The Death Anxiety Beliefs and Behaviours Scale (DABBS) is an 18-item self-report measure designed to assess death anxiety (i.e., fears of death or dying). The DABBS was developed specifically for use in clinical populations and was the first measure to provide a clinical cut-off score, normative data, and treatment-guiding subscales.
The DABBS includes three subscales:
DABBS Example Item
Death anxiety has been shown to play a role in various mental health conditions, with particular evidence for its key role in OCD, anxiety disorders, health anxiety, and related conditions. Given the relevance of death anxiety across different psychopathologies, the DABBS may be useful for building a formulation of the underlying factors contributing to a client’s presentation. The measure can be administered at baseline for assessment and screening purposes, and repeatedly throughout treatment to monitor progress and treatment outcomes.
The DABBS can also be used to inform psychological interventions and treatment targets for death anxiety. The Beliefs subscale can help identify maladaptive cognitions that may benefit from being addressed using cognitive interventions, and the Behaviours subscale can identify avoided stimuli which can be targeted using exposure therapy.
The DABBS produces a raw score, a corresponding percentile and a descriptor. A higher score indicates a higher level of death anxiety. There are three subscales and a total score:
A total score equal to or greater than 55 indicates that an individual’s death anxiety is in the clinically elevated range, suggesting significant fears of death. However, scores below this cut-off (i.e., within the normal range) may still warrant clinical intervention, particularly if an individual is expressly seeking treatment for this fear.
Percentiles are also displayed for the total score and each of the subscales. This community percentile allows for a comparison between the client’s score and a sample of non-clinical and university students (N = 553). A percentile of 50 indicates an average and typical level of death anxiety. As the total score of 55 equates to the 70th percentile, this percentile is used for the subscales to indicate a score within the ‘High’ (i.e., clinically elevated) range. A percentile of 90 is used to define the ‘Very High’ category.
Interpretation at the subscale level may also be clinically useful. For example, a high score on the Behaviours subscale relative to Beliefs may suggest that exposure-based interventions targeting avoidance may be most useful to consider. Conversely, a high score on the Beliefs subscale relative to the Behaviours subscale may indicate that treatments centering on addressing unhelpful thinking patterns may be beneficial.
On first administration of the DABBS, a stacked bar chart displaying percentile scores for the total score and subscales is presented with background shading indicating high and very high ranges. Multiple administrations of the DABBS will provide two plots. The first will plot the raw total score over time and the second will plot the subscale community percentiles over time.
When DABBS scores are available from multiple timepoints, changes in scores can provide valuable information about the effectiveness of interventions or changes in symptoms. Although DABBS does not have an established framework for interpreting change over time, we can use the established recommendation for comparative interpretation, changes of at least 0.5 standard deviations in scores being considered clinically meaningful (the minimally important difference) (Norman et al., 2003; Turner et al., 2010). These changes are categorised as ‘significant reduction’ (≥0.5 SD reduction in score), ‘significant increase’ (≥0.5 SD increase in score), or ‘minimal change’ (<0.5 SD or no change in score). If applicable, this interpretive text outlining change in scores is displayed first within the interpretive text section.
The DABBS has been validated in multiple clinical and non-clinical samples, demonstrating strong psychometric properties (Menzies et al., 2022). For the initial development, a larger pool of items was first piloted in a sample of community adults. An exploratory factor analysis was then conducted using a treatment-seeking clinical sample, revealing the expected three-factor structure. A subsequent confirmatory factor analysis showed that this three-factor structure held within a non-clinical community sample. The overall scale has excellent internal consistency (Cronbach’s α = .90), and the subscales have internal consistency of α = .94 (Affect), α = .83 (Beliefs), and α = .87 (Behaviours). The DABBS has shown good test–retest reliability over a three-week interval, for the total score (r = .86), Affect (r = .85), Beliefs (r = .78), and Behaviours subscales (r = .79).
Clinical utility has been supported through studies demonstrating that higher DABBS scores are associated with increased symptom severity, including depression, anxiety, and stress (Menzies et al., 2022; Sharpe et al., 2024), greater body dysmorphia symptoms (Menzies et al., 2023), and poorer quality of life (Sharpe et al., 2024).
Overall scores on the DABBS are also associated with mental health outcomes in individuals living with cancer and other chronic physical illnesses, including fears of illness recurrence and progression (Sharpe et al., 2024; Smith et al., 2024)
A clinical cut-off score of 55 or greater has been established to indicate the likely presence of clinically significant death anxiety. The AUC for the DABBS is .90, suggesting excellent discriminant ability.
A percentile is created based upon a combined university and non-clinical sample (N = 553) (R. Menzies, personal communication, August 11, 2025). The corresponding percentile for the cut-off score (i.e., at the 70th percentile) is used to define a category of ‘High’ death anxiety. The 90th percentile is used to define a ‘Very High’ category.
Although initially developed and validated in adult samples, the DABBS has been validated in adolescents (Mazidi et al., 2024).
It’s entirely normal to have occasional thoughts or concerns about death and dying – this is part of the human experience. The key difference lies in the intensity, frequency, and impact of these thoughts. Normal death concerns might arise during significant life events, illness, or bereavement, but they don’t substantially interfere with daily life. Clinically significant death anxiety, as measured by the DABBS, involves persistent and intrusive fears that cause significant distress and lead to avoidance behaviours. For example, someone with elevated death anxiety might avoid medical check-ups, refuse to attend funerals, or experience panic when encountering reminders of mortality. The DABBS clinical cut-off score of 55 helps distinguish between normative concerns and anxiety levels that may benefit from professional support.
The DABBS subscales – Affect, Beliefs, and Behaviours – provide a roadmap for targeted intervention. If the Beliefs subscale is most elevated, treatment might focus on cognitive restructuring to challenge catastrophic thoughts about death, such as fears of dying alone or beliefs about unbearable pain. High Behaviours scores suggest the need for exposure-based interventions to gradually confront avoided death-related stimuli, like visiting cemeteries or discussing end-of-life planning. Elevated Affect scores indicate intense emotional distress that might benefit from emotion regulation strategies. By identifying which aspects of death anxiety are most prominent, clinicians can tailor their approach rather than using a one-size-fits-all treatment.
Death anxiety often plays an unrecognised but significant role in various mental health presentations. Research shows it can be a maintaining factor in OCD (particularly contamination and checking compulsions), health anxiety, panic disorder, and specific phobias. For instance, someone with health anxiety might constantly monitor bodily sensations not just because they fear illness, but because illness represents a pathway to death. The DABBS helps identify when death anxiety is a core treatment target versus a secondary concern. Understanding these connections is crucial because treating surface-level symptoms without addressing underlying death anxiety may lead to incomplete recovery or symptom substitution.
The DABBS clinical cut-off of 55 provides valuable guidance, but it shouldn’t be the only consideration for treatment. Someone might score below 55 overall but have a significantly elevated subscale that causes substantial distress. Additionally, death anxiety can be highly contextual – scores might be lower during stable periods but spike during health scares, bereavements, or major life transitions. Cultural and religious factors also influence how death anxiety manifests and what levels cause impairment. If someone is actively seeking help for death-related fears or if these fears are limiting their life choices (avoiding medical care, refusing to make a will, inability to support grieving loved ones), clinical intervention may be beneficial regardless of the score.
The DABBS is designed for repeated administration throughout treatment, with the minimally important difference of 7 points helping determine whether changes are clinically meaningful. Beyond tracking the total score, monitoring subscale changes reveals which interventions are most effective. For example, cognitive work might reduce Beliefs scores before Behaviours change, while exposure therapy might show the opposite pattern. This information helps clinicians adjust their approach – if scores aren’t changing after several sessions, it might indicate the need for a different strategy or the presence of maintaining factors that haven’t been addressed. Regular monitoring also helps identify when clients are ready to transition from active treatment to relapse prevention planning.
Menzies, R. E., Sharpe, L., & Dar‐Nimrod, I. (2022). The development and validation of the Death Anxiety Beliefs and Behaviours Scale. British Journal of Clinical Psychology, 61(4), 1169-1187. https://doi.org/10.1111/bjc.12387
Mazidi, M., Zarei, M., Ahmadi Bouyaghchi, Z., Ranjbar, S., & Menzies, R. E. (2024). Evaluation of the death anxiety beliefs and behaviors scale in Iranian adolescents. Death Studies, 1-9. https://doi.org/10.1080/07481187.2024.2414935
Menzies, R. E., Sharpe, L., Richmond, B., & Cunningham, M. L. (2023). “Life’s too short to be small”: An experimental exploration of the relationship between death anxiety and muscle dysmorphia symptoms. Body Image, 44, 43-52. https://psycnet.apa.org/doi/10.1016/j.bodyim.2022.11.006
Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592. https://doi.org/10.1097/01.MLR.0000062554.74615.4C
Sharpe, L., Menzies, R. E., Richmond, B., Todd, J., MacCann, C., & Shaw, J. (2024). The development and validation of the Worries About Recurrence or Progression Scale (WARPS). British Journal of Health Psychology, 29(2), 454-467. https://doi.org/10.1111/bjhp.12707
Smith, M., Sharpe, L., Winiarski, N., & Shaw, J. (2024). The Worries About Recurrence or Progression Scale in Cancer (WARPS‐C): A Valid and Reliable Measure to Screen for Fear of Cancer Recurrence. Psycho‐Oncology, 33(12), e70055. https://doi.org/10.1002/pon.70055
Turner, D., Schünemann, H. J., Griffith, L. E., Beaton, D. E., Griffiths, A. M., Critch, J. N., & Guyatt, G. H. (2010). The minimal detectable change cannot reliably replace the minimal important difference. Journal of Clinical Epidemiology, 63(1), 28–36. https://doi.org/10.1016/j.jclinepi.2009.01.024
