Temporal associations between meaning in life, ultimate meaning struggles, and mental health outcomes in a spiritually integrated inpatient program.

BACKGROUND: Meaning in life is a benchmark indicator of flourishing that can likely mitigate the severity of depression symptoms among persons seeking mental healthcare. However, patients contending with serious mental health difficulties often experience a painful void or absence of ultimate meaning in their lives that might hinder recovery. This two-wave longitudinal study examined temporal associations between perceived presence of meaning in life, struggles with ultimate meaning, flourishing, and depression symptoms among adults in a spiritually integrated inpatient treatment program. METHODS: Of the 242 patients assessed at intake, 90% (N = 218; 40% Cisgender male; 57% Cisgender female; 3.0% nonbinary) completed validated measures of these meaning-related factors and mental health outcomes at discharge. RESULTS: Cross-sectional analyses revealed perceptions of meaning in life and ultimate meaning struggles were inversely linked with one another along with being associated with indices of positive and negative mental health in varying ways at the start and end of treatment. Drawing upon a two-wave cross-lagged panel design, longitudinal structural equation modeling analyses supported a Primary Meaning Model whereby having a subjective sense of meaning in life at intake was prospectively linked with lower levels of ultimate meaning struggles and greater flourishing at discharge. However, baseline levels of mental health outcomes were not predictive of the meaning-related factors in this sample. CONCLUSION: Findings highlight the utility of assessing patients' perceived meaning in life and ultimate meaning struggles in spiritually integrated programs and for clinicians to be prepared to possibly address these meaning-related concerns in the treatment process.

Perceptions of Divine Forgiveness, Religious Comfort, and Depression in Psychiatric Inpatients: A Mixed Methods Study.

Understanding how forgiveness relates to mental health outcomes may improve clinical care. This study assessed 248 adult psychiatric inpatients, testing associations of forgiveness, religious comfort (RC), religious strain (RS), and changes in depressive symptomatology from admission to discharge. Experiencing divine forgiveness and self-forgiveness was both directly associated with RC and inversely associated with RS. Using structural equation modeling, the path from divine forgiveness to depression through RC was significant, ß = - .106, SE = .046, z = - 2.290, p = .022, bootstrapped 95% CI = - .196 to - .015. Qualitative findings illustrated patients' changed perspectives on divine forgiveness during hospitalization.

The Influence of Culture, Social, and Religious Support on Well-Being in Breast Cancer Survivorship.

Objective Latina and African American breast cancer survivors (BCS) are affected by health disparities that have negatively impacted their health outcomes and quality of life more than other BCS. Examining the relationships among social support, culture, and well-being in underserved groups may help clarify critical factors that influence health disparities in cancer survivors. Methodology Ethnic salience (impact of ethnicity on identity), religious support, social support, and well-being were examined in African American and Latina breast cancer survivors using archival data. Participants included 320 breast cancer survivors (28% African American and 72% Latina) ranging from 26-89 years old and one to five years post breast cancer diagnosis. Results Ethnic salience was positively associated with well-being (p < .001). African American breast cancer survivors endorsed greater well-being, social support, religious support, and ethnic salience than Latinas (ps < .05). Religious support was associated with well-being even after controlling for the effects of general social support [ΔR 2 = .02, p = .005; F(5, 298) = 23.67]. Conclusion Ethnic salience and religious support are important factors in understanding health disparities and should inform survivorship care plans for underserved populations.

Gratitude and patience moderate meaning struggles and suicidal risk in a cross-sectional study of inpatients at a Christian psychiatric hospital.

OBJECTIVE: Suicidal behavior is a leading cause of injury and death, so research identifying protective factors is essential. Research suggests gratitude and life hardships patience are character strengths that might protect against the deleterious association of struggles with ultimate meaning and suicide risk. However, no studies have evaluated their utility among people experiencing acute/severe mental health concerns. METHOD: We tested the protective function of gratitude and life hardships patience with cross-sectional data from adults (Mage  = 31.83 years; SD = 14.84; range = 18-82) hospitalized in a Christian psychiatric inpatient facility (Mstay  = 6.37 days, SD = 4.64). RESULTS: Gratitude and life hardships patience moderated the positive relation between meaning struggles and suicide risk. Specifically, gratitude and life hardships patience protected against meaning struggles as a risk factor for suicide through mechanisms separate from ameliorating depressive symptoms. CONCLUSIONS: Findings provide initial support for gratitude and patience interventions as an adjunct to standard psychiatric treatment for minimizing suicide risk.

Religiousness, meaning, and quality of life: Test of a mediational model among adults seeking a spiritually integrated inpatient program.

OBJECTIVE: Religious beliefs and practices may augment a sense of meaning in life that could support quality of life (QOL) in physical, social, and emotional domains amid mental health crises. However, these associations have not been thoroughly tested among persons with serious mental illness (SMI). METHODS: Focusing on 248 adults who had recently enrolled in a spiritually integrated acute psychiatric hospitalization program, we incorporated structural equation modeling to examine whether (1) religiousness would be associated with better overall QOL; and (2) inpatients' sense of meaning in life would at least partially account for the religiousness-QOL link. RESULTS: Religiousness was linked indirectly with QOL at the time of admission: religiousness was associated with greater meaning in life, and a higher degree of meaning in life was associated with QOL. CONCLUSIONS: Findings underscore the crucial role of religiousness for meaning and wellness among many individuals with SMI who seek stabilization and healing.

Spiritual struggles and mental health outcomes in a spiritually integrated inpatient program.

BACKGROUND: Persons contending with serious mental health difficulties often experience struggles with religious faith and/or spirituality that may also demand clinical attention. However, research has not examined the relative importance of specific forms of spiritual struggles in mental health status or treatment outcomes of psychiatric patients. METHODS: Focusing on 217 adults who completed a spiritually integrated inpatient program, this study examined (1) which struggles in Exline et al.'s (2014) framework (Divine, Morality, Ultimate Meaning, Interpersonal, Demonic, and Doubting) represented the most salient indicators of major depressive disorder (MDD) symptomatology and positive mental health (PMH) and (2) whether alleviation of these struggles predicted improvements in patients' mental health status over the treatment period. RESULTS: Greater severity of spiritual struggles was generally associated with worse MDD symptomatology and less PMH at intake and discharge. However, when weighing the role of varying forms of struggles, issues with ultimate meaning emerged as a salient indicator of mental health status at the two assessments as well as longitudinal changes in both MDD symptomatology and PMH. LIMITATIONS: This sample was recruited from acute stabilization units in a single spiritually integrated behavioral health center with a general affiliation with Christianity. Hence, treatment periods were relatively brief in some cases and findings might not generalize to other psychiatric programs or settings. CONCLUSIONS: Findings highlight the utility of assessing prominent forms of spiritual distress for planning and delivering psychosocial interventions, particularly with respect to issues related to a perceived absence of ultimate meaning in life.

Spirituality and eating disorder risk factors in African American women.

PURPOSE: The increased prevalence of body dissatisfaction and eating disordered behaviors (EDBs) among African American women warrants further examination of critical factors that may contribute to this recent trend. This study sought to investigate whether ethnic identification, spirituality, and internalization of the thin ideal would be associated with decreased body dissatisfaction and EDBs. METHOD: A convenience sample of 55 African American college women was recruited from a college campus. The Eating Attitudes Test, Eating Disorders Inventory, Multigroup Ethnic Identity Measure, Sociocultural Attitudes toward Appearance Questionnaire, Life Regard Index-R, and Spiritual Transcendence Index were administered. RESULTS: Body dissatisfaction and internalization of the thin ideal were positively associated with EDBs. Higher scores on meaning in life were negatively associated with body dissatisfaction. Spiritual transcendence and internalization of the thin ideal were positively associated with body dissatisfaction. Spiritual transcendence was positively associated with meaning in life. CONCLUSIONS: These findings highlight the importance of exploring spirituality and ethnic identification in efforts to understand the relationships among the internalization of a thin ideal, body dissatisfaction, and EDBs in African American women. LEVEL OF EVIDENCE: Level V, Evidence obtained from a cross-sectional descriptive study.

Adapting Group Therapy to Address Real World Problems: Insights from Groups Offered in the Bahamas.

This article presents a cultural adaptation of a group therapeutic approach that is being offered in the Bahamas. "The Family: People Helping People" project was designed as an intervention to improve socialization in New Providence, the Bahamian capital and its most heavily populated city. "The Family" group model offers support and training to improve communication in relationships and to encourage constructive emotional expression. This article will provide an overview of "The Family," address key elements of this approach that are culturally tailored, and offer clinical examples and note implications for group therapy training. This cultural adaptation offers helpful insights for addressing community problems, such as violence and societal fragmentation, and may inform the development of community-based group interventions in other settings.

Neuroscience and Racism: The Power of Groups for Overcoming Implicit Bias.

Recent developments in brain imaging have enhanced our understanding of how individuals respond to racial cues and stereotypes. Evidence suggests that racial stereotypes are more emotional in nature than other phenotypic stereotypes. One challenging emotion that may be evoked is shame. The experience of shame may impede self-reflection, interfere with one's awareness of potential implicit racial biases, and impede the exploration of racial considerations. The group therapy setting provides a rich context for addressing racial bias as well as the emotions and challenging interactions that often accompany it. Practical techniques are presented for managing shame along with other emotions that may emerge in discussing race or addressing racial dynamics in groups.

God imagery and affective outcomes in a spiritually integrative inpatient program.

Religion and/or spirituality (R/S) can play a vital, multifaceted role in mental health. While beliefs about God represent the core of many psychiatric patients' meaning systems, research has not examined how internalized images of the divine might contribute to outcomes in treatment programs/settings that emphasize multicultural sensitivity with R/S. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually integrative inpatient program over a two-year period, this study tested direct/indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes (positive and negative). When accounting for patients' demographic and religious backgrounds, structural equation modeling results revealed: (1) overall effects for God imagery at pre-treatment on post-treatment levels of both positive and negative affect; and (2) religious comforts and strains fully mediated these links. Secondary analyses also revealed that patients' generally experienced reductions in negative emotion in God imagery over the course of their admission. These findings support attachment models of the R/S-mental health link and suggest that religious comforts and strains represent distinct pathways to positive and negative domains of affect for psychiatric patients with varying experiences of God.

Scapegoating in Group Therapy: Insights from Girard's Mimetic Theory.

Scapegoating in group psychotherapy is a pervasive, complex, and challenging phenomenon for many group leaders. How scapegoating is worked through by the group can have a profound impact on whole-group dynamics and functioning. Although some key aspects of scapegoating have been identified in the psychoanalytic literature, the authors urge group leaders to consider systemic and group-level perspectives in depth. This article draws heavily from Yvonne Agazarian's Systems-Centered Therapy, which provides a practical foundation for anticipating and preventing scapegoating in group therapy. The authors also explore scapegoating through the framework of René Girard's Mimetic Theory, which offers a compelling anthropological explanation for why human beings scapegoat as well as a description of how scapegoat dynamics evolve in groups. Insights based on Mimetic Theory are integrated with existing interventions to suggest new ways of working through this critical group phenomenon.

Empathy in group therapy: facilitating resonant chords.

Empathy has consistently been identified as an important quality of psychotherapists. Understanding unique ways that empathy emerges in group therapy may assist group therapists in fostering empathy. Rogerian and selected psychodynamic and interpersonal perspectives on empathy are discussed. Group psychotherapy poses a challenge for empathic responding, but also a rich opportunity for utilizing a more varied embodied approach to empathy.

Intrinsic religiousness as a mediator between fatalism and cancer-specific fear: clarifying the role of fear in prostate cancer screening.

Understanding factors that influence screening receptivity may enhance African-American men's receptivity to prostate cancer screening. Men of African descent (N = 481) between the ages of 40 and 70 were recruited. The hypotheses that Fatalism would be related to Intrinsic Religiousness and Fear, Intrinsic Religiousness would act as a mediator between Fatalism and Fear, and Fatalism as well as Prostate Cancer-Specific Fear would be negatively related to past Prostate-Specific Antigen Testing and Screening Intent were supported. This meditational finding suggests that when religious beliefs are a motivating force, the fear-inducing effects of fatalism are reduced.

Supervisory reactions: an important aspect of supervision.

Anne Alonso was passionate about the practice of supervision. An excellent supervisor herself, she sought to identify and teach the ingredients of effective supervision throughout her career. Her first book, The Quiet Profession (1985), was about the supervisory relationship and the various influences on it from within and without the relationship, and she insisted that the Center for Psychoanalytic Studies training program that she directed for many years include a required course on supervision. While the usual focus in supervision is on the supervisee and the clinical material presented, supervisors often experience powerful emotional reactions. Sometimes this is parallel process, in which the dynamics of the psychotherapy are replayed in the supervisory relationship. However, many other sources can contribute to supervisory affect, including the personality, background, and developmental stage of the supervisor, the impact of the clinical material, and the setting in which the supervision takes place. Supervisory reactions can be informative about the psychotherapy being supervised, about the supervisory relationship, or about the supervisor. Supervisors need self-awareness in order to identify their own contribution to their affective responses in supervision. The use of a supervisor decision tree of 1) awareness of reaction, 2) identification of its source, 3) relevance to current supervision, and 4) appropriate use of the reaction in the current supervision is recommended.

Religiousness and prostate cancer screening in African American men.

This study was designed to examine the relationship between religiousness (organized, nonorganized, and intrinsic) and religious problem solving (collaborative, deferring, and self-directing) in prostate cancer screening (PCS) attitudes and behavior. Men (N = 481) of African descent between the ages of 40 and 70 participated. Hierarchical regression analyses revealed that religiousness and self-directed problem solving were associated with PCS attitudes. Intrinsic religiousness was associated with PCS attitudes after controlling for health and organized religiousness. Religiousness was not associated with PCS behavior. Intrinsic religiousness may be an important dimension of religiousness to be considered in tailoring cancer interventions for individuals from faith-based communities.

Personal communication in primary and secondary cancer prevention: evolving discussions, emerging challenges.

Over the past several years, the science of cancer communication has been recognized as integral to the dissemination of cancer prevention and control strategies in both the general population as well as higher-risk groups. In this article we draw upon current literature and small group discussion in the 2008 Society for Behavioral Medicine Cancer Special Interest Group Pre-Conference Workshop on Cancer Communication to identify current findings, critical challenges, and future opportunities regarding personal communication of primary and secondary prevention of cancer. We organize our article with six critical questions: (1) What are the most important directions of research in this area? (2) Does personal cancer communication work through rational processes, or are affective and nonrational processes also involved? (3) Are our efforts adequate to reach underserved populations? (4) Are naturalistic communicative contexts given adequate consideration? (5) Has the field been adequately informed by social psychological and communication theories? (6) What are the best outcomes to document communication effectiveness? Our goals are to initiate thought and collaborative efforts among communication, public health, and behavioral science experts, as well as to establish research priorities at the interface of communication and cancer prevention and control sciences.

Using prayer in psychotherapy: applying Sue's differential to enhance culturally competent care.

In this article, the authors discuss the application of Sue's cultural competence differential of hypothesis testing, dynamic sizing, and cultural specific expertise as a model for considering cultural factors in the treatment of an African American family. Three cultural dimensions are highlighted: spirituality, womanism, and community exposure to trauma. Given the centrality of spirituality for this African American family, prayer is used to facilitate the therapeutic process. Discussion from a womanist perspective highlights the spiritual, communal, and personal dimensions that the aunt faces as an African American woman. Consideration of the community context and potential exposure to trauma and loss allows for a fuller appreciation of the psychosocial context of the nephew. Sue's differential guides the case discussion.

Recruiting African American men for cancer screening studies: applying a culturally based model.

In a study of psychosocial factors related to prostate cancer screening (PCS) of African American men, researchers achieved significant success in recruitment. Key strategies included addressing specific barriers to PCS for African American men and placing recruitment efforts in a conceptual framework that addressed cultural issues (PEN-3 model). To conduct cancer prevention research in the African American community, to engage in health promotion in collaboration with churches, and to recruit African American men, a culturally competent approach that incorporates the values of the community is essential. Implications for addressing specific barriers to recruitment and building partnerships in health promotion research are discussed.

Religious coping and depression among spouses of people with lung cancer.

A cancer diagnosis frequently activates a range of coping responses in patients and their spouses and may affect their emotional well-being. The authors hypothesized a curvilinear relationship between religious coping and depression in 156 spouses of lung cancer patients. Hierarchical regression analyses were conducted with blocks of variables entered as follows: demographic characteristics; cancer stage; perceived control, self-efficacy, and social support; religious coping (linear); and religious coping squared (quadratic). There was a significant association between religious coping squared and depression. Spouses who used moderate levels of religious coping were rated as less depressed than those who used lower or higher levels.