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.

Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis

Objectives: To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. Methods: A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. Results: The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. Conclusion: Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.

Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis.

OBJECTIVES: To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. METHODS: A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. RESULTS: The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. CONCLUSION: Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.

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.

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.

Teaching Spiritual and Religious Competencies to Psychiatry Residents: A Scoping and Systematic Review.

PURPOSE: For many persons worldwide, mental health is inseparably linked with spirituality and religion (S&R), yet psychiatrists have repeatedly expressed doubts regarding their preparedness to address patients' spirituality or religion appropriately. In recent decades, medical educators have developed and implemented curricula for teaching S&R-related competencies to psychiatry residents. The authors reviewed the literature to understand the scope and effectiveness of these educational initiatives. METHOD: The authors searched 8 databases to identify studies for a scoping review and a systematic review. The scoping review explored educational approaches (topics, methods) used in psychiatry residency programs to teach S&R-related competencies. The systematic review examined changes in psychiatry trainees' competencies and/or in patient outcomes following exposure to these educational interventions. RESULTS: Twelve studies met criteria for inclusion in the scoping review. All reported providing residents with both (1) a general overview of the intersections between mental health and S&R and (2) training in relevant interviewing and assessment skills. Seven of these studies-representing an estimated 218 postgraduate psychiatry trainees and at least 84 patients-were included in the systematic review. Residents generally rated themselves as being more competent in addressing patients' S&R-related concerns following the trainings. One randomized controlled trial found that patients with severe mental illness who were treated by residents trained in S&R-related competencies attended more appointments than control patients. CONCLUSIONS: S&R-related educational interventions appeared generally well tolerated and appreciated by psychiatry trainees and their patients; however, some topics (e.g., Alcoholics Anonymous) received infrequent emphasis, and some experiential teaching methodologies (e.g., attending chaplaincy rounds) were less frequently used for psychiatry residents than for medical students. The positive association between teaching S&R-related competencies to psychiatry residents and patient appointment attendance merits further study. Future trainings should supplement classroom learning with experiential approaches and incorporate objective measures of resident competence.

Controlled semi-naturalistic protocol to investigate anomalous information reception in mediumship: Description and preliminary findings.

INTRODUCTION: In the current resurgence of studies investigating anomalous information reception (AIR) in mediumship, it has become a major challenge to balance ecological validity and rigorous control. OBJECTIVE: To describe the method and present preliminary findings of a new controlled semi-naturalistic protocol combining ecological validity and control to investigate AIR in psychography (automatic writing), a form of mediumship that does not allow for instantaneous feedback. METHOD: Experienced Brazilian psychography mediums and bereaved sitters were selected and blinded to each other until the automatic writing experimental sessions began. Mediums were continually monitored and filmed during all the procedures. Sitters filled in questionnaires on grief, spirituality, and paranormal beliefs. Investigators controlled all information received by the mediums: names of the sitter and deceased, age and cause of death and short interviews (usually ≤ 1 min). The experimental automatic writing sessions took place under the view of sitters and researchers. Immediately after the sessions, and then a few months later, sitters rated how likely the letter is to have come from their deceased loved ones. RESULTS: A total of 142 sitters and three mediums participated, producing 26 automatically written letters to 21 sitters. Mediums felt comfortable with the protocol. Most sitters were women (82.4%) and had completed higher education (57.8%). Sitters who received letters had higher grief scores. At the time, 96.2% of letters were considered definitely or probably from the deceased relative, with a small but significant decline (92.3%) a few months later. CONCLUSION: The new controlled semi-naturalistic method was well accepted and seems to be promising as a complementary method for investigating AIR in mediumship. Information obtained by mediums during sitters` brief interviews is a limitation, but they were registered by video recording and will be taken in consideration in the future analysis that will explore further the accuracy and probability of leakage of verifiable items of information in the letters.

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.

The role of spirituality and religiosity on suicidal ideation of homeless people in a large Brazilian urban center.

BACKGROUND: Suicidal ideation is an important mental health issue among homeless people. Despite the fact that spirituality and religiousness (S/R) have been associated with lower levels of suicide behavior, there is little evidence on this relationship among homeless individuals. Thus, this study aims to investigate the association between S/R and suicidal ideation among homeless people living in a large Brazilian city. METHODS: This cross-sectional study included 456 homeless individuals living in Sao Paulo, Brazil. Logistic and linear regression models were used to determine the role of religious and spiritual beliefs (Duke Religion Index, FACIT SP-12 and Brief-RCOPE) on suicidal ideation, after adjustements. RESULTS: Most participants were male (75%) with a mean age of 44.53(SD 12.62) years. A total of 49.6% had significant depressive symptoms and the prevalence of suicidal ideation was 29.8%. In the adjusted logistic regression, higher levels of religiousness (organizational, nonorganizational and intrinsic), positive religious/spiritual coping, peace and meaning were associated with a lower suicidal ideation. The same results were found when using linear regression models. LIMITATIONS: Long questionnaires can be factors of inhibition and fatigue for the participants. Suicidal ideation was based on a single question. CONCLUSION: Our results revealed a high prevalence of suicidal ideation and depression in our sample. Religiousness and spirtuality were important factors in the life of homeless individuals, being negatively associated with suicidal ideation. These results could make healthcare professionals aware of the importance of addressing S/R issues in this vulnerable population.

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.

Religiosity and spirituality in psychiatry residency programs: why, what, and how to teach?

OBJECTIVE: To propose a core curriculum for religiosity and spirituality (R/S) in clinical practice for psychiatry residency programs based on the available evidence. METHODS: After performing a review of studies on the implementation of R/S curricula and identifying the most commonly taught topics and teaching methods, an R/S curriculum was developed based on the most prevalent strategies, as well as recommendations from psychiatric associations, resulting in a fairly comprehensive R/S curriculum that is simple enough to be easily implemented, even where there is a shortage of time and of faculty expertise. RESULTS: The curriculum is a twelve-hour course (six 2-hour sessions). The topics include: concepts and evidence regarding R/S and mental health relationships, taking a spiritual history/case formulation, historical aspects and research, main local R/S traditions, differential diagnosis between spiritual experiences and mental disorders, and R/S integration in the approach to treatment. The teaching methods include: classes, group discussions, studying guidelines, taking spiritual histories, panels, field visits, case presentations, and clinical supervision. The evaluation of residents includes: taking a spiritual history and formulating an R/S case. The program evaluation includes: quantitative and qualitative written feedback. CONCLUSIONS: A brief and feasible core R/S curriculum for psychiatry residency programs is proposed; further investigation of the impact of this educational intervention is needed.

Espiritualidade: do conceito à anamnese espiritual e escalas para avaliação / Spirituality: from concept to spiritual anamnesis and evaluation scales

A integração da espiritualidade de forma sistemática e profunda na prática clí-nica tem sido recomendada como forma de transmitir aos pacientes a certeza de sua posição no centro dos cuidados. A maioria dos pacientes tem alguma forma de religiosidade/espiritualidade que influencia tanto os processos envolvidos na manutenção da saúde e no adoecimento, quanto nas formas de enfrentamento das adversidades. Muitos pacientes e seus familiares têm demandas na esfera da espiritualidade, principalmente em doenças graves, crônicas ou próximas do fim. Há um conjunto de evidências que indicam que diversas expressões da espirituali-dade têm impacto significativo na saúde e no bem-estar, que se associa a menores níveis de mortalidade geral, depressão, suicídio e uso de substâncias e a aumento da qualidade de vida. Além de grande lacuna na formação médica para realizar a anamnese espiritual adequada, muitos profissionais têm incertezas sobre a recep-tividade dos pacientes, a percepção de invasão de privacidade ou a imposição de religião, dificuldades na linguagem da espiritualidade, divergências de crença ou mesmo falta de tempo. Para que essa abordagem não seja conflitante há que haver preparo e aceitação tanto por parte dos profissionais de saúde, quanto dos pacientes e cada momento de interação deve ser transformado em oportunidade para uma avaliação natural e sensível da espiritualidade. Neste artigo, os autores apresentam diversos conceitos sobre espiritualidade e propostas para o rastreamento e anamnese baseadas em questionários e escalas disponíveis tanto para prática clínica como para pesquisa.

Investigação dos conceitos de religiosidade e espiritualidade em amostra clínica e não clínica em contexto brasileiro: uma análise qualitativa

Introdução: Já é conhecido o papel (geralmente positivo) da religiosidade e espiritualidade (R/E) sobre a saúde física e mental dos indivíduos, porém, mesmo com evidências robustas, não existe um consenso científico com relação aos conceitos de R/E, podendo levar a: instrumentos não acurados, ampliação ou "redução" dos conceitos a outros constructos que não necessariamente são R/E. Objetivo: avaliar de forma qualitativa os principais atributos que os conceitos de R/E possuem em uma amostra clínica e não clínica do contexto brasileiro. Métodos: 14 sujeitos, pacientes e acompanhantes de 2 hospitais gerais de Juiz de Fora-MG foram sorteados a partir de uma amostra prévia (estudo quantitativo) e responderam a um questionário semi-estruturado (10 questões) sobre os conceitos de R/E. Análise de conteúdo foi utilizada para as interpretações. Resultados: percebe-se insegurança para a definição dos conceitos (especialmente o de espiritualidade), a palavra 'fé' presente em muitos discursos, a importância dos aspectos religiosos privados na vida dos respondentes, a associação que os alguns participantes fizeram entre espiritualidade e espiritismo e a maioria acreditar haver algo além do mundo material, especialmente após a morte. Conclusão: fé, religiosidade não organizacional, religiosidade intrínseca e coping religioso espiritual foram as principais dimensões associadas aos conceitos de R/E.

Introduction: The role of religiousness and spirituality (R/S) on the physical and mental health of individuals is already known (usually positive), but even with robust evidence among these associations, there is no scientific consensus regarding the concepts of R/S, a fact that leads to implications as: non-accurate measures, the extension, or "reduction" of the concepts to other constructs that are not necessarily R/S, besides clinical aspects that can confuse R/S with psychopathological aspects. Objective: to evaluate in a qualitative way, the main attributes that the concepts of religiousness and spirituality have in a clinical, and in a non-clinical sample of the Brazilian context. Methods: 14 subjects, patients and caregivers from 2 general hospitals of Juiz de Fora-MG were sorted out from a previous sample (quantitative study) and responded to a semi-structured questionnaire about the concepts of religiosity and spirituality. Content analysis was used for interpretations. Results: the definition of the concepts (especially of spirituality) was confuse, the word 'faith' was present in many discourses, the importance of private religious aspects in respondents' lives, the association of spirituality with spiritism, and to believe there is something beyond the material world was very frequent. Conclusion: faith, aspects of private religiousness (non-organizational religiousness), intrinsic religiosity and spiritual religious coping, were the main dimensions of R/S associated with the concepts of religiosity and spirituality.

Association between religiosity and happiness in patients with chronic kidney disease on hemodialysis / Associação entre religiosidade e felicidade em pacientes com doença renal crônica em hemodiálise

Abstract Objectives: Religiosity/spirituality (R/S) seems to be a relevant factor in chronic diseases adaptation, but there is a lack of studies involving chronic kidney disease (CKD). This study aimed to investigate the association between R/S and happiness among CKD patients on hemodialysis and whether Sense of Coherence (SC) mediates this possible association. Methods: This was a cross-sectional study in two renal replacement therapy centers in Brazil, involving 161 adults on hemodialysis. Linear regressions were performed to evaluate the association between R/S (predicting variable measured with Duke Religious Index - DUREL) and happiness (outcome variable), adjusted for sociodemographic, clinical, and some laboratory variables. Later, SC was added to the model to test the possible mediating effect. Results: Most patients (91.20%) reported some religious affiliation. Private Religiosity (PR) (β = 0.53; 95% CI = 0.01 a 1.06), Intrinsic Religiosity (IR) (β = 0.48; 95% CI = 0.18 a 0.79), and SC (β = 0.11; 95% CI = -0.09 a 0.15) correlated with higher levels of happiness, controlling for clinical and sociodemographic variables. When SC was included in the model, IR (β = 0.34; 95% CI = 0.07 to 0.60) and SC (β = 0.11; 95% CI = 0.08 to 0.14) remained significantly. No clinical or sociodemographic variable correlated with happiness. Conclusions: Patients on hemodialysis showed high levels of R/S, which correlated with higher happiness levels. Clinical and sociodemographic variables were not correlated with patients' happiness. Psychosocial variables such as R/S and SC are potential key targets for interventions to promote better survival quality among CKD patients.

Resumo Objetivos: Religiosidade/espiritualidade (R/E) parecem ser fatores relevantes na adaptação a doenças crônicas, mas faltam estudos nessa área envolvendo pacientes com doença renal crônica (DRC). O presente estudo teve como objetivo investigar a associação entre R/E e felicidade em pacientes com DRC em hemodiálise e se o senso de coerência (SC) faz a mediação dessa possível associação. Métodos: Estudo transversal realizado em dois centros de terapia renal substitutiva no Brasil com 161 adultos em hemodiálise. Regressões lineares foram utilizadas para avaliar a associação entre R/E (variável preditora medida pelo Índice de Religiosidade de Duke - DUREL) e felicidade (variável de desfecho), ajustadas para variáveis sociodemográficas, clínicas e algumas variáveis laboratoriais. Posteriormente, o SC foi acrescentado ao modelo para testar seu possível efeito mediador. Resultados: A maioria dos pacientes (91,20%) relatou alguma afiliação religiosa. Religiosidade Privada (RP) (β = 0,53; IC 95% = 0,01 a 1,06) e Religiosidade Intrínseca (RI) (β = 0,48; IC 95% = 0,18 a 0,79) e SC (β = 0,11; IC 95% = -0,09 a 0,15) foram correlacionadas a níveis mais elevados de felicidade após controle para variáveis clínicas e sociodemográficas. Quando SC foi incluído no modelo, IR (β = 0.34; 95% IC = 0.07 a 0.60) and SC (β = 0.11; 95% IC = 0.08 a 0.14) continuaram se correlacionando significativamente com felicidade. Nenhuma variável clínica ou sociodemográfica apresentou correlação com felicidade. Conclusões: Os pacientes em hemodiálise apresentaram altos níveis de R/E, que por sua vez foi correlacionada com elevados níveis de felicidade. As variáveis clínicas e sociodemográficas não exibiram correlação com a felicidade dos pacientes. Variáveis psicossociais como R/E e SC são possíveis alvos para intervenções destinadas a promover a melhora da qualidade de sobrevida dos pacientes com DRC.

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.

Association between religiosity and happiness in patients with chronic kidney disease on hemodialysis.

OBJECTIVES: Religiosity/spirituality (R/S) seems to be a relevant factor in chronic diseases adaptation, but there is a lack of studies involving chronic kidney disease (CKD). This study aimed to investigate the association between R/S and happiness among CKD patients on hemodialysis and whether Sense of Coherence (SC) mediates this possible association. METHODS: This was a cross-sectional study in two renal replacement therapy centers in Brazil, involving 161 adults on hemodialysis. Linear regressions were performed to evaluate the association between R/S (predicting variable measured with Duke Religious Index - DUREL) and happiness (outcome variable), adjusted for sociodemographic, clinical, and some laboratory variables. Later, SC was added to the model to test the possible mediating effect. RESULTS: Most patients (91.20%) reported some religious affiliation. Private Religiosity (PR) (ß = 0.53; 95% CI = 0.01 a 1.06), Intrinsic Religiosity (IR) (ß = 0.48; 95% CI = 0.18 a 0.79), and SC (ß = 0.11; 95% CI = -0.09 a 0.15) correlated with higher levels of happiness, controlling for clinical and sociodemographic variables. When SC was included in the model, IR (ß = 0.34; 95% CI = 0.07 to 0.60) and SC (ß = 0.11; 95% CI = 0.08 to 0.14) remained significantly. No clinical or sociodemographic variable correlated with happiness. CONCLUSIONS: Patients on hemodialysis showed high levels of R/S, which correlated with higher happiness levels. Clinical and sociodemographic variables were not correlated with patients' happiness. Psychosocial variables such as R/S and SC are potential key targets for interventions to promote better survival quality among CKD patients.

Elderly caring for the elderly: spirituality as tensions relief.

OBJECTIVE: To investigate the forms of coping used to relieve tensions by elderly caregivers of elderly relatives and to know the type of support they receive from the Primary Health Care service at home. METHOD: A qualitative study with a theoretical-methodological contribution of Grounded Theory, carried out with 10 elderly caregivers interviewed between August 2014 and January 2015. RESULTS: Participants use primarily religious coping to deal with adverse situations that arise in their lives; they attribute to the sacred the strength to continue to age and care for another elderly person at home. Religiousness was the main coping strategy used by the participants, but little recognized by the health service. FINAL CONSIDERATIONS: It is recommended that the Primary Health Care service provide greater support to these caregivers and be attentive to the spiritual dimension as an auxiliary element in the process of comprehensive and inclusive health care of these elderly caregivers.