat unexpected relationship with death anxiety. People who are either strongly religious or strongly atheistic are typically less anxious about death than those who are more agnostic or uncertain of their religious belief.
- Gender is another relevant factor: women tend to score higher than men on questionnaires that measure death anxiety, as they do on measures of anxiety more generally. This might suggest that death anxiety is more commonly experienced by women, although it’s possible that women simply feel more comfortable with disclosing their emotions.
Whoever you are and whatever your background, if you frequently feel anxious about death, this Guide is intended to help you get a better handle on your thoughts and feelings – and to become more accepting of the idea of death as something you can live with.
When does death anxiety become a problem?
Significant, recurring anxiety about death often begins to take a toll on someone’s day-to-day life. Below are a few illustrations of what this can look like, based loosely on my work with patients who have struggled with death anxiety. In certain cases, the person is experiencing a mental health condition that is closely intertwined with their death anxiety:
- Ahmed experiences daily thoughts about his own death and what it will be like to no longer exist one day. He can’t shake the feeling that life is utterly pointless if it is all going to end. Since he began to have these thoughts, Ahmed has started to withdraw into himself. He has lost motivation in the job he once enjoyed, has started cancelling plans with friends, and no longer feels excited about his future.
- Charlotte says she has always been a worrier, and was diagnosed with generalised anxiety disorder (GAD) as a teenager. She has a close relationship with her parents, and she’s terrified that she would not be able to cope if they were to suddenly die. She worries about a range of events, including car accidents, illness, natural disasters and violence. Charlotte often checks on her parents to make sure that they are safe, and gets very anxious if she sees a missed call from them. She would like to move out of home or travel overseas, but fears what might happen to her parents if she is away.
- Helen suffers from obsessive-compulsive disorder (OCD), and frequently worries that she might somehow harm the people she cares about. Before going to bed each night, she repeatedly checks that she has turned the stove off, fearing that a fire might start while she and her family are asleep. She also repeats certain phrases to herself because she feels it will somehow keep her family safe.
In short, death anxiety becomes problematic when it takes up a lot of your time, causes you distress or emotional pain, and stops you from living the kind of life that you would like to live. Research by my colleagues and I has shown that death anxiety can play a central role in many mental health conditions (including those noted in the above examples). However, even people who do not have such conditions may benefit from beginning to tackle their fear of death.
There are tested approaches for reducing death anxiety
I am often asked if death anxiety is simply incurable, given that death is inevitable and the fear of it is relatively universal. Fortunately, although we cannot prevent death itself, we can all change our attitudes toward death and the way we respond to it.
In research evaluating different treatments for death anxiety, cognitive behavioural therapy (CBT) has been shown to lead to improvements. CBT involves identifying and addressing the unhelpful beliefs and behaviours that feed anxiety. If we take social anxiety as an example, the treatment might include challenging negative thoughts such as I’ll embarrass myself if I go to that party, as well as addressing behaviours such as excessively rehearsing conversations before a social event or avoiding such events entirely.
When it comes to death anxiety, although the focus may be different, the underlying approach is similar. For example, if a person thinks I can’t cope with the possibility of dying, this thought is going to create a lot of anxiety. As a result, a person might try very hard to avoid anything that reminds them of death, such as by changing the topic if it comes up in conversation. This behaviour will feed into the person’s belief that they can’t cope with thoughts about death, because they will never get the opportunity to see whether they actually can cope with the thoughts, nor will they ever get a chance to improve their coping skills by sitting with something they find uncomfortable.
In essence, the CBT approach to death anxiety centres on developing more helpful and balanced ways of thinking about death, and changing your behaviour so that you start to face the fear of mortality rather than running away from it. In my work with patients who have been burdened by death anxiety, I have seen first-hand how techniques from CBT can help alleviate that burden – enabling them to move toward a life that is no longer dominated by fear. In the next section of this Guide, I will break down some of these approaches so that you can start to practise them yourself.
What to do
Identify distressing thoughts and beliefs about death
‘It is not things themselves that trouble people, but their opinions about things.’
– Epictetus, 2nd century CE
This deceptively simple quote illustrates a central teaching about death anxiety. It is not death alone that causes distress – if it were, each of us would have identical feelings about it. It is our thoughts and beliefs about death that cause us distress. This is why it is crucial to identify the ones that are feeding your own death anxiety. They might include intrusive thoughts about death that automatically pop into your head, or more deep-seated, persistent beliefs (eg, Death is unfair).
To help you identify some of your own thoughts and beliefs about death, you might ask yourself some of the following questions:
- What is it about death that I think is so awful?
- Are there certain types of death that I worry about more than others?
- If I were to die, what do I think would be so bad about that?
- If someone I care about were to die, what would be so bad about that?
Below are some examples of common thoughts that can play a role in death anxiety:
- Thoughts about your own death, eg, It will be horrible to never think or feel again; if I died, my family would have nobody to care for them; I need to leave a legacy before I die.
- Thoughts about the dying process, eg, Dying will be very painful; I wouldn’t be able to cope if I were diagnosed with a terminal illness.
- Thoughts about a loved one’s death, eg, I would never recover if ____ died; I couldn’t cope with watching a loved one die; I have to preserve all the memories of my loved ones in case they die.
- Thoughts about needing certainty or control over death, eg, I need to do everything I can to prevent death; it’s up to me to keep my loved ones safe; I need to know for certain what happens after death.
- Thoughts about death as a whole, eg, Life is too short; people shouldn’t have to die.
Writing down some of your thoughts or beliefs about death is a useful first step before proceeding to the next stage.
Scrutinise and challenge your death-related thoughts
‘You have power over your mind – not outside events. Realise this, and you will find strength.’
– Marcus Aurelius, 2nd century CE
Thoughts are not facts. Rather than buying into distressing thoughts unquestioningly, it is important to practise holding them at arm’s length and looking at them through a sceptical lens. This is especially true for thoughts about death.
Once you have identified the thought(s) about death that are feeding your anxiety, the next step is starting to challenge them. By beginning to challenge your thoughts rather than taking them at face value, you can start to drain some of the power out of them. This can help you to feel less troubled by the thoughts, particularly if you come to discover that they are exaggerated or unhelpful.
There are a number of different questions you can ask yourself in order to challenge distressing thoughts about death:
1. What evidence do you have for and against the thought?
Weighing up the evidence can help you determine whether the thought is realistic or exaggerated. Make sure you are focusing on concrete, objective facts. For example, let’s take the thought Dying will be painful. Evidence against this thought could include the fact that, thanks to modern medicine, many people do not experience a lot of pain when they die. What about a thought such as I won’t be able to cope when my partner dies – how do we find evidence for or against that? You might consider relevant evidence from your past, such as whether you have previously coped with difficult life events better than you had anticipated you would. You might also look to evidence from how other people cope, such as research showing that people commonly recover from the death of a spouse with enough time. The idea here is not to compulsively reassure yourself that everything will be fine. Instead, you are trying to rationally and deliberately weigh up the evidence to better judge whether your thought is true or simply the product of an anxious mind.
2. What would you tell a friend if they had the thought?
It can be quite difficult to challenge your own thoughts, particularly when your mind makes them sound so compelling. But we are often much calmer, more compassionate and more reassuring with our friends and their worries than we are with ourselves. So, imagine that a friend spoke to you about their own fear of death and how troubled they were by a thought they were having. What might you say to help them calm down, or to help them develop a more balanced perspective?
3. What would the calmest person you know say about this thought?
Is there someone you know who stands out as being generally calm, balanced and rational? If nobody in your personal life comes to mind, you can think of a TV or film character who fits this description, or an inspirational public figure. Whoever it is, they probably tend to think in a fairly helpful and rational way. Imagine what they would say if you told them about your distressing thought. Is there anything they might see differently? Say your thought is It will be awful never to think or feel again. Perhaps they might remind you that there will be no conscious you to experience that ‘awful’ feeling, or to feel anxious about it. Maybe they would reassure you that you’ve experienced similar states of non-consciousness before, such as when you’ve been under general anaesthetic, or when you are asleep, and that death may not be so different from this.
4. Are you worrying about an outcome that you can’t control? If so, is there any point to this type of worry?
While you might be able to exert some control over certain aspects of death (for example, if you make an advanced care directive specifying end-of-life wishes), there are countless things over which you do not have control. Consider the thought My family wouldn’t be able to cope if I died. If you were to draw a circle representing things within your complete control, what aspects of this worry would be inside that circle? Very few, I suspect. Certainly the fact of your mortality, and the emotional response of your family when the time comes, would sit outside of your circle of control. If you can identify that the worry you’re experiencing actually serves little or no function, try cultivating indifference to what you can’t control. (You might quietly remind yourself I can’t really control that, so there’s no point in worrying about it.)
5. How does the thought make you feel?
It’s important to consider whether the thought is helpful to you or not. Take a thought such as Life is short. One person might find this thought motivating: it could help them to focus on making the most out of each day. For someone else, this same thought could provoke severe anxiety. It might stop them from being able to unwind and enjoy time with their loved ones, or leave them feeling paralysed by dread. It is especially important to try to question your thought in cases like this. Try to imagine: how would your life be different if you were able to dismiss your death-related thought? Would you feel or act differently? Reminding yourself of the benefits of dismissing the thought – such as being better able to savour the present moment – could help provide the motivation you need to let it go.
In addition to asking yourself these questions, it might also be very helpful to get an outside perspective on your thoughts, such as by talking about them with a therapist or someone else you trust.
Recognise any habits that feed your death anxiety
Now that you have started to examine your thoughts about death, let’s turn to behaviours. There are multiple types of behaviours that feed into anxiety about death. Each of them can make you feel better in the short term (which is why people keep doing them), but they tend to worsen anxiety in the long term. Here are some of the most common ones:
- Seeking reassurance from other people from time to time is natural. However, reassurance-seeking can become a problem if you are relying on it very often, or if you find that you are unable to manage your anxiety without getting reassurance from others. Reassurance-seeking might include things like frequently contacting loved ones to check that they are safe, or spending hours on Google trying to find answers about what happens after death. The problem is that such behaviours are ultimately futile, because any relief that you feel is likely to fade quickly, leading to further reassurance-seeking.
- Checking is another kind of behaviour that can feed death anxiety. You might check stovetops, electrical outlets or the locks on windows or doors to try to prevent death by fire, electrocution or invasion. Or you might check your body for signs of illness. Medical practitioners often encourage us to keep an eye out for such signs. But if you are going above and beyond standard health recommendations and excessively checking your body, it can backfire, as you are bound to eventually notice something that concerns you, which in turn will create more anxiety.
- Safety behaviours give you a false feeling of safety, particularly when you are not able to avoid a distressing situation. For example, someone who is worried about dying on an upcoming trip might engage in safety behaviours such as booking a plane seat near an exit. They might also spend excessive amounts of time planning for worst-case scenarios, such as violent attacks or natural disasters. Safety behaviours can also include superstitious behaviours, such as carrying an object thought to be lucky or protective, repeating certain phrases to yourself, or avoiding things that seem like ‘bad luck’. The problem with safety behaviours is that they give the illusion of control by making you feel as though you can magically keep death at bay.
- Avoidance is one of the most common ways in which people deal with death anxiety. Unfortunately, the more you avoid certain situations or reminders of death, the fewer opportunities you have to learn how to cope with the anxiety. If you avoid anything to do with death, it’s likely to only strengthen your sense that death is unbearable to think about. How can you possibly learn to accept something if you avoid thinking about it at every turn? This is why it is especially important for us to work on overcoming the urge to avoid.
If you identify with any of the above behaviours, try to consider ways you might begin to rein them in. It can be helpful to first estimate how often, or for how long, you are currently engaging in the behaviour. Next, you might try to set goals for reducing its frequency or duration. For example, if you currently spend around three hours per week Googling physical symptoms online, you might aim to reduce this to two hours, before moving to one hour, and so forth. You might also experiment with using other strategies to help reduce this behaviour, such as setting a screen-time limit on your phone or laptop (this can be particularly useful for people who find that their anxiety and their Googling are worse at night).
Keeping a log of the amount of time you spend on the unhelpful behaviour or its frequency (eg, how many times per week) can help you monitor your progress and stick to your goals. If privacy permits it, leaving this log somewhere accessible and visible, such as on your fridge or bedside table, can help you build accountability and motivation.
Remember that each of the problematic behaviours may provide temporary relief from your anxiety, but they ultimately make it worse. Reducing some of these behaviours will also be an important part of the next step.
Deliberately expose yourself to reminders of death
‘Study death always, so that you’ll fear it never.’
– Seneca, 1st century BCE
Two thousand years ago, Stoic philosophers such as Seneca already understood the importance of facing reminders of death in order to overcome anxiety about it. This practice has occasionally been referred to as memento mori, a Latin phrase that translates to ‘remember you will die’. Similar approaches have been used in other philosophical and spiritual traditions. Buddhism has also encouraged regular reflection on mortality and impermanence, such as through observing a corpse while it decays – an exercise that was much more accessible in ancient times.
Research has shown that these intuitions were correct: today we know that something called exposure therapy can effectively reduce death anxiety. Exposure therapy involves deliberately facing situations, places or images that remind you of what you fear. In general, it works by providing opportunities to learn to tolerate the anxiety that comes about when you face these things. In relation to death anxiety specifically, facing reminders of death also helps to normalise death and cultivate an acceptance of mortality.
Exposure therapy can often seem daunting. You might even be experiencing some discomfort right now simply reading about the idea. This is all completely normal and understandable – facing our fears can be a challenging thing to do, but is ultimately key to being able to live more fully. What’s more, it’s not uncommon for someone to find that their imagined idea of exposure therapy is more terrifying than actually doing the exposure tasks.
There are different approaches you might take with exposure therapy for death anxiety. One pathway would be to write out a list of situations you would typically avoid due to anxiety, to rank them from least to most difficult (this is known as an ‘exposure hierarchy’), and then proceed to put yourself in each situation after starting with the least challenging. Exposure tasks can also be chosen in a more random way, such as by drawing them from a hat – which can be helpful for learning to deal with the uncertainty and spontaneity that life itself often presents.
In either case, you could plan out exposure tasks and carry them out on your own. However, you might also benefit from seeking the guidance of a clinical psychologist who can work with you on planning and completing exposure tasks. This extra support can be particularly useful if the idea of completing any of the below tasks feels overwhelming.
Here is a list of potential exposure tasks, though you might think of others that could be helpful for you:
- Collect memento mori. Surround yourself with visual reminders of death. These don’t have to be graphic. For example, you might place images of death symbols (eg, a skull, an hourglass, or artworks in the vanitas style) on your desk, on your refrigerator, or even as your phone wallpaper. Reflect on these often.
- Visit a cemetery. Go for a slow stroll through a cemetery. Read the gravestones, and keep an eye out for any graves of people who died around your age. You are trying here to cultivate an acceptance that death can come at any time, instead of simply reassuring yourself that you will live for decades to come, which is never guaranteed.
- Watch media about death. Seek out films or TV shows in which death is a theme. Watch programmes that feature people discussing death (eg, ‘Ask a Mortician’ on YouTube).
- Read books about death. These could include novels in which a character is dying, or memoirs written by people who are dying (or by their loved ones after their death).
- Use technology to remind you of death. Certain mobile apps will prompt you with regular reminders of death (eg, the app WeCroak). Other forms of technology, such as video games in which you play as a mortician, can also help cultivate acceptance of mortality.
- Write a story that depicts your own death. Try to make it detailed and vivid. Read over it repeatedly (daily if possible), until you feel that it is starting to get easier and the anxiety feels more tolerable.
- Write a will. Take some time to sit down and prepare your will. (This has the added benefit of making your eventual death easier on the people you love.)
- Imagine your funeral. Think about what you would wish your funeral to look like. Are there any particular songs you would want played? Would you like to be buried or cremated? Who would you like to give a eulogy? Consider taking it one step further and discussing your preferences with people you trust. This can be an excellent opportunity to face your fear of talking about death with others.
A few tips for conducting exposures are:
- Start small. Don’t feel that you need to start with the most confronting task. It’s OK to dip your toe in the water before building up to bigger challenges. You might also like to monitor or rate your anxiety during each task. This can help you figure out how your actual anxiety compares with what you expected it to be. If you find, for example, that your anxiety during a task is actually higher than you predicted it would be, it might be a good idea to adjust your planned exposure tasks, choosing a task that feels a little more manageable than the current one.
- The more the better. Your anxiety about death may be something you’ve learned over the course of years, even decades. As a result, it can take time and a lot of repetition to chip away at it. The more often you are able to tackle some of these exposure tasks, the greater your benefits will be. Tasks such as collecting memento mori are ideal for this purpose, because they will allow you to have regular, even daily reminders of death.
- Variety is the spice of life (and death). The more varied your exposure tasks are, the more quickly you will start to reap the benefits.
- Watch out for those unhelpful behaviours. Try to rein in any safety behaviours, checking behaviours or urges to seek reassurance while you are doing the exposure task.
How do you know if exposure therapy is working? If you start to reach a point where the anxiety feels more manageable, or where you feel you would not need to avoid a particular situation or trigger in the future, those are two good signs that you are on the right track. The goal during exposure therapy is not to get rid of anxiety entirely, but to build up your tolerance to it.
Remember: if you think you could use further guidance in dealing with death anxiety, I would encourage you to seek professional support from a clinical psychologist. It is also important to seek professional support if you are experiencing symptoms of depression or thoughts of suicide, which can sometimes coincide with death anxiety. It is not recommended to start targeting death anxiety if someone is currently experiencing thoughts of suicide. Instead, a psychologist can assist in first treating symptoms of depression, before later addressing death anxiety once it is appropriate and safe to do so. Please see the Links & Books section below for some additional resources related to support options.
Key points – How to get more comfortable with death
- Death anxiety refers to the anxiety and related emotions people have about death. Everyone has to grapple with these emotions at times but, for many, they are especially intense and disruptive.
- There are tested approaches for reducing death anxiety. Although you can’t prevent death itself, you can change how you relate to it by addressing unhelpful thoughts and behaviours.
- Identify distressing thoughts and beliefs about death. Ask yourself what, specifically, troubles you about death. You might notice negative thoughts about your own death, about other people’s death, about the process of dying, or something else. Write down some of these thoughts.
- Scrutinise and challenge your death-related thoughts. Instead of taking a thought at face value, start asking questions, such as whether the thought is supported by evidence; what an especially calm, rational person would tell you about the thought; and whether the thought serves any real purpose.
- Recognise any habits that feed your death anxiety. Identify and plan to rein in behaviours such as excessive reassurance-seeking, repeated checking, or rituals that provide a false sense of safety.
- Deliberately expose yourself to reminders of death. Whether on your own or with the aid of a therapist, completing tasks such as regularly viewing death symbols, watching media about dying, and writing about death could help you better tolerate – and ultimately reduce – your anxiety.
How mortality is acknowledged, or hidden, across cultures
One of the reasons death can be so difficult to face is that, for many of us, our cultures have not imparted helpful coping strategies or attitudes concerning death. In many Western countries, death sadly remains a taboo. When someone has experienced the death of a loved one, they are often expected to grieve quickly and quietly. People are frequently at a loss for what to say to the bereaved. The subtle (though unintentional) message is that we should not ‘dwell’ on those who have died.
Further, in much of the Western world, the dying are typically cared for in hospitals by medical professionals, or in aged care settings. Once dead, a person’s body will usually be dealt with by a funeral home. Both of these are relatively modern developments; for most of human history, family members shouldered the tasks of caring for the dying and preparing the body for burial. As a result, death now largely happens outside of the public eye, with a firm border between the dead and the living.
Many cultures, however, take a radically different approach. This includes, for example, encouraging people to maintain ties to their dead loved ones, such as through personal or communal rituals. In Japan, it’s been estimated that more than half of residents have an altar to their dead ancestors in their home, adorned with photos, ashes and memorial tablets. This is known as a butsudan, and it allows a person to regularly commemorate and connect with lost loved ones. In fact, having such an altar is associated with less psychological distress. Japan is also one of several countries that commemorates the dead with an annual festival. Each year in Mexico during the Día de los Muertos (Day of the Dead) festival, people gather at cemeteries, decorate the graves of their loved ones, and celebrate death as a natural part of life.
Certain religious faiths also encourage a more intimate role for loved ones in the burial process. In Islamic culture, it is the family members of the deceased who are usually responsible for bathing a corpse and draping it in its burial shroud. In Madagascar, the Malagasy people regularly reopen their family’s tomb, talking to the corpse and even parading it through the street.
While some of these practices might sound unusual to many readers, there is much to learn from them. When people are encouraged to maintain ties to their dead and to talk about (or even celebrate) mortality, it is far easier to face it. Societies should strive to normalise death rather than sweeping it under the rug. Only by bringing death into the open can we truly begin to grapple with it, and overcome our anxiety.
Links & books
In the book Mortals: How the Fear of Death Shaped Human Society (2021), which I co-authored with Ross Menzies, we delve deep into the countless ways that death anxiety influences human behaviour. We explore how the fear of death unconsciously impacts many of our day-to-day choices, and how it has driven the creation of art, literature and religious belief across our species’ history. We offer potential solutions, such as the acceptance of death endorsed by the Stoics, for living a more authentic and fulfilling life.
My book Free Yourself from Death Anxiety: A CBT Self-Help Guide for a Fear of Death and Dying (2022), co-authored with David Veale, is a structured self-help guide focused on directly targeting this fear. Based on the principles of CBT, this book is full of practical exercises to help you understand and work through your own death anxiety.
In an episode of the podcast How To! titled ‘How to Face Your Fear of Dying’ (2020), I discuss death anxiety with the host Charles Duhigg and a listener, Katie – a comedy writer who called into the show for help with overcoming her fear. The conversation that unfolds offers a real-world example of how this anxiety can affect someone’s life, as well as how one can start to tackle it.
The book Staring at the Sun: Overcoming the Dread of Death (2008) by the world-renowned existential psychiatrist Irvin Yalom is one of the earliest and best-known books on this topic. Yalom describes his own work with people dealing with this fear – including those facing imminent death from terminal illnesses – and offers his own reflections on mortality.
Lastly, for a collection of free articles, media and further reading on the topic of death anxiety, you can visit the resources page on my website.
If you are experiencing a mental health crisis or having thoughts of suicide, the following resources offer support:
In Australia, the crisis support service Lifeline is 13 11 14.
Other international helplines can be found at www.befrienders.org
If you are interested in seeing a therapist privately, there are online resources that can help you locate one. In the US, the American Psychological Association offers a ‘Psychologist Locator’ for finding licensed clinicians. In the UK and Ireland, the British Association for Counselling and Psychotherapy (BACP) website has a list of accredited therapists. The UK charity Mind lists further options. If you’re in Australia, you can search the ‘Find a Psychologist’ tool on the website of the Australian Psychological Society. And Psychology Today’s directory includes information about local therapists in these and a number of other countries.