Annual Meeting: 2010 Poster Sessions

Categories

Interdisciplinary Research
Mediators & Pathways
Religious Organizations & Public Health
Spirituality & Clinical Care
Theological Considerations

Interdisciplinary Research

"Illuminating the Need for Religion and Spirituality in the Lives of Lesbian and Gay Individuals"
Kacey D. Greening, BA
Graduate Student, Doctoral Candidate in Clinical Psychology
Wright State University
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Religion and spirituality have been associated with several psychological benefits. Previous research has demonstrated a positive relationship between religious and spiritual involvement, interpersonal satisfaction, family cohesion, and identity development. In addition, religious and spiritual involvement have been successful in reducing symptoms of depression (Heermann, Wiggins, & Rutter, 2007). Regrettably, the religious and spiritual experiences of many lesbian and gay individuals have been compromised by intolerance, oppression, and exclusion. Consequently, the benefits that surround religion and spirituality are not readily available to lesbian and gay individuals (Tan, 2005). Furthermore, these individuals are often denied spiritual refuge and support. Therefore, the aims of this presentation are as follows: to examine the importance of religion and spirituality in the lives of lesbian and gay individuals and to illuminate the paths that can be taken to encourage the expression and reception of religion and spirituality in lesbian and gay individuals.

"Spirituality and Well-being in an African-American Sample"
M. C. Joëlle Fignolé Lofton, MA
PhD Student
Howard University
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Psychologists recognize health as a state of total well-being, being sound in body, mind, and spirit, and are therefore uniquely positioned to empirically explore correlates of mental health using this holistic perspective. It is from a larger study titled "Factors Influencing Renal Health and Disease" that data were obtained to analyze associations between spirituality and depression. The data were collected from a community sample of 197 African-Americans who completed the Daily Spiritual Experiences Scale (DSES) and the BDI-II (a depression inventory). These data were compared to results from a meta-analysis performed by the creators of the DSES: 1,663 participants, 2 factors extracted from the exploratory factor analysis and an inverse correlation between the DSES and the Center for Epidemiological Studies—Depression scale. Although the methods were not replicated, valuable insights were gained. The study revealed 3 factors, and two of the three DSES factors were inversely correlated with the depression.

"Compassionate Exchange: Investigating the Use of Current Compassion Research Methodologies to Study the Tibetan Buddhist Practice of Tonglen"
Daphna McKnight, MEd, MA
Graduate Student, PhD Program for Buddhist Studies
University of the West
Research supports the efficacy of Calm-abiding Buddhist meditation on health, but researchers are just now examining compassion meditations, primarily that of Loving-kindness. However, a few healthcare professionals have suggested Tonglen, a Tibetan Buddhist compassion practice, as a "new" tool for the development of emotional, social, and physical wellbeing, but no research has been conducted. This paper suggests there may be enough correlation between Tonglen and Loving-kindness that researchers may hypothesize Tonglen-study outcomes based on results attained from Loving-kindness meditation. This paper also investigates whether there is a strong enough relationship between the practices to employ the same research tools used for Loving-kindness on Tonglen. It then examines critical differences which may negatively influence outcomes. Finally, several concerns regarding the introduction of Tonglen as a non-Buddhist tool for wellbeing are discussed. Initial findings suggest that, though there are significant concerns, Tonglen could legitimately be tested via current Loving-kindness compassion research designs.

"Research in Spirituality and Health: A Model for Promoting and Funding Spiritual Research, Saint Mary’s Hospital Sponsorship Board, Inc."
Katherine M. Piderman, PhD
Staff Chaplain, Coordinator of Research
Assistant Professor of Psychiatry
Mayo College of Medicine
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Co-authors: Jason S. Egginton, MPH; Jeanne M. Klein, BA; Cheryl A. Nelson, BS; Heidi L. Durland, BS; Ann Marie Dose, PhD
The Saint Marys Hospital Sponsorship Board, Inc. provides a model for promoting and funding spiritual research in the context of organizational values, i.e., primacy of the patient, spirituality, compassion, respect, trust, excellence, and teamwork. Applications for funding are reviewed by the Sponsorship Research Committee and funds are awarded to investigators of qualified studies from Mayo Clinic Rochester. Grants have been given to physicians, nurses, chaplains, and social workers using a variety of research methodologies to study inpatients and outpatients. Research participants have included those with alcohol dependence, breast cancer, cardiovascular disease, chronic pain, chronic fatigue syndrome, depression, diabetes, end-of-life issues, fibromyalgia, multiple myeloma, nicotine dependence, ovarian cancer, and spinal cord dysfunction. Results have led to many presentations and publications and important implications for clinical care. This model provides guidelines that make it adaptable to other organizations seeking to express their mission by encouraging and funding scientifically-sound, spirituality-oriented research.

"What Do You Got a Bible in Your Room For? Teacher Spirituality and Violent Students"
A. Quinn Stanley, PhD
Assistant Professor of Special Education
University of Wisconsin, Stevens Point
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The purpose of this qualitative study was to explore how experienced teachers of students with emotional or behavioral disturbance working in separate, self-contained, public day schools maintain their teacher efficacy through stress management. Most educators consider working with these violent students highly stressful which has resulted in a shortage of experienced educators willing to teach this population. Yet, other teachers maintain their effectiveness teaching these challenging students. Spirituality was particularly useful for participants because it was a technique that could be used at school when others were present and, when necesssary, without others knowing. It allowed participants to feel a sense of purpose, helped in anxiety reduction, and functioned as a "tool" to connect with students. Some specific methods included Bible reading and sharing, meditation, prayer, Pantheism, and matrial arts. This study relates to teacher and student welfare and school violence reduction methods

"Illness as Isolation/Wellness as Belonging: A Qualitative Exploration of Addiction and Recovery"
Sarah V. Suiter, MS, PhD
Postdoctoral Fellow
Center for Spirituality, Theology and Health
Duke University Medical Center
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Using data gathered from a photovoice project conducted with residents of an addiction recovery program in Raleigh, North Carolina, this exhibit explores participant notions of illness and health in the context of addiction.

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Mediators & Pathways

"Assessing Clergy Mental Health: Relationships Between Desire to Please Others, Guilt or Shame, Self-Compassion, Differentiation of Self from Role, and Clergy Burnout"
Laura Barnard, BA
Graduate Student
Duke University
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Religious leaders often experience burnout, which is characterized by emotional exhaustion in ministry (SEEM) and low satisfaction in ministry (SIM). Clergy with high SEEM feel drained and discouraged. Clergy with high SIM report that the ministry gives purpose and meaning to their life. This study asks how religion and mental health are related by examining if one’s desire to please others, guilt or shame orientation, self-compassion, and ability to differentiate self from role are pathways to SEEM and SIM among Methodist clergy. Correlations between these predictors are explored and hierarchal regression is used to examine their ability to uniquely predict clergy burnout. This reveals that clergy who are self-compassionate are less likely to experience burnout. Although other variables explain significant variation in burnout when examined individually, due to inter-correlations between predictors only self-compassion is significant in the full model. By increasing self-compassion we may be able to prevent clergy burnout.

"Prayer/Religiosity as Primary Stress Coping Strategy Predicts Health-Related Pregnancy and Birth Factors in a Rural Appalachian Sample"
Andrea D. Clements, PhD
Professor, Department of Psychology
East Tennessee State University
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Co-authors: Beth A. Bailey, PhD; Heather Wright, BS; Anna Ermakova, BS
During intake, a rural sample of 1312 women admitted for low-risk singleton birth was asked the open-ended question, "How do you deal with stress?" Responses were categorized into 18 stress coping strategies, including Prayer/Religiosity (n = 22). Demographically, women endorsing prayer/religiosity (PR) were older (p < .001), more educated (p = .007), more likely to be married (p = .004), and had more children (p = .001) than non PR women. PR women were significantly less likely to report alcohol use (p = .028), tobacco use (p = .034), or have a positive prenatal drug screen (p = .045), and far more likely to breastfeed (p = .006) compared to Non PR women, all factors predictive of pregnancy and birth health. PR women did not differ from others in presence of complications, but they did have infants who were hospitalized fewer days at birth (p = .005).

"Perceptions of Control as Mediators of the Link between Religiousness and Obesity"
Justin Marschall
Student
Luther College
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Co-authors: Whitney Keltner; Kaela Stuart; Loren Toussaint, PhD; Alyssa C. D. Cheadle, BA; Tyler VanderWeele, PhD; Amy D. Owen, PhD
Obesity is a critical national health problem. Despite the prevalence of this condition, little scientific work has addressed the potential role of religiousness in explaining obesity. What work exists has been limited by design and confounding problems. Theory indicates variables such as mastery and self-efficacy may mediate the effects of religiousness on health. The purpose of this study was to examine the causal role of religiousness in body mass and to explore potential mediators/moderators of this relationship. Data was analyzed from over 1500 adults in the American’s Changing Lives survey, across three time points spanning almost twenty years. Results of cross-lagged path models show a small but statistically significant effect of religiousness on body mass index. Causal mediation analyses explored the role of two theologically relevant variables: mastery and self-efficacy. The results provide greater insight into how and why religiousness is associated with health outcomes such as obesity.

"Psychosocial and Physical Wellbeing: The Relationship with Religious Coping in the Elderly"
Jon Jore
Student
Northwestern College
Co-authors: Jordan Kinney, Dan Schumann, and Allison Keuning
The relationship between religiousness/spirituality (R/S) and physical health has been explored at some length in the psychological literature. This topic is particularly relevant in the elderly, who often experience significant psychosocial stress in addition to deteriorating physical health. this study explores the relationship between religious coping, physical health, and psychosocial stress in the elderly as part of a larger research study examining psychosocial functioning and R/S. Participants from diverse backgrounds are being recruited from senior living facilities in a large metropolitan area and will be administered the Life Events Scale, the SF-12v2, the Fetzer Brief Multidimensional Measure of R/S, the Brief RCOPE, and the DUREL. Approximately 30 elderly have already participated toward a goal of 60 completed participants by the end of April 2010. Data will be analyzed using correlation and regression analysis. Conclusions of the current study will be discussed, and implications for future research will be presented.

"An Exploration of Spirituality, Emotional Functioning, and Life Stress in the Elderly"
Nicola Rodwell, BA
Student Research Associate
Northwestern College
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Co-authors: Shaina Olsen, Kelli Anderson, and Allison Keuning
The relationship between religiousness, spirituality, and health has received increasing attention in behavioral sciences research, revealing a generally positive impact of religion and spirituality (R/S) on health. However, the relationship between R/S, emotional functioning, and life stress has not been as extensively examined, particularly in the elderly population, which is the purpose of this study. Elderly participant from diverse backgrounds are being recruited from senior living facilities in a large metropolitan area. Approximately 30 elderly have already completed the study toward a goal of at least 60 participants by the end of April 2010. The Fetzer Brief Multidimensional Measures of Religiousness/Spirituality, Brief RCOPE, Duke University Religion Index, Lubben Social Network Scale, Brief Symptom Inventory, and Life Events Scale will be administered. Data will be analyzed using correlation and regression analysis. Conclusions of the current study will be discussed and implications for future research will be presented.

"Holistic Needs and the Brain: A Theoretical Model"
Nava R. Silton, PhD
Templeton Postdoctoral Research Fellow
Healthcare Chaplaincy
Co-author: Kevin J. Flannelly, PhD
Obesity is a critical national health problem. Despite the prevalence of this condition, little scientific work has addressed the potential role of religiousness in explaining obesity. What work exists has been limited by design and confounding problems. Theory indicates variables such as mastery and self-efficacy may mediate the effects of religiousness on health. The purpose of this study was to examine the causal role of religiousness in body mass and to explore potential mediators/moderators of this relationship. Data was analyzed from over 1500 adults in the American’s Changing Lives survey, across three time points spanning almost twenty years. Results of cross-lagged path models show a small but statistically significant effect of religiousness on body mass index. Causal mediation analyses explored the role of two theologically relevant variables: mastery and self-efficacy. The results provide greater insight into how and why religiousness is associated with health outcomes such as obesity.

"Forgiveness and Physical Health: Psychosocial Mediators"
Kaela Loise Stuart
Student
Luther College
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Co-authors: Whitney Keltner; Justin Marschall; Amy Owen, PhD; Loren Toussaint, PhD
Evidence is accumulating that forgiveness of others is related to improved physical health, however, little is known about the mechanisms through which this effect may occur. The purpose of this study was to examine the psychosocial mechanisms of this association. In a sample of 436 participants, structural equation modeling (SEM) was used to examine the mediating effect of four different latent mediators on the association between forgiveness and physical health: distress, positive outlook, anger/hostility, and spirituality. Only distress and positive outlook were shown to be mediators of the association between forgiveness and physical health. The SEM model with forgiveness (exposure variable), distress and positive outlook (mediators), and physical health (outcome) showed an acceptable fit to the data. This model suggests that forgiveness of others may have beneficial effects on physical health through its negative association with distress and positive association with optimistic outlook.

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Religious Organizations & Public Health

"Critical Elements for Successful Community-Based Research Endeavors to Address Musculoskeletal Health Disparities: Faith Communities as Potential Environments Fostering Healthy Aging"
Elizabeth Gerken Hooten, ScD, MSPH, CPH
Research Associate, Center for Spirituality, Theology and Health
Duke University Medical Center
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Co-authors: Christine Grant, PhD & Keith Meador, MD, ThM, MPH
In this poster, we articulate a framework (using extant research practices and intervention models) for developing and implementing community-based endeavors using faith communities as a location through which to: 1) build health literacy around many topics related to aging (with a special emphasis on musculoskeletal health); 2) foster resource and support networks to facilitate better medical care utilization and compliance; and 3)engage people across generations in health advocacy, not only for themselves and their families but also for their community. These endeavors are targeted toward communities chronically underserved (and culturally and ethnically diverse).

"Spirituality, Health-Seeking Behavior and Stress in Mumbai, India"
Hillary A. Lewin, MA
PhD Candidate
Ferkauf Graduate School of Psychology
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Co-authors: Heather Glubo, MA; Pejman Sehatpour, MBBS, PhD; Sonia Suchday, PhD
This study assesses spirituality and it's relation to health-seeking behavior, stress and somatic symptoms in India. Students completed questionnaires on: Spiritual Well-Being (SWB) measuring Existential (EWB) & Religious Well-Being (RWB), somatic symptoms (CHIPS), and perceived stress (PSS). The Participants rated how frequently they engaged in behaviors to cope with health issues (Health-Seeking Behavior Scale: HSBS). Principal component analysis of the HSBS revealed three factors: Religious Practice (prayer), Alternative Practices (yoga/meditation), Home Care (home remedies, parental support). RWB, EWB, SWB positively correlated (p<.001) with religious practice. Alternative practices were not correlated with spirituality, even though these practices originated in eastern cultures; possibly because this sample was drawn from a liberal, westernized institution whose culture exemplifies rapid globalization, representing acculturation to western values. EWB and SWB were negatively correlated with stress and SWB negatively correlated with CHIPS (p<.001). Health-seeking behaviors were not correlated with stress and CHIPS, therefore mediation was not possible.

"Mental Health and Chaplaincy: A New Paradigm for Integrative Care in the Veterans Health Administration"
Jason Nieuwsma, PhD
Associate Director, Veterans Affairs Mental Health and Chaplaincy
VA Mid-Atlantic MIRECC
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As a result of their military service, veterans and their families are at heightened risk not only for mental health problems (Hoge et al., 2004; Mansfield et al., 2010) but also for particular types of spiritual suffering, including guilt for wartime atrocities (Henning & Frueh, 1997), moral distress (Litz et al., 2009), and loss of meaning and purpose in life (Fontana & Rosenheck, 2004). Recognizing that mental health and spirituality are interrelated aspects of overall health and are optimally attended to within a coordinated system of care, the VA has launched a new initiative entitled Mental Health and Chaplaincy. This presentation will overview ongoing efforts within the initiative – outreach to faith communities, chaplain training conferences, and research examining chaplains’ roles in mental health care – as well as future intentions to engage care providers from faith communities, chaplaincy, and mental health for participation in an integrated system of health care.

"Walking as Spiritual Practice: Developing Practical Opportunities for Congregational Health"
Rev. Stacy Smith
Supervisor, Christian Formation in Wellness
Church Health Center
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Co-authors: Butch Odom; John Shorb; Kira Dault
This poster will present a theological grounding for the Christian practice of walking, which leads to health improvements and strengthening the bonds of Christian fellowship. Specifically we will consider different avenues (an individual walking journal, a "walking bible study" for small groups, a Lenten walking devotion) and assess how they impact an individual's commitment to their physical and spiritual health. We will also address clergy health problems and assess the benefits of "healthy competition" in motivating clergy to increase their walking activity. We will draw on two programs for this data: first, the Church Health Center’s various walking programs, which challenge individuals and groups to increase their average daily number of steps in effort to increase overall health. Secondly, we will utilize research completed by the Amazing Pace, an initiative created for the Mississippi conference of the United Methodist Church, which tracks the steps of a group of community pastors.

"Body Image Perception and Religion: A Qualitative Examination Utilizing Semi-Structured Interviews"
Chasisity Springs, MSPH
Epidemiologist, SC State Influenza Surveillance Coordinator
Walden University student
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Black women tend to be more satisfied with their bodies, regardless of their weight (Ard, Greene, Malpede & Jefferson, 2007). Body image perception (BIP) contributes to whether or not a person will attempt to gain or lose weight. Racial differences in motivation to lose weight likely contribute to the higher proportion of obese black women (Stevens, Kumanyika & Keil, 1994). Therefore, it is important to understand how women of varying races feel about their bodies and what factors influence these feelings. Some studies have indicated that religion may be associated with higher BIP in some women (Boyatzis & Cline, 2007). This qualitative study will explore how women feel about their bodies, their religious beliefs and practices, and potential links between the two. In-depth telephone interviews will be conducted with five females recruited from a pool of research participants affiliated with an online university.

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Spirituality & Clinical Care

"A Qualitative Exploration of Spiritual Care at the End-of-Life (Final Report)"
Ann M. Callahan, PhD, MSSW, LCSW
Assistant Professor of Social Work
Lincoln Memorial University
Spirituality is a significant resource for patients at the end-of-life; however, there is limited research on the processes underlying spiritual care and access to training and practice guidelines. A qualitative study was conducted to explore how hospice workers identified spiritual needs, provided spiritual care, and determined their effectiveness. Respondents indicated that patient verbal and nonverbal cues were the most important in assessing patient spiritual needs and the effectiveness of spiritual care. Three styles of spiritual care emerged relative to the degree of interpersonal intimacy associated with each intervention. Overall, the results revealed a range of factors that could have influenced the delivery of spiritual care, and, thus, realize the potential for patients to experience peace at the end of life.

"Religion, Spirituality and Palliative Care"
Kevin J. Flannelly, PhD
Associate Director of Research
Healthcare Chaplaincy
Co-authors: Nava Silton, PhD; Kathleen Galek, PhD
This paper presents the results of an electronic search of the PubMed database to identify articles pertaining to religion and spirituality in palliative care journals. Of the 7,051 articles published in eight palliative care journals from 2000 to 2009, 153 articles (2.2%) featured religion and spirituality as the major focus of the articles. The percentages varied widely across the journals, with religion and/or spirituality articles comprising less than 1% of all articles in three of the journals and up to 7.5% in one of the other journals. Approximately three-quarters of these articles centered on spirituality in palliative care, with the most common themes relating to spiritual care, spiritual distress and spiritual pain. Several of the religion articles discussed the provision of palliative care to patients of different religious faiths. The paper explores these and other prominent themes in the literature and assesses the current research being conducted in this area.

"The Widow, Orphan, and Stranger Within: Jewish Ethics and Intrapsychic Otherness in Psychotherapy"
David M. Goodman, PhD
Department of Psychiatry Clinical Fellow
Harvard Medical School
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The dichotomy between self and other so prominent in Eurocentric philosophical/psychological paradigms buckles under the weight of more recent discourses that locate otherness not merely outside of the self, but also within the self. Though recognizing increasing multiplicity in selfhood, without a healthy dialogue with spiritual and/or religious traditions, psychological paradigms and practices remain impoverished of any substantive guiding ethics or language for the conversation between diverse facets of the self; they retain implicit, disguised, "thin," and unrecognized ethical systems. Joining with others that describe psychotherapy as a moral discourse, this presenter uses the thought of Emmanuel Levinas to put forward a Jewish ethical system to formulate and enrich a model that engenders gentleness and conversation between disavowed facets of the self, recognizing them as the "widow, orphan, and stranger" to which we are called to ethical responsibility and non-violence. Implications for psychotherapeutic practice are explored.

"Hope and Hospice: What We Can Do When ‘There’s Nothing More We Can Do’"
Charlotte LaForest, MA, MSW, LCSW
Spiritual Care Coordinator
AseraCare Hospice
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With death as an immanent possibility, and with curative interventions no longer indicated, it is easy for a hospice patient to fall into despair. Because of this, the members of the interdisciplinary hospice team are charged with identifying hope in seemingly hopeless circumstances, ensuring that all patients approach death in a state of physical, emotional, and spiritual comfort. This can be challenging, as hope must shift from that of total recovery to other goals that can bring meaning to one's final days. These hopes may be focused on a specific event, such as attending a family wedding, on the reconciliation of shattered relationships, or perhaps on the attainment of some measure of peace and integration of life experiences. This paper utilizes theory and case studies to suggest approaches for fostering hope in patients with terminal illness. This paper also addresses the particular challenges for patients with advanced dementia.

"The Unique Contribution of Spiritual Coping to Health-related Quality of Life with Heart Failure"
Terry Larsen, RN, PhD, CNS
Lecturer, Simulation Coordinator
California State University San Marcos at Temecula
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Depression commonly accompanies heart failure affecting quality of life (HRQoL). The purpose of this study was to examine possible factors affecting HRQoL in adults with heart failure. A cross-sectional correlation design conducted at a large regional cardiomyopathy clinic(N=115) using The Duke University Religion Index, Religious Coping Scale, the Demoralization Scale, the Beck Depression Inventory-II, and the Kansas City Cardiomyopathy Questionnaire. T-tests revealed significant differences for positive religious/spiritual coping t(113) = 2.72, 95, 84, p< .05. Women reported lower mean HRQoL scores 58.86 (SD 26.59) than men 68.57 (SD 24.77); and used more positive religious coping 20.95 (SD 4.97) than men 18.05(SD 6.20) p<.05. Correlation analysis found depression and demoralization to be highly correlated (r = .801; p<.05). A significant negative relationship between depression and HRQoL (r = -.645, p<.001), demoralization (r = -.507; p<.001) and spiritual distress (r = -.218; p<.05) was found. Only depression significantly contributed to HRQoL at 42%.

"The Importance of Spirituality in Twelve-Step Programs: A National Opinion Survey of Primary Care Physicians"
Ryan E. Lawrence, MDiv
Student, Pritzker School of Medicine
University of Chicago
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Co-author: Farr A. Curlin, MD
Twelve-step programs help many recover from addictions, but physicians disagree about why they work. Method: We conducted a national probability sample mail survey of 1500 U.S. primary care physicians. The criterion variable was agreement with the statement, "An emphasis on spirituality is critical to the success of twelve-step programs." Covariates included demographic, clinical, and religious characteristics. Response was 58% (875/1500). Most strongly agree (40%) or somewhat agree (45%) that emphasizing spirituality is critical to twelve-step program success. Nearly all Catholics (90%), Protestants (97%), and Muslims (90%) believe spirituality is critical, versus 66% of unaffiliated doctors (OR 4.4-16). Doctors who attend services at least twice a month were more likely than non-attenders to believe spirituality is critical (94% versus 66%, OR 7.2). We concluded that religious physicians are more likely to believe an emphasis on spirituality is critical to the success of twelve-step programs.

"Religiosity and Utilization of Formal Mental Health Services among African Americans"
Alicia Lukachko, DrPH
NIMH Postdoctoral Fellow
Columbia University
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The Black Church has historically provided African Americans (AA) an important measure of autonomy and affirmation in the face of racism. AA have turned to the Church for many reasons, including mental health. Reliance on the Church and religious norms, however, may contribute to underutilization of formal mental health services among AA. This study used a U.S. representative sample of 3,570 AA to assess the relationship between religiosity and utilization of formal mental health services. High organizational religiosity and subjective religiosity were associated lower formal service use (OR = .7; OR = .6). Presence of a diagnosable DSM-IV anxiety, mood, or substance disorder moderated this relationship, such that organizational religiosity inversely predicted utilization only among those without disorder. No significant interaction was detected between subjective religiosity and disorder. Efforts should focus on how formal mental health services might complement the concrete and intangible benefits associated with religiosity in this population.

"Multidimensional Forgiveness: Development of a Brief Measure, Links to Health, and Use in Spiritual Care"
Amy D. Owen, PhD
Postdoctoral Fellow
Center for Spirituality, Theology and Health
Duke University Medical Center
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Co-authors: Kaela L. Stuart; Justin C. Marschall; Whitney J. Keltner; Loren L. Toussaint, PhD
Issues of forgiveness are common concerns among patients seeking spiritual counseling, yet few appropriate measures exist to screen for forgiveness-related problems in patients. The purpose of these studies was to develop a brief, psychometrically sound multidimensional measure of forgiveness for use in research and spiritual care, assessing forgiveness of oneself and others, feeling forgiven by others, and feeling forgiven by God. Several self-report measures were completed by 178 participants. The construct validity of this measure was demonstrated using confirmatory factor analyses, and in three separate samples, its reliability and validity was further demonstrated showing expected correlations. In addition, a comparison of the measure with health assessments found that forgiveness of self and others and feeling forgiven by others was associated with less perceived stress, mental distress, and physical illness symptoms. Future studies will assess its validity in patient samples. Implications for research and clinical care will be discussed.

"The Lived Experience of Being Physically Healed at a Religious Service"
Renee Provost, PhD, APRN, BC
Associate Professor
Saint Joseph College
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The purpose of this study was to discover the essence of the lived experience of being physically healed at a religious healing service. Using the heuristic, phenomenological design, the study examined the psychological factors associated with the experience of being physically healed. The investigation included motivations, attitudes, beliefs, and feelings that occur before, during, and after the healing phenomenon. Data was gathered through in-depth interviews and journaling. Data analysis used Moustakas’ (1990) six steps. No universal set of motivations, attitudes, or beliefs prior to the experience of being healed were discovered. The diverse individual motivations, attitudes, and beliefs were unified by an experience of surrender that preceded the experience of healing. The moment of healing was characterized by the experience of unusual and extraordinary physical sensations, emotions, and awareness and a sense of peace and transcendence. After the healing experience, all participants reported a deeper, living faith.

"Perspectives of Service Providers and Recipients on Spirituality and its Role in the Management of Chronic Medical Conditions and Disabilities"
Parameshwaran Ramakrishnan, MBBS, DPM
Director, Medical Education and Clinical Research
H.E.L.P. Foundation of Omaha
The AdiBhat Foundation of India
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Spirituality plays a major role in the health care needs of a person with chronic medical illness or disability and in coping with the burden among caregivers. Many American and European professional schools have courses on spirituality as a part of their curriculum while schools from other nations do not. Representative samples of service providers and caregivers of persons with mental retardation were interviewed. Instruments used were GHQ-12, Professional QOL scale, and Caregiver’s Burden Scale. All the participants were also asked about their views and visions regarding the relationship between spirituality and health care issues using a survey questionnaire (Curlin et. al. 2007). Preliminary findings reveal that high caregiver burden correlates with high GHQ scores, female caregivers experience more burden than males. Elderly caregivers were more likely to seek spiritual support. There was an overwhelming endorsement by service providers and caregivers for instituting curricular courses on spirituality as a part of professional courses.

"Human Systems Dynamics: Embedding Spirituality into Long Term Memory Care"
Janice K. Ryan, OTD
Owner and Program Consultant
Human Systems Occupational Therapy
Adjunct Professor
University of Tennessee Health Sciences Center
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The Social-Spiritual Model of Dynamic Memory Care (Ryan, 2009), a program development process emerging from doctoral research is concurrently identifying and informing "best" memory care practices through facilitation of social-spiritual staff and community behaviors. A five year developmental process, theoretical modeling, observational journaling and thematic analysis provide ongoing insights on supportive social processes that increase engagement of residents with memory loss through targeted staff and community behavior changes. Using human systems dynamics tools, spirituality is embedded in all aspects of staff training and resident care as a relationship-building behavior pattern attractor. Two key social-spiritual patterns embedded in all aspects of staff and program development are "system-wide interconnectivity" and "sharing of inner knowledge of self with others." Periodic coaching further shifts staff-focus from automatic work behaviors toward spiritual patterns of adaptive social processes utilizing intercommunication strategies such as simplified language, non-verbal cues or increased staff understanding of automatic behavioral patterns.

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Theological Considerations

"Theology of Disability: Attitudes toward Clergy with Mobility Impairments; A Photo Elicitation"
James R. Brennan, PT, PhD
Assistant Professor
The Sage Colleges
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The purpose of this study, through the use of photo elicitation, is to describe attitudes that able-bodied people have towards clergy with disabilities. Subjects were shown pictures of clergy in wheelchairs and asked open-ended questions. The results can be divided into the following two categories; 1) The theology of the disabled body, whereby disability is linked to increased levels of compassion and spirituality, and the awareness of suffering. 2) The socio-cultural construction of the disabled body which addresses the complexity of attitudes of able-bodied people and society in general towards persons with disabilities.

"The Influence of Various Theological Views of Suffering on Health"
Arvin M. Gouw, MA, MA
PhD Candidate in Pathobiology
Johns Hopkins University School of Medicine
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Patients in suffering often ask: "why God?" Christianity provides multiple explanations to why we suffer. They can be grouped into deontological and teleological explanations. Deontological explanations include: retributive justice, original sin, free will and demonic influence as sources of suffering. Teleological answers to suffering include: the test view, the contrast view and the divine plan argument. Patient’s perception of suffering and why suffering happens will influence their healing or dying process. As each of aforementioned view is discussed, this paper argues that the deontological understanding of suffering will dishearten patients, while the teleological view of suffering gives patients hope. It is more important to remember that God will end suffering, than to keep wondering what caused suffering. Compared to the deontological understanding, the teleological view of suffering will help patients battle their illness better.

"On the Faithfulness of Letting Go: Hospice, Religion, and Redefining the Good Death"
Aaron Klink, MAR, MDiv, ThM
Chaplain
Amedisys Hospice
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In the wake of papal pronouncements by John Paul II and Benedict the XVI there has been a renewed stress in some bioethical circles on the value of maintaining life at almost any cost, fearful that "letting go" may represent a willingness to ignore and not care for "the least of these my brethren". It is time that we reclaim faithful dying and a faithful forgoing of medical technology as a means of being faithful to human finitude. Still, barriers to good palliative care, even in hospice settings remain. This paper explores ways to conceive of hospice, and the forgoing of medical interventions for loved one's as a faithful path within Christian tradition. It focuses on ways in which hospice care returns to ancient Christian traditions of dying well, hospitality, and a willingness to attend to one's relationship to God and significant others.

"The Rosary at the Bedside: A Helpful Conceretized Meditative Practice"
Fr. Christopher M. Saliga, OP, BSN, STB, MDiv, MA, RN
Chaplain and Bioethics Lecturer
Walsh University and The Dominican Friars Health Care Ministry of New York
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Co-authors: Sr. Margaret Oettinger, OP; Br. Ignatius Perkins, OP, Br. Augustine Reisenhauer, OP
Within this presentation, a history and theology of the Rosary as a concrete Christocentric meditative prayer is provided. Then, the results of an informal qualitative survey (personal interviews) given to a convenience sample of 40 self identified Catholic patients at Hospital for Special Surgery indicate that positive effects, such as comfort to the lonely and suffering, do occur in conjunction with this prayer/spiritual practice. One patient states "I am not alone when I pray the Rosary;" another claims "When I pray the Rosary, I feel that I do have a companion in my suffering;" while another shares "the Rosary gives me the opportunity to celebrate life, hope, and God's promises." Given the full list of responses and limited research on the subject, further research regarding holistic effects on patients praying the Rosary is encouraged.

"Conversations at the Edge of Life: Towards a Theological Assessment of the Needs of the Dying"
James H. Wise, DM, MA, MBA, BS, PE
Interim Director, Center for Faith & Health
Palliative Medicine Chaplain
Penn State Hershey Medical Center and College
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Studies indicate that the spiritual needs of the dying often go unmet. Although the reasons for this situation are multi-dimensional, a fundamental reason may lie in the unavailability of a suitable spiritual assessment instrument. Although JCAHO mandates a spiritual assessment for all patients, it does not indicate what constitutes a spiritual assessment. Current research suggests that the majority of existing instruments use mental health criteria as opposed to spiritual or theological criteria, rendering them useless for an effective assessment of spiritual needs. Preliminary results will be presented from a pilot study being conducted with Palliative Medicine patients for whom cure is no longer possible. The hypothesis of the study states that the needs of these patients are grounded in intrapersonal, interpersonal, and transcendent relationships. A "Pyramid of Needs" provides a framework for understanding these needs and leading to a proposed theological-sensitive spiritual assessment (tSA©) for assessing those same needs.

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