Spiritual Interventions in Veterans with PTSD: A Systematic Review

Journal of Religion and Health - This article reports the results of a systematic review on the effectiveness of religious/spiritually (R/S)-based interventions in veterans with post-traumatic...     

Help-Seeking from Clergy and Spiritual Counselors Among Veterans with Depression and PTSD in Primary Care

Little is known about the prevalence or predictors of seeking help for depression and PTSD from spiritual counselors and clergy. We describe openness to and actual help-seeking from spiritual counselors among primary care patients with depression. We screened consecutive VA primary care patients for depression; 761 Veterans with probable major depression participated in telephone surveys (at baseline, 7 months, and 18 months). Participants were asked about (1) openness to seeking help for emotional problems from spiritual counselors/clergy and (2) actual contact with spiritual counselors/clergy in the past 6 months. At baseline, almost half of the participants, 359 (47.2 %), endorsed being “very” or “somewhat likely” to seek help for emotional problems from spiritual counselors; 498 (65.4 %) were open to a primary care provider, 486 (63.9 %) to a psychiatrist, and 409 (66.5 %) to another type of mental health provider. Ninety-one participants (12 %) reported actual spiritual counselor/clergy consultation. Ninety-five (10.3 %) participants reported that their VA providers had recently asked them about spiritual support; the majority of these found this discussion helpful. Participants with current PTSD symptoms, and those with a mental health visit in the past 6 months, were more likely to report openness to and actual help-seeking from clergy. Veterans with depression and PTSD are amenable to receiving help from spiritual counselors/clergy and other providers. Integration of spiritual counselors/clergy into care teams may be helpful to Veterans with PTSD. Training of such providers to address PTSD specifically may also be desirable.     

Assessment and Treatment of Combat-Related PTSD in Returning War Veterans

Over the past 9 years approximately 2 million U.S. military personnel have deployed in support of Operation Iraqi Freedom in Iraq and Operation Enduring Freedom in and around Afghanistan. It has been estimated that 5–17% of service members returning from these deployments are at significant risk for combat-related posttraumatic stress disorder (PTSD). Many of these returning war veterans will seek medical and mental health care in academic health centers. This paper reviews the unique stressors that are related to the development of combat-related PTSD. It also reviews evidence-based approaches to the assessment and treatment of PTSD, research needed to evaluate treatments for combat-related PTSD, and opportunities and challenges for clinical psychologists working in academic health centers.     

Childhood Maltreatment and PTSD: Spiritual Well-Being and Intimate Partner Violence as Mediators

Childhood maltreatment places individuals, including African American women who are undereducated and economically disadvantaged, at risk for developing posttraumatic stress disorder (PTSD) symptoms. Participants were 192 African American women with a history in the prior year of both a suicide attempt and intimate partner violence (IPV) exposure. They were recruited from a public hospital that provides medical and mental health treatment to mostly low-income patients. A simple mediator model was used to examine if (a) existential well-being (sense of purpose) or religious well-being (relationship with God) mediated the link between childhood maltreatment and adult PTSD symptoms. Sequential multiple mediator models determined if physical and nonphysical IPV enhanced our understanding of the mediational association among the aforementioned variables. Findings suggest that existential well-being mediated the association between childhood maltreatment and adult PTSD symptoms in a simple mediator model, and existential well-being and recent nonphysical IPV served as sequential multiple mediators of this link. However, religious well-being and physical IPV were not significant mediators. Findings underscore the importance of enhancing existential well-being in the treatment of suicidal African American women with a history of childhood maltreatment and IPV.     

Cognitive Functioning in Treatment-Seeking Gulf War Veterans: Pyridostigmine Bromide Use and PTSD

Gulf War (GW) deployed veterans have reported health symptoms since returning from the war that suggest dysfunction of the central nervous system (CNS). These symptoms include memory and concentration difficulties, fatigue, and headaches. Leading hypotheses for the etiology of these cognitive complaints include psychological factors and/or exposures to chemicals with neurotoxic properties. In this study, cognitive functioning was compared in treatment-seeking GW-deployed veterans and a treatment-seeking non–GW-deployed veteran control group. Results indicated that GW-deployed veterans performed significantly worse than the comparison group on tests of attention, visuospatial skills, visual memory, and mood. GW-deployed veterans who reported taking pyridostigmine bromide (PB) performed worse than GW-deployed veterans without PB use on executive system tasks. Treatment-seeking GW-deployed veterans with diagnoses of posttraumatic stress disorder (PTSD) did not differ on cognitive test measures compared with GW-deployed veterans without PTSD. No interaction effect of PTSD and PB use was found.     

The Factor Structure of the Spiritual Well-Being Scale in Veterans Experienced Chemical Weapon Exposure

This study aimed to determine the factor structure of the spiritual well-being among a sample of the Iranian veterans. In this methodological research, 211 male veterans of Iran–Iraq warfare completed the Paloutzian and Ellison spiritual well-being scale. Maximum likelihood (ML) with oblique rotation was used to assess domain structure of the spiritual well-being. The construct validity of the scale was assessed using confirmatory factor analysis (CFA), convergent validity, and discriminant validity. Reliability was evaluated with Cronbach’s alpha, Theta (θ), and McDonald Omega (Ω) coefficients, intra-class correlation coefficient (ICC), and construct reliability (CR). Results of ML and CFA suggested three factors which were labeled “relationship with God,” “belief in fate and destiny,” and “life optimism.” The ICC, coefficients of the internal consistency, and CR were >.7 for the factors of the scale. Convergent validity and discriminant validity did not fulfill the requirements. The Persian version of spiritual well-being scale demonstrated suitable validity and reliability among the veterans of Iran–Iraq warfare.     

Effects of Spiritual Well-Being on Subsequent Happiness,Psychological Well-Being,and Stress

Recently, Gomez and Fisher (Gomez R and Fisher JW (2003) Pers Individ Dif 35: 1975–1991) proposed that four facets of spiritual well-being exist, namely, personal, communal, environmental, and transcendental spiritual well-being. Based on data from three independent studies, the present research effort tested the validity of a German version of (Gomez R and Fisher JW (2003) Pers Individ Dif 35: 1975–1991) of the Spiritual Well-Being Questionnaire (SWBQ-G). It was found that the SWBQ-G was factorially valid and that each of the four SWBQ-G scales was discriminant to mental, physical, and emotional well-being. Also, it was found that the SWBQ-G predicted levels of subsequent happiness, psychological well-being (positive relationship), and stress (negative relationship). These results add to our knowledge about the validity of the construct of spiritual well-being.     

Neuropsychological Sequelae of PTSD and TBI Following War Deployment among OEF/OIF Veterans

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent among Veterans of the conflicts in Iraq and Afghanistan. These conditions are associated with common and unique neuropsychological and neuroanatomical changes. This review synthesizes neuropsychological and neuroimaging studies for both of these disorders and studies examining their co-occurrence. Recommendations for future research, including use of combined neuropsychological and advanced neuroimaging techniques to study these disorders alone and in concert, are presented. It is clear from the dearth of literature that addiitonal studies are required to examine and understand the impact of specific factors on neurocognitive outcome. Of particular relevance are temporal relationships between PTSD and mTBI, risk and resilience factors associated with both disorders and their co-occurrence, and mTBI-specific factors such as time since injury and severity of injury, utilizing comprehensive, yet targeted cognitive tasks.     

Spiritual Experiences of War Veterans Who Suffer from Combat-Related Post-Traumatic Stress Disorder: A Qualitative Study

Recognition of the spiritual experiences of patients with post-traumatic stress disorder may be helpful in their rehabilitation. Accordingly, the present study has been carried out to determine the spiritual experiences of Iranian Muslim warriors who suffer from the previously mentioned disorder. In this qualitative study, 22 patients were selected using an objective-based sampling method and underwent an individual, semi-structured thorough interview. The data were analyzed using content analysis. The spiritual experiences of the participants were divided into two main categories as follows: (1) religious attitude consisting of three sub-categories known as “religious beliefs,” “religious sentiments,” and “religious behaviors” and (2) a national sensibility that includes the two sub-categories of “patriotism” and “proud” of being injured for my homeland. The analysis of the participants’ spiritual experiences showed that their specific religious orientation and feelings of nationalism assisted with their improved ability to cope with the consequences of their disorder. Therefore, it is recommended that caregivers use patients’ spiritual values to help them cope more efficiently.     

Near-Death Experiences and Spiritual Well-Being

People who have near-death experiences often report a subsequently increased sense of spirituality and a connection with their inner self and the world around them. In this study, we examined spiritual well-being, using Paloutzian and Ellison’s Spiritual Well-Being Scale, among 224 persons who had come close to death. Participants who reported having near-death experiences reported greater spiritual well-being than those who did not, and depth of spiritual well-being was positively correlated with depth of near-death experience. We discussed the implications of these findings in light of other reported aftereffects of near-death experiences and of spiritual well-being among other populations.     

Group Therapy, Spiritual Issues, and Vietnam Veterans

This article describes a form of therapy that focuses on the spiritual dimension of the experience of American military veterans. Since definitions of spirituality abound, it is important that therapists be able to work with multiple understandings of spirituality simultaneously. Such veterans often resist facing, much less integrating, the spiritual dimension of their experience in therapy. A process is described that uses a VA Chaplain as a co-therapist on a monthly basis in an ongoing group. Telling Biblical stories and parables, in the context of therapy, is reported as a valuable means to enable clients to deal with their spiritual issues.     

Spiritual Inquiry and Well-Being in Life-Limiting Illness

ABSTRACT

Introduction: End of life, as a developmental phase, is accompanied by inner resources as well as losses. Spirituality is a potential inner resource for integrating illness that often occurs during this time. Despite the increase in spirituality research, how spiritual perspectives are used in life-limiting illness remains under-investigated. Better knowledge about this process may be useful for health care providers, family caregivers and patients themselves to enhance well-being at end of life. This study describes the process of how patients and family care-givers use their spiritual resources to facilitate well-being at the end of life.

Method: A qualitative study was designed, based upon the grounded theory method, that entails theoretical sampling of concepts (not sampling of people as in quantitative designs), and the analytic technique of constant comparison of the data until conceptual categories are saturated with supporting data and a theory can be identified. The sample consisted of 12 respondents: 6 dyads of elderly patients with a life-limiting illness and family caregivers. Interviews occurred over a 2-year period.

Results: Data analysis generated a theory about a process called “transcending life-limiting illness,” which derived from two related themes: spiritual inquiry and end-of-life dimensions.

Conclusion: The results expand existing knowledge about how people, either as patients or as family caregivers of persons facing end of life, live with life-limiting illness. The process of transcending life-limiting illness goes beyond merely coping to tap resources for well-being. This resource is expressed through an ongoing dialectic process of spiritual inquiry about life and death as supported by six critical life dimensions.     

Suffering and the Shape of Well-Being in Buddhist Ethics

This article explores the defense Indian Buddhist texts make in support of their conceptions of lives that are good for an individual. This defense occurs, largely, through their analysis of ordinary experience as being saturated by subtle forms of suffering (du?kha). I begin by explicating the most influential of the Buddhist taxonomies of suffering: the threefold division into explicit suffering (du?kha-du?khatā), the suffering of change (vipari?āma-du?khatā), and conditioned suffering (sa?skāra-du?khatā). Next, I sketch the three theories of welfare that have been most influential in contemporary ethical theory. I then argue that Buddhist texts underdetermine which of these theories would have been accepted by ancient Indian Buddhists. Nevertheless, Buddhist ideas about suffering narrow the shape any acceptable theory of welfare may take. In my conclusion, I argue that this narrowing process itself is enough to reconstruct a philosophical defense of the forms of life endorsed in Buddhist texts.     

The Comorbidity of Post-traumatic Stress Disorder and Suicidality in Vietnam Veterans

Vietnam veterans (N = 232) recruited from three sources were assessed for suicidal thinking and behaviors, and symptoms of posttraumatic stress disorder (PTSD) and depression. Findings support the notion that suicidal thoughts are prevalent in this group, with veterans in psychotherapy reporting a greater likelihood of such symptoms (82.6%) than veterans in the community (35.7%) or those seeking assistance through a veteran's outreach center (66.7%). Thoughts of ending one's life and a previous suicide attempt were significantly correlated with a diagnosis of PTSD (r = .53, p < .001; and r = .33, p < .001, respectively). Veterans with a diagnosis of PTSD and depression or dysthymia were also more likely to report suicidal thinking and behaviors than veterans with only one of the diagnoses.     

Anhedonia, Emotional Numbing, and Symptom Overreporting in Male Veterans with PTSD

We used measures of positive affect and emotional expression to distinguish and better understand veterans with PTSD with symptom overreporting presentation styles. Based on prior research, symptom overreporting was defined as scores greater than eight on the F(p) (Infrequency-Psychopathology) scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Data were drawn from an archival dataset of 227 combat veteran outpatients. Results were consistent with theory and research on the distinction between negative and positive affect. Major findings indicated that (a) veterans endorsing greater anhedonia had a greater likelihood of being classified as a symptom overreporter (controlling for PTSD symptoms), and (b) compared to non-symptom overreporting veterans, overreporters showed greater congruency in their presentation of diminished positive affect and their expression across self- and clinician-ratings. Our data suggest that diminished positive emotions and their behavioral expression are uniquely associated with veterans' psychological experiences, providing insight into the nature of symptom overreporters.     

Co-Occurring Traumatic Brain Injury,PTSD Symptoms,and Alcohol Use in Veterans

Traumatic brain injury (TBI) has been identified as a significant health problem among veterans. Recent research demonstrates the potential interaction and magnification of symptoms of posttraumatic stress disorder (PTSD) and substance use disorders (SUD) in veterans with a history of TBI; however, there is very limited research on the co-occurrence of the three conditions. Veterans (N = 115) with comorbid PTSD and SUD completed a baseline assessment for enrollment into a larger treatment study. As part of that assessment, participants completed a TBI screener as well as self-report measures for pain and physical health, affective symptoms, and substance use. Almost half of the sample (48 %) endorsed a history of a previous head trauma with loss of consciousness (LOC). Participants with and without head trauma with LOC were compared across various measures of functioning. Increased severity of physical health complaints and affective symptoms were reported by the TBI group compared to controls. However, the increases in affective symptoms were relatively small. No group differences were observed for alcohol use. Together, the findings suggest that treatment-seeking veterans with a history of head trauma with LOC may present with roughly equivalent symptoms of PTSD and SUD to those without said history.     

Everyday Strivings in War Veterans With Posttraumatic Stress Disorder: Suffering From a Hyper-Focus on Avoidance and Emotion Regulation

This research investigated whether combat veterans' daily strivings are related to the presence of post-traumatic stress disorder (PTSD) and well-being. Veterans created a list of their most important strivings, which were content-analyzed for emotion regulation and approach or avoidance themes. It was hypothesized that veterans pursuing strivings with themes of emotion regulation or avoidance experience deleterious consequences compared with other veterans. For all veterans, devoting finite time and energy in daily life to regulating emotions was associated with less purpose, meaning, and joy compared with other strivings. Veterans with PTSD endorsed more strivings related to emotion regulation and devoted considerable effort to emotion regulation and avoidance strivings. Yet, these efforts failed to translate into any discernible benefits; veterans without PTSD derived greater joy and meaning from strivings focusing on approac- oriented behavior and themes other than emotion regulation. The presence of PTSD and a high rate of emotion regulation strivings led to the lowest global well-being and daily self-esteem during a 14-day assessment period. The presence of PTSD and a high rate of avoidance strivings also led to lower emotional well-being. Results indicate that strivings devoted to regulating emotions or avoidance efforts influence the mental health of veterans with and without PTSD. Studying personality at different levels of analysis—traits, strivings, and life narratives—allows for a fine-grained understanding of emotional disorders.     

Different Types of Religious/Spiritual Well-Being in Relation to Personality and Subjective Well-Being

In this study the authors attempt to present different types of Religious/Spiritual Well-Being (RSWB) and discuss their relation to personality and psychological well-being. The Multidimensional Inventory for Religious/Spiritual Well-Being 48 is employed for this study, which consists of 6 subscales. To find different types of RSWB, an agglomerative cluster analysis on these subscales was performed based on the responses obtained in a nonclinical adult sample (n = 463). A 4-cluster solution was accepted. The clusters were labeled as Religious/Spiritual High, Religiously Oriented, Existentially Oriented, and Religious/Spiritual Low, and were found to be substantially related to Sense of Coherence (n = 263) and Six Factors of Personality (n = 200) in two different subsamples. By presenting a first empirical model for a 4-field typology of RSWB, we hope to further contribute to the ongoing discussion on how to deal with religious/spiritual issues in personality research.     

Measuring Spiritual Fitness: Atheist Military Personnel,Veterans, and Civilians

This study investigated the impact of transcendent item phrasing (i.e., phrasing which assumes the respondent believes in certain sacred or supernatural concepts) on the validity of the U.S. Army’s Comprehensive Soldier Fitness (CSF) program’s spiritual fitness scale when administered to atheist military personnel, veterans, and civilians. Results indicated that the inclusion of transcendent phrasing led to reduced concurrent validity for the spiritual fitness scale when administered to atheist military personnel and veterans, reduced concurrent and predictive validity when administered to atheists’ but not Christians’ spiritual fitness. Notably, the removal of transcendent phrasing actually led to increased concurrent validity for Christian respondents. Taken together, these findings suggest the Revised scale, which is composed of items that do not rely on transcendent phrasing, produces better psychometric outcomes for both atheist and Christian respondents. Implications for the CSF program and the measurement of spiritual fitness are addressed.