{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:49:16Z","timestamp":1790815756010,"version":"4.1.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study measured three of the psychological stages of dying in patients with cancer and explored the differences in proximal and intimacy-related defense mechanisms at each stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>A total of 220 cancer patients were recruited for this study; 168 patients met the inclusion criteria and were included in the data analysis. The participants were divided into three groups using the \u201cDeath Attitudes Questionnaire Revised\u201d (1994) and then completed the Death-Thought Accessibility Test, Self-Control Questionnaire, Rumination Reflection Questionnaire, Attachment Type Test, Intimacy Test, External Control Test, and Positive and Negative Affect Scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the death avoidance stage, which represents a defense stage without cognitive processes, patients are in an irrational state with the highest level of self-control and the lowest level of external control; they tend to prefer close relationships with many people while experiencing high levels of fear and depression. In the bargaining stage, which represents a biased cognitive defense stage, the level of rationality increases, the level of fear and depression decreases, and patients tend to prefer relationships with many people that do not involve intimacy. In the neutral death acceptance stage, which represents a defense stage without cognitive bias, self-control is lowest, external control is highest, patients tend to prefer intimate relationships with a few people, and experience the lowest levels of fear and depression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Three psychological stages of death exist in cancer patients, with differences in proximal and intimacy-related defense mechanisms in each stage. The findings have theoretical and practical implications for psychological interventions for cancer patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2024.1329043","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T15:36:45Z","timestamp":1708443405000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Differences in proximal and intimacy-related defense mechanisms among patients with cancer in different psychological stages of dying"],"prefix":"10.3389","volume":"15","author":[{"given":"Jia","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengxiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarui","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meihong","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1177\/08980101211017766","article-title":"\u2018They stay with you\u2019: nursing home staff\u2019s emotional experiences of being in a close relationship with a resident in long-term care who died","volume":"40","author":"\u00c5dland","year":"2022","journal-title":"J. Holist. Nurs."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.paid.2014.03.012","article-title":"From avoidance to approach: the effects of mortality salience and attachment on the motivation to repair troubled relationships","volume":"66","author":"Anglin","year":"2014","journal-title":"Pers. Individ. Dif."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1080\/13576275.2015.1071344","article-title":"Funerals against death","volume":"21","author":"Bailey","year":"2016","journal-title":"Mortality (Abingdon)."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1475-6811.2010.01298.x","article-title":"Desire in the face of death: terror management, attachment, and sexual motivation","volume":"18","author":"Birnbaum","year":"2011","journal-title":"Personal. Relat."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1037\/0278-6133.17.6.494","article-title":"Influence of HIV status and age on cognitive representations of others","volume":"17","author":"Carstensen","year":"1998","journal-title":"Health Psychol."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"453","DOI":"10.2190\/XFF0-C6UA-58PC-PHPB","article-title":"Factor structure, reliability, and validity of the death attitude profile-revised","volume":"40","author":"Clements","year":"2000","journal-title":"Omega (Westport)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1111\/bjso.12392","article-title":"The contagion of mortality: a terror management health model for pandemics","volume":"59","author":"Courtney","year":"2020","journal-title":"Br. J. Soc. Psychol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1037\/a0025947","article-title":"How sweet it is to be loved by you: the role of perceived regard in the terror management of close relationships","volume":"102","author":"Cox","year":"2012","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref9","first-page":"36","article-title":"Coping strategies used by cancer patients to deal with physical and psychological problems of chemotherapy","volume":"5","author":"D\u2019Souza","year":"2016","journal-title":"Int. J. Innov. Res. Dev."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1080\/02699931.2018.1460322","article-title":"Terror in time: extending culturomics to address basic terror management mechanisms","volume":"33","author":"Dechesne","year":"2019","journal-title":"Cogn. Emot."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.jpsychores.2018.10.016","article-title":"Defense mechanisms in cancer patients: a systematic review","volume":"115","author":"Di Giuseppe","year":"2018","journal-title":"J. Psychosom. Res."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1080\/07481187.2020.1793432","article-title":"Death thoughts predict increased depression for those with low self-worth","volume":"46","author":"Fairlamb","year":"2022","journal-title":"Death Stud."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1037\/0882-7974.5.3.335","article-title":"Choosing social partners: how old age and anticipated endings make people more selective","volume":"5","author":"Fredrickson","year":"1990","journal-title":"Psychol. Aging"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2260","DOI":"10.12677\/AP.2021.1110257","article-title":"A review of fear management theories","volume":"11","author":"Fu","year":"2021","journal-title":"Adv. Psychol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s00520-022-07490-9","article-title":"What do bereaved relatives of cancer patients dying in hospital want to tell us? Analysis of free-text comments from the International Care of the Dying Evaluation (i-CODE) survey: a mixed methods approach","volume":"31","author":"Gerlach","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.neubiorev.2019.01.010","article-title":"Pair-bonding, fatherhood, and the role of testosterone: a meta-analytic review","volume":"98","author":"Grebe","year":"2019","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1111\/1467-9280.03454","article-title":"Psychological defense in anticipation of anxiety: eliminating the potential for anxiety eliminates the effect of mortality salience on worldview defense","volume":"14","author":"Greenberg","year":"2003","journal-title":"Psychol. Sci."},{"key":"ref19","first-page":"85","article-title":"Terror management theory and research: how the desire for death transcendence drives our strivings for meaning and significance","volume-title":"Advances in motivation science","author":"Greenberg","year":"2014"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1177\/0269216317722123","article-title":"Death anxiety interventions in patients with advanced cancer: a systematic review","volume":"32","author":"Grossman","year":"2018","journal-title":"Palliat. Med."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1037\/0022-3514.52.3.511","article-title":"Romantic love conceptualized as an attachment process","volume":"52","author":"Hazan","year":"1987","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref22","volume-title":"The wheel of life: a memoir of living and dying","author":"K\u00fcbler-Ross","year":"1997"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1001\/jama.1972.03200150040010","article-title":"On death and dying","volume":"221","author":"K\u00fcbler-Ross","year":"1972","journal-title":"JAMA"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"344","DOI":"10.3724\/SP.J.1042.2019.00344","article-title":"The relationship of death anxiety defense mechanisms in terror management theory","volume":"27","author":"Lu","year":"2019","journal-title":"Adv. Psychol. Sci."},{"key":"ref25","volume-title":"Attachment in adulthood: structure, dynamics and change. Attachment theory and close relationships","author":"Mikulincer","year":"2007"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1177\/1088868317753505","article-title":"The role of close relationships in terror management: a systematic review and research agenda","volume":"22","author":"Plusnin","year":"2018","journal-title":"Personal. Soc. Psychol. Rev."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1111\/1468-4446.12934","article-title":"\u2018If no one grieves, no one will remember\u2019: cultural palimpsests and the creation of social ties through rituals","volume":"73","author":"Prickett","year":"2022","journal-title":"Br. J. Sociol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1037\/0033-295x.106.4.835","article-title":"A dual-process model of defense against conscious and unconscious death-related thoughts: an extension of terror management theory","volume":"106","author":"Pyszczynski","year":"1999","journal-title":"Psychol. Rev."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1521\/soco.2009.27.6.929","article-title":"Quantity and proximity: the terror-managing function of abstract figures","volume":"27","author":"Renkema","year":"2009","journal-title":"Soc. Cogn."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"666373","DOI":"10.3389\/fpsyg.2021.666373","article-title":"Defense mechanism functioning in patients with breast cancer: using the defense mechanism rating scale","volume":"12","author":"Saab","year":"2021","journal-title":"Front. Psychol."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2559","DOI":"10.1002\/pon.4783","article-title":"Fear of cancer recurrence and death anxiety","volume":"27","author":"Sharpe","year":"2018","journal-title":"Psycho-Oncology"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s12630-023-02431-4","article-title":"A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline","volume":"70","author":"Shemie","year":"2023","journal-title":"Can. J. Anaesth."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1002\/ejsp.301","article-title":"Scared to death or scared to love? Terror management theory and close relationships seeking","volume":"36","author":"\u015amieja","year":"2006","journal-title":"Eur. J. Soc. Psychol."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1200\/JCO.18.02331","article-title":"Pediatric palliative care in oncology","volume":"38","author":"Snaman","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1111\/j.0022-3506.2004.00263.x","article-title":"High self-control predicts good adjustment, less pathology, better grades, and interpersonal success","volume":"72","author":"Tangney","year":"2004","journal-title":"J. Pers."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1080\/07481180490490988","article-title":"Intimacy and risky sexual behavior-what does it have to do with death?","volume":"28","author":"Taubman-Ben-Ari","year":"2004","journal-title":"Death Stud."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1348\/014466602760344296","article-title":"The effects of mortality salience on relationship strivings and beliefs: the moderating role of attachment style","volume":"41","author":"Taubman-Ben-Ari","year":"2002","journal-title":"Br. J. Soc. Psychol."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.3390\/brainsci13081197","article-title":"The role of serotonin in fear learning and memory: a systematic review of human studies","volume":"13","author":"Tortora","year":"2023","journal-title":"Brain Sci."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1038\/s41398-021-01715-x","article-title":"Secure attachment priming protects against relapse of fear in young adults","volume":"11","author":"Toumbelekis","year":"2021","journal-title":"Transl. Psychiatry"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1037\/0022-3514.76.2.284","article-title":"Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection","volume":"76","author":"Trapnell","year":"1999","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1002\/pchj.128","article-title":"The revising of the Tangney self-control scale for Chinese students","volume":"5","author":"Unger","year":"2016","journal-title":"Psych J."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1080\/00207578.2022.2100785","article-title":"Autoimmunity and its expression in the analytic situation: a contemporary reflection on our inherent self-destructiveness","volume":"103","author":"Winters","year":"2022","journal-title":"Int. J. Psychoanal."},{"key":"ref43","first-page":"121","article-title":"Death attitude profile\u2014revised: a multidimensional measure of attitudes toward death","volume-title":"Series in death education, aging, and health care. Death anxiety handbook: research, instrumentation, and application","author":"Wong","year":"1994"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"10179","DOI":"10.3390\/ijerph191610179","article-title":"The effect of group identification on death anxiety: the chain mediation role of close relationships and self-esteem","volume":"19","author":"Xiao","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1177\/0146167214525473","article-title":"Parenthood as a terror management mechanism: the moderating role of attachment orientations","volume":"40","author":"Yaakobi","year":"2014","journal-title":"Personal. Soc. Psychol. Bull."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.2147\/PRBM.S361432","article-title":"Facing a real threat of death: dynamic changes in death-thought accessibility","volume":"15","author":"Zhou","year":"2022","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.3389\/fpsyg.2018.01703","article-title":"Bad healthy state compress temporal extension both in past and future orientations","volume":"9","author":"Zhou","year":"2018","journal-title":"Front. Psychol."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2024.1329043\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T15:36:51Z","timestamp":1708443411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2024.1329043\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":46,"alternative-id":["10.3389\/fpsyg.2024.1329043"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2024.1329043","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]},"article-number":"1329043"}}