The ACPE Research Network

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Spring-Summer 2012 Newsletter

On-Line Newsletter Volume 10, Number 3
Published July 2, 2012

Edited by Chaplain John Ehman, Network Convener

Network members are encouraged to submit articles for upcoming issues.
The Newsletter is published three times a year: Fall, Winter, and Spring-Summer.
(The Fall 2012 issue will be published in late October.)


Table of Contents

1.   Webinar Syllabus added to Resources for Incorporating Research into CPE
2.   "Predicting the Importance of Hospital Chaplain Care in a Trauma Population" --Invited Comment by Shannon Borchert
3.   Critical Components in the Formation of Clinical Pastoral Education Supervisors --DMin Thesis by Amy Greene
4.   Pew Survey of US Prison Chaplains
5.   Fifteenth Annual Spirituality Research Symposium at the University of Pennsylvania
6.   Nine Demonstration Projects in California, Integrating Spiritual Care within Palliative Care
7.   Research from 2011 Not Previously Noted on the Research Network Website


1.     Webinar Syllabus added to Resources for Incorporating Research into CPE

The syllabus from Introduction to Research: A Webinar Didactic for CPE Residents, by George Fitchett and Patricia Murphy from the Department of Religion, Health & Human Values at Rush University Medical Center, has been added our page of resources for incorporating research into CPE. The document lists a careful progression of articles matched to key topics for the education of CPE students about research.


2.     "Predicting the Importance of Hospital Chaplain Care in a Trauma Population" --Invited Comment by Shannon Borchert

Editor's Note: ACPE Supervisor Shannon Borchert is a co-author of this study out of the Wesley Medical Center and Kansas University School of Medicine, Wichita, KS. See: Berg, G. M., Crowe, R. E., Borchert, S., Siebert, J. and Lee, F., "Predicting the Importance of Hospital Chaplain Care in a Trauma Population," Kansas Journal of Medicine 5, no. 2 (2012): 44-50; freely available online from the University of Kansas Medical Center website. Chaplain Borchert was invited to offer some thoughts on this study and its involvement of chaplains as one model for how pastoral care departments may participate in research.   --JE

The results of this research are not necessarily "earth shattering" or monumental, so the importance of this study may be hidden to the average reader. This article is an excellent example of chaplains collaborating with researchers to advance the study of pastoral care and promote our findings among a wider audience. Many Level I trauma centers are required to conduct research as a part of their accreditation. This was the case at Wesley Medical Center, and so the trauma team hired a professional researcher, Gina Berg, PhD, to conduct all of their research projects.

Because the chaplains had been an integral part of the trauma team at Wesley for many years, it was only natural that as we worked alongside the physicians and physician assistants, we developed a relationship with the researcher as well. Dr. Berg asked the chaplains if we would be interested in participating in the research project, and because we were a teaching hospital with a clinical pastoral education program, we said yes.

In this study, the chaplains served as content experts, in advising on the project. The actual data collection was done by a team of graduate research assistants. The data analysis was done by the primary researcher, Dr. Berg. The chaplains read and critiqued the findings and gave input to the final article.

This research is a small piece of a much larger study. It is important to note that when studying larger issues, time can be carved out to focus on smaller questions that are still significant and relevant. What this means practically is that chaplains may be able to "cut their teeth" on smaller research projects that are not complex, expensive, or time consuming.

It is also worth noting that this research article references previous pastoral care research. This is important because as chaplains gain more experience participating and conducting research, our contribution to the field of spirituality and medicine grows significantly.

So what about the findings? The question was asked among the team:"Would people value the presence of a chaplain more if they were more severely injured? Would you not want a chaplain present if you were only slightly injured?" Through data analysis it was determined that you cannot predict how much a patient will value the presence of a chaplain based solely on the severity of his/her injury. A better predictor is actually prior religious affiliation. This makes some intuitive sense. However, one of the limitations of this study was that we sometimes had difficulty identifying a person’s religious preference. In trauma, it is not a question we usually ask until after the patient is settled in a hospital room. And, if they are not conscious, then we may not be able to ask the question for several days.

The conclusion that this article makes is that one cannot predict the value of a chaplain being present based on the severity of the injury. So, we wouldn’t be able to make a policy decision that said for example, chaplains will only respond to Level I traumas and not Level II traumas. Because we have demonstrated other valuable contributions to the trauma team, it is presumed that we should participate in all traumas until further research would indicate otherwise.


3.     Critical Components in the Formation of Clinical Pastoral Education Supervisors --DMin Thesis by Amy Greene

Amy Greene, Director of CPE at the Cleveland Clinic, has completed her survey of ACPE Supervisors (first reported in our Winter 2011 Newsletter, §3) for her Doctor of Ministry dissertation at Ecumenical Theological Seminary in Detroit. The focus was on the supervisory training process, with the goal of gathering insights into best practices for formation of ACPE Supervisors for the 21st century. With her research and program are complete, she is working on publication of her findings.

The abstract for Critical Components in the Formation of Clinical Pastoral Education Supervisors:

This dissertation is based on the results from an electronic survey conducted by one researcher from among the membership of fellow certified Supervisors within the Association for Clinical Pastoral Education, Inc. (ACPE) who maintain and utilize email. The survey was taken for the purpose of determining which components in the training/formation process were most critical for participants. The study finds the top three (of ten) choices in order of importance to be "consultation with peers and other supervisors," "relationship to supervisor," and "individual psychotherapy." Other significant findings were that women tend to proceed through the process faster than men and that persons who presented their work to peers and other supervisors twice monthly or more during their training also achieved certification more than one year faster than those who presented once a month or less.
Outline of the 100-page dissertation (from the Table of Contents):
Chapter One -- Context
        Introduction -- The Researcher
        What is (and Who Are We in) the ACPE?
        Understanding the Training Process
        What is the timeline for supervisory training?
        What does it take to become an ACPE Supervisor?
        Why would anyone go this route when it does not yield a degree?
        What are the different committees?
        What are some comparable professional models of training?
Chapter Two -- Hypothesis and Literature Review
        Literature Review
Chapter Three -- Methodology
        Questionnaire Design
        Administration of the Survey
                Source of Database Names and Survey Instrument
                Texts for the three email invitations
                Response Rates
        Key Variables: Gender and Date of Certification
Chapter Four -- Findings and Analysis
        Findings - Summary of Data
                Demographic information
                Practice-related information
                Certification process
                Relationship to ACPE
                Formation experience
                Description of Relationship with Supervisor in Theological Terms
        Analysis: The Significance of the Findings
                Most important components of training process
                Correlation between frequency of consultation and faster move through process
                Age of Newly Certified Growing
                Tiny minority had a detailed curriculum that was followed closely
                Number of women growing
                Men in their 20s and 40s take longer in process
                Post-1990, women pass committees at a faster rate
                The majority were only denied one request during their process
                More women than men chose someone other than primary supervisor as most influential in the process
                Many and varied responses to "describe relationship to supervisor in theological terms"
Chapter Five – Reflections and Suggestions for Further Study
        We Are Not Getting Any Younger
        To Recruit or Not To Recruit, That is the Question
        We Can Speak Our Own Language
        Women Get Through Faster But We Don't Know Why
        How Do You Get Through Faster? Practice, Practice, Practice
        Would Better Curricula Help?
        Where Are Our Own Theorists?
        Relationships are Key
Network members may contact Dr. Greene at for a copy of the dissertation.


4.     Pew Survey of US Prison Chaplains

The Pew Forum on Religion & Public Life ( has published on their website the results of a survey, "Religion in Prisons: A 50-State Survey of Prison Chaplains" Of 1,474 chaplains identified across the US, 730 completed Web-based or paper questionnaires September 21 - December 23, 2011, for a 50% response rate. Among the findings:

More than seven-in-ten state prison chaplains say efforts by inmates to convert others are very or somewhat common. About three-quarters of them report that a lot or some religious switching occurs among inmates, and they note growth in the numbers of Muslims and Protestant Christians in particular as a result of this switching. Nearly three-quarters of the chaplains surveyed say they consider access to religion-related programs in prison to be "absolutely critical" to successful rehabilitation of inmates. A sizable minority of chaplains say that religious extremism is either very or somewhat common among inmates, but an overwhelming majority report that religious extremism seldom poses a threat to the security of the facility in which they work. [--from the general announcement of the report on]
The report is available as an HTML Executive Summary or the full 108-page PDF. The website also offers a webcast of the release of the study as well as a transcript of that event.


5.     Fifteenth Annual Spirituality Research Symposium at the University of Pennsylvania

Tracy Balboni and Michael Balboni addressing the Symposium

The Department of Pastoral Care at the Hospital of the University of Pennsylvania partnered this year with the Penn Medicine Palliative Care Program for the 15th annual Spirituality Research Symposium, exploring Spirituality & Palliative Care. Over 200 people attended the program on Jun3 13, 2012, with keynote addresses [photos above] by Tracy Balboni, MD, MPH, Assistant Professor of Radiation Oncology at the Harvard Medical School and with the Center for Psycho-Oncology and Palliative Care Research at the Dana Farber Cancer Institute; and Michael Balboni, MDiv, ThM, PhD, also with Center for Psycho-Oncology and Palliative Care Research. Their tandem presentations (available online) looked at historic connections and tensions between religion and medicine and the current potential for the development of spiritual care as part of palliative care, reviewing a number of their studies. The Balbonis' work has received national attention regarding patients' experience of advanced illness, the role of spirituality in health care decision-making, and the effect of spiritual support on medical costs at the end of life. In addition, David Casarett, MD, Chief Medical Officer, Penn Wissahickon Hospice, spoke on the importance of meaning in patients "last acts"; Barbara Reville, DNP, CRNP, Co-Director, Palliative Care, Hospital of the University of Pennsylvania, on communication issues in palliative care; and Sarah Kagan, RN, PhD, Professor of Gerontological Nursing, on aging, illness, and the human spirit. The program concluded with a panel discussion moderated by Chaplain Kava Schafer, MDiv, MA.


6.     Nine Demonstration Projects in California, Integrating Spiritual Care within Palliative Care

The Journal of Palliative Medicine published in its February 2012 issue [vol. 15, no. 2, pp, 154-162], "Integrating Spiritual Care within Palliative Care: An Overview of Nine Demonstration Projects," by Shirley Otis-Green, Betty Ferrell, Tami Borneman, Christina Puchalski, Gwen Uman and Andrea Garcia. The projects, funded by the Archstone Foundation and targeted for California institutions, are based out of Cedars-Sinai Medical Center, City of Hope National Medical Center, Keck School of Medicine/UCLA, Palomar Pomerado North County Health Development, Inc., St. John's Regional Medical Center, Saint Joseph Hospital of Orange, Scripps Memorial Hospital, Santa Monica-UCLA Medical Center & Orthopedic Hospital, and the Veterans' Administration of Greater Los Angeles. A table on pp. 156-158 gives investigators and lists of goals for each project. The article also offers a bibliography for recommended reading on pp. 160-161, and an annotated resource list of 19 websites (including that of the ACPE Research Network) on pp. 159-160. The nine demonstration projects are only in their first year of funding, so results should emerge in the literature beginning in 2013.


7.     Research from 2011 Not Previously Noted on the Research Network Website

The Research Network highlights a good number of studies in the course of a year, but many good articles are not featured. The following 45 articles have until now gone unnoted but may be of special interest. They are taken from an annual annotated bibliography of 394 Medline-indexed articles available from the Penn Medicine Department of Pastoral Care.

Bediako, S. M., Lattimer, L., Haywood, C. Jr., Ratanawongsa, N., Lanzkron, S. and Beach, M. C. (Department of Psychology, University of Maryland, Baltimore; "Religious coping and hospital admissions among adults with sickle cell disease." Journal of Behavioral Medicine 34, no. 2 (Apr 2011): 120-127. [(From the abstract:) The present study examined the relation between religious coping and hospital admissions among a cohort of 95 adults with sickle cell disease-a genetic blood disorder that, in the United States, primarily affects people of African ancestry. Multiple regression analyses indicated that positive religious coping uniquely accounted for variance in hospital admissions after adjusting for other demographic and diagnostic variables. Specifically, greater endorsement of positive religious coping was associated with significantly fewer hospital admissions (beta=-.29, P<.05).]

Berg, G. (Chaplain Service, Department of Veterans Affairs Medical Center Saint Cloud, MN; "The relationship between spiritual distress, PTSD and depression in Vietnam combat veterans." Journal of Pastoral Care & Counseling 65, nos. 1-2 (Spring-Summer 2011): 6:1-11. [(Abstract:) Presents empirical data showing the relationship between combat-related posttraumatic stress disorder (PTSD), depression and spiritual distress. Uses spiritual injury scale to measure distress; scale measures guilt, anger or resentment, sadness/grief, lack of meaning, feeling God/life has treated one unfairly, religious doubt, and fear of death. Shows high association between spiritual injuries and both PTSD and depression. Also finds inverse relationship between intrinsic religious faith and these two diagnostic categories. An inverse relationship also exists between religious faith as measured by regular worship with a faith community and both depression and PTSD.]

Bremner, R. H., Koole, S. L. and Bushman. B. J. (University of Michigan, Ann Arbor). "'Pray for those who mistreat you': effects of prayer on anger and aggression." Personality & Social Psychology Bulletin 37, no. 6 (Jun 2011): 830-837. [(From the abstract:) Three experiments tested the hypothesis that praying for others brings out the more peaceful side of religion by reducing anger and aggression after a provocation. In Experiment 1, praying for a stranger led provoked participants to report less anger than control participants who thought about a stranger. In Experiment 2, provoked participants who prayed for the person who angered them were less aggressive toward that person than were participants who thought about the person who angered them. In Experiment 3, provoked participants who prayed for a friend in need showed a less angry appraisal style than did people who thought about a friend in need.]

Burkhart, L., Schmidt, L. and Hogan, N. (School of Nursing, Loyola University Chicago, IL; "Development and psychometric testing of the Spiritual Care Inventory instrument." Journal of Advanced Nursing 67, no. 11 (Nov 2011): 2463-2472. [(From the abstract:) METHOD: In February/March 2007, a convenience sample of 298 adult and paediatric acute care, ambulatory, home health, hospice staff and rehab nurses at two hospitals (n = 248) and graduate students at a school of nursing (n = 50) completed a 48-item initial version of the Spiritual Care Inventory. In study 2 from July through August 2007, 78 staff nurses at one hospital (n = 30) and a different cohort of graduate students at a school of nursing (n = 48) completed the 18-item second version of the Spiritual Care Inventory. RESULTS: Exploratory factor analysis in study 1 supported a 3-factor solution (spiritual care interventions, meaning making and faith rituals) with internal consistency measures for the subscales above 0.80. In study 2, internal consistency remained high. ]

Calder, A., Badcoe, A. and Harms, L. (Uniting Church in Australia, Melbourne, Australia). "Broken bodies, healing spirits: road trauma survivor's perceptions of pastoral care during inpatient orthopaedic rehabilitation." Disability & Rehabilitation 33, nos. 15-16 (2011): 1358-1366. [(From the abstract:) METHOD: A mixed-method research design was used. The survey method elicited demographic, pastoral care contact and hospitalisation data. It included the Posttraumatic Growth Inventory (PTGI; Tedeschi and Calhoun 1996) and an adapted World Health Organisation Pastoral Intervention (WHO 2002) coding schema (Constitution of the World Health Organisation, basic documents, supplement. 45 ed.). An interview method was used to elicit information about participants' prior and current experiences of faith and spirituality, expectations, and experiences of the pastoral care service, and perceptions of the role of pastoral care in their rehabilitation. RESULTS: A thematic analysis of both quantitative and qualitative data identified nine core themes of supportive pastoral care. Pastoral care was seen as a valued and supportive intervention. Participants who completed the PTGI reported at least some degree of posttraumatic growth.]

Callen, B. L., Mefford, L., Groer, M. and Thomas, S. P. (University of Tennessee, College of Nursing, Knoxville). "Relationships among stress, infectious illness, and religiousness/spirituality in community-dwelling older adults." Research in Gerontological Nursing 4, no. 3 (Jul 2011): 195-206. [(From the abstract:) Four assessment tools were completed by 82 older adults (mean age = 74, age range = 65 to 91): the Perceived Stress Scale, the Carr Infection Symptom Checklist (SCL), the Brief Multidimensional Measurement of Religiousness/Spirituality, and a demographic form. A significant correlation was found between stress and SCL scores; however, four dimensions of religiousness/spirituality moderated the relationship between stress and infection. Older adults who were unable to forgive themselves or forgive others, or feel forgiven by God, were more likely to have had an infection in the previous month. Increased infections also occurred when older participants did not feel they had religious support from their congregations.]

Capps, L. L. (Resurrection University, Oak Park, IL; "Ua neeb khu: a Hmong American healing ceremony." Journal of Holistic Nursing 29, no. 2 (Jun 2011): 98-106. [(From the abstract:) Ua neeb khu (pronounced "oo-ah neng kue") is a ceremonial healing practice engaged in by Hmong Americans for the treatment of various health problems involving spiritually focused concerns that only a shaman practitioner is qualified to treat. A qualitative ethnographic case study method with participant observation was used to analyze a spiritual healing ceremony performed by a shaman healer (txiv neeb) for an elderly Hmong American male residing in a midwestern city in the United States. The healing ritual was filmed and reviewed with the shaman healer to identify symbolic meanings and processes. Through ritual exchange and reciprocal transaction between the spirit and living world, the shaman facilitated the resolution of the spiritual problem and promoted the patient's healing and sense of well-being.]

Chlan, K. M., Zebracki, K. and Vogel, L. C. (Department of Clinical Research, Shriners Hospitals for Children, Chicago, IL; "Spirituality and life satisfaction in adults with pediatric-onset spinal cord injury." Spinal Cord 49, no. 3 (Mar 2011): 371-375. [(Abstract:) STUDY DESIGN: This study was a cross-sectional, follow-up survey. OBJECTIVES: To examine the role of importance of religion and spiritual coping on life satisfaction in adults with pediatric-onset spinal cord injury (SCI). SETTING: This study was carried out in a specialty hospital system. METHODS: Individuals who sustained an SCI before age 18 completed a structured telephone interview at ages 24-45. Demographic/medical questionnaires along with standardized measures were administered: Brief COPE, FIM, Craig Handicap Assessment and Reporting Technique (CHART), 12-item Short-Form Health Survey (SF-12) and Satisfaction with Life (SWL) scales. Spirituality was measured with a question assessing importance of religion and using the spiritual coping domain of the Brief COPE. RESULTS: A total of 298 individuals (62% men; 56% with tetraplegia) participated in this study. Approximately half (141) of the participants reported that religion is 'important to very important' to them and 55% (163) used spiritual coping. Importance of religion and spiritual coping was significantly associated with older age (P<0.01), longer duration of injury (P<0.01) and higher SWL (P<0.05). Importance of religion was also related to higher SF-12 mental component (P<0.05). Spiritual coping was negatively associated with motor independence (P<0.05) and CHART occupation (P<0.05). Moreover, spiritual coping emerged as a predictor of SWL, whereas importance of religion did not. CONCLUSION: Over half of the participants endorsed importance of religion and the use of spiritual coping. Spiritual coping, in particular, may serve a unique role in promoting SWL. Consequently, assessment of spirituality needs to become a standard part of care in the treatment of individuals with SCI and the use of spirituality-focused interventions to promote SWL should be explored.]

Cooper, R. S. (Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; "Case study of a chaplain's spiritual care for a patient with advanced metastatic breast cancer." Journal of Health Care Chaplaincy 17, nos. 1-2 (2011): 19-37. [(Abstract:) The case study seeks to describe an oncology chaplain's pastoral relationship with a 64-year-old woman with advanced metastatic breast cancer. The patient's distress was complicated by a history of anxiety and other chronic medical conditions. Approximately 16 pastoral encounters occurred during the last year of the patient's life. The patient, chaplain, and the pastoral conversations are presented as well as a retrospective assessment of them. The chaplain's interventions were appropriate for the patient's spiritual needs, particularly in regard to her fear of death, loneliness, grief that her life was "too short" and estrangement from her inherited faith tradition, with observable benefits for the patient. The oncology chaplain has a distinctive role in the healthcare team as one who can meet the patient at the point of their spiritual need, provide appropriate interventions and, thereby, ameliorate the distress, particularly in regard to death anxiety, peace of mind, and issues of meaning.]

Cottam, S., Paul, S. N., Doughty, O. J., Carpenter, L., Al-Mousawi, A., Karvounis, S. and Done, D. J. (University of East London, UK). "Does religious belief enable positive interpretation of auditory hallucinations?: A comparison of religious voice hearers with and without psychosis." Cognitive Neuropsychiatry 16, no. 5 (Sep 2011): 403-421. [(Abstract:) Introduction: Hearing voices occurs in people without psychosis. Why hearing voices is such a key pathological feature of psychosis whilst remaining a manageable experience in nonpsychotic people is yet to be understood. We hypothesized that religious voice hearers would interpret voices in accordance with their beliefs and therefore experience less distress. Methods: Three voice hearing groups, which comprised: 20 mentally healthy Christians, 15 Christian patients with psychosis, and 14 nonreligious patients with psychosis. All completed (1) questionnaires with rating scales measuring the perceptual and emotional aspects of hallucinated voices, and (2) a semistructured interview to explore whether religious belief is used to make sense of the voice hearing experience. Results: The three groups had perceptually similar experiences when hearing the voices. Mentally healthy Christians appeared to assimilate the experience with their religious beliefs (schematic processing) resulting in positive interpretations. Christian patients tended not to assimilate the experience with their religious beliefs, frequently reporting nonreligious interpretations that were predominantly negative. Nearly all participants experienced voices as powerful, but mentally healthy Christians reported the power of voices positively. Conclusion: Religious belief appeared to have a profound, beneficial influence on the mentally healthy Christians' interpretation of hearing voices, but had little or no influence in the case of Christian patients.]

Crammer, C., Kaw, C., Gansler, T. and Stein, K. D. (Behavioral Research Center, American Cancer Society, Atlanta, GA; "Cancer survivors' spiritual well-being and use of complementary methods: a report from the American Cancer Society's Studies of Cancer Survivors." Journal of Religion & Health 50, no. 1 (Mar 2011): 92-107. [(Abstract:) We examined associations between spiritual well-being and CAM use among 4,139 cancer survivors. We also explored the classification of religious/spiritual practices (R/S) as CAMs and alternative subscale structures of the Functional Assessment of Chronic Illness Therapy--Spiritual Well-being (FACIT-Sp). We evaluated three aspects of spirituality, Faith, Peace, and Meaning, and use of 19 CAMs in 5 domains. Mind-body methods were subdivided into R/S and non-R/S. All FACIT-Sp factors were associated with CAM use, but in different directions: Meaning and Faith were positively associated; Peace was negatively associated. Peace was negatively associated with R/S CAMs, but not non-R/S CAMs. The prevalence of CAM use dropped from 79.3 to 64.8% when R/S items were excluded. These findings confirm an association between spiritual well-being and CAM use, including some non-R/S CAMs, and provide evidence of the benefits of using the three-factor FACIT-Sp solution and treating R/S CAMs as a separate category.]

Delaney, C., Barrere, C. and Helming, M. (University of Connecticut, School of Nursing, Storrs; "The influence of a spirituality-based intervention on quality of life, depression, and anxiety in community-dwelling adults with cardiovascular disease: a pilot study." Journal of Holistic Nursing 29, no. 1 (Mar 2011): 21-32. [(From the abstract:) METHODS: Self-reported QOL, depression, and anxiety data were provided by cardiac patients recruited from three community-based organizations, ( N = 27) at baseline and one month later. The Spirituality Scale developed by the principal investigator assessed study participants' level of spirituality and scoring on the subscales activated one or more of three spirituality-based interventions. Repeated measures analysis of variance was used to evaluate temporal changes. FINDINGS: Patients who participated in the 1-month intervention demonstrated a significant modest increase in overall QOL. There was a trend toward lower depression scores but this was not significant. No significant changes were seen in anxiety scores. Content analysis of patients' perceptions of feasibility supports the acceptability of the intervention. CONCLUSION: Results from this small pilot study provide preliminary evidence that the individualized spirituality-based intervention used in this study holds promise as an addition to traditional cardiac care and has the potential to improve QOL in community-dwelling adults with CVD.]

Exline, J. J., Park, C. L., Smyth, J. M. and Carey, M. P. (Department of Psychology, Case Western Reserve University, Cleveland, OH; "Anger toward God: social-cognitive predictors, prevalence, and links with adjustment to bereavement and cancer." Journal of Personality & Social Psychology 100, no. 1 (Jan 2011): 129-148. [(Abstract:) Many people see themselves as being in a relationship with God and see this bond as comforting. Yet, perceived relationships with God also carry the potential for experiencing anger toward God, as shown here in studies with the U.S. population (Study 1), undergraduates (Studies 2 and 3), bereaved individuals (Study 4), and cancer survivors (Study 5). These studies addressed 3 fundamental issues regarding anger toward God: perceptions and attributions that predict anger toward God, its prevalence, and its associations with adjustment. Social-cognitive predictors of anger toward God paralleled predictors of interpersonal anger and included holding God responsible for severe harm, attributions of cruelty, difficulty finding meaning, and seeing oneself as a victim. Anger toward God was frequently reported in response to negative events, although positive feelings predominated. Anger and positive feelings toward God showed moderate negative associations. Religiosity and age correlated negatively with anger toward God. Reports of anger toward God were slightly lower among Protestants and African Americans in comparison with other groups (Study 1). Some atheists and agnostics reported anger involving God, particularly on measures emphasizing past experiences (Study 2) and images of a hypothetical God (Study 3). Anger toward God was associated with poorer adjustment to bereavement (Study 4) and cancer (Study 5), particularly when anger remained unresolved over a 1-year period (Study 5). Taken together, these studies suggest that anger toward God is an important dimension of religious and spiritual experience, one that is measurable, widespread, and related to adjustment across various contexts and populations.]

Finlay, C. J. and Krueger, G. (Annenberg School for Communication, The University of Pennsylvania, Philadelphia, PA). "A space for mothers: grief as identity construction on memorial websites created by SIDS parents." Omega - Journal of Death & Dying 63, no. 1 (2011): 21-44. [(Abstract:) In this article we conduct a textual analysis of memorial websites created by mothers who have experienced a loss due to sudden infant death syndrome (SIDS). Using an online Internet ethnographic approach, we reviewed a series of 20 sites in an attempt to analyze the motivations of the site creators as manifested in their online projects. We spent time on the sites, moving through all facets of them, following links, and experiencing them the way a visitor would encounter them. In this virtual exploration we uncovered personal narratives, community building, religious imagery, and numerous examples of social networking. We also analyzed guest books in order to understand who visits these sites and their reasons for doing so. We conclude that development of these sites are a process that helps some mothers in their grief and gives them a focus and activity that is helpful and perhaps healing. More importantly perhaps is the potential for community building and networking that this type of activity allows. As an extension of a real-world memorial such as a gravesite, a virtual mourning space provides more in the way of these types of communications. Our work suggests that memorial websites constructed by SIDS parents help in meaning and identity reconstruction after loss.]

Flavelle, S. C. (Izaak Walton Killam Health Centre and Department of Pediatrics, Dalhousie University, Halifax, Canada; "Experience of an adolescent living with and dying of cancer." Archives of Pediatrics & Adolescent Medicine 165, no. 1 (Jan 2011): 28-32. [(Abstract:) This is a case report of a 15-year-old boy with osteosarcoma who died a year after diagnosis. It is based upon an analysis of his 90-page personal journal, which revealed five themes: adolescent development, escape from illness, changing relationships, symptoms, and spirituality. See esp. the section on Spirituality on p. 31.]

Geary, C. and Rosenthal, S. L. (Department of Pediatrics, University of Texas Medical Branch, Galveston; "Sustained impact of MBSR on stress, well-being, and daily spiritual experiences for 1 year in academic health care employees." Journal of Alternative & Complementary Medicine 17, no. 10 (Oct 2011): 939-944. [(Abstract:) OBJECTIVES: The objectives of the study were (1) to evaluate self-reported stress levels and daily spiritual experiences in academic health care employees before, immediately after, and 1 year after enrolling in a mindfulness-based stress reduction (MBSR) course; and (2) to evaluate the correlation between a potential measure of pulse rate variability and self-reported stress levels. SUBJECTS: Fifty-nine (59) participants in the MBSR course offered to employees at the University of Texas Medical Branch in Galveston (UTMB) comprised the intervention group, and 94 health care providers in the neonatal nurseries comprised the control group. INTERVENTION: MBSR is an 8-week course that introduces mindfulness meditation practices. No intervention was offered to the control group. All participants were employees (or relatives of employees) at UTMB. DESIGN: All MBSR participants completed Cohen's Perceived Stress Scale, the SCL-90, the SF-36 Measure of Health and Well-Being, the Daily Spiritual Experiences Scale, and a 5-minute measure of pulse rate coherence. This testing was done before and after the MBSR course and 1 year later. Ninety-four (94) neonatal health care providers completed the same series of questionnaires and pulse rate variability (PRV) measures, with 49 of the 94 completing the questionnaires 2 months and 1 year later. RESULTS: MBSR participants improved on all measures except the physical component score of the SF-36 upon completion of the MBSR course, and these results were maintained at the 1-year follow-up. The control group did not significantly change on any of the measures. PRV as measured by the Heart Math system did not correlate with any of the self-report questionnaires. CONCLUSIONS: MBSR effectively reduces self-report measures of stress and increases daily spiritual experiences in employees in an academic health care setting, and these effects are stable for at least 1 year. Using a simple measure of PRV was not a clinically reliable biologic measure of stress.]

Gray, K., Knickman, T. A. and Wegner, D. M. (Department of Psychology, University of Maryland, MD; "More dead than dead: perceptions of persons in the persistent vegetative state." Cognition 121, no. 2 (Nov 2011): 275-280. [(Abstract:) Patients in persistent vegetative state (PVS) may be biologically alive, but these experiments indicate that people see PVS as a state curiously more dead than dead. Experiment 1 found that PVS patients were perceived to have less mental capacity than the dead. Experiment 2 explained this effect as an outgrowth of afterlife beliefs, and the tendency to focus on the bodies of PVS patients at the expense of their minds. Experiment 3 found that PVS is also perceived as "worse" than death: people deem early death better than being in PVS. These studies suggest that people perceive the minds of PVS patients as less valuable than those of the dead - ironically, this effect is especially robust for those high in religiosity.]

Green, M. R., Emery, C. F., Kozora, E., Diaz, P. T. and Make, B. J. (Department of Psychology, Ohio State University, Columbus; "Religious and spiritual coping and quality of life among patients with emphysema in the National Emphysema Treatment Trial." Respiratory Care 56, no. 10 (Oct 2011): 1514-1521. [(From the abstract:) OBJECTIVE: To describe the utilization of religious and spiritual coping and its relationship to quality of life among patients with emphysema, in a 2-year longitudinal follow-up study. METHODS: Forty patients with emphysema (mean age 63.5 +/- 6.0 y, 8 women) who participated in the National Emphysema Treatment Trial were matched on age, sex, race, and education with 40 healthy individuals recruited from the community. We conducted baseline assessment of overall coping strategies, psychological functioning, quality of life, pulmonary function, and exercise capacity, and we assessed overall coping strategies and religious and spiritual coping at 2-year follow-up. RESULTS: Ninety percent of the patients with emphysema considered themselves at least slightly religious and spiritual. The patients reported using both negative religious coping (e.g., questioning God) and positive religious coping (e.g., prayer) more than the healthy control subjects at follow-up. However, greater use of religious and spiritual coping was associated with poorer illness-related quality of life.]

Harris, J. I., Erbes, C. R., Engdahl, B. E., Thuras, P., Murray-Swank, N., Grace, D., Ogden, H., Olson, R. H., Winskowski, A. M., Bacon, R., Malec, C., Campion, K. and Le, T. (VA Medical Center, Minneapolis, MN; "The effectiveness of a trauma focused spiritually integrated intervention for veterans exposed to trauma." Journal of Clinical Psychology 67, no. 4 (Apr 2011): 425-438. [(Abstract:) Building Spiritual Strength (BSS) is an 8-session, spiritually integrated group intervention designed to address religious strain and enhance religious meaning making for military trauma survivors. It is based upon empirical research on the relationship between spirituality and adjustment to trauma. To assess the intervention's effectiveness, veterans with histories of trauma who volunteered for the study were randomly assigned to a BSS group (n = 26) or a wait-list control group (n = 28). BSS participants showed statistically significant reductions in PTSD symptoms based on self-report measures as compared with those in a wait-list control condition. Further research on spiritually integrated interventions for trauma survivors is warranted.]

Hasnain, M., Connell, K. J., Menon, U. and Tranmer, P. A. (Department of Family Medicine, College of Medicine, University of Illinois at Chicago, IL; "Patient-centered care for Muslim women: provider and patient perspectives." Journal of Women's Health 20, no. 1 (Jan 2011): 73-83. [(From the abstract:) OBJECTIVE: The purpose of this study was twofold: (1) to address the gap in existing literature regarding provider perspectives about provision of high-quality, culturally appropriate, patient-centered care to Muslim women in the United States and (2) to explore congruence between provider and patient perceptions regarding barriers to and recommendations for providing such care. METHODS: Using a cross-sectional study design, a written survey was administered to a convenience sample of healthcare providers (n=80) and Muslim women (n=27). RESULTS: There was considerable congruence among patients and providers regarding healthcare needs of Muslim women. A majority (83.3%) of responding providers reported encountering challenges while providing care to Muslim women. A majority (93.8%) of responding patients reported that their healthcare provider did not understand their religious or cultural needs. Providers and patients outlined similar barriers/challenges and recommendations. Key challenges included lack of providers' understanding of patients' religious and cultural beliefs; language-related patient-provider communication barriers; patients' modesty needs; patients' lack of understanding of disease processes and the healthcare system; patients' lack of trust and suspicion about the healthcare system, including providers; and system-related barriers. Key recommendations included provider education about basic religious and cultural beliefs of Muslim patients, provider training regarding facilitation of a collaborative patient-provider relationship, addressing language-related communication barriers, and patient education about disease processes and preventive healthcare.]

Hexem, K. R., Mollen, C. J., Carroll, K., Lanctot, D. A. and Feudtner, C. (Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA). "How parents of children receiving pediatric palliative care use religion, spirituality, or life philosophy in tough times." Journal of Palliative Medicine 14, no. 1 (Jan 2011): 39-44. [(From the abstract:) METHODS: Participants were parents of children who had enrolled in a prospective cohort study on parental decision-making for children receiving pediatric palliative care. Sixty-four (88%) of the 73 parents interviewed were asked an open-ended question on how religion, spirituality, or life philosophy (RSLP) was helpful in difficult times. Responses were coded and thematically organized utilizing qualitative data analysis methods. Any discrepancies amongst coders regarding codes or themes were resolved through discussion that reached consensus. RESULTS: Most parents of children receiving palliative care felt that RSLP was important in helping them deal with tough times, and most parents reported either participation in formal religious communities, or a sense of personal spirituality. A minority of parents, however, did not wish to discuss the topic at all. For those who described their RSLP, their beliefs and practices were associated with qualities of their overall outlook on life, questions of goodness and human capacity, or that "everything happens for a reason." RSLP was also important in defining the child's value and beliefs about the child's afterlife. Prayer and reading the bible were important spiritual practices in this population, and parents felt that these practices influenced their perspectives on the medical circumstances and decision-making, and their locus of control. From religious participation and practices, parents felt they received support from both their spiritual communities and from God, peace and comfort, and moral guidance. Some parents, however, also reported questioning their faith, feelings of anger and blame towards God, and rejecting religious beliefs or communities.]

Hodge, D. R. and Horvath, V. E. (School of Social Work, Arizona State University, Phoenix). "Spiritual needs in health care settings: a qualitative meta-synthesis of clients' perspectives." Social Work 56, no. 4 (Oct 2011): 306-316. [(Abstract:) Spiritual needs often emerge in the context of receiving health or behavioral health services. Yet, despite the prevalence and salience of spiritual needs in service provision, clients often report their spiritual needs are inadequately addressed. In light of research suggesting that most social workers have received minimal training in identifying spiritual needs, this study uses a qualitative meta-synthesis (N=11 studies) to identify and describe clients' perceptions of their spiritual needs in health care settings. The results revealed six interrelated themes: (1) meaning, purpose, and hope; (2) relationship with God; (3) spiritual practices; (4) religious obligations; (5) interpersonal connection; and (6) professional staff interactions. The implications of the findings are discussed as they intersect social work practice and education.]

Hodge, D. R. and Limb, G. E. (School of Social Work, Arizona State University, Phoenix). "Spiritual assessment and Native Americans: establishing the social validity of a complementary set of assessment tools." Social Work 56, no. 3 (Jul 2011): 213-223. [(Abstract:) Although social work practitioners are increasingly likely to administer spiritual assessments with Native American clients, few qualitative assessment instruments have been validated with this population. This mixed-method study validates a complementary set of spiritual assessment instruments. Drawing on the social validity literature, a sample of experts in Native culture (N = 50) evaluated the instruments' cultural consistency, strengths, limitations, and areas needing improvement. Regarding the degree of congruence with Native American culture, verbally based spiritual histories ranked highest and diagrammatically oriented spiritual genograms ranked lowest, although all instruments demonstrated at least moderate levels of consistency with Native culture. The results also suggest that practitioners' level of spiritual competence plays a crucial role in ensuring the instruments are operationalized in a culturally appropriate manner.]

Johnson, D. C., Polusny, M. A., Erbes, C. R., King, D., King, L., Litz, B. T., Schnurr, P. P., Friedman, M.. Pietrzak, R. H. and Southwick, S. M. (Naval Health Research Center, San Diego, CA). "Development and initial validation of the Response to Stressful Experiences Scale." Military Medicine 176, no. 2 (Feb 2011): 161-169. [(Abstract:) This report describes the development and initial validation of the Response to Stressful Experiences Scale (RSES), a measure of individual differences in cognitive, emotional, and behavioral responses to stressful life events. We validated this instrument with active-duty and reserve components of military and veterans samples (N = 1,014). The resulting 22-item scale demonstrated sound internal consistency (alpha = 0.91-0.93) and good test-retest reliability (r = 0.87). Factor analysis suggested 5 protective factors: (a) meaning-making and restoration, (b) active coping, (c) cognitive flexibility, (d) spirituality, and (e) self-efficacy. Associations with other measures supported convergent, discriminant, and concurrent validity. In separate military samples, the RSES accounted for unique variance in posttraumatic stress disorder symptoms above and beyond existing scales measuring resilience-related constructs, thereby demonstrating incremental validity. The RSES provides a brief, reliable, and valid measure of individual differences in cognitive, emotional, and behavioral responses to life's most stressful events.]

Johnson, K. S., Tulsky, J. A., Hays, J. C., Arnold, R. M., Olsen, M. K., Lindquist, J. H. and Steinhauser, K. E. (Duke University School of Medicine, Durham, NC; "Which domains of spirituality are associated with anxiety and depression in patients with advanced illness?." Journal of General Internal Medicine 26, no. 7 (Jul 2011): 751-758. [(From the abstract:) DESIGN: Cross-sectional cohort study PARTICIPANTS: Two hundred and ten patients with advanced illness, of whom 1/3 were diagnosed with cancer, 1/3 COPD, and 1/3 CHF. The mean age of the sample was 66 years, and 91% were Christian. MEASUREMENTS: Outcome measures were the Profile of Mood States' Anxiety Subscale (POMS) and 10-item Center for Epidemiologic Studies Depression Scale (CESD). Predictors were three subscales of the Spiritual History Scale measuring past religious help-seeking and support, past religious participation, and past negative religious experiences and two subscales of the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale measuring the role of faith in illness and meaning, peace, and purpose in life. We conducted multiple regression analyses, controlling for demographics, disease type and severity, self-rated religiousness/spirituality, and frequency of religious attendance and devotion. RESULTS: In adjusted analyses, greater spiritual well-being, including both beliefs about the role of faith in illness and meaning, peace, and purpose in life were associated with fewer symptoms of anxiety (P <= 0.001) and depression (P < 0.001). Greater past negative religious experiences were associated with more symptoms of anxiety (P = 0.04) and depression (P = 0.004). No other measures of spiritual history were associated with the outcomes. CONCLUSIONS: In this diverse sample of seriously ill patients, current spiritual well-being and past negative religious experiences were associated with symptoms of anxiety and depression. Healthcare providers should consider asking about current spiritual well-being and past negative religious experiences in their assessment of seriously ill patients with symptoms of anxiety and depression.]

Johnson, M. (University of Utah Health Sciences Center, Salt Lake City; "A randomized study of a novel Zen dialogue method for producing spiritual and well-being enhancement: implications for end-of-life care." Journal of Holistic Nursing 29, no. 3 (Sep 2011): 201-210. [(From the abstract:) DESIGN: A pretest-posttest design was used with participants being randomly assigned to either treatment or no treatment group at the Zen Center. The participants were 14 females and 2 males within each group with no prior formal Zen or meditation training. Those participants in the treatment group received intensive interaction for 1 day with an experienced Zen teacher using a dialogue method to induce a deep meditative state without instruction in formal meditation sitting practice. The outcome was measured with multiple previously standardized instruments designed to assess meditation states, well-being, and spirituality. RESULTS: A repeated-measures analysis of variance showed statistically significant differences between the treatment and control groups for all parameters measured. In addition, the meditative state measure suggested qualities consistent with deep meditation experiences. The results justify further investigation of the technique as a rapid spiritual intervention tool particularly for clients facing end-of-life issues.]

Kelly, J. F., Stout, R. L., Magill, M., Tonigan, J. S. and Pagano, M. E. (Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston; "Spirituality in recovery: a lagged mediational analysis of alcoholics anonymous' principal theoretical mechanism of behavior change." Alcoholism: Clinical & Experimental Research 35, no. 3 (Mar 2011): 454-463. [(From the abstract:) METHOD: Adults (N = 1,726) participating in a randomized controlled trial of psychosocial treatments for alcohol use disorder (Project MATCH) were assessed at treatment intake, and 3, 6, 9, 12, and 15 months on their AA attendance, spiritual/religious practices, and alcohol use outcomes using validated measures. General linear modeling (GLM) and controlled lagged mediational analyses were utilized to test for mediational effects. RESULTS: Controlling for a variety of confounding variables, attending AA was associated with increases in spiritual practices, especially for those initially low on this measure at treatment intake. Results revealed AA was also consistently associated with better subsequent alcohol outcomes, which was partially mediated by increases in spirituality. This mediational effect was demonstrated across both outpatient and aftercare samples and both alcohol outcomes (proportion of abstinent days; drinks per drinking day). CONCLUSIONS: Findings suggest that AA leads to better alcohol use outcomes, in part, by enhancing individuals' spiritual practices and provides support for AA's own emphasis on increasing spiritual practices to facilitate recovery from alcohol use disorder.]

Kurita, A., Takase, B., Shinagawa, N., Kodani, E., Okada, K., Iwahara, S., Kusama, Y. and Atarashi, H. (Special Nursing Home for Elderly, Fukuinkai Clinic, Tokyo, Japan). "Spiritual activation in very elderly individuals assessed as heart rate variability and plasma IL/10/IL-6 ratios." International Heart Journal 52, no. 5 (2011): 299-303. [(Abstract:) Proinflammatory cytokine responses might occur in elderly individuals with cardiovascular (CV) disease, cerebro-vascular (CVA) disease, and/or pulmonary disease (PD). Spiritual activation is an important coping mechanism, since psychiatric depression is an important risk factor for these individuals. Thirty-three very elderly individuals (87 +/- 8 years) with previous CVD, CVA and/or PD participated in weekly 30 minute sermons by chaplains for over 20 months of chaplain liturgy (CL group). All underwent Holter ECG during the procedures and cardiac autonomic activities were assessed by maximum entropy analysis. Plasma IL-10 and IL-6 levels were compared with 26 age-matched (85 +/- 10 years) individuals who did not participate in these activities (non-CL group). Both high frequency (HF) and pNN50 of heart rate variability (HRV) were higher in the CL group than in the non-CL group (HF, 190 +/- 55 versus 92 +/- 43 nu, P < 0.05; pNN50, 10.5 +/- 16% versus 3.6 +/- 3.8%, P < 0.05), whereas LF/HF was lower (1.4 +/- 1.5 versus 2.2 +/- 2.8, P < 0.05). Levels of IL-10/IL-6 were higher in the CL group (3.96 +/- 5.0 versus 1.79 +/- 1.6, P < 0.05). Hospitalization rates due to CVD and/or PD were lower in the CL group than in the non-CL group (4/33 versus 11/26, P < 0.05). We conclude that spiritual activation can modify proinflammatory cytokines and suppress CVD, CVA and/or PD via vagal modifications. Spiritual activation might be helpful for health in these very elderly individuals.]

Leone, A. F. (Palmetto Health Senior Primary Care, Columbia, SC). "Improving compliance: does it matter to your patients if you are spiritual." Journal - South Carolina Medical Association 107, no. 2 (Apr 2011): 42-47. [(Abstract:) "The purpose of the study was to determine if there is an association between the perception that a patient has about his/her physician’s spirituality and the patient’s diabetes outcome by determining : (1) the prevalence of spirituality and religiosity among health providers and patients (2) the number of times a patient discussed spirituality and religion with his medical provider, (3) the perception of this discussions or spiritual/ religious elements in his/her compliance, (4) comparison of objective markers of diabetes management (glycemic control measured by HbA1c, random finger stick blood glucose) and subjective perception of appropriate management of diabetes. (5) Evaluation of compliance to diabetes treatment using standardized and widely recognized tools." [p. 42] The study involved 50 patients from an outpatient clinic and 13 providers. "Most medical providers and patients of this Family Medicine Outpatient Clinic considered themselves very spiritual. This in turn appeared to translate into the practice of talking about spirituality during the medical encounter, using spiritual topics to illustrate health teaching, prayer in and outside the medical office. No negative comments were received about unwelcome use of spiritual or religious topics. Results appear to point that the interaction between patient and health provider that included spiritual discussions were positive. There was a clear trend for patients who stated they were more compliant with exercise and following their doctor’s advice and the perception of spirituality in the physician. Further studies with bigger samples and multiple sites will bring more light on the subject. A tactful and measured approach to discussing health and spirituality not only appears to be appropriate during a medical encounter but may provide a closer and stronger relationship between doctors and patients that can translate in improved compliance and better outcomes. Objective measures of Hemoglobin A1c and FSBG were not statistically linked to the perception of spirituality in the care provider." [p. 47]]

Lucchetti, G., Lucchetti, A. L. G. and Koenig, H. G. (Sao Paulo Medical Spiritist Association, Sao Paulo, Brazil; "Impact of spirituality/religiosity on mortality: comparison with other health interventions." Explore: The Journal of Science & Healing 7, no. 4 (Jul-Aug 2011): 234-238. [(Abstract:) Scientists have been interested in the influence of religion on mortality for at least 130 years. Since this time, many debates have been held by researchers who believe or do not believe in this association. The objective of this study is to compare the impact of spirituality and religiosity (S/R) with other health interventions on mortality. The authors selected 25 well-known health interventions. Then, a search of online medical databases was performed. Meta-analyses between 1994 and 2009 involving mortality were chosen. The same was done for religiosity and spirituality. The combined hazard ratio was obtained directly by the systematic reviews and the mortality reductions by S/R and other health interventions were compared. Twenty-eight meta-analyses with mortality outcomes were selected (25 health interventions and three dealing with S/R). From these three meta-analyses, considering those with the most conservative results, persons with higher S/R had an 18% reduction in mortality. This result is stronger than 60.0% of the 25 systematic reviews analyzed (similar to consumption of fruits and vegetables for cardiovascular events and stronger than statin therapy). These results suggest that S/R plays a considerable role in mortality rate reductions, comparable to fruit and vegetable consumption and statin therapy.]

McCauley, J., Haaz, S., Tarpley, M. J., Koenig, H. G. and Bartlett, S. J. (Johns Hopkins School of Medicine, Baltimore, MD;"A randomized controlled trial to assess effectiveness of a spiritually-based intervention to help chronically ill adults." International Journal of Psychiatry in Medicine 41, no. 1 (2011): 91-105. [(Abstract:) OBJECTIVE: Creative, cost-effective ways are needed to help older adults deal effectively with chronic diseases. Spiritual beliefs and practices are often used to deal with health problems. We evaluated whether a minimal intervention, consisting of a video and workbook encouraging use of patient spiritual coping, would be inoffensive and improve perceived health status. METHODS: A randomized clinical trial of 100 older, chronically ill adults were assigned to a Spiritual (SPIRIT) or Educational (EDUC--standard cardiac risk reduction) intervention. Individuals in each group were shown a 28-minute video and given a workbook to complete over 4 weeks. Selected psychosocial and health outcome measures were administered at baseline and 6 weeks later. RESULTS: Participants were mostly female (62%), with a mean age of 65.8 +/- 9.6 years and had an average of three chronic illnesses. More than 90% were Christian. At baseline, frequent daily spiritual experiences (DSE) were associated with being African American (p < .05) and increased pain (p < .01) and co-morbidities (p < or = .01). Energy increased significantly (p < .05) in the SPIRIT group and decreased in the EDUC group. Improvements in pain, mood, health perceptions, illness intrusiveness, and self-efficacy were not statistically significant. CONCLUSIONS: A minimal intervention encouraging spiritual coping was inoffensive to patients, associated with increased energy, and required no additional clinician time.]

McConnell, T. R., Trevino, K. M. and Klinger, T. A. (Bloomsburg University, Bloomsburg, PA;"Demographic differences in religious coping after a first-time cardiac event." Journal of Cardiopulmonary Rehabilitation & Prevention 31, no. 5 (Sep-Oct 2011): 298-302. [(From the abstract:) METHODS: Patients (N = 105), who were enrolled in cardiac rehabilitation after a first-time myocardial infarction or coronary artery revascularization bypass surgery, completed the Religious Coping Activities Scale. Independent variables included age, gender, religious affiliation, diagnosis, marital status, and education level. The 6 types of religious coping activities were compared for each level of the independent variables. RESULTS: Significant differences emerged for gender, religious affiliation, marital status, and level of education. Women scored higher than men on spiritually based activities (T = 1550, P = .03), good deeds (T = 1504, P = .08), and religious avoidance coping (T = 1505, P = .08). Participants who claimed no religious affiliation scored lowest on good deeds (H[2] = 9.7, P = .008) and interpersonal religious support coping (H[2] = 13.4, P = .001) and higher on discontent coping (H[2] = 5.4, P = .07). Single participants scored higher on spiritually based coping than did married participants (T = 1251, P = .04) and lower on discontent coping (H[1] = 4.3, P = .04). Plead coping was an inverse function of education (H[3] = 6.8, P = .08). CONCLUSIONS: Patients beginning cardiac rehabilitation, particularly those with the demographic characteristics discussed in this study, may benefit from assessment of their desire for pastoral intervention.]

Mihaljevic, S., Vuksan-Cusa, B., Marcinko, D., Koic, E., Kusevic, Z. and Jakovljevic, M. (Psychiatry Department, General Hospital Virovitica, Virovitica, Croatia; "Spiritual well-being, cortisol, and suicidality in Croatian war veterans suffering from PTSD." Journal of Religion & Health 50, no. 2 (Jun 2011): 464-473. [(Abstract:) We present our preliminary results of work that aims to observe the relationship between the cortisol level, the level of spiritual well-being, and suicidal tendencies in Croatian war veterans suffering from PTSD. The survey was conducted on 17 PTSD veterans who completed the Spiritual Well-Being Scale and the Beck Hopelessness Scale. The plasma cortisol level was obtained by venepuction at 8.00, 12.00, 13.00, 16.00, and 22.00 h. Results showed that veterans with higher spiritual well-being scores had lower cortisol levels, and evening cortisol levels showed significant correlation with suicidal risk. The results of the present study could be a stimulus for further investigation into spiritually based interventions, exploring their impact both on mental status and physical health.]

Rasic, D., Robinson, J. A., Bolton, J., Bienvenu, O. J. and Sareen, J. (Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; "Longitudinal relationships of religious worship attendance and spirituality with major depression, anxiety disorders, and suicidal ideation and attempts: findings from the Baltimore Epidemiologic Catchment Area Study." Journal of Psychiatric Research 45, no. 6 (Jun 2011): 848-854. [(Abstract:) We present findings on the longitudinal relationships of religious worship attendance and seeking spiritual comfort with subsequent major depression, anxiety disorders and suicidal ideation/attempts using data from Waves 3 and 4 of the Baltimore Epidemiologic Catchment Area Study (N=1091). Respondents who attended religious services at least once per year had decreased odds of subsequent suicide attempts compared with those who did not attend religious services (AOR=0.33, 95% CI: 0.13-0.84). Seeking spiritual comfort at baseline was associated with decreased odds of suicidal ideation (AOR=0.55, 95% CI: 0.31-0.99). These finding were independent of the effects of the presence of the suicidal ideation/attempts, comorbid mental disorders, social supports and chronic physical conditions at baseline. These results suggest that religious attendance is possibly an independent protective factor against suicide attempts.]

Rickhi, B., Moritz, S., Reesal, R., Xu, T. J., Paccagnan, P., Urbanska, B., Liu, M. F., Ewing, H., Toews, J., Gordon, J. and Quan, H. (Canadian Institute of Natural and Integrative Medicine, Calgary, Canada). "A spirituality teaching program for depression: a randomized controlled trial." International Journal of Psychiatry in Medicine 42, no. 3 (2011): 315-329. [(Abstract:) OBJECTIVE: This randomized controlled trial assessed the efficacy of a Spirituality Teaching Program to treat unipolar major depression. METHOD: A randomized controlled, assessor blinded trial design was used. A total of 84 individuals aged 18 years or older with unipolar major depression of mild to moderate severity were recruited in Calgary, Canada and randomized to two study arms: 1) Spirituality Teaching Program Group (8 week, home-based Spirituality Teaching Program); and 2) Waitlist Control Group (no intervention followed by Spirituality Teaching Program starting at week 9). Outcome measures (depression severity, response rate, remission rate) were assessed at baseline, 8, 16, and 24 weeks using the Hamilton Depression Rating Scale (HAM-D). RESULTS: The two trial groups were similar in their demographic and disease characteristics at baseline. At the 8-week point, the change in depression severity was significantly different between the two groups (change in HAM-D score: 8.5 for the Spirituality Group and 2.3 for the Waitlist Control Group, p < 0.001). The Spirituality Teaching Program Group had significantly higher response (36% vs. 4.4%, p < 0.001) and remission rates (31% vs. 4.4%, p < 0.001) than the Waitlist Control Group. The benefits remained throughout the observation period for the Spirituality Teaching Program Group participants with response rates of 56.4% at 16 weeks and 58.9% at 24 weeks. CONCLUSION: The Spirituality Program significantly reduced depression severity and increased response and remission rates. This non-drug treatment program should be investigated further as a treatment option for depression.]

Robinson, E. A., Krentzman, A. R., Webb, J. R. and Brower, K. J. (University of Michigan Addiction Research Center, Ann Arbor; "Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes at nine months." Journal of Studies on Alcohol & Drugs 72, no. 4 (Jul 2011): 660-668. [(Abstract:) OBJECTIVE: Although spiritual change is hypothesized to contribute to recovery from alcohol dependence, few studies have used prospective data to investigate this hypothesis. Prior studies have also been limited to treatment-seeking and Alcoholics Anonymous (AA) samples. This study included alcohol-dependent individuals, both in treatment and not, to investigate the effect of spiritual and religious (SR) change on subsequent drinking outcomes, independent of AA involvement. METHOD: Alcoholics (N = 364) were recruited for a panel study from two abstinence-based treatment centers, a moderation drinking program, and untreated individuals from the local community. Quantitative measures of SR change between baseline and 6 months were used to predict 9-month drinking outcomes, controlling for baseline drinking and AA involvement. RESULTS: Significant 6-month changes in 8 of 12 SR measures were found, which included private SR practices, beliefs, daily spiritual experiences, three measures of forgiveness, negative religious coping, and purpose in life. Increases in private SR practices and forgiveness of self were the strongest predictors of improvements in drinking outcomes. Changes in daily spiritual experiences, purpose in life, a general measure of forgiveness, and negative religious coping also predicted favorable drinking outcomes. CONCLUSIONS: SR change predicted good drinking outcomes in alcoholics, even when controlling for AA involvement. SR variables, broadly defined, deserve attention in fostering change even among those who do not affiliate with AA or religious institutions. Last, future research should include SR variables, particularly various types of forgiveness, given the strong effects found for forgiveness of self.]

Sacco, L. M., Griffin, M. T., McNulty, R. and Fitzpatrick, J. J. (Emergency Department, Naval Medical Center San Diego, CA). "Use of the Serenity Prayer among adults with type 2 diabetes: a pilot study." Holistic Nursing Practice 25, no. 4 (Jul-Aug 2011): 192-198. [(Abstract:) The incidence of type 2 diabetes is rising rapidly with significant associated morbidity and mortality. Treatment efforts are focused on control of serum blood glucose levels. It was anticipated that the use of the Serenity Prayer would assist those who need to gain control over their physiological symptoms. A pilot study of the effect of daily recitation of the Serenity Prayer for 6 weeks on serum blood glucoses in patients with uncontrolled type 2 diabetes was implemented. Thirty-six participants were enrolled in the study; there was a very high attrition rate over the course of the study. Serum blood glucose levels over the duration of the study were analyzed. At 4 to 6 weeks, time 2, there were 2 participants who had lower serum blood glucose levels, 2 had increased serum blood glucose levels, and 4 had no change. Challenges in completing this research and specific recommendations for future research are addressed.]

Saguil, A., Fitzpatrick, A. L. and Clark, G. (Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; "Is evidence able to persuade physicians to discuss spirituality with patients?." Journal of Religion & Health 50, no. 2 (Jun 2011): 289-299. [(Abstract:) Patients believe that spirituality informs health; frequently, they wish to share their beliefs with physicians. Although a large number of physicians believe it their responsibility to be aware of patient beliefs, many do not address spirituality because they do not believe it their role to do so. These physicians would perhaps feel differently if presented with evidence that associated spirituality with positive health outcomes. This national sample of family medicine residents were asked if, presented with evidence that spirituality was associated with improved outcomes, they would be more likely to initiate discussions of spirituality with patients. To varying degrees, most residents agreed that they would be more willing to initiate spirituality discussions if presented with good evidence. Geographic region of training, religious preference, and Spiritual Well-Being Scale quartile predicted both strength of agreement and whether a resident would be as responsive to spirituality oriented research as to investigations of traditional therapeutic modalities. Although residents indicated that they would be more responsive to publications on traditional medical therapies, familiarity with the spirituality literature as part of a residency educational curriculum may help break down barriers to addressing this issue with patients.]

Salsman, J. M., Yost, K. J., West, D. W. and Cella, D. (Department of Medical Social Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL; "Spiritual well-being and health-related quality of life in colorectal cancer: a multi-site examination of the role of personal meaning." Supportive Care in Cancer 19, no. 6 (Jun 2011): 757-764. [(From the abstract:) This study had two aims: (1) examine the associations between SpWB (faith and meaning/peace) and health-related quality of life (HRQL) outcomes and (2) examine competing hypotheses of whether the relationship among distress, SpWB, and HRQL is better explained by a stress-buffering (i.e., interaction) or a direct (main effects) model. METHODS: Study 1 consisted of 258 colorectal cancer survivors (57% men) recruited from comprehensive cancer centers in metropolitan areas (age, M=61; months post-diagnosis, M=17). Study 2 consisted of 568 colorectal cancer survivors (49% men) recruited from a regional cancer registry (age, M=67; months post-diagnosis, M=19). Participants completed measures of SpWB (functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp)) and HRQL (functional assessment of cancer therapy-colorectal) in both studies. Measures of general distress (profile of mood states-short form) and cancer-specific distress were also completed in study 1 and study 2, respectively. RESULTS: After controlling for demographic and clinical variables, faith and meaning/peace were positively associated with HRQL. However, meaning/peace emerged as a more robust predictor of HRQL outcomes than faith. Planned analyses supported a direct rather than stress-buffering effect of meaning/peace. CONCLUSIONS: This study provides further evidence of the importance of SpWB, particularly meaning/peace, to HRQL for people with colorectal cancer. Future studies of SpWB and cancer should examine domains of the FACIT-Sp separately and explore the viability of meaning-based interventions for cancer survivors.]

Schafer, R. M., Handal, P. J., Brawer, P. A. and Ubinger, M. (Psychology Department, Saint Louis University, St. Louis, MO). "Training and education in religion/spirituality within APA-accredited clinical psychology programs: 8 years later." Journal of Religion & Health 50, no. 2 (Jun 2011): 232-239. [(Abstract:) This study was a follow up investigation of Brawer et al.'s (Prof Psychol Res Pr 33(2):203-206, 2002) survey of education and training of clinical psychologists in religion/spirituality. Directors of clinical training were surveyed to determine whether changes had occurred in the coverage of religion and spirituality through course work, research, supervision, and in the systematic coverage of the content area. Results indicated an increased coverage in the areas of supervision, dedicated courses, inclusion as part of another course, and research. There was no increase in systematic coverage, but significantly more programs provided at least some coverage. The current study also assesses other areas of incorporation as well as directors' opinions regarding the importance of religion/spirituality in the field of psychology.]

Stanley, M. A., Bush, A. L., Camp, M. E., Jameson, J. P., Phillips, L. L., Barber, C. R., Zeno, D., Lomax, J. W. and Cully, J. A. (Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; "Older adults' preferences for religion/spirituality in treatment for anxiety and depression." Aging & Mental Health 15, no. 3 (Apr 2011): 334-343. [(From the abstract:) OBJECTIVES: To examine patient preferences for incorporating religion and/or spirituality into therapy for anxiety or depression and examine the relations between patient preferences and religious and spiritual coping styles, beliefs and behaviors. METHOD: Participants (66 adults, 55 years or older, from earlier studies of cognitive-behavioral therapy for late-life anxiety and/or depression in primary care) completed these measures by telephone or in-person: Geriatric Anxiety Inventory, Client Attitudes Toward Spirituality in Therapy, Patient Interview, Brief Religious Coping, Religious Problem Solving Scale, Santa Clara Strength of Religious Faith, and Brief Multidimensional Measure of Religiousness and Spirituality. Spearman's rank-order correlations and ordinal logistic regression examined religious/spiritual variables as predictors of preferences for inclusion of religion or spirituality into counseling. RESULTS: Most participants (77-83%) preferred including religion and/or spirituality in therapy for anxiety and depression. Participants who thought it was important to include religion or spirituality in therapy reported more positive religious-based coping, greater strength of religious faith, and greater collaborative and less self-directed problem-solving styles than participants who did not think it was important. CONCLUSION: For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.]

Symonds, L. L., Yang, L., Mande, M. M., Mande, L. A., Blow, A. J., Osuch, J. R., Boivin, M. B., Giordani, B., Haan, P. S. and Smith, S. S. (Department of Radiology, Michigan State University, East Lansing, MI; "Using pictures to evoke spiritual feelings in breast cancer patients: development of a new paradigm for neuroimaging studies." Journal of Religion & Health 50, no. 2 (Jun 2011): 437-446. [(Abstract:) This study was designed to develop and validate a method for enhancing spiritual feelings, particularly in women who have received a diagnosis of breast cancer. The protocol specifically was developed to be used in functional magnetic resonance imaging (fMRI) studies. Eighteen breast cancer survivors rated pictures for their ability to enhance feelings of spirituality, happiness, and sadness. Results indicate that presenting carefully selected pictures with spiritual content (e.g., nature scenes, people engaged in contemplative behaviors) can effectively enhance spiritual feelings among breast cancer survivors. Future fMRI studies will explore the use of the protocol developed in this study for investigating neural activity during spiritual feelings and states.]

Taylor, D., Mulekar, M. S., Luterman, A., Meyer, F. N., Richards, W. O. and Rodning, C. B. (Department of General Surgery, College of Medicine and Medical Center, University of South Alabama, Mobile). "Spirituality within the patient-surgeon relationship." Journal of Surgical Education 68, no. 1 (Jan-Feb 2011): 36-43. [(From the abstract:) DESIGN: Prospective, voluntary, self-administered, and anonymously-completed questionnaire, regarding religious beliefs, spiritual practices, and personal faith, March-August, 2009. SETTING: General and orthopaedic surgical outpatient settings, Health Services Foundation, College of Medicine, University of South Alabama, a tertiary care academic medical center in Mobile, Alabama. PARTICIPANTS: All patients referred for evaluation and management of general and orthopaedic surgical conditions, pre- and postoperatively, were approached. METHODOLOGY: The questionnaire solicited data regarding patient: (1) demographics; (2) religious beliefs, spiritual practices, and personal faith; and (3) opinions regarding inquiry into those subjects by their surgeon. The latter opinions were stratified on a 5-point Likert scale ranging from "strongly disagree" to "strongly agree." Statistical analysis was conducted using software JMP([REGISTERED]) 8 Statistical Discovery Software (S.A.S. Institute Inc., Cary, North Carolina) and a 5% probability level was used to determine significance of results. RESULTS: Eighty-three percent (83%) of respondents agreed or strongly agreed that surgeons should be aware of their patients' religiosity and spirituality; 63% concurred that surgeons should take a spiritual history; and 64% indicated that their trust in their surgeon would increase if they did so. Nevertheless, 17%, 37%, and 36% disagreed or strongly disagreed with those perspectives, respectively.]

Waldron-Perrine, B., Rapport, L. J., Hanks, R. A., Lumley, M., Meachen, S. J. and Hubbarth, P. (Department of Psychology, Wayne State University, Detroit, MI)."Religion and spirituality in rehabilitation outcomes among individuals with traumatic brain injury." Rehabilitation Psychology 56, no. 2 (May 2011): 107-116. [(Abstract:) OBJECTIVE: The long-term consequences of traumatic brain injury affect millions of Americans, many of whom report using religion and spirituality to cope. Little research, however, has investigated how various elements of the religious and spiritual belief systems affect rehabilitation outcomes. The present study sought to assess the use of specifically defined elements of religion and spirituality as psychosocial resources in a sample of traumatically brain injured adults. PARTICIPANTS: The sample included 88 adults with brain injury from 1 to 20 years post injury and their knowledgeable significant others (SOs). The majority of the participants with brain injury were male (76%), African American (75%) and Christian (76%). MEASURES: Participants subjectively reported on their religious/spiritual beliefs and psychosocial resources as well as their current physical and psychological status. Significant others reported objective rehabilitation outcomes. ANALYSES: Hierarchical multiple regression analyses were used to determine the proportion of variance in outcomes accounted for by demographic, injury related, psychosocial and religious/spiritual variables. RESULTS: The results indicate that religious well-being (a sense of connection to a higher power) was a unique predictor for life satisfaction, distress and functional ability whereas public religious practice and existential well-being were not. CONCLUSIONS: The findings of this project indicate that specific facets of religious and spiritual belief systems do play direct and unique roles in predicting rehabilitation outcomes whereas religious activity does not. Notably, a self-reported individual connection to a higher power was an extremely robust predictor of both subjective and objective outcome.]

Winkelman, W. D., Lauderdale, K., Balboni, M. J., Phelps, A. C., Peteet, J. R., Block, S. D., Kachnic, L. A., VanderWeele, T. J. and Balboni, T. A. (Harvard Medical School, Boston, MA). "The relationship of spiritual concerns to the quality of life of advanced cancer patients: preliminary findings." Journal of Palliative Medicine 14, no. 9 (Sep 2011): 1022-1028. [(Abstract:) PURPOSE: Religion and/or spirituality (R/S) have increasingly been recognized as key elements in patients' experience of advanced illness. This study examines the relationship of spiritual concerns (SCs) to quality of life (QOL) in patients with advanced cancer. PATIENTS AND METHODS: Patients were recruited between March 3, 2006 and April 14, 2008 as part of a survey-based study of 69 cancer patients receiving palliative radiotherapy. Sixteen SCs were assessed, including 11 items assessing spiritual struggles (e.g., feeling abandoned by God) and 5 items assessing spiritual seeking (e.g., seeking forgiveness, thinking about what gives meaning in life). The relationship of SCs to patient QOL domains was examined using univariable and multivariable regression analysis. RESULTS: Most patients (86%) endorsed one or more SCs, with a median of 4 per patient. Younger age was associated with a greater burden of SCs (beta = -0.01, p = 0.006). Total spiritual struggles, spiritual seeking, and SCs were each associated with worse psychological QOL (beta = -1.11, p = 0.01; beta = -1.67, p < 0.05; and beta = -1.06, p < 0.001). One of the most common forms of spiritual seeking (endorsed by 54%)--thinking about what gives meaning to life--was associated with worse psychological and overall QOL (beta = -5.75, p = 0.02; beta = -12.94, p = 0.02). Most patients (86%) believed it was important for health care professionals to consider patient SCs within the medical setting. CONCLUSIONS: SCs are associated with poorer QOL among advanced cancer patients. Furthermore, most patients view attention to SCs as an important part of medical care. These findings underscore the important role of spiritual care in palliative cancer management.]



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