Can memento mori help set us free?

What is 'death anxiety' and how can it affect people's lives and relate to mental health difficulties?

Death anxiety broadly refers to the dread or fear of death itself, or of the dying process. It includes fears of our own death or dying, as well as fears of losing loved ones. Death anxiety is associated with lots of psychological outcomes. For example, higher death anxiety is associated with lower self-esteem, less secure attachments, and reduced meaning in life. There is also growing evidence which shows that death anxiety plays a key role in mental health conditions, including OCD, panic disorder, health anxiety, depression, PTSD, eating disorders, addictive disorders, and more.

What prompted you and David Veale to write a book about death anxiety?

There are several books out there which explore death anxiety from a theoretical point of view, which are often aimed at academics, or clinicians. For example, David and I had recently collaborated on a chapter about treating death anxiety for a book on existential issues, aimed at practitioners. However, we realised that there is not one book which explains evidence-based, practical strategies to reduce death anxiety, geared specifically towards the people who are actually struggling with this fear. We decided to write this book to try and help those in need of such a resource.

Your book explores issues around death anxiety but as its title says it aims to help people 'free' themselves from it – how should people use this book?

We designed the book to be as practical as possible. The early chapters focus on introducing key ideas and laying the groundwork for the tasks to come. Most of the chapters centre on written worksheets and exercises, including goal setting, challenging our own thoughts, and changing our behaviours. We encourage the reader to fill out as many of these pages as possible, and to apply what they are learning in their daily lives, to get the most out of the book. It is a book which is designed to be not just read, but lived.

How can religion and culture affect our attitudes to death? Your book notes how non-Western cultures may celebrate the dead more eg Mexico's Dia de los Meurtos (Day of the Dead).

The culture we are raised in has a big impact on how we view death. For example, we may be raised in a culture which views death as a natural part of life, or emphasises maintaining continuing bonds to dead loved ones. On the other hand, in many Western cultures, death is seen as a taboo, and is often not talked about. This culture of silence around death can make it difficult to normalise death, to talk freely about it, and to cultivate an attitude of acceptance.

How can exposure and facing death fears help people with this anxiety? Could you give some examples of the type of exposure tasks they might try?

Exposure therapy has been shown to be the most evidenced-based method to reduce death anxiety. This allows people to gradually face reminders of death, and to tolerate the feeling of anxiety. We outline many different options for exposure tasks in our book. Some of those include very practical tasks, such as writing one's own will, or making an advance care directive or end-of-life plan, while others might include imaginal exposure, such as imagining one's own funeral. Visiting places associated with death, such as funeral homes or cemeteries, can also be useful exposure tasks. Even just having a conversation about death with friends or family could be considered a type of exposure therapy.

How can 'memento mori' help people with death anxiety? Should they seek this out?

Memento mori, which translates to 'Remember that you will die', is a practice which has its roots in classical antiquity. At its heart, it involves surrounding oneself with visual reminders of death, such as images of skulls or coffins, or other symbols of impermanence, including hourglasses, or wilting flowers. This helps to remind us of the inevitability of death, to cultivate acceptance of this fact, and can also help remind us to make the most of the time we do have right now.

Chapter 7 is named 'Exercises to Prepare Yourself for Death'. How does anyone do this, and how can we as a society prepare ourselves better for death?

As we discuss in this chapter, preparing ourselves for death can include practical tasks, such as writing one's will, or more creative tasks, such as vividly imagining the process of our own death, listening to music about death, or listening to interviews with inspirational figures who talk about their imminent death. Just as one would prepare for an important event like a job interview, such as by rehearsing or role-playing, we would encourage people to do the same sort of exercise to help prepare for what is arguably one of the most important events of our lives: Death. As a society, we need to normalise talking about death. The death positive movement has been a wonderful step forward in this regard. Events like death cafes, or the 'death over dinner' phenomenon, in which a group of people meet to discuss death in an open, informal setting, are one way of starting to break down those taboos.

Your co-author David said he threw himself a death-themed 50th birthday party, with guests dressing up as they wished to die and a ladder to walk under and mirrors to smash – do you know if any of your readers took up the suggestion to do something similar, and if so what kind of event did they do?

I haven't heard from any readers who have tried this yet, but I hope people do! I would love to hear people's stories, or see photos, if they do give this a go.

How do you hope your book might be used by psychologists?

I hope psychologists can use it either to inform their own practice and learn what kinds of therapeutic techniques they could implement, or to walk through it step-by-step with patients who might benefit from an extra level of guidance or support.

- Dr Rachel Menzies co-authored Free Yourself from Death Anxiety: A CBT Self-Help Guide for a Fear of Death and Dying with David Veale, published by Jessica Kingsley Publishers. She is a clinical psychologist in Sydney, Australia and a postdoctoral research fellow at the University of Sydney.