Varieties of Religious and Spiritual Struggles by Type of Mental Disorder: A Qualitative Approach.

INTRODUCTION: Little is known about types of religious/spiritual (R/S) struggles with regard to various diagnostic groups in mental health care. The current qualitative study aims to give an impression of R/S struggles as observed in six diagnostic groups in clinical mental health care. METHODS: Inductive thematic content analysis was applied to 34 semi-structured interviews. The interviews were performed among (day) clinical mental health care patients in two institutions. RESULTS: Among patients with depression, a lack of positive R/S experiences, isolation, and feelings of guilt and shame were present. Those with cluster C and anxiety disorders reported uncertainty toward God and faith and R/S reticence. Psychotic disorders were accompanied by impressive R/S experiences, reticence to share these, and mistrust toward health professionals. Patients with bipolar disorder struggled with the interpretation of their R/S experiences and with both attraction and distance toward R/S. Cluster B patients showed ambivalence and anger toward God and others, and some reported existential tiredness. Patients with autism mentioned doubts and troubles with religious beliefs. In all groups, many patients had questions like "why?" or "where is God?" CONCLUSION: R/S struggles to some extent may be the language of the illness. Mental health professionals are recommended to take this into account, taking heed of the content of individual R/S struggles and considering using R/S interventions.

Psychometric Properties of the Dutch Surrender to God Scale: Relationships with Religious Behavior, God Representation, Well-being, and Health.

Given that surrender to God has been associated with health and well-being in believers, research in this area would benefit from the availability of scales outside the United States, where these were first developed. To this end, we conducted two studies (N = 130 and N = 574) in Christian samples in the Netherlands to test the psychometric properties of a Dutch translation of the Surrender to God Scale (D-StGS). In addition, the abbreviated Religious Surrender Scale-2 was tested to examine whether the two-item scale would show validity and reliability, as this would benefit research in which there are time (and other) constraints on assessment. Both scales showed adequate to excellent internal consistency, convergent validity with religious coping and religious orientation, and predictive validity; specifically with (I) lower anxiety, stress, and depression symptoms and (II) higher scores on religious behavior and meaning in life. Likewise, both scales were related to (III) more positive, supportive, and ruling, and less passive, anxious, and angry God representations. However, explorative factor analysis of the D-StGS in the first study resulted in two factors (Imitation of God's will and Peace through God's will), which were confirmed with confirmatory factory analysis in the second study. It can be concluded that the D-StGS and abbreviated scale are useful for future research in Christian samples.

The Experience Sampling Method: A New Way of Assessing Variability of the Emotional Dimensions of Religiosity and Spirituality in a Dutch Psychiatric Population.

Religiosity and spirituality (R/S) are often regarded as being relatively stable over time. The present exploratory experience sampling method (ESM) study aims to assess the variability of three R/S parameters concerning affective representations of God and spiritual experiences in a psychiatric population. Depressed in- and outpatients self-identifying as being spiritual or religious participated, from two Dutch mental health care institutions. The twenty-eight participants rated momentary affective R/S-variables up to 10 times per day over a 6-day period when prompted by a mobile application. All three examined R/S parameters varied significantly within the day. ESM examination of R/S showed good compliance and little reactivity. This indicates that ESM offers a feasible, usable, and valid way to explore R/S in a psychiatric population.

Coping, Meaning Making and Resilience Within the Dutch Reformed Pietist Community During the COVID-19 Outbreak: An Exploratory Qualitative Study.

In this qualitative study, we examined how community members of the Dutch reformed pietist community coped with the COVID-19 pandemic, and which religious sources of meaning making and resilience they used during this time of crisis. Based on seven in-depth interviews, we found that the representation of God being 'above all things' was prominent in times of close encounter with the coronavirus. In actively interpreting the pandemic, community members tended to stay away from concrete eschatological or ecological interpretations. Rather, the general theme of 'malleability' was used and linked to notions of calling and punishment. Furthermore, we identified the importance of community and scepticism towards the government as sources of resilience, whereas thinking about the future of the church was a source of fear and concern.

God Representation Types Are Associated With Levels of Personality Organization and Christian Religious Orthodox Culture.

ABSTRACT: This exploratory study shows that God representation types are associated with levels of personality organization. Among two Dutch samples of psychiatric patients (n = 136) and nonpatients (n = 161), we found associations between the psychotic, borderline, and neurotic personality organizations, and passive-unemotional, negative-authoritarian, and positive-authoritative God representation types, respectively. Both patients and nonpatients reported positive God representations, but only nonpatients and higher-level functioning patients reported an integrated God-object relation. For persons with personality pathology, the relationship with God can be a struggle and might have a defensive and/or compensating function. In addition to personality organization, Christian religious orthodox culture is a statistical predictor of God representations, but not of anger toward God. We offer suggestions for how psychotherapeutic work with God representations might differ for patients with different levels of personality organization.

Conversations and Beyond: Religious/Spiritual Care Needs Among Clinical Mental Health Patients in the Netherlands.

This study examines religious/spiritual (R/S) care needs and their possible determinants among mental health patients in the Netherlands. Patients in a Christian (CC, n = 100) and a secular (SC, n = 101) mental health clinic completed a questionnaire. Analysis revealed three factors on the R/S care needs measure: (1) "R/S conversations," (2) "R/S program and recovery," and (3) "R/S similar outlook on life." The presence of R/S care needs was predicted by the following: site (CC versus SC), R/S involvement, and religious strain. Most commonly, unmet R/S care needs were explanation about R/S and illness by the practitioner, prayer with a nurse, conversations about religious distress with a nurse, conversation when R/S conflicts with treatment, help in finding a congregation, and contact between chaplain and practitioner. "R/S similar outlook on life" was equally important to patients with and without R/S involvement. Patients appreciate a match in worldview with health professionals, either religious or secular.

Patients' Needs of Religion/Spirituality Integration in Two Mental Health Clinics in the Netherlands.

INTRODUCTION: In the last decades, the attention for religion/spirituality (R/S) in mental health care (MHC) has considerably increased. However, patients' preferences concerning R/S in treatment have not often been investigated. The aim of this study was to find out how patients in clinical multidisciplinary MHC want R/S to be addressed in their care. METHODS: Thirty-five semi-structured interviews were carried out between September 2015 and July 2016 among patients in a secular and a Christian MHC in the Netherlands. Qualitative inductive content analysis was performed, using Atlas Ti. RESULTS: Patients appreciated (1) individual R/S conversations between patients and care team members (mainly nurses), (2) a familiar R/S environment, (3) a special R/S program and (4) contact with their R/S network. Patients varied in their presentation of R/S care needs from (a) explicit, mostly in the Christian MHC, to (b) implicit, predominantly in the secular MHC, or showed (c) hidden R/S care needs. A non-acute stage of the illness and R/S affinity of the mental health professionals, were classified as possible conditions for addressing R/S. Discussion and implications for practice: Nurses are recommended to be aware of the diversity of patients' R/S care needs. Actively addressing R/S may help in recognizing implicit or even hidden R/S care needs. Further considerations on whether and how to respond to patients' R/S care needs would be justified.

Twelve-year history of late-life depression and subsequent feelings to God.

OBJECTIVES: Growing evidence shows several possible relations between religiousness and late-life depression. Emotional aspects of religiousness such as facets of the perceived relationship with God can be crucial in this connection. The aim of the current study was to examine the association between the course of late-life depression and feelings about God and religious coping. DESIGN: Longitudinal survey study; naturalistic; 12-year follow-up. SETTING: Longitudinal Aging Study Amsterdam; population-based, in three regions in The Netherlands. PARTICIPANTS: A subsample of 343 respondents (mean age: 77.2 years), including all respondents with high levels of depressive symptoms at any measurement cycle between 1992 and 2003 (assessed by using the Center for Epidemiologic Studies Depression Scale and the Diagnostic Interview Schedule) and a random sample of nondepressed respondents who completed a postal questionnaire in 2005. MEASUREMENTS: Scales on God Image and Religious Coping. Twelve-year depression course trajectories serve as predicting variables and are specified according to recency and seriousness. RESULTS: Persistent and emergent depression are significantly associated with fear of God, feeling wronged by God, and negative religious coping. In terms of negative religious coping, significant associations were observed after adjustment for concurrent depression with a history of repeated minor depression and previous major depression. CONCLUSIONS: Late-life depression seems to maintain a pervasive relationship over time with affective aspects of religiousness. Religious feelings may parallel the symptoms of anhedonia or a dysphoric mood and could represent the experience of an existential void.

Experience sampling of suicidality, religiosity and spirituality in depression: Network analyses using dynamic time warping.

BACKGROUND: Suicidality is a clinically important and multifaceted phenomenon, frequently present in depressed subjects. Religiosity and spirituality (R/S) can have an attenuating as well as a reinforcing effect on suicidality. METHODS: From two Dutch mental health care settings, a sample of 31 depressed and in- and outpatients with suicidal ideation, self-identifying as being religious or spiritual, was selected by convenience sampling. Using an experience sampling method (ESM) mobile application, during six days (mean of 42 assessments per subject), the association between symptoms of depression, suicidality, and specific positive-supportive affective R/S and positive psychology variables. For 28 participants symptom network plots on a group level, and on an individual level, were analyzed using dynamic time warping (DTW). RESULTS: Participants were on average 35.7 years old, and 65 % were women. In the group-level undirected network, R/S variables were linked to positive psychology variables via a bridge function of inner peace. Changes in the experience of inner peace and enjoying a physical activity preceded changes of several other symptoms. A network dynamic appeared with a dense cluster of 'positive psychology' items. LIMITATIONS: Only a limited number of R/S variables were included. CONCLUSION: The results of this study suggest that religiosity and spirituality function as meaningful factors in depression and suicidality in religiously or spiritually engaged persons. Experienced inner peace has a positive association with reasons to live. Experience sampling method data can be effectively analyzed using dynamic time warping. Exploring individual religious or spiritual engagement can prove important in treating suicidality and depression.

The experiences of living with a suicidal family member, and the impact on daily life: A systematic review and meta-aggregation.

INTRODUCTION: Because of the pivotal role that family members play in caring for their suicidal relative, insight into their experiences is necessary to develop good support for them. AIM: This systematic review aimed to aggregate qualitative research examining the experiences of family members living with their suicidal relative, and their impact on daily life. METHODS: Systematic searches, covering the period 2000-2022, were conducted in Medline, Embase, PsycINFO, Ovid Nursing database and CINAHL. The JBI-QARI meta-aggregation approach and the PRISMA guidelines were followed. RESULTS: Eleven studies met the inclusion criteria. Six themes were identified: The hard job of managing the risk of suicide; contributing to the relative's survival; struggling with professional care; being in a lonely position; pressure on relationships; and disruption of well-being. DISCUSSION: The constant worry of losing their relative and ever-present vigilance dominates their lives in such a way that their well-being may be decreased. Professionals often overlook family members, which leads to feelings of powerlessness and loneliness. IMPLICATIONS FOR PRACTICE: Collaborating with families in treatment, allowing them to share information and supporting them in the care at home may lead to better outcomes for both the family and their suicidal relative.

Positive and negative religiousness and search for meaning: Impact on treatment of substance abuse after 6 months.

BACKGROUND: Religiousness and meaning in life are protective factors against addiction. Understanding this relationship may help to improve treatment. The aim of the current study was to assess the associations of positive and negative religiousness and search for meaning with treatment outcome, for patients with substance disorder (SUD). METHOD: The sample consisted of 115 participants attending a Christian drug addiction treatment center in the Netherlands. The study had a longitudinal design in which associations of positive/negative religiousness and search for meaning at baseline (T0) with treatment outcome after six months (T1) were assessed by means of regression analyses. Treatment outcome was measured by clinical dysfunction and the degree of addiction. Instruments used were the ROM (Routine Outcome Monitoring) Meaning and Religious Faith, the Outcome Questionnaire (OQ-45) and the Measurements in the Addictions for Triage and Evaluations (MATE-1). RESULTS: A high degree of positive religiousness at T0 was associated with less addiction at T1 (p < .01). A high degree of negative religiousness at T0 was related to more clinical dysfunction at T1 (p = <0.05). A higher search for meaning at T0 predicted a higher level of addiction at T1 (p = <0.05). CONCLUSIONS: Positive religiousness is associated with less, whereas search for meaning is associated with more addiction after six months. Negative religiousness is not associated with addiction, but with clinical dysfunction. Health professionals are recommended to assess these factors at the start of treatment and to consider possibilities to integrate them into treatment.

Protocol for an RCT on cognitive bias modification for alcohol use disorders in a religion-based rehabilitation program.

INTRODUCTION: Alcohol-related cues trigger relapse in patients with alcohol use disorders (AUDs). These cues may automatically activate motivational approach tendencies. Through computerised cognitive bias modification (CBM), the tendencies of patients with AUD to approach alcohol can be reduced. The present protocol describes a training intervention with approach bias modification (ApBM) incorporating religion-related stimuli as an alternative to alcohol to improve the effectiveness of CBM in a religion-based rehabilitation centre. AUD is often related to patients' religious attitudes in this treatment context. The religion-adapted ApBM, therefore, combines training in avoidance of alcohol-related motivational cues and an approach to religion-based motivational cues. This combination's effectiveness will be compared with a standard ApBM and to a sham ApBM. METHODS AND ANALYSIS: Using a double-blind multiarm parallel randomised controlled trial procedure (ratio 1:1:1), 120 patients with AUD will be randomised into 1 of 3 conditions (religion-adapted ApBM, standard ApBM or sham ApBM) with personalised stimuli. The interventions are delivered over 4 consecutive days during an inpatient detoxification programme in addition to treatment as usual. Assessments occur before the start of the training and after the fourth training session, with follow-up assessments after 1 and 4 months. A multivariate analysis of variance will be used with the primary outcomes, the percentage of days abstinent and meaning in life 4-month follow-up. Secondary outcomes include differences in reported training satisfaction and symptoms of AUD. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Medical Research Ethics Committee Academic Medical Center Amsterdam (Reference number: 2020_251). Further, study results will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NL75499.018.20.

Treatment alliance and needs of care concerning religiousness and spirituality: A follow-up study among psychiatric inpatients.

BACKGROUND: Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance. AIMS: To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period. METHOD: 201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling. RESULTS: R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (ß = .25; p < .001), and unmet R/S care needs with lower WAI score (ß = -.36; p < .001), which were mainly between subjects effects. Patients reporting a high score of unmet R/S care at baseline, reported a decrease in SES over time (ß = -.13; p < .05). CONCLUSIONS: Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.

Religious/spiritual care needs and treatment alliance among clinical mental health patients.

WHAT IS KNOWN ON THE SUBJECT?: The relationship between patient and professional is one of the cornerstones of successful treatment in mental health care. For part of the mental health patients, a similar outlook on life with their caregiver(s) is important. Attention to religion/spirituality (R/S) in mental health care is likely to influence the relationship between a patient and mental health professional, for patients preferring so. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Patients, who appreciate and experience personalized attention to R/S in conversations with practitioners and nurses, are likely to receive the highest therapeutic benefit from their relationship with their mental health professionals Patients who welcome personalized attention to R/S in conversations but find themselves unsupported in this regard experience significantly lower levels of treatment alliance than do those whose needs are met or those who do not express such needs For religious and nonreligious patients attaching importance to a similar outlook on life with practitioner or nurse, this experience was also related to a better relationship, compared with patients preferring so but experiencing a different outlook on life. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Personalized attention to R/S in conversations is recommended, both for practitioners and nurses. In case of a different outlook on life between a patient and mental health professional, addressing R/S with an open and respectful attitude may prevent negative effects on a patient's treatment experience. ABSTRACT: Introduction Attention to religion and spirituality (R/S) in mental health care has increased and may benefit treatment alliance. Aim To describe the association of (un)met R/S care needs with treatment alliance and compliance among mental health patients. Methods Patients in a Christian and a secular mental health clinic (n = 201) filled in a questionnaire. Scales of met and unmet R/S care needs (range 0-14) were regressed on the Working Alliance Inventory (WAI), Service Engagement Scale and Medication Adherence Report Scale. Ancova analyses were performed for the fourteen R/S care needs separately. Results In the Christian clinic, met R/S care needs were associated with a higher WAI score (p = .001) and unmet R/S care needs, with a lower WAI score (p = .000). For the Secular clinic, the same trends were observed, but insignificant. Items with the strongest associations were conversations about religious distress with a nurse (p = .000) and a similar outlook on life with practitioner (p = .001) or nurse (p = .005). (Un)met R/S care needs were not associated with treatment compliance. Discussion and implications for practice We recommend personalized attention to R/S in conversations. A (perceived) similar outlook on life with mental health professionals may be beneficial for religious and nonreligious patients.

God image and happiness in chronic pain patients: the mediating role of disease interpretation.

OBJECTIVE: The present study explored the role of the emotional experience of God (i.e., positive and negative God images) in the happiness of chronic pain (CP) patients. Framed in the transactional model of stress, we tested a model in which God images would influence happiness partially through its influence on disease interpretation as a mediating mechanism. We expected God images to have both a direct and an indirect (through the interpretation of disease) effect on happiness. DESIGN: A cross-sectional questionnaire design was adopted in order to measure demographics, pain condition, God images, disease interpretation, and happiness. One hundred thirty-six CP patients, all members of a national patients' association, completed the questionnaires. RESULTS: Correlational analyses showed meaningful associations among God images, disease interpretation, and happiness. Path analyses from a structural equation modeling approach indicated that positive God images seemed to influence happiness, both directly and indirectly through the pathway of positive interpretation of the disease. Ancillary analyses showed that the negative influence of angry God images on happiness disappeared after controlling for pain severity. CONCLUSION: The results indicated that one's emotional experience of God has an influence on happiness in CP patients, both directly and indirectly through the pathway of positive disease interpretation. These findings can be framed within the transactional theory of stress and can stimulate further pain research investigating the possible effects of religion in the adaptation to CP.

Dimensions of Religion Associated with Suicide Attempt and Suicide Ideation in Depressed, Religiously Affiliated Patients.

There is substantial evidence to support the claim that religion can protect against suicide ideation, suicide attempts, and completed suicide. There is also evidence that religion does not always protect against suicidality. More insight is needed into the relationship between suicidal parameters and dimensions of religion. A total of 155 in- and outpatients with major depression from a Christian Mental Health Care institution were included. The following religious factors were assessed: religious service attendance, frequency of prayer, religious salience, type of God representation, and moral objections to suicide (MOS). Multiple regression analyses were computed. MOS have a unique and prominent (negative) association with suicide ideation and the lifetime history of suicide attempts, even after controlling for demographic features and severity of depression. The type of God representation is an independent statistical predictor of the severity of suicide ideation. A positive-supportive God representation is negatively correlated with suicide ideation. A passive-distressing God representation has a positive correlation with suicide ideation. High MOS and a positive-supportive God representation in Christian patients with depression are negatively correlated with suicide ideation. Both are likely to be important markers for assessment and further development of therapeutic strategies.