The Dark Night of the Soul: spiritual distress and its psychiatric implications

The Dark Night of the Soul is an expression describing phases in a person's spiritual life associated with a crisis of faith or spiritual concerns about the relationship with God, and which has intrinsic aspects of spiritual growth. This paper is concerned with the way in which those going through periods of angst and disillusionment do not see them as pathological phenomena. On the contrary, through a process of attribution of religious meaning they view them as opportunities for reflecting on their lives and as agents for beneficial change. Similarities and differences between the Dark Night and a depressive episode are discussed and illustrated using the accounts of five important religious figures. Their narratives have been constructed using original texts and their biographies. The Dark Night has clinical implications owing to the risk of its being pathologised, serving as a reminder of the importance of incorporating existential issues into clinical practice.     

An examination of attachment,religiousness, spirituality and well-being in a Baptist faith sample

The purpose of this research was to examine a mediational model of attachment, religiousness and spirituality in predicting well-being in people of Christian faith. One hundred and eighty-five participants were recruited from Baptist churches and 19 from a Baptist-based university. Whereas no support was found for a mediational model of attachment, religiousness and spirituality in predicting well-being, support was found for a path model whereby greater levels of insecure attachment to God were associated with lower levels of religious spirituality (RS). In turn, lower levels of RS were associated with greater levels of emotional distress (ED). Therefore, for this sample of Baptists, having a secure attachment to God was related to an increase in religious behaviours, fulfilment with one's prayer life and belief in a purpose for life. It seems that increases in these religious and spiritual variables are related to less ED. This suggests that heightened connection with God, both through religious behaviours and heightened spirituality, is a beneficial pursuit for people of Christian faith.     

Psychological Well-Being and Health Related Quality of Life among a Group of Low-Income Women Living with HIV/AIDS in South Africa

This study documented the relationships among biomedical factors, psychosocial factors, health related quality of life (HRQOL) and suicidality in respect of HIV positive women in KwaZulu-Natal. One hundred and thirty three (133) women over the age of 18 years (mean age 32.96 yrs; SD = 7.28) participated in the study. Participants completed a Suicidality Measure (SM: Sheebhan, Janavs, Amorim, Janavs, Weiller, Hergueta, Baker & Dunbar, 1998), Multidimensional Scale of Perceived Social Support (MPSS: Zimet, Dahlem, Zimet & Farley, 1988) and the Health Related Quality of Life Survey—SF-36 (Ware, Kosinski & Dewey, 2002). Information on social/contextual variables including income, marital status, employment status, number of children was obtained. Participants completed two biomedical measures, CD4 count and time since diagnosis information. The findings revealed a compromised level of HRQOL in the participants. After controlling for biomedical factors, psychosocial measures did not explain differences in quality of life. Perceived social support was inversely related to suicidality. Newly diagnosed patients were less likely to think of suicide as an option.     

Response expectancy versus response hope in predicting birth‐related emotional distress and pain

Response expectancies and response hopes have been shown to be two distinct constructs with important implications for nonvolitional outcomes. More specifically, studies show that response expectancies: (1) are sufficient to cause nonvolitional outcomes, (2) are not mediated by other psychological variables, and (3) are self‐confirming while seemingly automatic. A new programmatic research line has differentiated between people's response expectancies and their response hopes regarding nonvolitional outcomes and showed that even if response hope and response expectancy are separate constructs, they are not unrelated. These concepts have not yet been studied in pregnant women. Moreover, determining the causal factors that best explain the variance of emotional distress and pain in pregnancy is of great importance. Thus, the aim of this study was to investigate the interrelations between response expectancy and response hope in pregnant women with respect to (1) emotional distress prior to giving birth and (2) pain during giving birth. Additionally, self‐reported labor hours were analyzed as a secondary outcome. Results show that response expectancy for pain directly predicts pain, and that the discrepancy between response hopes and response expectancies is a strong predictor of investigated outcomes. Thus, our results support the idea that preventive psychological interventions for pregnant women should emphasize adjusting response expectancies and response hopes regarding the pain and emotional distress associated with giving birth. We believe that the results have both theoretical and practical implications and the topic deserves further investigation.     

Gender differences in the construction and experience of cancer care: The consequences of the gendered positioning of carers

The experience and construction of caring in 50 informal cancer carers, 35 women and 15 men, was examined using a critical realist approach and a mixed method design. Women reported higher rates of depression, anxiety, unmet needs and burden of care than men. No gender differences were found in time spent care-giving, suggesting that gendered roles are implicated in distress and coping. Semi-structured interviews with 13 carers were used to identify gender differences in caring, analysed using positioning theory. Women described being positioned as all encompassing expert carers, expected to be competent at decision-making, a range of physical caring tasks, and provision of emotional support for the person with cancer. The consequences of this positioning were over-responsibility and self-sacrifice, physical costs and overwhelming emotions, which were self-silenced. In contrast, men carers positioned caring as a competency task which they had mastered, and which provided them with satisfaction, with the emotions of the person with cancer, or their own emotions, being negative aspects of caring. It is concluded that cancer caring is tied to gendered constructions and expectations, with considerable implications for psychological well-being and coping, and for carer support services, which need to take gender issues on board.     

The indirect effect of contextual factors on the emotional distress of infertile couples

Few studies were dedicated to study the role of contextual factors, such as the socioeconomic status and urban or rural residence in emotional distress of infertile couples. This study aimed to explore the impact of contextual factors on emotional distress, either directly or by affecting the importance of parenthood in one's life, which in turn affects emotional distress. In this cross-sectional study, 70 couples recruited during hormonal stimulation phase prior to in vitro fertilisation completed clinical and sociodemographic forms and self-report questionnaires assessing representations about the importance of parenthood and emotional distress. Path analysis using structural equation modelling was used to examine direct and indirect effects among variables. Results indicated that socioeconomic status and place of residence had an impact in emotional distress by affecting the representations about the importance of parenthood in one's life. Gender differences were found regarding model paths, suggesting that the social context may have a stronger influence on women's emotional distress than on their partners’ distress. When delineating psychological interventions, health care providers should consider that cultural values about children and parenthood contribute to shape the infertility experience.     

Distress and emotional well-being in breast cancer patients prior to radiotherapy: an expectancy-based model

Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e. higher distress, lower EWB). Thus, this study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N?=?106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modelling was used to test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised – two factors), response expectancies (Visual Analog Scale items), medical (type of surgery, cancer stage and chemotherapy history) and demographic (age, race, ethnicity, education and marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy – Emotional Well-being Subscale) and distress (Profile of Mood States – short version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.     

Antecedents and consequences to perceived career goal–progress discrepancies

Informed by a goal setting and self-regulation perspective, we tested a model of perceived career goal–progress discrepancies (i.e., perception of progress made towards achieving career goals relative to where one should be if the goals were to be attained), which proposed that negative feedback from significant others predicts career goal–progress discrepancies, which, in turn, predicts levels of career-related distress. The model also proposes that active feedback seeking strengthens the relationship between feedback from significant others and goal–progress discrepancies, and that career self-regulatory behaviours (career exploration and planning) weaken the relationship between career goal–progress discrepancies and career distress. Using a sample of 420 young adults (mean age = 20.3 years, 73% female), we found that feedback from significant others was related to both career goal–progress discrepancies and career distress, career goal–progress discrepancies were related to career distress, and goal–progress discrepancies partially mediated between feedback from significant others and career distress. Supporting the moderated effects, goal–progress discrepancies were higher at higher levels of negative feedback for those more actively seeking feedback, and career distress was lower at lower levels of discrepancy for those more engaged in exploration and planning.     

Impact of average household income and damage exposure on post‐earthquake distress and functioning: A community study following the February 2011 Christchurch earthquake

Post‐traumatic stress, depression and anxiety symptoms are common outcomes following earthquakes, and may persist for months and years. This study systematically examined the impact of neighbourhood damage exposure and average household income on psychological distress and functioning in 600 residents of Christchurch, New Zealand, 4–6 months after the fatal February, 2011 earthquake. Participants were from highly affected and relatively unaffected suburbs in low, medium and high average household income areas. The assessment battery included the Acute Stress Disorder Scale, the depression module of the Patient Health Questionnaire (PHQ‐9), and the Generalized Anxiety Disorder Scale (GAD‐7), along with single item measures of substance use, earthquake damage and impact, and disruptions in daily life and relationship functioning. Controlling for age, gender and social isolation, participants from low income areas were more likely to meet diagnostic cut‐offs for depression and anxiety, and have more severe anxiety symptoms. Higher probabilities of acute stress, depression and anxiety diagnoses were evident in affected versus unaffected areas, and those in affected areas had more severe acute stress, depression and anxiety symptoms. An interaction between income and earthquake effect was found for depression, with those from the low and medium income affected suburbs more depressed. Those from low income areas were more likely, post‐earthquake, to start psychiatric medication and increase smoking. There was a uniform increase in alcohol use across participants. Those from the low income affected suburb had greater general and relationship disruption post‐quake. Average household income and damage exposure made unique contributions to earthquake‐related distress and dysfunction.     

Anxieties about aging and death and psychological distress: The protective role of emotional complexity

Death and aging anxieties are related to higher psychological distress, but no study has examined whether these relationships are moderated by emotional complexity, an important indicator of adaptive emotional regulation among older adults. Participants (N = 188; mean age = 57; range = 29–100) rated their death and aging anxieties, general psychological distress, and reported their emotions on a daily basis over 14 days. Results showed that emotional complexity moderated the relationship between each of the two anxieties and psychological distress (i.e., the positive relationship between the two anxieties and psychological distress existed only among subjects with low emotional complexity). The findings suggest that emotional complexity buffers against psychological distress, and can be further explored as a facilitating mechanism in protecting against the negative mental health effects of aging and death anxieties.