Prevalence of spiritual and religious experiences in the general population: A Brazilian nationwide study.

Spiritual and religious experiences (SREs) are common subjective phenomena related to the awareness of transcendence, which transforms one's perception of life, death and suffering. Despite the high prevalence of SREs worldwide, not enough studies have been conducted beyond Europe and North America. To fill this gap, this study investigates the prevalence of SREs in Brazil and their association with socio-demographic variables. This online cross-sectional study includes participants from all regions of Brazil. Sixteen SREs were investigated, being categorized into 4 groups: mystical, mediumistic, psi-related and past life/near-death experiences. Prevalence was calculated as percentages and multinomial logistic regression models were used. A total of 1,053 Brazilians were included; 92% reported one SRE in their lifetime and 47.5% experienced at least one SRE frequently. Participants reported having had at least one mystical experience (35%), one psi-related experience (27.7%), and one mediumistic experience (11%). Half the sample had "felt the presence of a dead person" and 70% experienced precognitive dreams at least once. In a multivariate analysis, SREs were associated with the female gender but showed no associations with income, education, employment status and ethnicity. Mystical experiences were associated with age 55 and older. In summary, SREs are very prevalent across different strata of the population, and deserve more attention from researchers and clinicians in order to clarify their nature and implications for mental health care and research in Brazil.

Development of an Instrument to Assess Spirituality: Reliability and Validation of the Attitudes Related to Spirituality Scale (ARES).

Background: Several instruments that measure spirituality present overlaps with positive emotions, impacting the interpretation of their findings. In order to minimize these problems, we aimed to develop, assess the reliability and validate a new scale to evaluate spirituality. Methods: The instrument was designed using a theoretical framework minimizing tautological issues (i.e., Koenig's framework), a qualitative study investigating the definitions of spirituality, the development of the first version of instrument by experts' meetings and a qualitative cognitive debriefing. Then, the instrument was examined for its content validity by a multidisciplinary group of judges and was pilot-tested in two different groups - less religious (medical students - n = 85) and more religious (practicing religious members - n = 85). Finally, psychometric properties and validity were assessed. Results: The developed Attitudes Related to Spirituality Scale (ARES) is a self-report 11-item instrument using five-level Likert items. ARES presented appropriate psychometric properties revealing excellent internal consistency (alpha = 0.98) and temporal stability (ICC = 0.98). Likewise, ARES was strongly correlated with other validated R/S instruments (i.e., Duke Religion Index and Brief Multidimensional Measure of Religiousness/Spirituality) and was able to discriminate higher and lower religious groups. In the exploratory factor analysis, a unidimensional structure of the scale was described. Fit indices for the scale demonstrated good fit in the unidimensional model. Conclusion: The ARES is a reliable, valid and stable one-dimension instrument that is appropriate for use in the Portuguese-speaking population. Descriptors: Spirituality; Scale; Factorial Analysis; Instrument; Measure; Psychometrics.

Mental Health and Quality of Life Among Adults With Single, Multiple, and No Religious Affiliations.

Few studies have investigated the "multiple religious affiliations" phenomenon. This study aims to understand those with "multiple religious affiliations," describing its prevalence and investigating if there are differences in mental health and quality of life between this group and those with a single religious affiliation and those with no religious affiliation. A total of 1169 adults were included, and 58% had a single religious affiliation, 27.7% had multiple religious affiliations, and 12.3% had no religious affiliation. Participants with a single religious affiliation presented better mental health and quality of life than those with multiple or no religious affiliations. Although most outcomes were similar between multiple and no religious affiliations, happiness and optimism were higher in the multiple religious group, and anxiety was lower in the no religious group. Health care professionals should be aware of the secondary religious affiliations of their patients to identify possible conflicts and to treat them comprehensively.

Neurophysiological, cognitive-behavioral and neurochemical effects in practitioners of transcendental meditation - A literature review.

The term meditation can be used in many different ways, according to the technique to which it refers. Transcendental Meditation (MT) is one of these techniques. TM could serve as a model for research on spiritual meditation, unlike the meditation techniques based on secular knowledge. The purpose of the present study is to conduct a bibliographic review to organize scientific evidence on the effects of TM on neurophysiology, neurochemistry, and cognitive and behavioral aspects of its practitioners. To conduct this critical narrative review of the literature, we searched for scientific papers on the PubMed database of the National Center for Biotechnology Information. The keywords used in the search were Transcendental Meditation, Neuroscience of meditation e Meditation and behavior. We selected 21 papers that analyzed different aspects that could be altered through meditation practice. We concluded that TM has positive and significant documentable neurochemical, neurophysiological, and cognitive-behavioral effects. Among the main effects are the reduction of anxiety and stress (due to the reduction of cortisol and norepinephrine levels), increase of the feeling of pleasure and well-being (due to the increase of the synthesis and release of dopamine and serotonin), and influence on memory recall and possible consolidation. Further studies are needed using creative and innovative methodological designs that analyze different neural circuitry and verify the clinical impact on practitioners.

Neurophysiological, cognitive-behavioral and neurochemical effects in practitioners of transcendental meditation - A literature review

SUMMARY The term meditation can be used in many different ways, according to the technique to which it refers. Transcendental Meditation (MT) is one of these techniques. TM could serve as a model for research on spiritual meditation, unlike the meditation techniques based on secular knowledge. The purpose of the present study is to conduct a bibliographic review to organize scientific evidence on the effects of TM on neurophysiology, neurochemistry, and cognitive and behavioral aspects of its practitioners. To conduct this critical narrative review of the literature, we searched for scientific papers on the PubMed database of the National Center for Biotechnology Information. The keywords used in the search were Transcendental Meditation, Neuroscience of meditation e Meditation and behavior. We selected 21 papers that analyzed different aspects that could be altered through meditation practice. We concluded that TM has positive and significant documentable neurochemical, neurophysiological, and cognitive-behavioral effects. Among the main effects are the reduction of anxiety and stress (due to the reduction of cortisol and norepinephrine levels), increase of the feeling of pleasure and well-being (due to the increase of the synthesis and release of dopamine and serotonin), and influence on memory recall and possible consolidation. Further studies are needed using creative and innovative methodological designs that analyze different neural circuitry and verify the clinical impact on practitioners.

RESUMO O termo meditação pode ser utilizado de diversas formas, de acordo com a técnica a que se refere. A meditação transcendental (MT) é uma dessas técnicas meditativas. A MT pode ser um modelo para pesquisas de meditação espiritual, diferentemente de técnicas de meditação baseadas em uma compreensão secular. O presente estudo objetiva realizar uma revisão bibliográfica para organizar as evidências científicas sobre os efeitos da MT sobre a neurofisiologia, neuroquímica e aspectos cognitivos e comportamentais dos seus praticantes. Para a realização desta revisão narrativa crítica da literatura, foi realizado um levantamento dos artigos científicos presentes na base de dados PubMed do National Center for Biotechnology Information. As palavras-chave utilizadas na busca foram Transcendental Meditation, Neuroscience of meditation e Meditation and behavior. Foram selecionados 21 artigos que analisavam diferentes aspectos que poderiam ser alterados pela prática meditativa. Conclui-se que a MT produz efeitos neuroquímicos, neurofisiológicos e cognitivo-comportamentais documentáveis em seus praticantes, de caráter positivo e significativo. Entre os principais efeitos estão a diminuição da ansiedade e do estresse (via diminuição nos níveis de cortisol e noradrenalina), aumento na sensação de prazer e bem-estar (em decorrência ao aumento na síntese e liberação de dopamina e serotonina) e influência na evocação e possível consolidação da memória. São necessários mais estudos utilizando desenhos metodológicos inovadores e criativos, analisando diferentes circuitos neurais e verificando o impacto clínico sobre os praticantes.

The association between spirituality and religiousness and mental health.

The present study aims to investigate how different levels of spirituality and religiousness (high spirituality and high religiousness -S/R, high spirituality and low religiousness -S/r, low spirituality and high religiousness s/R and low spirituality and low religiousness - s/r) are associated with quality of life, depressive symptoms, anxiety, optimism and happiness among adults. A cross-sectional study was carried out among 1,046 Brazilian adults. Concerning the different levels of spirituality and religiousness, 49.2% had s/r, 26.5% S/R, 17.2% S/r and 7.1% s/R. Participants with S/R had better outcomes as compared to those with s/r and those with S/r in WHOQOL Psychological, Social Relationship and Environment, Optimism and happiness. Participants with s/R had better outcomes as compared to those with s/r in WHOQOL Psychological and Social Relationship, Optimism and happiness. Participants with S/r were different from those with s/r, with higher levels of WHOQOL Environment and happiness but also anxiety. The results revealed that, having higher levels of both spirituality and religiousness were more correlated to better outcomes than having just one of them or none of them. Likewise, having higher levels of religiousness in detriment of higher levels of spirituality was also associated with better outcomes in comparison to others.

Religious landscape in Brazil: Comparing different representative nationwide approaches to obtain sensitive information in healthcare research.

Although the basis of religious studies start with demographics, nation-wide data are often extracted from face-to-face interviews (leading to a social-desirability bias) and in studies not originally designed to assess religion. This study aims to understand the religious landscape in Brazil and to investigate the feasibility of carrying out a representative nation-wide survey without interviewers, comparing it with other representative face-to-face surveys. We conducted a nationwide online survey representing all regions in Brazil. These results were compared with five other Brazilian representative surveys. A total of 1169 individuals completed the online questionnaires. The percentage of participants according to the gender and in relation to the Brazilian region was quite similar for all surveys. However, the online survey had the higher level of education among all surveys. In relation to the religious characteristics, the percentage of each variable varied from survey to survey. Those surveys originally designed to assess religion tended to yield more religious affiliations and less ceiling effects. The online survey was able to identify more diverse religious affiliations and more balanced responses in the religious attendance and importance of religion in life. The present study found that, even in nation-wide representative surveys, there are important differences in the results obtained while investigating religion. These differences could be associated with the type of data collection (face-to-face and online), the design of the study (originally designed to investigate religion or not) and options and the type of the questions used.

Coleta de uma história espiritual: fundamentos para uma prática profissional culturalmente sensível / Collecting a spiritual history: foundations for a culturally sensitive professional practice

Realizar a coleta de uma história espiritual é fundamental para se adotar, cotidianamente, práticas profissionais culturalmente sensíveis. Algumas razões para se considerar essa abordagem: religião e espiritualidade (R/E) são importantes para muitas pessoas, principalmente na realidade religiosa brasileira; R/E influencia desfechos de saúde, comumente por meio de associações positivas; a coleta de dados sobre a espiritualidade pode fornecer uma compreensão mais ampla da natureza e da relação entre a R/E e a sintomatologia do paciente. Já existem roteiros desenvolvidos para facilitar a obtenção de uma história espiritual pela equipe de saúde, mas também é possível ampliá-los e adaptá-los às características próprias de cada serviço de saúde. Essa identificação adequada das necessidades espirituais é central para que os profissionais possam tomar atitudes que facilitem aos pacientes a prática de suas crenças, particularmente diante de um momento de extrema vulnerabilidade, que é o adoecer

Collecting a spiritual history is fundamental to adopting culturally sensitive professional practices. Some reasons to consider this approach: religion and spirituality (R/S) are important to many people, especially in the Brazilian religious context; R/S influences health outcomes, commonly through positive associations; collecting spirituality data can provide a broader understanding of the nature and relationship between R/S and patient symptomatology. There are already scripts developed to facilitate the obtaining of a spiritual history by the health team, but it is also possible to expand them and adapt them to the characteristics of each health service. This proper identification of spiritual needs is central for professionals to take actions that facilitate patients to practice their beliefs, particularly in the face of a moment of extreme vulnerability, which is getting sick

Espiritualidade, saúde e suas aplicações práticas: desenvolvimento do Programa de Saúde, Espiritualidade e Religiosidade / Spirituality, health and its practical applications: development of the Health, Spirituality and Religious Program

O presente trabalho descreve o desenvolvimento e relato de experiências do Pro-grama de Saúde Espiritualidade e Religiosidade ­ ProSER. O ProSER foi implantado em 2008, com a finalidade de promover uma atenção mais ampla às necessidades espirituais e religiosas no contexto de saúde, bem como produzir e difundir conhe-cimento na interface saúde, espiritualidade e religiosidade para centros acadêmi-cos e instituições de saúde. Esse estudo tem como objetivo descrever a trajetória e atuação do ProSER nas áreas de ensino, pesquisa e assistência. A atuação do ProSER tem promovido mudanças nos cuidados em saúde, por meio de suas moda-lidades de assistência, além da disseminação de conhecimento para outros profis-sionais de saúde e centros acadêmicos, através de trabalhos científicos e cursos.

This paper describes the development and reporting of ProSER - Spirituality and Religiousness Health Program's experiences. ProSER was founded in 2008 to promote broader attention to spiritual and religious needs in health context, as well as to produce and disseminate knowledge at the health, spirituality and religiosity interface for academic centers and health institutions. This study aims to describe the trajectory and performance of ProSER in the areas of training, research and care. ProSER's work has promoted changes in health care mindset through its assistance modalities, as well as the dissemination of knowledge to other health professionals and academic centers, through scientific articles, classes and courses.

Mental and Physical Health and Spiritual Healing: An Evaluation of Complementary Religious Therapies Provided by Spiritist Centers in the City of São Paulo, Brazil.

The present study aims to describe the characteristics of the complementary religious treatment conducted by Spiritist centers in the city of São Paulo (Brazil), to understand how physical and mental health problems are addressed and how the directors of these centers differentiate between persons with spiritual experiences from those with psychiatric disorders. From 365 Spiritist centers, which received the questionnaire, 55 (15.1 %) were included in the final analysis. There were on average 261 people per week attending spiritual sessions in each center, totalizing approximately 15,000 attendees per week in all 55 centers. The most common treatment performed in these centers was disobsession (Spirit release therapy) (92.7 %); the least common was the 'spiritual surgery', present in only 5.5 %. The most frequent health problems reported by attendees were depression (45.1 %), cancer (43.1 %) and diseases in general (33.3 %). Concerning the directors' awareness to differentiate between spiritual experiences and psychiatric disorders, we found some remarkable divergent opinions. In conclusion, the Spiritist centers are an important health related support system for the city of São Paulo, responsible for a significant share of the city's total health consultations. The most common conditions the patients suffer from were depression and cancer.

Effects of transpersonal brief psychotherapy on general state of health and quality of life in patients with Crohn's disease / Efeitos da psicoterapia breve transpessoal sobre o estado de saúde geral e a qualidade de vida em pacientes com doença de Crohn

Introduction: Crohn's disease (CD) is a chronic illness with continuous and longstanding treatment, which affects general state of health and life quality of patients.Objectives:Evaluating the effects of Transpersonal Brief Psychotherapy (TBP) on general state of health and life quality of patients with CD.Methods:Eleven people diagnosed with CD of both sexes and aged between 25 and 50 years old have been evaluated. The clinical method was used and the procedure consisted of treatment with TBP and data collection before and after psychotherapy. In data collection, the following instruments were used: Sociodemographic Questionnaire (SDQ), Crohn's Disease Activity Index (CDAI), Inflammatory Bowel Disease Questionnaire (IBDQ) and General Health Questionnaire (GHQ), with descriptive analysis of results and the statistical methodology with Wilcoxon test. Results: The procedure turned out to be effective to all instruments (p< 0.05) and the most significant result was in relation to general state of health (-40.4%) and life quality (35.3%). The disease activity has decreased by 38.1% on CDAI. Conclusion: TBP has brought meaningful benefits to patients with CD, influencing the clinical picture, with reduction of the severity of the disease and, consequently, it has improved their general state of health and life quality. (AU)

Introdução: A doença de Crohn (DC) é uma enfermidade crônica que exige tratamento contínuo e prolongado, afetando a qualidade de vida e a saúde geral dos pacientes. Além do tratamento clínico, recomenda-se o acompanhamento psicológico para o desenvolvimento de estratégias adaptativas. Objetivo: Avaliar os efeitos da Psicoterapia Breve Transpessoal (PBT) sobre a qualidade de vida e estado geral de saúde de pacientes com DC, e possível correlação com a atividade da doença. Métodos: Foram avaliados 11 pacientes com diagnóstico de DC, de ambos os sexos, com idade entre 25 anos e 55 anos. Utilizou-se o método clínico e o procedimento consistiu no atendimento em PBT, com coleta de dados antes e depois da psicoterapia. Na coleta de dados foi utilizado o Questionário Sociodemográfico (QSD), Índice de Atividade da Doença de Crohn (IADC), Inflammatory Bowel Disease Questionnaire (IBDQ), Questionário de Saúde Geral de Goldberg (QSG), com análise descritiva para os resultados e estatística com o teste de Wilcoxon.Resultados:A intervenção mostrou-se significativamente eficaz para todos os instrumentos avaliados (p< 0,05), com melhor resultado para o estado de saúde geral (-40,4%) e qualidade de vida (35,3%). A atividade da doença apresentou uma redução de 38,1% no IADC. Conclusão: A PBT trouxe benefícios aos pacientes com DC, influenciando seu quadro clínico, com redução da severidade da doença, e consequentemente, melhorando o estado de saúde geral e a qualidade de vida destes doentes. (AU)

The effects of meditation-based interventions on the treatment of fibromyalgia.

Meditation is the third most commonly requested complementary and alternative medicine (CAM) therapy reported in a US survey. Those who suffer from chronic pain are those who most frequently use CAM therapies. This review aims to evaluate whether meditation-based interventions can help the treatment of fibromyalgia. A PubMed search was conducted using the terms "fibromyalgia" and "meditation", or "mindfulness", or "mantra" or "relaxation response". We selected articles which clearly described a meditation intervention being used in the treatment of fibromyalgia. Only four articles were classified with score 3 in the Jadad scale. Another seven articles were included in this review. Most of the results indicate improvement in fibromyalgia-related symptoms in patients who participated in a meditation-based intervention. Considering only 4 of the 13 studies achieved a score of 3 on the Jadad scale, researchers of meditation interventions should discuss the best methodologic control for these studies.

Aspectos éticos e legais da assistência religiosa em hospitais psiquiátricos / Ethical and legal aspects of religious assistance in psychiatric hospitals

A assistência religiosa a pacientes com transtornos psiquiátricos graves internados é um problema pouco discutido entre psiquiatras. Aspectos legais asseguram o direito à assistência religiosa aos pacientes, no entanto alguns aspectos específicos conduzem a reflexão e cautela em determinadas situações. Assim, objetiva-se com o presente trabalho discutir os aspectos éticos, legais e científicos da assistência religiosa em hospitais psiquiátricos. Serão abordados também alguns comentários sobre os conceitos de autonomia, beneficência e não maleficência, contidos nos princípios bioéticos. Ao final, é apresentada a experiência do Hospital João Evangelista na abordagem de tais casos. Como conclusão, situações de conflito ético e legal podem surgir, pois os pacientes têm direito a receber assistência religiosa, porém podem apresentar manifestações psicopatológicas que poderiam levar a prejuízo de seu quadro clínico diante da abordagem religiosa. A orientação dos familiares e as relações entre hospital, médico, paciente e família são essenciais para a resolução de tais conflitos.

The religious assistance to inpatients with severe psychiatric disorders is a problem rarely discussed among psychiatrists. Legal aspects ensure the right to religious assistance to such patients, although some specific aspects lead to reflection and caution in certain situations. Thus, the main of the work is to discuss ethical, legal, scientific and religious aspects of religious assistance in psychiatric hospitals. It will also address some comments on the concepts of autonomy, beneficence and nonmaleficence, contained in bioethical principles. Finally, it will be presented the experience of the João Evangelista Hospital approach on such cases. In conclusion, ethical and legal conflicts can appear because patients have the right to receive a religious attendance. However, in some conditions, this assistance could lead to a worse in patient's clinical status. Family orientation and doctor-patient-hospital relationship are essential to resolve these conflicts.