The Psychology of Religion and Coping: Theory, Research, Practice

https://www.mdpi.com/2077-1444/2/1/51/pdf

The Brief RCOPE: Current psychometric status of a short measure of religious coping.

Religious and spiritual struggles.

Many people experience struggle around religious and spiritual aspects of life, as shown in a steadily growing body of research. A need now exists for more comprehensive, reliable, concise measurement of religious and spiritual (r/s) struggles through a scale that covers multiple domains. This article describes the development and initial validation of a 26-item measure, the Religious and Spiritual Struggles (RSS) Scale. The measure assesses six domains of r/s struggle: divine (negative emotion centered on beliefs about God or a perceived relationship with God), demonic (concern that the devil or evil spirits are attacking an individual or causing negative events), interpersonal (concern about negative experiences with religious people or institutions; interpersonal conflict around religious issues), moral (wrestling with attempts to follow moral principles; worry or guilt about perceived offenses by the self), doubt (feeling troubled by doubts or questions about one’s r/s beliefs), and ultimate meaning (concern about not perceiving deep meaning in one’s life). Study 1 used factor analytic techniques in two adult samples (Ns 400 and 483) to refine the item pool for the RSS. Study 2, which sampled 1141 undergraduates, showed very good fit for a six-factor model using confirmatory factor analysis. Study 2 also provided evidence of convergent, discriminant and predictive validity by relating RSS scores to measures of religiousness, r/s struggle and mental health. Several potentially important demographic differences emerged on the RSS. For example, undergraduates without committed romantic relationships and those who self-identified as homosexual reported greater r/s struggles across multiple domains.

The Religious and Spiritual Struggles Scale: Development and initial validation

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.

Anger toward God: Social-cognitive predictors, prevalence, and links with adjustment to bereavement and cancer.

The present study investigated the relationship between spiritual struggles and various types of psychopathology symptoms in individuals who had and had not suffered from a recent illness. Participants completed self-report measures of religious variables and symptoms of psychopathology. Spiritual struggles were assessed by a measure of negative religious coping. As predicted, negative religious coping was significantly linked to various forms of psychopathology, including anxiety, phobic anxiety, depression, paranoid ideation, obsessive-compulsiveness, and somatization, after controlling for demographic and religious variables. In addition, the relationship between negative religious coping and anxiety and phobic anxiety was stronger for individuals who had experienced a recent illness. These results have implications for assessments and interventions targeting spiritual struggles, especially in medical settings.

Examining the links between spiritual struggles and symptoms of psychopathology in a national sample.

While the psychological, social, and physical dimensions of a traumatic experience are well 
recognized, the spiritual dimension is often overlooked. Yet, spirituality can play a critical 
role in the way traumas are understood, how they are managed, and how they are ultimately 
resolved. Spirituality can be potentially helpful or harmful. In this chapter, we will see 
that spirituality can be a positive resource for posttraumatic growth (PTG) or a source of 
struggle that may lead to growth or decline. We will consider some of the factors that may 
determine whether spirituality leads ultimately to growth or decline. Finally, we will con­
clude by discussing some of the practical implications of this body of theory and research 
for our efforts to help people coping with major trauma. We begin by discussing the mean­
ing of spirituality and religion and their place in the context of coping with life traumas.

Spirituality: A Pathway to Posttraumatic Growth or Decline?

Spiritual confession has a prominent role in the practices of many religious and spiritual traditions. This paper proposes a definition of spiritual confession and reviews confession practices in Christian, Jewish, Buddhist, Native American, and 12-step traditions. Psychological research on confession and disclosure processes is reviewed, and functions of confession are identified, based on prior empirical and theoretical work. Identified functions include: reducing guilt and shame, seeking social connection, seeking meaning and coherence, impression management, and spiritual functions. Finally, experimental studies focused on spiritual confession are reviewed, and specific suggestions for future research are proposed.

Understanding spiritual confession: A review and theoretical synthesis.

Background Cancer survivors represent one of the fastest growing populations in the United States. Unfortunately, nearly 1 in 3 survivors experience anxiety symptoms as a long-term consequence of cancer and its treatment. Characterized by restlessness, muscle tension, and worry, anxiety worsens the quality of life; impairs daily functioning; and is associated with poor sleep, depressed mood, and fatigue. Although pharmacological treatment options are available, polypharmacy has become a growing concern for cancer survivors. Music therapy (MT) and cognitive behavioral therapy (CBT) are evidence-based, nonpharmacological treatments that have demonstrated effectiveness in treating anxiety symptoms in cancer populations and can be adapted for remote delivery to increase access to mental health treatments. However, the comparative effectiveness of these 2 interventions delivered via telehealth is unknown. Objective The aims of the Music Therapy Versus Cognitive Behavioral Therapy for Cancer-related Anxiety (MELODY) study are to determine the comparative effectiveness of telehealth-based MT versus telehealth-based CBT for anxiety and comorbid symptoms in cancer survivors and to identify patient-level factors associated with greater anxiety symptom reduction for MT and CBT. Methods The MELODY study is a 2-arm, parallel-group randomized clinical trial that aims to compare the effectiveness of MT versus CBT for anxiety and comorbid symptoms. The trial will enroll 300 English- or Spanish-speaking survivors of any cancer type or stage who have experienced anxiety symptoms for at least 1 month. Participants will receive 7 weekly sessions of MT or CBT delivered remotely via Zoom (Zoom Video Communications, Inc) over 7 weeks. Validated instruments to assess anxiety (primary outcome), comorbid symptoms (fatigue, depression, insomnia, pain, and cognitive dysfunction), and health-related quality of life will be administered at baseline and at weeks 4, 8 (end of treatment), 16, and 26. Semistructured interviews will be conducted at week 8 with a subsample of 60 participants (30 per treatment arm) to understand individual experiences with the treatment sessions and their impact. Results The first study participant was enrolled in February 2022. As of January 2023, 151 participants have been enrolled. The trial is expected to be completed by September 2024. Conclusions This study is the first and largest randomized clinical trial to compare the short- and long-term effectiveness of remotely delivered MT and CBT for anxiety in cancer survivors. Limitations include the lack of usual care or placebo control groups and the lack of formal diagnostic assessments for psychiatric disorders among trial participants. The study findings will help guide treatment decisions for 2 evidence-based, scalable, and accessible interventions to promote mental well-being during cancer survivorship. International Registered Report Identifier (IRRID) DERR1-10.2196/46281

Telehealth-Based Music Therapy Versus Cognitive Behavioral Therapy for Anxiety in Cancer Survivors: Rationale and Protocol for a Comparative Effectiveness Trial

Prognostic understanding among advanced cancer patients is associated with higher levels of engagement in advance care planning (ACP), preference for comfort over aggressive care, and receipt of goal-concordant care, but few patients have accurate prognostic understanding. Talking about Cancer (TAC) is a communication-based intervention for advanced cancer patients and their caregivers designed to improve shared accurate prognostic understanding. This case study describes the use of TAC with an interracial friend dyad for whom medical mistrust and experienced bias on the part of the patient significantly impacted interactions with the medical team. Using TAC strategies, this dyad was able to improve communication with the oncology team and each other and engage in ACP. Dr. McConnell is a research consultant for OncoHealth. Dr. Daly serves on an advisory board for Varian Medical Systems and owns equity in Roche outside. He has an immediate family member owning equity in Eli Lilly and Company. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. 

Kelly M. McConnell

Papers

Examining the links between spiritual struggles and symptoms of psychopathology in a national sample.

Spirituality: A Pathway to Posttraumatic Growth or Decline?

Understanding spiritual confession: A review and theoretical synthesis.

Telehealth-Based Music Therapy Versus Cognitive Behavioral Therapy for Anxiety in Cancer Survivors: Rationale and Protocol for a Comparative Effectiveness Trial

Advance care planning in an interracial dyad: Case illustration of an intervention to improve engagement in end-of-life care planning.