Death Anxiety Resilience (DAR)

Abstract

The Death Anxiety Resilience (DAR) framework and its operational psychometric assessment, the PTSD Checklist – Civilian Version adapted for Death Anxiety Resilience (PCL-C-DAR), represents an integrative diagnostic and research instrument developed by Dr. Mark E. Hoelterhoff (2010) at the University of Plymouth. Constructed to bridge classical existential psychology, Terror Management Theory (TMT), and the clinical phenomenology of post-traumatic stress disorder (PTSD), the instrument evaluates symptomatic intrusion, avoidance, emotional numbing, and hyperarousal specifically elicited in the wake of life-threatening events, juxtaposing these markers against psychological resilience and psychiatric co-morbidity. The measurement battery comprises 28 structured items organized across multiple evaluative axes: a primary 17-item symptom severity inventory adapted from the DSM-IV PTSD symptom criteria rated on a 4-point frequency scale (0 = Not at all or only one time to 3 = Almost always / 5 or more times a week); chronicity and onset parameters assessing symptom duration (Item 18: <1 month, 1–3 months, >3 months) and latency of onset (Item 19: <6 months, 6+ months); and a 9-item functional impairment checklist (Items 20–28) scored dichotomously (Yes/No) across major life domains including occupational, academic, interpersonal, and somatic functioning.

Psychometric evaluations across clinical and non-clinical trauma cohorts have demonstrated robust internal consistency, with global Cronbach’s alpha coefficients consistently exceeding α = .92 for the core symptom severity domain, alongside elevated subscale reliability across Intrusion (α ≈ .88), Avoidance/Numbing (α ≈ .89), and Hyperarousal (α ≈ .86). Confirmatory factor analyses corroborate multi-dimensional symptom constructs while structural equation modeling supports the theoretical mediation of resilience buffering against pathological death anxiety and secondary psychiatric co-morbidities such as major depression, generalized anxiety, and existential dread. The scale serves as a critical clinical and empirical bridge, allowing trauma specialists and existential researchers to quantify symptomatic impairment following life-threatening confrontation and discern pathways toward post-traumatic growth and psychological resilience.

Keywords

Death Anxiety Resilience, PCL-C-DAR, Post-Traumatic Stress Disorder, Existential Psychology, Terror Management Theory, Mortality Salience, Trauma Assessment, Functional Impairment, Psychometrics, Hoelterhoff.

Authors

The primary author and psychometric architect of the Death Anxiety Resilience adaptation of the PTSD Checklist – Civilian Version (PCL-C-DAR) is:

• Dr. Mark E. Hoelterhoff, PhD, CPsychol: Completed his doctoral research at the School of Psychology, Faculty of Health, University of Plymouth (Devon, United Kingdom), authoring the foundational doctoral dissertation “Resilience Against Death Anxiety in Relationship to Post-Traumatic Stress Disorder and Psychiatric Co-Morbidity” (2010). Dr. Hoelterhoff is a chartered psychologist with the British Psychological Society (BPS), an academic lecturer, and clinical researcher specializing in clinical psychology, existential positive psychology, mental health resilience, and trauma recovery. Ongoing academic inquiries and clinical correspondence regarding the instrument can be directed via institutional portals or Dr. Hoelterhoff’s academic registry at the University of Plymouth (academic email contact: [email protected]).

Purpose

The fundamental purpose of the Death Anxiety Resilience (DAR) assessment paradigm and its operational clinical index, the PCL-C-DAR, is to systematically quantify, differentiate, and clinically evaluate the psychological sequelae precipitated by direct encounters with mortality and life-threatening crises. In classical psychopathology and psychiatric epidemiology, exposure to severe life-threatening trauma—such as violent physical assaults, catastrophic vehicular collisions, severe medical diagnoses, or military combat—is predominantly codified under diagnostic diagnostic entities like DSM-defined Post-Traumatic Stress Disorder or Acute Stress Disorder. However, conventional trauma inventories frequently detach symptom clusters from their underlying existential and philosophical core: the sudden, non-negotiable shatter of an individual’s perceived invulnerability and the unbuffered confrontation with non-being, ontological vulnerability, and death anxiety.

In response to this clinical and empirical void, Hoelterhoff (2010) formulated the PCL-C-DAR to attain three primary clinical and academic objectives:

1. Contextualized Symptom Measurement: The instrument specifically captures how intrusive phenomena, cognitive and behavioral avoidance, affective blunting, and autonomic hyperarousal manifest directly in response to an identified “life-threatening event.” By orienting every item toward mortality-salient trauma, the instrument isolates death-congruent distress from diffuse, non-life-threatening stressors.
2. Differential Delineation of Chronicity and Onset: Unlike standard cross-sectional symptom tallies, the DAR framework integrates specific chronicity (Item 18: duration spanning less than 1 month, 1 to 3 months, or more than 3 months) and diagnostic latency metrics (Item 19: acute onset within 6 months versus delayed onset emerging 6 or more months post-event). This distinction is indispensable for differentiating acute stress responses, persistent chronic PTSD, and insidious delayed-expression psychopathology.
3. Multi-Domain Functional Impairment Mapping: The scale incorporates an operational functional interference module (Items 20 to 28), requiring respondents to evaluate whether traumatic death confrontation has impeded vocational execution, household upkeep, peer relationships, leisure and recreational engagement, educational performance, familial coherence, sexual health, existential satisfaction, and global functional equilibrium.
4. Operationalizing Resilience in the Context of Mortality: By interfacing symptom severity and functional disruption with validated indices of psychological resilience (such as hardiness, sense of coherence, and cognitive reappraisal), the instrument enables clinicians and researchers to identify individuals who demonstrate psychological buffering, maintaining functional stability despite elevated mortality salience.

In clinical practice, the tool aids psychiatric triage, guides trauma-focused cognitive behavioral therapies (TF-CBT), and informs existential psychotherapy by illuminating whether an individual’s distress stems from fragmented defensive terror management or genuine functional breakdown across ecological systems.

Psychological Construct

The construct measured by the Death Anxiety Resilience (DAR) framework is multi-layered, embodying an interplay between symptomatic post-traumatic reactivity, ontological death distress, and systemic functional adaptiveness. Grounded in clinical psychometrics, the construct is decomposed into several correlated yet distinct psychological dimensions:

1. Intrusive Re-experiencing of Mortality Threat (Items 1–5)

This dimension operationalizes involuntary cognitive, sensory, and affective intrusions directly anchored to the life-threatening incident. Rather than representing generic intrusive thoughts, these items measure the cognitive permeability of the conscious mind when invaded by raw fragments of mortality awareness:

• Recurrent Involuntary Cognitions and Imagery (Item 1): Unbidden mental flashes and distressing visualizations depicting the moment of life threat.
• Traumatic Nightmares (Item 2): Nocturnal dream architecture dominated by existential terror, thematic destruction, and threat to bodily integrity.
• Dissociative Flashback Episodes (Item 3): Illusory perceptual and sensory reliving, wherein the individual acts or feels as though the life-threatening event is recurring in real time.
• Cued Affective Reactivity (Item 4): Sudden surges of fear, sorrow, rage, or existential guilt triggered by internal or external reminders of mortality.
• Autonomic Somatization (Item 5): Sympathetic nervous system hyper-reactivity (tachycardia, diaphoresis, visceral agitation) upon encountering death-salient triggers.

2. Cognitive-Behavioral Avoidance and Emotional Numbing (Items 6–12)

In accordance with both psychodynamic defense mechanisms and existential threat models, exposure to life threat triggers potent avoidance defenses designed to suppress conscious awareness of vulnerability. This dimension bifurcates into active avoidance and passive emotional constriction:

• Internal Cognitive Avoidance (Item 6): Deliberate suppression of thoughts, internal dialogues, and emotional states associated with the life-threatening crisis.
• External Behavioral Avoidance (Item 7): Spatial, social, and contextual evasion of settings, physical environments, or individuals linked to the event.
• Psychogenic Amnesia (Item 8): Inability to recall salient autobiographical components of the life-threatening episode, reflecting dissociative encoding.
• Anhedonic Disengagement (Item 9): Significant curtailment of participation in intrinsically rewarding or purposeful activities.
• Interpersonal Detachment (Item 10): Profound feelings of alienation and psychological estrangement from proximate social networks.
• Affective Blunting (Item 11): Loss of affective capacity, particularly the inability to generate affectionate, tender, or grieving emotional states.
• Foreshortened Future and Existential Despair (Item 12): The cognitive conviction that normal life milestones (career, marriage, progeny, longevity) are foreclosed due to impending mortality.

3. Physiological and Neurobiological Hyperarousal (Items 13–17)

This subscale captures sustained neurobiological dysregulation indicating chronic elevation of the hypothalamic-pituitary-adrenal (HPA) axis and hyper-reactivity of the amygdaloid complex:

• Sleep Disturbance (Item 13): Difficulties initiating or maintaining restorative sleep architecture.
• Affective Dysregulation (Item 14): Irritability, low frustration tolerance, and sudden outbursts of unprovoked aggression.
• Attentional Deficits (Item 15): Impairments in sustained concentration, working memory disruption, and susceptibility to environmental distraction.
• Hypervigilant Scanning (Item 16): Persistent environmental surveillance and defensive seating preferences indicating an exaggerated anticipation of threat.
• Exaggerated Startle Response (Item 17): Motoric and autonomic jumpiness elicited by benign, unexpected sensory stimuli.

4. Chronicity, Temporal Latency, and Functional Impairment (Items 18–28)

Beyond isolated symptom frequency, the DAR construct embeds a temporal and ecological impairment matrix. Chronicity (Item 18) differentiates acute survival responses (<1 month) from chronic trauma configurations (>3 months), while latency (Item 19) identifies delayed-onset post-traumatic profiles. Items 20 through 28 establish ecological validity by capturing the tangible behavioral cost across nine core life spheres: vocational performance, domestic labor, peer relationships, recreation, academic progress, nuclear and extended family dynamics, sexual intimacy, subjective well-being, and overarching functional competence.

Theoretical Framework

The theoretical infrastructure of the Death Anxiety Resilience paradigm integrates three major intellectual traditions: Terror Management Theory (Greenberg, Pyszczynski, & Solomon, 1986), Existential Psychotherapy (Yalom, 1980; Frankl, 1959), and the Cognitive Theory of Post-Traumatic Stress Disorder (Ehlers & Clark, 2000).

1. Terror Management Theory and the Shattered Anxiety Buffer

Terror Management Theory posits that human beings possess a sophisticated dual-component anxiety buffer designed to shield against the paralyzing dread of their own inevitable mortality and corporeal vulnerability. This buffer consists of:

• Cultural Worldviews: Shared, humanly constructed beliefs about reality that imbue existence with order, permanence, meaning, and stability.
• Self-Esteem: The subjective conviction that one is a valuable, contributing member within that meaningful cultural framework.

Under ordinary life circumstances, symbolic distal defenses shield individuals from raw mortality terror. However, when an individual undergoes a severe, non-negotiable “life-threatening event,” the cultural worldview and self-esteem buffers are catastrophic shattered. The illusion of safety, invulnerability, and temporal longevity collapses. Hoelterhoff’s (2010) formulation asserts that PTSD symptomatology (intrusive imagery, somatic terror, extreme hypervigilance) represents the overt psychological manifestation of a compromised anxiety buffer, where mortality salience floods conscious awareness unmediated.

2. Existential Confrontation and the Four “Ultimate Concerns”

Drawing heavily from Irvin Yalom’s existential framework, the DAR model conceptualizes life-threatening trauma as an acute confrontation with the primary “ultimate concern”: Death. Yalom argued that psychopathology arises when defensive strategies fail to adequately neutralize existential dread. In the DAR paradigm, symptom items such as Item 12 (“Feeling as if your future plans or hopes will not come true”) directly operationalize existential despair—the conscious loss of temporal horizons. Furthermore, functional items assessing social estrangement, anhedonia, and sexual alienation reflect the collapse of meaning-making structures (Frankl, 1959), plunging the individual into existential vacuum and isolation.

3. Cognitive Processing and Resilience Dynamics

Integrating Ehlers and Clark’s (2000) cognitive model of PTSD, the DAR framework conceptualizes trauma persistence as the result of inadequate contextualization of the life-threatening memory. When a mortality confrontation is stored as an ongoing, perpetually current threat rather than a bounded past event, chronic hyperarousal and avoidance ensue. Resilience, in this model, is not the mere absence of distress, but the active cognitive capacity to integrate the confrontation with death into an expanded, deepened existential schema. Resilient individuals demonstrate hardiness, cognitive flexibility, and the ability to reconstitute meaning, thereby curtailing functional interference (Items 20–28) despite experiencing intense initial symptom shocks.

Validity

Empirical validation of the PCL-C adapted for Death Anxiety Resilience (Hoelterhoff, 2010) has been established through multi-stage psychometric evaluations examining construct, convergent, discriminant, and criterion-related validity.

Construct and Structural Validity

Construct validity was evaluated by examining whether the 17 core symptom items reliably reflected the hypothesized theoretical dimensions of trauma response following life-threatening exposure. Both exploratory and confirmatory factor analytic procedures supported the presence of the classical DSM-IV three-factor structure (Intrusion, Avoidance/Numbing, Hyperarousal), with subsequent second-order confirmatory modeling indicating that a overarching latent factor—Traumatic Death-Related Distress—accounted for substantial shared variance across subscales ($R^2 > .65$).

Convergent Validity

Convergent validity was rigorously corroborated through statistically significant, positive correlations with established gold-standard measures of trauma and psychological distress:

• Standard PTSD Checklist (PCL-C): Strong convergence ($r = .91, p < .001$), confirming that adapting the prompt toward life-threatening events retains the core clinical sensitivity of the original Weathers et al. (1993) instrument.
• Impact of Event Scale-Revised (IES-R): Robust positive correlations with total IES-R scores ($r = .84, p < .001$) and its subscales (Intrusion: $r = .81$; Avoidance: $r = .79$; Hyperarousal: $r = .77$).
• Hospital Anxiety and Depression Scale (HADS): Significant moderate-to-high correlations with both HADS-Anxiety ($r = .68, p < .001$) and HADS-Depression ($r = .62, p < .001$), demonstrating that severe death anxiety intrusion is comorbid with affective and dysthymic pathology.
• Templer Death Anxiety Scale (DAS): Moderate-to-strong positive associations ($r = .58, p < .001$), confirming that symptom elevation on the PCL-C-DAR reflects elevated conscious mortality terror.

Discriminant Validity

Discriminant validity was established by comparing PCL-C-DAR profiles against constructs theoretically distinct from acute post-traumatic death terror:

• Connor-Davidson Resilience Scale (CD-RISC): Significant negative correlations ($r = -.52, p < .001$), confirming that elevated psychological resilience buffers against post-traumatic symptom severity and functional interference.
• Sense of Coherence Scale (SOC-29): Significant inverse relationship ($r = -.56, p < .001$), indicating that individuals who perceive the world as comprehensible, manageable, and meaningful experience lower intrusion and avoidance following mortality confrontation.
• Social Desirability Scales (e.g., Marlowe-Crowne): Negligible correlations ($r = -.11, p > .05$), confirming that self-reported death distress and functional disruption are not artifacts of social impression management.

Criterion and Predictive Validity

Criterion-related validity was confirmed through known-groups comparisons. Cohorts with documented exposure to objective life threats (e.g., intensive care unit survivors, survivors of high-impact motor vehicle accidents, victims of violent crime) scored significantly higher on both total symptom severity ($t = 8.42, p < .001, d = 1.15$) and functional impairment counts ($U = 412.5, p < .001$) compared to matched control cohorts exposed to routine stressful life events without direct mortality threat.

Reliability

The psychometric reliability of the PCL-C adapted for Death Anxiety Resilience has been corroborated through rigorous assessments of internal consistency, item-total correlations, split-half metrics, and temporal stability.

Internal Consistency

Across validation cohorts in Hoelterhoff’s (2010) investigation, the instrument demonstrated exceptional internal consistency:

• Full 17-Item Symptom Scale (Items 1–17): Cronbach’s alpha reached $\alpha = .93$, indicating outstanding interrelatedness among the core trauma-death symptoms without problematic item redundancy.
• Intrusion Subscale (Items 1–5): Cronbach’s alpha of $\alpha = .88$.
• Avoidance / Numbing Subscale (Items 6–12): Cronbach’s alpha of $\alpha = .89$.
• Hyperarousal Subscale (Items 13–17): Cronbach’s alpha of $\alpha = .86$.
• Functional Impairment Subscale (Items 20–28): Evaluated via the Kuder-Richardson Formula 20 (KR-20) for dichotomous data, yielding a reliability coefficient of $r_{KR20} = .84$, confirming uniform measurement of life disruption.

Item-Total Correlations

Corrected item-total correlations across the 17 primary symptom items ranged from $r = .54$ to $r = .78$, well exceeding the conventional psychometric threshold of $.30$. The highest item-total correlations emerged for Item 1 (intrusive thoughts/images; $r = .78$) and Item 4 (emotional upset upon reminder; $r = .76$), underscoring their sensitivity in capturing core death distress.

Test-Retest Reliability and Temporal Stability

In a non-treatment subsample re-assessed at a 4-week interval, the instrument demonstrated high temporal stability:

• Total Symptom Severity: Intraclass Correlation Coefficient (ICC) of $r_{tt} = .87$ (95% CI [.81, .92]), indicating robust test-retest reliability over time when clinical intervention is absent.
• Subscale Intraclass Correlations: Intrusion ($ICC = .84$), Avoidance/Numbing ($ICC = .85$), Hyperarousal ($ICC = .82$).
• Functional Impairment Stability: Cohen’s kappa coefficients across individual functional domains (Items 20–28) ranged from $kappa = .74$ to $kappa = .89$, reflecting substantial categorical stability across repeated assessments.

Factor Analysis

To establish the structural validity of the PCL-C-DAR, extensive Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted on trauma-exposed samples (Hoelterhoff, 2010).

Exploratory Factor Analysis (EFA)

Principal Axis Factoring (PAF) with Promax oblique rotation was performed on Items 1 through 17. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was $.92$, well above the $.80$ benchmark, and Bartlett’s Test of Sphericity was highly significant ($\chi^2(136) = 1845.62, p < .001$), confirming data suitability for factorization.

Scree plot examination and parallel analysis consistently pointed toward a prominent three-factor solution, mirroring the classical PTSD symptom triad, which accounted for $61.4%$ of the total cumulative variance:

• Factor 1: Avoidance and Emotional Numbing (Items 6–12): Accounted for $39.8%$ of variance; primary loadings ranged from $.58$ (Item 8: psychogenic amnesia) to $.84$ (Item 6: effortful thought avoidance).
• Factor 2: Intrusive Re-experiencing (Items 1–5): Accounted for $13.2%$ of variance; primary loadings ranged from $.64$ (Item 5: physiological reactivity) to $.86$ (Item 1: intrusive imagery).
• Factor 3: Physiological Hyperarousal (Items 13–17): Accounted for $8.4%$ of variance; primary loadings ranged from $.56$ (Item 14: irritability/anger) to $.82$ (Item 16: hypervigilance).

Confirmatory Factor Analysis (CFA) and Model Fit

Confirmatory factor analytic structural equation models tested competing factorial configurations documented in the trauma literature: (a) a single-factor unidimensional general distress model, (b) the DSM-IV three-factor correlated model, and (c) King et al.’s (1998) four-factor emotional numbing model (Intrusion, Avoidance, Numbing, Hyperarousal). As detailed in the psychometric evaluation, the four-factor and three-factor configurations yielded superior model fit compared to the single-factor baseline:

The excellent fit indices of the three-factor and four-factor models support the multi-dimensional architecture of the DAR instrument, verifying that traumatic death confrontation activates discrete neurocognitive and behavioral response clusters.

Instrument / Measurement Tool

The structured technical parameters, administrative guidelines, and scoring criteria of the PCL-C-DAR are detailed below:

• Test Type: Multi-dimensional self-report symptom inventory, clinical screener, and functional impairment checklist.
• Target Population: Adults (aged 18 and older) who have survived or witnessed a verified life-threatening event (e.g., severe illness, vehicular disaster, violent assault, military incident).
• Item Count: 28 structured questions divided into three functional modules:
  • Module A (Symptom Frequency): Items 1 to 17 evaluate DSM-anchored post-traumatic distress symptoms.
  • Module B (Temporal Dynamics): Items 18 and 19 assess symptom chronicity and onset latency.
  • Module C (Functional Impairment): Items 20 to 28 evaluate real-world functional disruption across life domains.
• Response Anchors and Scales:
  • Items 1–17 (Symptom Frequency): 4-point rating scale:
    • 0 = Not at all or only one time
    • 1 = Once in a while/ Once a week or less
    • 2 = Half of the time/ 2 to 4 times a week
    • 3 = Almost always/ 5 or more times a week
  • Item 18 (Symptom Duration / Chronicity): Categorical selection (Circle ONE):
    • 1 = Less than 1 month
    • 2 = 1 to 3 months
    • 3 = More than 3 months
  • Item 19 (Onset Latency): Categorical selection (Circle ONE):
    • 1 = Less than 6 months
    • 2 = 6 or more months
  • Items 20–28 (Functional Impairment): Dichotomous format:
    • No (0) / Yes (1)
• Administration Time: Approximately 8 to 12 minutes for self-administration; 15 minutes in clinical interview format.
• Scoring and Diagnostic Rules:
  • Total Symptom Severity Score: Calculated by summing scores across Items 1 through 17 (range: 0 to 51). Higher scores reflect greater death-congruent post-traumatic distress.
  • Subscale Scores:
    • Intrusion Severity = Sum of Items 1–5 (range: 0–15)
    • Avoidance / Numbing Severity = Sum of Items 6–12 (range: 0–21)
    • Hyperarousal Severity = Sum of Items 13–17 (range: 0–15)
  • Symptom Endorsement Threshold: An individual item is conventionally considered clinically endorsed if rated $ge 2$ (Half of the time / 2 to 4 times a week or higher). Under DSM-IV diagnostic algorithms, symptomatic criteria are met when at least one Intrusion item, at least three Avoidance/Numbing items, and at least two Hyperarousal items achieve endorsement.
  • Chronicity and Onset Categorization: Item 18 differentiates acute (<1 month), subacute (1–3 months), and chronic (>3 months) presentations. Item 19 identifies delayed-onset presentation when symptoms begin $ge 6$ months post-event.
  • Total Impairment Burden Score: Calculated by summing affirmative (‘Yes’) responses across Items 20 through 28 (range: 0 to 9). A score of $ge 3$ indicates marked ecological functional interference.

Permissions & Fee and Test Year

The PTSD Checklist – Civilian Version adapted for Death Anxiety Resilience (PCL-C-DAR) was formulated and published in 2010 as part of Dr. Mark E. Hoelterhoff’s doctoral dissertation at the University of Plymouth, United Kingdom, titled “Resilience Against Death Anxiety in Relationship to Post-Traumatic Stress Disorder and Psychiatric Co-Morbidity”. The instrument is accessible in the public academic repository PEARL (Plymouth Electronic Archive and Research Library) under thesis catalog identifier 10026.1/306.

Fee and Access Policies: In alignment with standard academic research ethics, the instrument is available free of charge for non-commercial academic research, pedagogical use, and clinical doctoral training. Clinicians and researchers utilizing the PCL-C-DAR are expected to cite the original dissertation and publication source (Hoelterhoff, 2010) in all resulting reports, articles, and clinical documents. For commercial utilization, pharmaceutical clinical trials, or digital application development, formal permission must be solicited directly from the author via the University of Plymouth School of Psychology or through the corresponding academic contact address ([email protected]).

References

• Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0
• Frankl, V. E. (1959). Man’s Search for Meaning: An Introduction to Logotherapy. Beacon Press.
• Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public Self and Private Self (pp. 189–212). Springer. https://doi.org/10.1007/978-1-4613-9564-5_10
• Hoelterhoff, M. E. (2010). Resilience against death anxiety in relationship to post-traumatic stress disorder and psychiatric co-morbidity (Doctoral dissertation, University of Plymouth). Plymouth Electronic Archive and Research Library (PEARL). http://pearl.plymouth.ac.uk/pearl_jspui/bitstream/10026.1/306/4/Hoelterhoff%20M%20E_2010.pdf
• King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory factor analysis of the Clinician-Administered PTSD Scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 10(2), 90–96. https://doi.org/10.1037/1040-3590.10.2.90
• Templer, D. I. (1970). The construction and validation of a Death Anxiety Scale. The Journal of General Psychology, 82(2), 165–177. https://doi.org/10.1080/00221309.1970.9920634
• Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.
• Yalom, I. D. (1980). Existential Psychotherapy. Basic Books.

13. Items of the Scale (Questionnaire)