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Death acceptance and the meaning-centred approach to end-of-life care

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... Existing theories provide hypotheses for the coping mechanisms of DA. At present, the defense-based terror management theory (TMT) remains the predominant theoretical explanation for our coping with DA, and in recent years the acceptance-based meaning management theory (MMT) has been gradually proposed to help explain the coping mechanisms of DA [24]. TMT assumes that humans have a self-protective instinct, and that their capacity for self-consciousness makes them terrified of their own mortality, then initiating proximal defenses (including EA). ...
... MMT establishes an adaptive coping mechanism for DA from a positive value orientation. It argues that MIL is the essence of individual motivation, that death evokes a strong need for individuals to seek MIL, and that meaning comes from accepting death and committing to the pursuit of life expansion and selftranscendence [24]. ...
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Background Death anxiety is thought to cause a range of mental disorders among cancer patients, which may affect their mental health and even quality of life. This study sought to investigate experiential avoidance, meaning in life, and death anxiety among Chinese cancer patients and then explore the relationship between these 3 variables. Methods A total of 300 cancer patients recruited from a tertiary cancer hospital participated in this study from October to December 2021. A cross-sectional survey was conducted using a demographic and clinical characteristics questionnaire, the Acceptance and Action Questionnaire II, the Meaning in Life Questionnaire, and Templer’s Death Anxiety Scale. Correlation analysis, hierarchical regression analysis, and mediating effect analysis were used to analyze the relationship among experiential avoidance, meaning in life (including 2 dimensions: presence of meaning and search for meaning), and death anxiety. Results A total of 315 questionnaires were distributed, and 300 valid questionnaires were returned, resulting in a valid response rate of 95.2%. Experiential avoidance (r = 0.552, p < 0.01) was moderately positively correlated with death anxiety. Presence of meaning (r = − 0.400, p < 0.01) was moderately negatively correlated with death anxiety, while search for meaning (r = − 0.151, p < 0.01) was weakly negatively correlated with death anxiety. Regression analysis showed that experiential avoidance (β = 0.464) and presence of meaning (β = −0.228) were predictors of death anxiety. Mediating effect analysis revealed that presence of meaning either completely or partially mediated the effect of experiential avoidance and death anxiety, and the indirect effect accounted for 14.52% of the total effect. Conclusion Overall, experiential avoidance predicts death anxiety in cancer patients, and meaning in life can mediate this effect. The results of this study provide a new path for studying the mechanism of death anxiety and suggest a more positive and promising strategy for its management.
... Based on the participants narratives, the acceptance of death is considered to be a personal decision and their strategies to overcome its pain is to find positive thoughts about it and reminisce precious memories of their loved ones. Wong (2017) identified three types of death acceptance: neutral acceptance, escape acceptance and approach acceptance. Some participants manifested neutral acceptance, recognizing death as a natural part of life while others demonstrated approach acceptance perceiving death as a bridge to the afterlife. ...
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Canada, a destination for a rising number of immigrants, reports declination in the mental health status of immigrants over time, especially among immigrant women, given the intersection of being immigrants and being women. However, evidence suggests the protective effect of social support on the mental health of these women. Additionally, research shows the positive impact of engagement with art on their mental health. Creating artwork and exchanging social support may occur concurrently in community art programs. Reports on grassroots art projects suggest promising psychological results for participants. Yet, there are scarce Canadian-based studies in this field. My (ongoing) doctoral research project explores immigrant women’s conceptualization of their mental health and the role of art as a research method in helping them express their mental health experiences. In this paper, consistent with my presentation at the International Conference on Mental Health and Addictions, I discuss early findings and implications.
... More than three decades of experimental research and hundreds of studies have shown that death anxiety affects a wide range of human behaviors. (1,2) To cope with death anxiety, human beings have developed a number of adaptation strategies, namely seeking for meaningful achievements and relationships, and creation of heritage. (3) While some people may cope with this anxiety effectively, others resort to ineffective coping mechanisms, such as avoidance, which only make their anxiety worse. ...
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Background Death and the anxiety of it becomes more apparent when confronted with a chronic disease. The aim of this study was to determine the level of death anxiety among patients with depression and schizophrenia, and the relationship between severity of the symptoms and death anxiety in these patients. MethodsA cross-sectional study was conducted on 29 patients with a depressive disorder, 18 with schizophrenia spectrum disorder and 31 healthy subjects, through face-to-face interviews. The general severity of the psychiatric disorder was measured using the Clinical Global Impression Scale (CGI). The severity of depressive symptoms was measured using the Beck Depression Inventory (BDI). Psychosocial performance was measured using the personal and social performance scale (PSP). To evaluate death anxiety, the Bochum Questionnaire on attitude to death and death anxiety 2.0 (BOFRETTA 2.0) was used. One-way ANOVA and Pearson correlation tests were used to analyze the data. ResultsRegarding the BOFRETTA attitude scale, the schizophrenic patients (23.1±9.12) showed significantly higher scores than healthy subjects (18.4 ±4.56) and depressive patients (19.8 ± 5.20) (p<0.050). The healthy controls achieved the least scores of BOFRETTA anxiety scale followed by depressive (30.67±10.33) and schizophrenic patients (31.30±12.18). However, there were no significant between-group differences regarding this scale. We found significant correlations of all BOFRETTA dimensions (attitude, anxiety, sum score) with CGI, PSP and BDI. Conclusion There was a significant relationship between the severity of symptoms and death anxiety in both depressed and schizophrenic patients. However, the latter showed a more negative attitude towards death.
... MMT suggests that the best way to reduce death anxiety is to facilitate acceptance of death and to seek meaning in life. According to MMT, afterlife is more than symbolic immortality because it is typically associated with religious belief in a transcendental reality (Wong, Carreno, & Gongora, 2018). ...
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Despite the centrality of afterlife reward and punishment beliefs in the religious life of Muslims, few empirical studies have sought to understand how such beliefs affect the psychological state and social behavior of Muslims. Past scant related studies have concluded that these beliefs are unhealthy, because they are positively associated with anxiety and death anxiety. This finding contradicts a central notion in Islamic theology, which states that avoiding afterlife punishment and obtaining afterlife reward is the primary motive for Muslim religiosity. The current study attempts to deepen our understanding of how Islamic afterlife reward and punishment beliefs affect the psychological state of Muslims. The study suggests that the influence of Islamic afterlife beliefs on well-being can be better understood from the perspective of meaning management theory as well as through the eudaimonistic tradition of well-being. This study has two goals: To develop the Islamic Afterlife Reward and Punishment Beliefs (IARPB) scale, and to examine the relationship between IARPB and Muslim religiosity, death anxiety, death acceptance and integrity. Data were collected from Jordanian university students (N = 605). Exploratory and confirmatory analyses support the construct validity of the IARPB Scale. IARPB positively predicted Muslim religiosity, death anxiety, death acceptance, and integrity. Results of ad hoc analysis indicated that IARPB suppresses death anxiety and amplifies death acceptance by increasing Muslim religiosity. In general, the results indicate a positive relationship between IARPB and the psychological state of Muslims. The limitations of the study and suggestions for future research are discussed.
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Objectives: Certified Nursing Assistants (CNAs) are responsible for 80-90% of direct-to-resident care in skilled nursing facilities (SNFs), and may develop close, family-like relationships with their residents. With SNFs becoming a common place of death for older adults, CNAs now find themselves engaging in end-of-life caregiving with limited training and institutional support for emotional outcomes. This study aimed to understand and evaluate the relations between bereavement, death exposure, and compassion fatigue among CNAs, hypothesizing that (a) experiential avoidance moderates the relation between death exposure and negative death attitudes and (b) death attitudes moderate the relation between death exposure and compassion fatigue. Method: One hundred and ten CNAs across all shifts from four skilled nursing facilities in the southeastern United States participated in surveys and, potentially, focus groups. Results: Results failed to find support for death exposure being related either to experiential avoidance or negative death attitudes. However, results supported the relation between negative death attitudes and compassion fatigue. Conclusion: Implications highlight the need to develop interventions focusing on palliative skills-based training and emotional support of CNAs in their role as end-of-life caregivers. By reducing compassion fatigue, it may be possible to decrease job turnover and increase quality-of-care for residents.
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This study investigates the coping strategies of bereaved family members who lost their loved ones because of the restricted burial protocols due to COVID-19. Following the hermeneutic phenomenological design, this study employed transcendental phenomenology (TPh) for the data analysis. Utilizing qualitative interviews, 10 participants aged 19 to 60 were selected using convenient sampling. The data revealed six themes: unknown farewell, emotional roller coaster comes with grieving, a sense to cope up, importance of surrounding environment, an urge to fulfill the wishes of a deceased loved one, and uncertainty. Thus, the bereaved family members struggled physically, psychologically, and mentally as they experienced being stripped of the right to practice burial rites or to be able to feel and receive comfort from their family, relatives, friends, or churchmates for the loss of their loved ones. These supports were an integral part of the participants’ coping strategies, which they employed to either move forward or already moved on after the death of their loved ones. Despite the tragic experience, their coping strategies showed resilience.
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To appear in Wong, L. C. J. (Ed.) (in press). Undefeatable: The Saga of Paul T. P. Wong's Quest for Meaning and the New Science of Suffering.
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The starting point in the wellbeing research of this chapter is that life is full of suffering, just as the living environment is full of bacteria, viruses, and toxins. Therefore, a realistic strategy to research sustainable happiness needs to include at least two components: (1) the capacity to overcome or live with suffering and stress, as measured by a comprehensive misery index, and (2) the process to achieve mature happiness and flourishing despite the dark side of human existence. This two-pronged approach is based on the second wave of positive psychology (PP 2.0). At the broadest level, wellbeing research needs to be situated in the context of universal human suffering, while a middle level of theorizing needs to specify the special circumstances and people. Furthermore, a complete theory needs to integrate the best evidence and wisdom from both the East and West. Mature or noetic happiness is characterized by a sense of acceptance, inner serenity, harmony, contentment, and being at peace with oneself, others, and the world.
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