Spirituality and Religious Practices in Recovery from Behavioral Health Issues
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Victorious Living - Spiritual Foundation for Healthy Living and Coping
By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T
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The Issues at Hand
Research published this year found a relationship between coping behaviors and mental health symptoms. The coping behaviors were: 1) talking to a friend, 2) exercising or playing sports, 3) engaging in a hobby, and 4) thinking of a plan. These behaviors were associated with fewer anxiety, perceived stress, and depression symptoms, whereas smoking a cigarette, having a drink, and thinking about hurting or killing oneself were associated with more anxiety, perceived stress, and depressive symptoms. Marijuana and illicit drug use was also associated with higher depressive symptoms. Saying a prayer was not significantly related to individuals’ mental health (Morgan, Hourani & Tueller, 2017). These findings ignore spiritual/religious practices as being healthy coping behaviors which flies in the face of other research and data which support such practices and we are now going to look at this data.
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Why use spiritual/religious practices?
Data has shown that there is use of prayer to lessen the symptoms of depression especially with individuals who smoke, use alcohol, and have irregular exercise. Individuals’ use of prayer as a potential complementary treatment for depression suggests that it is critical for mental and physical health treatment providers to be aware of the use of prayer as a coping resource (Wachholtz & Sambamoorthi, 2013). Research has shown that there is a connection between loving images of God and a sense of meaning and purpose and that a specific way of thinking about God is related to a prevailing understanding of personal well-being which strengthens individuals’ commitment to the recovery from their pressing behavioral health problems (Stroope, Draper & Whitehead, 2013). In researching individuals’ approach to spiritual/religious practices four types of practices were identified: 1) religious service attendance, 2) prayer, 3) positive religious coping, and 4) daily spiritual experiences (Park, et al., 2013). Also, there are 4 classes of spiritual/religious oriented individuals: 1) highly religious, 2) moderately religious, 3) somewhat religious, and 4) minimally religious or non-religious. These four classes were distinctively different in psychological well-being, in that the highly religious class was most likely to be happy and satisfied with finances and least likely to be psychologically distressed (Park, et al., 2013). Clearly working with individuals using spiritual/religious practices involves helping them to overcome their own resistance to the effectiveness of such practices in helping them recover and stay healthy.
Research in 2005 found that women, African-Americans, and those with lower incomes pray more often than males, whites, and those with higher incomes (Baker,2008). This study also found that African-Americans and those at lower levels of income and education are more likely to pray about petitionary concerns such as asking God to influence personal health or one's financial situation (Baker, 2008). Also, people at lower income levels are more likely to offer prayer in an effort to gain supernatural favor and good standing with the divine which for these people is using prayer as a coping mechanism. More recent data suggests that religion and spirituality play a key role in African-American adolescents’ experiences of depression and it is believed that these factors may be important for improving treatment-seeking behaviors and reducing racial mental health disparities in this population of youth (Breland-Noble, Wong, Childers, Hankerson & Sotomayor, 2015). Black men who reported the use of religion and spirituality as a coping strategy for diabetes management used the following coping strategies: 1) prayer and belief in God, keeping me alive, 2) turning things over to God, 3) changing my unhealthy behaviors, 4) supplying my needs, 5) reading the Bible, and 6) networking with helpful religious or spiritual individuals (Namageyo-Funa, Muilenbrug & Wilson, 2015). Clearly when working with individuals who are African American offering spiritual/religious practices for their recovery programs would be supported based on the research data collected within this population.
After 9/11, positive spiritual coping was highly associated with positive spiritual outcomes of feeling closer to God by survivors, but it was unrelated to lower stress or mental health which supports the belief that spiritual/religious practices will improve outlook on life and help individuals to feel spiritually invigorated as they work to relieve the trauma and stress they are dealing with post experiencing traumatic events (Meisenhelder & Cassem, 2009). Cognitive processing within a prayer relationship with a Deity may well be related to current theories of posttraumatic distress, which posit that healthy adaptation to traumatic events requires an ability to tolerate the distress or trauma-related memories so that the memories, and the affect associated with them, can be processed and assimilated into healthy memory structures. Prayer provides a calm and focused coping function facilitating cognitive processing and meaning-making, and ultimately posttraumatic growth (Harris, et al., 2010).
Of the Alcohol and Substance Abuse treatment centers surveyed in a research study, 91% indicated that they include a twelve-step orientation treatment component in their delivery of services. Given the spiritual basis of the 12-step approach, these results are significant that these centers employ a conspicuously spiritual approach in their treatment and supports the use of 12-step programming in all efforts used to assist individuals to address their behavioral health needs (Priester et al., 2009).
Use of spiritual/religious practices as a coping strategy is widespread and often claimed to have positive effects on physical disorders including pain. Religious beliefs and practices are complex phenomena and the use of prayer may be mediated by general psychological factors known to be related to the pain experience, such as expectations, desire for pain relief, and anxiety (Jegindo, et al., 2013). In terms of dealing with chronic pain it was found that it is important to distinguish between pain severity and pain tolerance, and that prayer can play a role in pain management, especially for pain patients willing to utilize spiritual/religious practices in dealing with pain. It was shown that prayer assists in the positive re-appraisal of stress and coping with pain as an important underlying mechanism in the association between prayer and pain (Dezutter, Wachholtz & Corveleyn, 2011).
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Why do people use spiritual/religious practices?
Often people pray to hand over their problems to God. Putting the problem in God’s hands is similar to the idea of ‘‘spiritual surrender’’ and ceasing to strive for complete control over uncontrollable events (Levine, 2008). This concept is employed in Alcoholic Anonymous groups when members are encouraged to give up control to a ‘‘higher power.’’ The advice to give up control to a higher power or to surrender spiritually may be relieving simply because the person ceases to expend energy in a futile quest (Levine, 2008).
On the other hand, for many, using spiritual/religious practices is a duty based on how they were raised. If this is the case, then practicing spiritual/religious practices will enhance their self-esteem because they will have fulfilled a duty and lived up to an ‘‘ego ideal.’’ Fulfilling a duty or acting in accord with an ideal will result in enhanced self-esteem. ‘‘I did the right thing, or I did a good thing, therefore I am a good person’’ is the the self-talk in this regard. People who are socialized in religious belief and practice feel ill at ease if they fail to pray. They feel more comfortable after having fulfilled their religious duty (Levine, 2008).
Feelings of despair and hopelessness are based at least in part on psychologically restricting one’s life space to a narrow present. Foreclosing the future may be related to depression, hopelessness, and even suicide. A psychological focus on future events may temporarily lift a depressed mood on a path from religiousness and prayer through optimism, to a better adaptation to behavioral health. Optimism and hope are certainly semantically related in that both are future oriented concepts (Levine, 2008).
Invoking the image of a supportive God is also antidote to a feeling of loneliness. The act of praying thus may provide immediate relief from loneliness by directing thinking to a supportive God, and away from distress by arousing a future oriented feeling of hope (Levine, 2008).
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Prayer and Meditation are Closely Allied
The descriptions of mental states associated with some forms of prayer seem similar to those accompanying meditation. If the regular practice of prayer induces a state of mind and a sense of relaxation much like that achieved in meditation, the person who prays regularly should attain the benefits described in the extensive literature on physiological changes associated with meditation. These include effects on the autonomic, endocrine, immune, skeletal, and smooth muscle systems. The benefits of the regular practice of prayer may derive in part from the physiological changes associated with the meditative state and with the relaxation of tension subsequent to giving the problem over to God, and perhaps with the conditioned response to praying of distress relief (Levine, 2008).
The Downside of Use of Spiritual/Religious Practices in Behavioral Health Treatment
There are people who have negative religious coping methods with the fear of evil and constant threats to their value systems which become stressors in their lives. These people might be experiencing anger, depression or anxiety based on spiritual struggles, such as demonic reappraisals, punishing God reappraisals, spiritual discontent, and reappraisals of God’s powers (Phillips & Ano, 2015). Recent theory into the importance of spiritual integration suggests that a “match” between one’s own beliefs and one’s religious group might result in better psychological health and spiritual well-being (Phillips & Ano, 2015). It would be important for individuals who are working on their personal recovery be helped to work on healing their personal relationships with the spiritual/religious foundations in which they were raised before they are encouraged in utilizing spiritual/religious practices in their recovery efforts.
Impact of Spiritual/Religious Practices on Behavioral Health
Research has shown that:
- There are protective effects from faith-based behaviors rather than simply from the changing cognitive beliefs about health and wellness
- Prayer for health concerns has increased-35% of American Adults report recent use of prayer for health concerns and 69% of them reported prayer as helpful (Wachholtz & Sambamthoori, 2011 & 2013)
- Regular worship attendance increases lifespan 7 years
- Regular attendance at religious services protects health by these folks cutting down on their smoking
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What are common issues involved with people who seek out help in Recovery
- Addictive behaviors
- Stress
- Depression
- Problems in Social functioning or Interpersonal Relationships
Types of Spiritual Beliefs and Practices
- Positive vs. Negative
- Public vs. Private
- Intrinsic vs. Extrinsic
- Existential vs. Religious
Unique factors of Spiritual Beliefs and Practices
- Spiritual Support
- Spiritual Growth
- Spiritual Meaning Making Attributions
- Additional Efficacy Beliefs
Impact of Spiritual Beliefs and Practices on Psycho-Social Changes
- Meaning Making Attributions
- Self-Efficacy
- Distraction
- Social Support
- Instrumental Support
- Relaxation
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Physiological/Neurological Changes based on Spiritual Beliefs and Practices
- Altered neurotransmitter levels
- Changed conduction of pain signals
- Different threshold for recognizing pain signals
- Decreased Hypothalamic–Pituitary–Adrenal Axis (HPA) activity levels
Who are the people who utilize Spiritual Beliefs and Practices to address their emotional concern?
- Older (>33 years)
- Female
- More Educated (> High School)
- Have chronic mental or physical health issues: depression, chronic headaches, back and/or neck pain
Examples of Spiritual/Religious Coping Techniques
There are 4 distinct types of Religious/Spiritual Coping Styles
- Deferential-Giving all control of problem to God
- Collaborative-Joint problem solving with God
- Independent-God not involved due to no belief
- Abandoned- God not involved because feel abandoned
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Common Spiritual/Religious Coping Tools
- Prayer
- Hope
- Meditation
- Reading faith-based literature
- Finding spiritual role models for coping
- Seeking spiritual support/connection
- Seeking instrumental support
- Religious reappraisal
- Church attendance
Positive Spiritual/Religious Coping Behaviors
- Seek spiritual connection
- Seek spiritual support
- Religious assistance to forgive others
- Asking forgiveness
- Benevolent religious reappraisal
- Religion as distraction
- Collaborative problem solving with God
Negative Spiritual/Religious Coping Behaviors
- Interpersonal religious discontent
- Punishing God reappraisal
- Demonic reappraisal
- Spiritual discontent
- Reappraisal of God’s power
FICA – Quest to ask self or others about Spiritual/Religious Beliefs
- F: Faith or beliefs: “Tell me something about my (your) faith or beliefs.”
- I: Importance & influence: “How does this influence my (your) health/well-being?”
- C: Community:” Am I (Are you) a part of a supportive community?”
- A: Address or application: “How would I (you) like to address these issues in my (your) behavioral health care?”
What to remember about use of Spiritual/Religious Beliefs in Recovery from Behavioral Health Concerns
- Spirituality can have a powerful effect on pain and health - Both positive and negative
- Assessing spiritual health is an important component of a behavioral health assessment
- Critical to assess for type of spiritual coping
- Do not attempt to do spiritual counseling, but know available professional resources in your area
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References:
Baker, J. (2008). An investigation of the sociological patterns of prayer frequency and content. Sociology of Religion, 69(2), 169-185.
Banziger, S., Van Uden, M. & Janssen, J. (2008). Praying and coping: The relation between varieties of praying and religious coping styles. Mental Health, Religion & Culture, 11(1), 101-118. DOI: 10.1080/13674670600748386
Breland-Noble, A.M., Wong, M.J., Childers, T., Hankerson, S., & Sotomayor, J. (2015). Spirituality and religious coping in African-American youth with depressive illness. Mental Health, Religion & Culture, 18(5), 330-341. DOI:10.1080/13674676.2015.1056120.
Dezutter, J., Wachholtz, A. & Corveleyn, J. (2011). Prayer and pain: The mediating role of positive re-appraisal. Journal of Behavioral Medicine, 34, 542-549. DOI:10.1007/s10865-011-9348-2
Harris, J.I., Erbes, C.R., Engdahl, B.E., Tedeschi, R.G., Olson, R.H., Winskowski, A.M.M., & McHahill. (2010). Coping functions of prayer and posttraumatic growth. The International Journal for the Psychology of Religion, 20, 26-28. DOI:10.1080/10508610903418103
Jegindo, E.E., Vase, L., Skewes, J.C., Terkelsone, A.J., Hansen, J., Geertz, A.W., Roepstorff, A., & Jensen, T.S. (2013). Expectations contribute to reduced pain levels during prayer in highly religious participants. Journal of Behavioral Medicine, 36(4),413-426. DOI 10.1007/s10865-012-9438-9
Levine, M. (2008). Prayer as coping: A psychological analysis. Journal of Health Care Chaplaincy, 15, 80-98. DOI:10.1080/08854720903113424
Meisenhelder, J.B. & Cassem, E.H. (2009). Terrorism, posttraumatic stress, spiritual
coping, and mental health. Journal of Spirituality in Mental Health, 11, 218-230. DOI:10.1080/19349630903081275
Morgan, J.K., Hourani, L. & Tueller, S. (2017). Health-related coping behaviors and mental health in military personnel. Military Medicine, 182 (3/4), 1620-1627. DOI:10.7205/MILMED-D-16-00165.
Namageyo-Funa, A., Muilenbrug, J. & Wilson, M. (2015). The role of religion and spirituality in coping with type 2 diabetes: A qualitative study among black men. Journal of Religion & Health, 54(1), 242-252. DOI:10.1007/s10943-013-9812-0.
Park, N.S., Lee, B.S., Sun, F., Klemmack, D.L., Roff, L.L., & Koenig, H.G. (2013). Typologies of religiousness/spirituality: Implications for health and well-being. Journal of Religion & Health, 52(3), 828-839. DOI 10.1007/s10943-011-9520-6
Phillips, R.E. & Ano, G.G. (2015). A re-examination of religious fundamentalism: Positive implications for coping. Mental Health, Religion & Culture, 18(4), 299-311. DOI:10.1080/13674676.2015.1022521.
Priester, P.E, Scherer, J., Stenfeldt, J.A., Jana-Masri, A., Jashinsky, T., Jones, J.E. & Vang, C. (2009). The frequency of prayer, meditation and holistic interventions in addiction treatment: A national survey. Pastoral Psychology, 58(3), 315-322. DOI:10.1007/s11089-009-0196-8
Stewart, W.C., Adams, M.P., Stewart, J.A. & Nelson, L.A. (2013). Review of clinical medicine and religious practice. Journal of Religion & Health, 52(1), 91-106. DOI:10.1007/s10943-012-9578-9
Stroope, S., Draper, S., & Whitehead, A.L. (2013). Images of a loving god and sense of meaning in life. Social Indicators Research, 111(1), 25–44. DOI 10.1007/s11205-011-9982-7
Wachholtz A, & Sambamoorthi U. (2011). National trends in prayer use as a coping mechanism for health concerns: Changes from 2002 to 2007. Psychology of Religion and Spirituality, 3(2):67–77.
Wachholtz A, & Sambamoorthi U. (2013). National trends in prayer Use as a coping mechanism for depression: Changes from 2002 to 2007. Journal of Religious Health, 52, 1356-1368. DOI:10.1007/s10943-012-9649-y
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