International Journal of Science Annals, Vol. 6, No. 1, 2023 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa LETTERS TO THE EDITOR LETTER TO THE EDITOR Integrating Meditation Practice into Thanatophobia Therapy Ho T. T. H.1 1 Lincoln University College, Malaysia Received: 31.05.2023; Accepted: 22.06.2023; Published: 30.06.2023 Abstract Background and We explore the potential effectiveness of incorporating maranassati meditation Aim of Study: into therapeutic practices, highlighting its ability to mitigate thanatophobia and improve psychological well-being. Drawing upon Buddhist psychological perspectives, maranassati emphasizes the contemplation of mortality, impermanence, and interconnectedness. The aim of the study: to integrate Buddhist meditative practice into thanatophobia therapy. This article presents research evidence from real-world scenarios involving individuals with coronary artery disease, cancer patients, and the elderly. The initial findings provide a solid foundation, reinforcing the efficacy of mindfulness- based therapies in reducing death anxiety and improving psychological well- being. The proposed approach offers valuable insights for counselors and therapists in assisting future clients in cultivating a positive outlook on death, thereby alleviating fear and anxiety associated with mortality. Keywords: meditation, contemplating, cognitive therapy, thanatophobia, maranassati, Buddhist practice Copyright: © 2023 Ho T. T. H. Published by Archives of International Journal of Science Annals DOI and UDC DOI https://doi.org/10.26697/ijsa.2023.1.6 UDC 159.98:615.8:24-17 Conflict of interests: The author declares that there is no conflict of interests Peer review: Double-blind review Source of support: This research did not receive any outside funding or support Information about Ho Thi Thu Hang – https://orcid.org/0009-0002-5383-2815; the author: thuhang.phdscholar@lincoln.edu.my; PhD Student, Centre of Postgraduate Studies, Lincoln University College, Selangor, Malaysia. Dear Editor, While contemporary science studies consciousness, Black (1977/2014) provides an ethical and practical social interactions, and emotional and moral responses in approach to understanding the dying process, focusing on the study of the dying process, Buddhism simplifies them the heart, lungs, and brain. However, traditional vital for introspection and reflection (MN 9, Trans. by Sujato, signs such as circulation and respiration challenge the n. d.). Buddhist practice, dating back 2,600 years, unveils determination of death in modern medicine. Black an understanding of demise encompassing both physical suggests considering additional connotations and and mental aspects. conflicting meanings of the dying process in light of “What is death? The passing away, perishing, societal pressures. In line with this, Hoffman (1979) disintegration, demise, mortality, death, decease, presents three perspectives on the meaning of death, breaking up of the aggregates, laying to rest of the emphasizing brain function, brain and heart/lung corpse, and cutting off of the life faculty of the function, and the value of artificial means. While clinical various sentient beings in the various orders of death primarily concerns biological function, it often sentient beings. This is called death.” overlooks emotional reactions and moral judgments. (Sammāditthi Sutta (M i.46). Hoffman’s ethical implications underscore the It was only in the last quarter of the 20th century that importance of nurturing relationships and valuing human science has reevaluated the concept of death as the life. Biomedical ethics support ethical choices amidst cessation of vital functions, prompting exploration in ongoing debates on death. literature and biomedical ethics. 54 International Journal of Science Annals, Vol. 6, No. 1, 2023 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Thanatophobia continue to occupy our thoughts until our last breath. Since 1969, Colett and Lester’s research has brought While the presence of loved ones during the dying attention to the fear of mortality in academia (Colett & process can be beneficial, learning to confront death Lester, 1969/2012). Their study aimed to differentiate alone holds value in attaining inner peace. between death distress and the fear of the dying process, Life entails uncertainty and choices, and the fear of death constructing measurements for death fears. The study and uncertainties endure. Consequently, the integration entailed 25 undergraduate females who completed a of maranassati in therapeutic practices becomes essential questionnaire assessing different types of fear related to for addressing latent fears and living a meaningful life. death. Results revealed that the greatest fear was Mindfulness-based Cognitive Therapy associated with one’s own demise, followed by the fear The effect of Mindfulness-Based Cognitive Therapy of one’s own dying process. Interestingly, the least fear (MBCT) in alleviating death anxiety among diverse was linked to others’ dying, indicating that personal populations has been explored in several studies. experience has a vital influence. Despite the small sample Ghadampour et al. (2018) conducted a study involving 30 size, the study sheds light on an important and women diagnosed with coronary artery disease. They understudied topic, paving the way for future research on used a semi-experimental design, randomly assigning a larger scale. Newly released data from Statista (2023) participants to either an experimental or control group. spotlights the prevalence of fear of death among a sample The experimental group received eight 2-hour sessions of of 1,220 American respondents, with a majority (68%) MBCT training. The results showed a significant reporting some level of fear. Notably, in a recent study decrease in death anxiety levels after the MBCT conducted by Anālayo et al. (2022), a rigorous intervention, and these positive effects were maintained randomized controlled trial examined the impact of during the follow-up phase. mindfulness practices on the fear of dying and death. The In a similar vein, Nabipour et al. (2018) examined the findings demonstrated that engaging in mindfulness and efficacy of MBCT in mitigating suicidal ideation and contemplative practices effectively reduced the fear death anxiety in cancer patients. They selected 30 cancer related to one's own impending death and the death of patients and divided them into experimental and control others. More notably, these practices had the intriguing groups using a pre-test and post-test design. The effect of both heightening the fear of experiencing others' experiment revealed a significant reduction in both dying and fostering the cultivation of mindfulness and suicidal thoughts and death anxiety following the MBCT self-compassion. group therapy sessions, indicating the outcome of this Meditation Practice intervention in addressing psychological distress Maranassati, the contemplation on death in early associated with cancer. Buddhism, is integral to Vipassanā meditation. Gautama Moreover, Pirkalani et al. (2019) investigated the Buddha draw attention to the benefits of mindfulness of effectiveness of MBCT in addressing depression, death death, including peaceful living and the cessation of anxiety, and life expectancy among elderly women. They defilements. Detailed instructions on cultivating recruited 30 elderly women from specific districts in awareness of the dying process are found in the Tehran using a random stratified sampling method. The Satipaṭṭhānasutta (MN 10, Trans. by Sujato, n. d.), which experimental group participated in 10 group-based guides the four foundations of mindfulness. MBCT sessions. The results indicated a significant Contemplating death involves reflecting on the difference in life expectancy, depression, and death impermanence and ending of life, with corpses, anxiety scores between the experimental and control skeletons, and bones serving as objects for groups. contemplation. In contemporary discussions on Overall, the reviewed studies consistently illustrate the maranassati, Allen and Catherine (2017) pay attention to efficacy of MBCT in decreasing death anxiety in the spiritual urgency known as samvega, which facilitates individuals with chronic illnesses. The long-term effects successful meditation on death. More than 2,600 years of MBCT beyond the intervention periods highlight its ago, the Buddha-to-be renounced worldly comforts in his value as a sustainable therapeutic approach, offering quest to transcend the cyclical nature of existence ongoing benefits to individuals with thanatophobia and characterized by birth, aging, illness, and death. aiming to enhance their overall quality of life. Presently, the continuous cycle of samsara continues to Attitudes towards Death in the Elderly impact all sentient beings, eliciting varying degrees of Among institutionalized elderly individuals in Egypt death-related apprehension within the human psyche. (Fadila et al., 2018), approach acceptance was identified The dying process extends beyond external locations as the most prevalent attitude towards death, followed by such as morgues and cemeteries, encompassing escape acceptance and fear of death. The researchers biological and physiological changes occurring within discovered moderate correlations between different our bodies and minds continuously. Processes like attitudes towards death and variables such as loneliness, digestion, waste elimination, and the growth and death of life satisfaction, health status, and comorbidities. skin cells influence our thoughts and emotions. Accordingly, they suggested to promote social Understanding the impermanence inherent in these relationships and engage in periodic discussions about momentary dying processes can alleviate fears related to death with elderly individuals and their families. the final passing of the physical body. However, the With regard to therapeutic practices, narrative therapy karmic actions we have undertaken throughout our lives (Nozari et al., 2019) has shown promise in alleviating 55 International Journal of Science Annals, Vol. 6, No. 1, 2023 рrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa distress and uncertainties associated with fear of death. integration brings forth new insights and interventions to Narrative group therapy (NGT) exhibited positive effects tackle Thanatophobia, offering hope and potential on aging perceptions and death anxiety in older adults. advancements in the field. NGT therein proved beneficial in mitigating death anxiety, and these benefits were sustained over time. Ethical Approval Meanwhile, another study by Golestanifar and The study protocol was consistent with the ethical DashtBozorgi (2021) demonstrated the effectiveness of guidelines of the 1975 Declaration of Helsinki as acceptance and commitment therapy (ACT) in reducing reflected in a prior approval by the Institution’s Human depressive symptoms and improving psychological well- Research Committee. being among elderly individuals with nonclinical depression. Participants who received 10 sessions of Funding Source ACT experienced a significant reduction in depression This research did not receive any outside funding or levels and showed improvements in psychological health support. and life expectancy. Particularly in the work of Menekli and Dogan (2021), References religious attitudes were found to be inversely associated Allen, K. & Catherine, S. (2017). Maranasati for the with death anxiety and positively linked to attitudes modern world: Reflections on death. Insight towards death among elderly patients. Higher levels of Meditation South Bay. religious attitudes correlated with lower levels of death https://www.imsb.org/written-teachings-articles- anxiety and more positive perspectives on mortality. and-interviews/maranasati-for-the-modern- Nurses and other healthcare professionals were world/ encouraged to consider the impact of religious beliefs Anālayo, B. (2019). Buddhist antecedents to the body when addressing death anxiety and fostering positive scan meditation. Mindfulness, 11(1), 194-202. attitudes towards death in intensive care patients. https://doi.org/10.1007/s12671-019-01259-8 Collectively, these studies provide valuable insights into Anālayo, B., Medvedev, O. N., Singh, N. N., & interventions and factors related to the psychological Dhaussy, M. R. (2022). Effects of mindful well-being, attitudes towards death, and anxiety practices on terror of mortality: A randomized experienced by elderly individuals. They underscore the controlled trial. Mindfulness, 13(12), 3043-3057. potential benefits of interventions such as narrative https://doi.org/10.1007/s12671-022-01967-8 therapy, acceptance and commitment therapy, and the Black, P. M. (2014). Three definitions of death. The influence of religious beliefs in improving the Monist, 60(1), 136-146. (Original work published psychological well-being and attitudes towards death 1977). https://doi.org/10.5840/monist197760137 among the elderly. Healthcare professionals can leverage Colett, L. J. & Lester, D. (2012). The fear of death and these therapeutic practices to reduce depressive fear of dying. The Journal of Psychology, 72(2), symptoms, anxiety, and negative attitudes associated 179-181. (Original work published 1969). with aging and mortality in older adults. https://doi.org/10.1080/00223980.1969.1054349 Integration of Maranassati into Therapy: A Proposed 6 Approach Fadila, D. E., Ebeid, I. A., & El-Gilany, A. (2018). Death Considering the on-going body of research discussed, attitude and its associated factors in integrating maranassati into therapy promises a institutionalized elderly: A cross-section study in comprehensive approach to addressing Thanatophobia North Eastern Delta, Egypt. IOSR Journal of and fostering psychological well-being. The practice of Nursing and Health Science, 7(6), 12-19. Maranassati, as highlighted by Anālayo (2019), brings a http://iosrjournals.org/iosr-jnhs/papers/vol7- deep understanding of transience and cultivates issue6/Version-3/B0706031219.pdf acceptance, reduced fear, improved well-being, and Ghadampour, E., Radmehr, P. & Yousefvand, L. (2018). spiritual development. In addition, Moon (2019) also The effect of mindfulness-based cognitive therapy emphasized the positive effects of mindfulness of death in reducing death anxiety in women suffering on life, particularly in an adolescent population. from coronary artery disease. Journal of Shahrekord University of Medical Sciences, Conclusions 19(6), 38-47. http://journal.skums.ac.ir/article-1- The integration of maranassati meditation in therapy 3112-en.html holds great significance in addressing Thanatophobia, as Golestanifar, S., & DashtBozorgi, Z. (2021). Comparing it provides a comprehensive perspective. Through the effectiveness of acceptance and commitment dedicated practice, both meditation practitioners and therapy and well-being therapy on life expectancy individuals struggling with thanatophobia can effectively and psychological health in elderly nonclinical navigate anxieties related to mortality and cultivate a depressed patients. Journal of Rafsanjan deep understanding of impermanence and equanimity. University of Medical Sciences, 20(3), 297-312. By embracing the benefits of maranassati in therapeutic https://doi.org/10.52547/jrums.20.3.297 settings, therapists and counselors have the opportunity Hoffman, J. C. (1979). 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SuttaCentral. to improve aging perceptions and reduce https://suttacentral.net/mn10/en/sujato Cite this article as: Ho, T. T. H. (2023). Integrating meditation practice into thanatophobia therapy. International Journal of Science Annals, 6(1), 54–57. https://doi.org/10.26697/ijsa.2023.1.6 The electronic version of this article is complete. It can be found online in the IJSA Archive https://ijsa.culturehealth.org/en/arhiv This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/deed.en). 57