Treatment of existential distress in life threatening illness: a review of manualized interventions

Understanding the factors that underlie existential suffering at the end of life has become the focus of a growing body of research. A number of studies have concluded that existential questions can be distressing for some patients. Other studies have shown that existential concerns are an important dimension of quality of life and can increase a patient's risk for suicidal ideation and desire for death. Over the years, a number of psychological interventions have been developed aimed at addressing such suffering in patients with cancer. In this paper, we review the evidence supporting the importance of existential concerns in terminally ill patients, describe eight manualized interventions explicitly addressing existential themes, and evaluate the effectiveness of these interventions. Similarities and differences between each intervention are noted, and clinical and empirical considerations are discussed.