Death anxiety in the time of COVID-19

God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

Living one day at a time;
enjoying one moment at a time;
accepting hardships as the pathway to peace;
taking, as He did, this sinful world
as it is, not as I would have it;
trusting that He will make all things right
if I surrender to His Will;
that I may be reasonably happy in this life
and supremely happy with Him
forever in the next.

Terror management theory

Terror management theory (TMT), a social psychological theory based on the work of cultural anthropologist Ernest Becker, is the leading psychological framework for explaining this effect of death fears on human behaviour (Greenberg et al., 1992). TMT posits that our awareness of our own death produces a crippling terror, and that humans have developed two distinct buffers in order to allay this fear: cultural worldviews, and self-esteem. Cultural worldviews involve shared symbolic concepts of the world, including identifying with cultural values or endorsing belief systems, such as the belief in an afterlife. Sharing these cultural worldviews is thought to offer a sense of ‘symbolic immortality’, by giving an individual a sense of permanence and meaning in the face of death. Secondly, self-esteem, gained through fulfilling the expectations of our cultural worldview, is also said to buffer death anxiety, by making one feel like a valuable member of their culture, who will be remembered after death (Greenberg, 2012).

TMT also proposes that humans use different defence mechanisms depending on whether thoughts of death are within or outside of conscious awareness. According to this ‘dual process model’, when thoughts of death are conscious, we engage in ‘proximal defences’, which include suppressing these thoughts (e.g. turning off a news report about COVID-19 death tolls), denying one’s vulnerability (e.g. ‘I’m not in a high risk group, so I’ll probably be fine’), or trying to prevent death (e.g. cleaning down all home surfaces with antibacterial wipes) (Pyszczynski et al., 1999). On the other hand, when thoughts of death leave conscious awareness, we instead engage in ‘distal defences’, which involve bolstering our two buffers (e.g. by endorsing our cultural worldviews, or enhancing our self-esteem).
(US National Library of Medicine National Institutes of Health, 2020).

Fear is a reactive emotional state to a real or perceived threat that is accompanied by surges of autonomic arousal, thoughts of immediate danger, and escape behaviours (American Psychiatric Association, 2013; Kalat & Shiota, 2007). Fear often develops into anxiety when attempts to cope with a threat are not successful (Ohman, 2000) and both of these unpleasant states are often experienced together (American Psychiatric Association, 2013). Because death is so unpredictable and unavoidable, we feel vulnerable. With the current pandemic, even more so, with death on every front page. Reassurance-seeking is a repetitious act of making sure one is not sick with a disease (Taylor, 2019). Fears of death may manifest in the frequent reassurance seeking from doctors, checking of one’s body, and requests for medical testing seen in the somatic symptom-related disorders (Furer et al., 2007).

Cognitive approaches

Two thousand years ago, the Stoic philosophers of ancient Greece observed that ‘it is not things themselves that trouble people, but their opinions about things’ (Epictetus, 2018, p. 11). This principle lies at the heart of both Stoic philosophy (which emphasised the need to accept death as a universal event outside of our control) and CBT. All of us hold an array of beliefs surrounding death, which may fluctuate between being adaptive (e.g. the belief that we would ultimately cope with the death of a loved one) or maladaptive (e.g. the belief that dying will inherently involve pain and suffering). Beliefs of this latter type will understandably cause distress for many individuals, and should be explicitly identified and challenged in therapy. For example, in the context of COVID-19, the distress of some individuals will be grounded on over-estimating the probability of death from the virus; over-estimates of the fatality risk are commonplace (Newton-John et al., 2020). Individuals should be guided to cultivating an attitude of ‘neutral acceptance’ towards death; that is, an acceptance of death as a universal fact outside of one’s control, and therefore neither good nor bad (Wong et al., 1994). Standard cognitive challenging techniques can also be used to challenge unrealistic beliefs surrounding death. For example, for individuals fearing pain associated with dying, corrective information may be provided in the form of information from palliative care, and research indicating that dying is less unpleasant than people typically imagine.

Hypochondriasis, also known as health anxiety, is also a relatively enduring trait like neuroticism, but it is focuses specifically on excessive fear or worry about having a serious illness and one’s health (Alberts et al., 2013). Previous research on pandemics, such as the swine flu crisis of 2009, demonstrate that hypochondriasis is positively correlated with depression and anxiety (Wheaton et al., 2012). Individuals high in hypochondriasis likely experience mental anguish during infectious disease outbreaks because they misinterpret their symptoms of somatic distress as signs of infection (Taylor, 2019). Therefore, we also expected this vulnerability and fear factor to predict psychopathology during the COVID-19 pandemic.

A research data collected from around 8,000 teachers in England between September 2019 and September 2020 found that slightly fewer teachers were highly-anxious about work after lockdown was imposed, with about one in 20 reporting very high anxiety compared to one in eight before lockdown.

The same was not true for headteachers, however, many of whom were highly anxious about work while the country was in lockdown. There were particular spikes in anxiety among headteachers in the week before school lockdown, when the proportion of headteachers reporting very high anxiety doubled to 38%, and in June when school re-openings were first announced (Nuffield Foundation, 2020).

Find small moments to yourself

Try to keep in touch with how you feel and what if anything is a particular issue for you. Try and find a distraction technique to get you through difficult times. It might be headphones on the way in, a podcast in the car, or just five minutes of peace at lunch or break to do a meditation track or have a moment of fresh air.

Note things you’re grateful for

Keep a note of things you’re grateful for and things you’ve learned each day. You do this job for a reason – and the reasons why teaching and working with kids are so appealing may be even more important now, even though the challenges are tough.


both toward the self and toward others, is an emotional response believed by many to be an essential aspect of well-being. Its development may often have the benefit of improved mental and emotional health.

Loving Kindness Meditation

Western research has shown that there is very good reason why Loving Kindness Meditation has been practiced for thousands of years. Studies have shown many benefits, including:

Increases Positive Emotions & Decreases Negative Emotions : In a landmark study, Barbara Frederickson and her colleagues ( Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008) found that practicing 7 weeks of loving-kindness meditation increased love, joy, contentment, gratitude, pride, hope, interest, amusement, and awe.

Decreases Migraines: A recent study by Tonelli et al (2014)demonstrated the immediate effects of a brief Loving Kindness Meditation intervention in reducing migraine pain and alleviating emotional tension associated with chronic migraines.

Decreases Chronic Pain: A pilot study of patients with chronic low back pain randomized to Loving Kindness Meditation or standard care, Loving Kindness Meditation was associated with greater decreases in pain, anger, and psychological distress than the control group (Carson et al., 2005).

Decreases PTSD: A study by Kearney et al (2013) found that a 12 week Loving Kindness Meditation course was associated with decreases in depression and PTSD symptoms among veterans diagnosed with PTSD.

Slows Aging: We know that stress decreases telomere length (telomeres are tiny bits of your genetic materials – chromosomes – that are a biological marker of aging). However, Hoge et al (2013) found that women with experience in Loving Kindness Meditation had relatively longer telomere length compared to age-matched controls!


Death anxiety in the time of COVID-19: theoretical explanations and clinical implications
Rachel E. Menzies1, and Ross G. Menzies2

Fear and Psychopathology During the COVID-19 Crisis: Neuroticism, Hypochondriasis, Reassurance-Seeking, and Coronaphobia as Fear Factors. Sherman A. Lee, Elizabeth A. Crunk

Good Therapy Org., 2018

Nuffield Foundation, 2020

Take care,

Love always,

Vassiliki xxx