Religious and spiritual factors and the consequences of trauma: a review and model of the interrelationship

How are experiences and acceptability of child maltreatment related to resilience and posttraumatic growth: a cross cultural study

Background: Post-traumatic growth (PTG) and resilience, regarded as positive psychological change following a traumatic experience, are under-researched across cultures in people exposed to child maltreatment (CM).Objective: We investigated how experiences and the perceived acceptability of CM are related to resilience and PTG in countries with different cultures, living standards, and gross national income.Method: A total of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122) completed an online survey with self-reported questionnaires, including the Brief Resilience Scale and the Post Traumatic Growth Inventory-Short Form.Results: Across countries, self-reported male gender and age were positively associated with resilience, while experiences of physical abuse and emotional maltreatment were negatively associated with resilience. Experiences of emotional maltreatment were positively associated with PTG. Higher levels of PTG and resilience were found amongst Cameroonian participants as compared to other countries.Conclusion: Our results suggest that positive changes following CM can vary significantly across cultures and that experiences of specific CM subtypes, but not the perceived acceptability of CM, may be important for a deeper understanding of how individuals overcome trauma and develop salutogenic outcomes. Our findings may inform CM intervention programmes for an enhanced cultural sensitivity.

Religion, spirituality, and risk for incident posttraumatic stress disorder, suicidal ideation, and hazardous drinking in U.S. military veterans: A 7-year, nationally representative, prospective cohort study

While religion and spirituality (R/S) have been linked to positive mental health outcomes, most studies have employed cross-sectional designs, which do not allow one to evaluate the utility of R/S in predicting these outcomes. To address this gap, this study analyzed data from a 7-year nationally representative, prospective cohort study of U.S. military veterans to examine the effects of R/S on the development of incident mental health outcomes in this population. Specifically, we examined the association between organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiosity (IR), and the risk of incident PTSD, suicidal ideation (SI), and hazardous drinking (HD). Multivariable logistic regression analyses revealed that ORA predicted a lower incidence of PTSD and SI; NORA a greater risk of developing HD; and IR a lower risk of developing HD. These results suggest that religion and spirituality, assessed in a nationally representative sample of military veterans, predict risk of developing PTSD, SI, and HD, over and above sociodemographic factors and perceived social support. Clinical implications and strategies for incorporating R/S into mental health assessment and interventions in this population are discussed.

The Effect of Trauma on Religious Beliefs: A Structured Literature Review and Meta-Analysis

INTRODUCTION

Empirical research has shown that religious beliefs support people recovering from traumatic experiences. However, there is relatively little research on the inversion of this dynamic, the way that trauma changes a person's religious beliefs. The authors of this article conducted a structured literature review and meta-analysis of published quantitative and qualitative literature related to the effects of interpersonal trauma on religious beliefs in adults. Their aims were to determine whether religious beliefs act as cognitive schemas, to support or reject the "shattered assumptions" hypothesis, and to assess whether post-traumatic stress disorder (PTSD) symptoms have an additive effect on changing beliefs.

METHOD

Five academic databases were searched using permutations of the key words: Religion, Trauma, and Posttraumatic Stress Disorder (PTSD). The resulting references were compared to predetermined inclusion/exclusion criteria, and the reference lists of these papers were also searched for additional matches. Included papers were then subjected to a meta-analysis.

RESULTS

Five quantitative, two qualitative, and two mixed-methodologies papers were matched. Aggravated analyzes confirmed the hypothesized effect (r = .19, p < .05).

CONCLUSIONS

The reviewed literature suggests that most people do not change their religious beliefs after a trauma but significant changes occur for a smaller proportion of people-either increasing or decreasing their religious beliefs. These effects are greatest for people who develop PTSD. This review supports the shattered assumptions hypothesis of Janoff-Bulman, explains the cognitive mechanisms of change, and proposes a model for the additive effects of PTSD.

A Spirituality Mind-Body Wellness Center in a University Setting; A Pilot Service Assessment Study

Increasing rates of mental illness among college students over the past 10 years suggest a collective deficit in meaning and purpose unattended to by many university campuses. Psychopathology among young adult college students is associated with developmental tasks such as spiritual individuation, suggesting that interventions aimed at spiritual wellbeing may support the stated need for comprehensive mental health services. The aim of this pilot service assessment study is to investigate the feasibility, acceptability, and helpfulness of spiritually integrated programs at a Spirituality Mind Body (SMB) Wellness Center at a graduate-level academic institution. Wellness Center demographic and attendance data of N = 305 adult graduate students (M = 27.7 years, SD = 6.05) were used to assess acceptability and feasibility. To evaluate helpfulness, measures assessing symptoms of depression, anxiety, post-traumatic stress (PTS), spirituality, mindfulness, and psychological inflexibility were completed before and after eight-week programs on a subset of participants (n = 141). SMB users completed a total of 64% of sessions and reported significant pre/post gains in spirituality and mindfulness and decreases in psychological inflexibility, symptoms of depression and PTS. The preliminary findings of this open-trial are encouraging but inherently limited by the design; foremost, the results offer support for future research, which might draw on a larger sample and a study design involving a comparison group.

Trauma exposure, PTSD symptoms, and tobacco use: Does church attendance buffer negative effects?

Traumatic stress and posttraumatic stress disorder (PTSD) are overrepresented in urban African American communities, and associated with health risk behaviors such as tobacco use. Support and resources provided by churches may reduce trauma-related health risks. In the current study, we assessed weekly church attendance as a moderator of relations between (a) traumatic event exposure and probable PTSD, and (b) probable PTSD and tobacco use. Data were drawn from a health surveillance study conducted in seven churches located in Chicago's West Side. Participants (N = 1015) were adults from churches as well as the surrounding community. Trauma exposure was reported by 62% of participants, with 25% of those who experienced trauma reporting probable PTSD. Overall, more than one-third of participants (37.2%) reported current tobacco use. As compared with non-weekly church attendance, weekly church attendance was associated with a lower likelihood of PTSD (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.26-0.62; p < .0001) and lower tobacco use overall (OR = 0.22; 95% CI = 0.16-0.30; p < .0001), but did not moderate the effect of trauma exposure on risk of PTSD, or the effect of PTSD on tobacco use. Findings support church attendance as a potential buffer of trauma-related stress.

Spiritual Interventions in Veterans with PTSD: A Systematic Review

This article reports the results of a systematic review on the effectiveness of religious/spiritually (R/S)-based interventions in veterans with post-traumatic stress disorder (PTSD). A total of 385 unique records were identified with eight meeting the inclusion criteria. Seven studies reported significant improvement in reported outcome measures demonstrating the effectiveness of R/S-based interventions in PTSD, with the eighth study reporting positive improvements. We conclude that the few existing published studies report significant benefits to veterans on several outcomes. R/S interventions for veterans with PTSD need to be further developed and tested to determine their efficacy and safety.

Spiritual Transcendence and Psychological Adjustment: The Moderating Role of Personality in Burn Patients

The current study examined the moderating role of personality traits (neuroticism and extraversion) on the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The sample (N = 98) comprised adult burn patients (age = 25-50) admitted to three hospitals in Lahore, Pakistan. They were assessed according to a demographic information sheet, the NEO Personality Inventory (McCrae and Costa in J Personal Soc Psychol 52:81-90, 1987), the Spiritual Transcendence Index (Seidlitz et al. in J Sci Study Relig 41:439-453, 2002), the Depression, Anxiety, Stress Scales-21 (Lovibond and Lovibond in Manual for the Depression Anxiety Stress scales, Psychology Foundation, Sydney, 1995), and the Perceived Benefit Scales (McMillen and Fisher in Soc Work Res 22(3):173-186, 1998). Stepwise moderated regression analysis showed that both personality traits (neuroticism and extraversion) played a moderating role in the relationship between spiritual transcendence and positive change, and spiritual transcendence and distress in burn patients. The findings highlight the potential role spiritual transcendence may have in understanding and improving the psychological adjustment of burn patients.

Posttraumatic growth among childhood cancer survivors: Associations with ethnicity, acculturation, and religious service attendance

This study assessed the association between ethnicity, religious service attendance (RSA), and acculturation with posttraumatic growth (PTG) in a diverse sample of 235 childhood cancer survivors (CCS). PTG scores were estimated for each ethnicity, and by level of RSA and acculturation. There was a significant curvilinear relationship (inverted U) between RSA and PTG, such that moderate levels of RSA were associated with the highest PTG scores. Hispanics reported the highest PTG, and both Hispanic and Anglo cultural orientation were significantly positively associated with PTG. CCS with high or low frequency of RSA as well as Hispanic CCS who lack a strong sense of cultural identity may benefit from targeted efforts to promote psychosocial adaptation in the aftermath of cancer.

The Effect of Adverse Childhood Experience on Clinical Diagnosis of a Substance Use Disorder: Results of a Nationally Representative Study

BACKGROUND

Substance abuse is one of the most common health outcomes associated with adverse childhood experience, and poses a significant public health threat.

OBJECTIVES

The purpose of this study is to demonstrate a relationship between adverse childhood experience and a substance use disorder using nationally representative data as well as to test whether religion moderates this relationship.

METHODS

We conducted a secondary analysis using data from the National Longitudinal Study of Adolescent to Adult Health (n = 11,279). Three types of adverse childhood experiences were considered; physical, emotional, and sexual abuse. Logistic regression was used to determine whether risk for developing an alcohol use, cannabis use, or other drug use disorder in adulthood increased as exposure to multiple types of adverse childhood experiences increased while controlling for prior substance use and other demographic variables that have shown associations with substance use. In addition, religiosity was investigated as a possible moderator of the relationship between adverse childhood experience and substance abuse.

RESULTS

The likelihood of developing a substance use disorder later in life increased as the score on the adverse childhood experience index increased. While religiosity did significantly reduce the likelihood of developing a substance use disorder, no moderating effects were observed. Conclusions/importance: This study underscores the long-term consequences of exposure to childhood adversity.

Risk, coping and PTSD symptom trajectories in World Trade Center responders

Trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms are often heterogeneous, and associated with common and unique risk factors, yet little is known about potentially modifiable psychosocial characteristics associated with low-symptom and recovering trajectories in disaster responders. A total of 4487 rescue and recovery workers (1874 police and 2613 non-traditional responders) involved during and in the aftermath of the unprecedented World Trade Center (WTC) attacks, were assessed an average of 3, 6, 8, and 12 years post-9/11/2001. Among police responders, WTC-related PTSD symptoms were characterized by four trajectories, including no/low-symptom (76.1%), worsening (12.1%), improving (7.5%), and chronic (4.4%) trajectories. In non-traditional responders, a five-trajectory solution was optimal, with fewer responders in a no/low-symptom trajectory (55.5%), and the remainder in subtly worsening (19.3%), chronic (10.8%), improving (8.5%), and steeply worsening (5.9%) trajectories. Consistent factors associated with symptomatic PTSD trajectories across responder groups included Hispanic ethnicity, pre-9/11 psychiatric history, greater WTC exposure, greater medical illness burden, life stressors and post-9/11 traumas, and maladaptive coping (e.g., substance use, avoidance coping). Higher perceived preparedness, greater sense of purpose in life, and positive emotion-focused coping (e.g., positive reframing, acceptance) were negatively associated with symptomatic trajectories. Findings in this unique cohort indicate considerable heterogeneity in WTC-related PTSD symptom trajectories over 12 years post-9/11/2001, with lower rates of elevated PTSD symptoms in police than in non-traditional responders. They further provide a comprehensive risk prediction model of PTSD symptom trajectories, which can inform prevention, monitoring, and treatment efforts in WTC and other disaster responders.

Religious Moral Beliefs Inversely Related to Trauma Experiences Severity and Presented Posttraumatic Stress Disorder Among Bosnia and Herzegovina War Veterans

The aim of this study was to determine the correlation of the level of religious moral beliefs (RMB) with trauma experiences and posttraumatic stress disorder (PTSD) severity in war veterans of Bosnia and Herzegovina. The sample consists of 120 Bosnian war veterans divided into two equal groups-one with and one without PTSD. We used the Harvard Trauma Questionnaire and the RMB belief scale. We then correlated the severity of trauma experiences and PTSD symptoms with veterans' scores on the RMB scale. The score on the RMB scale was negatively correlated to severity of trauma experiences and PTSD symptoms (Pearson's r = -0.509, P = 0.004; Pearson's r = -0.325, P < 0.001, respectively). The RMB may have protective role in the mental health stability of severely traumatized war veterans.

Religiousness in times of job insecurity: job demand or resource?

Purpose

– Departing from the job demands resources model, the purpose of this paper is to investigate whether religion, defined as strength of religious faith, can be viewed as resource or as demand. More specifically, the authors addressed the question as to how job insecurity and religion interact in predicting burnout and change-oriented behavior.

Design/methodology/approach

– The authors conducted moderated structural equation modeling on survey data from a sample of 238 employees confronted with organizational change.

Findings

– Results were largely consistent with the “religion as a demand” hypothesis: religion exacerbated rather than buffered the negative effects of job insecurity, so that the adverse impact of job insecurity was stronger for highly religious employees than for employees with low levels of religiousness. Religious employees appear to experience more strain when faced with the possibility of job loss.

Originality/value

– The results of this study challenge and extend existing knowledge on the role of religion in coping with life stressors. The dominant view has been that religion is beneficial in coping with major stressors. The results of this study, however, suggest otherwise: religion had an exacerbating rather than a buffering effect on the relationship between job insecurity and outcomes.

Could spirituality and religion promote stress resilience in survivors of childhood trauma?

Trauma is a precursor to many mental health conditions that greatly impact victims, their loved ones, and society. Studies indicate that neurobiological associations with adverse childhood experiences are mediated by interpersonal relationships and play a role in adult behavior, often leading to cycles of intergenerational trauma. There is a critical need to identify cost effective community resources that optimize stress resilience. Faith-based communities may promote forgiveness rather than retaliation, opportunities for cathartic emotional release, and social support, all of which have been related to neurobiology, behavior, and health outcomes. While spirituality and religion can be related to guilt, neurotic, and psychotic disorders, they also can be powerful sources of hope, meaning, peace, comfort, and forgiveness for the self and others. This article provides an overview of religion and spirituality as they relate to the neurobiology of resilience in victims of childhood trauma.

Posttraumatic Stress and Meaning Making in Mexico City

Mexico City, established in 1524, is Mexico’s most important educational, financial and cultural centre. As is typical of large metropolitan cities, Mexico City has its share of crime, violence and poverty. It also has a history of natural disasters, particularly large-scale earthquakes. There is a lack of research on the impacts and correlates of chronic exposure to trauma in developing societies such as Mexico City. Particularly, a dearth of research that examines the relationship between exposure to trauma and posttraumatic growth in these populations exists. Recently, the Association of Trauma Outreach and Prevention (ATOP) organised a humanitarian mission to Mexico City to assess posttraumatic symptomatology and identify factors that contributed to meaning making and posttraumatic growth, including socio-demographic variables. The results demonstrated that age and marital status were associated with traumatic stress symptomatology and the ability to find meaning in trauma and purpose in one’s life. Inconsistent with previous research, there were no differential associations in symptomatology or posttraumatic growth on the basis of gender. Of note, the results suggested that individuals who had offered support to others during a traumatic event were currently experiencing lower levels of posttraumatic stress and an increased ability to find meaning in the trauma.

The roles of support seeking and race/ethnicity in posttraumatic growth among breast cancer survivors

Posttraumatic growth (PTG) after cancer can minimize the emotional impact of disease and treatment; however, the facilitators of PTG, including support seeking, are unclear. The authors examined the role of support seeking on PTG among 604 breast cancer survivors ages 40 to 64 from the Health Eating, Activity, and Lifestyle (HEAL) Study. Multivariable linear regression was used to examine predictors of support seeking (participation in support groups and confiding in health care providers) as well as the relationship between support seeking and PTG. Support program participation was moderate (61.1%) compared to the high rates of confiding in health professionals (88.6%), and African Americans were less likely to report participating than non-Hispanic Whites (odds ratio = .14, confidence intervals [0.08, 0.23]). The mean (SD) PTG score was 48.8 (27.4) (range 0-105). Support program participation (β = 10.4) and confiding in health care providers (β = 12.9) were associated (p < .001) with higher PTG. In analyses stratified by race/ethnicity, PTG was significantly higher in non-Hispanic Whites and African American support program participants (p < .01), but not significantly higher in Hispanics/Latinas. Confiding in a health care provider was only associated with PTG for non-Hispanic Whites (p = .02). Support program experiences and patient-provider encounters should be examined to determine which attributes facilitate PTG in diverse populations.

Resilience in mental health: linking psychological and neurobiological perspectives

OBJECTIVE

To review the literature on psychological and biological findings on resilience (i.e. the successful adaptation and swift recovery after experiencing life adversities) at the level of the individual, and to integrate findings from animal and human studies.

METHOD

Electronic and manual literature search of MEDLINE, EMBASE and PSYCHINFO, using a range of search terms around biological and psychological factors influencing resilience as observed in human and experimental animal studies, complemented by review articles and cross-references.

RESULTS

The term resilience is used in the literature for different phenomena ranging from prevention of mental health disturbance to successful adaptation and swift recovery after experiencing life adversities, and may also include post-traumatic psychological growth. Secure attachment, experiencing positive emotions and having a purpose in life are three important psychological building blocks of resilience. Overlap between psychological and biological findings on resilience in the literature is most apparent for the topic of stress sensitivity, although recent results suggest a crucial role for reward experience in resilience.

CONCLUSION

Improving the understanding of the links between genetic endowment, environmental impact and gene-environment interactions with developmental psychology and biology is crucial for elucidating the neurobiological and psychological underpinnings of resilience.

Schutz- und Risikofaktoren für Traumafolgestörungen

Theoretischer Hintergrund: Schutzfaktoren und Risikofaktoren tragen zur Prognose, Indikation und Interventionsplanung bei Menschen nach traumatischen Ereignissen bei. Bisherige systematische Reviews fassen die Befunde bis maximal 2007 zusammen und fokussieren auf Posttraumatische Belastungsstörungen. Fragestellung: Systematisches Review unter Einschluss der Befunde für die Jahre 2007 bis 2010 und Berücksichtigung weiterer Traumafolgestörungen. Methode: Analyse von 13 systematischen Reviews und 29 prospektiven Originalarbeiten zu Schutz- und Risikofaktoren für Traumafolgestörungen nach Typ-I-Traumata. Ergebnisse: Es werden Befunde zu prätraumatischen (Soziodemographie, Biographie, psychische Störungen, Persönlichkeitsfaktoren), peritraumatischen (Art und Schwere des Ereignisses, psychische Verfassung während des Ereignisses, peritraumatische Reaktion) und posttraumatischen Faktoren (akute psychische Symptome, Kognitionen, Coping, Vermeidungsverhalten, soziale Unterstützung, zusätzliche Stressoren) dargestellt. Schlussfolgerungen: Vor allem peri- und posttraumatische Schutz- und Risikofaktoren eignen sich für die Vorhersage von Traumafolgestörungen.

Post-traumatic growth and spirituality in burn recovery

For decades, research on long-term adjustment to burn injuries has adopted a deficit model of focusing solely on negative emotions. The presence of positive emotion and the experience of growth in the aftermath of a trauma have been virtually ignored in this field. Researchers and clinicians of other health and trauma populations have frequently observed that, following a trauma, there were positive emotions and growth. This growth occurs in areas such as a greater appreciation of life and changed priorities; warmer, more intimate relations with others; a greater sense of personal strength, recognition of new possibilities, and spiritual development. In addition, surveys of trauma survivors report that spiritual or religious beliefs played an important part in their recovery and they wished more healthcare providers were comfortable talking about these issues. Further evidence suggests that trauma survivors who rely on spiritual or religious beliefs for coping may show a greater ability for post-traumatic growth (PTG). This article reviews the literature on these two constructs as it relates to burn survivors. We also provide recommendations for clinicians on how to create an environment that fosters PTG and encourages patients to explore their spiritual and religious beliefs in the context of the trauma.