Interest in spiritually integrated psychotherapy among acute psychiatric patients

ACTing Spiritually: Integrating Spiritual Care and Mental Health Care within a US Department of Veterans Affairs Inpatient Psychiatric Unit

As a part of the VA's interprofessional fellowship in psychosocial rehabilitation, the authors developed an 8-week spirituality group manual, ACTing Spiritually, which incorporates principles of acceptance and commitment therapy (ACT) into a spirituality group protocol. The group, administered weekly as possible for 28 weeks on an inpatient psychiatric unit at a veterans affairs (VA) medical center in West Haven, CT, aimed to incorporate veterans' spirituality into their mental health treatment through concepts of acceptance, values, mindfulness, and committed action. ACTing Spiritually ran in tandem with a basic ACT group and the two groups had comparable average group sizes, suggesting interest in ACTing Spiritually similarly compares to interest in a basic ACT group in this context. In addition, development of the group yielded several qualitative findings, including a discussion of the similarities and differences between ACT and spiritual care, clinical gains for chaplains conducting the group, and clinical tensions that arose through the process of integration. The study provided preliminary evidence of the potential feasibility and acceptability of ACTing Spiritually. Next steps should include a formal evaluation of its potential efficacy.

Fearlessness about death and suicidal ideation: Religious identity matters

INTRODUCTION

Religion is a salient aspect of patient background in treatment (The psychology of religion and coping: Theory, research, practice; Guilford Press). However, research investigating the role of religion in suicide is lacking and inconsistent (Journal of Religion and Health, 57, 2478-2499). The current study (1) clarifies the association between religious identity and fearlessness about death in a psychiatric sample and (2) tests whether religious identity moderates the association between fearlessness about death and suicidal ideation.

METHODS

Participants were 155 patients seeking treatment in a partial hospital program. Religious identity was assessed using the Identities in Treatment Scale (The Behavior Therapist). Fearlessness about death was assessed with two relevant items from the acquired capability with rehearsal for suicide scale (Psychological Assessment, 28, 1452-1464), as in prior studies (Suicide & Le-Threatening Behavior, 50, 1230-1240; Journal of Affective Disorders Reports, 12, 100492).

RESULTS

Fearlessness about death interacted with religious identity to predict suicidal ideation, b = 0.47, 95% C.I. [0.02, 0.91], p = 0.042. Conditional effects showed that greater fearlessness about death was associated with greater suicidal ideation among non-religious patients, b = -0.56, 95% C.I. [-0.88, -0.24], p = 0.001, but not in religious patients, b = -0.09, 95% C.I. [-0.41, 0.22], p = 0.559.

CONCLUSIONS

Our results suggest that fearlessness about death is a risk factor for suicidal ideation, but only among those who do not identify as religious. Results from this study inform theories of suicide and elucidate the influence of religious identity on links among suicide risk factors and suicide-related outcomes.

Temporal associations between meaning in life, ultimate meaning struggles, and mental health outcomes in a spiritually integrated inpatient program

BACKGROUND

Meaning in life is a benchmark indicator of flourishing that can likely mitigate the severity of depression symptoms among persons seeking mental healthcare. However, patients contending with serious mental health difficulties often experience a painful void or absence of ultimate meaning in their lives that might hinder recovery. This two-wave longitudinal study examined temporal associations between perceived presence of meaning in life, struggles with ultimate meaning, flourishing, and depression symptoms among adults in a spiritually integrated inpatient treatment program.

METHODS

Of the 242 patients assessed at intake, 90% (N = 218; 40% Cisgender male; 57% Cisgender female; 3.0% nonbinary) completed validated measures of these meaning-related factors and mental health outcomes at discharge.

RESULTS

Cross-sectional analyses revealed perceptions of meaning in life and ultimate meaning struggles were inversely linked with one another along with being associated with indices of positive and negative mental health in varying ways at the start and end of treatment. Drawing upon a two-wave cross-lagged panel design, longitudinal structural equation modeling analyses supported a Primary Meaning Model whereby having a subjective sense of meaning in life at intake was prospectively linked with lower levels of ultimate meaning struggles and greater flourishing at discharge. However, baseline levels of mental health outcomes were not predictive of the meaning-related factors in this sample.

CONCLUSION

Findings highlight the utility of assessing patients' perceived meaning in life and ultimate meaning struggles in spiritually integrated programs and for clinicians to be prepared to possibly address these meaning-related concerns in the treatment process.

Beyond the Asylum Walls: Tracing the Tapestry of Mental Health Interventions Across Eras and Cultures

This article offers an extensive review of the changing field of mental health therapies, charting a transformational path from traditional methods to modern breakthroughs and speculating on potential future developments. The story develops by investigating historical viewpoints while reflecting on the present and highlighting the lessons learned and their impact on contemporary practices. We have advanced from the stigmatized constraints of asylums to a paradigm that puts human rights, dignity, and individualized, culturally sensitive treatment first. Modern methods are much more varied and evidence-based, from cutting-edge technical advancements to evidence-based psychotherapies. The ethical considerations arising from the delicate balance of pharmacological therapies underline the responsibility of administering drugs that significantly affect mental health. Cultural factors become a pillar, highlighting how crucial cultural sensitivity is to promoting tolerance. By acknowledging how many facets of the human experience are interrelated, holistic methods help close the gap between the mind and body. Integrative medicine and alternative therapies represent a shift away from reductionist approaches and toward a holistic viewpoint. The delivery of mental health treatment is being reimagined by technological advancements, with virtual and digital environments opening up new access and support channels. These developments cut beyond regional boundaries, reinventing conventional therapy dynamics and paving the way for individualized therapies. Cultural concerns highlight the significance of cultural competency in navigating the complex mental health treatment system and adapting interventions to fit the particular requirements of various cultural contexts. With telepsychiatry, virtual reality, and artificial intelligence among the new technologies that promise to further revolutionize mental health therapies, the essay looks to the future. This review concludes by imagining a day when mental health is prioritized, therapies are available, and the diversity of human experience is valued. The path to a society that values, nurtures, and celebrates mental health continues.

Effects of religion on the course of suicidality among geriatric patients with mood disorders

BACKGROUND

A growing volume of research suggests that religion protects against late-life suicide, but it remains unclear whether effects are relevant to clinical samples, which facets of religion are most relevant, and variations over the course of mood disorders (e.g. during periods of euthymia, depression, and/or heightened suicidality).

METHOD

Eighty adults aged 55-85 years with mood disorders completed assessments of religion (affiliation, service attendance, importance of religion, belief and faith in God), depression, and suicidality over time (M = 7.31 measurements over M = 727 days). We computed metrics to identify mean and maximum levels of depression and suicidality, and the number of episodes of significant depression and suicidality experienced by each participant.

RESULTS

Religious affiliation and importance of religion, but not service attendance, belief, or faith in God, were associated with lower mean and maximum depression. Conversely, all facets of religion predicted significantly lower mean and maximum levels of suicidality (rs ranging from -0.24 to -0.39), and substantially less likelihood of experiencing significant suicidality during the study (ORs ranging from 0.19 to 0.33). Service attendance, belief, and faith in God predicted less suicidality even among individuals who did not affiliate with a religious group.

CONCLUSIONS

Religious factors, particularly faith in God, are associated with substantially less suicidality over time among older adults with mood disorders, irrespective of religious affiliation.

Integrating Religion and Spirituality into Psychiatric Outpatient Treatment in the United States

It is common for mental health clients to desire that religion and spirituality (RS) be integrated into their treatment. Despite this preference, clients' RS beliefs often go overlooked in therapy for a variety of reasons including lack of provider training on integration, fear of causing offense, or concerns about wrongly influencing clients. The present study assessed the effectiveness of using a psychospiritual therapeutic curriculum to integrate RS into psychiatric outpatient treatment for highly religious clients (n = 150) seeking services through a faith-based clinic. The curriculum was well accepted by both clinicians and clients, and a comparison of clinical assessments administered at intake and program exit (clients averaged 6.5 months in the program) showed significant improvement across a broad range of psychiatric symptoms. These results suggest the use of a religiously integrated curriculum within a broader psychiatric treatment program is beneficial and may be a way to overcome clinicians' RS concerns and shortcomings while meeting religious clients' desires for inclusion.

Spirituality/Religion and Self-Harm Among Patients With Alcohol/Substance Use Versus Other Disorders

ABSTRACT

Spirituality/religion (S/R) is clinically relevant to recovery from alcohol use disorders (AUDs)/substance use disorders (SUDs) and also associated with less self-injury; however, the interplay of these factors has not been adequately evaluated. Participants (n = 1443) were culled from a larger study among psychiatric patients. We assessed for S/R using self-report measures, and medical records were reviewed for demographics, clinical diagnoses, psychiatric medications, and self-harm engagement. Self-harm engagement was significantly higher among patients without AUD/SUD. S/R distress was higher among participants with AUD/SUD, but S/R community activity and importance of religion were lower. Interest in discussing S/R in treatment did not significantly differ across patients. Religious affiliation, importance of religion, and belief in God were associated with less self-harm, but effects were not moderated by presence of AUD/SUD. S/R factors are associated with lower self-harm, irrespective of the presence or absence of AUD/SUD. In contrast with clinical lore, S/R may be equally salient to psychiatric patients with AUD/SUD versus other disorders.

Spiritual Interventions Used by Jewish Women to Facilitate the Family Continuum: A Qualitative Study

Introduction: Spiritual interventions (SI) are used by patients and their families as a means to promote health. The family continuum (FC), which includes finding a partner/spouse, getting married, becoming pregnant, and having a safe pregnancy/birth, is an important concept for the Jewish culture as well as other cultures that have a traditional family-centered approach. There is a dearth of professional literature pertaining to SI to promote the FC. Although patients may use SI, this information is not routinely collected in a health history. The purpose of the study was to describe the experience of Jewish women's use of SI to promote the FC. Methods: This ethnographic study included interviews of Jewish women pertaining to FC, a text review, and field study. Coding of the text, site visits, and interviews were performed and reviewed to identify categories and themes and were refined until saturation was achieved. Results: Fifty-three observant and non-observant Jewish women participated in the study. Women expressed that SI were the means for them playing an active role in fulfilling the FC, and included intermediaries to God, self-improvement, and folk/spiritual remedies. The examples of SI included: visits to holy sites and spiritual leaders for blessings and advice, prayers, psalms, doing good deeds, eating special foods, wearing amulets, and performing certain SI with predesignated repetitions. Women attributed these SI to attaining an FC. Women who achieved each FC milestone without difficulty tended to use less SI, whereas women's SI usage increased the longer a milestone was not achieved. Conclusions: Jewish women are using many SI to promote the FC. Health care should be delivered in a culturally competent manner, which includes the incorporation of safe cultural practices. Obtaining a cultural assessment as part of the medical history could assist the health care professional in integrating safe SI into patient care.

Self and suffering in Indian thought: implications for clinicians

The four main Indian religions – Hinduism, Buddhism, Jainism and Sikhism – have several shared concepts about self and suffering, which are salient to the world-view of the followers of these faiths. Understanding the concepts of mind, self and suffering in these faiths can help clinicians build better rapport and gain deeper understanding of the inner world of patients of these faiths. This article highlights the broad cultural and religious beliefs of these groups, with the hope that increased knowledge among clinicians might lead to better therapeutic engagement.

Effects of Sexual Orientation on Spiritual Psychotherapy for Inpatient, Residential & Intensive Treatment

Objectives

Spiritual psychotherapy addresses mental health concerns by integrating spirituality/religion into treatment. There is scant research on how such approaches interact with sexual minority status. We sought to identify and compare how sexual minority and heterosexual patients respond to spiritual psychotherapy.

Method

We collected data from heterosexual (n = 66) and sexual minority (n = 15) patients who self‐referred to participate in Spiritual Psychotherapy for Inpatient Residential & Intensive Treatment (SPIRIT), a spiritually‐integrated, group‐based, cognitive‐behavioral treatment.

Results

We did not find significant differences between heterosexual and sexual minority patients across demographic/clinical variables, spiritual/religious characteristics, or effects of SPIRIT. Both groups reported notable perceived benefit of SPIRIT.

Conclusions

Although not specifically tailored for sexual minority patients, or intended to reconcile spiritual/religious conflicts around sexual identity, programs like SPIRIT may benefit sexual minority patients by providing a safe space to explore both sexual orientation and religious identity. In turn, this may help sexual minority patients develop frameworks to recruit spirituality/religion in the process of coping with distress, as a catalyst for clinical change.

To our knowledge, this is the first study to examine responses to spiritually integrated therapy among sexual minority individuals.

Sexual minority and heterosexual patients were equivalent with regard to clinical severity, spiritual/religious characteristics, and spiritual distress.

Sexual minority and heterosexual individuals benefited equally from spiritually‐integrated therapy.

Spiritual/religious involvement and spiritual distress did not differentially predict perceived benefit from spiritually‐integrated psychotherapy among sexual minority or heterosexual patients.

Findings underscore the importance of clinicians being open to exploration of relevant spiritual/religious topics with all patients, without assumption that such themes may be inherently problematic for sexual minorities.

Predictors of Patients' Responses to Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT)

OBJECTIVE

Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) is a flexible clinical protocol for delivering spiritually integrated group psychotherapy within acute psychiatric settings. The authors evaluated SPIRIT's feasibility by examining patients' perceptions of its benefits and clinical and spiritual predictors of observed effects associated with this intervention.

METHODS

Over a 1-year period, 22 clinicians stationed on 10 clinical units provided SPIRIT to 1,443 self-referred patients with a broad range of demographic, clinical, and spiritual and religious characteristics.

RESULTS

Overall, patients' perceptions of benefit from SPIRIT were not associated with demographic factors. Clinical factors similarly did not predict treatment responses, suggesting that SPIRIT is equally suitable for patients with mood, anxiety, traumatic, substance use, psychotic, feeding or eating, or personality disorders and for patients with high levels of acuity. Patients with high levels of religious belief responded better to treatment, but patients with low levels of spiritual and religious identity also reported significant benefits. Patients responded better to SPIRIT when it was delivered by clinicians who reported not being affiliated with a religion than did patients receiving the SPIRIT intervention through clinicians who reported a religious affiliation.

CONCLUSIONS

Results indicate that SPIRIT is feasible in providing spiritually integrated treatment to diverse patients across multiple levels of acute psychiatric care.

Religiousness, meaning, and quality of life: Test of a mediational model among adults seeking a spiritually integrated inpatient program

OBJECTIVE

Religious beliefs and practices may augment a sense of meaning in life that could support quality of life (QOL) in physical, social, and emotional domains amid mental health crises. However, these associations have not been thoroughly tested among persons with serious mental illness (SMI).

METHODS

Focusing on 248 adults who had recently enrolled in a spiritually integrated acute psychiatric hospitalization program, we incorporated structural equation modeling to examine whether (1) religiousness would be associated with better overall QOL; and (2) inpatients' sense of meaning in life would at least partially account for the religiousness-QOL link.

RESULTS

Religiousness was linked indirectly with QOL at the time of admission: religiousness was associated with greater meaning in life, and a higher degree of meaning in life was associated with QOL.

CONCLUSIONS

Findings underscore the crucial role of religiousness for meaning and wellness among many individuals with SMI who seek stabilization and healing.

Perceived barriers to providing spiritual care among psychiatric mental health nurses

BACKGROUND

Although nurses typically view spiritual care as important, it is provided infrequently.

OBJECTIVES

This research investigated psychiatric mental health nurses' perceived barriers to providing spiritual care, and how these barriers were associated with frequency of spiritual care and demographic factors.

METHODS

This cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care.

RESULTS

The most frequent barriers to providing spiritual care were lack of education and fear of exacerbating psychiatric symptoms. Psychiatric mental health nurses provided spiritual care infrequently.

CONCLUSIONS

Nurses need education about providing spiritual care to those with psychiatric mental health needs.

How are psychotic symptoms and treatment factors affected by religion? A cross-sectional study about religious coping among ultra-Orthodox Jews

Religious coping is prevalent among individuals diagnosed with psychotic disorders, however its clinical relevance has been insufficiently studied. Thirty ultra-Orthodox Jewish patients experiencing current psychotic symptoms and receiving treatment in the inpatient and day-care units were administered measures assessing severity of psychotic symptoms, psychological distress/well-being, beliefs about treatment credibility/expectancy, and aspects of religious belief and coping. Among men, negative religious coping was associated with lower treatment credibility. Among women, positive religious coping was associated with increased treatment expectancy and greater quality of life; and trust in God was associated with reduced psychiatric symptoms and greater treatment expectancy. Study findings indicate that religious factors may promote treatment motivation and engagement, crucial factors for subpopulations facing culturally-based barriers to treatment, as well as boost more favorable outcomes. Sensitivity to religious factors in treatment appears to play an important role in the management of psychotic disorders and should be engaged when culturally appropriate in order to maximize treatment potential.

A practice-based evidence investigation of God representations in spiritually integrated psychotherapies

OBJECTIVE

This practice-based evidence study examined trajectories of God representations and psychological distress among Christians participating in spiritually integrated psychotherapies (SIPs).

METHODS

In total, 17 clinicians practicing SIPs in a mid-sized city on the US Gulf Coast implemented session-to-session assessments of these outcomes with 158 clients over a 4-month period and also reported their use of specific spiritual interventions after each session (e.g., affirmed client's divine worth).

RESULTS

Multivariate growth modeling revealed clients' psychological distress decreased over the study period whereas authoritarian God representations increased and benevolent God representations remained stable. In addition, clients who increased in benevolent representations of God had a greater likelihood of experiencing alleviation of psychological distress.

CONCLUSION

These findings affirm the potential efficacy of SIPs and cultural importance of belief in a benevolent deity as a source of strength, identity, and potential healing among Christians clients who prefer a spiritually integrated approach in psychotherapy.

Conversations and Beyond: Religious/Spiritual Care Needs Among Clinical Mental Health Patients in the Netherlands

This study examines religious/spiritual (R/S) care needs and their possible determinants among mental health patients in the Netherlands. Patients in a Christian (CC, n = 100) and a secular (SC, n = 101) mental health clinic completed a questionnaire. Analysis revealed three factors on the R/S care needs measure: (1) "R/S conversations," (2) "R/S program and recovery," and (3) "R/S similar outlook on life." The presence of R/S care needs was predicted by the following: site (CC versus SC), R/S involvement, and religious strain. Most commonly, unmet R/S care needs were explanation about R/S and illness by the practitioner, prayer with a nurse, conversations about religious distress with a nurse, conversation when R/S conflicts with treatment, help in finding a congregation, and contact between chaplain and practitioner. "R/S similar outlook on life" was equally important to patients with and without R/S involvement. Patients appreciate a match in worldview with health professionals, either religious or secular.

Understanding Preferences for Addressing Spirituality Among Adults Seeking Outpatient Mental Health Care

Focusing on 472 religiously heterogenous adult patients seeking psychotherapy at a university-based outpatient clinic, this brief report examined (1) these patients' preferences about clinicians appreciating their religion and/or spirituality (R/S) backgrounds (spiritually affirming) and addressing spiritual concerns in treatment (spiritually integrated) and (2) role of demographic factors and psychological functioning in predicting preferences for R/S integration. Analyses revealed that more than half of patients reported moderate or greater importance for spiritually affirming care and one-third hoped to address spiritual issues. Furthermore, these factors emerged as indicators of stronger preferences for R/S integration: female sex, racial minority status (African American, Native American), history of marriage (past and present), affiliation to organized religion (Christianity, Islam), and importance placed on R/S. In general, findings suggest that most patients seeking psychotherapy in a university-based clinic in southern Alabama might desire a spiritually affirming approach, and a smaller subset prefer an approach in which R/S is integrated into treatment.

Do religious patients need religious psychotherapists? A naturalistic treatment matching study among orthodox Jews

Religion is professed by the majority of the general population, but a minority of mental health practitioners. We evaluated whether religious patients benefited more from treatment with religious psychotherapists in a naturalistic study among adult Orthodox Jewish (n = 117) and control patients (n = 91) receiving psychotherapy from Orthodox Jewish (n = 15) and other (n = 7) psychotherapists at a New York based outpatient clinic. Groups did not differ with respect to diagnoses (χ²(200) = 7.5, p = .76), likelihood of having an Orthodox Jewish therapist (χ²(200) = .06, p = .81), or number of therapy sessions (t(206) = .73, p =  .47). Multilevel regression modeling revealed that Orthodox patients reported lower initial anxiety (t(198) = 3.71, p < .001, d = .54) and depression (t(198) = 3.71, p < .001, d = .54, d = .50), but were equivalent to controls at termination (Anxiety t(189) = .36, p =  .72; Depression t(182) = 1.00, p =  .32). Interactions between patient and therapist religious affiliations were not significant. These results suggest that religious (and non-religious) patients may benefit equally from treatment delivered by religious and non-religious therapists.

Religious coping in patients with severe substance use disorders receiving acute inpatient detoxification

BACKGROUND AND OBJECTIVES

Religious coping, one of the most widely studied components of spirituality among psychiatric populations, has rarely been addressed in patients with severe substance use disorders (SUD). The aim of our study was to elucidate whether religious coping is related to symptom expression and mutual-help participation.

METHODS

Self-reported religious coping was assessed in individuals sequentially admitted to a private psychiatric hospital for inpatient detoxification. Target symptoms of SUD included severity of substance use prior to admission and craving during detoxification. Three hundred thirty-one patients (68.6% male) participated in the survey; mean age was 38.0 years, and primary presenting diagnosis was most commonly alcohol use disorder (n = 202; 61%), followed by opioid use disorder (n = 119; 36%).

RESULTS

Positive religious coping was associated with significantly greater mutual-help participation, fewer days of drug use prior to admission, and was modestly, yet significantly associated with lower drug craving. Negative religious coping was associated with lower confidence in the ability to remain abstinent post-discharge and higher drug craving.

CONCLUSIONS

Consistent with hypotheses, greater positive religious coping was associated with greater mutual-help participation, lower severity of pre-admission drug use, and lower substance craving during detoxification. Use of positive religious coping may modify the course of SUD recovery by promoting engagement in mutual-help activities.

SCIENTIFIC SIGNIFICANCE

The findings of this study suggest that positive and negative religious coping are linked with several key SUD recovery variables. Further research to replicate this finding and to assess mechanisms within this potential association is warranted. (Am J Addict 2017;26:744-750).

Service user views of spiritual and pastoral care (chaplaincy) in NHS mental health services: a co-produced constructivist grounded theory investigation

BACKGROUND

Within the UK National Health Service (NHS), Spiritual and Pastoral Care (SPC) Services (chaplaincies) have not traditionally embraced research due to the intangible nature of their work. However, small teams like SPC can lead the way towards services across the NHS becoming patient- centred and patient-led. Using co-production principles within research can ensure it, and the resulting services, are truly patient-led.

METHODS

A series of interviews were conducted with service users across directorates of a large NHS mental health Trust. Their views on the quality of SPC services and desired changes were elicited. Grounded theory was used with a constant comparative approach to the interviews and analysis.

RESULTS

Initial analysis explored views on spirituality and religion in health. Participants' concerns included what chaplains should do, who they should see, and how soon after admission. Theoretical analysis suggested incorporating an overarching spiritual element into the bio-psycho-social model of mental healthcare.

CONCLUSIONS

Service users' spirituality should not be sidelined. To service users with strong spiritual beliefs, supporting their spiritual resilience is central to their care and well-being. Failure will lead to non-holistic care unlikely to engage or motivate.