The role of attachment to God in secular and religious/spiritual ways of coping with a serious disease

This study investigated the role of security in one's attachment to God in relation to both secular and religious/spiritual ways of coping with a serious illness. The main objective was to test whether attachment to God and type of disease were related to secular coping strategies, when controlling for the effects of religious/spiritual coping. Study participants (N = 105) had been diagnosed either with cancer (i.e., an acute disease) and were under chemotherapy/awaiting surgery or with renal impairment (i.e., a chronic disease) and were attending dialysis. Results showed that secure attachment to God was uniquely related to fighting spirit, whereas insecure attachment to God was uniquely linked to hopelessness, suggesting that security, unlike insecurity, in one's attachment to God may impact favourably on adjustment to the disease. The only coping strategy related to type of disease was cognitive avoidance, which was linked to chronic disease.     

Religious Coping and Quality of Life Among Severely Ill Lung Patients in a Secular Society

This survey study investigated the prevalence of religious beliefs and religious coping and possible associations between religious factors and quality of life (QoL) among a group of severely ill lung patients (lung cancer and chronic obstructive pulmonary disease) in Denmark (N = 111). Almost two thirds (64.8%) reported having some belief in God and/or a spiritual power. Patients who reported believing in God and patients who believed in God and a spiritual power reported better QoL than patients who reported that they believed in a spiritual power only. Religious coping was prevalent; for positive religious coping strategies, those used from least to most often, respectively, were invoked 15% to 37% of the time; for negative religious coping strategies the percentages were 3% to 16%. Negative religious coping was associated with lower QoL (β = ?0.320, p < .006), whereas no associations were found between positive religious coping and QoL. Results are discussed in relation to the cultural context of secularized societies like the Scandinavian countries.     

Spiritual pathology and religious coping as predictors of forgiveness

Spiritual pathology, religious coping, and dispositional forgiveness were investigated in two studies with graduate students at a Christian university-based seminary. Spiritual pathology was operationalised using measures of spiritual instability and spiritual grandiosity. Study 1 (N?=?194) examined patterns of correlation between positive and negative religious coping items, spiritual pathology, and dispositional forgiveness. Spiritual instability correlated with numerous positive and negative religious coping items while spiritual grandiosity did not. Dispositional forgiveness correlated with more positive than negative religious coping items. Study 2 (N?=?214) tested regression models with these variables. Spiritual grandiosity showed a significant quadratic (concave down) effect in predicting dispositional forgiveness while the linear effect was not significant. A hierarchical regression model showed positive religious coping, spiritual instability, and the quadratic effect for spiritual grandiosity each predicted unique variance in dispositional forgiveness after controlling for spiritual impression management. Negative religious coping was not related to dispositional forgiveness when included with these variables.     

Self-Transformation at the Boundary of Religious Conversion and Psychosis

The relationship between religious conversion, as a form of spiritual emergency, and psychosis is one of the fundamental issues at the meeting point of theology and clinical psychology. In the present study, we assessed 53 individuals referred to a psychiatry center with the initial diagnosis of a psychotic episode by focusing on the clinical diagnosis (psychosis vs. spiritual emergency), subjective experiences (basic symptoms), and neuropsychological functions. Twenty-nine individuals meet the diagnosis of schizophrenia-spectrum disorders, but 24 persons experienced only religious and spiritual problems (religious conversion). Both groups reported similar levels of perplexity (e.g., ambivalence, inability to discriminate between own feelings, and hyperreflectivity) and self-disorder (e.g., depersonalization, impression of a change in one’s mirror image, and experience of discontinuity in own action). Diminished affectivity, disturbed contact, and perceptual/cognitive disorders were pronounced in psychosis, whereas anxiety and depressive symptoms were more severe in people with spiritual and religious problems. These results indicate that perplexity, self-disorder, and emotional turmoil are common features of turbulent religious conversion and psychosis, but a broader emergence of anomalous subjective experiences and cognitive deficits are detectable only in psychosis.

     

Attachment and affective resolution following a stressful event: General and religious coping as possible mediators

The current study replicated and extended previous research on mediators of attachment qualities and outcome (affective resolution), including appraisal, coping, and religious coping. Structural equation models were used to analyze the responses on an Internet survey for a primarily Christian sample of 1,289 adults (416 men and 873 women). As expected, appraisal was a significant mediator of ambivalent attachment qualities and coping, as well as ambivalent attachment qualities and religious coping. Avoidance coping significantly mediated ambivalent attachment qualities and affective resolution; it also mediated avoidant attachment qualities and affective resolution. Fit indices for models were adequate only when differences between interpersonal and non-interpersonal events were taken into account. Substantial similarities were found in the relationships among variables for the two models examined, one including coping in general and the other including religious coping. Religious coping provided additional explanatory value to more secular models of coping in a highly religious sample. The implications for assimilating religious coping into mainstream coping research are discussed.     

Integrating Religious Resources Within a General Model of Stress and Coping: Long-Term Adjustment to Breast Cancer

The purpose of the present cross-sectional study was to explore the role of religious resources in long-term adjustment to breast cancer. A sample of fifty-two survivors was assessed on indices of religious resources (e.g., image of God), nonreligious resources (e.g., cognitive appraisal) and emotional and spiritual well-being. Results indicated that both relationship with God/God image and religious coping behaviour were related to the nonreligious mediator variables of cognitive appraisal and coping in response to the current cancer situation. Various experiences of relationship with God (e.g., Presence) were related to more positive appraisals of the current cancer situation as well as to the greater use of the nonreligious coping behaviour of focusing on the positive. In contrast, religious coping behaviours demonstrated more complex associations with cognitive appraisal and nonreligious coping factors. The same coping behaviour, for example religious avoidance, could be related to both positive and negative appraisals of the cancer situation. Finally, religious resources, but not nonreligious resources predicted emotional and spiritual well-being for these long-term breast cancer survivors.     

The effect of psychologists’ disclosure of personal religious background on prospective clients

The present study explored the relation of religious coping and spirituality to adjustment and psychological distress in urban early adolescents. The participants were 76 sixth-, seventh-, and eighth-grade students attending Catholic day schools in the New York City area. They completed a set of self-report measures assessing religious coping, daily spiritual experiences, positive and negative affect, life satisfaction, and psychological distress. Correlational and regression analyses found positive religious coping and daily spiritual experiences to be associated with positive affect and life satisfaction, while negative religious coping was associated with negative affect and psychological distress. The relations generally were more robust among males, and their overall robustness decreased with age. Implications of the findings for research and clinical practice are offered to address the gap (compared to adults) in the literature on youth religious coping.     

Religious Coping and Cancer: Proposing an Acceptance and Commitment Therapy Approach

A cancer diagnosis is one of the most difficult diagnoses for any person to receive and cope with. Numerous individuals turn to religion or their spiritual beliefs to find meaning through the process of coping with such a serious illness. Therefore, in recent years research on religious coping has received increased attention. The aim of the present paper is to examine the area of religious coping, along with its dimensions and ways to assess it, as it relates to cancer. Moreover, this paper presents a relatively new approach to the psychological treatment of individuals with cancer. Namely, Acceptance and Commitment Therapy (ACT) is a spiritually and religiously sensitive treatment. This approach aims to first explore a person's values (including spiritual and religious values), to subsequently help the person accept any experience that the person has no control over in light of these values, and to then commit and take actions consistent with these values. Recent evidence providing initial support for this approach is discussed. Finally, a case example is presented to illustrate how ACT may be carried out to address religious coping in outpatient clinical practice with cancer patients.     

The Role of Attachment in Predicting Spiritual Coping with a Loved One in Surgery

Research has examined the relationship between spiritual coping and adjustment and found that individuals employ spirituality in coping in various ways. However, the reasons that individuals choose certain strategies remains unclear. The current project examined whether spiritual coping mediates the relationship between attachment to God and adjustment for individuals (N = 155) waiting for a loved one undergoing inpatient surgery. Results from the present study indicated that attachment to God was differentially related to spiritual coping activities and styles. In turn, spiritual coping was associated with the adjustment to the surgery vigil. Data were analyzed through path analysis of models for each of the outcome variables (Religious Outcome, General Outcome, Stress-Related Growth, and General Health Questionnaire). Attachment to God was predictive of spiritual coping, which, in turn, was predictive of adjustment. Attachment to God provides a useful framework for understanding why individuals choose particular coping strategies.     

Spiritual Distress and Depression in Bereavement: A Meaning-Oriented Contribution

One key focus of a meaning reconstruction model of bereavement concerns spiritual meanings attributed to the death, whether consoling or troubling. Specifically, previous studies in our research program suggest that religiously inclined violent death survivors are at risk for elevated levels of both bereavement distress and complicated spiritual grief, a crisis of faith following loss that refers to the erosion of the mourner’s relationship to God and/or the religious community. However, more research is needed to understand the convergence of depression and spiritual struggle in the context of violent and natural loss. In this study of a diverse sample of 59 American Christians bereaved less than 5 years, we sought to: (1) determine if individuals bereaved by homicide, suicide or fatal accident differed from those bereaved by natural causes in their levels of depression and spiritual coping; (2) investigate the relation between the latter constructs; and (3) ascertain if cause of death mediates the effect of religious coping on depression. We found that: (a) violently bereaved individuals endorsed more negative religious coping, and (b) depression was associated with greater spiritual struggle, particularly a sense of disrupted relationship with God. Contrary to expectations, positive religious coping was unrelated to post-loss depression, and cause of death did not mediate the relationship between spiritual coping and depressive symptomatology. A clinical case study concludes the article, illustrating the interweaving of spiritual and psychological distress in tragic bereavement, and their implications for a meaning-oriented grief therapy.     

Manic depression and religious experience: The use of religion in therapy

In the article, I explore the use of spiritual strategies in the treatment of manic depression in religiously oriented psychiatric inpatients. Manic depression, a disorder primarily of mood, is characterized by bouts of mania alternating with depression. Religious themes and mystical experiences pervade the language of manic depressive illness, e.g., sensing one is God, being given a divine mission, receiving divine messages, having ecstatic experiences, and so on. Debate exists concerning the effectiveness of spiritual interventions in manic patients. I suggest that a trained religious leader may be able to work therapeutically with such patients, provided that two goals are kept in mind: emphasizing beliefs that facilitate positive coping and challenging irrational religious beliefs (i.e., beliefs that lead to negative coping). When examined psychoanalytically, patients’ religious symbols and beliefs reveal deeply held beliefs about themselves. In particular, splitting and idealization and devaluation can be seen in their religious belief system. The role of culture in promoting maladaptive belief systems must not be overlooked. In employing spiritual interventions in patients diagnosed with manic depression, potential dangers are imposing one's values on patients and overstating the importance of spirituality.     

Attachment,religiousness, and distress among the religious and spiritual: links between religious syncretism and compensation

Using the Adult Attachment Interview, we explored differences in attachment, distress, and religiousness among groups of traditionally religious, New Age spiritual, and religiously syncretistic (high on both) participants (Ps) (N?=?75). Religiously syncretistic Ps showed a preponderance of insecure attachment and were raised by non-religious parents, who were estimated as relatively insensitive. Moreover, religiously syncretistic Ps perceived a personal relationship with God and had experienced increased religiousness/spirituality during difficult life periods, but did not suffer elevated distress. New Agers often mirrored the religiously syncretistic, but had a more even secure–insecure attachment distribution, typically did not perceive a personal relationship with God, and did suffer elevated distress. Traditionally religious Ps were low on distress and raised by religious parents, estimated as relatively sensitive. We conclude that religious syncretism may often express religion/spirituality as compensation. Finally, we speculate that a perceived relationship with God may attenuate distress among those at risk.     

Expanding coping goodness-of-fit: religious coping, health locus of control, and depressed affect in heart failure patients

The goodness-of-fit coping hypothesis posits that problem-focused (PF) coping is particularly helpful under high controllability conditions, while emotion-focused (EF) coping is more helpful in low controllability situations. However, little research has examined whether the goodness-of-fit hypothesis applies to religious coping, a distinct set of coping resources and efforts. Further, little goodness-of-fit research has been conducted in the context of life-threatening illness. We tested coping goodness-of-fit for PF and EF as well as religious coping resources and strategies in 202 congestive heart failure (CHF) patients. Multiple regression analyses examined the extent to which each type of coping, health locus of control (HLOC) regarding their CHF, and their interactions related to subsequent depressed affect. Neither religious coping efforts nor religious resources were related to depressed affect. However, when examined in conjunction with internal HLOC, active coping and organized religious commitment were related to less depression for those higher in internal HLOC, while daily spiritual experience was related to less depression for those lower in HLOC. These results partially support the goodness-of-fit hypothesis and indicate a need to consider the perceived controllability of situations when examining the associations of religious coping resources and activities on depressive symptoms in the context of illness.     

Religious coping in highly religious psychiatric inpatients

This study among highly religious psychiatric patients in a mental hospital in the Netherlands focused on the following issues: their religious and spiritual beliefs and activities; their religious coping activities, measured using Pargament's three coping styles and a positive religious coping scale; the influence of religious coping on psychological and existential well-being; and the predictive value of general religiousness, as compared with religious coping activities, regarding psychological and existential well-being.

For this population of inpatients, religion had a positive influence on their ways of dealing with mental problems; religious coping was positively correlated with existential and psychological well-being. General religiousness as well as religious coping were positively correlated with existential well-being, whereas psychological well-being primarily was predicted by positive religious coping.

Results are discussed in the context of theoretical notions of religious coping, addressing in particular the positive influence of religious beliefs, relying on God, religious activities and religious social support in psychological and existential times of crisis.     

In Search of Serenity: Religious Struggle Among Patients Hospitalized for Suspected Acute Coronary Syndrome

Hospitalization for a sudden cardiac event is a frightening experience, one that is often marked by uncertainty about health status, fear of recurrent cardiac problems, and related existential, religious, and spiritual concerns. Religious struggle, reflecting tension and strain regarding religious and spiritual issues, may arise in response to symptoms of acute coronary syndrome (ACS). The present study examined the prevalence and types of religious struggle using the Brief RCOPE, as well as associations between religious struggle, psychological distress, and self-reported sleep habits among 62 patients hospitalized with suspected ACS. Fifty-eight percent of the sample reported some degree of religious struggle. Questioning the power of God was the most frequently endorsed struggle. Those struggling religiously reported significantly more symptoms of anxiety, depression, and sleep disturbance. Non-White participants endorsed greater use of positive religious coping strategies and religious struggle. Results suggest that patients hospitalized for suspected ACS experiencing even low levels of religious struggle might benefit from referral to a hospital chaplain or appropriately trained mental health professional for more detailed religious and spiritual assessment. Practical means of efficiently screening for religious struggle during the often brief hospitalization period for suspected ACS are discussed.     

Walking Down the Sunny Side of the Street: Three Studies Developing a Spiritually Nuanced Measure of Optimism

Across a series of studies, an effort was made to operationalize optimism in a spiritually nuanced fashion. In the first study, it was proposed and tested that spiritual optimism might consist of two factors: “here and now” and “end of story” optimism. However, a second study suggested that spiritual optimism had more of a unitary quality. The second study also suggested that the construct of spiritual optimism was separate from the construct of hope. The third study confirmed the unitary nature of the spiritual optimism measure and provided evidence for the construct validity of the measure. Spiritual optimism was directly related to a general measure of coping and a measure of religious coping. The relationships between spiritual optimism and different types of religious coping appeared stronger than between spiritual optimism and the more general measures of coping.     

The Spiritual Needs and Resources of Hospitalized Primary Care Patients

Previous studies have recognized the importance of hospitalized primary care patients’ spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients’ internal and external resources for addressing spiritual questions, while also exploring the physician’s role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients’ desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as “R/S respondents”) reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients’ physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.     

Religion and emotional compensation: results from a prospective study of widowhood

Based on recent applications of attachment theory to religion, the authors predicted that the loss of a spouse would cause widowed individuals to increase the importance of their religious/spiritual beliefs. This hypothesis was examined using the Changing Lives of Older Couples sample from which preloss measures of religiosity were available for widowed individuals and matched controls. A total of 103 widowed individuals provided follow-up data, including reports of religious beliefs and grief, at 6 months, 24 months, and 48 months after the loss. Results indicated that widowed individuals were more likely than controls to increase their religious/spiritual beliefs. This increase was associated with decreased grief but did not influence other indicators of adjustment such as depression. Finally, insecure individuals were most likely to benefit from increasing the importance of their beliefs. Results are discussed in terms of the potential value of applying psychological theory to the study of religion.