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Fear of Death: How CBT Can Decrease Fears of the Dying Process

Fear of Death: How CBT Can Decrease Fears of the Dying Process

People who fear the dying process itself often imagine catastrophic scenarios, such as being in intense pain, feeling humiliated in front of others, or burdening/causing pain to loved ones. My clients have described many unpleasant scenarios about how they envision themselves on their ‘deathbed.’ Their stories paint quite a morose picture of the dying process.

Thoughts are not facts

But, it is important to note that this is all fiction—these scenarios came from my clients’ imaginations. Which begs the question, what assumptions are these fictional stories based on and how accurate are they? Keep in mind that people with anxiety tend to have cognitive biases. Future scenarios, including death scenarios, are perceived to be more catastrophic than they likely will be in reality. So, let’s break down your assumptions about the dying process and subject them to a critical analysis.

Before we dive in, grab my free guide on improving health/death anxiety with CBT! 

Guide to Improve Health Anxiety with Cognitive Behavioral Therapy

Fears about physical or emotional pain

Many people with death anxiety assume that dying inevitably involves intense physical and emotional pain. But this may not necessarily be true, at least not to the extent one might think. The very goal of palliative and hospice care is to reduce physical, emotional, and spiritual suffering among people with serious diseases through a patient-centered approach. Research suggests palliative care improves symptom burden and quality of life.1-3 The availability of palliative care has grown steadily, as 72 percent of hospitals in the United States have palliative care teams.4

I spent several years surrounded by death and dying as a clinical social worker in hospice and hospital settings. I served on large teams of medical, mental health, and spiritual experts collaborating to ensure patients were emotionally and physically comfortable. The patients I worked with amazed me with their resilience, strength, and determination. Many of them, just weeks or even days before death, were having intimate conversations with family and friends, laughing, making jokes, watching their favorite TV shows, eating junk food, and even drinking their favorite beer. Sure, I was with my patients during some intensely hard moments. But they also shared a lot of meaningful moments with family, friends, and their wider support system. Anticipatory grief, regrets, anxiety, and heartbreak were interspersed with reflection, vulnerability, honesty, reconciliation, support, gratitude, acceptance, and even joy.

Fears about burdening loved ones

People with death anxiety also often assume that dying inevitably means that loved ones will be burdened by caring for them, resentful and/or inconsolable and unable to cope. They tend to assume that if a loved one struggles, they will surely collapse and face utter ruin. Indeed, grief, caregiver burden, and other difficult experiences related to losing a loved one are common and even expected. But we must consider the many factors that influence how loved ones will cope. Personal characteristics, resources, and support systems all play a vital role in how one is able to deal with adversity.

In my work with terminally ill patients, I spent a lot of time supporting their loved ones. Through these experiences, do you know what stands out in my mind? Not their sadness or exhaustion (even though that was certainly present) but their incredible strength, resilience, commitment, and determination. They showed up for the patient and for each other. They drove or flew in from long distances, stayed up for days, made each other meals, and comforted each other. Further, a key priority of hospice and palliative care is to ensure that the needs of loved ones are met. Research highlights the benefits of palliative care in reducing caregiver burden, financial costs, anxiety, depression, and grief.5-6

A revised perspective

It is possible that how you have envisioned your death is based on inaccurate assumptions. Of course, as is true with anything in life, we cannot be guaranteed a pleasant death. Unfortunate circumstances surrounding how one dies are possible. But it is likely that your death will not be as painful, terrifying, or depressing as you think it will be. With the support of family, friends, faith, pain management, and other palliative/hospice care interventions as well as personal strength and resilience, there is sound reason to assume that you and your loved ones will be able to cope with this difficult process.

Socratic questions about the dying process

I could prattle on about all the reasons your assumptions might be inaccurate. But you will be more likely to change your view if you challenge your own assumptions. Below are some questions for you to consider, inspired by the type of Socratic dialogue used in CBT.

  • Have you ever been with someone you loved during the dying process? Did you (or would you) think they should be ashamed/humiliated?

  • What would you do to help ensure someone close to you was able to maintain dignity? How do you think your loved ones would do this for you?

  • Other than seeing you as a burden, how else might your loved ones see the opportunity to care for you? How would you see having to care for your loved one?

  • Even if your loved ones did experience caregiver burnout, a very common experience, does that mean they don’t want to care for you or don’t love you? If you were exhausted from caring for a loved one, would this mean you didn’t want to care for them or that you just needed some respite/recharge time?

  • How might your loved ones access additional support to cope with the demands of caring for you? Their support system, members of religious or other types of communities, hired help, palliative care professionals?

  • How do you think palliative/hospice care might help you with physical pain?

  • In addition to support from loved ones, what type of additional support would you want? Leaders of your religious organization to provide spiritual support or guidance and pray with you? Therapists/counselors/social workers?

  • What sorts of hobbies would make you feel stimulated, excited, and entertained? Would you want loved ones to be a part of any of these sorts of activities with you?

Take the first step toward improving your health anxiety today and grab my free guide! 


Improve health anxiety with cognitive behavioral therapy




1. Bajwah S Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FE, Higginson IJ. The effectiveness and cost‐effectiveness of hospital‐based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD012780. DOI: 10.1002/14651858.CD012780.pub2. Accessed 20 October 2021.

2. Michelle S. Diop, James L. Rudolph, Kristin M. Zimmerman, Mary A. Richter, and L. Michal Skarf.Journal of Palliative Medicine.Jan 2017.84-92.http://doi.org/10.1089/jpm.2016.0330

3. Fulton, Jessica J, et al. “Integrated Outpatient Palliative Care for Patients with Advanced Cancer: A Systematic Review and Meta-Analysis.” Palliative Medicine, vol. 33, no. 2, 2018, pp. 123–134., https://doi.org/10.1177/0269216318812633.

4. America’s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals. Center to Advance Palliative Care and the National Palliative Care Research Center. September 2019.

5. May P, Normand C, Cassel JB, et al. Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis. JAMA Intern Med. 2018;178(6):820–829. doi:10.1001/jamainternmed.2018.0750

6. Kustanti, Christina Yeni, et al. “The Effectiveness of Bereavement Support for Adult Family Caregivers in Palliative Care: A Meta‐Analysis of Randomized Controlled Trials.” Journal of Nursing Scholarship, vol. 53, no. 2, 2021, pp. 208–217., https://doi.org/10.1111/jnu.12630.


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