The Effectiveness of an Online Self-Delivered Death Anxiety Intervention

The Effectiveness of an Online Self-Delivered Death Anxiety Intervention: A Pilot Randomized Controlled Trial

The goal of this clinical trial is to examine the effectiveness of the online self-delivered death anxiety intervention developed by our team in the general population with a randomized controlled trial. The study will recruit 50 participants, with 25 randomized to the death anxiety intervention group and 25 randomized to the control group (waiting list). The online intervention on death anxiety consists of 4 phases that take about 2 hours in total. The primary outcome DAS (Death Anxiety Scale) and DABBS (Death Anxiety Beliefs and Behaviors Scale) will be administered on baseline, post-treatment, 1-week follow-up, and 2-week follow-up assessments.

Study Overview

• Status: Completed
• Conditions: Death Anxiety
• Intervention / Treatment: Behavioral: Online self-delivered death anxiety intervention; Behavioral: Waiting-List (WL) condition

• Study Type: Interventional
• Enrollment (Actual): 47
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Beijing Municipality
    • Beijing, Beijing Municipality, China, 100871
      • Peking University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 18-65 years of age
• Normal literacy skills and ability to use a smartphone proficiently
• Higher death anxiety that is above the cutoff of our measurement
• Voluntarily participate in this intervention and be able to provide informed consent.

Exclusion Criteria:

• Severe depressive state or risk of suicidal self-injury, i.e., the total score of Patient Health Questionnaire 9-item ≥19 or the score of 9th item ≥2
• Diagnosed within 6 months with schizophrenia, depression, bipolar disorder, and other psychiatric disorders
• Have received any intervention for death anxiety or CBT intervention on any topic within the past 6 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Death anxiety	Behavioral: Online self-delivered death anxiety intervention; The online self-guided death anxiety intervention developed in this study is based on the Death Education and CBT framework. It took approximately two hours to complete the full intervention. The main content includes: Emotional reactions and behavioral manifestations about death, fear management theories, and Chinese cultural attitudes toward death;; Imagine what you would like to say to yourself at the end of your life, and learn about various attitudes towards death through numerous examples;; Expressive writing, with moderate emotional exposure to stimulate reflection, accompanied by breathing exercises and positive thinking about death, to improve tolerance and control of death anxiety, and finally to correct biased perceptions by examining bad beliefs about death;; Prioritize the importance of things and make a practical action plan to enrich your life.
Other: Waiting-List (WL) condition; Participants assigned to WL will be asked not to use our death anxiety intervention or seek additional help related to death anxiety during the 1-week intervention period. After the one-month follow-up of the experimental group, the WL group will receive the same intervention for death anxiety. WL participants will also be given contact information to use in case of increasing distress.	Behavioral: Waiting-List (WL) condition; Participants assigned to WL will be asked not to use our death anxiety intervention or seek additional help related to death anxiety during the 1-week intervention period. After the one-month follow-up of the experimental group, the WL group will receive the same intervention for death anxiety. WL participants will also be given contact information to use in case of increasing distress.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Templer Death Anxiety Scale (T-DAS)	The T-DAS consists of 15 items, describing the experiences that individuals feel when facing death. The Chinese version suggests a 5-point scale according to the later extended version of the scale, ranging from 1 "Strongly Agree" to 5 "Strongly Disagree", with higher scores representing more severe death anxiety. The higher the score, the more serious the death anxiety, and a total score greater than 43 according to the rules can be considered to have a high level of death anxiety. The Chinese version of T-DAS has been widely used and has shown good reliability and validity.	baseline, post treatment (only for intervention group), 1 week, 2 weeks
Death Anxiety Beliefs and Behaviors Scale (DABBS)	The DABBS consists of 18 entries describing overall feelings about death (4 entries), thoughts and beliefs related to death (7 entries), and avoidance behaviors related to death (7 entries), with the scale being scored on a 5-point scale ranging from 1, "Strongly Disagree/Never Have This Thought/Never Avoid This Behavior" to 5 "Strongly agree/always have this thought/always avoid this behavior," with higher scores representing the severity of the individual's adverse beliefs and behaviors regarding death.	baseline, post treatment (only for intervention group), 1 week, 2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Health Questionnaire 9-item	Patient Health Questionnaire 9-item (PHQ-9), a self-report measure for depressive symptoms in the past two weeks, comprises 9 items rated from 0 (not at all) to 3 (nearly every day). The PHQ-9 has good psychometric properties in Chinese adolescents.	baseline, 1 week, 2 weeks
Generalized Anxiety Disorder 7-item	Generalized Anxiety Disorder 7-item (GAD-7) scale is a 7-item self-report measure to assess anxiety symptoms in the past two weeks. Each item is rated from 0 (not at all) to 3 (nearly every day). The Chinese version GAD-7 score has good psychometric properties among adolescents.	baseline, 1 week, 2 weeks
Insomnia Severity Index (ISI)	The ISI consists of seven items that assess the severity of subjective insomnia in the past two weeks, including, for example, difficulty in falling asleep, sleep satisfaction, impairment of daytime functioning, etc. The total score ranges from 0-28, with higher scores representing more severe insomnia. The Chinese version of ISI has been shown to have good reliability and validity.	baseline, 1 week, 2 weeks
4-dimensional anxiety scale	This is a 40-item scale for measuring multi-dimensional anxiety, which includes 4 dimensions (emotional, physiological, cognitive, and behavioral) and 9 subscales (emotional, psychosomatic, autonomic, general cognitive, phobia, over-committed, repetitive, social, and avoidance). The higher the score on this scale, the more severe the anxiety in a certain area.	baseline, 1 week, 2 weeks
Ryff's Psychological Well-being Scale (PWS)	The short version used in this study contains 18 entries, including six dimensions of positive relations, autonomy, environmental mastery, personal growth, purpose in life, and self-acceptance. The six dimensions of self-acceptance are scored on a 6-point scale ranging from 1 "not at all" to 6 "very much", with higher scores representing higher psychological well-being. The Chinese version of PWS has been translated by Taiwanese scholars and has been proven to have Good reliability and validity.	baseline, post treatment (only for intervention group), 1 week, 2 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adverse Childhood Experiences	An adverse childhood experiences questionnaire measuring the adverse childhood experiences with 13 items. A higher number of adverse childhood experiences represents worse childhood experiences.	baseline
Social support	The 12-item Multidimensional Scale of Perceived Social Support (score from 1 to 7, and total score varies from 12 to 84). A higher score represents better social support.	baseline, 1 week, 2 weeks
Post-traumatic responses scale - Flight subscale	This is a 9-item subscale measuring flight responses of the Post-traumatic responses scale, which is a 5-point Likert scale (score from 0 to 4, and total score varies from 0 to 36). A higher score represents a higher post-traumatic avoidance tendency.	baseline, 1 week, 2 weeks
Irritability	A 17-item irritability measurement scale, the Peking irritability scale, measures impulsive emotions, thoughts, and behaviors on a 5-point Likert scale (score from 1 to 5, and total score varies from 17 to 85). A higher score represents higher irritability.	baseline, 1 week, 2 weeks
A sense of stability	A 7-item 6-point Likert scale that measures the subjective feeling of being settled and fulfilled in one's current life. The higher the score on the scale, the stronger the sense of stability.	baseline, 1 week, 2 weeks
Alexithymia	A 23-item Peking alexithymia scale measures thoughts and behaviors that prevent people from feeling or recognizing negative emotions on a 5-point Likert scale (1 to 5, and total scores vary from 23 to 115). A higher score represents more severe alexithymia.	baseline, 1 week, 2 weeks
Emotion regulation	An 18-item cognitive emotion regulation questionnaire measures the ability of emotion regulation on a 5-point Likert scale (1 to 5, and total scores vary from 18 to 90). A higher score represents better emotion regulation.	baseline, 1 week, 2 weeks

Collaborators and Investigators

• Sponsor: Peking University
• Collaborators: 101 Institute, Ministry of Civil Affairs of the People's Republic of China

Study record dates

Study Major Dates

• Study Start (Actual): February 14, 2025
• Primary Completion (Actual): April 4, 2025
• Study Completion (Actual): April 4, 2025

Study Registration Dates

• First Submitted: January 24, 2025
• First Submitted That Met QC Criteria: January 24, 2025
• First Posted (Actual): January 30, 2025

Study Record Updates

• Last Update Posted (Actual): March 16, 2026
• Last Update Submitted That Met QC Criteria: March 12, 2026
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: randomized controlled trial; Death Anxiety; self-delivered
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Necrophobia; Organization and Administration; Health Services Administration; Appointments and Schedules; Waiting Lists
• Other Study ID Numbers: Facing death anxiety pilot

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No