Holistic Approaches for Treating Thanatophobia Reflect Our Changing Attitude Towards Death

More widespread acceptance of discussing the unease surrounding death and dying has opened the door to new holistic approaches to death anxiety

In the last few decades, our society has gradually become much more holistic in our approach towards death, as well as how we manage death anxiety associated with it. We’ve moved away from “just ignoring it until it happens” toward active psychological management, and even “death positivity.” This societal shift has resulted in a more expansive list of potential treatments available for people who might be experiencing thanatophobia, or “death anxiety.” 

Shifting How We Interact With Death

Breaking the taboo of silence around death has encouraged people to speak openly about their mortality, which in turn demystifies it. For many people, this elucidation is enough to assuage ongoing anxiety about end-of-life matters.

For example, death cafés were conceived by Jon Underwood in the UK in 2012 as a way to gather people who were interested in having frank conversations about end-of-life. Lizzy Miles, the first person to host a death café in the US, told us: “A death café is a pop-up event where people get together to talk about death and have tea, coffee, and cake. It is not an educational session […] or grief support group. It’s simply an open discussion that is attendee driven.” Most attendees of these gatherings aren’t those who are experiencing acute anxiety about death, however. Instead, a lot of the people at death cafés are those who have lost someone and are asking, “Now that I know death is real, what does that mean for me?”

The growing number of dedicated, trained death doulas in the US are another reflection of this shift in attitude. Similar to birth doulas, these professionals provide emotional and spiritual support to the dying and their families, helping to make the process feel organized and sacred rather than clinical and terrifying. As more and more people learn about the services death doulas can provide, more people are in turn inspired to seek a similar path, hoping to ease someone else’s transition now that they have seen what it can be like.

Thanatophobia: When It Is More Than Just Anxiety

Anxiety about death is a deeply human experience; uncertainty about what comes afterward, coupled with concerns about the physical symptoms they may experience before the end can be upsetting to anyone. Similarly, most of us experience moments of dread when we think about losing our loved ones. But some people experience more intense or irrational fears about death and/or the dying process such that they interfere with daily life — a condition called thanatophobia. 

As Evolve Psychiatry, a mental health group located in New York and North Carolina notes, thanatophobia is a recurring, intrusive fear that triggers real physical and emotional distress. It can interrupt sleep, work, relationships and routine activities. The key distinction between thanatophobia and normal, healthy levels of anxiety about death is impact. “If thinking about death occasionally crosses your mind and then fades, that is normal awareness,” Evolve Psychiatry says. “If it grips you, won’t let go, and starts shaping your choices, that points toward something worth addressing with support.”

Psychotherapeutic Interventions

The gold standard for treating thanatophobia — or any phobia, for that matter — is cognitive behavioral therapy (CBT). This evidence-based treatment works by helping patients identify the thought patterns that fuel the fear, and deconditioning the “alarm” response triggered by thoughts of death or dying. With time and recurring sessions of talk therapy, CBT would help patients gradually rebuild a healthier relationship with those thoughts.

In some cases, gentle exposure-based techniques are used to reduce the intensity of the fear response over time. For thanatophobia, this might mean visiting cemeteries, writing a will or watching documentaries, for a few examples. 

Acceptance and commitment therapy, or ACT, emerged in the 1980s as an off-shoot of CBT in which focus is placed on increasing “psychological flexibility,” or the ability to manage change. During ACT, patients are encouraged to embrace a judgement-free mindset and accept their anxieties as appropriate reactions. Once acceptance is achieved, mindfulness exercises are introduced to help people learn how to cope better alongside those anxieties. In essence, rather than “fixing” the fear, ACT teaches people to accept that fear without succumbing to it; acknowledging the feeling in order to consciously decide to focus on core values, instead.

Using similar psychological theory, logotherapy has been shown to be effective in treating thanatophobia as well. Developed by psychiatrist and Holocaust survivor Viktor Frankl, logotherapy focuses on helping people find meaning and purpose in their lives and use that “why” as a tool for providing strength and resilience. As a treatment for thanatophobia, logotherapy emphasizes the importance of enjoying life to its fullest, finding meaning and a purpose in order to lessen the fears surrounding death.

Most recently, researchers have also found that controlled doses of psychedelic medicines like psilocybin or ketamine can be used in therapy to reduce end-of-life anxiety for terminal patients, particularly those who haven’t been responsive to other forms of therapy. 

Technological and Virtual Interventions

Texas A&M University researchers have found that a brief virtual reality (VR) simulation of a near-death experience can sharply reduce people’s anxiety about death. In a small pilot study of about 60 young adults, participants reported a 75% decrease in their fear of death after a single 12-minute session.

By using what is essentially technologically advanced exposure therapy, therapists hope to make the death transition less like a cliff and more like a change in perspective.

“Research shows that those people who had a real near-death experience totally changed their view on life, and they have been treating their family members differently,” Dr. Zhipeng Lu, lead author of the study, said in a Texas A&M University press release. “Most of them are really positive impacts for those having near-death experiences. We hope that immersive virtual reality can have the same impact.”

For others, the source of anxiety isn’t the transition that death represents but the total finality of it. Legacy projects, like digital time capsules or legacy values documents allow people to feel a sense of symbolic immortality, knowing their thoughts and stories will persist for future generations. Kimberly Wade-Benzoni, professor of management and organisations at the Fuqua School of Business at Duke University, told the BBC that thinking about legacy can help people move from a state of death anxiety into one of death reflection: “Death is really at the heart of the psychology of legacy motivation. When we’re reminded about death, we remember we don’t want to die, we want to live.” 

In one study, a group of US researchers interviewed a cohort of adults aged 65 and over who had created a legacy of values document and found that participants were able to find peace, accept the past and communicate what mattered most to them — and that it inspired them to continue living. 

Taking this one step further, AI-driven “dead bots” have been helping some people find peace with the anticipation of their own death or the death of a loved one. “Dead bots” — which go by several different names like “death bots” and “grief bots” — are virtual replicas of actual people, partially created using generative AI.  

This method is highly controversial; some experts have warned that dead bots could be easily used to manipulate people during times of grief, and exacerbate a dangerous dependency complex. “Griefbots give us the fantasy that we can maintain an external relationship with the deceased,” Charley Burlock wrote in an article on dead bots in The Atlantic. However, other experts have conceded that while the potential for abuse of the technology is broad, used in a controlled, therapeutic setting, deadbots could present a valuable tool for easing the grieving through a difficult transition. Furthermore, ethicists are also concerned about violating the autonomy of deceased people, who might not have wanted to be “resurrected” or “preserved” using technology.

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