Applying terror management theory to patients with life-threatening illness: a systematic review.

BACKGROUND: Terror management theory (TMT) posits that people manage death-related anxiety through the meaning provided by their cultural world-views and the sense of personal value provided by self-esteem. While a large body of research has supported the core propositions of TMT, little research has focused on its application to individuals with terminal illness. If TMT can help healthcare providers better understand how belief systems adapt and change in life-threatening illness, and the role they play in managing death-related anxiety, it may provide guidance on how to improve communication around treatments near the end of life. As such, we set out to review the available research articles that focus on describing the relationship between TMT and life-threatening illness. METHODS: We reviewed PubMed, PsycINFO, Google Scholar, and EMBASE through May 2022 for original research articles focused on TMT and life-threatening illness. Articles were only deemed appropriate for inclusion if direct incorporation of the principles of TMT were made in reference to a population of interest whom had life-threatening illness Results were screened by title and abstract, followed by full review of candidate articles. References were also scanned. Articles were assessed qualitatively. RESULTS: Six relevant and original research articles were published which provide varied levels of support for TMT's application in critical illness, each article detailed evidence of ideological changes consistent with what TMT would predict. Building self-esteem, enhancing the experience of life as meaningful, incorporating spirituality, engaging family members, and caring for patients at home where meaning and self-esteem can be better maintained are strategies supported by the studies and serve as starting points for further research. CONCLUSION: These articles suggest that applying TMT to life-threatening illness can help identify psychological changes that may effectively minimize the distress from dying. Limitations of this study include a heterogenous group of relevant studies and qualitative assessment.

Predictors of posttraumatic stress symptoms, COVID-related functional impairment, and burnout among medical professionals during the COVID-19 pandemic.

Physicians are particularly vulnerable to mental health symptoms during global stressors such as the COVID-19 pandemic. Such stressors can increase death anxiety, which is a vulnerability factor for psychological dysfunction. Thus, exposure to COVID-related death may play a unique role in physicians' mental health during the pandemic. This cross-sectional study collected self-reported data from 485 resident physicians and fellows. Participants reported mental health symptoms, including posttraumatic stress symptoms (PTSS), burnout, and functional impairment due to the pandemic. Participants also reported death anxiety, COVID-19 anxiety, cognitive accessibility of death-related thoughts (DTA), and workplace exposure to COVID-19. Death anxiety, COVID-19 anxiety, DTA, and workplace COVID-19 exposure all independently predicted PTSS. Furthermore, COVID-19 anxiety and DTA interacted to predict PTSS, such that high levels of COVID-19 anxiety predicted higher PTSS, regardless of DTA level. Death anxiety and COVID-19 workplace exposure interacted to predict PTSS as well, such that death anxiety predicted PTSS only when COVID-19 exposure was high. Burnout was predicted by COVID-19 anxiety and workplace exposure, and COVID-related functional impairment was predicted by death anxiety and COVID anxiety. These findings demonstrate that death-related and COVID-related concerns, independently and in interaction with each other, play an important role in psychological distress among physicians.

Pandemic reminders as psychological threat: thinking about COVID-19 lowers coping self-Efficacy among trauma-exposed adults.

Reminders of COVID-related problems have been pervasive throughout the COVID-19 pandemic. Such reminders could have negative mental health impacts, especially among psychologically vulnerable people, including those with trauma-related problems. We experimentally examined the effects of pandemic reminders among trauma-exposed participants sampled from Prolific (N = 238). Participants were induced to think about health-related or social isolation-related aspects of COVID-19 or their favourite TV show and existential anxiety and coping self-efficacy (CSE) were then assessed. Posttraumatic stress symptoms (PTSS) related to a prior stressor and COVID-related functional impairment were assessed as potential moderators of reactions to pandemic reminders. Results showed that both types of pandemic reminders lowered CSE among participants with either higher PTSS or COVID-related functional impairment. Pandemic reminders did not significantly affect existential anxiety. These findings suggest that reminders of the COVID-19 pandemic may undermine the mental health of psychologically vulnerable populations.

Terror Management Theory and the COVID-19 Pandemic.

Terror management theory is focused on the role that awareness of death plays in diverse aspects of life. Here, we discuss the theory's implications for understanding the widely varying ways in which people have responded to the COVID-19 pandemic. We argue that regardless of whether one consciously believes that the virus is a major threat to life or only a minor inconvenience, fear of death plays an important role in driving one's attitudes and behavior related to the virus. We focus on the terror management theory distinction between proximal defenses, which are activated when thoughts of death are in current focal attention and are logically related to the threat at hand, and distal defenses, which are activated when thoughts of death are on the fringes of one's consciousness and entail the pursuit of meaning, personal value, and close relationships. We use this framework to discuss the many ways in which COVID-19 undermines psychological equanimity, the diverse ways people have responded to this threat, and the role of ineffective terror management in psychological distress and disorder that may emerge in response to the virus.

Age Differences in the Effects of Mortality Salience on the Correspondence Bias.

According to terror management theory, awareness of death affects diverse aspects of human thought and behavior. Studies have shown that older and younger adults differ in how they respond to reminders of their mortality. The present study investigated one hypothesized explanation for these findings: Age-related differences in the tendency to make correspondent inferences. The correspondence bias was assessed in younger and older samples after death-related, negative, or neutral primes. Younger adults displayed increased correspondent inferences following mortality primes, whereas older adults' inferences were not affected by the reminder of death. As in prior research, age differences were evident in control conditions; however, age differences were eliminated in the death condition. Results support the existence of age-related differences in responses to mortality, with only younger adults displaying increased reliance on simplistic information structuring after a death reminder.

The role of perceived level of threat, reactance proneness, political orientation, and coronavirus salience on health behavior intentions.

OBJECTIVE: This pre-registered study was designed to test whether reminders of death and coronavirus would have similar or different effects on health behavior intentions concerning COVID-19 (e.g., mask wearing, social distancing) and whether the type of framing of these behaviors would moderate these effects. DESIGN: The study utilized a 3 (threat: mortality salience vs. coronavirus reminder vs. control topic) x 3 (framing: autonomy-supportive vs. controlled vs. neutral) design. Measures of perceived threat of COVID-19, reactance proneness, and political orientation were included as individual differences. RESULTS: Although the interaction between threat and framing conditions was not significant, the data revealed that (1) lower perceived threat of COVID-19 was associated with lower health behavior intentions to reduce the spread of the virus; (2) after an induction to express their thoughts and feelings about COVID-19, participants with low perceived threat of COVID-19 significantly increased their health intentions; (3) perceived threat of COVID-19 moderated the relationship between reactance proneness and health intentions, such that those high in reactance proneness reported lower intentions unless they had high perceptions of threat; and (4) politically conservative participants reported lower intentions to engage in healthy behaviors, and this relationship was mediated by their lower perceived threat of COVID-19.

Psychosocial Determinants of COVID-19 Vaccine Hesitancy and the Mediating Role of Various Attitudes towards Science.

This study examined the way attitudes towards science in the U.S. mediate the relationship between COVID-19 vaccine hesitancy and psychosocial predictors, such as political ideology, religiosity, reactance proneness, dogmatism, perceived communal ostracism, education, and socioeconomic status. We analyzed the structure of people's attitudes towards science, revealing four distinct factors: epistemic confidence, belief that science and technology are beneficial, trust in science in general, and trust in medical science. With all four factors included as mediators in a saturated path analysis, low levels of trust in medical science and low epistemic confidence fully mediated the relationships between nearly all of the psychosocial predictors and COVID-19 vaccine hesitancy. Political conservativism's negative association with vaccine hesitancy was partially mediated by the same two facets of people's attitudes towards science. Adding nuance to existing research, we found that trust in science in general was not a significant mediator once all four facets were included in the model. These findings are discussed with a focus on their implications for understanding attitudes towards science and their substantial and complex role in COVID-19 vaccine hesitancy.

Under the veil of tolerance: A justification-suppression approach to anti-Islamic implicit bias in reaction to terrorist attacks.

Twenty years after 9/11, the impact of terrorism on social and political attitudes remains unclear. Several large-scale surveys suggest that terrorism has no discernible effects on direct, self-report measures of prejudice toward Arab-Muslims. However, direct measures may lack the sensitivity to detect subtle underlying attitudes that are considered socially unacceptable to openly express. To tap these subtle reactions, we assessed more sensitive and implicit measures of the cognitive-affective aspects of prejudice. Building on the justification-suppression model of prejudice, we hypothesized that terrorist attacks increase implicit bias toward Arab-Muslims, especially among individuals who are unable to regulate automatic hostile reactions due to personality or situational variables. Study 1, using data from Project Implicit (N = 276,311), showed that terrorist attacks increased implicit bias but not expressed prejudice toward Arab-Muslims. Study 2, using data from Google Trends, showed that terrorist attacks increased anti-Islamic searches on the internet. Four studies that collected original data (total N = 851) showed that the effects of reminders of terrorism on anti-Islamic implicit bias are moderated by individual differences in prejudice and automaticity (Studies 3-4), by the strength of implicit Muslim-terrorist associations (Study 5), and by momentary self-control depletion (Study 6). Overall, the present research indicates that despite little evidence for elevated overt expression of prejudice against Arab-Muslims following terrorist attacks, terrorist attacks increase anti-Islamic implicit bias whenever individuals are unlikely to control automatic hostile reactions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Motivated reasoning: Election integrity beliefs, outcome acceptance, and polarization before, during, and after the 2020 U.S. Presidential Election.

The 2020 U.S. Presidential Election required voters to not only form opinions of leading candidates, Donald Trump and Joe Biden, but also to make judgments about the integrity of the election itself and what-if anything-to do about it. However, partisan motivated reasoning theory (Leeper and Slothuus, Political Psychology, 35(Suppl 1): 129-156; Lodge and Taber, The rationalizing voter, Cambridge University Press, 2013) suggests judgments are often strongly influenced toward affectively desirable conclusions. Before, during, and after election projections were announced, partisan supporters of Trump and Biden rated: judgments about voter fraud and foreign interference, their acceptance of the results, and their support for recourse against the outcome (e.g., legal challenges, legislative overhauls, violence). Before the election, partisans were mildly concerned about election integrity but willing to accept the outcome without recourse. However, during vote counting, and especially after Biden was projected to be the winner, partisans dramatically changed their judgments in opposite directions, consistent with the affectively desirable conclusions relevant to each group. Biden supporters affirmed the election's integrity and accepted the results whereas Trump supporters disputed the integrity, rejected the results, and began to support recourse against the outcome. Data are consistent with partisan motivated reasoning. Discussion highlights the practical implications. Supplementary Information: The online version contains supplementary material available at 10.1007/s11031-022-09983-w.

Will Life Extension Affect Our Social Judgments? Evidence That the Possibility of Indefinite Life Extension Increases Harshness Toward Social Transgressors.

We tested the hypothesis that if indefinite life extension (ILE) through medical technologies were to become a reality, then people may become harsher in their judgment of social transgressors. In support of this hypothesis, we found that higher positive attitudes towards ILE technologies related to harshness in judgment of social transgressions (Study 1), and that making ILE plausible (compared to not plausible) led participants to endorse harsher punishments for social transgressors (Studies 2-3). We replicated this effect and found that it is not amplified by subliminal death primes, although the primes also increased harshness (Study 3). These results may have implications to understanding how social judgment may be affected by the prospect of ILE.

Psychological Science in the Wake of COVID-19: Social, Methodological, and Metascientific Considerations.

The COVID-19 pandemic has extensively changed the state of psychological science from what research questions psychologists can ask to which methodologies psychologists can use to investigate them. In this article, we offer a perspective on how to optimize new research in the pandemic's wake. Because this pandemic is inherently a social phenomenon-an event that hinges on human-to-human contact-we focus on socially relevant subfields of psychology. We highlight specific psychological phenomena that have likely shifted as a result of the pandemic and discuss theoretical, methodological, and practical considerations of conducting research on these phenomena. After this discussion, we evaluate metascientific issues that have been amplified by the pandemic. We aim to demonstrate how theoretically grounded views on the COVID-19 pandemic can help make psychological science stronger-not weaker-in its wake.

Reducing defensive responses to thoughts of death: Meditation, mindfulness, and Buddhism.

Three studies investigated the effects of meditation on responses to reminders of death. Study 1 took a quasi-experimental approach, comparing defensive responses to mortality salience (MS) of South Korean participants with varying levels of experience with Buddhism and meditation. Whereas non-Buddhists without meditation showed the typical increase in worldview defense after mortality salience (MS), this effect was not found among non-Buddhists immediately after an initial meditation experience, nor among lay Buddhists who meditated regularly or Buddhist monks with intensive meditation experience. Study 2, a fully randomized experiment, showed that MS increased worldview defense among South Koreans at a meditation training who were assessed before meditating but not among participants assessed after their first meditation experience. Study 3 showed that whereas American students without prior meditation experience showed increased worldview defense and suppression of death-related thoughts after MS, these effects were eliminated immediately after an initial meditation experience. Death thought accessibility mediated the effect of MS on worldview defense without meditation, but meditation eliminated this mediation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Terror management and adults' attachment to their parents: the safe haven remains.

Six studies examined the role of young adults' parental attachment in terror management. Studies 1-3 revealed that activating thoughts of one's parent in response to mortality salience (MS) reduced death-thought accessibility and worldview defense and increased feelings of self-worth. Studies 4-5 demonstrated that MS led to greater ease of recalling positive maternal interactions and greater difficulty recalling negative interactions, and increased attraction to a stranger who was described as being similar to one's parent. If reliance on parents for terror management purposes reflects the operation of attachment mechanisms, then such effects should vary on the basis of an individual's attachment style. Study 6 demonstrated that, after MS, insecure individuals were more likely to rely on relationships with their parents, whereas secure individuals were more likely to rely on relationships with romantic partners.

Age-related differences in responses to thoughts of one's own death: mortality salience and judgments of moral transgressions.

Two experiments explored age differences in response to reminders of death. Terror management research has shown that death reminders lead to increased adherence to and defense of one's cultural worldview. In Study 1, the effect of mortality salience (MS) on evaluations of moral transgressions made by younger and older adults was compared. Whereas younger adults showed the typical pattern of harsher judgments in response to MS, older adults did not. Study 2 compared younger and older adults' responses to both the typical MS induction and a more subtle death reminder. Whereas younger adults responded to both MS inductions with harsher evaluations, older adults made significantly less harsh evaluations after the subtle MS induction. Explanations for this developmental shift in responses to reminders of death are discussed.

Mother's milk: an existential perspective on negative reactions to breast-feeding.

Drawing from an existential perspective rooted in terror management theory, four studies examined the hypothesis that breast-feeding women serve as reminders of the physical, animal nature of humanity and that such recognition is threatening in the face of one's unalterable mortality. Study 1 demonstrated that mortality salience (MS) led to more negative reactions toward a scenario depicting a woman breast-feeding her infant in public, and in Study 2, MS decreased liking and increased physical avoidance of a potential task partner described as breast-feeding in another room. Further supporting the hypothesis that such reactions are rooted in threats associated with human creatureliness, MS in conjunction with a breast-feeding prime led to an increase in the accessibility of creaturely related cognitions (Study 3) and priming human/animal similarities (i.e., creatureliness) led to increased negativity toward a magazine cover depicting a woman breast-feeding her child (Study 4). Implications of this research are discussed.

Terror mismanagement: evidence that mortality salience exacerbates phobic and compulsive behaviors.

Terror management theory (TMT) posits that cultural worldviews and self-esteem function to buffer humans from mortality-related anxiety. TMT research has shown that important behaviors are influenced by mortality salience (MS) even when they have no obvious connection to death. However, there has been no attempt to investigate TMT processes in anxious responding. The present research examines that question. In Study 1, compared to a control condition, MS increased anxious responding to spider-related stimuli, but only for participants who met criteria for specific phobia. In Study 2, compared to an aversive control condition, MS increased time spent washing hands, but only for those scoring high on a measure of compulsive hand washing (CHW). In Study 3, compared to a different aversive control condition, MS increased avoidance of a social interaction, but only for those scoring high on a measure of social interaction anxiety. The relevance of TMT in anxious responding is discussed.

Burnout Disrupts Anxiety Buffer Functioning Among Nurses: A Three-Way Interaction Model.

Over the last 40 years, job burnout has attracted a great deal of attention among researchers and practitioners and, after decades of research and interventions, it is still regarded as an important issue. With the aim of extending the Anxiety Buffer Disruption Theory (ABDT), in this paper we argue that high levels of burnout may disrupt the anxiety buffer functioning that protects people from death concerns. ABDT was developed from Terror Management Theory (TMT). According to TMT, reminders of one's mortality are an essential part of humans' daily experience and have the potential to awake paralyzing fear and anxiety. In order to cope with death concerns, people typically activate an anxiety-buffering system centered on their cultural worldview and self-esteem. Recent ABDT research shows that individuals with post-traumatic stress disorder are unable to activate such anxiety buffering defenses. In line with these results, we hypothesized that the burnout syndrome may have similar effects, and that individuals with higher levels of burnout will be less likely to activate an anxiety buffering response when their mortality is made salient. Participants were 418 nurses, who completed a questionnaire including: a mortality salience (MS) manipulation, a delay manipulation, and measures of burnout, work-related self-efficacy, and representation of oneself as a valuable caregiver. Nurses are daily exposed both to the risk of burnout and to mortality reminders, and thus constituted an ideal population for this study. In line with an anxiety buffer disruption hypothesis, we found a significant three-way interaction between burnout, MS and delay. Participants with lower levels of burnout reported higher levels of self-efficacy and a more positive representation as caregivers in the MS condition compared to the control condition, when there was a delay between MS manipulation and the assessment of the dependent measures. The difference was non-significant for participants with higher levels of burnout. Theoretical and practical implications of findings are discussed.

Windows into nothingness: terror management, meaninglessness, and negative reactions to modern art.

Why do people dislike art that they find meaningless? According to terror management theory, maintaining a basic meaningful view of reality is a key prerequisite for managing concerns about mortality. Therefore, mortality salience should decrease liking for apparently meaningless art, particularly among those predisposed to unambiguous knowledge. Accordingly, mortality salience diminished affection for modern art in Study 1, and this effect was shown in Study 2 to be specific to individuals with a high personal need for structure (PNS). In Studies 3 and 4, mortality salient high-PNS participants disliked modern art unless it was imbued with meaning, either by means of a title or a personal frame of reference induction. Discussion focused on the roles of meaninglessness, PNS, and art in terror management.

Seeing I to I: a pathway to interpersonal connectedness.

The authors introduce the construct of I-sharing--the belief that one shares an identical subjective experience with another person--and the role it plays in liking. In Studies 1-3, participants indicated their liking for an objectively similar and an objectively dissimilar person, one of whom I-shared with them and the other of whom did not. Participants preferred the objectively similar person but only when that person I-shared with them. Studies 4 and 5 highlight the role that feelings of existential isolation and the need for closeness play in people's attraction to I-sharers. In Study 4, people with high needs for interpersonal closeness responded to I-sharers and non-I-sharers with great intensity. In Study 5, priming participants with feelings of existential isolation increased their liking for I-sharers over objectively similar others. The results highlight the importance of shared subjective experience and have implications for interpersonal and intergroup processes.

The siren's call: terror management and the threat of men's sexual attraction to women.

Why do sexually appealing women often attract derogation and aggression? According to terror management theory, women's sexual allure threatens to increase men's awareness of their corporeality and thus mortality. Accordingly, in Study 1 a subliminal mortality prime decreased men's but not women's attractiveness ratings of alluring women. In Study 2, mortality salience (MS) led men to downplay their sexual intent toward a sexy woman. In Study 3, MS decreased men's interest in a seductive but not a wholesome woman. In Study 4, MS decreased men's but not women's attraction to a sexy opposite-sex target. In Study 5, MS and a corporeal lust prime increased men's tolerance of aggression toward women. Discussion focuses on mortality concerns and male sexual ambivalence.