Document Type


Date of Degree

Fall 2016

Degree Name

PhD (Doctor of Philosophy)

Degree In

Psychological and Quantitative Foundations

First Advisor

Liu, William Ming

First Committee Member

Ali, Saba

Second Committee Member

Hua, Youjia

Third Committee Member

Noyes, Russell

Fourth Committee Member

Westefeld, John


As the U.S. population ages the number of family caregivers is expected to rise. Family caregivers are a valuable source of informal healthcare services for patients and the public, in terms of reducing healthcare costs. However, research suggests family caregiving is not only financially costly for individuals, but associated with a number of medical and mental health risks, with spouses at higher risk for negative outcomes compared to other family members. Traditional evidence-based therapies for stress in family caregivers have been shown to be minimally efficacious with spouses. No therapies take into account the existential nature of spouse caregiver stress, including the potential nonconscious role of loss of life meaning/purpose and death anxiety. This study of multiple baseline design preliminarily explored the effects of a novel 8-week Terror Management Theory integrated existential psychotherapy (TIE) on stress and nonconscious mechanisms believed to function as buffers for existential anxiety, in five women with spouses receiving cancer treatment. Methods included ecological momentary assessment (EMA) of anxiety and self-esteem states via text message sent three times daily – and intermittent assessment of death anxiety, self-compassion, meaning in life, and quality of life at baseline, intervention, immediate post, and 1-month follow-up. Visual and statistical analyses indicated significant between-phase trend changes in anxiety and self-esteem within participants, although direction of changes varied across participants. Additionally, changes in death anxiety, self-compassion, meaning in life, and quality of life between phases varied across participants in directions inconsistent with intervention aims and participants’ subjective impressions of intervention-related changes. Mixed findings point to the complexity of spouse caregiver psychology and highlight the need for more effective therapies with this population. Results may also guide future research and development of existentially-informed therapies.

Public Abstract

Caring for a loved one with a serious disease is stressful. Spouse caregivers tend to report higher levels of stress and anxiety compared to other family members. Research suggests many widely used psychotherapies are less effective with spouse caregivers compared to non-caregivers. This study explored the effects of a new psychotherapy designed to reduce caregiver stress by helping them develop healthier strategies for coping with reminders of death. Six women with spouses receiving cancer treatment participated in this study. Results suggested the therapy had inconsistent effects on participants’ self-esteem, anxiety, and other psychological variables. The strengths and limitations of this study may guide future development of this or new therapies that consider how a person’s strategies for coping with death might affect how they cope with everyday problems.


death anxiety, ecological momentary assessment, existential psychotherapy, family caregiving, stress, terror management theory


xi, 259 pages


Includes bibliographical references (pages 220-259).


Copyright © 2016 Adam Michael Lewis