Helpful and Harmful Approaches to Integrating Religion and Spirituality into Mental Health Care: A National Survey of Current Clients' Experiences in the United States.

This article describes a national sample of 989 current mental health clients' views regarding whether and how their mental health care providers integrated the client's religion/spirituality (RS) into treatment. Within the online Qualtrics survey, two open-ended items asked respondents what (if anything) the client perceived their therapist having done regarding the client's RS that was (1) helpful/supportive or (2) hurtful/harmful. Participants also reported various ways therapists included the topic of RS in practice, if any. Nearly half freely described helpful ways their providers integrated the client's RS, and half indicated it was not discussed or applicable. Although 9.6% described hurtful experiences, most indicated their provider had not done anything harmful related to integrating RS. Implications for practice and training across mental health disciplines are discussed.

Religious/spiritual struggles and whole person functioning among Colombian university students: Longitudinal evidence of mutual influence.

This prospective study examined the primary, secondary and complex conceptual models of religious/spiritual struggles with 18 indicators of whole person functioning across five domains: psychological well-being, psychological distress, social well-being, physical well-being and character. We used three waves of longitudinal data (Wave 1: August/September 2021, Wave 2: October/November 2021, Wave 3: February 2022) from Colombian university students (N = 2878, Mage = 20.88 ± 4.05 years). Adjusting for covariates assessed in Wave 1, our primary analysis applied the analytic templates for outcome-wide and lagged exposure-wide designs to estimate two sets of lagged linear regression models. Religious/spiritual struggles in Wave 2 were associated with a small-to-medium-sized decline in subsequent functioning on 17/18 indicators in Wave 3, and worse functioning on 16/18 indicators in Wave 2 was associated with very small-to-medium-sized increases in subsequent religious/spiritual struggles in Wave 3. The results provided evidence in favour of the complex conceptual model for 16/18 indicators of whole person functioning. Our findings extend existing evidence on the reciprocal association between religious/spiritual struggles and individual functioning to a wide range of indicators, reinforcing the need for practitioners to consider the dynamic interplay between religious/spiritual struggles and individual functioning as they work with younger populations.

Divine struggles and whole person functioning: a 9-year longitudinal study of middle-aged U.S. adults.

OBJECTIVE: This longitudinal study examined the associations of divine struggles with 25 psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior outcomes assessed approximately nine years later. METHODS: We used three waves of data from the National Survey of Midlife Development in the United States (N = 4041): M1 (1995-1996), M2 (2004-2006), and M3 (2013-2014). Following the analytic template for outcome-wide longitudinal designs, our primary analysis employed a series of regression models to estimate the associations between a continuous measure of divine struggles assessed at M2 with each outcome assessed at M3. All models adjusted for a rich set of covariates, including prior values of all outcomes. RESULTS: There was modest evidence suggesting that divine struggles were associated with worse subsequent functioning on one or more outcomes for each domain except health behaviors (effect sizes were generally very small). CONCLUSIONS: Divine struggles have the potential to degrade long-term functioning across multiple domains of life. Practitioners should attend to and address divine struggles in their clinical work.

Religious/spiritual struggles and psychological distress: A test of three models in a longitudinal study of adults with chronic health conditions.

OBJECTIVE: This study tested three conceptual explanatory models that have been theorized to account for the linkages between religious/spiritual (R/S) struggles and psychological distress: the primary model (i.e., R/S struggles lead to psychological distress), the secondary model (i.e., psychological distress leads to R/S struggles), and the complex model (i.e., R/S struggles and psychological distress reciprocally exacerbate each other). METHODS: Using prospective data from a sample of US adults living with chronic health conditions (n = 302), we performed a cross-lagged panel analysis with three timepoints to test for evidence of potential causal relations between R/S struggles and psychological distress. RESULTS: Consistent with the complex conceptual model of R/S struggles, we found evidence of positive reciprocal associations between R/S struggles and psychological distress. CONCLUSION: The findings highlight the importance of attending to the dynamic interplay between R/S struggles and psychological distress when working with adults who have chronic health conditions.

R|S Atlas: Identifying existing cohort study data resources to accelerate epidemiological research on the influence of religion and spirituality on human health.

OBJECTIVE: Many studies have documented significant associations between religion and spirituality (R/S) and health, but relatively few prospective analyses exist that can support causal inferences. To date, there has been no systematic analysis of R/S survey items collected in US cohort studies. We conducted a systematic content analysis of all surveys ever fielded in 20 diverse US cohort studies funded by the National Institutes of Health (NIH) to identify all R/S-related items collected from each cohort's baseline survey through 2014. DESIGN: An R|S Ontology was developed from our systematic content analysis to categorise all R/S survey items identified into key conceptual categories. A systematic literature review was completed for each R/S item to identify any cohort publications involving these items through 2018. RESULTS: Our content analysis identified 319 R/S survey items, reflecting 213 unique R/S constructs and 50 R|S Ontology categories. 193 of the 319 extant R/S survey items had been analysed in at least one published paper. Using these data, we created the R|S Atlas (https://atlas.mgh.harvard.edu/), a publicly available, online relational database that allows investigators to identify R/S survey items that have been collected by US cohorts, and to further refine searches by other key data available in cohorts that may be necessary for a given study (eg, race/ethnicity, availability of DNA or geocoded data). CONCLUSIONS: R|S Atlas not only allows researchers to identify available sources of R/S data in cohort studies but will also assist in identifying novel research questions that have yet to be explored within the context of US cohort studies.

The Relevance of Religion and Spirituality to Mental Health: A National Survey of Current Clients' Views.

Despite a growing interest in the relationship between religion and spirituality (RS) and mental health across helping professions, less is known about clients' perceived relevance of these areas. This article describes the development and validation of the Relevance of Religion and Spirituality to Mental Health (RRSMH) scale, and responses to the first national survey of clients' perceived relevance of RS to mental health. Specifically, a sample of 989 U.S. adults who saw a mental health care provider in the last month responded to an online survey that included 27 new items to measure clients' perceptions of the relevance of RS to mental health, both positive and negative. A confirmatory factor analysis revealed that the sample's data had an adequate fit to the final 12-item model, and the instrument's overall reliability was very good (α = .96). Descriptive analyses indicated that clients view RS as both supportive and relevant to their mental health. The RRSMH scale may be used in mental health research and practice settings. Authors recommend that RS be assessed and included in treatment planning, where appropriate, and addressed in training for mental health professionals.

Religion and Spirituality among American Indian, South Asian, Black, Hispanic/Latina, and White Women in the Study on Stress, Spirituality, and Health.

Social scientists have increasingly recognized the lack of diversity in survey research on American religion, resulting in a dearth of data on religion and spirituality (R/S) in understudied racial and ethnic groups. At the same time, epidemiological studies have increasingly diversified their racial and ethnic representation, but have collected few R/S measures to date. With a particular focus on American Indian and South Asian women (in addition to Blacks, Hispanic/Latinas, and white women), this study introduces a new effort among religion and epidemiology researchers, the Study on Stress, Spirituality, and Health (SSSH). This multi-cohort study provides some of the first estimates of R/S beliefs and practices among American Indians and U.S. South Asians, and offers new insight into salient beliefs and practices of diverse racial/ethnic and religious communities.

Spiritual intimacy, spiritual one-upmanship, and marital conflict across the transition to parenthood.

Dyadic discussions that directly tap into spouses' views on spirituality and religiousness (S/R) represent an understudied but important facet of marital functioning that may be tied, for better or worse, to marital conflict and resolution processes. This study used longitudinal data gathered from 164 married couples across the transition to parenthood (TtP) to address this possibility. Specifically, during late pregnancy and when their infant was 3, 6, and 12 months old, husbands and wives completed measures about both spouses' spiritual intimacy (i.e., self-disclosure and support of partner's disclosures about spirituality) and spiritual one-upmanship (i.e., relying on spiritual and religious [dis]beliefs and opinions to assert superiority in conflicts). Criterion variables were the frequency of marital conflict and both partners' use of collaborative, hostile, and stalemating communication strategies during marital conflicts. Using fixed-effects regression models with both predictors entered, we found that greater spiritual intimacy by wives and husbands predicted less frequent conflict (p < .01), more collaborative communication by husbands (p < .01) and less stalemating (p < .01) by both spouses. Wives' spiritual intimacy also predicted more collaboration and less verbal hostility by wives (p < .01). By contrast, greater spiritual one-upmanship by both spouses predicted greater stalemating by both spouses (p < .05) and verbal hostility by husbands (p < .05). The findings indicate that 2 contrasting types of S/R dialogues are differentially linked to disagreements and conflict-resolution skills after accounting for stable aspects of the couples across the TtP (e.g., personality traits). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Decoding of the Human Spirit: A Synergy of Spirituality and Character Strengths Toward Wholeness.

Little attention has been given to the integral relationship between character strengths and spirituality (the search for or communing with the sacred to derive meaning and purpose). The science of character strengths has surged in recent years with hundreds of studies, yet with minimal attention to spirituality or the literature thereof. At the same time, the science of spirituality has steadily unfolded over the last few decades and has offered only occasional attention to select strengths of character (e.g., humility, love, and forgiveness) or the universal typology of the VIA classification of character strengths and virtues. In this exploration, we argue that there is a robust synergy of these sciences and practices revealing that spirituality is vitally concerned with promoting character strengths. At the same time, character strengths can enhance and deepen spiritual practices, rituals, and experiences. We elaborate on how character strengths and spirituality come together in the context of the psycho-spiritual journey toward wholeness. By wholeness, we are referring to a way of being in the world that involves a life-affirming view of oneself and the world, a capacity to see and approach life with breadth and depth and the ability to organize the life journey into a cohesive whole. We further discuss six levels by which spirituality can be integrated within the VIA Classification, including a meta-perspective in which wholeness represents a meta-strength or superordinate virtue. We frame two pathways of integration: the grounding path, in which character strengths offer tangibility and thereby deepen and enhance spirituality, and the sanctification path, in which spirituality elevates character strengths. Finally, we turn to research-based practices and examine how character strengths might facilitate and contribute to spiritual practices and, conversely, how spirituality might enhance character strength practices. Such multifaceted integration offers insight and wisdom to both areas of study and opens up new directions for psycho-spiritual research and practices to deepen and broaden our understanding of what it means to be human.

The impact of social support and morally injurious events on PTSD symptoms in Veterans.

Potentially morally injurious events (PMIEs), including committing transgressions (Transgressions-Self) and perceiving betrayals, have been positively associated with posttraumatic stress disorder (PTSD). A proposed mechanism for the association between PMIEs and PTSD symptoms is social disconnection. However, research on PMIEs and social disconnection is limited. Secondary data analysis from a larger study examined the moderating role of different sources of perceived social support (Family, Friends, and Significant Other) on the relation between PMIEs (Transgressions-Self and Betrayal) and PTSD. The interaction of Transgressions-Self and perceived social support subscales did not predict PTSD symptoms. However, the interaction of Betrayals and perceived social support (Significant Other and Family) predicted PTSD symptoms. Results suggest that perceived social support provides a protective effect for low to mean levels of perceived betrayals; however, for Veterans reporting high levels of betrayal, perceived social support did not attenuate PTSD symptom severity. Additional research on perceived betrayals and the association with PTSD is needed, especially for Veterans who experience high levels of perceived betrayals.

Religious and spiritual struggles, religiousness, and alcohol problems among undergraduates.

Theoretically, religion/spirituality may protect against alcohol problems or facilitate recovery. However, challenges can arise in religious/spiritual life that may contribute to or complicate alcohol problems. Emerging adults often experience difficult transitions from family environments to independent membership in academic communities straddling the legal drinking age boundary. Among underage undergraduates, we hypothesized that religious/spiritual struggles predict more alcohol problems independently of distress and religiousness, and religiousness independently predicts fewer alcohol problems. Our survey of two U.S. universities (total N = 2525) supported these hypotheses. Structural equation models revealed positive correlations between alcohol problems and all six religious/spiritual struggles (divine, demonic, interpersonal, moral, ultimate meaning, doubt), but only moral struggle predicted alcohol problems moderately and independently of religiousness, distress, gender, and non/white ethnicity. Evidence also emerged for negative correlations between religious/spiritual struggles and drinking as it varies independently of alcohol problems. We recommend that alcoholism counselors address clients' religious/spiritual struggles.

Positive and negative religious coping as predictors of distress among minority older adults.

OBJECTIVES: The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults. METHODS: Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods. Participants screening positive for worry (PSWQ-A ≥ 23) with no significant cognitive impairment (Six-Item Screener for cognitive impairment ≤2) completed a diagnostic interview and baseline assessments. Positive and negative religious coping were assessed with the positive and negative coping subscales of the Brief Religious Coping scale. Psychological distress was assessed with measures of depression, anxiety, and worry. A set of multiple linear regression models were used to evaluate the relationship between religious coping and each measure of psychological distress. RESULTS: Negative religious coping was associated with greater anxiety, worry, and depression. Positive and negative religious coping interacted such that positive religious coping buffered the effects of negative religious coping on anxiety and depression. Significant main effects and interactions remained after controlling for age, gender, race, years of education, and study. CONCLUSIONS: The findings of this study are consistent with prior work showing that negative religious coping is associated with greater psychological distress. This study replicates previous findings that positive religious coping may buffer the harmful effects of negative religious coping and extends understandings of the specific psychological impacts that positive and negative religious coping may have on older, minority adults.

Predicting pornography use over time: Does self-reported "addiction" matter?

In recent years, several works have reported on perceived addiction to internet pornography, or the potential for some individuals to label their own use of pornography as compulsive or out of control. Such works have consistently found that perceived addiction is related to concerning outcomes such as psychological distress, relational distress, and other addictive behaviors. However, very little work has specifically examined whether or not perceived addiction is actually related to increased use of pornography, cross-sectionally or over time. The present work sought to address this deficit in the literature. Using two longitudinal samples (Sample 1, Baseline N = 3988; Sample 2, Baseline N = 1047), a variety of factors (e.g., male gender, lower religiousness, and lower self-control) were found to predict any use of pornography. Among those that acknowledged use (Sample 1, Baseline N = 1352; Sample 2, Baseline N = 793), perceived addiction to pornography consistently predicted greater average daily use of pornography. At subsequent longitudinal follow-ups (Sample 1, Baseline N = 265; Sample 2, One Month Later, N = 410, One Year Later, N = 360), only male gender and baseline average pornography use consistently predicted future use. These findings suggest that perceived addiction to pornography is associated with concurrent use of pornography, but does not appear to predict use over time, suggesting that perceived addiction may not always be an accurate indicator of behavior or addiction.

Reading the Bible, Stressful Life Events, and Hope: Assessing an Overlooked Coping Resource.

Many people rely on religion to deal with the stressors in their lives. The purpose of this study is to examine a religious coping resource that has received relatively little attention-reading the Bible. We evaluated three hypotheses: (1) reading the Bible moderates the relationship between stress and hope; (2) people who read the Bible more often are more likely to rely on benevolent religious reappraisal coping responses; and (3) individuals who rely on benevolent religious reappraisals will be more hopeful about the future. Support was found for all three hypotheses in our analyses.

The Relationship Between Religious and Psychospiritual Measures and an Inflammation Marker (CRP) in Older Adults Experiencing Life Event Stress.

Inflammation, often measured by C-reactive protein (CRP), is thought to be related to a number of debilitating illnesses as we age, including cardiovascular disease, cancer and diabetes. Stress has also been implicated in these processes. This study examines potential protective effects of spirituality and religion in older adults who have experienced stressful life events. As part of the nationwide Landmark Study of Spirituality and Health, a subsample of 643 middle-aged and older adults (age ≥ 50) who were at or above the median in number of life stressors (≥ 2) was included in this analysis. Psychospiritual and religious (PS/R) variables included: religious service attendance, prayer, religious meaning, religious hope, general meaning, general hope and sense of peace. Control variables included: age, gender, education, BMI, smoking, alcohol use, social support. Only church attendance predicted significantly lower CRP after controlling for covariates, even above the other PS/R variables (standardized ß = - 0.14, t = - 3.23 p = 0.001). Those with frequent religious service attendance were 38% less likely to have clinically elevated CRP than those who attend rarely or never. Religious service attendance may confer protection in older adults experiencing stressful events as it was significantly associated with lower CRP, an inflammatory marker associated with illness.

In the Shadow of Death: Religious Hope as a Moderator of the Effects of Age on Death Anxiety.

Objectives: The purpose of this study is to see whether feelings of death anxiety are lower among older than among younger people. In addition, an effort is made to see whether religious hope explains this relationship. It is proposed that the inverse relationship between a religiously oriented sense of hope and death anxiety increases across successively older age-groups. In contrast, it is hypothesized that the relationship between a generalized sense of hope and death anxiety will not vary across successively older age-groups. Method: Data on religious hope, a general sense of hope, and death anxiety were obtained from a recent nationwide survey of people aged 18 and older (N = 2,783). Results: The findings suggest that, compared with older adults, feelings of death anxiety are higher among younger and middle-aged people. The results further reveal that a religious sense of hope, but not a general sense of hope, reduces feelings of death anxiety across successively older age-groups. Discussion: These findings suggest that a previously unexamined dimension of religion (i.e., religious hope) may help people cope with feelings of death anxiety.

Moral disapproval and perceived addiction to internet pornography: a longitudinal examination.

BACKGROUND AND AIMS: Internet pornography use is an increasingly common, yet controversial, behavior. Whereas mental health communities are divided about potentially problematic use patterns, many lay people identify as feeling dysregulated or compulsive in their use. Prior work has labeled this tendency perceived addiction to internet pornography (PA). This study's aims were to (1) assess the association between PA at baseline and other factors, including actual levels of average daily pornography use and personality factors and (2) assess the associations between baseline variables and PA 1 year later. DESIGN: Two large-scale community samples were assessed using online survey methods, with subsets of each sample being recruited for follow-up surveys 1 year later. SETTING: United States. PARTICIPANTS: Participants were adults who had used pornography within the past 6 months recruited in two samples. Sample 1 (n = 1507) involved undergraduate students from three US universities and sample 2 (n = 782) involved web-using adults. Subsets of each sample (sample 1, n = 146; sample 2, n = 211) were surveyed again 1 year later. MEASUREMENTS: At baseline, we assessed average daily pornography use, PA and relevant predictors (e.g. trait neuroticism, trait self-control, trait entitlement, religiousness, moral disapproval of pornography use). One year later, we assessed PA. FINDINGS: Cross-sectionally, PA was correlated strongly with moral disapproval of pornography use [sample 1, Pearson's correlation: r = 0.68 (0.65, 0.70); sample 2, r = 0.58 (0.53, 0.63)]. Baseline moral disapproval [sample 1, r = 0.46 (0.33, 0.56); sample 2, r = 0.61 (0.51, 0.69)] and perceived addiction demonstrated relationships with perceived addiction 1 year later. We found inconclusive evidence of a substantial or significant association between pornography use and perceived addiction over time [sample 1, r = 0.13 (-0.02, 0.28); sample 2, r = 0.11 (-0.04, 0.25)]. CONCLUSIONS: Perceived addiction to internet pornography appears to be related strongly to moral scruples around pornography use, both concurrently and over time, rather than with the amount of daily pornography use itself.

Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles.

OBJECTIVE: Potentially morally injurious events (PMIEs)-violations (perpetrated or witnessed) of one's deeply held beliefs or values-have been associated with several forms of psychological distress. The values violated by PMIEs are often influenced by one's religion/spirituality (r/s). Struggles with one's r/s beliefs and/or practices may also contribute to elevated psychological distress. To further develop a framework for understanding and treating the sequelae of PMIE exposure, we examined the role of r/s struggles in the relation between PMIE exposure and psychological distress. METHOD: A diverse sample of 155 veterans at a large Veterans Affairs medical center completed questionnaires assessing PMIE exposure, r/s struggles, and psychological distress. RESULTS: Findings revealed greater PMIE exposure predicted elevated r/s struggles as well as elevated symptoms of anxiety and posttraumatic stress disorder (PTSD). Likewise, greater r/s struggles predicted elevated anxiety, PTSD, and depression symptoms. Regression analyses revealed r/s struggles fully mediated the relation between PMIE exposure and anxiety as well as PTSD, and a significant indirect effect of PMIE exposure on depression symptoms through r/s struggles was observed. Follow-up analyses revealed that no specific domain of r/s struggles accounted for the relation between PMIE exposure and psychological distress; rather, the overarching construct of r/s struggles accounted for this relation. CONCLUSION: These findings advance the evolving theoretical framework of moral injury, elucidating the salience of r/s struggles in the development of distress. Implications for moral injury intervention call for attention to potential dissonance between actions (witnessed or perpetrated) and r/s underpinnings of the individual's moral framework. (PsycINFO Database Record