Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-27T04:20:09.665Z Has data issue: false hasContentIssue false

Overcome Death Anxiety: The Development of an Online Cognitive Behaviour Therapy Programme for Fears of Death

Published online by Cambridge University Press:  01 September 2021

Rachel E. Menzies*
Affiliation:
School of Psychology, The University of Sydney, Sydney, NSW2006, Australia
Louise Sharpe
Affiliation:
School of Psychology, The University of Sydney, Sydney, NSW2006, Australia
Fjóla Dögg Helgadóttir
Affiliation:
AI Therapy, Vancouver, Canada
Ilan Dar-Nimrod
Affiliation:
School of Psychology, The University of Sydney, Sydney, NSW2006, Australia
*
*Corresponding author: Rachel E. Menzies, School of Psychology, Brennan MacCallum Building (A18), The University of Sydney, Sydney, NSW2006, Australia. Email: rachel.menzies@sydney.edu.au
Get access

Abstract

Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although cognitive behaviour therapy (CBT) has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Furthermore, there is a growing need for accessible, scalable and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based programme which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet individualised online treatment. The present study outlines the development and structure of this programme using responses from four users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical sample.

Type
Standard Paper
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, R, Saulsman, L and Nathan, P (2011). Helping health anxiety. Perth, WA: Centre for Clinical Interventions.Google Scholar
Andersson, G and Cuijpers, P (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38, 196205. doi:10.1080/16506070903318960.CrossRefGoogle ScholarPubMed
Bank, S, Burgess, M, Sng, A, Summers, M, Campbell, B and McEvoy, P (2020). Stepping out of social anxiety. Perth, WA: Centre for Clinical Interventions.Google Scholar
Barak, A, Hen, L, Boniel-Nissim, M and Shapira, N (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26, 109160. doi:10.1080/15228830802094429.CrossRefGoogle Scholar
Barakat, S, Maguire, S, Smith, KE, Mason, TB, Crosby, RD and Touyz, S (2019). Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 52, 10771094. doi:10.1002/eat.23131.CrossRefGoogle ScholarPubMed
Brown, TA and Barlow, DH (2014). Anxiety and related disorders interview schedule for DSM-5: Lifetime version. New York, NY: Oxford University Press.Google Scholar
Caras, GW (1995). The relationships among psychological separation, the quality of attachment, separation anxiety and death anxiety. Dissertation Abstracts International, Section B: The Sciences and Engineering, 56, 3436.Google Scholar
Christensen, H, Griffiths, KM, Korten, AE, Brittliffe, K and Groves, C (2004). A comparison of changes in anxiety and depression symptoms of spontaneous users and trial participants of a cognitive behavior therapy website. Journal of Medical Internet Research, 22. doi:10.2196/jmir.6.4.e46.Google Scholar
Cuijpers, P, Marks, IM, van Straten, A, Cavanagh, K, Gega, L and Andersson, G (2009). Computer-aided psychotherapy for anxiety disorders: A meta-analytic review. Cognitive Behaviour Therapy, 38, 6682.CrossRefGoogle ScholarPubMed
Fairburn, CG and Patel, V (2014). The global dissemination of psychological treatments: A road map for research and practice. The American Journal of Psychiatry, 171, 495498.CrossRefGoogle ScholarPubMed
Fleming, T, Bavin, L, Lucassen, M, Stasiak, K, Hopkins, S and Merry, S (2018). Beyond the trial: Systematic review of real-world uptake and engagement with digital self-help interventions for depression, low mood, or anxiety. Journal of Medical Internet Research, 20, e199.CrossRefGoogle ScholarPubMed
Furer, P, Walker, JR and Stein, MB (2007). Treating health anxiety and fear of death: A practitioner's guide. New York: Springer.CrossRefGoogle Scholar
Goldenberg, JL, Arndt, J, Hart, J and Brown, M (2005). Dying to be thin: The effects of mortality salience and body-mass-index on restricted eating among women. Personality and Social Psychology Bulletin, 31, 14001412. doi:10.1177/0146167205277207.CrossRefGoogle ScholarPubMed
Haug, T, Nordgreen, T, Öst, LG and Havik, OE (2012). Self-help treatment of anxiety disorders: A meta-analysis and meta-regression of effects and potential moderators. Clinical Psychology Review, 32, 425445. doi:10.1016/j.cpr.2012.04.002.CrossRefGoogle ScholarPubMed
Helgadóttir, FD, Menzies, RG, Onslow, M, Packman, A and O'Brian, S (2009a). Online CBT I: Bridging the gap between Eliza and modern online CBT treatment packages. Behaviour Change, 26, 245253.CrossRefGoogle Scholar
Helgadóttir, FD, Menzies, RG, Onslow, M, Packman, A and O'Brian, S (2009b). Online CBT II: A phase I trial of a standalone, online CBT treatment program for social anxiety in stuttering. Behaviour Change, 26, 254270. doi:10.1375/bech.26.4.254.CrossRefGoogle Scholar
Helgadóttir, FD, Menzies, RG, Onslow, M, Packman, A and O'Brian, S (2014). A standalone internet cognitive behaviour therapy treatment for social anxiety in adults who stutter: CBTpsych. Journal of Fluency Disorders, 41, 4754.CrossRefGoogle ScholarPubMed
Hoelter, JW (1979). Multidimensional treatment of fear of death. Journal of Consulting and Clinical Psychology, 47, 996999.CrossRefGoogle ScholarPubMed
Iverach, L, Menzies, RG and Menzies, RE (2014). Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review, 34, 580593.CrossRefGoogle ScholarPubMed
Johansson, R, Sjöberg, E, Sjögren, M, Johnsson, E, Carlbring, P, Andersson, T, … Andersson, G (2012). Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: A randomized controlled trial. PLoS One, 7, 5. doi:10.1371/journal.pone.0036905.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL and Williams, JB (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613. doi:10.1046/j.1525-1497.2001.016009606.x.CrossRefGoogle ScholarPubMed
Lester, D (1990). The Collett-Lester fear of death scale: The original version and a revision. Death Studies, 14, 451468.CrossRefGoogle Scholar
Loumidis, KS and Shropshire, JM (1997). Effects of waiting time on appointment attendance with clinical psychologists and length of treatment. Irish Journal of Psychological Medicine, 14, 4954.CrossRefGoogle Scholar
Lovibond, SH and Lovibond, PF (1995). Manual for the depression anxiety stress scales (2nd ed.). Sydney, NSW: Psychological Foundation.Google Scholar
Martz, E (2004). Death anxiety as a predictor of posttraumatic stress levels among individuals with spinal cord injuries. Death Studies, 28, 117. doi:10.1080/07481180490249201.CrossRefGoogle ScholarPubMed
McCall, HC, Richardson, CG, Helgadóttir, FD and Chen, FS (2018). Evaluating a web-based social anxiety intervention among university students: Randomized controlled trial. Journal of Medical Internet Research, 20, e91. doi:10.2196/jmir.8630.CrossRefGoogle ScholarPubMed
McCall, HC, Helgadóttir, FD, Menzies, RG, Hadjistavropoulos, HD and Chen, FS (2019). Evaluating a web-based social anxiety intervention among community users: Analysis of real-world data. Journal of Medical Internet Research, 21. doi:10.2196/11566.CrossRefGoogle ScholarPubMed
Menzies, RE and Dar-Nimrod, I (2017). Death anxiety and its relationship with obsessive-compulsive disorder. Journal of Abnormal Psychology, 126, 367377.CrossRefGoogle ScholarPubMed
Menzies, RE and Menzies, RG (2020). Death anxiety in the time of COVID-19: Theoretical explanations and clinical implications. The Cognitive Behaviour Therapist, 13, e19.CrossRefGoogle ScholarPubMed
Menzies, RE and Veale, D (2022). Creative approaches to treating the dread of death. In Menzies, RG, Menzies, RE and Dingle, G (eds), Existential concerns and cognitive-behavioral procedures: An integrative approach to mental health. United Kingdom: Springer Nature. In press.Google Scholar
Menzies, RE, Zuccala, M, Sharpe, L and Dar-Nimrod, I (2018). The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials. Journal of Anxiety Disorders, 59, 6473. doi:10.1016/j.janxdis.2018.09.004.CrossRefGoogle ScholarPubMed
Menzies, RE, Sharpe, L and Dar-Nimrod, I (2019). The relationship between death anxiety and severity of mental illnesses. British Journal of Clinical Psychology, 58, 452467.CrossRefGoogle ScholarPubMed
Menzies, RE, Zuccala, M, Sharpe, L and Dar-Nimrod, I (2020a). Subtypes of obsessive-compulsive disorder and their relationship to death anxiety. Journal of Obsessive-Compulsive and Related Disorders, 27, 100572. doi:10.1016/j.jocrd.2020.100572.CrossRefGoogle Scholar
Menzies, RE, Zuccala, M, Sharpe, L and Dar-Nimrod, I (2020b). Are anxiety disorders a pathway to obsessive-compulsive disorder? Different trajectories of OCD and the role of death anxiety. Nordic Journal of Psychiatry, 75, 170175. doi:10.1080/08039488.2020.1817554.CrossRefGoogle Scholar
Menzies, RE, Neimeyer, RA and Menzies, RG (2020). Death anxiety, loss and grief in the time of COVID-19. Behaviour Change, 37, 111115.CrossRefGoogle Scholar
Menzies, RE, Sharpe, L and Dar-Nimrod, I (2021). The effect of mortality salience on bodily scanning behaviors in anxiety-related disorders. Journal of Abnormal Psychology, 130, 141151. doi:10.1037/abn0000577.CrossRefGoogle ScholarPubMed
Neil, AL, Batterham, P, Christensen, H, Bennett, K and Griffiths, KM (2009). Predictors of adherence by adolescents to a cognitive behavior therapy website in school and community-based settings. Journal of Medical Internet Research, 11. doi:10.2196/jmir.1050.CrossRefGoogle ScholarPubMed
Newton-John, T, Chambers, S, Menzies, RE and Menzies, RG (2021). Psychological distress and COVID-19: Estimations of threat and the relationship with death anxiety. In preparation.Google Scholar
Noyes, R, Stuart, S, Longley, SL, Langbehn, DR and Happel, RL (2002). Hypochondriasis and fear of death. The Journal of Nervous and Mental Disease, 190, 503509. doi:10.1097/00005053-200208000-00002.CrossRefGoogle ScholarPubMed
Persons, JB and Hong, JJ (2015). Case formulation and the outcome of cognitive behaviour therapy. In Johnson, NTJ (ed.), Case formulation in cognitive behaviour therapy: The treatment of challenging and complex cases (pp. 1437). United Kingdom: Routledge.Google Scholar
Reger, MA and Gahm, GA (2009). A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxiety. Journal of Clinical Psychology, 65, 5375. doi:10.1002/jclp.20536.CrossRefGoogle ScholarPubMed
Richards, D and Richardson, T (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32, 329342. doi:10.1016/j.cpr.2012.02.004.CrossRefGoogle ScholarPubMed
Ritterband, LM, Thorndike, FP, Cox, DJ, Kovatchev, BP and Gonder-Frederick, LA (2009). A behavior change model for internet interventions. Annals of Behavioral Medicine, 38, 1827. doi:10.1007/s12160-009-9133-4.CrossRefGoogle ScholarPubMed
Routledge, C and Juhl, J (2010). When death thoughts lead to death fears: Mortality salience increases death anxiety for individuals who lack meaning in life. Cognition and Emotion, 24, 848854. doi:10.1080/02699930902847144.CrossRefGoogle Scholar
Scholten, WD, Batelaan, NM, van Balkom, AJ, Penninx, BW, Smit, JH and van Oppen, P (2013). Recurrence of anxiety disorders and its predictors. Journal of Affective Disorders, 147, 180185. doi:10.1016/j.jad.2012.10.031.CrossRefGoogle ScholarPubMed
Scholten, WD, Batelaan, NM, Penninx, BW, van Balkom, AJ, Smit, JH, Schoevers, RA and van Oppen, P (2016). Diagnostic instability of recurrence and the impact on recurrence rates in depressive and anxiety disorders. Journal of Affective Disorders, 195, 185190. doi:10.1016/j.jad.2016.02.025.CrossRefGoogle ScholarPubMed
Sethi, S, Campbell, AJ and Ellis, LA (2010). The use of computerised self-help packages to treat adolescent depression and anxiety. The Journal of Technology in Human Services, 28, 144160.CrossRefGoogle Scholar
Simon, L, Arndt, J, Greenberg, J, Solomon, S and Pyszczynski, T (1998). Terror management and meaning: Evidence that the opportunity to defend the worldview in response to mortality salience increases the meaningfulness of life in the mildly depressed. Journal of Personality, 66, 359382.CrossRefGoogle ScholarPubMed
Strachan, E, Schimel, J, Arndt, J, Williams, T, Solomon, S, Pyszczynski, T and Greenberg, J (2007). Terror mismanagement: Evidence that mortality salience exacerbates phobic and compulsive behaviours. Personality and Social Psychology Bulletin, 33, 11371151.CrossRefGoogle Scholar
Templer, D (1970). The construction and validation of a death anxiety scale. The Journal of General Psychology, 82, 167172.CrossRefGoogle ScholarPubMed
Titov, N, Dear, BF, Schwencke, G, Andrews, G, Johnston, L, Craske, MG and McEvoy, P (2011). Transdiagnostic internet treatment for anxiety and depression: A randomised controlled trial. Behaviour Research and Therapy, 49, 441452. doi:10.1016/j.brat.2011.03.007.CrossRefGoogle ScholarPubMed
Torales, J, O'Higgins, M, Castaldelli-Maia, JM and Ventriglio, A (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 66, 317320. doi:10.1177/0020764020915212.CrossRefGoogle ScholarPubMed
Weizenbaum, J (1966). ELIZA — A computer program for the study of natural language communication between man and machine. Communications of the Association for Computing Machinery, 9, 3645.CrossRefGoogle Scholar
Willson, R and Veale, D (2009). Overcoming health anxiety: A self-help guide using cognitive behavioural techniques. UK: Hachette.Google Scholar
Yalom, ID (2008). Staring at the sun: Overcoming the terror of death. San Francisco: Jossey-Bass.Google Scholar
Zuccala, M, Menzies, RE, Hunt, C and Abbott, M (2019). A systematic review of the psychometric properties of death anxiety self-report measures. Death Studies.CrossRefGoogle ScholarPubMed