Thanatophobia: learning to live with the fear of death

It often happens in the evening. You turn off the light and the thought arrives: one day, I won't be here. Or it is the image of a parent, a child, a partner disappearing. Your heart speeds up and sleep slips away. When this fear keeps coming back and ends up taking all the room, it has a name: thanatophobia, the fear of death.

I am a sophrologist, hypnotherapist and wellbeing coach in Bordeaux. The people who tell me about it often do so quietly, a little embarrassed, as if it were a subject you are not allowed to raise. Yet it is one of the most human fears there is.

Here I explain where the fear of death often comes from, why it so often chooses the evening, what you can do when it rises, what the studies say and when to see a doctor.

Thanatophobia: when the fear of death takes up all the room

Everyone thinks about death. When you hear that someone has died, when you reach a birthday ending in zero, when you become a parent. The thought passes and life carries on. Thanatophobia is when it no longer passes.

For phobias in general, the MSD Manual, a medical reference, describes a marked fear, present for at least six months, that pushes you to avoid whatever sets it off. Applied to death, it can look like this:

• you avoid funerals, hospitals, films or conversations that touch on it;
• you keep checking that the people you love are all right;
• every small pain makes you think of a serious illness;
• you put off flying, travelling or certain plans;
• in the evening, you delay going to bed so you are not alone with your thoughts.

Putting a medical name on what you are going through is a doctor's job, not mine. But if several of these points have rung true for months, the fear deserves to be taken seriously.

For yourself or for those you love

The fear of death does not always look the same. For some people, it is their own end that worries them: the moment itself, the pain, the nothingness. For others, it is the death of someone close, with the unbearable idea of having to live without them. The two often mix.

Where the fear of death comes from

There is no single cause. A review by Australian researchers from Macquarie University and the University of Sydney describes death anxiety as a basic fear found at the heart of several difficulties: constant worry about your health, panic attacks, anxiety and depressive disorders. In other words, it sometimes hides behind other fears.

A study of 200 people seeking help for a range of psychological difficulties points the same way. The stronger the fear of death, the heavier the difficulties, low mood included. This link does not show what causes what, as the authors point out, but it explains why the fear turns up so often when someone is going through a hard time.

What I often see

In the people I work with, the fear rarely wakes up for no reason. It comes after a bereavement, when you have seen up close what losing someone means. After a health scare, your own or a loved one's. When a child is born and you suddenly find yourself responsible for a life. Or at an age when you start to take stock. If you are grieving, my article on the stages of grief may help you see more clearly.

Why it comes back mostly in the evening

During the day, work, the children and the commute keep the mind busy. In the evening, everything goes quiet. There is only you and your thoughts, in the dark. That is when what you have kept at a distance comes back up.

Falling asleep adds something. To fall asleep is to let go of control. For someone afraid of dying, that letting go can feel like a small disappearance, and that is often when the fear slips in. Many people describe this exact moment to me: they are about to drop off, and a jolt of fear suddenly wakes them up again.

The body quickly joins in. The NHS lists among the signs of a phobia a racing heart, a tight chest, feeling dizzy, and an intense fear of fainting, losing control or dying. You then read these sensations as proof that something is wrong, and the fear climbs further.

When it is a panic attack

Sometimes the fear of death takes the form of a real attack. The NHS describes panic attacks: palpitations, shortness of breath, dizziness, a feeling of dread or a fear of dying. Most last between 5 and 20 minutes. It is very frightening, but the attack does pass. If you have them, especially if they keep coming back, see your doctor to check that there is no physical cause.

What to do when the fear rises

The usual reflex is to reason with yourself, to try to feel better by repeating that everything is fine. Or to search online for what that pain might mean. As a rule, this sets the whole thing off again. I suggest going through the body instead.

Come back to your sensations

Put one hand on your belly and the other on your chest. Feel the warmth of your hands, the weight of your body on the mattress or the chair. Notice three things you can hear and two you can touch. It is simple, almost too simple, and that is often what helps: your attention leaves the future and comes back to here.

Lengthen the out-breath

Breathe in through your nose for a count of four. Breathe out slowly through your mouth for a count of six, as if blowing on a candle without putting it out. Do this five times, then let your breathing find its own pace. The NHS includes breathing exercises among the things you can do yourself for a phobia.

Let the thought pass

The thought "I'm going to die" will come back. There is no point chasing it away, that only makes it stickier. You can simply name it: "there's the fear again". Then come back to your breath and to the feeling of being supported. It passes again, you come back again. This is practice, not a test.

An evening routine to calm the body

Since the fear so often chooses bedtime, you might as well prepare for it. This is what I often suggest in sessions, to adapt to your life. It will not make the fear of death disappear, but it helps the body go into the night less tense.

1. An hour before sleep, dim the lights and leave your phone outside the bedroom. Avoid news or series about illness or tragedy.
2. Write down in a notebook whatever is going round in your head. Once it is on paper, it no longer needs to circle.
3. Lying down, travel through your body: feet, legs, belly, shoulders, jaw. At each point, let go a little more.
4. Breathe for a few minutes with a long out-breath. Heart coherence breathing follows the same principle and works well at the end of the day.
5. Think of one precise moment in the day when you felt good, and relive it in detail: the light, the sounds, what you felt.

If sleep is difficult in general, my tips for better sleep complement this routine.

What the studies say about support

Research on the fear of death is still modest, and I would rather tell you so plainly.

A meta-analysis from the University of Sydney brought together 15 randomised trials. Overall, psychological support reduced the fear of death, with a small to medium effect. Cognitive behavioural therapy (CBT) clearly stood out, while the other approaches tested did no better than the comparison groups. The authors stress that the studies are few and often of low quality.

The same team tested an online programme based on CBT, to follow alone, without a professional. Of 20 people who started it, 10 finished, and 6 of them saw their fear of death drop clearly. There was no comparison group: it is a very first trial, and the researchers are calling for a larger study.

For phobias in general, the MSD Manual presents gradual exposure as the main approach: it does better than no treatment in about 85% of people. It also mentions relaxation, breathing and hypnosis among the techniques that go with it.

What sophrology and hypnosis can offer

There is no serious study of sophrology for thanatophobia. What I offer builds on what helps with fear in general, and on a simple idea: the fear of death lives in the future, the body lives in the present.

In sophrology, you learn to spot tension as soon as it settles, in the throat, the chest, the belly, and to release it. We work on breathing so that it becomes a support you can call on, in the evening as well as during the day. And we practise feeling the living body: the warmth, the breath, the heart beating calmly. This last point often surprises the people I work with. Sessions take place at my practice or by video call. For older people, I adapt the exercises in sophrology for seniors.

And hypnosis?

With hypnosis as I practise it, we work in a state of deep relaxation. There you can find an inner place of safety, then gently approach what frightens you, at a pace you choose. The NHS lists hypnotherapy among the options for phobias. Hypnosis takes place only at my practice, on rue Ducau.

What I don't do

I don't try to convince you of anything about death, nor to replace psychological care. Questions of meaning, belief and grief belong to each person. My work is to help you live with the question without it stopping you from living. If your emotions spill over more broadly, my article on managing stress and emotions may also be useful.

When to see a doctor and how to begin

Sophrology and hypnosis do not replace medical advice. See your doctor if:

• the fear of death stops you sleeping, working or seeing the people you love;
• you have panic attacks, by day or by night;
• you spend a lot of time monitoring your body or looking for what might be wrong;
• you have felt sad, empty or unmotivated for several weeks.

Your doctor can check that no physical cause lies behind the dizzy spells and, if needed, refer you to a professional trained in CBT, the best-studied approach for this fear. I work alongside this, never instead of it.

And if the fear of dying gives way to thoughts of death, to wishing everything would stop, don't wait. In France, the 3114, the national suicide prevention line, answers free of charge, 24 hours a day. Elsewhere, contact your local emergency services or your doctor straight away.

To start tonight, try the bedtime routine for a week, and the long out-breath for three minutes a day, even when all is well. If you would like support, you can book a sophrology session for adults, by video call or at my practice, or a hypnosis session for adults. I see clients as a hypnotherapist in Bordeaux, and you can read about my background on the about page.