The worm at the core: A terror management perspective on the roots of psychological dysfunction

Applied and Preventive Psychology 11 (2005) 191–213

The worm at the core: A terror management perspective on the roots of psychological dysfunction夽 Jamie Arndt a,∗ , Clay Routledge a , Cathy R. Cox a , Jamie L. Goldenberg b a

Department of Psychological Sciences, University of Missouri, Columbia, Columbia, MO 65211, USA b University of South Florida, Davis, USA

Abstract A growing body of research derived from terror management theory [e.g., Solomon, S., Greenberg, J., & Pyszczynski, T. (1991). A terror management theory of social behavior: The psychological functions of self-esteem and cultural worldviews. In M. P. Zanna (Ed.), Advances in experimental social psychology: vol. 24 (pp. 93–159). New York: Academic Press] suggests that the human struggle with the awareness of inevitable death can greatly impact people’s physical and psychological well-being. The current article reviews converging lines of research that investigate the role of terror management processes in physical and mental health. Specifically, we present research that elucidates the role of death concerns in (1) conscious threat-focused defenses, (2) self-esteem striving, (3) depression, (4) anxiety disorders, (5) discomfort with the physicality of the body and (6) neuroticism. We conclude that terror management theory builds upon the work of other existential scholars and mental health perspectives to provide a broad conceptual and empirically based account of how deeply rooted existential fears manifest in ways that prove both psychologically and physically problematic. We also suggest how future research and social interventions can be employed to help individuals manage basic fears in ways that do not compromise their psychological and physical health. © 2005 Elsevier Ltd. All rights reserved. Keywords: Psychological; Physical; Social; Terror management

The popular comedian Jerry Seinfeld was fond of introducing his musings with the colloquially phrased question, “What’s up with that?” Applied to the topic of psychological dysfunction, such a query would no doubt elicit its fair share of stumped expressions and quizzical responses. Yet it does highlight a fundamental question about basic motivating forces that influence human cognition and behavior, and thus issues relevant to the manifestation (and prevention) of psychological problems. From a motivational perspective, few psychologists would likely disagree with the notion that many psychological maladies manifest when individuals are not getting their psychological needs met. The relative simplicity of this idea of course masks the diversity of views about what the central needs are that drive human functioning, the multifarious ways in which they can be thwarted and the variety of ways people can manifest problems. It also begs 夽 Preparation of this article was partially supported by NCI grant R01 CA09658. ∗ Corresponding author. Tel.: +1 573 884 4678; fax: +1 573 882 7710. E-mail address: [email protected] (J. Arndt).

0962-1849/$ – see front matter © 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.appsy.2005.07.002

the question: is there a central motivating force that can be identified and that contributes to many of the psychological problems with which people so often contend? In the present article, we argue that one prospective explanation for a broad understanding of psychological dysfunction and distress derives from terror management theory (TMT; Greenberg, Pyszczynski, & Solomon, 1986). The theory contends that a wide spectrum of people’s social behavior reflects psychological efforts to deal with the uniquely human awareness of inevitable mortality. According to TMT, to function with relative psychological equanimity in a world where the only certainty is the inevitable decay of one’s corporal body into fertilizer, people need to sustain beliefs wherein, to paraphrase the late Becker (1973), they are significant contributors to an enduring cultural drama. That is, people need to maintain self-esteem (the sense that they are meeting the standards of value prescribed by their culturally derived view of the world) and the belief that their personal significance occurs in the context of a meaningful world. In an effort to examine the merits of these core propositions, TMT has inspired over 250 empirical studies. These studies have

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provided a well articulated theoretical basis for understanding the role of existential concerns about mortality in fundamental aspects of the human condition. In so doing, the theory has also generated a significant body of empirical research that points to applied implications for understanding psychological maladjustment. The purpose of the present article is to review those areas of TMT research that are applicable to psychological problems. We hope this may facilitate a deeper theoretical understanding of psychological maladjustment that may in turn offer greater practical insights. From the perspective of TMT, the human awareness of mortality is an ever-present rumbling beneath the conscious veneer of our daily cognition. In the words of James (1902/1978), it is “the worm at the core.” As such, it is posited to influence a range of ongoing psychological processes. Typically, research derived from TMT has examined how people maintain those psychological structures that buffer existential anxiety and thus enable them to function within the range of socially accepted normality. However, as alluded to above, a further implication is that psychologically problematic behaviors may manifest when existential anxiety can no longer be effectively kept at bay through the more typical avenues of psychological defense. For those readers familiar with the classic works of Yalom (1980), May (1953) and Lifton (1983), this perspective may ring a familiar bell. Indeed, in his seminal book, Existential Psychotherapy (1980), Yalom has a chapter entitled “death and psychopathology” in which he argues that “. . . the individual who enters the realm of “patienthood” has found insufficient the universal modes of dealing with death fear and has been driven to extreme modes of defense” (p. 111). Notably, however, in this chapter there is paucity of experimental research. TMT draws heavily from such existential clinical theorists, primarily Yalom and Lifton who trace psychological difficulties specifically back to anxiety about mortality. However, the theory goes beyond the insights provided by proposing a theoretical model that allows for specific predictions for how and when mortality concerns affect psychological well-being and behavior. Thus, while TMT converges with the general insights of existential clinical theorists, TMT is unique in offering a well-articulated theoretical model that affords specific hypotheses that can be tested experimentally. In doing so (and in this manuscript), we aim to provide a bridge between academic and applied clinical psychology. In this article, we begin with a brief overview of TMT. We pay particular attention to the developmental role of anxiety in the need for self-esteem as this provides the foundation for understanding dysfunctional approaches to managing existential anxiety. We then present a summary of some of the basic research the theory has generated including the psychodynamic and cognitive architecture that underlies terror management defenses. This is by no means intended as an exhaustive review or presentation of TMT and research (see Greenberg, Solomon, & Pyszczynski, 1997; Solomon, Greenberg, & Pyszczynski, 2004). Rather, we hope to lay

the foundation for how the terror management lens has been used to illuminate a number of psychological problems. It is in this light that we then turn to considering lines of research that have been directed to understanding six forms of psychological challenges and problems. Specifically, we cover the effects of the awareness of death on the consequences of managing conscious death-related fear, self-esteem striving, depression, anxiety disorders, discomfort with the physicality or creatureliness of the body and finally, neuroticism. We consider these particular areas for two primary reasons. First, these are the areas of psychological dysfunction to which TMT has been empirically applied thus far. Second, we are hopeful the breadth of these applications illustrates the potential of a terror management analysis to reveal important insights across seemingly disparate problems. We conclude by outlining some directions for future theory and research.

1. Terror management theory and research As noted, TMT is heavily grounded in the writings of a number of existential and psychodynamic scholars (most notably, Ernest Becker, but also including Irvin Yalom, Rollo May, Otto Rank, Robert Jay Lifton and Norman O. Brown among others). The theory asserts that humans, like all other forms of life, have a fundamental orientation toward selfpreservation and continued survival in the service of genetic replication.1 Just as all organisms posses self-regulatory systems and adaptations that facilitate their survival (e.g., skunk’s stench, porcupine quills, fish gills) so too do humans. According to this perspective, however, humans are unique in that their most pronounced adaptation takes the form of highly sophisticated cognitive abilities that render them capable of complex patterns of thinking. The aspiring Olympian, for example, might imagine himself (i.e., capacity for selfreflective thought) winning in the summer games (i.e., capacity for temporal and future thought) and standing on the podium draped in his country’s flag and all that it represents (i.e., capacity for symbolic thought). Such cognitive sophistication certainly facilitates a remarkable degree of adaptive self-regulatory behavior, response flexibility and goal directed accomplishment. Yet these abilities also evolved with a heavy psychological price. People are aware of their inevitable mortality and the reality that death can happen at any time for reasons that can often not be anticipated or controlled. Whether the victim of a hurricane, car accident, homicide, terrorist attack, brain tumor or if one is lucky, old age, we know the curtain will fall. According to TMT, the juxtaposition of a biological predisposition for self-preservation combined with the uniquely human awareness of the inevitability of death gives rise to the potential for extreme anxiety or terror. Because it would be hard to function knowing that we are merely transient 1 For a more detailed exposition of how this relates to evolutionary thinking, see Solomon, Greenberg, Schimel, Arndt, and Pyszczynski (2003).

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creatures sharing the mortal fate of a platypus, porcupine or pineapple, humans are able to minimize this existential dilemma by engaging the same cognitive abilities that give rise to the problem. Specifically, following Becker (1973), TMT asserts that the human solution is the creation of, and immersion in, culture. Culture worldviews are humanly constructed beliefs about the nature of reality that function in part to minimize anxiety engendered by the awareness of death. They provide a meaningful account for the origins of the universe, prescriptions for appropriate conduct or behavior and explanations for what happens after death. This may take a literal form, as in a belief in an afterlife or a symbolic form with something that endures beyond an individual’s lifetime (e.g., writing a book, having children; Solomon, Greenberg, & Pyszczynski, 1991). For many, if not most individuals, their worldview is composed of a variety of different domains of beliefs. Although religion is often a major component of a cultural worldview, this analysis views many other types of identifications as ultimately (fictional) socially constructed conceptions of reality that imbue the world with meaning. For example, these beliefs may include investment in one’s romantic relationship, corporation, political party or even basketball team. Indeed, one might also note the tenacity with which scientists often cling to their theories as reflections of the trenchant need to sustain faith in a system of beliefs, which provides a basis for meaning and purpose. Sustaining belief in a cultural worldview does not, however, in and of itself, sufficiently abate existential anxiety. People are able to maintain psychological equanimity and death transcendence by meeting or exceeding the standards of value prescribed by their culture (i.e., selfesteem). For TMT, self-esteem consists of the belief that one is a person of value in a meaningful universe, and functions in part to buffer the anxiety resulting from the awareness of death. From this theoretical perspective, the need for self-esteem is universal. Humans need to feel as though life has meaning and that they are significant contributors to a meaningful reality (Pyszczynksi, Greenberg, Solomon, Arndt, & Schimel, 2004). Yet the specific standards one must live up to in order to maintain self-esteem are culturally derived and can vary considerably from one culture to the next. For example, in America many people value individualism, independence, self-sufficiency, personal success and competitiveness. In many Asian cultures, members value collectivism, cooperation, the importance of others and responsibilities to the group (e.g., Sedikides, Gaertner, & Toguchi, 2003). Or consider the Igbo of Western Africa where adolescent girls are fed high-calorie foods to gain weight, which is considered an important aspect of their physical beauty (Dissanayake, 1992). Of course, in the United States, many adolescent American females often starve themselves (or binge and purge) in order to look attractive (e.g., Stice, Mazotti, Krebs, & Martin, 1998). And herein lies one of the critical implications of this analysis. Because our sense of self-esteem and meaning are socially constructed and culturally relative, they

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are effective psychological structures only to the extent that an individual can maintain faith in their validity (see Berger & Luckman, 1966). As Festinger (1954) and many others observed, such confidence in a particular view of the world is fortified when others believe similarly and thus corroborate our conceptions of reality. However, those who endorse beliefs that conflict with our own, or act in such a way as to undermine our conceptions of right and wrong, pose a fundamental threat to the integrity of our sense of self-worth and cultural worldview. To the extent that others may threaten these structures, people are strongly motivated to maintain them and defend them. 1.1. A developmental analysis of the need for self-esteem From the perspective of TMT, the developmental process by which individuals learn to buffer anxiety through self-esteem and cultural identification is important for understanding how maladaptive anxiety buffering mechanisms can engender psychological dysfunction. Following Bowlby (1969/1982), TMT asserts that infants experience anxiety in response to threats in the environment (e.g., a loud noise) and unmet physical and psychological needs (e.g., hunger, fear). Bowlby reasoned that this anxiety was the impetus for the formation and development of early attachments, which function primarily to provide infants with physical contact and affection from their primary caregivers, or parents. By staying in close proximity and good affections with one’s caregivers, an infant’s survival is more likely. Over the course of development, parental affection becomes increasingly contingent upon engaging in certain behaviors and refraining from others. For example, although there is nothing inherently harmful about eating a handful of dog food (potential gastrointestinal objections notwithstanding), many parents react negatively and discourage this kind of culinary deviance. Through the process of socialization, and the conditional dispensation of affection, parents then directly and indirectly modify their child’s behavior to be in accordance with prevailing (or at least individualized) standards of value. When children behave appropriately (e.g., using the toilet in the bathroom), parents respond with increased enthusiasm and in response children feel safe and good. However, when children behave inappropriately (e.g., rendering their own Picasso on the new living room carpet), parents may respond punitively or at a minimum withhold overt affection and children experience insecurity as a result. Thus, from early in life, children equate being good with being safe and being bad with anxiety or insecurity (Solomon et al., 2004). This sense of security is later transferred from personal relationships to culture when children begin to realize that their parents are mortal and are ultimately unable to provide them with enduring safety and security. This, in Becker’s (1962/1971) terminology, is the ultimate transference. Culture facilitates this transference of the child’s security from the parents to the larger social matrix by providing a sense of

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comfort and safety to individuals who perceive themselves as living up to socially prescribed standards of value (e.g., thinness, fatness, independence). Thus, from this perspective, self-esteem becomes a basic human need that functions in part to protect people from deeply rooted existential fears associated with the awareness of one’s inevitable demise. 1.2. Basic empirical assessments of terror management theory TMT was first proposed by Greenberg, Pyszczynski and Solomon in 1986 and since that time the theory has inspired a considerable amount of empirical research, much of it beyond the scope of the current article. However, it may be informative to briefly review some of the basic research that speaks to the viability of this theoretical framework.2 Two hypotheses were primarily responsible for directing initial lines of terror management research. According to the anxiety-buffer hypothesis, if self-esteem functions to reduce anxiety, then raising self-esteem (or assessing high self-esteem dispositionally) should lead to reduced anxiety in response to a variety of physical and psychological threats. In accord with this hypothesis, research has found, for example, that high self-esteem leads to lower levels of self-reported and physiological anxiety after watching graphic death-related video footage or being threatened with painful electric shocks (Greenberg et al., 1992, 1993; see Pyszczynksi et al., 2004 for a review of six converging lines of evidence supporting the anxiety-buffering effects of self-esteem). A second line of terror management research was inspired by the mortality salience hypothesis. If cultural worldviews and self-esteem function to assuage the threat associated with mortality, then asking people to contemplate their own death (mortality salience) should increase their need for the protection provided by such beliefs. Thus, priming thoughts of death should lead to what is referred to as “worldview defense”; positive reactions to those who support one’s beliefs and negative reactions to those who threaten them. In addition, priming thoughts of death should also motivate self-esteem striving, that is, efforts to live up to those standards that provide a sense of self-worth. In initial support of this reasoning, Rosenblatt, Greenberg, Solomon, Pyszczynski, and Lyon (1989) found that after being reminded of their mortality, municipal court judges awarded a much stricter punishment to someone accused of prostitution (i.e., they responded to a hypothetical legal 2 Note that the theory obviously posits constructs that are quite abstract. Deeply rooted fears about death, symbolic constructions of reality and psychological defenses of cultural worldviews are all abstractions that are not directly amenable to empirical analysis. As with many ideas in social and other branches of psychology, these abstract concepts must therefore be operationalized and defined in measurable forms for research to be conducted. In so doing, we acknowledge there can at times be some ambiguity between the hypothesized construct (e.g., cultural worldview defense) and the measured construct (e.g., attitudinal evaluations of someone who disparages a religious belief).

case with an average bond of US$ 455) compared to judges in a control group (the average bond was set at US$ 50). Consistent with these findings, over 200 studies to date have found that priming people with thoughts of their own death results in increased defense and bolstering of their cultural worldviews across such domains as religious, nationalistic, political, ethnic, gender, university and sports team identifications compared to participants primed with control topics. For example, mortality salience has been shown to influence a wide range of attitudes and behavior, including increased prejudice (Greenberg et al., 1990) and aggression toward worldview threatening others (McGregor et al., 1998), heightened conformity to cultural standards (Pyszczynski et al., 1996), and over reliance on stereotypical information (Schimel et al., 1999). While the anxiety-buffer and mortality salience hypotheses have provided much of the impetus for TMT research, the theory has also been applied to a diverse array of psychological phenomena. To note just a handful of examples, studies have shown that inducing thoughts of death influence materialism and consumerism (see Arndt, Solomon, Kasser, & Sheldon, 2004 for a review), attitudes toward the environment (Koole & Van Den Berg, 2004), creativity (Arndt, Greenberg, Solomon, Pyszczynski, & Schimel, 1999), cultural trauma and recovery (Salzman & Halloran, 2004), people’s need for close relationships (for a review see Mikulincer, Florian, & Hirschberger, 2003), legal judgments (see Arndt, Lieberman, Cook, & Solomon, in press for a review), attitudes toward politics and world leaders (Landau et al., 2004b); and terrorism (Pyszczynski, Solomon, & Greenberg, 2003). Although the bulk of this research has been conducted in the United States, terror management effects have been documented in at least 13 different countries (e.g., The Netherlands, Israel, Iran, Japan). Most recently, mortality salience effects have been observed in a study of Australian Aborigines (Halloran & Kashima, 2004). Mortality salience has been typically manipulated by having participants respond to two open-ended questions regarding their attitudes toward death (e.g., “Please briefly describe the emotions that the thought of your own death arouses in you” and “Jot down, as specifically as you can, what you think will happen as you physically die and once you are physically dead”). Additional research has also found that mortality salience effects can be obtained by using a variety of experimental stimuli (e.g., fear of death scales, subliminal death primes), as well as a number of more routine stimuli that activate death-related cognition (e.g., being in the proximity of a funeral home, watching automobile accident footage). It is of course also important to consider whether these “mortality salience effects” are caused by thoughts of death, or whether they stem from any generally anxiety provoking contemplation. There are three points to mention in this regard. First, reminders of death have been compared to a variety of aversive control topics (e.g., being paralyzed, Arndt et al., 1999; meaninglessness, Baldwin & Wesley, 1996; general anxieties about the future, e.g., Greenberg et al., 1995;

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social exclusions, e.g., Schimel et al., 1999; uncertainty, e.g., Landau et al., 2004a; taking an exam, e.g., McGregor et al., 1998; giving a speech in public, Greenberg et al., 1994, Study 2; death of a loved one, Greenberg et al., 1994, Study 1; experiencing intense physical pain, including dental pain and a broken bone, e.g., Goldenberg, Arndt, Hart, & Brown, in press; failure, e.g., Arndt, Greenberg, & Cook, 2002; an actual failure experience, see Greenberg et al., 1997). Across a variety of outcomes, reminders of death have been found to produce different effects than the topics mentioned above. Second, as we discuss in more detail later, mortality salience effects have been strongly tied to patterns of death thought accessibility, the extent to which death thought are active but outside of focal attention (usually measured by counting up the number of word fragments completed with death-related words, e.g., COFF could be coffee or coffin). For example, threats to an individual’s worldview have been found to produce increased death thought accessibility (e.g., Goldenberg, Pyszczynski, McCoy, Greenberg, & Solomon, 1999; Mikulincer, Florian, Birnbaum, & Malishkevish, 2002), and bolstering of one’s worldview (e.g., Arndt et al., 1997a) or self-worth (e.g., Mikulincer & Florian, 2002) have been found to reduce elevated death thought accessibility after mortality salience. Third, unlike other aversive topics, mortality salience manipulations have generally not been found to increase anxiety or negative affect (see, e.g., Greenberg et al., 1997). We discuss this specific point more fully below. Here, we note that while other threats can certainly give rise to such reactions as prejudice and self-esteem defense, reminders of death seem to posses unique motivational consequences (see, e.g., Pyszczynksi et al., 2004 for further discussion of this issue). Said differently, though there are of course a great many aversive cognitions and affective states that trigger psychological defenses, the effects of deathrelated thoughts have been empirically distinguished from the effects of many other anxiety-provoking topics. Interestingly, from the outset of TMT research, as we noted above, reminders of death have failed to generate selfreported negative affect or physiological signs of anxiety (as assessed by skin conductance; Rosenblatt et al., 1989). Moreover, even when the death primes that give rise to worldview defenses do elicit subtle forms of negative affect (as measured by facial electromyography; Arndt, Allen, & Greenberg, 2001), this affect has not been found to influence the extent of worldview defense. This leaves one to wonder, “where’s the terror?” Certainly the threat of death has the potential for eliciting a great deal of distress. Anybody who has experienced turbulence on an airplane, for example, is easily reminded of this. However, according to the theory, people avert or avoid the subjective experience of distress that should accompany the awareness of existential vulnerability by increasing defensive processes (i.e., worldview and self-esteem maintenance). In support of this contention, Greenberg et al. (2003) recently found that mortality salience induced worldview defense was attenuated when participants were given a placebo that they were told eliminated their potential to experience to anxiety.

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This suggests that the effect of mortality reminders on worldview defenses and self-esteem strivings are influenced by the potential to experience affect rather than the actual subjective experience of anxiety. In this way, worldview defenses and self-esteem strivings can be considered a pre-emptive defense employed by individuals to avoid experiencing potentially psychologically paralyzing death anxiety. The significance and necessity of such a pre-emptive defense becomes clear later in our discussion when we consider the psychological effects of traumatic experiences in which death anxiety cannot be avoided. Of course, as we later explore, such defensive processes reflect what are considered to be the typical state of affairs, but in certain situations or among certain individuals, these defenses can break down or function in an otherwise maladaptive manner. 1.3. Dual defenses against conscious and unconscious death concerns One strength of TMT, which goes beyond the insights of the theory’s main influences (e.g., Becker and Yalom) and other clinically driven existential perspectives, is its power to elucidate the cognitive processes that underlie terror management responses and distinctions between reactions to conscious and unconscious thoughts of mortality (see, e.g., Pyszczynski, Greenberg, & Solomon, 1999). A heuristic model presenting this process is depicted in Fig. 1. Briefly, the process of psychological defense to the awareness of death begins with the notion that thoughts of death assume a central position within a cognitive network and can be activated by associated events or breakdowns in the protective mechanisms that keep concern with death at bay. For example, exposure to news stories that heighten perceived vulnerability to breast cancer (Arndt, Cook, Goldenberg, & Cox, 2005) or proximity to a funeral home (Pyszczynski et al., 1996) have been found to increase death thought accessibility. Studies have also revealed that compromises in a person’s anxiety buffering structures (e.g., thinking about potential disruptions in one’s close relationships) can increase levels of death thought accessibility (e.g., Mikulincer et al., 2002). When death thoughts are explicitly in people’s minds, they tend to first provoke proximal (or direct) defenses. These defenses are rationally oriented, threat focused and function primarily to remove the death-related thoughts from current focal attention. This may be akin to a “not me, not now” kind of response (Chaplin, 2000). For example, research indicates that when reminded of their mortality, people tend to suppress the associated activation of death-related cognition (Arndt, Greenberg, Solomon, Pyszczynski, & Solomon, 1997b). We note later other examples of such defenses. Once such proximal defenses are relaxed, there is a delayed increase in death thought accessibility. In laboratory research, the necessity of delay in increasing death thought accessibility outside of focal attention can be circumvented by priming death subliminally (e.g., Arndt, Greenberg, Pyszczynski, & Solomon, 1997). A need for such a delay can also be bypassed by having

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Fig. 1. The cognitive architecture of terror management dual defenses (adapted from Arndt, Cook, & Routledge, 2004).

participants contemplate their mortality under conditions that limit cognitive resources and reduce the effectiveness of ensuing suppression of death-related thought (i.e., high cognitive loads, such as trying to remember a 10 digit number; Arndt et al., 1997b). Increased death thought accessibility outside of focal attention then signals the need for the worldview and self-esteem relevant distal or symbolic defense. This occurs, in part, by increasing the accessibility of belief constructs associated with the individual’s culturally prescribed investments in meaning and esteem. For example, subliminal death primes, or explicit mortality primes after a delay, spontaneously increase accessibility of nationalistic cognitions for men and relationship cognitions for women (Arndt et al., 2002). Notably, this sequence of activation depends on the elements of a person’s belief system that are both dispositionally and situationally salient as available trajectories of symbolic investment. With the increased accessibility of these domains of symbolic meaning and value, they are more likely to be defended; an action which then serves to reduce the heightened accessibility of death-related thoughts (Arndt et al., 1997b). For example, when one is faced with a reminder

of physical vulnerabilities (e.g., during a cancer screening), her or his immediate or proximal response to the conscious thought of death may reflect an effort to suppress the thought of mortality (e.g., “Stop worrying, I am too healthy to have cancer”). However, after such a proximal defense transpires and death thoughts have been sufficiently suppressed, a distal symbolic defense may be necessary (e.g., “I am a good father and my children are happy” or reaffirming a sense of nationalism). 1.4. Summary To summarize, TMT posits that the biological predisposition for continued existence combined with the human awareness of the inevitability of death creates the potential for paralyzing terror. This potential for terror is managed by investing in cultural worldviews and by meeting or exceeding the standards of value prescribed their cultural worldview (self-esteem). Insulated in this fashion, humans are able to see themselves as significant contributors to a meaningful reality. A range of empirical studies have not only provided support

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for the central tenets of this analysis, but also elucidate the cognitive mechanisms that are involved in the management of existential fear rooted in the awareness of death. Such mechanisms reflect what is needed to mitigate existential insecurity. We turn next to how this analysis can be used to understand psychological problems that can result from either these more typical forms of defense, or from more psychologically and physically problematic strategies for managing concerns about mortality.

2. Applied implications of terror management theory for mental health problems 2.1. The dangers of proximal defenses against conscious mortality concerns This conceptualization of proximal and distal responses to death-related concerns affords considerable insight into understanding a range of psychologically problematic as well as productive behavior (see also, Arndt, Goldenberg, Solomon, Greenberg, & Pyszczynski, 2000). With regard to proximal defenses, as we previously reviewed, the goal here is to remove death-related thoughts from consciousness so that other goal directed action can ensue. It is, after all, difficult to make that manuscript deadline if one is preoccupied with the fear that a “bump” on one’s body may be cancerous. For consciousness to let go of such thoughts it may be necessary for the individual to replace the threatening thoughts in consciousness with alternative thoughts, to consciously construe death as not worthy of current concern, or to take active steps to reduce vulnerability to whatever risk factors may be currently most salient. As this latter option implies, there are certainly productive strategies through which conscious mortality concerns can be combated. Indeed, the notion that conscious reminders of mortality can awaken people to their vulnerabilities and to their life-threatening behaviors (e.g., smoking) is a large part of the rationale behind using fear appeals in health education campaigns (e.g., Leventhal, 1970). Terror management research has started to examine the potential for conscious death-related thought to inspire beneficial health oriented responses. Studies have recently found that when thoughts of death are in focal attention, people may increase their intentions to exercise (Arndt, Schimel, & Goldenberg, 2003), engage in safe-sun behavior (i.e., use high sun protection factor sunscreen; Routledge, Arndt, & Goldenberg, 2004), as well as conduct a breast self-exam, among women, if they are high in health optimism (Arndt, Routledge, & Goldenberg, 2005). Thus, conscious reminders of mortality can be useful to the extent that they motivate people to engage in rational actions that actually serve to forestall death. However, research from the fear appeal literature also indicates that fear eliciting imagery must by juxtaposed with recommended strategies for protection or prevention to be effective (Leventhal, 1970) because grim reminders

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can also arouse other less adaptive, and in this sense ironic, responses. 2.1.1. Suppression The first proximal defense against conscious mortality concerns that was uncovered by terror management research involved people’s tendencies to suppress conscious death-related ideation. Greenberg et al. (1994) found that immediately after contemplating mortality, death thought accessibility (as well as worldview defense) was low but increased when participants were confronted with a distraction (e.g., completing an innocuous word search puzzle). This suggested that participants were engaging some form of psychological defense to reduce conscious concerns with death. Arndt et al. (1997b) then examined whether this initially low level of death thought accessibility after reminders of mortality was due to active suppression. Specifically, they reasoned that if people are initially suppressing death-related thoughts, then – as with other cognitive operations – it is unlikely that such suppression could occur without the availability of sufficient processing resources (cf. Gilbert & Hixon, 1991; Wegner, 1994). In support of this hypothesis, Arndt et al. found that when participant’s cognitive resources were not being taxed (i.e., low cognitive load), death thought accessibility was initially low after consciously thinking about death but then increased following a delay. However, when participants were under high cognitive load (by mentally rehearsing a number), death thought accessibility was immediately high after conscious contemplation. Therefore, it appears that participants were in fact engaging in death thought suppression immediately after a death prime. A recent series of studies by Arndt, Cook et al. (2005) extends the findings on the suppression of death-related thought to a situation in which individuals are confronted with information and risk about cancer. In a first study, Arndt et al. found that asking participants to think about cancer did not increase death thought accessibility. This (lack of) an effect in many ways contradicts the expectations of basic priming principles. Arndt et al. thus hypothesized that thinking about cancer may be particularly threatening to people and arouse an especially robust suppression effort, therefore leading to low death accessibility. Three additional studies supported this reasoning. First, following Arndt et al. (1997b), under high cognitive load, cancer prime participants evidenced increased death thought accessibility. Second, whereas the initial study found that explicit contemplation of cancer did not increase death thought accessibility, subliminal primes of cancer (i.e., presenting the word cancer outside of conscious awareness) did increase death thought accessibility. Third, when female participants were led to believe that they were especially vulnerable to breast cancer (and therefore would be in greater need of suppression), they showed lower levels of death thought accessibility than female participants led to believe they were not vulnerable to breast cancer. Taken together, these findings indicate that after exposure to conscious thoughts of death or the salience of threatening

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topics connected to death, participants suppress death-related thoughts. The extent to which suppression of mortality concerns from conscious awareness adversely affects physical and psychological health is an important question for future research. In light of the literatures attesting to the unfortunate consequences of suppressing emotionally laden knowledge on a variety of physical and psychological outcomes (e.g., Pennebaker, 1989), this may be an especially important topic to examine. Interestingly, it may also be important to examine how such suppression in certain cases facilitates adaptive responses to health threats. For example, an additional study in Arndt, Cook et al. (2005) suggested that the ability to suppress death-related when thinking about cancer led to higher intentions to conduct breast self-exams for women and testicular self-exams for men. 2.1.2. Distraction and avoidance One simple response to conscious death related ideation is to simply remove oneself from the situation that activates or threatens to activate death-related concerns. Drawing from Ernest Becker’s insight that the prospect of mortality becomes psychologically problematic when paired with the capacity for self-reflective thought (cf. Duval & Wicklund, 1972), after being consciously reminded of death, individuals should be more prone to avoid those stimuli that foster self-focused attention. Arndt, Greenberg, Simon, Pyszczynski, and Solomon (1998) have found that this is in fact the case. Immediately after being asked to contemplate their own mortality, participants were more prone to avoid situations and stimuli that tend to focus attention on themselves (e.g., avoiding sitting in a room with a mirror or writing shorter essays that necessitated the use of self-reflective words). It appears that people may adopt an external focus of attention to avoid the implications of being self-aware and hence cognizant of their mortality (see Pyszczynski, Greenberg, Solomon, & Hamilton, 1990 for more detailed discussion of this issue). This is a potentially important connection given the ubiquity with which people are confronted with reminders of vulnerability and mortality, and that avoidance of selfawareness can be facilitated by the use of alcohol and drugs (e.g., Hull & Young, 1983; Hull, Levenson, Young, & Sher, 1983). To the extent that conscious thoughts about mortality motivate people to avoid self-awareness, they may also promote high levels of alcohol and drug use, which of course can adversely affect both physical and mental health. 2.1.3. Vulnerability denial and information seeking There is also clear evidence that people more actively engage cognitive distortions and biases to deny their vulnerability to an early death when they are consciously confronted with information that reminds them of their vulnerability (e.g., Croyle & Sande, 1988; Ditto, Jemmot, & Darley, 1988; Kunda, 1987; Quattrone & Tversky, 1984). In this way, people are able to operate under the belief that death is around someone else’s corner, not theirs. Because conscious thoughts of death are posited to provoke direct efforts

to minimize the threat posed by the awareness of mortality, these defenses should be unnecessary once the problem of death is no longer conscious. Greenberg, Arndt, Simon, Pyszczynski, and Solomon (2000) report findings in accord with this hypothesis. Specifically, when participants were provided with information suggesting that emotionality was associated with a shorter life expectancy, they biased their self-reports of their own emotionality (i.e., claimed they were less emotional) when this assessment immediately followed an explicit mortality salience treatment; however, they did not do so after a delay. There thus appear to be a variety of ways that individuals may respond to conscious thoughts of death that ironically do little to actually productively deal with the problem. Moreover, these less adaptive responses – often taking the form of distortions that only minimize and avoid the matter of mortality – may be more prevalent than pro-active responses to reminders of mortality. As Festinger (1957) noted with regard to smokers, it is much more difficult to change entrenched behavior patterns than it is simply to use cognitive strategies to avoid or rationalize away threats. Such responses, while reducing conscious focus on the idea of death, do so at potentially considerable cost because they may contribute to the actual occurrence of death. Of course, many people often do respond to conscious death concerns by taking pre-emptive measures to improve their health or reduce their vulnerability to disease and death. Whereas some people seem particularly motivated to deny, suppress and avoid dealing with their mortal vulnerabilities, others seem to actively wage war against health problems by maintaining an exercise regiment, improving their diet and getting recommended health screenings. One important question, then, is who are these people who actively confront information about their vulnerability to health risks (and death) with health promotion? Recent research suggests that an individual’s level of health optimism may play a critical role in determining reactions to conscious thoughts about mortality (Arndt et al., 2005). This study used a community sample of women and found a significant interaction between level of health optimism and mortality salience such that immediately after reminders of death, level of health optimism was significantly and positively related to women’s intentions to conduct breast self-exams and interest in participating in a (purported) study in which they would conduct a breast self-exam. Similarly, those individuals who adopt adaptive coping strategies tended to respond to explicit thoughts of mortality by reporting higher desires for health information, whereas those who use less adaptive coping strategies tended to report lower desires for health information after mortality thoughts were explicitly activated. These studies thus suggest that individual differences in attitudes about one’s health may play a critical role in determining whether or not people will actively confront the many health issues that affect the quality and longevity of their lives. The challenge for future research, then, is to uncover ways to foster these kinds of productive responses.

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2.2. Consequences of self-esteem striving to manage unconscious mortality concerns The proximal defenses reviewed above operate under the auspice of rationality. In contrast, the distal defenses provoked by unconscious reverberations of death-related cognition are directed toward the symbolic conception of self as a valuable and meaningful entity. In our review of the theory, we noted the tendency for death-related thought outside of focal attention to elicit increased investment in one’s worldview relevant beliefs. To be sure, this investment – often but not always reflected in forms of ingroup and outgroup bias – can be seen as having considerable implications for understanding prejudice, aggression and other forms intergroup strife (see, e.g., Pyszczynski et al., 2003). However, such consideration is beyond the scope of this article, where our focus lies more with the problematic individual consequences of efforts to manage one’s awareness of inevitable finitude. As reviewed earlier, in addition to the effects of mortality salience on worldview defense, a host of studies have also documented the propensity for reminders of death to motivate self-esteem striving (see Pyszczynksi et al., 2004 for a comprehensive review). The basic hypothesis driving this research is that, if self-esteem serves the vital function of protection from deeply rooted existential anxiety, when reminded of the source of that anxiety (i.e., one’s inevitable mortality), individuals will strive more vigorously to meet relevant standards of value. Thus, the terror management perspective departs from some recent views that cast self-esteem pursuit either directly or indirectly in a negative light (e.g., Baumeister, Bratslavsky, Finkenauer, & Vohs, 2001; Crocker & Park, 2004). The theory suggests that self-esteem represents a beneficial (and essential for equanimity) resource via its capacity to buffer the potential for existential anxiety. Without self-esteem, people would be paralyzed in a valueless vacuum, bereft of standards of conduct by which to facilitate social interaction and guide behavior. Indeed, as we propose later in this article, it may be the absence of self-esteem and or a sense of existential meaninglessness that contributes to a variety of forms of psychopathology. But this is not to say that there are not problematic aspects to self-esteem striving. As Crocker and Park (2004) review, the pursuit of self-esteem can often lead to a defensively oriented creature hungry for social approval and driven to distortion, bias and misplaced energies.3 In our view, self-esteem striving and the implicated psychological pro3 It is also important to point out that recent theory and research have uncovered a number of important global distinctions in types of self-esteem that may vary in their implications for defensiveness and psychological well-being. For example, building in large part from Kernis and colleagues’ attention to stability in self-esteem levels (see Kernis & Waschull, 1995), research has been examining differences in implicit versus explicit selfesteem (e.g., Pelham, 1997), contingent versus authentic self-esteem (e.g., Deci & Ryan, 1995) and intrinsic versus extrinsic bases of self-worth (e.g.,

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cesses that fuel its pursuit are not good or bad, they just are. That is, the valenced character of self-esteem pursuit fundamentally depends on the nature of the values through which one seeks to acquire a sense of self worth. In many situations, these standards can promote behavior that is harmful to others and or individually psychologically (or physically) problematic. However, in many other situations, different standards through similar processes promote behavior that is benevolent and psychologically rewarding. Recent terror management work has examined both such consequences. Recall, for example, the findings of Arndt et al. (2003), wherein conscious thoughts of death lead to increased fitness intentions. Importantly, this effect was obtained regardless of the relevance of fitness to an individual’s sense of self-worth; presumably because the effect reflected proximal efforts to rationally diffuse vulnerability to health risks. However, how does mortality salience affect exercise intentions when thoughts of death are allowed to fade from focal attention? In this case, Study 2 of Arndt et al. (2003) found that it was only those for whom fitness was relevant to self-esteem that non-conscious death thoughts increased exercise intentions. In this context, then, one sees mortality salience exerting a “positive” effect (increasing exercise intentions). That is, if one’s sense of self-worth is derived from a physically or socially beneficial domain (e.g., exercise), non-conscious death thoughts should provoke investment in that domain. Other positive self-esteem relevant effects of mortality salience have also been uncovered in a number of different domains. As examples, Jonas, Schimel, Greenberg, and Pyszczynski (2002) found that reminders of death increased donations to national (but not foreign) charities. Joireman and Duell (2005) extended this effect to a more generalized increase in pro-social values. Interestingly, whereas Kasser and Sheldon (2000) found that mortality salience increased greed and materialistic endorsement, Cozzolino, Staples, Meyers, and Samboceti (2004) found that imagining a neardeath experience led to less endorsement of materialistic and self-serving values. Jonas, Martens, Johns, Greenberg, and Reis (2005) offers some clarification of these seemingly disparate results. This research demonstrated that the propensity for reminders of death to stimulate greed versus benevolent reactions stems at least in part from the particular norms that are currently salient (see Arndt, Solomon et al., 2004, for a review of TMT applications to materialism). Thus, there does indeed appear to be the potential for the awareness of mortality to stimulate self-esteem and related goal striving in ways that can have benevolent and productive consequences. Unfortunately, this is only one slice of the motivational pie. A number of studies elucidate the potential for people’s awareness of death to actually motivate behaviors that, on Schimel et al., 2001). Although there are important differences between these views, they all tend to share a focus on elucidating factors that contribute to different needs for defending a sense of self-worth versus developing a more optimal and expansive sense of self value.

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the surface, appear quite antithetical to prolonging one’s life. While this is true in a physical sense, on a symbolic level, these behaviors may enable individuals to gain feelings of self-esteem and in so doing buffer the potential for anxiety associated with the awareness of death. The first evidence for this particular point was provided by Taubman Ben-Ari, Florian, and Mikulincer (1999) on their research with risky driving behavior. In this series of studies, reminders of mortality led people who had previously indicated that they derived feelings of esteem from their driving ability to not only report that they wanted to drive faster, but to actually take more risks while driving in a driving simulator. Miller and TaubmanBen-Ari (2004) have uncovered similar effects with regard to intentions to engage in risky scuba diving behavior. These latter studies also demonstrate, following Arndt and Greenberg (1999) and Harmon-Jones et al. (1997), how a more global sense of self-worth can provide a buffer from the distal effects of mortality reminders. Specifically, Miller and Taubman Ben-Ari found that a mortality salience manipulation was especially likely to increase risky scuba diving intentions among those who had low overall self-esteem but high scuba diving self-efficacy. Additionally, Hirschberger, Florian, Mikulincer, Goldenberg, and Pyszczynski (2002) showed that for males, for whom risk-taking is more selfesteem relevant, these effects generalized to a variety of risk-taking behaviors, including drug and alcohol use. The motivation to pursue self-esteem as a means to buffer existential fears also has the propensity to create physical health problems in a variety of other ways. Many of these problems, at least in Western cultures, appear to stem from the cultural emphasis on viewing particular standards of physical attractiveness as an important contingency of self-worth (e.g., Crocker & Wolfe, 2001). The ubiquity with which beautiful bodies saturate the media attests to the popular appeal of such standards. We later turn to specific psychological problems that may be engendered by existential concerns associated with the physical body. Here, we note that because nonconscious death-related thought triggers increased efforts to maintain self-esteem, to the extent personal value is contingent on being attractive, reminders of death should intensify the importance of physical attractiveness (Goldenberg, McCoy, Pyszczynski, Greenberg & Solomon, 2000). Because women more than men are evaluated on the basis of their appearance (i.e., objectified, e.g., Fredrickson & Roberts, 1997), this should be particularly the case among women. Consistent with this reasoning, research indicates that mortality salience increases the objectification of women by women, the tendency for women to self-objectify (i.e., evaluate themselves based on appearance rather than competence), and the tendency for people, regardless of gender, to self-objectify more when their self-worth is invested in their attractiveness (Grabe, Routledge, Cook, Anderson, & Arndt, 2005). These general findings, in turn, have implications for understanding some of the physical and psychological problems that result from self-esteem oriented pursuits related to maintaining a culturally sanctioned level of physical attractiveness.

Recall, for example, the previously referenced study by Routledge et al. (2004) showing that conscious death reminders lead to an increased desire to use protective sun lotion. How do we reconcile this finding with, on the one hand, what we have claimed are ubiquitous reminders of death and, on the other hand, the countless hours that are directed to sun tanning? From a TMT perspective, such appearance oriented enhancement behavior can be understood as efforts, in part, to maintain the sense of self-worth that provides vital protection from, not the conscious fear of death, but from its unconscious reverberation. If this is the case, then when mortality concerns are activated but allowed to fade from focal attention, intentions to engage in tanningrelated behavior should increase for those individuals who derive self-esteem from their appearance. This is exactly what was found by Routledge et al. (2004). To the extent that advertisements perpetuate the appeal of tan skin as a standard of attractiveness, they may highlight a self-esteem enhancing strategy that people can use to protect themselves from unconscious death-related thought. Routledge et al. (2004) conducted a follow-up study that is consistent with this implication. Participants were reminded of their mortality, or as a control topic, thoughts of uncertainty. After a delay, participants were then presented with one of two advertisements for a new store, The Beach Company, that was purportedly soon to open locally. In one condition the advertisement featured a well-tanned, attractive woman in a bikini swimsuit and in the other condition the advertisement featured a beach ball. Subsequently, participants reported how interested they would be in a variety of products The Beach Company would offer (tanning lotions, tanning services, beach toys, etc.). As expected, when participants were reminded of mortality and then primed with the advertisement of the attractive tanned woman, they were the most favorably disposed to the tanning products the store would offer. This suggests a certain degree of malleability of response to death-related cognitions as a function of salient standards for self-esteem. Presumably, the advertisement highlighted a cultural standard suggesting that tanned skin is attractive, and thereby rendered associated judgments more likely after reminders of death. The potentially adverse health consequences associated with self-esteem oriented pursuits extend beyond tanning. While maintaining the culturally desired skin tone is one way in which people try to be attractive, another is maintaining a socially accepted body size. Studies show that the overwhelming majority of women report feeling fat and dissatisfied with their body (e.g., Sondhaus, Kurtz, & Strube, 2001) and many go on to engage in excessive dieting and even eating disorders (e.g., Polivy & Herman, 1987). Dieting therefore provides another example of how self-esteem concerns can override concerns about one’s health. From a TMT perspective, this should be particularly likely when thoughts of death are highly accessible but outside of focal attention. Goldenberg, Arndt et al. (in press) examined this possibility by priming thoughts of mortality or not, and following

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a delay, measuring how much of a “nutritious but fattening snack food” women consumed. As expected, when thoughts of death were activated but outside of focal attention, women ate less than when another topic was primed. A replication of this study in a group setting found that it was those women who were over the median of body-mass index, and therefore presumably aware of their failure to meet cultural standards for body-weight, who restricted their eating as a function of mortality salience. A third experiment revealed that women who were relatively higher in body-weight became more aware of their failure to meet the cultural standards for thinness after being reminded of death. Moreover, this perceived discrepancy from a thin ideal mediated the effects of mortality salience on restrained eating. Taken together, this research speaks to the health and psychological problems that can result from pursuing selfesteem. Although self-esteem is posited to facilitate protection from anxiety, not all self-esteem is created equally in terms of its capacity to engender psychological (and physical) health. As we suggested earlier, certain contingencies of self-worth can promote greater physical and psychological risk taking, and are especially likely to do so when people are pressed with the need for managing unconscious concerns with mortality. On more global levels, research derived from self-determination theory (see, e.g., Deci & Ryan, 2000) and related perspectives makes clear that selfesteem derived from materialistic and consumptive goals can have a deleterious effect on well-being (e.g., Kasser & Ryan, 1993). Further, self-esteem derived from extrinsic sources of value, as opposed to intrinsic sources of value, can promote increased defensiveness (e.g., Schimel, Arndt, Pyszczynski, & Greenberg, 2001), and emerges as a more fragile and unstable psychological resource (Kernis, 2003). With a greater understanding of the notions that (a) people need self-esteem in large part to facilitate the management of existential terror, and that (b) certain contingencies of self-worth can engender further psychological problems, researchers will hopefully be in a better position to uncover more benevolent and adaptive self-esteem trajectories. Such research is important because, lacking the protection afforded by self-esteem and perceptions of meaning, people may be exposed to other forms of psychological dysfunction. We turn now to one such domain. 2.3. Death and depression Deficits in self-esteem and existential meaning have long been thought to play a central role in depression by a number of clinicians (e.g., Beck, 1967; Frankl, 1969; Yalom, 1980). From the perspective of TMT, depression occurs in part because some individuals lose faith in their conception of life as meaningful (Simon, Harmon-Jones, Greenberg, Solomon, & Pyszczynski, 1996). Perhaps because of precipitating events, an individual is unable to stop focusing on a lost or unattainable goal, and this perseveration leads the individual to experience deficiencies in the sense of mean-

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ing and purpose that fulfillment of the lost goal provided (see Pyszczynski & Greenberg, 1992). They develop, in other words, a tenuous immersion in a meaningful cultural worldview that ultimately provides the much needed protection from the existential awareness of mortality. Note this analysis does not discount, and can in fact be seen as complimenting, biologically and cognitively based perspectives. A number of findings suggest depressed individuals do indeed suffer from a lack of perceived meaning in life as well as from a preoccupation with death. For example, depressed individuals have been found to report morbid thoughts and appear less able to repress dismal cognitions associated with thoughts of death (Kunzendorf & McLaughlin, 1989). More broadly, a number of studies reveal negative correlations between level of depression and various measures of the extent to which life is regarded as just, purposeful and meaningful (e.g., Crumbaugh, 1968; Davis, Nolen-Hoeksema, & Larson, 1998; Emmons, 1992; Kunzendorf & Mcguire, 1995; Lipkus, Dalbert, & Siegler, 1996).4 The initial strategy for examining the manifestation of (inadequate) terror management mechanisms in depression was to reason that if the cultural worldview is what imbues life with meaning, then this deficit in meaning among depressed individuals may indicate tenuous faith in their cultural worldview. Therefore, individuals who are depressed should be especially vulnerable to thoughts of death, and thus have a particularly great need to strengthen their investment in their worldview when reminded of their mortality. Simon et al. (1996) examined the merits of this hypothesis in two studies wherein mildly depressed subjects wrote about their mortality or a control topic and then evaluated targets who praised or derogated their worldview. In the first study, participants evaluated targets that threatened and supported beliefs about the United States, and in the second study, participants were recruited who either favored or opposed legalization of flag burning and then were asked to evaluate targets who both supported and opposed their view. The results indicated that those with mild depression show more vigorous defense of their beliefs when reminded of death. In the absence of mortality salience, mildly depressed individuals exemplified particularly low defense of their worldview. In contrast, when exposed to mortality salience, mildly depressed participants demonstrated higher levels of worldview defense when compared to either non-depressed participants exposed to mortality salience or mildly depressed participants not exposed to mortality salience. Simon et al. (1996) argued that this occurred because mildly depressed participants are less well insulated by the worldview. A reminder of mortality was therefore particularly threatening 4 Of course some depressed individuals may not consciously focus on issues of meaning, and certainly some do not manifest a pre-occupation with death-related thoughts. However, following Pyszczynski and Greenberg (1992), we suggest the issues that pervade consciousness for depressed individuals may often pertain more to the subordinate concerns and goals, rather than the underlying superordinate concerns.

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for them, engendering intensified efforts to bolster faith in their worldview. If this interpretation is correct, how then might these findings be used to uncover ways to augment the deficits in meaning that those with depression often report? According to Simon, Arndt, Greenberg, Solomon, and Pyszczynski (1998), these intensified reactions to those who impinge on the cultural worldview following mortality salience may serve to reinvest mildly depressed persons in their belief system, increasing faith in the worldview. This may allow them to benefit more from the perceptions of meaning the worldview is posited to provide. That is, expressing distain for the person who criticized America or liking for the person who supported America, may serve to remind mildly depressed participants that there are, in fact, things worth caring about. It may be that this sense of investment is, at least in part, what enables people to see life as meaningful. To examine this possibility, Simon et al. (1998) followed Simon et al. (1996, Study 1) and exposed mildly depressed and non-depressed American college students to a mortality salience or control manipulation, and then had them read essays that either supported or threatened beliefs about the United States. The researchers further manipulated whether after reading the essays, participants were able to defend their worldview by evaluating the essays or were not given the opportunity to evaluate the essays and thus could not defend their worldviews. All participants then completed a scale designed to measure the perception of meaning in life (Kunzendorf & Mcguire, 1995). The results revealed a significant three-way interaction that was in accord with hypotheses. Mildly depressed participants reported less meaning in life than their non-depressed counterparts, except when they defended their worldviews in response to mortality salience. In this latter condition only, depressed individuals perceptions of meaning in life were just as high as those of the non-depressed. These results provocatively suggest that behaving defensively to bolster the integrity of one’s worldview in response to mortality salience may in part serve to reinvest mildly depressed persons in a conception of the world that carries with it the feelings that life can be meaningful and worthwhile. For ethical reasons this research has only been conducted with those who report significant symptoms of depression (i.e., scoring highly on the Beck Depression Inventory) but not with samples that have been clinically diagnosed. Thus, generalizations must be offered with extreme caution. Notably, however, these findings are consistent with the perspective advanced by existential psychotherapists (e.g., Yalom, 1980) and support the possibility that confrontation with one’s mortality may stimulate depressed persons to find the sense of meaning they previously lacked. Of course, in the present research, this was presumably accomplished by reminding people of their mortality and then giving them the opportunity to defend their sense of national pride after it had been attacked or supported. Such biased reactions have their own unfortunate intergroup consequences (see, e.g., Arndt et

al., in press). Future research may thus benefit from studying the extent to which other more benevolent worldview relevant beliefs could be used toward similar ends. For example, a number of studies indicate that mortality salience can intensify commitments to intimate relationships (see Mikulincer et al., 2002) as well as certain prosocial values (e.g., Jonas et al., 2002). In this way, with further research, confrontation with existential concerns and the subsequent encouragement to invest in worldview beliefs may be one way in which the deficits in meaning experienced by those with depression can be mitigated. 2.4. Anxiety disorders as terror mismanagement As discussed earlier, TMT posits that cultural worldviews and self-esteem provide an anxiety buffer that allows people to navigate through life without having to fully consider the uncertain, cosmically insignificant and ultimately terminal nature of physical existence. Thus, not surprisingly, the theory implies that a relative inability to manage death concerns should leave people more vulnerable to anxiety and associated psychological disorders. From this perspective, then, anxiety-related disorders may develop, in part, as attempts to compensate for compromised means of buffering existential anxiety (Strachan et al., 2005). Faced with ineffective management of existential anxiety via socially acceptable mechanisms, people may fixate on specific threatening aspects of life that they believe they can exert control over as a way to redirect and manage underlying concerns about death. A recent series of studies by Strachan et al. (2005) has found support for the basic tenets of this analysis by examining the effects of mortality salience on individuals meeting diagnostic criteria for spider phobia (Study 1) and individuals showing obsessive-compulsive tendencies (Study 2). In Kosloff et al. (2005), two additional studies apply this analysis to dissociation and anxiety sensitivity after reflecting on a trauma. 2.4.1. Phobias Currently, the exact origin of phobias is unknown, although genetic factors, classical conditioning, social learning experiences and cultural factors are recognized as playing a potentially important role (see, e.g., Merckelbach, de Jong, Muris, & van den Hout, 1996, for a review). We suggest that further insight can also be gained by considering that for certain people phobias may serve an existential function of providing a sense of control over anxiety ultimately rooted in the awareness of mortality. Though people can take certain precautions to reduce the risk of death, they cannot stop the passing of time or the inevitability of physical demise. Most people are sufficiently protected from the full psychological impact of this reality via the complete immersion into a cultural meaning system. However, for certain individuals, in this case phobics, death concerns are not adequately managed by cultural investments and therefore must be dealt with in some other way. Latching onto a specific physical threat

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that one can exert control over is one potential way in which such unbuffered death fears can be combated. In this light, Strachan et al. (2005) posited that activating thoughts about death should increase phobic tendencies for those who have phobias. Study 1 of this research specifically hypothesized that if phobias help people manage underlying concerns about death, then reminders of death should increase fear reactions in spider phobics but not non-phobics. To test this idea, participants who had previously been clinically classified as spider phobic or not were exposed to a mortality salience or control topic induction and were then presented with neutral and spider pictures. The amount of time that participants spent viewing the different pictures was recorded. In addition, participants completed a measure of how much of a threat the pictured spiders pose to humans. Consistent with the hypothesis, spider phobics reminded of death, compared to a control condition, showed increased avoidance of spider pictures (as measured by average viewing times of spider pictures) and increased perception of threat from the spiders in those pictures. However, these effects did not emerge among non-spider phobics. 2.4.2. Obsessive-compulsive disorder Like phobias, there is little consensus as to what causes the onset of obsessive-compulsive disorder (OCD), although presumably neuropsychological deficits, conditioning and cognitive factors play an important role (see, e.g., Salkovskis, Shafran, Rachman, & Freeston, 1999; Wilson, 1998). In addition, however, TMT suggests that OCD, like phobias, may manifest in situations in which death concerns are not being sufficiently managed by cultural beliefs that make the threat of mortality seem controllable and less threatening (e.g., symbolic transcendence of death). In such situations, people may react by trying to reassert a sense of control over specific perceived threats (e.g., germs, disease, potential physical dangers). OCD sufferers may thus lack the psychological fortitude needed to dismiss or ignore relatively low-risk threats and fixate on such threats because they are more manageable and controllable than the looming existential reality of mortality. That is, like phobias, OCD may, in part, be a redirection of underlying fears about death. Strachan et al. (2005) thus hypothesized that if obsessivecompulsive behavior helps people manage underlying concerns about death then reminders of death should increase obsessive-compulsive behaviors among individual who show OCD tendencies, but not individuals without such tendencies. To examine the merits of this hypothesis, participants previously identified as having OCD tendencies (or not) were recruited and completed a variety of materials including a mortality salience or control manipulation. Subsequently, participants were led to believe that the experimenter was taking some physiological measurements. At this point, the experimenter placed gel on the participant’s hand for the supposed purpose of improving the machine’s ability to record physiological data. After the experimenter finished with the fictitious physiological measurement, participants were told

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that they could wash the gel off of their hands. The amount of time taken and number of paper towels used was recorded. Consistent with the hypothesis, participants who had been classified as demonstrating OCD tendencies, relative to participants not demonstrating such tendencies, responded to mortality salience, compared to a control condition, with significant increases in compulsive-hand washing (i.e., longer duration and increased number of towels used). In sum, research demonstrates that thoughts about death exacerbate symptomatic behaviors for spider phobics and people with obsessive-compulsive tendencies. These findings are consistent with the notion that anxiety related to death may play a role in the development and persistence of anxiety-related disorders. Specifically, people may fixate on specific threatening aspects of life that they believe they can exert control over as a way to redirect and manage underlying concerns about death. 2.4.3. Dissociative reactions to trauma Whereas phobias and obsessive fixations attempt to transform underlying mortality fears to more manageable threat fixations, there are clearly situations in life that make intolerably salient the unavoidable and uncontrollable threat of mortality. According to recent work by Gershuny and colleagues (Gershuny & Thayer, 1999; Gershuny, Cloitre & Otto, 2003), in traumatic situations in which people cannot control or avoid the threat of mortality, they often protect themselves from the overwhelming presence of the threat of death by emotionally disengaging from the traumatic experience. This dissociative reaction then becomes a means of coping with trauma (van der Kolk, van der Hart, & Marmar, 1996) that reflects a process of depersonalization and fragmentation of thoughts and emotions related to a traumatic event (e.g., Steinberg, 1995). Though dissociation serves to disconnect one from the immediate emotional ramifications of a traumatic experience, this form of psychological defense is ultimately problematic because it leaves the emotional repercussions of the event unresolved and thus can lead to chronic stress-related problems (e.g., Griffen, Resick, Mechanic, 1997). For example, dissociation is often considered an important precursor to pathologies like post-traumatic stress disorder (Foa, Riggs, & Gershuny, 1995), borderline personality disorder (ZweigFrank, Paris, & Guzder, 1994), and eating disorders such as bulimia (van Ijzendoorn & Schuengel, 1996). Thus, like other death-denying defenses (e.g., denying vulnerability to health problems), dissociation provides immediate psychological relief but may ultimately lead to other potentially serious problems. Building from this work, Gershuny et al. (2003) hypothesized and found that peritraumatic dissociation predicted post-traumatic stress disorder symptoms, and that this relationship was mediated by thoughts of death. Taking this analysis one step further, Kosloff et al. (2005) examined these relationships in an experimental manner. Specifically, these researchers examined the effect of mortality salience

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on reactions to a traumatic experience that had a significant collective psychological impact on Americans, the terrorist attacks of September 11, 2001. This study posited that in situations in which the salience of mortality is coupled with an uncontrollable and unavoidable threat (a terrorist attack), people may defend themselves via a process of dissociation which will in turn lead to increased susceptibility to anxiety. In accord with this hypothesis, among a sample of New York City students recruited to participate in the study, participants in the mortality salience condition, compared to the control condition, showed significantly higher levels of dissociative reactions (e.g., higher levels of agreement with statements like, “There were moments when I wasn’t sure about where I was or what time it was.”) to thinking about September 11 and significantly higher levels of anxiety sensitivity. Further, dissociation significantly predicted anxiety sensitivity, and the effect of mortality salience on anxiety sensitivity was mediated by dissociation. Interestingly, whereas dissociation after mortality salience led to increased anxiety sensitivity, in a second study Kosloff et al. found that a more typical form of worldview defense (e.g., like those described earlier) did not. This suggests that dissociation may indeed create its own unique psychological problems. These findings further our understanding of how terror management processes relate to pathologies that originate from traumatic experiences. TMT suggests that people invest in cultural belief systems that allow them to deny mortality in some fashion. However, in certain life circumstances, such as a traumatic event, the reality of death is impossible to avoid or control. The research of Kosloff et al. (2005) and Strachan et al. (2005), coupled with previous research by Gershuny and colleagues (1999, 2003), suggests that in such situations, people emotionally shut-down as a way to cope with the uncontrollable and unavoidable threat of mortality. This defense against death concerns may in turn ultimately pave the way for a host of psychological problems. As hinted at earlier, this example of the potential effects of unavoidable confrontations with mortality highlights the importance of pre-emptive symbolic defenses. In addition, this research suggests that traumatic events can have a significant impact on people even if they are not directly involved in the traumatic event. The findings of Kosloff et al. were produced by individuals who were reflecting back on the terrorist attacks. These participants were therefore not actually in any physical danger as they were completing the materials of the study. Yet, they still experienced the process of dissociation and the resultant increase in anxiety sensitivity after mortality salience. This suggests the possibility that particularly threatening traumatic events can create psychological ripples beyond the obvious effects such events have on those individuals who experience the trauma first-hand. Indeed, recent research by Landau and colleagues (2004, Study 2) found that subliminally priming the digits 911 or the letters WTC (for World Trade Center) in October 2001 significantly increased the accessibility of death-related cognitions among mid-western college students who were far

removed from the attacks in New York City. This finding suggests that the September 11 terrorist attacks were traumatic enough for people who were not physically present during the attacks that even the presentation of 911 and WTC outside of conscious awareness was sufficient to activate death-related cognitions. 2.5. Psychological discomfort with the physicality of the body Thus far our application of TMT to understanding psychological dysfunction has focused on the ways in which conscious and non-conscious concerns about death can promote maladaptive or ineffective ways of buffering existential anxiety. There are also additional facets of peoples’ existential reality that pose a psychological burden and can thus contribute to further difficulties in navigating through a social world. In this light, one important domain to consider revolves around the physicality of our existence. As we have outlined, the terror management solution to the problem of death is for people to live their lives on an abstract symbolic plane. People cope with the threat of death by embedding themselves in a meaningful culture and living up to the culture’s standards. In this way people elevate themselves above the rest of the animal kingdom. The lion roars, but people speak. But the question remains, how then do we cope with our physical bodies, the part of ourselves that is absolutely certain to die and decay? In a recent extension of TMT, Goldenberg, Pyszczynski, Greenberg, and Solomon (2000; see also, Goldenberg, in press) have addressed just these types of questions. An examination across history and cultures reveals that although the body is the vehicle through which we experience much pleasure, it is also a source of anxiety and inhibition. People engage in countless practices to deny and distance their self from their physical nature (e.g., dressing, grooming and feeding the body according to cultural rules of decorum). This is a point poignantly made by Swift (1730) in his classic poem, “Lady’s Dressing Room”, where the protagonist, Strephon, is shocked by the creaturliness of his adored Cecila. So things, which must not be expressed, When plumped into the reeking chest, Send up an excremental smell To taint the parts from whence they fell. The petticoats and gown perfume, Which waft a stink round every room. Thus finishing his grand survey, Disgusted Strephon stole away Repeating in his amorous fits, Oh! Celia, Celia, Celia shits! This theoretical analysis suggests that such reactions to the human body can be attributed at least in part to that worm at the core—our awareness of inevitable death. Consistent with this hypothesis, on their measure of sensitivity to disgust, Haidt, McCauley, and Rozin (1994) found that items

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assessing contact with death (e.g., “touching a corpse”) were most predictive of overall disgust sensitivity. This finding fits nicely within the framework offered by TMT, in which concerns about mortality underlie the need to distinguish ourselves from animals and disgust can be understood as an emotional distancing from anything that threatens this need. In support of this position are also a number of experimental findings. For example, Goldenberg et al. (2001) showed that reminding participants of their mortality led to an increase in the experience of disgust on the Haidt et al. (1994) measure. Cox, Goldenberg, Pyszczynski, and Weise (2005) found that the accessibility of death-related thoughts increased when people were primed with disgust-provoking stimuli. More direct support for the hypothesis that mortality concerns fuel a need to distance oneself from one’s animal nature is evidenced by death reminders leading people to respond more positively to an essay that described humans as distinct from other animals, and to like it significantly more than an essay that emphasized the biological similarities between humans and animals (Goldenberg et al., 2001). Conceptualizing difficulties with the body as rooted in part in peoples’ trepidation about their mortality affords a number of insights into a range of applied domains. It further shows the breadth of psychological problems that can be understood from a TMT perspective. For example, if people are threatened by the physical aspects of their bodies, it follows that there would be important implications for attitudes about sex. This perspective thus offers an explanation for why, despite its capacity for immense pleasure, people often seem quite conflicted, embarrassed, guilty or anxious about sex (e.g., Kahr, 1999). A number of studies support the notion that the negative side of ambivalence about sex is fueled by the potential for sex to make salient our animal, and thus mortal, nature. For example, Goldenberg, Cox, Pyszczynski, Greenberg, and Solomon (2002) manipulated how likely participants were to perceive sex as an animalistic act. Specifically, participants were randomly assigned to read one of the two aforementioned essays that highlight either the similarities between humans and other animals (i.e., creatureliness) or human uniqueness. In a first study, the essay prime was followed by a mortality salience manipulation and then a measure of the appeal of physical and romantic aspects of sex. When the similarities between humans and animals were made salient via the creaturely essay, reminders of death decreased the appeal of physical, but not romantic (and hence uniquely human), aspects of sex. In the human uniqueness essay condition, mortality salience had no effect on the appeal of sex. In a second study, after reading one of the two essays, thoughts about either physical or romantic aspects of sex were primed and participants then completed a death-thought accessibility measure. When participants were reminded of their creatureliness (but not when human uniqueness was primed), thinking about physical, but not romantic, aspects of sex increased the accessibility of death-related thoughts. These findings provide unique evidence that sex can pose a psychological

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threat due to the connection between its physical aspects and reminders of one’s physicality. In addition to psychological reactions to sex, there are also implications of this perspective for physical health. If people are threatened by the physicality of the body, then healthpromoting activities that involve an intimate confrontation with the physicality of the body may be avoided due to the associated existential threat. Goldenberg, Arndt, Routledge, and Hart (2005) recently demonstrated support for this idea in a series of studies concerning women’s breast self-examinations (BSE). Although researchers investigating BSEs have found embarrassment and anxiety to be inhibitory factors (e.g., Olson & Morse, 1996), research has yet to elucidate the source of, or the conditions that contribute to, this discomfort. Of course, there are many factors that may make screening behaviors threatening, most notably the fear of detecting cancer. The research of Goldenberg et al. (2005a, 2005b) suggests, however, that this activity is also problematic because it involves treating the body as a biological entity. Essentially, the breasts are treated as mounds of flesh through, which one must kneed in search of abnormalities which may be indicative of cancer. Therefore, when concerns about death are activated, a creaturely conception of the body should increase a sense of existential discomfort with breast exams and thus undermine one’s willingness to engage in such a behavior. In an initial experiment on this topic, Goldenberg, Arndt et al. (2005) primed college women with reminders of their mortality or a control topic, and exposed them to the creatureliness or human uniqueness essay. Participants then reported their intentions to conduct BSE in the future. The results revealed a significant interaction such that women who were primed with death in the context of being reminded of their creatureliness reported decreased intentions to conduct BSE. Mortality salience in the absence of the creaturely reminder did not decrease intentions to conduct BSE, suggesting that it is not merely fears associated with mortality that contribute to this effect but specific difficulties associated with the threat posed by the physicality of the body. Additional analyses revealing that decreased intentions were not accounted for by worry about breast cancer also suggest that that the exam itself poses a unique threat separate from concerns about cancer. Although these effects were found only when thoughts of mortality had been primed, in subsequent studies more realistic confrontation with BSEs (which were shown to make thoughts of death accessible) were sufficient to obtain theoretically predicted effects. For example, in a study in which women performed exams on a breast model, women receiving the creaturely essay conducted shorter exams than both the human uniqueness essay and a no-essay condition. Another experiment had women at greater risk for breast cancer (i.e., age 35 and up) actually conduct a BSE on their own breasts while the time was surreptitiously recorded. This study also included a classic misattribution of arousal manipulation (e.g., Zanna & Cooper, 1974) to directly address the assumption that reminders of one’s physicality increase the

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distress that one experiences when faced with a BSE, and that this distress undermines the behavior. Briefly, after the creatureliness essay, exam times were reduced when participants had no alternative explanation for their discomfort compared to when participants were provided with a discomfort inducing placebo, and thus had a reasonable alternative source to misattribute their discomfort. Becker (1973) contends that “the body is a universal problem to a creature who must die” (p. 164). According to TMT, symbolic culture transforms the body, and provides a means through which people can feel that they are transcending it. That is, the body is stripped of its creaturely connotations when it conforms to cultural prescriptions and standards. Research on the objectification of women (Fredrickson & Roberts, 1997) suggests that women are particularly likely to be transformed into cultural objects, and Goldenberg and Roberts (2004) have argued that one reason this might be the case (in addition to socio-political factors) is that women are more closely linked to the very creaturely process of reproduction. For it is women who menstruate, lactate and gestate and to the extent that these processes can serve as threatening reminders of one’s creatureliness, objectification can serve as a means of distancing women from this threat. That is, objectification of the body involves transforming it from a physical entity into a cultural symbol in which the body is evaluated according to the rules and standards of the culture. Roberts, Goldenberg, Power, and Pyszczynski (2002) provided initial support for this notion by showing that male and female participants not only devalued a woman who revealed her menstrual cycle (by accidentally dropping a wrapped tampon), but they also responded by viewing women in a more objectified light (i.e., placing greater importance on women’s appearance). This research suggests applications, not only for understanding attitudes towards women, but also for understanding objectification of one’s own body by women. Consistent with this position, as noted previously, Grabe et al. (2005) demonstrated that reminders of mortality increase self-objectification among women, and that this was especially true among individuals who based their self-esteem on their appearance. To the extent that there are psychological consequences associated with self-objectification (e.g., shame and anxiety regarding the body, Noll & Fredrickson, 1998; diminished awareness of internal bodily states, Tiggemann & Slater, 2001; decreased mental performance and restrained eating, Fredrickson, Roberts, Noll, Quinn, & Twenge, 1998), this is of particular concern. Thus, there are threats associated with the physicality of the body, but a solution that involves transforming the body into a cultural symbol poses a number of other psychological and also physical health risks. 2.6. The plight of the neurotic Unlike depression and anxiety disorders, contemporary classifications do not designate neuroticism as a clinical diag-

nosis (DSM-IV; American Psychiatric Association, 1994), but yet, there is a broad class of symptoms and characteristics associated with neuroticism. At a most basic level, neuroticism can be defined as a broad dimension of individual differences in the tendency to worry, be anxious and experience negative emotions (e.g., Costa & McCrae, 1985; Eysenck, 1967). Consistent with research on depression and anxiety disorders, there is evidence that genetic differences predispose some individuals to be more neurotic than others (e.g., Lesch et al., 1996). However, when seeking to understand the more proximal mechanisms that contribute to the manifestation of neurotic symptoms, a number of insights can be garnered by considering the way individuals high and low in neuroticism manage existential terror. Most theorists and researchers converge on the idea that neurotics are predisposed to have difficulties because they are emotionally hyper-reactive and therefore unstable (e.g., Eysenck, 1967; Gray, 1982; Larsen, 1992). For example, naturalistic studies (Suls, Green, & Hillis, 1998) as well as controlled experiments (Gross, Stutton, & Ketelaar, 1998) demonstrate that, even after adjusting for prior mood, neurotics are more reactive to daily and emotional stressors. They also exhibit less adaptive coping strategies (Gunthert, Cohen, & Armeli, 1999) and poor coping contributes to negative affectivity (Gunthert et al., 1999; Suls et al., 1998). So although neuroticism is predictive of mood, researchers have demonstrated that it is distinct from mood (Nolan, Roberts, & Gotlib, 1998; Wakefield, 1989). Some researchers suggest that cognitive processing styles (i.e., ruminative, apprehensive, vigilant and negativistic; Gray, 1982; Larsen, 1992; Nolan et al., 1998; Tellegen, 1985) may mediate the relationship between neuroticism and affect. Applying these ideas to our analysis of terror management processes, this work suggests that the mechanisms necessary for successful defense of existential concerns would be more difficult to engage and sustain for individuals high in neuroticism. Specifically, the ability to maintain a sense of meaning and value should be more difficult for individuals who are emotionally labile and prone to negative interpretation of events. Consistent with this notion, neuroticism is negatively correlated with perceptions of the world as meaningful (Addad, 1987; Gibson & Cook, 1996) as well as self-esteem (e.g., Roberts & Kendler, 1999). Individuals high in neuroticism also suffer more from anxiety about death (e.g., Loo, 1984). It is not surprising then that individuals high in neuroticism are at increased risk for other disorders implicated in terror management, including anxiety disorders (e.g., Slade, 1974) and depression (e.g., Roberts & Kendler, 1999). These correlational findings suggest that high neurotics should be especially threatened by mortality reminders and may lack the mechanisms to productively manage deathrelated fears. Recent experimental evidence converges with these hypotheses. For example, whereas those low in neuroticism respond to reminders of death with increased desires for personal control, those high in neuroticism respond to such reminders with decreased desires for personal control

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(Arndt & Solomon, 2003). In a second experiment, Arndt and Solomon provided evidence that an important component of low neurotic’s mortality salience induced desire for control is the extent to which they can maintain confident faith in their cultural worldview. After being exposed to a threat to the worldview in the form an essay attacking the US, low neuroticism participants responded to mortality salience like high neurotics in the absence of worldview threat, moving in the direction of desiring less control. These findings buttress our suggestion that neurotic individuals lack those meaningful belief structures and are thus exposed to greater difficulties in their management of concerns associated with the awareness of mortality. The lion’s share of research concerning neurotic individuals’ difficulties managing existential terror, however, has focused on reactions to the physicality of the body. Goldenberg et al. (2000a, 2000b) posit that neurotics would be particularly likely to have problems with their physical bodies, because the symbolic modes of defense (meaning and value) that function to obscure the threatening link between the body and death are more tenuous for such persons. Certainly, correlational research supports the proposition that neurotic individuals have more difficulties maintaining satisfaction with their bodies (e.g., Davis, Calridge, & Brewer, 1996) and are more prone to disgust associated with their physical nature (e.g., Haidt et al., 1994) and sex (Eysenck, 1971). Other research reveals that neurotics are more attentive to their bodies’ physical symptoms and sensations and are more likely to interpret normal symptoms as pathological (Costa & McCrae, 1985; Watson & Pennebaker, 1989). A number of experimental findings further support this contention. For example, Goldenberg, Hart et al. (2005) recently demonstrated that individuals high in neuroticism but not those low in neuroticism respond to mortality salience by distancing from basic physical sensations. These findings hold true for unpleasant sensations (i.e., submerging one’s arm in ice cold water) as well as pleasurable sensations (i.e., using an electric foot massager). They do not occur for sensations that are not of a bodily nature (i.e., listening to music). Such findings in turn suggest a range of important applied implications. Consider again the domain of reactions to physical aspects of sex. According to the present analysis, the threatening association between physical aspects of sex and death should be most apparent for high neurotics; a prediction supported by a series of experiments (Goldenberg, Pyszczynski, McCoy, Greenberg, & Solomon, 1999). In Study 1 of this series, individuals scoring high in neuroticism expressed a decreased attraction to the physical, but not romantic, aspects of sex subsequent to reminders of their own death. In Study 2, thinking about the physical aspects of sex produced heightened death thought accessibility for high but not low neurotics. This finding was replicated in a third experiment that included conditions in which participants were asked to write about either love or a neutral topic. Thinking about love after thinking about physical sex eliminated the increased death-thought

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accessibility but thinking about other pleasant topics did not. This supports the proposition that people cope with the threat inherent in sexuality by attaching symbolic meaning to sex. We suspect that under ordinary circumstance this is more difficult for highly neurotic individuals. These results also shed light on at least one reason that neurotic individuals may particularly likely to be conflicted and guilty about sex (e.g., Eysenck, 1971). Goldenberg, Arndt et al. (2005) have also extended the aforementioned work on BSEs by examining neuroticism in the context of comfort with mammography. Mammograms, from this perspective, are another activity that can ultimately protect one’s health but that also serves to implicate problematic concerns with being a physical creature. This research assessed individual differences in neuroticism in keeping with our hypothesis that highly neurotic individuals are particularly apt to be threatened by the physicality of the body. In one study, when concerns about mortality were primed, reminders of one’s physical nature led women who were high in neuroticism to report reduced willingness to undergo a mammogram. A field experiment then extended this finding by showing that among women undergoing a mammogram at a cancer clinic (in the absence of any explicit mortality salience prime), exposure to the creaturely essay prime increased perceptions of physical discomfort among women high in neuroticism. Taken together, the correlational findings that neurotics suffer from a number of negative symptoms and the experimental evidence showing that mortality concerns can exacerbate such difficulties, especially in the realm of the physicality of the body, suggest that neurotics are often unsuccessful in the management of existential terror. This makes strong sense considering extensive research revealing that such individuals are emotionally liable and prone to a negative interpretation of events. Although there are certainly organic factors contributing to this tendency, an understanding of a mechanism (i.e., insufficient terror management) by which neurotics come to exhibit some classical symptoms (e.g., difficulty with sex) can offer means of alleviating the problem. For example, when neurotics were provided with a sense of symbolic meaning (by directing them to think about love in the context of sex) they were able to act with the relative equanimity of their non-neurotic counterparts (Goldenberg et al., 1999).

3. Conclusion There is little doubt that research focusing on complex cognitive mechanisms, neurological substrates and genetic precursors will continue to yield important insights into the etiology, risk factors and aggravating conditions of psychological dysfunction, and, ideally, help uncover interventions and cures. However, increasing specialization risks compartmentalization, and the larger picture of the human condition can be overlooked. In this light, a vital level of analysis is afforded by theoretically driven research that considers the

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Fig. 2. Implications of terror management defenses for psychological dysfunction.

gestalt of the human condition. This article presents one rubric through which to broadly study deeply rooted motivations underlying psychological problems. The overarching psychological predicament that is the human awareness of mortality reverberates throughout the psychological landscape to greatly impact the very foundation of the social context in which humans live. From this terror management perspective, people exert a significant amount of time and energy into maintaining a socially constructed cultural world that shines a light of hope on an otherwise hopelessly mortal existence. Cultural worldviews and the sense of self-esteem they enable provide the psychological fortitude needed to press on in the face of this potential for existential despair. However, what happens when there is a crack in our cultural armor? What happens when the cultural worldviews and feelings of self-worth that imbue our lives with meaning are undermined either by circumstances in life or our own personal dispositions? The current analysis suggests that situations (e.g., the awareness of death and creatureliness) and traits (e.g., neuroticism) that challenge the cultural anxiety buffer potentially contribute to a host of psychological problems. For it is when our psychological defenses are vulnerable or weakened that basic fears and insecurities about our mortal nature surface. Though a variety of existential scholars and clinicians have articulated a significant role for deathrelated fears in psychological distress and pathology (e.g., Becker, 1962/1971; Brown, 1959; Lifton, 1979/1983; Rank, 1936/1945; Yalom, 1980), it is only in the last 20 years that a programmatic empirical examination of these ideas was undertaken. The distinct lines of terror management research presented in the current article converge to suggest that underlying existential concerns about mortality play an important

role in the cognitive processes and social behavior that greatly affect both our psychological and physical health. A summary of these implications are presented in Fig. 2. Specifically, concerns emanating from the awareness of death have been found to impact the (1) conscious defenses that people use when confronting their mortality, (2) the nature and trajectories by which people garner self-esteem, (3) depressives identification with cultural beliefs and resultant perceptions of meaning, (4) the manifestation of reactions symptomatic of anxiety disorders, (5) broad issues stemming from the physicality of the body and (6) the psychological reactions to issues of control and physicality among those high in neuroticism. Taken together, TMT can thus be seen as offering a theoretical framework from which to understand a range of psychological difficulties. To be sure, however, more research is needed to provide a finer grained analysis of a number of issues. For example, when will concerns about mortality increase risk for certain forms of psychological dysfunction? How can social and therapeutic campaigns use these insights to assist individuals who are susceptible to the negative psychological and physical consequences of inadequately or maladaptively buffered death-anxiety? On this first front, the extant research indicates that death-related concerns can contribute to neuroticism, depression and anxiety-disorders. However, this then prompts the question: what leads some individuals to manifest neurotic symptoms whereas others become depressed or fixated on a particular localized fear object? These are undoubtedly critical questions that await the next wave of terror management research. One potential line of inquiry to pursue might entail examining differences between specific factors that contribute to the breakdown in the terror

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management system (e.g., dysfunctional family environments, exposure to traumatic events, breakdown in social networks). For example, research has shown that neuroticism is positively associated with attachment insecurity, especially among individuals who have a history of being abandoned by their relationships with close others (Shaver & Brennan, 1992). In addition to extraneous influences, the strength and resilience of one’s systems of coping can influence the manifestation of a psychopathological illness. Someone who adopts a rigid, heavily defended system of meaning might find that it crumbles under extreme trauma or stress (e.g., in the case of people with PTSD); whereas, people with a highly flexible coping system can adapt to change and incorporate new information which enables them to withstand future challenges (Pyszczynski et al., 2003). Future research should also continue to explore the second issue noted above; namely, how this analysis may be used to facilitate the development of productive social and therapeutic campaigns. From the clinical perspective, a number of approaches exist – such as that offered by Yalom (1980) in his classic text, Existential Psychotherapy – and the work reviewed here may be seen in part as providing an important empirical foundation to this approach. In these and other domains, however, additional insights may be gained. Consider, for example, the realm of health intervention campaigns. As suggested earlier, even though we as a society are constantly bombarded with medical statistics and warnings related to our vulnerability to disease, people often avoid the basic health screenings that can potentially save their lives. The current medical model builds upon the premise that humans are rational beings who will act pre-emptively if made aware of the seriousness of certain health threats. Therefore, the primary strategy for promoting healthy behavior is widespread dissemination of health statistics and information related to risk factors. However, the current analysis follows classic work on fear appeals (e.g., Leventhal, 1970) and recent urgings to consider non-rational influences on health-oriented decisions (e.g., Salovey, Rothman, & Rodin, 1998). That is, reminding people of their vulnerability to death and disease may actually decrease, not increase, pro-active health behavior if (1) death concerns are inside of conscious awareness and the individual is not optimistic about their health, (2) death concerns are outside of conscious awareness and the health behavior potentially undermines self-esteem and (3) the awareness of death is juxtaposed with peoples’ concerns about the physicality of the body. In sum, if the awareness of mortality is, in part, the metaphorical worm at the core, empirically rigorous investigations of how such awareness affects human thought and behavior may prove important for continued efforts to understand when and why people will (a) engage in risky physical behavior in order to gain self-esteem, (b) fear and obsess over low-risk threats, (c) employ maladaptive coping strategies for dealing with traumatic experiences, (d) become uncomfortable with their own physicality and (e) engage in productive health behavior. The present paper provides converging sup-

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port that neuroticism, negative attitudes toward the body, anxiety-disorders, depression and the need for self-esteem are rooted in part in the problem of death and problems with the individual’s psychological structures for coping with their mortality. In the current political and social climate where reminders of our human vulnerability and mortality have perhaps never been more pressing, where the percentage of people suffering from various psychological maladies are riding a seemingly unending escalator, we believe it is especially important to consider the implications of this analysis for understanding psychological problems.

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