Methodological Exclusion of the Transcendent? Implications for Theory and Research in Religion, Spirituality and Health.

Early in the founding of psychology of religion, a debated issue was the methodological exclusion of the transcendent (MET). While cautiously endorsed by Theodore Flournoy, others, notable William James and Frederic Myers, refused to be limited by this principle. This paper discusses (a) what is MET as proposed by Flournoy and the reasons he provided to adopt it, (b) problems with MET, implications for research and theory in religion/spirituality and health, and why the transcendent should be included in psychological, medical and other academic research and theory on spiritual experiences (SE), and (c) some methodological guidelines perform it fruitfully.

Existential meaning, spiritual unconscious and spirituality in Viktor Frankl.

There is robust evidence to support the relationship between spirituality and mental health, but the mechanisms of this association are not well-understood. The existential meaning provided by spirituality may be one of these mechanisms. This was the central theme of Viktor Frankl's psychology, which he explained using the notion of the spiritual unconscious. Thus, we sought to explain how Frankl understands this spiritual unconscious and the two pieces of evidence he presents for its existence: the phenomenological description of responsible action and the analysis of dreams. Lastly, we discuss his contribution to the current understanding of the relationship between having an overarching purpose and/or religious meaning and improvement in mental health.

The epistemologies of research on the survival of consciousness after death in the golden era of the Society for Psychical Research (1882-1930).

The Society for Psychical Research (SPR) of London was founded in 1882 with the purpose of investigating psychical phenomena, especially the theme of survival, with scientific rigour. Despite the recognized importance of the SPR for dynamic psychiatry in the nineteenth and twentieth centuries, there are few studies of its epistemological contributions to the theme of survival and its implications to science. In order to fill this gap, we have consulted the main journals of the SPR in its golden period, and highlight the epistemologies of Sidgwick, Myers, James, Podmore, Schiller, Lodge and Richet. We conclude that the authors, whether for or against survival, argued in defence of an expanded science, and looked forward to understanding the complexity of human experience.

Religion-Adapted Cognitive Behavioral Therapy: A Review and Description of Techniques.

Systematic reviews have shown the efficacy of religion-adapted cognitive behavioral therapy (R-CBT); however, many clinicians lack practical knowledge of these protocols. We describe here the techniques of religious adaptation to CBT that have proved effective. We selected randomized clinical trials comparing R-CBT with control conditions in clients with a diagnosis of a psychiatric disorder and extracted the information from their adapted manuals. The most frequent religious adaptations were the integration of religious content to perform cognitive restructuring, psychoeducation and motivation; engagement in religious activities such as behavioral activation, meditation, or prayer to help cognitive restructuring, using religious values and coping strategies. A description of these techniques is presented here, as well as some practical examples.

Ninety Years of Multiple Psychotic-Like and Spiritual Experiences in a Doctor Honoris Causa: A Case Report and Literature Review.

ABSTRACT: Psychotic experiences are common experiences shared by a considerable part of the world's population. Moreover, most of the individuals who report these experiences also report those called spiritual and dissociative phenomena. In specific culture and religious backgrounds, these experiences are frequently seen as a part of normal human experiences, usually called mediumship. We report a case of a famous Brazilian medium with 90 years of experiencing psychotic-like, dissociative and/or spiritual experiences, but coped well with the experiences and never sought psychiatric or psychological assistance. The medium received several honorific prizes, such as doctor honoris causa from different institutions, published more than 200 books, and ran a nonprofit organization that takes care of 5000 people daily. Finally, we review the literature on this topic and stress the urge for more research aiming to distinguish pathological and nonpathological psychotic experiences to avoid overmedicalization and iatrogenic treatments.

An Empirical Investigation of Alleged Mediumistic Writing: A Case Study of Chico Xavier's Letters.

The scientific study of mediumship can contribute to the understanding of the mind-brain relationship. This study investigated a letter written by the influential Brazilian "medium" Chico Xavier, whose authorship was attributed to a deceased person. We identified the letter's pieces of information that were objectively verifiable, and we analyzed their accuracy based on documents and on interviews with the deceased's relatives, and the likelihood of Xavier's access to the information via ordinary means. All the 29 items of verifiable information conveyed on the letter were rated as "clear and precise fit." The information conveyed was highly specific (e.g., names, dates, and specific events). Fourteen items (48.3%) conveyed information that was also very private. We concluded that ordinary explanations for accuracy of the information (i.e., fraud, chance, information leakage, and cold reading) were highly unlikely. We recommend further research on the phenomenon of mediumistic writing, particularly experimental controlled studies with exceptionally gifted mediums.

Who Does Believe in life After Death? Brazilian Data from Clinical and Non-clinical Samples.

Belief in afterlife is frequent, but little is known about how it relates to religiousness/spirituality (R/S) and socio-demographic variables. To investigate how the beliefs in afterlife and that "there is something beyond matter" are associated with socio-demographic, health, and R/S dimensions in a sample of medical inpatients and their companions. In multivariate analysis, afterlife belief correlated positively to educational level, religious affiliation, belief in something beyond matter, and private religious practices. Believe in something beyond matter correlated positively to afterlife belief and being spiritual. Educational level, rates of spirituality, religious affiliation, and private religious practices seem to influence the belief of afterlife and in a non-materialist cosmology.

Using traditional or flipped classrooms to teach "Geriatrics and Gerontology"? Investigating the impact of active learning on medical students' competences.

BACKGROUND: The present study aims to investigate the effect of two educational strategies to teach geriatrics (flipped classroom-FL and traditional lectures-TR) in relation to a control group (no intervention) on students' competences. METHOD: An intervention study was conducted during the third year of medicine. Two different educational strategies (flipped classroom and traditional lectures) were incorporated into a theoretical-practical discipline of geriatrics. Students were evaluated about their attitudes towards older persons (Maxwell-Sullivan, UCLA geriatric attitudes), empathy (Maxwell-Sullivan), knowledge (Palmore and cognitive knowledge), skills (standardized patient assessment), and satisfaction with the activities. RESULTS: A total of 243 students were assessed. The FL group demonstrated greater gains in knowledge among students and improved attitude compared to the TR. We found no differences in the skills using a standardized patient. In addition, students exposed to FL felt more prepared to treat older people, believed they had more knowledge, were more satisfied, and evaluated the discipline's format better in relation to the traditional group. CONCLUSIONS: Strategies in teaching geriatrics can impact students' knowledge, attitudes, and satisfaction with the course. We found that the way this teaching is delivered can influence students' learning, since there were differences between active and traditional strategies.

Research on Experiences Related to the Possibility of Consciousness Beyond the Brain: A Bibliometric Analysis of Global Scientific Output.

This study aims to conduct a search of publications investigating experiences commonly associated with the possibility of the existence of a consciousness independent of the brain held on the main scientific databases (Pubmed, Web of Knowledge, PsycINFO, Science Direct, and Scopus). Of the 9065 articles retrieved, 1954 were included (598 near-death experiences, 223 out-of-body experiences, 56 end-of-life experiences, 224 possession, 244 memories suggestive of past lives, 565 mediumship, 44 others). Over the decades, there was an evident increase in the number of articles on all the areas of the field, with the exception of studies on mediumship that showed a decline during the late 20th century and subsequent rise in the early 21st century. Regarding the types of articles found, with the exception of past-life memories and end-of-life experiences (mostly original studies), publications were predominantly review articles. The articles were published in journals with an impact factor similar to other areas of science.

Methodological guidelines to investigate altered states of consciousness and anomalous experiences.

Anomalous experiences (AE) (uncommon experiences or one that is believed to deviate from the usually accepted explanations of reality: hallucinations, synesthesia, experiences interpreted as telepathic…) and altered states of consciousness (ASC) have been described in all societies of all ages. Even so, scientists have long neglected the studies on this theme. To study AE and ASC is not necessary to share the beliefs we explore, they can be investigated as subjective experiences and correlated with other data, like any other human experience. This article presents some methodological guidelines to investigate these experiences, among them: to avoid dogmatic prejudice and to 'pathologize' the unusual; the value of a theory and a comprehensive literature review; to utilize a variety of criteria for pathology and normality; the investigation of clinical and non-clinical populations; development of new appropriate research instruments; to be careful to choose the wording to describe the AE; to distinguished the lived experience from its interpretations; to take into account the role of culture; to evaluate the validity and reliability of reports and, last but not least, creativity and diversity in choosing methods.

Self-Directedness Predicts Quality of Life in Individuals with Psychotic Experiences: A 1-Year Follow-Up Study.

There is a high prevalence of psychotic-like experiences in nonclinical patient cohorts from Brazil. This study aimed to test whether personality dimensions, as well as schizotypy, are important predictors of quality of life (QoL) in individuals with psychotic experiences (PE). METHOD: 115 participants were recruited from Spiritist Centers in Brazil. At the 1-year follow up, 90 participants (78%) were reassessed. Instruments were the SCID-I (Structured Clinical Interview for DSM-IV), TCI-R 140 (Revised Temperament and Character Inventory), OLIFE-R (Oxford-Liverpool Inventory of Feelings and Experiences), and WHOQOL-BREF (World Health Organization QoL Instrument). RESULTS: Mean age (±SD) was 36.8 (±12.5) years; 70% were female. Participants reported 74.4% of PE at time 1 and 72.3% at time 2. At time 1, temperament and character explained 47% of the psychological QoL variance; self-directedness was the strongest predictor of higher QoL, while harm avoidance and introverted anhedonia predicted worse QoL. At the 1-year follow-up, self-directedness remained the most important predictor of psychological QoL. CONCLUSION: Individuals reporting PE can show psychological QoL when they are high on self-directedness. Those with high levels of introverted anhedonia and cognitive disorganization can have a lower QoL and may be at risk for mental health problems.

Experiencing aging or demystifying myths? - impact of different "geriatrics and gerontology" teaching strategies in first year medical students.

BACKGROUND: With the aging of the population comes a greater need for geriatric and gerontology teaching. However, there is currently a dearth of investigations on the impact of different educational methodologies for teaching in this area early in medical courses. The present study aims to determine the impact of two educational strategies on the topic "Geriatrics and Gerontology" ("experiencing aging" and "myths of aging") as compared to a control group (no intervention) on the attitudes, empathy and knowledge of first year medical students. METHODS: An intervention-based study in education was conducted at the beginning of the first year of a medical course. Students submitted to educational strategies were compared against students with no intervention. The two strategies were: "Experiencing Aging" - also known as the "aging game" (simulation of the disabilities and physiological changes of aging), and "Myths of Aging" - a knowledge discussion based on a "quiz show", questioning common myths about aging. All students were assessed on their attitudes towards older persons (Maxwell-Sullivan, UCLA attitudes), empathy (Maxwell-Sullivan), knowledge on facts and positive view about aging (Palmore), and cognitive knowledge. Data were analysed using Student's t, Chi-squared or ANOVA tests. RESULTS: A total of 230 students were assessed. The "experiencing aging" intervention was associated with improvement in empathy but worsening of attitude. The "myths of aging" intervention was associated with an improved attitude overall and positive view about aging but with no change in empathy towards older persons. CONCLUSION: Educational strategies can influence the attitudes and empathy of students, leading to different outcomes. These data highlight the importance of assessing the outcomes of educational strategies in medical teaching to ascertain in what manner (how), situations (when) and settings (where) these activities should be introduced.

Can the DSM-5 differentiate between nonpathological possession and dissociative identity disorder? A case study from an Afro-Brazilian religion.

The aim of this article is to examine whether the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are able to differentiate between nonpathological religious possession and dissociative identity disorder (DID). We use the case study of an individual who leads an Afro-Brazilian religious group (Umbanda), focusing on her personal development and possession experiences from early childhood to the present, spanning a period of more than 40 years, and examine these data following DSM-5 criteria for DID (300.14). Her experiences of possession can be broken into 2 distinct stages. In the 1st stage (childhood and early adulthood), she displayed intrusive thoughts and a lack of control over possession states, which were associated with a heightened state of anxiety, loneliness, amnesia, and family conflict (meeting all 5 criteria for DID). In the 2nd stage (late 20s up to the present), she regularly experienced possession states but felt in control of their onset and found them religiously meaningful. In this 2nd stage, she only fulfilled 3 criteria for DID. We question the accuracy of diagnosing this individual with DID in her earlier life and suggest that the DSM-5 criteria fail to address the ambiguity of affect surrounding possession experiences (positive at the individual level, negative at the interpersonal level) and lack a clearer acknowledgment of the prevalence of possession and other unusual experiences in general populations.

Validation of the Portuguese version of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS-P) in clinical and non-clinical samples.

Despite Brazil's high levels of religious involvement, there is a scarcity of validated religiousness/spirituality (R/S) measures in Portuguese, particularly multidimensional ones. This study presents the validation of the Portuguese version of the "Brief Multidimensional Measure in Religiousness and Spirituality" (BMMRS) within the Brazilian context. Inpatients (262) and caregivers (389) at two hospitals of Brazil answered the BMMRS, the DUREL-p, and a sociodemographic questionnaire. The internal and convergent validity and test-retest reliability for major dimensions were good. Discriminant validity was high (except for the Forgiveness dimension). The Portuguese version of the BMMRS is a reliable and valid instrument to assess multiple R/S dimensions in clinical and non-clinical samples.

Almost 40 years investigating near-death experiences: an overview of mainstream scientific journals.

This article reviews mainstream scientific publications on near-death experiences (NDEs). We searched near-death experience in titles, key words, and abstracts at the Web of Knowledge database published between 1945 and 2013. We identified 266 relevant documents, the oldest from 1977. There was a strong predominance of opinion articles (book reviews, commentaries, and editorials), review articles, phenomenological description articles, and articles that originated in the United States. Since 2000, the number of longitudinal and cross-sectional studies has increased; there has been a diversification in the countries that have published on the subject and more articles that discuss the implications of NDEs for the mind-brain relationship. The results indicate that most scholarly publications on NDEs are recent, usually have no original empirical data, and are concentrated in North America and Western Europe. Future studies should focus on increasing the cultural diversity in the field and on testing explanatory hypotheses based on high-quality empirical data.

End-of-life experiences in the dying process: scoping and mixed-methods systematic review.

OBJECTIVES: To identify the current state of understanding about end-of-life experiences (ELEs) and examine evidence concerning prevalence, the impact on the process of dying and the perceptions/explanations of patients, relatives and healthcare professionals (HCPs) with regard to ELEs. METHODS: Scoping review and mixed-methods systematic review (ScR and MMSR). Nine academic databases were searched for a screening of the available scientific literature (ScR). Articles reporting qualitative, quantitative or mixed-methods studies were selected (MMSR), the quality of which was assessed using the Joanna Briggs Institute (JBI) standardised critical appraisal tools. The quantitative data were synthesised in narrative form while a meta-aggregation approach was adopted for the qualitative results. RESULTS: The ScR identified 115 reports, with 70.4% published after 2010, 55.6% from the USA and the most common terminology for ELE was deathbed visions (29%). The MMSR included 36 papers, describing 35 studies in various settings. The combination of quantitative and qualitative evidence indicated a greater prevalence of ELEs in samples of patients and HCPs compared with relatives. The most common ELEs were visions and dreams of the presence of deceased relatives/friends with references to making ready for a journey. The impact of ELEs was mainly positive, and there was a tendency to interpret them as spiritual experiences inherent to the process of dying. CONCLUSIONS: ELEs are often reported by patients, relatives and HCPs and have a significant, generally positive impact on the process of dying. Guidelines for the furtherance of studies and clinical applications are discussed.

Religiosity, mood symptoms, and quality of life in bipolar disorder.

OBJECTIVES: The aim of the present study was to investigate the relationship between religiosity and mood, quality of life, number of hospitalizations, and number of severe suicide attempts among bipolar disorder patients. METHODS: In a cross-sectional study of bipolar disorder outpatients (N = 168), we assessed symptoms of mania [Young Mania Rating Scale (YMRS)], depression [Montgomery-Åsberg Depression Rating Scale (MADRS)], religiosity (Duke Religious Index), religious coping (Brief RCOPE), and quality of life [World Health Organization Quality of Life-Brief Version (WHOQOL-BREF)]. Sociodemographic data, number of suicide attempts, and number of hospitalizations were obtained through an interview with the individual and analysis of the patient's medical records. Logistical and linear regressions of the association between the religious indicators and clinical variables were conducted, controlling for sociodemographic variables. RESULTS: A total of 148 (88.1%) individuals reported some type of religious affiliation. Intrinsic religiosity [odds ratio (OR) = 0.19, 95% confidence interval (CI): 0.06-0.57, p = 0.003] and positive religious coping strategies (OR = 0.25, CI: 0.09-0.71, p = 0.01) were associated with fewer depressive symptoms. All four domains of quality of life were directly and significantly correlated with intrinsic religiosity. Positive religious coping was correlated with higher levels of the psychological (ß = 0.216, p = 0.002) and environmental (ß = 0.178, p = 0.028) quality-of-life domains. Negative religious coping was associated with lower scores on the psychological domain of quality of life (ß = -0.182, p = 0.025). CONCLUSIONS: Intrinsic religiosity and positive religious coping are strongly associated with fewer depressive symptoms and improved quality of life. Negative religious coping is associated with worse quality of life. Religiosity is a relevant aspect of patients' lives and should be taken into consideration by physicians when assessing and managing bipolar disorder patients. Further longitudinal studies are needed to determine the causality and therapeutic implications of our findings.

William James and psychical research: towards a radical science of mind.

Traditional textbooks on the history of psychiatry and psychology fail to recognize William James's investigations on psychic phenomena as a legitimate effort to understand the human mind. The purpose of this paper is to offer evidence of his views regarding the exploration of those phenomena as well as the radical, yet alternative, solutions that James advanced to overcome theoretical and methodological hindrances. Through an analysis of his writings, it is argued that his psychological and philosophical works converge in psychical research revealing the outline of a science of mind capable of encompassing psychic phenomena as part of human experience and, therefore, subject to scientific scrutiny.

Guidelines for integrating spirituality into the prevention and treatment of alcohol and other substance use disorders.

Alcohol and other substance use disorders are complex problems with multiple variables and determinants, requiring a multidimensional approach to prevention and treatment. A robust body of research shows that religiosity and spirituality (R/S) play a prominent role in these disorders; however, how to apply this knowledge remains unclear. We present practical guidelines on how to integrate R/S into substance use prevention and treatment in an ethical, evidence-based manner. These guidelines have been endorsed by prominent academic leaders in these topics and by health associations affiliated with the three major Brazilian religions. The integration of R/S is part of a respectful, person-centered, interdisciplinary approach, which imposes neither religious beliefs nor secular worldviews. The most critical interventions include collecting a history of spiritual and religious beliefs, practices, and experiences and evaluating how these may be used positively in treatment. It is also essential that health professionals are encouraged to value and respect the R/S of patients, and that religious groups recognize that professional and technical interventions can make a valuable contribution to preventing and treating these disorders.