The role of positive and negative religious/spiritual coping in women's adjustment to breast cancer: A longitudinal study.

Purpose: Investigate change in women's use of religious/spiritual coping (R/S) in relation to breast cancer.Design: Longitudinal, prospective.Sample: Fifty-six breast cancer and 82 benign diagnosis.Methods: R/S coping and depressed mood were assessed at pre-diagnosis, 3, 6, and 12 months post-diagnosis.Findings: Breast cancer patients increased their use of benevolent reappraisal coping from 3 to 6 months post-diagnosis while women with a benign diagnosis evidenced stability in this coping strategy. Negative R/S coping and depressed mood were associated concurrently and longitudinally for both diagnostic groups.Conclusions: Depressed mood and negative R/S coping are intertwined across time suggesting that women from both diagnostic groups may experience emotional and spiritual struggle in their adjustment to the threat of breast cancer.Implications for Psychosocial Providers: Clinicians need to identify and intervene early to help women address negative R/S coping as it may influence women's adjustment within the first year post-diagnosis.

"Why me?" - women's use of spiritual causal attributions in making sense of breast cancer.

OBJECTIVE: This study addressed the role of positive (event is due to God's Love or to God's Will) and negative (event is due to God's Anger) spiritual causal attributions in women's adjustment to breast cancer. DESIGN: Ninety-three women diagnosed with breast cancer were assessed at six times from pre-diagnosis through two years post-surgery. MAIN OUTCOME MEASURES: Women completed positive and negative measures of spiritual causal attributions (e.g. God's Love), cognitive appraisals (e.g. threat), coping behaviour (e.g. avoidance) and well-being (e.g. distress). RESULTS: Positive spiritual attributions were consistently related to positive aspects of adjustment (e.g. positive appraisal, acceptance coping, and/or emotional well-being) while negative spiritual attribution was related to negative factors (e.g. appraisals of loss and uncontrollability, avoidance coping, and/or emotional distress). Path analyses revealed that the effects of positive and negative spiritual attributions on well-being were mediated by general cognitive appraisal and coping behaviour. Cross-lagged correlational analysis revealed a 'downward spiral' effect wherein the negative attribution of God's Anger at pre-diagnosis predicted greater distress at 1 week pre-surgery which in turn predicted an increase in the negative attribution and so on across time. CONCLUSION: Although positive spiritual attributions may help women maintain an attitude of hope and acceptance in the face of cancer, results indicate that the effects of negative spiritual attribution can play a significant role in undermining their well-being.

The relationship between religious/spiritual factors and perceived growth following a diagnosis of breast cancer.

This study investigates the role of religious salience, God image and religious coping in relation to perceived growth following a diagnosis of breast cancer. Eighty-seven breast cancer patients were followed from pre-diagnosis up to 24 months post-surgery. The findings of this study provided limited support for the role of positive aspects of spirituality in relation to perceived growth. Religious involvement at pre-diagnosis was predictive of less growth at 24 months post-surgery while a positive image of God had no association with growth. While some forms of positive religious coping demonstrated positive associations, others evidenced no relationship or negative relationships with growth. Negative aspects of spirituality were more consistently related to growth with the nature of the association again depending on the type of negative spirituality being assessed. For example, passive deferral coping was related to less growth while spiritual discontent coping was related to greater growth across time. Such findings underscore the need to attend to negative aspects of spirituality from early on in the process of cancer adjustment as such expressions may have implications for women's ability to develop and maintain a positive perspective in their coping over the long-term.

The trajectory of religious coping across time in response to the diagnosis of breast cancer.

OBJECTIVES: This study investigates the mobilization of religious coping in women's response to breast cancer. METHODS: Ninety-three breast cancer patients and 160 women with a benign diagnosis participated. Breast cancer patients were assessed on their use of religious coping strategies and their level of emotional distress and well-being at pre-diagnosis, 1 week pre-surgery, and 1 month, 6 months, 1 year, and 2 years post-surgery. RESULTS: In general, breast cancer patients used religious strategies more frequently than women with a benign diagnosis; however, the patterns of use were similar across time for the majority of strategies. Results showed that religious coping strategies are mobilized early on in the process of adjustment to breast cancer. Breast cancer patients' use of support or comfort-related strategies peaked around surgery and then declined, while the use of strategies that reflected more a process of meaning-making remained elevated or increased into the long-term. Positive and negative forms of religious coping were predictive of concurrent distress and emotional well-being. As well, there was evidence that the mobilization of religious coping was predictive of changes in distress and well-being across time. For example, women's increased use of active surrender coping from 1 to 6 months post-surgery was related to a concomitant decrease in emotional distress and increase in emotional well-being. CONCLUSIONS: Notably the nature of the relationship between religious coping and emotional adjustment depended on the type of religious coping strategy as well as the specific time of assessment. Specificity of information in the use of religious coping can allow health-care professionals to better identify resources and address potential points of difficulty during the process of women's adjustment to breast cancer.

A longitudinal study on the role of spirituality in response to the diagnosis and treatment of breast cancer.

This longitudinal study addressed the role of spirituality in women's response to breast cancer. Ninety-three women diagnosed with breast cancer were assessed on various measures of image of God, positive attitude, social well-being and emotional distress at pre-diagnosis, 6 months post-surgery and 1 year post-surgery. As compared to women who dropped out of the study, this sample reported religion to be less important in their daily lives. Path analyses showed evidence of direct and indirect effects of positive and negative images of God on emotional distress in cross-sectional but not longitudinal data. A positive image of God was related to greater concurrent distress while a negative image of God was indirectly related to greater distress through the pathways of social well-being and positive attitude. In the longitudinal path model, a pre-diagnosis measure of religious salience was the only aspect of spirituality that predicted an increase in distress at 1 year post-surgery. The cross-sectional analyses provided limited support for the "religious/spiritual mobilization" hypothesis as put forth by Pargament (The psychology of religion and coping. New York: Guilford Press, 1997). There was also limited support for the mediator variables of positive attitude and social well-being as mechanisms through which spirituality influences adjustment. Finally, there was no support that spirituality acted in a protective manner rather the negative elements of spirituality were more prominent in relation to various aspects of women's adjustment to breast cancer. Such results suggest that women who were less spiritually/religiously involved prior to the onset of breast cancer and who attempt to mobilize these resources under the stress of diagnosis may experience a negative process of spiritual struggle and doubt that, in turn, has implications for their long-term adjustment.

Spirituality and coping with life stress among adult survivors of childhood sexual abuse.

OBJECTIVE: The purpose of this study was to explore the role of spiritual coping in adult survivors' responses to current life stressors. Although there has been research on general coping and adult survivors of childhood sexual abuse (CSA), there has been no work done on spiritual coping behaviour and survivors' current adjustment. METHOD: One hundred and one adult survivors of childhood sexual abuse volunteered to participate in this study. Survivors were recruited through advertisements placed in various community venues. Survivors completed questionnaires on abuse descriptors, the coping resources of social support and general cognitive appraisal, spiritual coping and current distress. Spiritual coping was assessed in relation to a current negative life event. RESULTS: In general, spiritual coping predicted the current distress of adult survivors beyond the contribution of demographics, severity of abuse, cognitive appraisal and support satisfaction. For example, self-directed (beta=.27), active surrender (beta=.32), and passive deferral (beta=-.35) significantly contributed to the prediction of anxious mood, [F(15, 60)=3.31, p<.0001], while only spiritual discontent (beta=.26) predicted depressive mood, [F(15, 60)=3.66, p<.0001] beyond the contribution of other factors. Negative forms of spiritual coping (e.g., spiritual discontent) tend to be related to greater distress, while more positive forms of spiritual coping (e.g., spiritual support) were related to less distress. For instance, spiritual discontent coping was related to greater depressive mood, while active surrender coping and religious forgiveness coping (i.e., seeking God's help to relinquish negative emotion) were associated with lower levels of depressive mood. CONCLUSIONS: The results highlight the importance of making a distinction between negative and positive forms of spiritual coping when investigating the role of spirituality in the current life functioning of adult survivors of childhood sexual abuse.

Relationship with God and the quality of life of prostate cancer survivors.

This study explored the role of relationship with God with respect to the quality of life of men with prostate cancer. Thirty-four men with prostate cancer completed questionnaires on demographic and illness factors, aspects of relationship with God (e.g., God image), nonreligious resources (e.g., optimism) and physical, social and emotion functioning. Results showed that relationship with God was a significant factor in the prediction of role, emotional and social functioning for these men after controlling for age, reported severity of treatment reactions and nonreligious resources. Notably, different aspects of relationship with God (e.g., causal attribution) evidenced different associations with functioning and the nonreligious resource of perceived health control. Such results suggest that relationship with God may function in a complex manner as a resource in coping with prostate cancer. Longitudinal research is needed to clarify the role of religious/spiritual resources in the short- and long-term quality of life of men with prostate cancer.

The role of religious coping in adjustment to prostate cancer.

This study explored the role of religious coping in men's long-term adjustment to prostate cancer. Thirty-four men with prostate cancer completed questionnaires on demographic and illness factors, religious and general coping, and physical, social, and emotional functioning. Results showed that religious coping was related to poorer role, social, and emotional functioning for these cancer survivors. In contrast, religious coping was related to positive aspects of cognitive appraisal and to both active and avoidance forms of general coping. Notably, religious coping may be used to help cancer survivors "block out" their everyday experience of the prostate cancer and its related complications. Such results suggest that religious coping functions in a complex manner within the context of long-term prostate cancer survival.

The role of religious resources for older adults coping with illness.

The present study investigated the role of religious/spiritual appraisal and coping among a community sample of older adults with illness. In particular this study explored the relationship between these religious resources and nonreligious cognitive appraisals (e.g., threat) and coping behavior in response to illness. These religious resources were related to more adaptive forms of general appraisal and coping. For example, meaning-making related to God (e.g., God's will) was linked to more positive appraisals of the illness and its potential to lead to growth. As well, various forms of religious coping behavior were associated with older adults' use of positive reframing and active forms of general coping. Such findings have implications for counselors and health care providers in their work with older adults adjusting to illness.

Breast cancer survivors give voice: a qualitative analysis of spiritual factors in long-term adjustment.

As part of a cross-sectional, quantitative study on adjustment factors in long-term breast cancer survival, 52 women were asked to write in their own words how religious and spiritual factors played a part in their understanding of and coping with this illness. A subsample of 39 women responded to this question. The qualitative method of content analysis was used to define meaning units, descriptive categories and themes from the data. Interpretation of themes in the data focused on the role or function of spiritual/religious factors in long-term adjustment to breast cancer. The majority of women discussed the positive role of various spiritual resources in their response to the experience of cancer, including relationship with God, religious coping activities (e.g. prayer), meaning and social support. A cognitive model of adjustment was proposed which shows how spiritual resources can help breast cancer survivors make meaning of and experience a sense of life affirmation and personal growth in relation to the cancer.