Religion, Culture and Spirituality

Religion, Culture and Spirituality

Critically discuss the ethics and efficacy of including religion and spirituality in clinical practice

Intro

Theme 1: religious coping

Theme 2: religion=protective through regulation of substance abuse for example.

Theme 3: religious delusions. The adverse role religion may play in schizophrenic and bipolar patients.

Theme 4: POV from individuals themselves, research shows they want it included person centered care upmost importance

Conclusion: practical applications, what we can now do after knowing this information from the research evidence. Such as, better training in religion for psychologists before taking on clients.

Religious coping - Religious coping refers to functionally oriented expressions of religion in times of stress.

recent changes instituted by the Joint Commissionthe most prominent health care accrediting organization in the United states which now requires behavioral health organizations providing addiction services to administer a spiritual assessment (Hodge, 2006b; Koenig, 2007). -alcohol reading

Introduction

In the past, religion and mental health were closely related, with priests and monks operating several of the earliest mental hospitals. When Freud begun to link hysteria and neurosis to religion in the 19th Century (Parsons, 2021), claiming that religion was merely a role in the father complex, this close relationship begun to untangle. During recent times, the viewpoint that religion has no place in psychological development, has begun to alter. The rise of research and practise into person-centred care, advocating for whole aspects of service users to be considered, has influenced this returning perspective. This reinstated viewpoint can further be seen, for example, within intuitions placing requirements for Mental Health training in religion and spirituality (Koenig, 2009). Understanding how a person's faith and beliefs interact with their health is challenging, which can be seenby the diversity in theresearch and the numerous fields of study that attempt to investigate this association.

Definitions pertaining to religion and spirituality has changed over the years in order to successfully capture the accurate prevalence of religious and spiritual individuals universally. Building on the work of Hill et al. (2000) religion can be defined as the search for meaning that takes place within the context of established institutions that are intended to aid spirituality. Thus, spirituality can be defined as the search for the sacred. According to Hill et al. (2000), religion and spirituality are bothcomprised of two major components. This includes a concept of the sacred and a search for what is sacred. Throughout this essay, religion and spirituality will be referred to as RS.

Mental illnesses test coping resources and RS may serve as either a beneficial factor in coping oraharmful component in coping. Pargament (2001) argues there are two forms of religious coping, positive and negative. Positive religious coping refers to feeling a sense of closeness to God. In this form, God is seen as supportive hence life events are interpreted in a positive way. Contrastingly, negative religious coping refers to feelings of anger towards God, feeling God deserted you and having religious doubts by i.e., questioning Gods goodness.

This essay will critically evaluate the efficacy of including RS in clinical practice, by analysing whether religious beliefs play a favourable role in psychological development, or whether they adversely affect the course of these disorders and patients responses to treatment.

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Originally, religion and MH were tightly connected in the past. Many of the first mental hospitals were ran by priests and monasteries. Only 19th Century when Freud begun to associate religion with hysteria and neurosis. Universal obsessional neurosis. This has begun to change, American college psychiatry requirements include training on how RS influences psychological development.

Diverse fields of psychology (reading 1) what each field says.

The diversity of research and the various fields of study underscore the complexity of attempting to understand how a persons faith and beliefs relate to their illness or health.

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Theme 1: religious coping, research showing how positive religious coping is effective, research showing how negative religious coping is detrimental (so incorporating may cause more harm, finding alternatives to religion in this instance may be better and separating religion from treatment)

Many individuals with mental health conditions turn to religion for solace, hope, and significance. However, it may restrict life for some as opposed to enhancing life. Religious coping refers to expressions of religion that are functionally focused

This can be attributed to the service users religious orientation. According to Allport & Ross (1967) extrinsically oriented individuals tend to utilise religion for their own objectives, such as for comfort, distraction, sociability and self-justification. Whereas individuals who are intrinsically orientated discover their purpose and destinywithin theirreligious beliefs. Research has found the former to lower depression and the later to increase depression (Smith et al., 2004).

Further research into RS and depression shows religious coping being related to depression outcome. Religious coping refers to expressions of religion that are functionally focused during times of stress. Using a longitudinal study design, Bosworth et al. (2003) examined 114 geriatric depressed patients undergoing treatment. Patients completed a modified version of Pargaments RCOPE to measure religious coping along with supplementary measures such as social support and religious practise. The Montgomery-Asberg Depression Rating Scale (MADRS) was completed by a psychiatrist, both at baseline and at six-months. They found that religious coping was related to MADRS scores and that reporting higher levels of positive religious coping was significantly related to lower six-month MADRS scores. Thus, it was concluded that clinicians providing care for elderly depressed patients may consider inquiring about spirituality and religious coping for the purpose of enhancing depressed outcomes.

Bosworth et al. (2003) research was successfully able to contribute towards the literature surrounding religious coping by using a longitudinal design to measure levels of depression over time. At the time of publication, the majority of studies incorporated cross-sectional designs (Bush et al., 1999; Koenig et al., 1997), subsequently limiting the ability to identify changes over time. With respect to the nature of religious coping research, it may be beneficial to measure patients depression levels at independent stages, to make accurate assumptions on religious coping styles and its influence on depression progressively. Hence, the present study highlighted the need for longitudinal research in this area, feasibly influencing more recent research to also take on this approach. Moreover, an additional contribution to the literature can be noted through the data collection methods. Rather than using self-report measures that evaluate depressive symptoms, a geriatric psychiatrist was utilized in order to assess depression. This is advantageous as previous research failed to implement this important factor (Koenig et al., 1997). By employing a qualified clinician to measure the dependent variable, a more accurate picture of the patients depression severity can be drawn, anew maintaining high internal validity consistently. Furthermore, the well-defined exclusion criteria utilized, assures readers that confounding variables have been considered. By eliminating possible confounders, such as having another major psychiatric illness, this further contributes to the overall internal validity of the paper by adding to the credibility of its conclusions.

Nevertheless, it is important to note the role of social support as an issue when exploring religion and depression. Social support has been found to improve depressivesymptomsand functionsas a buffer against stressful life situations (Dollete & Phillips, 2004). According to research on intrinsic and extrinsic religiousness, social support components may bepresentwithin these variables (Idler and George, 1998).This raises questions on whether religious orienting systems' ability to reduce depression is in fact due to their inherent social support nature and whether social support should be pushed in place of RS being incorporated in treatment. Notwithstanding, Bosworth et al. (2003) were successfully able to demonstrate positive religious coping being significantly related to lower MADRS scores, irrespective of social support.

In addition to Bosworth et al. (2003) research, supplementary evidence for RS and depression outcomes can be seen in various additional papers as of more recent. Supporting these findings, studies such as Sandage et al., (2020); Voytenko et al., (2021); Kilbourne et al., (2009) further corroborate these conclusions.

Nevertheless, a few limitations can be noted and used to direct future research in this area. Like using more minorities and controlling for ..Also when looking at anxiety, this may differ .. critical

Though research provides evidence for positive religious coping leading to greater well-being and lower levels of depression, some studies have found this not to be consistent with their findings.

Furthermore,

Theme 2: more into detail on what it is specifically about religion, that is protective. research finding how religion=protective, why religion may protect against i.e., depression. Therefore, efficacy is high as may contribute to protective factors (when assessing)

A further way religion may protect against depression is through the characteristics and regulations imposed within religion. Religion prohibits the use of drugs and alcohol which consequently may aid in higher quality of life for individuals. Incorporating religion within clinical practise may therefore decrease patients levels of substance abuse. Research into substance abuse and depression has suggested the adverse role abusing substances has on mental health. For example, Fergusson et al. (2009) found that alcohol abuse leads to increased risk of major depression. Other studies have also corroborated these findings (Hasin & Grant, 2002); Wang & Patten, 2001). Consequently, over the years, such evidence has been used to enhance methods of reducing substance abuse to aid in the fight against depression. CBT is an effective approach used to treat alcoholism, however According to a survey of addiction treatment experts,84% believe spirituality should be emphasised more in treatment (Forman et al,. 2001). Such preferences have influenced the need for modified treatment approaches, such as spiritually adjusted CBT. According to (Hodge, 2011) delivering more culturally congruent services, spiritually adjusted CBT has been found to expedite recovery, improve treatment compliance, avoid relapse, and reduce treatment inequities. Similarly (Hodge, 2006) found the outcomes of spiritually adjusted CBT to be superior to the outcomes of regular CBT. Such research implies the efficacy of including RS in treatment approaches for patients.

But negative religious coping, guilt.

However research has shown how misinformation and imposing your views may be a problem. To control for this, cultural brokers may be the solution.

Theme 3: religious delusions. The part religion may play in schizophrenic and bipolar patients.

Theme 4: POV from individuals themselves, they want it included person centered care upmost importance. However number of religious professionals is very low compared to number of RS patients. Could be detrimental if RS not correctly understood and ps could be mislead. Practical application could be a cultural broker.

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Types of religious coping - times of mental illness are times that challenge coping resources and RS may be a positive or a negative factor in coping.

: positive religious coping with positive psychological adjustment, positive religious coping with negative psychological adjustment, negative religious coping with positive psychological adjustment, and negative religious coping with negative psychological adjustment.

Many people suffering from MH seek refuge in religion for comfort, hope and meaning. For some it may restrict life rather than enhance life however.

This essay will critically evaluate the efficacy of including RS in clinical practice, by analysing whether religious beliefs play a favourable role in psychological development or whether they adversely affect the course of these disorders and patients responses to treatment.

And whether the efficacy of including RS in clincical practice.

Define key terms religion, spirituality, state will be referred to as RS

General > Specific: common in Introductions, Backgrounds or any opening paragraphs. The topic (first) sentence in a paragraph would be a general statement and then you elaborate on this by adding more detailed information to support the general statement. This structure is often used to introduce a thesis statement.

Main body

RS efficacy in different areas of mental health: depressive disorders (suicide) psychotic disorders (schizophrenia and bipolar) and anxiety disorders.

Conclusion

Providing sensitive, patient-centred care involves the challenge of considering all aspects of our patients lives, being willing to examine and understand our own biases, working together to optimize mental health and being willing to engage in open dialogue with no restrictions.

Important notes

PLEASE STRESS THE IMPORTANCE OF PATIENT CENTERED CARE IN CLINICAL PRACTICE patient should always be involved in their treatment

Patient-centred care is the most ethical and successful type of care. If your patient is religious, important to include this in their care as some people their religion is a part of their life. If you want patients to engage and feel like an individual rather than part of a system, you must include. Patients express their preference for consideration of RS.

Pratical applications: It may be necessary to use a culture broker, someone from the same religious group as the patient who acts as the patients advocate.

Readings

Clinical Implications of Research on Religion, Spirituality, and Mental Health

Mental illness is a time when personal resources are challenged and RS may be a clinically significant positive or negative source of coping.

There is limited research into practical psychospiritual interventions in psychiatrically ill populations.

Research considering religion, spirituality, and health (physical or mental) comes from diverse fields including cognitive and social psychology, neuroscience, epidemiology, and medicine. This has led to widely varying models of religions influence on healthhealth behaviours, social support, psychological states, super empirical or psi states reflecting that the different pathways by which RS may influence health

Examples of religion- based influences on health behaviours include proscriptions regarding the excess use of nicotine, alcohol, or drugs of abuse, and in some cases prescriptions about diet. Substance dependence and abuse have high comorbidity with many psychiatric disorders but correlate negatively with RS measures.

Religious service attendance positively associated with other positive health behaviours including use of preventive health care, enhanced physical activity, and fewer risk-taking activities. Theme 2

People with an extrinsic orientation are disposed to use religion for their own ends (that is, security, solace, sociability, distraction, status, and self-justification). People with an intrinsic orientation find their reason for being in their religious beliefs one lowers depression later increases depression (intro)

Religious behaviours that contribute to self-regulation by reducing self-focus and worry while providing a calming effect (for example, contemplative prayer, mindfulness meditation, and religious rites) are positively associated with MH.

Pargament39 has developed positive and negative religious coping measures that reflect various coping styles, such as self-directing, collaborative, deferring, and surrender. He summarizes the findings in this body of research by noting that better mental health has been linked positively to a religion that is internalized, intrinsically motivated, and based on a secure relationship with God and negatively to a religion that is imposed, unexamined, and reflective

Altruism, gratitude and forgiveness religious teachings leading to lower MH problems. Also on physical health like chronic pain etc. So not reductionist. Better physical health leads to better MH. Link between physical and mental.

Interventions that have examined volunteering, gratitude, and forgiveness show promising results in healthier populations

Patients express their preference for consideration of Religion and Spirituality.

Contrasting views that say religion incorporation is not Ethical - Sloan et al argue the existence of 4 major areas of ethical concern. First, owing to the power differential between a physician and patient, an element of coercion can be present in matters of faith. Also, that a persons faith or spiritual practice is inherently private and need not be revealed to a health care professional. Further, occasions may occur where harm could come from the specific religious approach; for example, promotion of the belief that if one just has enough faith, their difficulties will resolve. Finally, they argue that, in effect, advice to engage in religious observances is inherently discriminatory. (theme 4)

Reading 2

Research on religion, spirituality and mental health a review

90% of worlds population involved in some form of RS practise. Further stats found in this reading (good for introduction).

Religious coping studies and stats. Most common beneficial coping strategy was RS, seen in various parts of the world, From US UK.

Suicide, religion prevents suicide through doctrines that inhibit suicide but also through comfort and supportive community.

Efficacy of mindfulness etc in anxiety disorders. Read up on research.

Religion might have potential to cause fear and guilt in patients with anxiety, which could cause them to be more anxious.

Substance abuse RS reduces self-destructive tendencies. Studies that find less substance abuse among the more religious. Recent studies support these findings and show difference in minority groups. However also, if religious and start using substances, this can become more severe and lead to completely withdrawing from RS causing worse MH due to guilt and shame.

Psychotic disorders RS may contribute to pathology rather than alleviate it.

Reading 3

Working with patients with religious beliefs

Cox argues that: if mental health services in a multicultural society are to become more responsive to user needs then eliciting this religious history with any linked spiritual meanings should be a routine component of a psychiatric assessment, and of preparing a more culturally sensitive care plan

Mystical states - It is important that psychiatrists respect and differentiate unusual but integrating experiences from those that are distressing or disorganising. A negative response to a mystical experience may intensify an individuals sense of isolation and block his or her efforts to seek assistance in integrating and assimilating the experience. So, it is important to make the patient feel comfortable to share their spiritual experiences as ignoring it can intensify certain negative reactions. May also answer questions of engagement, help the carer understand.

Religious delusions and bipolar disorder problems. There is some evidence that religious delusions may result in harm to self and others. A study of psychiatric inmates in an American penal institution found that over half of its most dangerous inmates had religious delusions.

Chaplains are increasingly becoming a part of the multidisciplinary team in the UK, a fact justified on the basis that religious and spiritual needs are prevalent among patients with acute and chronic mental illness.

Using religious imagery in cognitivebehavioural therapy, to enhance efficacy in patients with religious beliefs may be more effective than therapy lacking in this imagery. Other therapists have argued for the incorporation of religious values such as forgiveness into psychotherapy.

Reading 4

Religious coping and psychological adjustment to stress a SR

Many studies have found that religious coping is typically related to more positive outcomes to stressful events. Pargament, et al. (1990) found that religious coping efforts involving the belief in a just and loving God, the experience of God as a supportive partner, involvement in religious rituals, and the search for spiritual and personal support were significantly related to better outcomes, such as recent mental health status and spiritual growth. However, other studies have found religious coping to be related to more negative outcomes, i.e., more negative mood, lower self-esteem, and greater anxiety while coping with a major negative life event such as an illness or injury, death.

Positive coping (1) religious purification/ forgiveness; (2) religious direction/conversion; (3) religious helping; (4) seeking support from clergy/ members; (5) collaborative religious coping; (6) religious focus; (7) active religious sur- render; (8) benevolent religious reappraisal; (9) spiritual connection; and (10) marking religious boundaries. The negative strategies included (1) spiritual discontent; (2) demonic reappraisal; (3) passive religious deferral; (4) interpersonal religious discontent; (5) reap- praisal of Gods powers; (6) punishing God reappraisal; and (7) pleading for direct inter- cession

Positive outcomes included (1) acceptance; (2) emotional well-being; (3) general positive outcome; (4) happiness; (5) hope; (6) life satisfaction; (7) optimism; (8) personal adjustment; (9) personal growth; (10) positive affect; (11) purpose in life; (12) resilience; (14) self-esteem; (16) spiritual growth; (17) quality of life. Negative outcomes included (1) anxiety; (2) burden; (3) callousness; (4) depression; (5) distress; (6) global distress; (7) guilt; (8) hopelessness; (9) hostility; (10) impairment; (11) mood disturbance; (12) negative affect; (13) negative mood; (14) perceived stress; (15) social dysfunction; (16) spiritual injury; (19) suicidality

Although negative religious coping may be harmful, it does not necessarily prevent people from experiencing positive outcomes. In fact, a few empirical studies have shown that negative religious coping is associated with some positive outcomes, such as stress-related growth and spiritual growth

References

Parsons, W. B. (Ed.). (2021).Totem and Taboo: The Origin of Religion. Cambridge University Press; Cambridge University Press. https://www.cambridge.org/core/books/abs/freud-and-religion/totem-and-taboo/EF968DF6A97E0AAAD1F06166051E33E8#access-block

Koenig, H. G. (2009). Research on Religion, Spirituality, and Mental Health: A Review.The Canadian Journal of Psychiatry,54(5), 283291. https://doi.org/10.1177/070674370905400502Hill, P. C., Pargament, K. II., Hood, R. W., McCullough, Jr., Michael E., Swyers, J. P., Larson, D. B., & Zinnbauer, B. J. (2000). Conceptualizing Religion and Spirituality: Points of Commonality, Points of Departure.Journal for the Theory of Social Behaviour,30(1), 5177. https://doi.org/10.1111/1468-5914.00119 Pargament, K. I. (2001).The Psychology of religion and coping : theory, research, practice. Guilford Press.

Allport, G. W., & Ross, J. M. (1967). Personal religious orientation and prejudice.Journal of Personality and Social Psychology,5(4), 432443. https://doi.org/10.1037/h0021212

Smith, T. B., McCullough, M. E., & Poll, J. (2004). Religiousness and depression: Evidence for a main effect and the moderating influence of stressful life events: Correction to Smith et al. (2003)..Psychological Bulletin,130(1), 6565. https://doi.org/10.1037/h0087878

Bosworth, H. B., Park, K.-S., McQuoid, D. R., Hays, J. C., & Steffens, D. C. (2003). The impact of religious practice and religious coping on geriatric depression.International Journal of Geriatric Psychiatry,18(10), 905914. https://doi.org/10.1002/gps.945Koenig, H. G., Hays, J. C., George, L. K., Blazer, D. G., Larson, D. B., & Landerman, L. R. (1997). Modeling the cross-sectional relationships between religion, physical health, social support, and depressive symptoms.The American Journal of Geriatric Psychiatry,5(2), 131-144.

Bush, E. G., Rye, M. S., Brant, C. R., Emery, E., Pargament, K. I., & Riessinger, C. A. (1999). Religious coping with chronic pain.Applied psychophysiology and biofeedback,24, 249-260.

Steese, S., Dollette, M., Phillips, W., & Hossfeld, E. (2006). Understanding GIRLS'CIRCLE as an intervention ON perceived social support, body image, self-efficacy, locus OF control, and self-esteem.Adolescence,41(161), 55.

Idler, E. L., & George, L. K. (1998). What sociology can help us understand about religion and mental health. InHandbook of religion and mental health(pp. 51-62). Academic Press.

Sandage, S. J., Rupert, D., Stavros, G., & Devor, N. G. (2020).Relational spirituality in psychotherapy: Healing suffering and promoting growth. American Psychological Association.

Voytenko, V. L., Pargament, K. I., Cowden, R. G., Lemke, A. W., Kurniati, N. M. T., Bechara, A. O., ... & Worthington Jr, E. L. (2021). Religious coping with interpersonal hurts: Psychosocial correlates of the brief RCOPE in four non-Western countries.Psychology of Religion and Spirituality.

Kilbourne, B., Cummings, S. M., & Levine, R. S. (2009). The influence of religiosity on depression among low-income people with diabetes.Health & Social Work,34(2), 137-147.

Theme 2 -

Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2009). Tests of Causal Links Between Alcohol Abuse or Dependence and Major Depression.Archives of General Psychiatry,66(3), 260. https://doi.org/10.1001/archgenpsychiatry.2008.543Hasin, D. S., & Grant, B. F. (2002). Major Depression in 6050 Former Drinkers: Association With Past Alcohol Dependence.Archives of General Psychiatry,59(9), 794800. https://doi.org/10.1001/archpsyc.59.9.794Wang, J., & Patten, S. B. (2001). Alcohol Consumption and Major Depression: Findings from a Follow-up Study.The Canadian Journal of Psychiatry,46(7), 632638. https://doi.org/10.1177/070674370104600708Hodge, D. R. (2011). Alcohol treatment and cognitive-behavioral therapy: Enhancing effectiveness by incorporating spirituality and religion.Social work,56(1), 21-31.

Hodge, D. R. (2006). Spiritually modified cognitive therapy: A review of the literature.Social Work,51(2), 157-166.

Critical essay guidance

refer to what other scholars have already said. But you dont want to just repeat it.

Instead, you want to try to build on it to make a pointof your own.

Creating your own theoretical framework.

Evaluating other scholars work.

Analysing their evidence or logic.

-Putting their work into a wider context.

- Making evaluative observations about what they choose to emphasise, the concepts

that they use and their methodology.

-Comparing and contrasting their work with that of other authors.

Paraphrase instead of quoting where possible

Use questions as rhetorical device to guide readers attention

The question of why failed to is central here.

Relate your discussion back to your argument

Evaluative questions that prompt you to clarify the implications of what youre reading or writing why am I saying this? Or how does this relate to the question?

Evaluative questions prompt us to think about the wider significance of a text.

What are the implications of this?

What can be learnt from this?

Describing

Giving examples

Providing definitions

Describing methods

Analysing

Comparing and contrasting

Make a concession

Evaluate

appraisal (how important is it?)

estimation (what is the value?)

rating (how good is it?)

interpretation (what does it mean?)

assessment (what can I make of it?)

draw a conclusion (end of paragraphs too not just essay)

suggest a solution (also evaluate your solution)

Questions to think about when analysing literature

Is their conclusion justified? Is it supported by the evidence?

What are the flaws in their work? What are the positives?

Does the author support a certain theory, method or school of thought?

How does the work fit in with other literature? (I.e., does it support what others have said or argue against others?).

Cornell Notes. This involves dividing your page into four parts: bibliographical details, notes, questions and summary.

Tips:

If you have many texts that say similar things, use exemplars:

This pattern has been noted by many researchers including, for example, Jackson et al, who found that

Point out the gaps in the literature:

While much has been written on childhood and teenage obesity (for example, Hobbs 2016, Shuster et al 2017, Claridge et al 2020) little research has been conducted on obesity in young adults.

Where appropriate, tell the reader what you will not be including in your literature review:

While the causes of the Russian Revolution are often debated, it is beyond the scope of this work to discuss them.