Religion and spirituality

Many clients highly value religious and spiritual (R/S) commitments, and many psychotherapists have accommodated secular treatments to R/S perspectives. We meta-analyzed 51 samples from 46 studies (N = 3,290) that examined the outcomes of religious accommodative therapies and nonreligious spirituality therapies. Comparisons on psychological and spiritual outcomes were made to a control condition, an alternate treatment, or a subset of those studies that used a dismantling design (similar in theory and duration of treatment, but including religious contents). Patients in R/S psychotherapies showed greater improvement than those in alternate secular psychotherapies both on psychological (d =.26) and on spiritual (d = .41) outcomes. Religiously accommodated treatments outperformed dismantling-design alternative treatments on spiritual (d = .33) but not on psychological outcomes. Clinical examples are provided and therapeutic practices are recommended.     

The royal free interview for spiritual and religious beliefs: development and validation of a self-report version

BACKGROUND: Spiritual beliefs are rarely considered in psychological or medical publications. We recently published the psychometric properties of an interview designed to measure religious and spiritual belief. In this study, we aimed to develop this instrument further as a self-report questionnaire and to make it more comprehensive by including measurement of spiritual experiences in addition to faith or intellectual assent. METHODS: Based on extensive discussion with colleagues, advice from users of the interview and comments from respondents, a self-report format was designed. We then evaluated the final format of the questionnaire in terms of (1) patterns of response and demographic predictors of beliefs; (2) test-retest reliability and internal consistency; (3) criterion and internal validity; and (4) the nature of spiritual experiences and their relationship to beliefs and strength of beliefs. RESULTS: Two hundred and ninety-seven people took part in the validity and reliability tests of the questionnaire. Criterion validity, predictive validity, internal consistency and test-retest reliability were acceptably high. The instrument consistently differentiated between people with high and low spiritual beliefs. CONCLUSIONS: This instrument is brief and simple to complete. We would recommend that measures of religious and/or spiritual belief like this be more widely applied in health services research as they evaluate aspects of people's lives that go somewhat further than health status or quality of life.     

Exploring the Relationship between Spirituality,Coping, and Pain

There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelationship among biological, psychological, social, and spiritual factors. Chronic pain patients use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual forms of coping, such as prayer, and seeking spiritual support to manage their pain. This article will explore the relationship between the experience of pain and religion/spirituality with the aim of understanding not only why some people rely on their faith to cope with pain, but also how religion/spirituality may impact the experience of pain and help or hinder the coping process. We will also identify future research priorities that may provide fruitful research in illuminating the relationship between religion/spirituality and pain.     

A social cognitive perspective on religious beliefs: their functions and impact on coping and psychotherapy

Religious beliefs are an important part of clients' culture, whether acknowledged or not. Psychological theories about social and cognitive processes can help mental-health professionals better understand the function of religious beliefs in coping and their role in therapy. Religious individuals are likely to use heuristics to form rapid judgments rather than engage in formal information-gathering processes. The confirmatory and in-group/out-group biases support such judgments and shield them from disconfirmatory evidence. Religious beliefs provide order and understanding to an otherwise chaotic and unpredictable world. Many religions advocate forgiveness, which is often helpful in resolving conflicts. Another beneficial religious belief is an ever-present spiritual attachment figure. Negative effects of religion include its exercising aversive control to maintain conformity and its promoting an external locus of control. In contrast, mental-health professionals belong to a tradition of free inquiry and self-development, and guide clients to acquire competencies necessary to change and direct their lives. Therapist attitudes are far less likely to include allegiance to religion than are those of the public and psychiatric patients. Rather than being biased against religion or trying to debate religion, therapists need to engage in problem solving with clients in the context of this example of sociocultural factors.     

Struggling and enduring with God, religious support, and recovery from severe mental illness

Objectives: People with severe mental illnesses may achieve varying degrees of recovery, including symptom reduction and community integration. Research also indicates that religiosity facilitates coping with psychological disorders. In this study, we assessed the relationship between religiosity and recovery from severe mental illnesses. Design: Self‐report data were collected from 81 participants with severe mental illnesses. We measured recovery, religious support, and participants' struggle or endurance with faith. Results: Religious support and enduring with faith were positively associated with recovery. Struggling was negatively associated with recovery, and that relationship was mediated by religious support. Conclusions: Religious variables, including religious support and spiritual struggle, might affect recovery from severe mental illnesses. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–16, 2011.     

Identifying Religious and/or Spiritual Perspectives of Adolescents and Young Adults Receiving Blood and Marrow Transplants: A Prospective Qualitative Study

The potential benefits (or detriments) of religious beliefs in adolescent and young adults (AYA) are poorly understood. Moreover, the literature gives little guidance to health care teams or to chaplains about assessing and addressing the spiritual needs of AYA receiving hematopoietic stem cell transplants (HSCT). We used an institutional review board–approved, prospective, longitudinal study to explore the use of religion and/or spirituality (R/S) in AYA HSCT recipients and to assess changes in belief during the transplantation experience. We used the qualitative methodology, grounded theory, to gather and analyze data. Twelve AYA recipients were interviewed within 100 days of receiving HSCT and 6 participants were interviewed 1 year after HSCT; the other 6 participants died. Results from the first set of interviews identified 5 major themes: using R/S to address questions of “why me?” and “what will happen to me;” believing God has a reason; using faith practices; and benefitting from spiritual support people. The second set of interviews resulted in 4 major themes: believing God chose me; affirming that my life has a purpose; receiving spiritual encouragement; and experiencing strengthened faith. We learned that AYA patients were utilizing R/S far more than we suspected and that rather than losing faith in the process of HSCT, they reported using R/S to cope with illness and HSCT and to understand their lives as having special purpose. Our data, supported by findings of adult R/S studies, suggest that professionally prepared chaplains should be proactive in asking AYA patients about their understanding and use of faith, and the data can actively help members of the treatment team understand how AYA are using R/S to make meaning, address fear, and inform medical decisions.     

Collaborative Empiricism,Guided Discovery,and the Socratic Method: Core Processes for Effective Cognitive Therapy

[Clin Psychol Sci Prac 18: 62–66, 2011] Cognitive therapy sessions typically blend content and process issues to help clients make effective changes in their attitudes, beliefs, and expectations. Collaborative empiricism helps therapists and clients work together to examine the evidence supporting or refuting the client’s beliefs. In a similar manner, guided discovery helps to structure the process of therapy toward an exploration of critical issues involved in the client’s struggles. Finally, the Socratic method provides a comprehensive framework for the complex processes involved in therapy, while remaining aligned with the core concepts of cognitive therapy. These process issues may force the field to confront the mixed blessing derived from structured treatment manuals, psycho‐educational approaches, and directive forms of therapy.     

Religion and spirituality in psychotherapy: a practice‐friendly review of research

The role of religion and spirituality in psychotherapy has received growing attention in the last two decades, with a focus on understanding the ways that religion and spirituality relate to therapists, clients, and treatment methods. The authors reviewed recent empirical research on religion and spirituality in psychotherapy to inform practitioners about effective ways to incorporate the sacred into their clinical work. Three main areas are covered: religion/spirituality and therapists, religion/spirituality and clients, and religious/spiritual interventions. Research indicates that therapists are open to religious/spiritual issues, that clients want to discuss these matters in therapy, and that the use of religious/spiritual interventions for some clients can be an effective adjunct to traditional therapy interventions. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:131–146, 2009.     

Spiritually oriented psychodynamic psychotherapy

Spiritually oriented psychodynamic psychotherapy pays particular attention to the roles that religious and spiritual beliefs, practices, and experiences play in the psychological life of the client. Contemporary psychoanalytic theorists offer multiple approaches to understand the functions of religious experience. Spirituality provides a means to address existential issues and provide a context to form personal meaning. Religious narratives present schemas of relationship and models of experiences salient to mental health, such as hope. God images or other symbolic representations of the transcendent have the power to evoke emotions, which in turn, influence motivation and behavior. While employing theories and techniques derived from psychodynamic psychotherapy, this therapeutic approach encourages the analysis of the functions religion and spirituality serve, while respecting the client's act of believing in faith. Psychotherapists address a client's spirituality by exploring the psychological meaning of such personal commitments and experiences and refrain from entering into discussion of faith claims. ©2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:1–11, 2009.     

Incorporating spiritual beliefs into a cognitive model of worry

Cognitive theory and research have traditionally highlighted the relevance of the core beliefs about oneself, the world, and the future to human emotions. For some individuals, however, core beliefs may also explicitly involve spiritual themes. In this article, we propose a cognitive model of worry, in which positive/negative beliefs about the Divine affect symptoms through the mechanism of intolerance of uncertainty. Using mediation analyses, we found support for our model across two studies, in particular, with regards to negative spiritual beliefs. These findings highlight the importance of assessing for spiritual alongside secular convictions when creating cognitive-behavioral case formulations in the treatment of religious individuals.     

Empirically supported religious and spiritual therapies

This article evaluated the efficacy status of religious and spiritual (R/S) therapies for mental health problems, including treatments for depression, anxiety, unforgiveness, eating disorders, schizophrenia, alcoholism, anger, and marital issues. Religions represented included Christianity, Islam, Taoism, and Buddhism. Some studies incorporated a generic spirituality. Several R/S therapies were found to be helpful for clients, supporting the further use and research on these therapies. There was limited evidence that R/S therapies outperformed established secular therapies, thus the decision to use an R/S therapy may be an issue of client preference and therapist comfort. © 2009 Wiley Periodicals, Inc. J Clin Psychol 66: 1–27, 2010.     

Spiritual beliefs in bipolar affective disorder: their relevance for illness management

BACKGROUND: There has been growing interest in investigating religion as a relevant element in illness outcome. Having religious beliefs has been shown repeatedly to be associated with lessened rates of depression. Most of the limited published research has been restricted to elderly samples. Religious coping is thought to play a key role in religion's effects. Strangely, psychiatric research has neglected this area. METHODS: A questionnaire covering religious, spiritual and philosophical beliefs and religious practice was given to a sample of patients with bipolar affective disorder in remission. RESULTS: Most patients often held strong religious or spiritual beliefs (78%) and practised their religion frequently (81.5%). Most saw a direct link between their beliefs and the management of their illness. Many used religious coping, and often religio-spiritual beliefs and practice put them in conflict with illness models (24%) and advice (19%) used by their medical advisors. LIMITATIONS: This was a cross-sectional design without a control group and thus it is not possible to determine causal associations from the data set. CONCLUSIONS: Religio-spiritual ideas are of great salience to many patients with bipolar disorder and shape the ways in which they think about their illness. Many reported experiencing significant paradigm conflict in understanding and managing their illness between medical and their spiritual advisors. These data suggest that the whole area of religion and spirituality is directly relevant to people living with a chronic psychiatric illness and should be firmly on the discussion agenda of clinicians working with patients with bipolar disorder.     

Factors in outcome of cognitive‐behavioural therapy for psychosis: Users' and clinicians' views

Objectives. Despite increasing evidence to suggest that cognitive‐behavioural therapy (CBT) is helpful for a significant proportion of people with psychosis, only limited information is available regarding factors implicated in outcome. The present study investigated factors differentiating outcomes on the basis of accounts from participants in the therapeutic process. Method. Four therapists and eight of their clients were interviewed about their experiences of CBT. Clients were defined as having progressed or not progressed during therapy. Interview data were analysed using a qualitative ‘grounded theory’ methodology. Results. A number of major categories differentiated the two client groups, including ability to let go of distressing beliefs, logical thought, holding therapy, and presence of a shared goal. Overall, clients who progressed were better able to move into the therapist's frame of reference. Therapists and clients also felt that non‐specific benefits accrued from the therapy for both groups. Conclusion. The results were consistent with previous studies suggesting that ability to disengage from distressing beliefs is important in therapeutic progression. Reasons considered for the inability to progress include emotional investment in psychotic beliefs and cognitive processing. Further research is required to clarify the role of logical thought and therapeutic alliance in progress and in predicting outcome.     

Positivity in illness: Self‐delusion or existential growth?

Objectives: This study investigated the relationship between a measure of positivity in illness, the Silver Lining Questionnaire (SLQ), and measures of personality and spirituality/religious beliefs as a way of determining whether positivity in illness is a delusion or existential growth. Method: This is a cross‐sectional study comparing response to the SLQ, to the Eysenck Personality Questionnaire (EPQ‐R), breathlessness, illness type, and spiritual and religious beliefs in a final total sample of 194 respiratory outpatients. Results: The SLQ was associated positively with extraversion (r = .16, p< .05), unrelated to neuroticism (r = .11, n.s.) and repression (r = .10, n.s.) and was positively associated with spiritual and religious beliefs, F(2; 187) = 7.12, p < 001, as predicted by the existential growth but not the delusion interpretation. There was no relationship between positivity and age, r(194) = .09, n.s., or between positivity and gender t(192) = ?1.27, n.s., and nor were there relationships with type of illness, F(4, 188) = 2.17, n.s., or breathlessness, F (5, 173) = 0.42, n.s. Conclusions: The results suggest that positivity in illness is associated with existential growth, though the cross‐sectional nature of the study precludes a conclusion of causal direction. The non‐significant correlation between the SLQ and neuroticism is in the opposite direction predicted by the delusion explanation, but the non‐significant relationship between the SLQ and repression is in the predicted direction. We cannot rule out the possibility that some positivity is delusion.     

Psychotherapy with religious and spiritual clients: an introduction

This invited issue of the Journal of Clinical Psychology: In Session is devoted to psychotherapy with religious and spiritual clients. After offering definitions of religion and spirituality, noting areas of potential convergence and differentiating nuances, the authors highlight the prevalence and types of spirituality among both clients and mental health professionals. They describe the historical and current context for examining approaches to psychotherapy with clients who endorse religion, experience spirituality within their religion, or define themselves as spiritual even if not religious. They then summarize the subsequent articles in this issue, which offer practical guidance for practitioners. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 69:1–8, 2009.     

Prayer and reverence in naturalistic,aesthetic, and socio-moral contexts predicted fewer complications following coronary artery bypass

This prospective study explores prayer, reverence, and other aspects of faith in postoperative complications and hospital length of stay of patients undergoing coronary artery bypass graft surgery. Alongside traditional religiousness measures, we examined sense of reverence in religious and secular contexts. Face-to-face interviews were conducted with 177 patients 2 weeks before surgery at a medical center. Medical variables were retrieved from the national Society of Thoracic Surgeons’ Database. Logistic and multiple regression models were performed to predict outcomes. Prayer frequencies were associated with reduced complications but not hospitalization. Sense of reverence in secular contexts predicted fewer complications and shorter hospitalization. Controlling for complications reduced the initial influence of reverence on hospitalization, suggesting the potential mediation of complications. No interaction between demographics and faith factors was evident. The role of faith in medicine is complex and context-dependent. Future studies are needed on mediating factors.     

Secular Versus Religious Norms Against Smoking: Which Is More Important as a Driver of Quitting Behaviour Among Muslim Malaysian and Buddhist Thai Smokers?

Background

This paper prospectively examined two kinds of social normative beliefs about smoking, secular versus religious norms.

Purpose

The purpose of this paper is to determine the relative importance of these beliefs in influencing quitting behaviour among Muslim Malaysian and Buddhist Thai smokers.

Methods

Data come from 2,166 Muslim Malaysian and 2,463 Buddhist Thai adult smokers who participated in the first three waves of the International Tobacco Control Southeast Asia project. Respondents were followed up about 18 months later with replenishment. Respondents were asked at baseline about whether their society disapproved of smoking and whether their religion discouraged smoking, and those recontacted at follow-up were asked about their quitting activity.

Results

Majority of both religious groups perceived that their religion discouraged smoking (78% Muslim Malaysians and 86% Buddhist Thais) but considerably more Buddhist Thais than Muslim Malaysians perceived that their society disapproved of smoking (80% versus 25%). Among Muslim Malaysians, religious, but not societal, norms had an independent effect on quit attempts. By contrast, among the Buddhist Thais, while both normative beliefs had an independent positive effect on quit attempts, the effect was greater for societal norms. The two kinds of normative beliefs, however, were unrelated to quit success among those who tried.

Conclusions

The findings suggest that religious norms about smoking may play a greater role than secular norms in driving behaviour change in an environment, like Malaysia where tobacco control has been relatively weak until more recently, but, in the context of a strong tobacco control environment like Thailand, secular norms about smoking become the dominant force.     

Long-term impact of Huntington disease linkage testing

We performed a long-term follow-up of Huntington disease (HD) predictive testing (an average of 6 years post-test) for 16 of 20 people who received informative linkage test results. Although no pre-test or baseline psychological differences were noted between those with an increased versus a decreased risk of HD, the long-term impact was dramatically different in these two groups. The low-risk group reported less uncertainty, anxiety or worry, fear, and worry about children's risk, whereas the high-risk group reported either the same or increased concern in these areas. Those at low risk also acknowledged an increased sense of control and self-esteem, whereas those at high risk reported decreases or no changes. One high-risk individual reported chronic depression that had occurred since the testing. Additionally, those at low risk reported greater reliance and faith in spiritual or religious beliefs than those at high risk. The emotional impact of HD genetic testing justifies the continued utilization of pre- and post-test counseling protocols. Pre-test counseling should include discussion of the known risks and benefits of predictive testing, with special emphasis on the participant's expectations for future change and improvement. Although the psychological impact appears mostly favorable for those with decreased risk, there is risk for a decline in psychological well-being over time for those with an increased risk for HD. Am J. Med. Genet. 70:365–370, 1997. © 1997 Wiley-Liss, Inc.     

GOD AND THE UNCONSCIOUS

ABSTRACT This paper summarizes the author's recent book, The Symmetry of God . It proposes that the concepts of God in the Christian tradition and of the Unconscious in Freudian theory have much in common. In particular, the mystics may be seen as explorers of the Unconscious and religious narrative as revelation of the Unconscious into Consciousness. Matte Blanco's theory about the logic of the Unconscious is used to support this. Theology has often turned to philosophy for 'models' of God and using the Unconscious as such opens discussion between spiritual and psychological understandings of humanity. While the traditional Christian language is retained, it is given a less objective feel than is customary, and religious truth is sharply distinguished from factual or empirical truth. This may make the language of faith more accessible to those who find literal interpretations incredible.     

Forgiveness in Psychotherapy: The Key to Healing

The process of forgiveness in psychotherapy involves both letting go of resentment toward the offender and replacing the resentment with mindful awareness and empathy. By reconceptualizing past transgressions with a kinder, more equivocal outlook, clients attain a shift in perspective that is spiritual and cognitive in nature, thereby reducing symptomology and enhancing their quality of life. Such insights bring clients toward their inner Buddha nature, which transcends the suffering associated with clinging to past hurts and resentment. This process is facilitated by techniques such as concentrative meditation and identifying with transgressors through perspective taking. Forgiveness therapy improves clients’ sense of well‐being by promoting feelings of peacefullness toward oneself as well as others.