中国大陆宁养照顾对癌症末期患者生活质量之影响

宁养工作强调全人的照顾,不但能维持原有的生活方式,而且能提高生活的品质。本研究旨在探讨癌症末期患者在宁养照顾介入后,生活质量的改变。研究分为试验组（n=630）和对照组（n=241）。研究的结果显示癌症末期患者经过宁养介入后,其身、心、灵、社会之生活品质大幅度改善。而对照组患者仅在身体生活质量方面有显著改变。因此对医疗人员、社会大众的临终关怀观念的推广及教育是迫切需要的,立法更是不容忽视的课题,正确的立法才能真正推动宁养工作的发展。     

The difficulties assessing spiritual distress in palliative care patients: a qualitative study

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.     

Spiritual experience and mental distress: A clergy perspective

This qualitative study is based on a small group of clergy in the UK. The study explored the clergy’s views and perceptions on the relationship between spiritual experience and mental distress. Six clergy were interviewed using a semi-structured technique, and the interviews were recorded, transcribed, and analysed thematically. The findings explore the nature of spirituality in relation to mental distress highlighting a relationship between mental distress and spiritual experience and add to the debate surrounding these concepts. Implications and recommendations for future research are discussed.     

Martin Buber's relevance to institutional mental health care

A Buberian perspective on problems related to the establishment of therapeutic environments on mental hospital wards is offered. Depersonalization and over-reliance on a medical treatment orientation in human relationships are identified as central problem areas in mental hospitals. The therapeutic community is identified as a major alternative model to respond to these problem areas. Difficulties in applying the therapeutic community model are identified. Buber's social philosophy, especially his interpretations of spiritual crisis, cultural crisis, structural renewal, and genuine dialogue, are identified as useful tools to clarify and resolve those difficulties.     

Prayers, spiritual support, and positive attitudes in coping with the September 11 national crisis

This study was designed to help fill gaps in faith-related and positive psychology research. Psychologists have called for precise assessment of effective faith factors inherent within spiritual experiences that may explain their beneficial effects. Positive psychologists suggest the need to examine social and faith-related origins of optimism. Based on previous research, we redefined spiritual support and developed a new assessment. The study is a survey of 453 graduate and undergraduate students 3 months after the September 11, 2001, terrorist attacks. The results showed that participants, who believed in diverse spiritual entities, used various types of prayer for coping. A structural equation model showed that a linkage of spiritual support and positive attitudes mediated the effect of faith-based and secular factors on post-September 11 distress. Higher levels of initial negative emotional response were associated with the use of prayer for coping, which was, in turn, related to less distress through the pathway of the above linkage.     

A Mother,A Baby,and Two Treatment Approaches: Discussing A Switch Case from CBT and Mentalization Perspectives

ABSTRACT

As the literature on perinatal depression and anxiety grows, there is an increased need for dialogue among theoretical approaches for mother-infant mental health. This article describes a community mental health program incorporating a range of treatment models for pregnant and postpartum women experiencing issues during the transition to parenthood. Perinatal distress can affect parenting practices, from breastfeeding to health care access, creating the need for targeted, practical, and concrete interventions. Interventions that aim to foster secure attachment relationships and mentalization capacities can also help increase maternal sensitivity and attunement and joy in caregiving, and reduce withdrawn/hostile behaviors that may be associated with perinatal distress. The article describes psychotherapy with a mother and her newborn that began from a cognitive-behavioral approach and transitioned to a psychodynamic mentalization-focused treatment. Working principles and examples of two additional components of treatment, a group psychotherapy and research measures, are discussed. The case helps demonstrate how attachment theory can inform treatment and build a bridge between alternative approaches.     

Effects of Childhood Sexual Abuse on Client Spiritual Well‐Being

Forty‐three individuals receiving psychotherapy for childhood sexual abuse and 34 clients who sought psychotherapy for other reasons were compared on several aspects of spiritual functioning. The 2 groups did not differ significantly in spiritual well‐being. However, both groups scored lower than samples of medical outpatients and hospice workers. Most reported initiating and discussing spiritual issues during therapy, were satisfied and comfortable with these discussions, and rated spirituality as important to problem resolution. They also listed several obstacles to spiritual development. Possible research and practice implications are discussed.     

Relationships Among Religiousness,Spirituality, and Health for Individuals with Stroke

The current study evaluated the relationships among spiritual beliefs, religious practices, physical health, and mental health for individuals with stroke. A cross-sectional analysis of 63 individuals evaluated in outpatient settings, including 32 individuals with stroke and 31 healthy controls was conducted through administration of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36). For individuals with stroke, the SF-36 General Mental Health scale was significantly correlated with only the BMMRS Religious and Spiritual Coping scale (r = .43; p < .05). No other BMMRS factors were significantly correlated with SF-36 mental or physical health scales. Non-significant trends indicated spiritual factors were primarily related to mental versus physical health. This study suggests spiritual belief that a higher power will assist in coping with illness/disability is associated with better mental health following stroke, but neither religious nor spiritual factors are associated with physical health outcomes. The results are consistent with research that suggests that spiritual beliefs may protect individuals with stroke from experiencing emotional distress.     

American Indian Historical Trauma: Community Perspectives from Two Great Plains Medicine Men

The field of community psychology has long been interested in the relations between how community problems are defined, what interventions are developed in response, and to what degree power is distributed as a result. Tensions around these issues have come to the fore in debates over the influence of historical trauma (HT) in American Indian (AI) communities. After interviewing the two most influential medicine men on a Great Plains reservation to investigate how these tensions were being resolved, we found that both respondents were engaging with their own unique elaboration of HT theory. The first, George, engaged in a therapeutic discourse that reconfigured HT as a recognizable but malleable term that could help to communicate his “spiritual perspective” on distress and the need for healing in the reservation community. The second, Henry, engaged in a nation-building discourse that shifted attention away from past colonial military violence toward ongoing systemic oppression and the need for sociostructural change. These two interviews located HT at the heart of important tensions between globalization and indigeneity while opening the door for constructive but critical reflection within AI communities, as well as dialogue with allied social scientists, to consider how emerging discourses surrounding behavioral health disparities might be helpful for promoting healing and/or sociostructural change.     

Sacrilege: A Study of Sacred Loss and Desecration and Their Implications for Health and Well-Being in a Community Sample

In this study, we proposed that people understand major life events in terms of spiritual as well as psychological, social, and physical dimensions. Specifically, we examined the possibility that life events that are perceived to be sacred losses or violations of the sacred (i.e., desecrations) have significant implications for the health and well-being of the individual. A total of 117 adults, randomly selected from a community, identified the most negative life event they had experienced in the past two years. They then completed measures of the degree to which they appraised this event as a sacred loss and as a desecration, as well as measures of religious coping, the impact of the event, and four sets of criteria: traumatic impact, physical health, emotional distress, and growth. These hypotheses were largely supported. Sacred loss and desecration were unrelated to physical health. However, they were tied to higher levels, though somewhat differential patterns, of emotional distress. While sacred loss was predictive of intrusive thoughts and depression, desecration was tied to more intrusive thoughts and greater anger. Furthermore, sacred loss was linked to greater posttraumatic growth and positive spiritual change; in contrast, desecration was associated with less posttraumatic growth. The links between the spiritual appraisals and outcomes were partially mediated by positive and negative methods of religious coping. These findings underscore the importance and multidimensionality of the spiritual meanings people attribute to major life stressors.     

The Only Way Out Is Through: The Peril of Spiritual Bypass

Given the increased attention to spirituality in the counseling literature, with a primary emphasis on helping clients find their spiritual path, it is important for counselors to be aware of one potential pitfall of the spiritual path, namely spiritual bypass. Spiritual bypass occurs when clients seek to use their spiritual beliefs, practices, and experiences to avoid genuine contact with their psychological “unfinished business.” The purpose of this article is to define spiritual bypass, discuss the necessity of healing at the cognitive, emotional, and physical levels, as well as at the spiritual level for holistic wellness, and provide examples of clients in spiritual bypass.     

Social Comparison and the Subjective Well-Being of Cancer Patients

Although cancer patients may suffer from more physical and psychological distress than healthy persons, they seem not to differ in subjective well-being. In this article the influence of social comparison on the relation between physical distress and subjective well-being was examined among cancer patients. LISREL analyses provided support for the following model: First, the psychological distress that resulted from physical distress induced a need for comparison. This need, in turn, affected the frequency of downward comparison. Whereas psychological distress negatively affected perceptions of how well one was doing in comparison with others, selectively comparing downward had the reverse impact, contributing to a feeling of relative well-being. Unexpectedly, these relative evaluations also seemed to be affected directly by the amount of physical distress patients experienced. Finally, although both the amount of physical and psychological distress had strong direct effects on subjective well-being, the perception of how well one was doing compared to most others explained an additional significant amount of variance. Interestingly, this model was also supported in a healthy control group, suggesting that we are dealing here with a general behavioral model that suggests that social comparison processes may contribute to well-being when well-being is threatened by stress.     

晚期癌症患者宁养疗护与伦理

晚期癌症患者宁养疗护强调人的生活质量与生命价值,其在实践中得到了长足的发展,正成为姑息医学中的重要部分。随着医学向生物心理社会医学模式转变和姑息医学快速发展,宁养疗护伦理问题日益凸显。宁养疗护伦理在医疗方面强调适度治疗与合理用药,护理方面强调患者生理、心理、灵性、社会和宗教等层面的整体性照顾。梳理宁养疗护伦理有利于在宁养疗护服务中做出最优伦理选择,这种选择需遵循不伤害原则,注重生命质量原则、适度治疗和舒适生存原则、尊重患者意愿原则以及公平正义的原则。     

Taking spiritual experiences seriously in the religious education classroom: a transrational approach

ABSTRACT

Spiritual experiences are common across religious and non-religious faiths, but schoolchildren are often afraid to share these because they fear ridicule from peers who are convinced religion is irrational. The need to speak about spirituality in religious education is increasingly recognised. Signposts suggests that intercultural understanding implies recognising religious students’ perception of reality and helping others understand it. Religious education in Norway now includes exploration of existential questions as a core element, and in England, making sense of religious, spiritual and mystical experiences has been suggested as a big idea. In this paper, we discuss how the dualistic paradigm of modern science makes it difficult to take spirituality seriously as lived experience and empirical phenomenon. Instead we suggest a transrational approach to explore our multidimensional reality in an intercultural dialogue where insiders and outsiders learn from each other. We also explore examples of transrational research on spiritual phenomena.     

Religion and Science in America: Populism versus Elitism

Historian James Gilbert argues that the dialogue between science and religion is an important dynamic in the creation of contemporary American culture. He traces the dialogue not only in the confines of the academic world but also in popular culture. The science-religion dialogue reveals a basic tension between the material and the spiritual that helps define the core of the American psyche: fascination with material progress yet commitment to traditional religious beliefs. Gilbert's cultural narrative traces the dialogue in a unique way because of the attention given to popular renditions of science and religion in evangelical films used by the military, in televised science programs, in science-fiction literature, and at the Seattle World's Fair in 1962. Gilbert suggests that the discussion between science and religion is significant because it is part of the process of creating new cultural structures necessitated by social, scientific, and technological developments. The tensions between religiously informed commonsense science and professional science work to create new cultural forms in a democratic society. Religion and science in dialogue are part of the process of cultural creation. Dogmatism on the part of either scientists or religionists is countered by the democratic process itself.     

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.     

A study of posttraumatic spiritual transformation and forgiveness among victims of significant interpersonal offences

Forgiveness and spiritual transformation, both gain and decline, may follow being victimised. The purpose of this study was to investigate the role of forgiveness in posttraumatic spiritual transformation following interpersonal offences. One hundred forty-six participants who had been “significantly wronged” by another person completed measures of event-related distress, forgiveness, and spiritual transformation. Results showed that spiritual growth was positively related to the personal importance of religion. Event-related distress and unforgiveness were positively correlated with spiritual decline. Regression analyses revealed that forgiveness did not uniquely account for a significant amount of the variance in spiritual growth after controlling for demographic variables, religious and spiritual importance, and event-related distress. Rather, religious and spiritual importance accounted for a significant amount of variance in spiritual growth. Unforgiveness uniquely predicted spiritual decline. This study suggests a complex relationship between spiritual transformation and forgiveness. Results are discussed within the context of implications for clinicians and researchers alike.     

Psychological Distress Among Religious Nonbelievers: A Systematic Review

Studies of religious belief and psychological health are on the rise, but most overlook atheists and agnostics. We review 14 articles that examine differences between nonbelievers and believers in levels of psychological distress, and potential sources of distress among nonbelievers. Various forms of psychological distress are experienced by nonbelievers, and greater certainty in one’s belief system is associated with greater psychological health. We found one well-documented source of distress for nonbelievers: negative perceptions by others. We provide recommendations for improving research on nonbelievers and suggest a model analogous to Pargament’s tripartite spiritual struggle to understand the stresses of nonbelief.     

Religious Resources,Spiritual Struggles,and Mental Health in a Nationwide Sample of PCUSA Clergy

A growing body of research explores patterns and correlates of mental health among clergy and other religious professionals. Our study augments this work by distinguishing between religious resources (i.e., support from church members, positive religious coping practices), and spiritual struggles (i.e., troubled relations with God, negative interactions with members, chronic religious doubts). We also explore several conceptual models of the interplay between these positive and negative religious domains and stressful life events. After reviewing theory and research on religious resources, spiritual struggles, and mental health, we test relevant hypotheses using data on a nationwide sample of ordained clergy members in the Presbyterian Church (USA). At least some support is found for all main effects hypotheses. Religious resources predict well-being more strongly, while spiritual struggles are more closely linked with psychological distress. There is some evidence that stressful life events erode mental health by fostering an elevated sense of spiritual disarray and struggle. We find limited support for the stress-buffering role of religious resources, and limited evidence for a stress-exacerbating effect of spiritual struggle. Study limitations are identified, along with a number of implications and promising directions for future research.     

Theology: Reduction or Autonomy?

Issues of the nature and task of theology remain important to the science-theology dialogue. This paper lays out a framework for understanding the nature of theology in relation to the other sciences. In particular, I argue that the primary question remains one of autonomy and reduction. If theology is a genuine academic discipline, then it should be an autonomous field with its own subject matter and norms. Wolfhart Pannenberg argues that theology is the science of God, but I suggest that theology be more broadly understood as the science of meaning. If we recognize this, the modes of interaction between theology and the other sciences becomes clearer.