Transcript God Help Me: The Psychology of Religion and Coping

A Rationale for Spiritually
Integrated Psychotherapy
Kenneth I. Pargament
Department of Psychology
Bowling Green State University
[email protected]
Presented at
Samaritan Annual Conference
Spiritually Integrated Psychotherapy
Denver, Colorado
August 8, 2009
Overview of the Day
A
Rationale for Spiritually Integrated
Psychotherapy
 Understanding Spirituality
 Assessing Spirituality
 Addressing Spirituality
Albert Ellis on Religion
“Obviously the sane and effective psychotherapist
should not go along with the patient’s religious
orientation and try to help these patients live
successfully with their religions, for this is
equivalent to trying to help them live successfully
with their emotional illness” (p. 15; The Case
against Religion).
Reasons for the
Tension between Religion and
Health
 Irreligiousness
Professionals
among Health
Reasons for the
Tension between Religion and
Health
 Irreligiousness
among Health
Professionals
 Competing Religions
Values of Health and Religion
Empiricism
 Individualism
 Skepticism
 Autonomy
 Pragmatism
 Physical and Mental
Health

•
•
•
•
•
•
Faith
Love
Humility
Surrender
Transformation
Forbearance
Reasons for the
Tension between Religion and
Health
 Irreligiousness
among Health
Professionals
 Competing Religions
 Lack of Knowledge
A Lack of Training
 Only
15% of Ph. D. training programs in clinical
psychology in the United States and Canada offer a
course in religion and spirituality
Why Consider Spiritual Issues?
 Patients
want spiritually sensitive care
Rose et al (2001)
Journal of Counseling Psychology
 74
clients surveyed from 9 diverse counseling
centers
 Only 18% say they prefer not to discuss religious
or spiritual issues in counseling
Spiritual Needs of Clients
 Lindgren
and Coursey (1995)
 65% of people with serious mental illness would
like to talk about spiritual concerns with therapists
 35% talk to their therapists about spiritual concerns
Why Consider Spiritual Issues?

Patients want spiritually sensitive care
 Many
times
people turn to spirituality in stressful
Drawing on the Sacred as a Resource
on Flight 232
“The plane was moving more erratically. I knew it wasn’t
good by the increase in activity of the stewardesses. . . The
guy next to me at minus four minutes said, ‘We ain’t
going to make it’. . . I noticed the nun across from me had
been praying on her rosary. I remembered I had a cross in
my pocket. I pulled it out and held it in my hand for the
rest of the ride.”
 “I’d done a lot of Buddhist meditation in my life, and this
trained me to become one pointed in my awareness. I was
totally focused on the brace position.”

Most Frequent Method of Coping
 Conway
(1985-1986)
 Black and white elderly women with medical
problems
 Prayer was most frequent method of coping
 Prayer was more common than resting, seeking
information, prescription drugs, or going to a
physician
Coping with 9/11
 Schuster
et al. (2001)
 90% of national sample of Americans sought
solace and support from religion
Spirituality among People with Serious
Mental Illness
Tepper et al. (2001)
 Surveyed over 400 people with serious mental illness
 80% cope with their symptoms and daily problems
through religion
 65% found religious coping helpful
 30% say religion was most important resource
 More religious coping over time tied to less frustration,
less depression and hostility, and fewer hospitalizations

Why Consider Spiritual Issues?
Patients want spiritually sensitive care
 Many people turn to spirituality in stressful times

 Spirituality
has been linked to positive
health outcomes
Church Attendance as a
Predictor of Mortality
 Hummer
et al. (2000)
National
sample of adults
Frequent church attendance is tied to 7
year increase in life expectancy
Frequent church attendance is tied to 14
year increase in life expectancy among
African-Americans
Spiritual Meditation among Patients
with Vascular Headaches
(Wachholtz & Pargament, 2005)


83 college students with vascular headaches according to criteria of
the International Headache Society (1988)
Random assignment to four groups






Spiritual Meditation (e.g., “God is peace,” “God is joy” )
Internally Focused Secular Meditation (“I am content,” “I am joyful”)
Externally Focused Secular Meditation (“Grass is green,” “Sand is soft”)
Progressive Muscle Relaxation
Practice technique 20 minutes per day for four weeks
Assess changes in headache frequency, pain tolerance, affect,
headache control efficacy
Headache Occurrence Prior to and during the
Intervention
15
14
Headaches
13
12
GROUP
11
Spiritual Meditation
10
Internal Secular
9
Exter nal Meditation
8
Relax ation
1
2
Time
Diary Analyses of Headache Occurrence by Group and Time
2.2
2.0
Headaches
1.8
1.6
GROUP
1.4
1.2
Spiritual Meditation
1.0
Internal Secular
ay
ay
ay
ay
0
-3
26
5
-2
21
0
-2
16
5
-1
11
5
1-
10
6-
ay
ay
D
D
T ime Period
D
Relaxation
D
.6
D
External Meditation
D
.8
Pain Tolerance by Group and Time
120
110
100
90
80
GROUP
70
60
Spiritual Meditation
50
Internal Secular
40
External Meditation
30
Relaxation
1
2
TIME
Negative Affect by Group and Time
28
26
NPANAS
24
22
GROUP
20
Spiritual Meditation
Internal Secular
18
External Meditation
16
Relaxation
1
2
T ime
Migraine Specific Quality of Life by Group and Time
83
82
81
MSQL
80
79
GROUP
78
Spiritual Meditation
77
Internal Secular
76
External Meditation
75
Relaxation
1
2
T ime
Headache Management Self-Efficacy by Group and
Time
130
HMSE
120
110
GROUP
Spiritual Meditation
100
Internal Secular
External Meditation
90
Relaxation
1
2
T ime
Why Consider Spiritual Issues?
Patients want spiritually sensitive care
 Many people turn to spirituality in stressful times
 Spirituality has been linked to positive health
outcomes

 Spirituality
has been linked to negative
health outcomes
Spiritual Struggles
 Divine
struggles
 Interpersonal spiritual struggles
 Intrapsychic spiritual struggles
Ano and Vasconcelles Meta-Analysis
(2004, Journal of Clinical Psychology)
Number of Studies
Religious Struggles
with Negative Health
Outcomes
22
Cumulative
Effect Size
.22*
Confidence
Interval
.19 to .24
Spirituality and Health Study
 Participants
 1629
participants
 Age: Mean = 49.1 years, SD = 17.76
 75.3% Christian
 56.2% Attend religious services “almost every day” or
“every day”
 55.3% Engage in private prayer “almost every day” or
“every day”
 59.9% “Very religious” or “fairly religious”
Spirituality and Health Study

Measures

Mental Health: Symptom Assessment-45 Questionnaire
(Davison, Bershadsky, Bieber, Silversmith, Maruish, & Kane, 1997)
Obsessive-Compulsive
 Anxiety
Paranoid
 Depression
 Hostility
 Interpersonal
Sensitivity
Ideation
Phobic Anxiety
Somatization
Religious Struggle: Negative Religious Coping Subscale of
Brief RCOPE (Pargament, Koenig, & Perez, 2000)
 Social Support: Six items adapted from previous research

(Zimet, Dahlem, Zimet, & Farley, 1988)
Spirituality and Health Study
 Procedure
 Sample
recruited from sampling frame maintained by
Survey Sampling International
 Sampling frame reflects demographics of 2000 U.S.
census
 Contacted 8,500 individuals
 1,895 completed the survey (22% response rate)
 266 surveys excluded due to missing data
Spirituality and Health Study
 Summary
 Religious
struggle positively associated with
various forms of psychopathology
 Relationship between religious struggle and
psychopathology stronger for individuals with
recent illness or injury
Measures
(Pargament, Koenig et al. 2004)










Number of Active Diagnoses
Subjective Health
Severity of Illness Scale (ASA)
Activities of Daily Living (ADL)
Mini-Mental State Exam (MSE)
Depressed Mood
Quality of Life
Positive Religious Coping and Religious Struggle
Global Religious Measures (Church Attendance, Private
Religiousness, Religious Importance)
Demographics
Consequences of Religious Struggles
Study of medically ill elderly patients over two years
(Pargament, Koenig, Tarakeshwar, & Hahn, 2004)
 Struggles with the divine predicted increases in depressed
mood, declines in physical functional status, declines in
quality of life after controls
 Struggles with the divine predicted 22-33% greater risk of
mortality after controls
 Struggles also predict stress-related growth

Specific Religious Struggle
Predictors of Mortality
 “Wondered
whether God had abandoned me”
(RR = 1.28)
 “Questioned God’s love for me” (R = 1.22)
 “Decided the devil made this happen” (R = 1.19)
Why Consider Spiritual Issues?
Patients want spiritually sensitive care
 Many people turn to spirituality in stressful times
 Spirituality has been linked to positive health
outcomes
 Spirituality has been linked to negative health
outcomes

 Spirituality
treatment
cannot be separated from
A Forgiveness Intervention
 Rye
and Pargament (2002)
 College students hurt in romantic relationship
 Religious forgiveness intervention
 Secular forgiveness intervention
 Both groups facilitate forgiveness and well-being
 No group differences in efficacy
Strategies for Forgiveness
 Two
of top three strategies for secular forgiveness
group
 “I
asked God for help and/or support as I was trying to
forgive.”
 “I prayed for the person who wronged me as I was
trying to forgive.”
The Secular Impacts the Spiritual
 Theresa
Tisdale et al. (1997)
 Evaluation of psychiatric inpatient treatment
 Individual, group, milieu, and psychotropic
interventions
 Patients in treatment improved in adjustment
 Patients in treatment developed more positive
images of God
Common Measures of Religiousness
and Spirituality
What is your religious denomination?
 How often do you attend religious services at your
congregation?
 How often do you pray outside of your congregation?
 On a 1 to 5 scale, would you say you are very religious (5)
or not at all religious (1)?
 On a 1 to 5 scale, would you say you are very spiritual (5)
or not at all spiritual (1)?

Research Populations
Victims of 1993 Midwest floods
 Survivors of OK City bombing
 Parents of autistic children
 Medically ill hospitalized elderly
 Hospice care providers
 Cardiac pacemaker patients
 African-Americans coping with racism
 People coping with 9/11

Stereotypes about Spirituality
 Spirituality
is a defense against anxiety
Spirituality and the Search for Comfort
College student recovering from an eating disorder
“He just watches over me all the time. When
something good happens, God’s there. But when
something bad happens, God’s there too. . . Just
knowing that there’s somebody up there . . . who is
paying attention. . . makes me feel more secure.”
Spirituality and the Search for Meaning
Quadriplegic young man paralyzed by spinal cord
injury:
“Well, I’m put in this situation to learn certain
things, ‘cause nobody else is in this situation. It’s
a learning experience; I see God’s trying to put me
in situations, help me learn about Him, and
myself.”
Spirituality and the Search for
Intimacy
Roman Catholic priest describing mother’s funeral:
“The funeral was astounding. The whole church was
there. Many, many friends were there. My blind
niece played the piano and my best friend gave the
homily. So there were many powerful religious
expressions and family expressions. It is hard to
separate one from the other.”
Spirituality and the Search for
Transformation
Mormon man describing death of wife in car crash:
“I knew that she was killed. There was a big gash on
her wrist, and it wasn’t bleeding and I couldn’t get
any pulse. And I felt that I could lay my hands on
her head and bring her back. And a voice spoke to
me and said: ‘Do you want her back a vegetable?
She’s fine. She’s alright. And . . . to let her go.’
That [voice] was just as clear to me as though
somebody spoke to me.”
Spirituality and the Search for the
Sacred
9 year old boy:
“I’d like to find God! But He wouldn’t just be there,
waiting for some spaceship to land! He’s not a
person, you know! He’s a spirit. He’s like the fog
and the mist. . . I should remember that God is
God, and we’re us. I guess I’m trying to get from
me, from us, to Him with my ideas when I’m
looking up at the sky!” (Coles, 1990)
Stereotypes about Spirituality

Spirituality is a defense against anxiety
 Spirituality
is a passive or avoidant way of coping
Three Styles of Spiritual
Coping
-- “When I feel nervous or
anxious, I calm myself without relying on
God.”
 Deferring -- “I do not think about
different solutions to my problems
because God provides them for me.”
 Collaborative -- “When it comes to
solving a problem, God and I work
together.”
 Self-Directing
Who Says We’re Not a Science?
C.R.C.
Y2
C.P.S
Y1
.87

Collaborative
Religious
Coping
.83*
 x11
.93
2
.12*
2
P sy chosocia l
Competence
21

.48*
21
y32
D.P .S.
Y3
* p < .05
.27*
- .57
 32
Def err ing
Religious
Coping

3

5
.77

BAPC
Y6
.40*

6
.40*
.72*

.74*
y53
y63
.85
** p < .10
.51*
 31
.94*
 x21
S- E
Y5
.64**
 11
I ntrinsic
Religiousness
Feagin
X
y21
.32*
1

.22*
Hoge
X
.61*
y11
1
.14*
2
.62**
1
.25*
.60*

y42
D.R.C.
Y4
.65*

4
.86*

y73
Trust
Y7
.84*

7
Stereotypes about Spirituality
Spirituality is a defense against anxiety
 Spirituality is a passive or avoidant way of coping

 Spirituality
is a form of denial
Spirituality and Denial
 “Since
I got Jesus, I don’t have no memories
of the past” (prisoner serving time for theft
and robbery offenses)
Spirituality and Hope
 “It’s
all right to cry. It’s all right to hurt. It’s
all right to be confused. Hope will rebuild
landmarks. Hope will outlive the broken
hearts” (pastor of the First Baptist Church in
Oklahoma City following devastating
tornadoes).
Envisioning a Spiritually Integrated
Psychotherapy
 Based
on a theory of spirituality
 Empirically-oriented
 Ecumenical
 Transformational
Some Dangers of a Spiritually
Integrated Psychotherapy
 Trivializing
spirituality
 Spiritual reductionism
 Value imposition
Respect for Client’s Autonomy
“We need to be honest and open about our views,
collaborate with the client in setting goals. . ., then
step aside and allow the person to exercise autonomy
and face consequences” (Bergin, 1995, p. 107).
Some Dangers of a Spiritually
Integrated Psychotherapy
 Trivializing
spirituality
 Spiritual reductionism
 Value imposition
 Overstating the importance of spirituality
The Law of the Instrument
“When you have a hammer in your hand,
everything around you starts to look like a nail.”
The Greatest Danger
“Medical and mechanistic models have made useful contributions
that should be integrated into any comprehensive theory of
psychotherapy, but when these models serve as the foundation of
our profession, they produce a psychology that is barren of soul.
Thus, they unintentionally participate in the further desacralization
of our society and in the de-souling of individual lives. Make no
mistake: Soulless therapies produce soulless results. When our
psychotherapies . . . become permeated with the same desacralizing
assumptions that often cause our clients problems in the first place,
then perhaps it is time for us to ask what we are doing as therapists
and to seek other approaches that support rather than destroy the
soul” (Elkins, 1995, p. 82).