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Fuchshuber J, Schöber H, Wohlmuth M, Senra H, Rominger C, Schwerdtfeger A, Unterrainer HF. The effectiveness of a standardized tobacco cessation program on psychophysiological parameters in patients with addiction undergoing long-term rehabilitation: a quasi-experimental pilot study. BMC Med 2024; 22:184. [PMID: 38693570 PMCID: PMC11064355 DOI: 10.1186/s12916-024-03405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/25/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption. METHODS The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6 weeks). RESULTS We observed significant improvements in self-efficacy (F(1,53) = 5.86; p < .05; ηp2 = .11) and decreased CPD in the IG (β = 1.16, ρ < .05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV. CONCLUSIONS The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step. TRIAL REGISTRATION ISRCTN15684371.
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Affiliation(s)
- J Fuchshuber
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
| | - H Schöber
- Institute of Psychology, University of Graz, Graz, Austria
| | - M Wohlmuth
- Institute of Psychology, University of Graz, Graz, Austria
| | - H Senra
- IEETA, University of Aveiro, Aveiro, Portugal
- School of Health and Social Care, University of Essex, Colchester, UK
| | - C Rominger
- Institute of Psychology, University of Graz, Graz, Austria
| | | | - H F Unterrainer
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria.
- Institute of Psychology, University of Graz, Graz, Austria.
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.
- Department of Religious Studies, University of Vienna, Vienna, Austria.
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria.
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Hiebler-Ragger M, Perchtold-Stefan CM, Unterrainer HF, Fuchshuber J, Koschutnig K, Nausner L, Kapfhammer HP, Papousek I, Weiss EM, Fink A. Lower cognitive reappraisal capacity is related to impairments in attachment and personality structure in poly-drug use: an fMRI study. Brain Imaging Behav 2021; 15:2187-2198. [PMID: 33222012 PMCID: PMC8413209 DOI: 10.1007/s11682-020-00414-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 01/19/2023]
Abstract
Insecure attachment, impaired personality structure and impaired emotion regulation figure prominently in substance use disorders. While negative emotions can trigger drug-use and relapse, cognitive reappraisal may reduce emotional strain by promoting changes in perspective. In the present study, we explored behavioral and neural correlates of cognitive reappraisal in poly-drug use disorder by testing individuals' capability to generate cognitive reappraisals for aversive events (Reappraisal Inventiveness Test). 18 inpatients with poly-drug use disorder and 16 controls completed the Adult Attachment Scale, the Emotion Regulation Questionnaire, the Brief Symptom Inventory, the Wonderlic Personnel Test, and the Operationalized Psychodynamic Diagnosis Structure Questionnaire, as well as two versions of the Reappraisal Inventiveness Test (during fMRI and outside the lab). Compared to controls, polydrug inpatients reported impaired personality structure, attachment and emotion regulation abilities. In the Reappraisal Inventiveness Test, poly-drug inpatients were less flexible and fluent in generating reappraisals for anger-eliciting situations. Corresponding to previous brain imaging evidence, cognitive reappraisal efforts of both groups were reflected in activation of left frontal regions, particularly left superior and middle frontal gyri and left supplemental motor areas. However, no group differences in neural activation patterns emerged. This suggests that despite cognitive reappraisal impairments on a behavioral level, neural reflections of these deficits in poly-drug use disorder might be more complex.
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Affiliation(s)
- M. Hiebler-Ragger
- University Clinic of Psychiatry and Psychotherapeutic Medicine, Medical University, Auenbruggerplatz 31, 8036, Graz, Austria ,Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Simmeringer Hauptstraße 101, 1110 Vienna, Austria
| | | | - H. F. Unterrainer
- University Clinic of Psychiatry and Psychotherapeutic Medicine, Medical University, Auenbruggerplatz 31, 8036, Graz, Austria ,Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Simmeringer Hauptstraße 101, 1110 Vienna, Austria ,Department of Religious Studies, University of Vienna, Schenkenstraße 8-10, 1010 Vienna, Austria
| | - J. Fuchshuber
- University Clinic of Psychiatry and Psychotherapeutic Medicine, Medical University, Auenbruggerplatz 31, 8036, Graz, Austria ,Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Simmeringer Hauptstraße 101, 1110 Vienna, Austria
| | - K. Koschutnig
- Institute of Psychology, University of Graz, Universitätsplatz 2, 8010 Graz, Austria
| | - L. Nausner
- Fachsektion Integrative Gestalttherapie, Österreichischer Arbeitskreis für Gruppentherapie und Gruppendynamik, Lenaugasse 3, 1080 Vienna, Austria
| | - H. P. Kapfhammer
- University Clinic of Psychiatry and Psychotherapeutic Medicine, Medical University, Auenbruggerplatz 31, 8036, Graz, Austria ,Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 43, 8036, Graz, Austria
| | - I. Papousek
- Institute of Psychology, University of Graz, Universitätsplatz 2, 8010 Graz, Austria
| | - E. M. Weiss
- Institute of Psychology, University of Innsbruck, Innrain 52f, 6020 Innsbruck, Austria
| | - A. Fink
- Institute of Psychology, University of Graz, Universitätsplatz 2, 8010 Graz, Austria
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Fuchshuber J, Unterrainer HF, Hiebler-Ragger M, Koschutnig K, Papousek I, Weiss EM, Fink A. Pinpointing Neural Correlates of Attachment in Poly-Drug Use: A Diffusion Tensor Imaging Study. Front Neurosci 2020; 14:596. [PMID: 32595448 PMCID: PMC7300178 DOI: 10.3389/fnins.2020.00596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/15/2020] [Indexed: 01/03/2023] Open
Abstract
An increasing amount of evidence indicates the significance of attachment in the etiology of poly-drug use disorder (PUD). The aim of this study was to investigate associations between PUD and adult attachment in particular, with a focus on white matter (WM) fiber tract integrity. For this purpose, we selected several regions-of-interest based on previous findings which were examined for their role in PUD and estimated whole-brain associations between adult attachment and WM integrity. A total sample of 144 right-handed males were investigated (Age: M = 27; SD = 4.66). This included a group of patients diagnosed with PUD (n = 70) and a group of healthy controls (HC; n = 74). The Adult Attachment Scales (AAS) was applied to assess attachment attitudes in participants. Diffusion Tensor Imaging was used to investigate differences in WM integrity. The findings suggest substantially less attachment security in PUD patients compared to HC. Furthermore, PUD patients exhibited reduced integrity in WM fiber tracts, most pronounced in the bilateral corticospinal tract, the fronto-occipital fasciculus, and the right inferior longitudinal fasciculus. However, these results were not controlled for comorbid depressiveness. With regard to associations between adult attachment and WM integrity, the results for PUD patients indicate a negative relationship between "Comfort with Closeness" and the structural integrity of a cluster comprising parts of the right anterior thalamic radiation, the inferior fronto-occipital fasciculus and the uncinate fasciculus. Despite being limited by the cross-sectional design of this study, the results emphasize the significance of attachment in PUD etiology, both at a behavioral and a neurological level. Largely in line with previous research, the findings revealed tentative links between adult attachment and WM fiber tracts related to cognitive and affective functions in PUD patients.
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Affiliation(s)
- J. Fuchshuber
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - H. F. Unterrainer
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
- Department of Religious Studies, University of Vienna, Vienna, Austria
| | - M. Hiebler-Ragger
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - K. Koschutnig
- Institute of Psychology, University of Graz, Graz, Austria
| | - I. Papousek
- Institute of Psychology, University of Graz, Graz, Austria
| | - E. M. Weiss
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - A. Fink
- Institute of Psychology, University of Graz, Graz, Austria
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Aberer E, Hiebler-Ragger M, Zenker M, Weger W, Hofer A, Unterrainer HF. Facets of shame are differently expressed in dermatological disease: a prospective observational study. Br J Dermatol 2020; 183:169-171. [PMID: 31997342 PMCID: PMC7383988 DOI: 10.1111/bjd.18899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - M Hiebler-Ragger
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria.,Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - M Zenker
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - W Weger
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Hofer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - H F Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.,CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria.,Department of Religious Studies, University of Vienna, Vienna, Austria
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Fuchshuber J, Hiebler-Ragger M, Ragger K, Rinner A, Kapfhammer HP, Unterrainer HF. Increased attachment security is related to early therapy drop-out in substance use disorders. BMC Res Notes 2018; 11:141. [PMID: 29463316 PMCID: PMC5819233 DOI: 10.1186/s13104-018-3251-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/13/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Previous research work suggests a positive association between secure attachment and increased therapy adherence (TA) in different patient groups. However, there is still a strong need for research focusing on the influence of attachment on TA in substance use disorder (SUD) treatment. Hence, this study attempts to investigate the predictive value of different attachment patterns concerning TA in SUD inpatients. RESULTS 122 (34 female) SUD inpatients completed the Attachment Style Questionnaire (ASQ) during the entry phase of therapeutic community treatment. After 6 weeks, subjects who remained in therapy (n = 47) completed the ASQ for a second time. In line with the literature, agglomerative Cluster Analysis suggested a two-cluster solution (Cluster I: increased secure attachment pattern; Cluster II: increased insecure attachment pattern). Notably, inpatients in Cluster I were more likely to drop out of treatment within the first 6 weeks (p < .001). Furthermore, subjects showed less "Confidence in Self and Others" (p < .05) after 6 weeks of treatment. Our findings indicate a negative predictive value of increased attachment security for TA in SUD inpatients. This finding probably mirrors a more realistic kind of self-assessment. More generally, the importance of considering attachment styles in SUD treatment is underlined.
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Affiliation(s)
- J Fuchshuber
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - M Hiebler-Ragger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - K Ragger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - A Rinner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - H P Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - H F Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria. .,Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria. .,Department of Religious Studies, University of Vienna, Schenkenstraße 8-10/5th Floor, 1010, Vienna, Austria.
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Unterrainer HF, Hiebler M, Ragger K, Froehlich L, Koschutnig K, Schoeggl H, Kapfhammer HP, Papousek I, Weiss EM, Fink A. White matter integrity in polydrug users in relation to attachment and personality: a controlled diffusion tensor imaging study. Brain Imaging Behav 2017; 10:1096-1107. [PMID: 26542619 DOI: 10.1007/s11682-015-9475-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The relationship between substance use disorders (SUD) and brain deficits has been studied extensively. However, there is still a lack of research focusing on the structural neural connectivity in long-term polydrug use disorder (PUD). Since a deficiency in white matter integrity has been reported as being related to various parameters of increased psychopathology, it might be considered an aggravating factor in the treatment of SUD. In this study we compared two groups of PUD inpatients (abstinent: n = 18, in maintenance treatment: n = 15) to healthy controls (n = 16) with respect to neural connectivity in white matter, and their relation to behavioral parameters of personality factors/organization and attachment styles. Diffusion Tensor Imaging was used to investigate white matter structure. Compared with healthy controls, the PUD patients showed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) mainly in the superior fasciculus longitudinalis and the superior corona radiata. These findings suggest diminished neural connectivity as a result of myelin pathology in PUD patients. In line with our assumptions, we observed FA in the biggest cluster as negatively correlated with anxious attachment (r = 0.36, p < 0.05), personality dysfunctioning (r = -0.41; p < 0.01) as well positively correlated with personality factors Openness (r = 0.34; p < 0.05) and Agreeableness (r = 0.28; p < 0.05). Correspondingly these findings were inversely mirrored by RD. Further research employing enhanced samples and addressing longitudinally neuronal plastic effects of SUD treatment in relation to changes in personality and attachment is recommended.
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Affiliation(s)
- H F Unterrainer
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria. .,Center for Integrative Addiction Research (Grüner Kreis Society), Vienna, Austria. .,University Clinic of Psychiatry, Medical University, Graz, Austria. .,Karl-Franzens-University Graz, Universitätsplatz 2, 8010, Graz, Austria.
| | - M Hiebler
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria
| | - K Ragger
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria
| | - L Froehlich
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria
| | - K Koschutnig
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria
| | - H Schoeggl
- University Clinic of Psychiatry, Medical University, Graz, Austria
| | - H P Kapfhammer
- University Clinic of Psychiatry, Medical University, Graz, Austria
| | - I Papousek
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria
| | - E M Weiss
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria
| | - A Fink
- University of Graz, Institute of Psychology, BioTechMed-Graz, Graz, Austria
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Lackner N, Unterrainer HF, Skliris D, Wood G, Dunitz-Scheer M, Wallner-Liebmann SJ, Scheer PJZ, Neuper C. [Neurofeedback in the Treatment of Anorexia Nervosa: a Case Report]. Fortschr Neurol Psychiatr 2016; 84:88-95. [PMID: 26953548 DOI: 10.1055/s-0042-103027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anorexia nervosa has been related to alterations in brain activity in terms of hyperactive EEG patterns. This case report illustrates the principles and results of a five-week neurofeedback treatment in a 29-year-old woman suffering from anorexia nervosa. A neurofeedback protocol to enhance alpha activity (8 - 12 Hz) was developed and conducted additionally to the standardized treatment for eating disorders in training sessions twice a week. Pre- and post-test measurements included resting state EEG measurements and a psychological test battery. The results show improvements from pre- to post-test in eating disorder psychopathology including psychological wellbeing, emotional competence, and eating behavior traits. In addition, a decrease in theta power (4 - 7 Hz), a well-known trait marker of anorexia nervosa, was measured. However, our data should be interpreted with caution because this is a single case study. Nevertheless, this report documents the practicability and method of neurofeedback as treatment adjunct in eating disorders from the clinical perspective. Although the use of neurofeedback in the treatment of anorexia nervosa is recommended in literature, empirical studies are still lacking. Randomized controlled trials to evaluate short- and long-term effects of neurofeedback are needed.
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Affiliation(s)
- N Lackner
- Psychiatrie, Medizinische Universität Graz, Austria
| | | | - D Skliris
- Neuropsychologie, Karl-Franzens-Universität Graz, Austria
| | - G Wood
- Neuropsychologie, Karl-Franzens-Universität Graz, Austria
| | - M Dunitz-Scheer
- 3. Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Austria
| | | | - P J Z Scheer
- 3. Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Austria
| | - C Neuper
- Neuropsychologie, Karl-Franzens-Universität Graz, Austria
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Unterrainer HF, Lewis AJ, Fink A. Religious/Spiritual Well-being, personality and mental health: a review of results and conceptual issues. J Relig Health 2014; 53:382-92. [PMID: 22965652 DOI: 10.1007/s10943-012-9642-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The current paper provides background to the development of the Multidimensional Inventory for Religious/Spiritual Well-being and then summarises findings derived from its use with other measures of health and personality. There is substantial evidence for religiosity/spirituality being positively related to a variety of indicators of mental health, including subjective well-being and personality dimensions. Furthermore, religiosity/spirituality can play an important role in the process of recovering from mental illness as well as providing a protective function against addictive or suicidal behaviours. However, further research is needed to examine the mechanisms through which religiosity/spirituality have an impact on health-related conditions.
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Affiliation(s)
- H F Unterrainer
- Center for Integrative Addiction Research (Grüner Kreis Society/ARS), Vienna, Austria,
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Unterrainer HF, Schoeggl H, Fink A, Neuper C, Kapfhammer HP. Soul darkness? Dimensions of religious/ spiritual well-being among mood-disordered inpatients compared to healthy controls. Psychopathology 2012; 45:310-6. [PMID: 22797574 DOI: 10.1159/000336050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 12/22/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Religiosity and spirituality have been found to be substantially associated with a variety of mental health and illness parameters. However, relevant empirical evidence is sparse, and more research is needed in order to further understand what role religiosity/spirituality plays in the development, progression and healing process of a psychiatric disease. Thus, the purpose of this study was to find out more information about the religious/spiritual needs of anxious/depressive inpatients. SAMPLING AND METHODS A total sample of 200 well-characterized anxious/depressive inpatients was investigated. Results were compared to those from an adjusted group of healthy individuals (n = 200). A newly developed Multidimensional Inventory for Religious/Spiritual Well-Being was applied to both groups, together with established psychiatric measures (e.g. Beck Depression Inventory). RESULTS Of the dimensions measured, Hope and Forgiveness turned out to be the strongest negative correlates of anxious/depressive symptoms (p < 0.001). Moreover, a lower degree of Hope (p < 0.001) and Experiences of Sense and Meaning (p < 0.01) was found in the patient group compared to healthy controls. In accordance with the literature, religiosity was confirmed to be a substantial suicidal buffer (p < 0.01). CONCLUSIONS Our results account for a more comprehensive psychiatric evaluation, emphasizing in particular the role that religiosity/spirituality plays in overall well-being. Furthermore, religious/spiritual well-being might be considered an important resource to explore, in particular for affective mentally disordered patients.
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Affiliation(s)
- H F Unterrainer
- Institute of Psychology, Karl-Franzens-University, Graz, Austria.
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