Psychological protocol guidelines and intervention studies to reduce death anxiety in a clinical sample: A systematic review

Abstract

Objective: Researchers have identified death anxiety (DA) as a crucial factor in the onset and persistence of psychopathology, affecting both physical and mental health, and often leading to a diminished quality of life. Despite the well-established link between DA and various forms of psychopathological conditions, therapeutic interventions targeting DA, particularly in clinical samples, are limited. DA is observed across diverse populations, including university students, physicians, and mothers over the age of 18, and is not limited to aging or physiological illness. While it peaks in young to middle adulthood and declines in older age, it remains a critical concern in clinical settings, underscoring the importance of addressing DA beyond its traditional association with aging or disease. Despite the growing interest in the topic, the existing literature on DA remains limited, particularly in clinical samples. Given the link between DA and psychopathology, identifying effective psychological interventions for reducing DA in clinical samples is crucial. Yet, most studies in these populations remain descriptive, with limited interventional research. Systematic reviews can bridge this gap by synthesizing evidence to inform more effective therapies. None of the studies reviewed psychological protocol guidelines or interventions for DA within clinical populations. To address this gap, the present study aims to systematically review psychological protocols and interventions designed to alleviate DA in clinical settings conducted between January 2000 and January 2023. Methods: Following PRISMA guidelines, a search was conducted across PsycArticles, PubMed, Web of Science, ScienceDirect, and Scopus, utilizing the keywords “death, " “death anxiety, " “death phobia, " “fear of death, " “thanatophobia, " “intervention, " “treatment, "and “therapy." Results: Out of 3918 studies, 890 duplicates were excluded using Rayyan. Then, two independent examiners reviewed the full text of the remaining studies, and disagreements were resolved by consensus. Eight studies were identified through consensus. Conclusion: Intervention studies in clinical settings are notably scarce and often hindered by several limitations. Key limitations include insufficient sample sizes, lack of follow-up assessments, and limited reporting on intervention effects for pre-existing psychopathology. Additionally, there is a scarcity of specifically developed DA-focused interventions, challenges in balancing online applications with therapeutic alliance, and inadequate consideration of cultural beliefs, such as afterlife perspectives. Advancing the field requires the development of innovative protocols that incorporate concepts related to the afterlife into interventions aimed at reducing DA. Future research could prioritize exploring the complex interplay between religious beliefs, particularly those concerning the afterlife, coping strategies, and psychological outcomes among individuals facing significant stressors.