Improving psychiatric nurses' competencies in spiritual care and integration of clients' religion/spirituality into mental healthcare: outcomes of an online spiritual care training program

BACKGROUND

Religion/spirituality (R/S), which is associated with individuals' well-being and psychological health, plays a significant role in most clients' lives in healthcare systems. Although clients in mental healthcare settings prefer their R/S to be employed in nursing care, R/S has neither been adequately integrated into mental healthcare nor discussed in the assessment and nursing interventions of mental healthcare. Evidence shows that most psychiatric nurses receive little or no training in spiritual care (SC) and are unable to integrate clients' R/S into mental healthcare. To address this gap, the present study aimed to investigate the effects of an online SC training program on psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare.

METHODS

This experimental study was conducted with nurses working in a psychiatric hospital affiliated with a large University of Medical Sciences in southeast Iran. Random sampling was performed and 95 nurses were assigned to the intervention (n = 50) and control (n = 45) groups. Online SC training was conducted for the intervention group in four sessions over four weeks. Data were collected using the Self-Assessment of Spiritual Care Competency and R/S Integrated Practice Assessment Scale before and one month after the training program.

RESULTS

There were no significant differences between the two groups before training (p > 0.05). After the training, nurses in the intervention group obtained significantly higher scores in competencies in SC and integration of clients' R/S into mental healthcare compared to the control group, with a considerable effect size (P < 0.05).

CONCLUSION

The online training program positively affected psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare. Since SC is a critical need for clients, specifically in mental healthcare settings, nurses must receive continuous education to provide SC to various clients.

Adaptations of evidence-based trauma-focused interventions for children and adolescents: a systematic review

BACKGROUND

Rates of potentially traumatic events (PTEs) and other forms of adversity among children are high globally, resulting in the development of a number of evidence-based interventions (EBIs) to address the adverse outcomes stemming from these experiences. Though EBIs are intended to be delivered according to set parameters, these EBIs are frequently adapted. However, little is known about existing adaptations of EBIs for children who experienced PTEs or other adversities. As such, this review aimed to determine: (1) why existing EBIs designed to address PTEs and other adversities experienced by children are adapted, (2) what processes are used to determine what elements should be adapted, and (3) what components of the intervention are adapted.

METHODS

Nine academic databases and publicly available search engines were used to identify academic and grey literature. Initial screening, full-text review, data extraction, and quality determinations were completed by two members of the research team. Data were synthesized narratively for each adapted EBI by research question.

RESULTS

Forty-two studies examining the adaptations of nine different EBIs were located, with Trauma-Focused Cognitive Behavioral Therapy and Cognitive Behavioral Intervention for Trauma in Schools being the most commonly adapted EBIs. Most frequently, EBIs were adapted to improve fit with a new population and to address cultural factors. Most commonly, researchers in combination with others made decisions about adapting interventions, though frequently who was involved in these decisions was not described. Common content adaptations included the addition of intervention elements and the tailoring/tweaking/refining of intervention materials. Common contextual adaptations included changes to the intended population, changes to the channel of treatment delivery, and changes to who administered the intervention.

CONCLUSIONS

Most published studies of EBI adaptions have been developed to improve fit and address cultural factors, but little research is available about adaptations made by clinicians in day-to-day practice. Efforts should be made to evaluate the various types of adaptations and especially whether adaptations improve access to services or improve child outcomes in order to ensure that all children exposed to trauma can access effective treatment.

TRIAL REGISTRATION

The protocol for this systematic review was published with PROSPERO (CRD42020149536).

Exploring the Concept of Spiritual Sensitivity from the Perspectives of Healthcare Providers in Iran

Spiritual sensitivity (SS) is defined as attention to the available spiritual values in a conflicting situation and awareness of one's roles and responsibilities in that situation. It helps differentiate between the right and the wrong and leads to sound practice. This study explored the concept of SS from the perspectives of healthcare providers in Iran. This qualitative study was carried out in 2017-2019 using conventional content analysis. Twenty-two physicians, faculty members with clinical work experience, and healthcare providers were purposefully recruited. Data were collected using unstructured interviews and were analyzed using conventional content analysis. Participants' experiences of the concept of SS were grouped into three main themes, namely sense of value, spiritual growth and morale boosting, and SS as a motivator for purposeful service delivery. The findings of the present study will help healthcare managers develop programs for improving healthcare providers' spiritual sensitivity and also will help healthcare providers develop spirituality-based holistic care plans.

The Body, the Mind, and the Spirit: Including the Spiritual Domain in Mental Health Care

This article supports the expansion of Engel's (Science (AAAS) 196(4286):129-136, 1977) biopsychosocial model into a biopsychosocial-spiritual model, as Sulmasy (The Gerontologist 42(5):24-33, 2002) and others have suggested. It utilizes case studies to describe five areas of clinical work within mental health (religious grandiosity, depression and grief, demoralization and suicidality, moral injury, and opioid use disorder) with emerging evidence for the inclusion of the spiritual domain in addition to the biological, psychological, and social. For each clinical area, an underutilization of the spiritual domain is compared with a more developed and integrated use. An argument is made for continuing to develop, understand, and utilize a biopsychosocial-spiritual model in mental health.

Trusting in God: Religious and Spiritual Support in Mental Health Treatment Expectations in Mexico

Religious and spiritual practices have been identified as a main source of mental health support for Latinxs to improve overall health and well-being. This qualitative secondary data analysis sought to elucidate how Mexican patients and family members engaged in religious and spiritual practices to help alleviate patients' experiences of mental illness. Three main findings are discussed: (1) positive religious coping such as entrusting God with one's suffering, consejos (i.e., emotional support and advice giving), and positive social supports through religious communities; (2) negative religious coping such as harmful views of God as punishing; and (3) indigenous healing practices such as engagement with curanderos (medicine doctor) and limpias (i.e., herb-based cleanses). The authors discuss these findings in the context of tensions between culturally sanctioned healing and the perception of psychotherapeutic effectiveness reported by Mexican patients and their family members. The authors also provide future directions for incorporating patients' religious and spiritual practices into multiculturally competent treatment.

Indirect Effects of Forgiveness on Psychological Health Through Anger and Hope: A Parallel Mediation Analysis

Forgiveness often discussed as a religious idea is also a popular topic in psychology. Empirical studies have shown that forgiveness decreases anger, anxiety, and depression and increases self-esteem and hopefulness for the future. However, research on the relationship between various outcomes of forgiveness is scarce. Thus, we aimed at examining the mediating roles of anger and hope in the relationship between forgiveness and psychological health outcomes. A sample of college students from a large non-profit university (N = 202) filled out self-report measures on forgiveness, anger, anxiety, depression, hope, and self-esteem. A parallel mediation analysis examining the role of anger and hope in the forgiveness-psychological health link was conducted. Results supported the indirect effect of forgiveness on psychological health through anger and hope, and the two mediators had a comparable size of magnitude. Implications, limitations, and future directions are discussed.

Instruments for Assessing Spiritual/Religious Coping in Multicultural Clinical Settings

ABSTRACT

A review of literature was conducted to discover and compare various instruments that could be used in daily nursing practice to assess spiritual and religious coping in a variety of multicultural clinical settings. Fifteen spiritual and religious (S/R) instruments were identified, used in 31 studies in multiple countries. These S/R coping tools may be useful to nurses in assessment and for planning interventions.

Religious and Non-Religious Workplace Mobbing Victims: When Do People Turn to Religious Organisations?

Researchers' interest in the impact of religious-spiritual assistance on victims of violence has increased in recent decades; however, factors that are relevant to workplace mobbing victims who seek such assistance remain poorly investigated. The purpose of this study is to highlight the factors that make spiritual assistance of religious organizations acceptable to religious and non-religious workplace mobbing victims. The study involved 463 adults working in Lithuanian organizations, of whom 79.5 per cent indicated that they were religious. ANOVA and Chi-square tests revealed that the significant factors were similarity of personal and religious values, the relation with the person providing assistance, and the circumstances characterising assistance. This study promotes further scientific discussion on the involvement of religious organizations in helping victims of workplace mobbing and explains why religious and non-religious individuals seeking assistance turn to religious organizations. The article presents only a part of the research results of the implemented project.

Could Alcohol Abuse and Dependence on Junk Foods Inducing Obesity and/or Illicit Drug Use Represent Danger to Liver in Young People with Altered Psychological/Relational Spheres or Emotional Problems?

Recent data show that young people, mainly due to the pressure of some risk factors or due to disrupted interpersonal relationships, utilise greater reward value and display greater sensitivity to the reinforcing properties of “pleasurable stimuli”, specifically in those situations in which an enhanced dopamine release is present. Alcoholic beverages, foods rich in sugar and fat, and illicit drug use are pleasurable feelings associated with rewards. Research shows that there is a link between substance abuse and obesity in brain functioning. Still, alcohol excess is central in leading to obesity and obesity-related morbidities, such as hepatic steatosis, mainly when associated with illicit drug dependence and negative eating behaviours in young people. It is ascertained that long-term drinking causes mental damage, similarly to drug abuse, but also affects liver function. Indeed, beyond the pharmacokinetic interactions of alcohol with drugs, occurring in the liver due to the same metabolic enzymes, there are also pharmacodynamic interactions of both substances in the CNS. To complicate matters, an important noxious effect of junk foods consists of inducing obesity and obesity-related NAFLD. In this review, we focus on some key mechanisms underlying the impact of these addictions on the liver, as well as those on the CNS.

Clergy Resilience: Accessing Supportive Resources to Balance the Impact of Role-Related Stress and Adversity

Resilience is a helpful construct when considering how to support clergy well-being. The purpose of this study was to gain knowledge about clergy resilience, specifically those resources that clergy perceived had supported their professional resilience. The study gave attention to aspects of preservice training and professional development that helped to foster clergy resilience and initiatives that clergy desired to further support their resilience. Clergy reported multiple resources that supported their resilience including supports for spiritual life, relational supports, personal aspects, and organizational practices. Spiritual dimensions of support for resilience were prominent for clergy, especially the centrality of calling to ministry, theological meaning-making, and relationship with God. Participants also revealed helpful aspects of preservice training and professional development. Aspects of preservice training included rigorous discernment and screening of their callings and the inclusion of required practices, such as spiritual direction or mentorship. Aspects of professional development included a variety of skill development opportunities, lifelong learning, conferences, and networking with peers. Participants reported their desire for initiatives that included more wellness opportunities and an increased organizational prioritization of clergy wellness.

Embitterment - Conception of a Potential Moderator to Dysfunctional and Aggressive Behaviour in Children and Adolescents

Embitterment is an emotion which is known to everybody in reaction to injustice, humiliation, and breach of trust. Children and adolescents have an understanding of justice/injustice and fairness, violations of injustice, humiliation, and breach of trust are also stressors at a young age. In this conceptual paper it is argued that embitterment is also seen in children and adolescents, and that parents, educators and therapists should recognize this emotion. This could possibly help to early identify children at risk for severe dysfunctional and aggressive behaviours, when preventive interventions are still possible. The article concludes with concepts on how to diagnose and treat children with embitterment.

Can Rational Emotive Behaviour Therapy (REBT) and Mindfulness be Integrated Effectively within High Performance Settings?

Our critical commentary explores the overlaps and divergences between Rational Emotive Behaviour Therapy (REBT) and contemporary mindfulness practice and considers whether the approaches could be integrated and applied effectively within two high performance settings in particular: sport and business. It highlights how REBT and mindfulness share similar philosophical positions on the causes of emotional disturbance, on the importance of acceptance, and on cultivating self-awareness to respond healthily and adaptively to adverse events. It also acknowledges diverenges relating to REBT and mindfulness' respective positions on judgement of thoughts, an emphasis on the present moment, and meditative practice. We observe that by cultivating metacognitive awareness-a capacity to impartially observe thinking-mindfulness may help individuals in high performance settings to see more clearly how their beliefs influence their emotional, cognitive, and behavioural outcomes. Mindfulness could thus potentially aid an individual's transition from intellectual insight to emotional rational insight within an REBT framework. Moreover, appropriately integrated mindfulness practice alongside REBT-based work may help individuals within high performance settings, and beyond, to cultivate a mindset that is grounded in the present, less distracted and more task focused, potentially enhancing performance outcomes.

Exploring associations between the Modular Assessment of Risk for Imminent Suicide (MARIS) questionnaire and recent suicidal ideation and behavior among patients admitted at an acute psychiatric inpatient department

PURPOSE

The aim of the present study was to investigate the psychometric validity of the Modular Assessment of Risk for Imminent Suicide (MARIS) questionnaire in relation to recent suicidal ideation and behavior among a sample of patients admitted to an acute psychiatric inpatient department in Norway.

METHODS

The MARIS was completed within the first 24 h after admission by 338 patients and their clinicians. Information on recent suicidal ideation and behavior was extracted from patients' medical charts. Two out of four MARIS modules, the Suicide Trigger Scale Short-Form (STS-SF; modified version), and the Therapist Response Questionnaire Short-Form (TRQ-SF) demonstrated good internal consistency. The relationships between the STS-SF, addressing symptoms of the suicide crisis syndrome, and the TRQ-SF, exploring therapist emotional responses, and recent suicidal ideation was investigated by logistic regression analysis.

RESULTS

In the logistic regression analysis including pre-selected diagnoses, age, and gender as covariates, both STS-SF and TRQ-SF showed significant associations with recent suicidal ideation (inclusive of suicidal behavior in 27% of the patients with suicidal ideation).

CONCLUSION

Both the STS-SF and the TRQ-SF showed concurrent and incremental validity with regard to suicidal ideation. This is the first study showing the cross-cultural validity of the MARIS and supports its clinical utility as a suicide risk assessment tool in inpatient settings. Additionally, this study adds to the literature supporting the value of assessing clinicians' emotional responses to high risk patients.

Elizabeth Schuyler Hamilton in psychobiography: Sense of coherence and faith across her lifetime

This article focuses on the coping skills of one selected, extraordinary woman, Elizabeth Schuyler Hamilton (1757-1854) during the founding of the United States of America. This work contributes to theory on two different levels. First, it contributes to psychobiographical research on women in diverse spheres of society, thereby strengthening the aspect of gender and coping strategies in terms of psychobiographical perspectives. Second, it contributes to theory-building in psychobiographical research anchored in positive psychology, promoting the idea that a multiplicity (crystallisation) of theories should be used to explore and analyse the lifespan of extraordinary individuals. The psychobiography responds to the question how Elizabeth Schuyler Hamilton coped with life's challenges and tragedies through the lenses of sense of coherence and faith development theory. The article uses a psychobiographical case study design within the research paradigm of modern hermeneutics. First- and third-person data on the subject were collected and evaluated through thematic analysis, including articles, documentation, letters, film material, and political scripts. Customary ethical standards for psychobiographical research were followed, thereby ensuring an ethical, respectful, empathetic and accountable research approach. The article presents findings on the coping skills, sense of coherence, and faith development in the life of Elizabeth Schuyler Hamilton which strongly influenced her resilience and support for others during her long and extraordinary life. Conclusions are drawn with regard to the way women cope in different sociocultural, sociopolitical and socio-economic spheres using historical and contemporary retrospectives. Recommendations are provided for future psychobiographical research on women in diverse contexts and in psychobiographical, gendered practice.

The Well-Being and Resilience of Canadian Christian Clergy

Clergy play significant leadership, educational, and caregiving roles in society. However, burnout is a concern for the clergy profession, those they serve, and their families. Effects include decreased ministry effectiveness, lower sense of personal accomplishment in their role, and negative impacts on quality of family life and relationships. Given these risks, knowledge of the nature of Christian clergy's current resilience and well-being in Canada may provide valuable intelligence to mitigate these challenges. In summary, the purpose of this research was to describe and analyze the status of clergy resilience and well-being in Canada, together with offering focused insights. Resilience and well-being surveys used by the co-authors with educators and nurses were adapted for use in this study. This instrument was developed to gain insight into baseline patterns of resilience and well-being and included questions across seven sections: (1) demographic information. (2) health status, (3) professional quality of life, (4) Cantril Well-Being Scale, (5) Ego-Resiliency Scale, (6) Grit Scale, and (7) open-ended questions. The findings provided valuable insights into clergy well-being and resilience that can benefit individual clerics, educational institutions, denominations, and congregations. The participants' current resilience and well-being included high levels of resiliency, moderate grit, and satisfaction with health and wellness. Other significant findings included the impact of congregational flourishing and age. This study found that clergy well-being and resilience was doing well despite the increased adversity of the COVID-19 pandemic. Implications of this study are that clerics may need unique supports based on their age and also whether they serve in a congregation they perceive as flourishing.

Latent Class Analysis of Victimization Patterns and Associated Protective Factors among LGBTQ Youth

Youth victimization in schools remains a fervent public health issue, despite increased awareness of this issue, and this is especially true for marginalized populations like lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. Youth violence has been studied widely, but less research has sought to understand factors protective of violence victimization, particularly protective factors shared across multiple forms of violence. In the current study, we utilized latent class analysis to test patterns of three types of victimization: peer victimization (PV), homophobic name-calling victimization (HNCV), and sexual harassment victimization (SHV). In addition, we tested protective factors associated with experiencing these types of violence. Our sample included 4778 9-11th graders in the United States, of which about 15% identified as LGBTQ. Three unique classes of victimization emerged, suggesting that concurrent forms of violence occur among some groups of adolescents. LGBTQ youth were more likely to be members of classes which demonstrated higher levels of victimization. Consistent with previous literature, medical access, counseling access, family support, peer support, and spirituality emerged as significant protective factors associated with a lower risk of victimization. We discuss the implications of our findings with specific attention to protecting the wellbeing of SGM youth.

Family Support and Hope among People with Substance Use Disorder in China: A Moderated Mediation Model

Studies have shown that hope is an important protective factor. At present, few of the available studies on hope have been conducted on people undergoing compulsory rehabilitation. This study explores the mediating role of resilience between family support and hope, and whether relapse plays a moderating role between family support, resilience, and hope. A total of 647 people with substance use disorder completed surveys on Perceived Social Support from Family Scale, Connor-Davidson Resilience Scale, and Herth Hope Index. Structural equation modeling was used to examine the moderated mediation analysis. Family support not only has a direct effect on hope, but also has a significant indirect effect on hope through resilience. The indirect effect of family support on hope via resilience was significant among both the non-relapse group and relapse group; in addition, both the association between family support and resilience and the relation between resilience and hope were moderated by relapse experience. The results indicate that interventions targeting resilience might be an effective approach to improving hope among people with substance use disorder in China.

The role of repetitive thinking and spirituality in the development of posttraumatic growth and symptoms of posttraumatic stress disorder

Both post-traumatic growth (PTG) and post-traumatic stress disorder (PTSD) are associated with spirituality and different kinds of repetitive thinking, such as deliberate rumination (DR) and intrusive rumination (IR), respectively. This study aimed to examine if spirituality modifies the relationship between types of rumination and trauma outcomes. Ninety-six students completed an online survey of four questionnaires in a cross-sectional online survey: The Posttraumatic Stress Diagnostic Scale, the Event Related Rumination Inventory, the Posttraumatic Growth Inventory-Short form and the Expressions of Spirituality Inventory- Revised. Findings revealed that spirituality was related to DR and PTG, but not to IR or PTSD symptoms. Moderation analysis showed that spirituality significantly moderated the relationship between PTG and DR, but not the relationship between PTSD and IR. These findings indicate that while spirituality has no relationship with negative outcomes of trauma, it may help individuals to ruminate in a constructive manner in order to develop positive outcomes.

Four profiles of symptom change in residential Cognitive Processing Therapy

A significant portion of veterans do not respond to evidence-based treatments for PTSD. Therefore, researchers have sought to predict who will respond well to trauma-focused treatment. The present study examined pre- and posttreatment symptom profiles, session-by-session change, as well as demographic and additional diagnostic information to better understand PTSD treatment response. Participants included 332 veterans undergoing residential Cognitive Processing Therapy. Latent profile analyses were computed, and four meaningful profiles emerged: Fast Responders, Steady Responders, Partial Responders, and Minimal Responders. Each profile demonstrated symptom reduction at approximately the same rate in the first half of treatment. Two specific profiles, Steady Responders and Minimal Responders, showed key clinically important differences. Both profiles demonstrated severe pretreatment PTSD symptom severity; however, in the second half of treatment, Steady Responders saw the steepest decrease in symptoms of any of the profiles while Minimal Responders saw less symptom reduction compared to all other profiles. Via a thorough examination, membership in Steady Responders compared to Minimal Responders was not associated with demographic or health variables. Results suggest that pretreatment symptom severity does not necessarily determine a client's posttreatment symptom severity. Pretreatment symptom severity did not determine outcome, though some veterans (Minimal Responders) did not experience the same symptom change and treatment effectiveness. Further identifying the factors that lead to the separation of these groups will add important information for determining treatment selection and potential obstacles to effectiveness.

Health Effects of Religion, Spirituality, and Supernatural Beliefs in Mainland China: A Systematic Review

Effects of religion, spirituality and supernatural beliefs (RSS) upon health in mainland China remain poorly understood, despite strong RSS beliefs influencing Chinese society. We conducted a Chinese-English bilingual systematic review to summarize the state of RSS-health research in mainland China. Study quality was assessed using the Critical Appraisal Skills Program tool. We screened 1858 studies, 162 of which were included in the review. From 2000-2004 to 2015-2019, the number of RSS-health studies in China increased from five to 73. However, only 7% of studies were rated as higher quality. Cross-sectional and case-control studies represented the vast majority of study designs (94%) and religious affiliation was the only RSS measure for 58% of studies. Higher, moderate, and lower quality studies indicated that RSS has both beneficial and adverse health implications. RSS-health research in China has accelerated rapidly in the last 20 years, but fundamental gaps in knowledge remain. Longitudinal study designs and nuanced RSS measures are needed to advance understanding of RSS health effects in China.

Using Spiritual Connections to Cope With Stress and Anxiety During the COVID-19 Pandemic

During the initial phases of the COVID-19 pandemic, stress and anxiety were pervasive among the masses due to high morbidity and mortality. Besides the fear of coronavirus was also particularly driven by social media. Many people started to look for faith and spiritual connections to gain comfort. The role of spiritual ties and religious beliefs in relation to coping with pandemic stress has acquired the attention of researchers in some parts of the world. This cross-sectional survey aimed at assessing the intensity of stress and anxiety symptoms experienced by people and how much they were alleviated by employing spiritual connections. The study sample comprises 795 respondents with 52% males and 48% females living in Saudi Arabia. The brief online study questionnaire collected data about background variables, anxiety and stress scale from DASS-21, and items from the WHOQOL (SRBP) instrument assessed the use of spiritual beliefs to cope. Multiple regression models were tested to determine the role of spiritual connections after adjusting demographic variables. Results illustrated that after adjusting for gender and age, participants' anxiety symptoms decreased by (β = -0.27; p = 0.000) units with each unit increase in the use of spiritual connections, and participants' stress symptoms reduce by (β = -0.36; p = 0.000) units with each unit increase in coping with spirituality. Additionally, females' risk to experience anxiety and stress symptoms was more than males [(β = 0.88; p = 0.01) and (β = 0.92; p = 0.000)], respectively. An increase in age decreases the likelihood of experiencing anxiety symptoms and stress symptoms by (β = -0.75; p = 0.02) and (β = -0.11; p = 0.000) units, respectively. Findings support the protective role of spiritual connections despite small beta coefficients. The social and cultural context in Saudi Arabia favors deep-rooted connections with spirituality and faith. Our findings support the fact that the reliance on spiritual connections helped older people to deal with exaggerated fear during the initial phase of the COVID-19 pandemic and reduces the risk of experiencing anxiety and stress symptoms. Females and younger participants were relatively vulnerable to developing these symptoms. We discussed these findings considering some recent studies that reported similar relationships and made recommendations for future research.

Effectiveness of electronic learning for continuing interprofessional education on behavior change of healthcare professionals: A scoping review

Electronic learning (e-learning) for continuing professional education (CPE) in healthcare has been shown to improve learners' satisfaction, attitudes, and performance. E-learning outcomes for continuing interprofessional education (CIPE) are less known, and the features of electronic CIPE programs that promote behavior change are unclear. In this scoping review, we sought to identify the program features and areas of behavior change in healthcare professionals using e-learning for CIPE. PubMed, CINAHL, ERIC, PsycINFO, Cochrane Library databases, and Google/Google Scholar were searched for all English articles published in the last 10 years. From the 32 studies included in our review, eight types of e-learning methods were identified. More than 35,542 healthcare professionals of different professions had participated in the programs. Thirty studies demonstrated positive behavior changes, with four areas of behavior changes identified. The most common area of change was in patient care practices. Five common program features facilitating behavior change were also identified. Most successful programs provided interactive and authentic learning experiences, which promoted direct clinical application. Future researche should include monitoring of sustained behavior changes at work, linked to patient outcomes.

Loneliness From the Adolescent Perspective: A Qualitative Analysis of Conversations About Loneliness Between Adolescents and Childline Counselors

There is limited qualitative research on the experience of loneliness in adolescence, meaning key facets of the loneliness experience that are important in adolescence may have been overlooked. The current study addresses that gap in the literature and explores how loneliness is experienced in the context of adolescence from the perspective of adolescents. About 67 online counseling conversations between Childline counselors and adolescents (ages 12–18 years; 70% females) who had contacted Childline to talk about loneliness were analyzed using Thematic Framework Analysis to establish commonalities and salient issues involved in adolescent experiences of loneliness. Young people considered loneliness to be an intense experience that negatively impacted their daily lives. Experiences of loneliness revolved around difficulties with peer relationships, but turmoil at home worsened those experiences. Young people often employed short-term coping strategies that distracted them from loneliness. Issues with trusting others and self-worth acted as barriers to seeking long-term help. Recommendations include (1) the training of teachers and parents to recognize and support young people experiencing loneliness and (2) further research to establish the coping strategies that are used by adolescents who successfully overcome loneliness.

Building Spiritual Strength: a Spiritually Integrated Approach to Treating Moral Injury

PURPOSE OF REVIEW

This article reviews a spiritually integrated group therapy, Building Spiritual Strength (BSS), designed to treat moral injury and associated syndromes (e.g., PTSD, burnout) with Gestalt and cognitive techniques and psychoeducation about spiritual coping. BSS was designed for active duty and military veterans but has since been adapted and expanded for other groups experiencing moral injury.

RECENT FINDINGS

Two RCTs have demonstrated BSS led to a decrease in PTSD symptoms in military members. Though BSS did not outperform a person-centered group therapy control in one RCT, the BSS group reported a decrease in spiritual struggle compared to the control. While no studies have yet been published on the expansion of BSS to new populations, emergent qualitative evidence on BSS for volunteers working with refugees indicates effectiveness in increasing positive spiritual coping. This expansion also revealed an opportunity for BSS to increase cultural humility in group members, in addition to reducing moral injury and other symptoms of distress.

SUMMARY

BSS is an effective, spiritually integrated means of reducing distress and improving spiritual coping. There are numerous opportunities for expansion of BSS to new populations and to test a variety of outcomes, including moral injury, spiritual flourishing, and cultural humility.

Adjustment to the COVID-19 pandemic: associations with global and situational meaning

COVID-19 has created pervasive upheaval and uncertainty in communities around the world. This investigation evaluated associations between discrete dimensions of personal meaning and psychological adjustment to the pandemic among community residents in a southern US state. In this cross-sectional study, 544 respondents were assessed during a period of reopening but accelerating infection rates. Validated measures were used to evaluate theoretically distinct dimensions of perceived global meaning (Meaning-in-Life Questionnaire) and pandemic-specific meaning (Meaning in Illness Scale). Adjustment outcomes included perceived stress, pandemic-related helplessness, and acceptance of the pandemic. In multivariate models that controlled for demographic and pandemic-related factors, stronger attained global meaning (i.e., perceptions that life is generally meaningful) and attained situational meaning (i.e., perceptions that the pandemic experience was comprehensible) were related to better adjustment on all three outcomes (all p's < .001). In contrast, seeking situational meaning (i.e., ongoing efforts to find coherence in the situation) was associated with poorer adjustment on all indices (all p's < .001). Results offer novel information regarding theoretically salient dimensions of meaning, which may have direct relevance for understanding how community residents adapt to the challenges of a major public health crisis.

Associations of Childhood Maltreatment and Attachment Styles with Romantic Breakup Grief Severity: The Role of Emotional Suppression

Childhood maltreatment (CM) and insecure attachment styles may partly explain grief severity following romantic breakup. Empirical studies examining the factors that could possibly explain this association, however, remain sparse. The present study tested whether the relations among CM, attachment styles, and romantic breakup grief severity could be explained by emotional suppression in Iranian college students. In a cross-sectional study, 239 Iranian college students (ages 18-45; M = 24.11, SD = 15.29; 50.6% women) with a recent romantic breakup experience were recruited from University of Tabriz. Participants completed a diagnostic interview and self-report battery, including the Persian version of the Child Abuse Self-Reported Scale, Revised Adult Attachment Scale, Romantic Breakup Grief Inventory, and Weinberger Adjustment Inventory. Structural equation modeling was used to empirically explore the relations among variables. Results indicated that those who reported higher levels of CM also reported higher levels of romantic breakup grief. Attachment closeness showed a significant negative and direct effect on romantic breakup grief severity. However, attachment anxiety was positively associated with greater levels of romantic breakup grief. Bootstrapping results showed that CM might affect romantic breakup grief severity via emotional suppression. Furthermore, attachment closeness and attachment anxiety exerted indirect effects on romantic breakup grief severity through emotional suppression. Clinical and empirical implications are discussed.

Social cognitive mechanisms in healthcare worker resilience across time during the pandemic

PURPOSE

Healthcare workers are at increased risk for mental health problems during disasters such as the COVID-19 pandemic. Identifying resilience mechanisms can inform development of interventions for this population. The current study examined pathways that may support healthcare worker resilience, specifically testing enabling (social support enabled self-efficacy) and cultivation (self-efficacy cultivating support) models.

METHODS

Healthcare workers (N = 828) in the Rocky Mountain West completed self-report measures at four time points (once per month from April to July of 2020). We estimated structural equation models to explore the potential mediating effects that received social support and coping self-efficacy had (at time 2 and time 3) between traumatic stress symptom severity (at time 1 and time 4). Models included covariates gender, age, minority status, and time lagged co-variations between the proposed mediators (social support and coping self-efficacy).

RESULTS

The full model fit the data well, CFI = .993, SRMR = .027, RMSEA = .036 [90% CIs (0.013, 0.057)]. Tests of sequential mediation supported enabling model dynamics. Specifically, the effects of time 1 traumatic stress severity were mediated through received social support at time 2 and time 3 coping self-efficacy, in sequential order to reduce time 4 traumatic stress severity.

CONCLUSIONS

Findings show the importance of received social support and coping self-efficacy in mitigating psychopathology risk. Interventions can support mental health by focusing on social resource engagement that facilitates coping empowerment, which may decrease risk for mental health job-related problems among frontline healthcare workers exposed to highly stressful events.

Nonattachment mediates the associations between mindfulness, well-being, and psychological distress: A meta-analytic structural equation modeling approach

Research on nonattachment, a Buddhist psychological construct closely related to mindfulness, has burgeoned since the development of the Nonattachment Scale. The aim of the current meta-analysis was to investigate the mediating role of nonattachment in the relationship between mindfulness and well-being and psychological distress using a meta-analytic structural equation modeling approach. The respective associations of nonattachment and mindfulness with well-being and psychological distress, after controlling for each other, were also examined. Forty-one independent cross-sectional data sets with 24,704 individuals were coded. Results showed that nonattachment partially mediated the associations between mindfulness and well-being and psychological distress. Nonattachment and mindfulness were both significantly positively associated with well-being and negatively associated with psychological distress after controlling for each other. Given the present findings were based on cross-sectional data, more studies with rigorous research design, such as longitudinal, experimental, and intervention studies, should be conducted to further investigate the mediating effect of nonattachment between mindfulness with well-being and distress outcomes and establish causal relations between them. Future research directions regarding nonattachment and its application in mindfulness-based interventions were discussed.

Characteristics of Kundalini-Related Sensory, Motor, and Affective Experiences During Tantric Yoga Meditation

Traditional spiritual literature contains rich anecdotal reports of spontaneously arising experiences occurring during meditation practice, but formal investigation of such experiences is limited. Previous work has sometimes related spontaneous experiences to the Indian traditional contemplative concept of kundalini. Historically, descriptions of kundalini come out of Tantric schools of Yoga, where it has been described as a “rising energy” moving within the spinal column up to the brain. Spontaneous meditation experiences have previously been studied within Buddhist and Christian practices and within eclectic groups of contemplative practitioners. Prior explorations of kundalini have emphasized extreme experiences, sometimes having clinical consequences. We conducted a first such investigation of kundalini-related experiences within a sample of meditators from a single Tantric Yoga tradition (known as Ananda Marga) that emphasizes the role of kundalini. We developed a semi-structured questionnaire to conduct an exploratory pilot investigation of spontaneous sensory, motor and affective experiences during meditation practice. In addition to identifying the characteristics of subjective experiences, we measured quantity of meditation, supplemental practices, trait affect and trait mindfulness. We administered it to 80 volunteers at two Ananda Marga retreats. Among reported experiences, we found the highest prevalence for positive mood shifts, followed by motor and then sensory experiences. The frequency of spontaneous experiences was not related to the quantity of practiced meditation or trait measures of mindfulness and affect. Self-reports included multiple descriptions of rising sensations, sometimes being directly called kundalini. Experiences with rising sensations were complex and many included references to positive affect, including ecstatic qualities. There were also reports of spontaneous anomalous experiences. These experiences of rising sensations resemble prior clinical descriptions that were considered kundalini-related. The individuals who reported rising sensations could not be distinguished from other participants based on the incidence of experiences, quantity of meditation practice, or trait measures of mindfulness and affect. In contrast, greater amount of Tantric Yoga meditation practice was associated with greater positive affect, less negative affect and greater mindfulness. Further study of these exploratory findings and how they may be related to spiritual and well-being goals of meditation is warranted along with scientific investigation of purported kundalini phenomena.

Case Study of Recognition Patterns in Haunted People Syndrome

Haunted People Syndrome (HP-S) denotes individuals who recurrently report various “supernatural” encounters in everyday settings ostensibly due to heightened somatic-sensory sensitivities to dis-ease states (e.g., marked but sub-clinical levels of distress), which are contextualized by paranormal beliefs and reinforced by perceptual contagion effects. This view helps to explain why these anomalous experiences often appear to be idioms of stress or trauma. We tested the validity and practical utility of the HP-S concept in an empirical study of an active and reportedly intense ghostly episode that was a clinical referral. The case centered on the life story of the primary percipient, a retired female healthcare worker. Secondary percipients included her husband and adult daughter, all of whom reported an array of benign and threatening anomalies (psychological and physical in nature) across five successive residences. Guided by prior research, we administered the family online measures of transliminality, sensory-processing sensitivity, paranormal belief, locus of control, desirability for control, and a standardized checklist of haunt-type phenomena. The primary percipient also completed a measure of adverse childhood events and supplied an event diary of her anomalous experiences. We found reasonably consistent support for HP-S from a set of quantitative observations that compared five proposed syndrome features against the family members’ psychometric profiles and the structure and contents of their anomalous experiences. Specifically, the reported anomalies both correlated with the family’s scores on transliminality and paranormal belief, as well as elicited attributions and reaction patterns aligned with threat (agency) detection. There was also some evidence of perceptual congruency among the family members’ anomalous experiences. Putative psi cannot be ruled out, but we conclude that the family’s ordeal fundamentally involved the symptoms and manifestations of thin (or “permeable”) mental boundary functioning in the face of unfavorable circumstances or overstimulating environments and subsequently acerbated by poor emotion regulation, histrionic and catastrophizing reactions, and active confirmation biases.

Predictors and consequences of intellectual humility

In a time of societal acrimony, psychological scientists have turned to a possible antidote — intellectual humility. Interest in intellectual humility comes from diverse research areas, including researchers studying leadership and organizational behaviour, personality science, positive psychology, judgement and decision-making, education, culture, and intergroup and interpersonal relationships. In this Review, we synthesize empirical approaches to the study of intellectual humility. We critically examine diverse approaches to defining and measuring intellectual humility and identify the common element: a meta-cognitive ability to recognize the limitations of one’s beliefs and knowledge. After reviewing the validity of different measurement approaches, we highlight factors that influence intellectual humility, from relationship security to social coordination. Furthermore, we review empirical evidence concerning the benefits and drawbacks of intellectual humility for personal decision-making, interpersonal relationships, scientific enterprise and society writ large. We conclude by outlining initial attempts to boost intellectual humility, foreshadowing possible scalable interventions that can turn intellectual humility into a core interpersonal, institutional and cultural value.

Intellectual humility involves acknowledging the limitations of one’s knowledge and that one’s beliefs might be incorrect. In this Review, Porter and colleagues synthesize concepts of intellectual humility across fields and describe the complex interplay between intellectual humility and related individual and societal factors.

Cognitive-Emotional Benefits of Weekly Exposure to Nature: A Taiwanese Study on Young Adults

Empirical evidence of nature’s benefits to cognitive and emotional well-being is emerging. In this study, 48 Taiwanese young adults (24 indoors and 24 outdoors in urban greenspace) completed four weekly 45 min exposure sessions. The study explores whether the outdoor group surpasses the indoor group in cognitive and emotional well-being and nature connectedness. There were no significant differences for the indoor group across different measurements of rumination and connectedness to nature. However, the outdoor group displayed a significant reduction in rumination post-test compared to the one week prior and the first session. Similarly, for sessions two, three, and four and one month post-test, the outdoor group’s connectedness to nature was significantly higher than pre-test. Specific autobiographical memory was enhanced while overgeneral autobiographic memory was reduced during the third and fourth sessions, though these changes were not sustained at one-month follow-up. Surprisingly, both groups yielded similar results in decreased depression, anxiety, and stress. A significantly higher number of outdoor group participants had employed nature exposure for coping with stress or emotions after the program. We discuss the implications of this for counseling services for young adults and highlight future research possibilities, including formulating a nature-exposure protocol and a program evaluation for consolidating evidence-based nature prescription.

Models of Psychedelic-Assisted Psychotherapy: A Contemporary Assessment and an Introduction to EMBARK, a Transdiagnostic, Trans-Drug Model

The current standard of care in most uses of psychedelic medicines for the treatment of psychiatric indications includes the provision of a supportive therapeutic context before, during, and after drug administration. A diversity of psychedelic-assisted psychotherapy (PAP) models has been created to meet this need. The current article briefly reviews the strengths and limitations of these models, which are divided into basic support models and EBT-inclusive therapy models. It then discusses several shortcomings both types of models share, including a lack of adequate attention to embodied and relational elements of treatment, and insufficient attention to ethical concerns. The article then introduces the EMBARK model, a transdiagnostic, trans-drug framework for the provision of supportive psychotherapy in PAP clinical trials and the training of study therapists. EMBARK was designed to overcome challenges that prior models have had in conceptualizing therapeutic change in psychedelic treatment, incorporating elements of non-psychedelic evidence-based therapies, incorporating therapists' prior skills and clinical orientations, delimiting therapist interventions for research standardization, and determining specific factors that contribute to treatment outcomes. The article explains EMBARK's six clinical domains, which represent parallel conceptualizations of how therapists may support therapeutic benefit in PAP treatment, and its four care cornerstones, which reflect therapists' broad ethical responsibility to participants. The article describes how these elements of the model come together to structure and inform therapeutic interventions during preparation, medicine, and integration sessions. Additionally, the article will discuss how EMBARK therapist training is organized and conducted. Finally, it will demonstrate the broad applicability of EMBARK by describing several current and upcoming PAP clinical trials that have adopted it as the therapeutic frame.

Spirituality During the COVID-19 Pandemic: An Online Creative Arts Intervention With Photocollages for Older Adults in Italy and Israel

The present study aimed to examine how expressions of spirituality were stimulated and reflected in an online creative arts intervention for older adults during COVID-19 lockdowns. The online process focused on the creation of digital photocollages together with narrative elements of dignity therapy. Twenty-four Israeli and Italian community-dwelling older adults aged 78–92 participated in a three-session online intervention involving the production of three photocollages. The visual and verbal data (participants’ chosen photos and photocollages, and transcripts of the sessions) were qualitatively analyzed within an abductive framework. Four themes were generated, representing the four domains of spirituality that were stimulated by and expressed in the process: (1) Connectedness with the self, (2) connectedness with others, (3) connectedness with the environment, and (4) connectedness with the transcendent. The findings show how photographs can serve as projective visual stimuli which elicit personal content through spontaneous thinking, and they reveal the multifaceted nature of spirituality, wherein each domain nourishes the others. Overall, the findings illustrate how creative arts intervention guided by the tenets of dignity therapy can contribute to the spiritual care of older adults during periods of social isolation, or to the spiritual support provided in palliative care.

The Efficacy of Health Realization/Innate Health Psycho-education For Individuals With Eating Disorders: Pilot Study

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Bütünün Bir Parçası Olarak Maneviyat: Gestalt Terapinin Maneviyata Bakışı

Bireyin manevi inançları ve ihtiyaçlarını göz ardı eden pozitivist anlayışın aksine günümüzde psikolojik danışma yaklaşımlarının önemli bir bölümü, maneviyatı bireyin önemli bir parçası olarak değerlendirmektedir. Psikolojik danışma yaklaşımları, bireyin dini ve manevi boyutlarını görmezden gelmek yerine artık bunları bireyin bütünselliğinin bir parçası olarak kabul etmekte ve terapötik süreçlere dahil etmektedir. Gelişmesinde Fritz Perls, Laura Perls ve Paul Goodman gibi isimlerin öncülük yaptığı Gestalt terapi, danışanların şimdi ve buradaya dair farkındalık kazanarak bütünlüğe ulaşmasını amaçlayan bir yaklaşımdır. Psikanaliz, Gestalt psikolojisi, varoluşçu felsefe, fenomenoloji, alan kuramı, psikodrama, Doğu dinleri ve maneviyattan etkilenen Gestalt terapi, bütünün parçaların bir toplamı değil; tüm bu farklı parçaların ince bir koordinasyonu olduğu görüşünü esas alarak danışanı bir bütün olarak değerlendirmektedir. İnsanı bir bütün olarak anlamanın onun tüm yönlerinin kabul edilmesiyle gerçekleşebileceği fikrini vurgulayan bu yaklaşımda, insanın önemli bir yönü olduğu düşüncesiyle maneviyat ele alınacak konulardan biri olarak görülmektedir. Bu çalışmanın amacı, sözü edilen bu bütünsellik çerçevesi içerisinde Gestalt terapinin maneviyata bakış açısını, Gestalt terapinin temel kavramlarının maneviyatla ilişkisini ve maneviyatın Gestalt terapide uygulama sürecini değerlendirmektir.

The Efficacy of Health Realization/Innate Health Psycho-education For Individuals With Eating Disorders: Pilot Study

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Feeling safe and content: Relationship to internalized sexual stigma, self-awareness, and identity uncertainty in Italian lesbian and bisexual women

Research has linked feelings of safety and contentment to lower adverse mental health outcomes (e.g., stress, anxiety, depression) in the general population. The current study aimed at exploring the relationship between safe/content positive affect and minority stress (e.g., internalized sexual stigma) in lesbian and bisexual women, considering the effect of potential mediators such as identity self-awareness and identity uncertainty. An online survey was administered to 400 Italian women (220 lesbian and 180 bisexual women), aged 18-40 years (M = 25.98, SD = 6.07). The results showed that lesbian women reported lower internalized sexual stigma and identity uncertainty and higher safe/content positive affect and identity self-awareness, relative to bisexual women. Higher internalized sexual stigma predicted lower safe/content positive affect, regardless of sexual orientation. Furthermore, identity self-awareness and identity uncertainty significantly mediated the relationship between internalized sexual stigma and safe/content feelings, thus confirming the protective role of sexual identity variables on lesbian and bisexual women's positive affectivity. Finally, univariate analyses suggested that lesbian women were more resilient than bisexual women in the face of minority stressors. The results contribute to the understanding of the differences between lesbian and bisexual women in their perception of salient identity categories. In addition, the findings highlight the relevance of protective factors (e.g., identity certainty, lesbian and bisexual positive identity) in ameliorating the adverse effects of minority stress and promoting positive affect and social adjustment in lesbian and bisexual women. Research and clinical implications and directions are discussed.

Pastoral Leaders Perceptions of Mental Health and Relational Concerns within Faith Based Organizations

The purpose of this study was to explore the attitudes, beliefs, and perspectives of pastoral leaders regarding mental health and relational concerns within Faith-Based Organizations (FBO). As a follow-up to a previous study (Moore et al., 2016), the authors intended to gain insight regarding how pastoral leaders view their role within their organizations related to promoting sound mental health and relational health. Utilizing a qualitative description, authors disseminated a survey to 12 pastoral leaders to complete. Three themes emerged from their responses, which included: (1) Defining mental health; (2) The role of pastoral leaders in mental health; and (3) Mental health needs in pastoral leadership. In the study, investigators discuss clinical implications and provide recommendations regarding how pastoral leaders and Faith- Based Organizations may address the topic of mental health and relational health among its constituents. We believe this research is relevant to the readers of this journal as it contributes to a discussion about pastoral leaders and mental health, as well as how pastoral leaders' perception of mental health may impact how they discuss this topic within their own organizations. Furthermore, for readers who are clinicians, this study contributes to the body of knowledge about what pastoral leaders and constituents may need, as one considers opportunities for collaboration.

Gender and age differences in forgivingness in Italian and Polish samples

This study explores gender and age differences in forgivingness using the crosscultural and stress-and-coping perspective. Polish and Italian versions of the Heartland Forgiveness scale (HFS) were used. The sample consisted of 1957 individuals aged 18–80 (61% females and 39% males). A 3-way between groups ANOVA was used to examine the main effects and interactions of country, age and gender as they relate to total HFS score. Post-hoc analyses were performed where appropriate. The results revealed that Polish and Italian respondents did not differ in the level of the general tendency to forgive. Gender differences in trait forgiveness were reported in whole sample and in Italian subsample, showing males to be more forgiving than females. Further, our results for all study participants, in Polish subsample and among Italian males showed that older adults were more forgiving than young respondents, which is consistent with the previous findings showing an increase in forgivingness with age.

The relationship between fatalistic beliefs and well-being depends on personal and national religiosity: A study in 34 countries

Modern social science suggests that fatalistic beliefs are generally detrimental to mental well-being because these beliefs reflect a lack of perceived efficacy and control. However, many religions downplay the role of personal agency and emphasize the importance of external factors that determine people's lives (e.g., God’s will and fate). Thus, individual and cross-cultural differences in the links between fatalism and well-being are to be expected. Using a sample of 38,426 individuals from 34 countries and Bayesian multilevel modeling, this study shows that personal and national religiosity moderate the relationship between fatalism and life satisfaction. Whereas fatalism is negatively associated with life satisfaction in more secular countries and among less religious individuals, it is unrelated to life satisfaction in more religious countries and among highly religious individuals.

The Effect of Spirituality in Quality of Life of Hemodialysis Patients

This study aimed to assess the effect of spirituality on quality of life of end-stage renal disease patients undergoing hemodialysis (HD). A cross-sectional study was carried out in six HD Units. The sample consisted of 367 patients averaging 61.8 years of age. For the measuring of spirituality and the quality of life, the FACIT-Sp-12 and the Missoula Vitas Quality of Life Index-15, respectively, were completed. Social and demographic data were, also, collected. Spirituality and its dimensions such as Meaning in Life and Peace had a positive effect on Global QoL, Symptoms, Interpersonal and in Well-being. Spirituality can have a positive effect on the QoL of HD patients. Therefore, in the context of the holistic approach of the individual, health systems can include spiritual evaluation and care of HD patients.

The Therapeutic Potential of Psychedelic-assisted Therapies for Symptom Control in Patients Diagnosed With Serious Illness: A Systematic Review

CONTEXT

People affected by serious illness usually experience suffering in its various dimensions, not only in the physical but also in the psychosocial and spiritual aspects. The interest in psychedelic-assisted therapies as a potential new therapeutic modality has increased since evidence suggests a significant impact of their use on the outcomes of patients with serious illness.

OBJECTIVES

To systematically review the available evidence on the effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness.

METHODS

The protocol of this systematic review has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This review included randomized and non-randomized controlled trials published in peer-reviewed scientific journals. A comprehensive search for studies was carried out in the main scientific databases, including Web of Science, Scopus, Cochrane Library, PsycINFO, PubMed, CINAHL, and EMBASE. There were no limitations regarding the year or language of publication.

RESULTS

The sample was composed of 20 studies. The results suggest positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, with considerable safety of use. Most studies have been conducted with lysergic acid diethylamide, psilocybin, and N,N-dipropyltryptamine in cancer patients. The adverse effects reported were of physical and/or psychological nature and of mild to moderate intensity, transient, and self-resolutive.

CONCLUSION

The evaluated evidence suggests positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, especially regarding symptoms of psychological and spiritual nature.