Balancing the Self: Intervention for Family Caregivers Through the Lens of Terror Management Theory

Family caregivers play a vital role in supporting older adults, yet caregiving often brings persistent exposure to mortality, leading to heightened death anxiety and psychological distress. Applying terror management theory (TMT), this study explores how caregivers navigate death anxiety and maintain anxiety-buffering systems (cultural worldviews, self-esteem, and close relationships) while participating in a supportive intervention program. This qualitative study employed in-depth semi-structured interviews (approximately 90 min) with 17 family caregivers of older adults participating in a national caregiver intervention program in Israel. The interviews explored four key domains: (1) caregiving experience, (2) daily challenges, (3) program participation, and (4) program evaluation. Theory-driven deductive content analysis, guided by TMT's framework, was used to identify patterns related to mortality awareness, psychological defenses, and intervention effects. The TMT-driven data analysis revealed three primary themes: (1) "This is death, it is hard, death, of course": Heightened death anxiety in caregiving; (2) "You know there are things you don't talk about, you don't talk about death": Disrupting of anxiety-buffering system due to caregiving; and (3) "You free the soul": Intervention rebuilds anxiety-buffering system and balanced self. This study highlights the need for existentially informed caregiver support programs that integrate TMT principles to address the deeper emotional and philosophical challenges of caregiving. Implications for healthcare professionals, policymakers, and social workers emphasize the importance of developing interventions that not only alleviate caregiver burden but also strengthen resilience by addressing existential fears inherent in caregiving.