Amy B. Wachholtz

Exploring the relationship between spirituality, coping, and pain

There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelationship among biological, psychological, social, and spiritual factors. Chronic pain patients use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual forms of coping, such as prayer, and seeking spiritual support to manage their pain. This article will explore the relationship between the experience of pain and religion/spirituality with the aim of understanding not only why some people rely on their faith to cope with pain, but also how religion/spirituality may impact the experience of pain and help or hinder the coping process. We will also identify future research priorities that may provide fruitful research in illuminating the relationship between religion/spirituality and pain.

Religion and HIV: a review of the literature and clinical implications

Despite substantive research documenting the connection between various religious dimensions and physical and mental health, surprisingly little attention has been given to the study of religion among individuals with the human immunodeficiency virus (HIV). Although initially considered to be a white, “gay man’s” disease, today women and ethnic minorities are subgroups that are the most severely affected by the HIV pandemic. Importantly, these disenfranchised subgroups report greater use of religion in their everyday lives. A small but growing number of studies conducted mostly within the past few years have recognized the importance of religion in the lives of individuals with HIV. In particular, research has noted the frequent use of religious coping by men and women with HIV to deal with the loss of their loved ones to AIDS, to overcome their sense of guilt and shame in engaging in risky behaviors, and to find a renewed sense of purpose in life. However, clinical interventions with persons with HIV have largely neglected religiousness and spirituality as resources for treatment and, to date, few spirituality-based interventions exist that can be empirically evaluated. In this paper, we review the literature on religious coping among individuals with HIV and outline a clinical intervention that incorporates religious issues relevant to this population. We first provide an overview of religious coping.

Prayer and pain: the mediating role of positive re-appraisal

The present study explored in a sample of Flemish pain patients the role of prayer as a possible individual factor in pain management. The focus on prayer as a personal religious factor fits with the current religious landscape in Western-Europe where personal religious factors are more important than organizational dimensions of religion. Our study is framed in the transactional theory of stress and coping by testing first, whether prayer was related with pain severity and pain tolerance and second, whether cognitive positive re-appraisal was a mediating mechanism in the association between prayer and pain. We expected that prayer would be related to pain tolerance in reducing the impact of the pain on patient’s daily life, but not necessarily to pain severity. A cross-sectional questionnaire design was adopted in order to measure demographics, prayer, pain outcomes (i.e., pain severity and pain tolerance), and cognitive positive re-appraisal. Two hundred and two chronic pain (CP) patients, all members of a Flemish national patients association, completed the questionnaires. Correlational analyses showed that prayer was significantly related with pain tolerance, but not with pain severity. However, ancillary analyses revealed a moderational effect of religious affiliation in the relationship between prayer and pain severity as well as pain tolerance. Furthermore, mediation analysis revealed that cognitive positive re-appraisal was indeed an underlying mechanism in the relationship between prayer and pain tolerance. This study affirms the importance to distinguish between pain severity and pain tolerance, and indicates that prayer can play a role in pain management, especially for religious pain patients. Further, the findings can be framed within the transactional theory of stress and coping as the results indicate that positive re-appraisal might be an important underlying mechanism in the association between prayer and pain.

Meaning in life: an important factor for the psychological well-being of chronically ill patients?

PURPOSE This study aimed to investigate 2 dimensions of meaning in life--Presence of Meaning (i.e., the perception of your life as significant, purposeful, and valuable) and Search for Meaning (i.e., the strength, intensity, and activity of peoples efforts to establish or increase their understanding of the meaning in their lives)--and their role for the well-being of chronically ill patients. RESEARCH DESIGN A sample of 481 chronically ill patients (M = 50 years, SD = 7.26) completed measures on meaning in life, life satisfaction, optimism, and acceptance. We hypothesized that Presence of Meaning and Search for Meaning will have specific relations with all 3 aspects of well-being. RESULTS Cluster analysis was used to examine meaning in life profiles. RESULTS supported 4 distinguishable profiles (High Presence High Search, Low Presence High Search, High Presence Low Search, and Low Presence Low Search) with specific patterns in relation to well-being and acceptance. Specifically, the 2 profiles in which meaning is present showed higher levels of well-being and acceptance, whereas the profiles in which meaning is absent are characterized by lower levels. Furthermore, the results provided some clarification on the nature of the Search for Meaning process by distinguishing between adaptive (the High Presence High Search cluster) and maladaptive (the Low Presence High Search cluster) searching for meaning in life. CONCLUSIONS The present study provides an initial glimpse in how meaning in life may be related to the well-being of chronically ill patients and the acceptance of their condition. Clinical implications are discussed.

Beyond descriptive research: advancing the study of spirituality and health.

The past three decades have witnessed a surge in research on spirituality and health. This growing body of literature has linked many aspects of spirituality as well as religion to both positive and negative indices of human functioning. However, studies have primarily been descriptive, focusing on identifying associations between spirituality and health, rather than explanatory, focusing on identifying mechanisms underlying observed relationships. Earlier research is also limited by failure to control for salient covariates, apply prospective design, and use sophisticated measurements with well defined and empirically-validated factors. Recent research, however, is advancing the study of spirituality and health by examining not only whether religious factors are relevant to human health, but also how spirituality may functionally impact medical and psychological wellbeing and illness. This article introduces a special issue on Spirituality and Health containing 12 full-length research reports to further this welcomed, emerging trend.

The effect of religious and spiritual interventions on the biological, psychological, and spiritual outcomes of oncology patients: A meta-analytic review

Abstract In addition to biomedical forms of treatment, many cancer patients have elected to use complementary and alternative medicine (CAM) of a spiritual or religious nature. However, the effectiveness of such spiritual and religious interventions is uncertain. Using a meta-ana-lytic approach, the present study synthesized available treatment-outcome studies on spiritual and religious interventions for cancer patients to determine the efficacy of such interventions. Effect sizes were calculated for three types of outcome measures: biological, psychological, and spiritual. The authors found that nondrug spiritual and religious interventions produced small to moderate effect sizes for treatment versus control comparisons and small effect sizes for pre— versus posttreatment comparisons. Studies that used psychedelic drugs to promote spiritual experiences produced large effect sizes for both treatment versus control and preversus posttreatment comparisons. Finally, they found that, overall, treatment versus control comparisons produced larger effect sizes than did preversus posttreatment comparisons. Limitations of the studies discussed in the present meta-analysis included the lack of control groups, randomization, and a large number of participants. The results suggest that there is a shortage of sufficiently detailed, high-quality treatment outcome studies examining the efficacy of spiritual and religious interventions for oncology patients.

Migraine: treatments, comorbidities, and quality of life, in the USA

This study sought to characterize the experience of stress, treatment patterns, and medical and disability profile in the migraineur population to better understand how the experience of migraines impacts the social and psychological functioning of this group. A 30-minute self-report survey was presented via a migraine-specific website with data collection occurring between May 15 and June 15, 2012. Recruitment for the study was done through online advertisements. In total, 2,907 individuals began the survey and 2,735 met the inclusion criteria for the study. The sample was predominantly female (92.8%). Migraine-associated stress was correlated with length of time since first onset of symptoms (P<0.01) and number of symptoms per month (P<0.01). Disorders related to stress, such as depression (P<0.01) and anxiety (P<0.01), were also positively correlated with the measured stress resulting from migraines. Migraine-associated stress must be understood as a multidimensional experience with broader impacts of stress on an individual correlating much more highly with negative mental and physical health profiles. Stress resulting from frequent migraine headaches may contribute to the development of medical and psychological comorbidities and may be a part of a cyclical relationship wherein stress is both a cause and effect of the social and medical impairments brought about by migraine.

A systematic review and meta-analysis of meditative interventions for informal caregivers and health professionals

Background Burnout, stress and anxiety have been identified as areas of concern for informal caregivers and health professionals, particularly in the palliative setting. Meditative interventions are gaining acceptance as tools to improve well-being in a variety of clinical contexts, however, their effectiveness as an intervention for caregivers remains unknown. Aim To explore the effect of meditative interventions on physical and emotional markers of well-being as well as job satisfaction and burnout among informal caregivers and health professionals. Design Systematic review of randomised clinical trials and pre–post intervention studies with meditative interventions for caregivers. Data sources PubMed, EMBASE, CINAHL and PsycINFO were searched up to November 2013. Of 1561 abstracts returned, 68 studies were examined in full text with 27 eligible for systematic review. Results Controlled trials of informal caregivers showed statistically significant improvement in depression (effect size 0.49 (95% CI 0.24 to 0.75)), anxiety (effect size 0.53 (95% CI 0.06 to 0.99)), stress (effect size 0.49 (95% CI 0.21 to 0.77)) and self-efficacy (effect size 0.86 (95% CI 0.5 to 1.23)), at an average of 8 weeks following intervention initiation. Controlled trials of health professionals showed improved emotional exhaustion (effect size 0.37 (95% CI 0.04 to 0.70)), personal accomplishment (effect size 1.18 (95% CI 0.10 to 2.25)) and life satisfaction (effect size 0.48 (95% CI 0.15 to 0.81)) at an average of 8 weeks following intervention initiation. Conclusions Meditation provides a small to moderate benefit for informal caregivers and health professionals for stress reduction, but more research is required to establish effects on burnout and caregiver burden.

Psychophysiology of pain and opioid use: Implications for managing pain in patients with an opioid use disorder

BACKGROUND Opioid therapy is one component of an effective pain management regimen for patients with chronic pain and the majority of these patients use their medications responsibly. However, there are a growing number of these patients who develop an opioid use disorder and in some cases require opioid replacement therapy. Managing these patients is complex and the underlying mechanisms of pain and addiction are not well understood. Developing an effective interdisciplinary treatment program for the individual with pain and an opioid use disorder will depend on enhancing our knowledge of the psychophysiology of pain and addiction. METHOD Authors gathered key empirical and theoretical papers examining the psychophysiology of comorbid pain and opioid misuse disorders. RESULTS This article reviews the current theory of the effect of pain on patients with pain and concomitant addiction, the psychophysiology of pain, opioid use and addiction, and future research in this area. CONCLUSIONS Individuals with a history of opioid misuse have greater levels of hyperalgesia which may be due to alterations in psychophysiological pathways. More research is needed into the psychophysiological biomarkers among individuals with comorbid pain and addiction in order to develop better treatment approaches and improve outcomes among this difficult to treat population.

Advancing our understanding of religion and spirituality in the context of behavioral medicine

Recognizing and understanding the potentially powerful roles that religiousness and spirituality (RS) may serve in the prevention and amelioration of disease, as well as symptom management and health related quality of life, significantly enhances research and clinical efforts across many areas of behavioral medicine. This article examines the knowledge established to date and suggests advances that remain to be made. We begin with a brief summary of the current knowledge regarding RS as related to three exemplary health conditions: (a) cardiovascular disease; (b) cancer; and, (c) substance abuse. We then focus on particular concerns for future investigations, emphasizing conceptual issues, possible mediators and moderators of relationships or effects, and methodology. Our discussion is framed by a conceptual model that may serve to guide and organize future investigations. This model highlights a number of important issues regarding the study of links between RS and health: (a) RS comprise many diverse constructs, (b) the mechanisms through which RS may influence health outcomes are quite diverse, and (c) a range of different types of health and health relevant outcomes may be influenced by RS. The multidimensional nature of RS and the complexity of related associations with different types of health relevant outcomes present formidable challenges to empirical study in behavioral medicine. These issues are referred to throughout our review and we suggest several solutions to the presented challenges in our summary. We end with a presentation of barriers to be overcome, along with strategies for doing so, and concluding thoughts.