Brick Johnstone

Religion and disability: Clinical, research and training considerations for rehabilitation professionals

Purpose. This article (i) reviews existing research on the relationships that exist among spirituality, religion, and health for persons with disabilities; and (ii) compares different theoretical coping models (i.e., spiritual vs. psychoneuroimmunological). Background. Over the past decade interest has increased in relationships among spirituality, religion, and health in both the mainstream media (e.g., Newsweek) and scientific literature (e.g., Koenig). In general, research has concluded that religion and spirituality are linked to positive physical and mental health outcomes. Most religion and health research has focused on populations with life-threatening diseases (e.g., cancer, cardiovascular disorders, AIDS) with minimal attention to persons with chronic, life-long disabling conditions such as brain injury, spinal cord injury, and stroke. However, religion is used by many individuals with disabilities to help them adjust to their impairments and to give new meaning to their lives. Conclusions. Religion and spirituality are important coping strategies for persons with disabilities. Practical suggestions for rehabilitation professionals are provided regarding: (a) strategies to enhance religious coping; (b) methods to train rehabilitation professionals about religious issues; and (c) issues to consider regarding future research on rehabilitation and religion.

Extent of Cognitive Decline in Traumatic Brain Injury Based on Estimates of Premorbid Intelligence

Global cognitive impairment following traumatic brain injury (TBI) is common, with some abilities more significantly affected than others. However, due to difficulties in estimating premorbid intelligence, there has been no systematic evaluation of the extent of decline in different cognitive abilities following TBI. Recent studies indicate that the Wide Range Achievement Test-Revised (WRAT-R) Reading subtest is an accurate estimate of premorbid intelligence, suggesting that post-TBI cognitive test scores can be compared to the WRAT-R to estimate the extent of decline that occurs in specific cognitive abilities. The current study estimated the extent of deficit in intelligence, memory, attention, speed of processing, and cognitive flexibility for 97 outpatients with TBI. Extent of decline was calculated by subtracting WRAT-R z-scores from cognitive test z-scores to determine a z-difference score (ZDiff) for each cognitive ability. The results suggest that intelligence is least declined following TBI (WAIS-R 3-4-point decline; VIQ ZDiff = -0.23: FIQ ZDiff = -0.27), followed by attention (WMS-R 5-point decline; ZDiff = -0.31), memory (WMS-R 6-9-point decline; Verbal Memory ZDiff = -0.41; General Memory ZDiff = -0.51; Delay Memory ZDiff = -0.57), speed of processing (Trails A 15-16 second decline; ZDiff = -1.90) and cognitive flexibility (Trails B 35-52 second decline; ZDiff = -2.65). Implications for provision of feedback to individuals with TBI and their families are discussed.

Determining Relationships Between Physical Health and Spiritual Experience, Religious Practices, and Congregational Support in a Heterogeneous Medical Sample

Previous research indicates that increased religiosity/spirituality is related to better health, but the specific nature of these relationships is unclear. The purpose of this study was to determine the relationships between physical health and spiritual belief, religious practices, and congregational support using the Brief Multidimensional Measure of Religiousness/Spirituality and the Medical Outcomes Scale Shortform-36. A total of 168 participants were surveyed with the following medical disorders: Cancer, Spinal Cord Injury, Traumatic Brain Injury, and Stroke, plus a healthy sample from a primary care setting. The results show that individuals with chronic medical conditions do not automatically turn to religious and spiritual resources following onset of their disorder. Physical health is positively related to frequency of attendance at religious services, which may be related to better health leading to increased ability to attend services. In addition, spiritual belief in a loving, higher power, and a positive worldview are associated with better health, consistent with psychoneuroimmunological models of health. Practical implications for health care providers are discussed.

Re-conceptualizing the Factor Structure of the Brief Multidimensional Measure of Religiousness/Spirituality

Rationale This study attempted to differentiate statistically the spiritual and religious factors of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS), which was developed based on theoretical conceptualizations that have yet to be adequately empirically validated in a population with significant health disorders. Participants One hundred sixty-four individuals with heterogeneous medical conditions [i.e., brain injury, spinal cord injury (SCI), cancer, stroke, primary care conditions]. Methods Participants completed the BMMRS as part of a pilot study on spirituality, religion, and physical and mental health. Results A principal components factor analysis with varimax rotation and Kaiser normalization identified a six-factor solution (opposed to the expected 8-factor solution) accounting for 60% of the variance in scores, labeled as: (1) Positive Spiritual Experience; (2) Negative Spiritual Experience; (3) Forgiveness; (4) Religious Practices; (5) Positive Congregational Support; and (6) Negative Congregational Support. Conclusions The results suggest the BMMRS assesses distinct positive and negative aspects of religiousness and spirituality that may be best conceptualized in a psychoneuroimmunological context as measuring: (a) Spiritual Experiences (i.e., emotional experience of feeling connected with a higher power/the universe); (b) Religious Practices (i.e., prayer, rituals, service attendance); (c) Congregational Support; and (d) Forgiveness (i.e., a specific coping strategy that can be conceptualized as religious or non-religious in context).

Multidimensional telecare strategies for rural residents with brain injury.

Rural residents with brain injury have difficulty in accessing care from qualified psychologists for consequent cognitive, emotional and behavioural symptoms. We examined high-quality videoconferencing to enhance care for persons with brain injury in three areas: cognitive assessment, psychotherapy and rural mental health training. The assessment study evaluated 52 outpatients seen for diagnostic visits over videoconferencing, and compared their experiences with those of 52 age- and diagnosis-matched controls seen in person. Persons seen via telemedicine were more likely than controls to want to repeat their experience and more satisfied than were the neuropsychologists who examined them. In the psychotherapy study, neurorehabilitation patients were seen via videoconferencing for therapy related to brain injury or stroke. Persons receiving psychotherapy were less likely than persons receiving assessment services to want to repeat their experience. In the training study, 39 rural mental health providers were trained via videoconferencing, and trainees demonstrated significant improvement on tests of knowledge about brain injury. Trainees formed a network of mental health provider referrals for persons with brain injury in a wide geographic area. Given adequate training and ongoing support, rural clinicians can treat many brain-injury adjustment issues locally, reserving specialist consultation for emergency or complex problems.

Relationships Among Spirituality, Religious Practices, Personality Factors, and Health for Five Different Faith Traditions

To determine: (1) differences in spirituality, religiosity, personality, and health for different faith traditions; and (2) the relative degree to which demographic, spiritual, religious, and personality variables simultaneously predict health outcomes for different faith traditions. Cross-sectional analysis of 160 individuals from five different faith traditions including Buddhists (40), Catholics (41), Jews (22), Muslims (26), and Protestants (31). Brief multidimensional measure of religiousness/spirituality (BMMRS; Fetzer in Multidimensional measurement of religiousness/spirituality for use in health research, Fetzer Institute, Kalamazoo, 1999); NEO-five factor inventory (NEO-FFI; in Revised NEO personality inventory (NEO PI-R) and the NEO-five factor inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, Costa and McCrae 1992); Medical outcomes scale-short form (SF-36; in SF-36 physical and mental health summary scores: A user’s manual, The Health Institute, New England Medical Center, Boston, Ware et al. 1994). (1) ANOVAs indicated that there were no significant group differences in health status, but that there were group differences in spirituality and religiosity. (2) Pearson’s correlations for the entire sample indicated that better mental health is significantly related to increased spirituality, increased positive personality traits (i.e., extraversion) and decreased personality traits (i.e., neuroticism and conscientiousness). In addition, spirituality is positively correlated with positive personality traits (i.e., extraversion) and negatively with negative personality traits (i.e., neuroticism). (3) Hierarchical regressions indicated that personality predicted a greater proportion of unique variance in health outcomes than spiritual variables. Different faith traditions have similar health status, but differ in terms of spiritual, religious, and personality factors. For all faith traditions, the presence of positive and absence of negative personality traits are primary predictors of positive health (and primarily mental health). Spiritual variables, other than forgiveness, add little to the prediction of unique variance in physical or mental health after considering personality. Spirituality can be conceptualized as a characterological aspect of personality or a distinct construct, but spiritual interventions should continue to be used in clinical practice and investigated in health research.

Relationships Between the Brief Multidimensional Measure of Religiousness/Spirituality and Health Outcomes for a Heterogeneous Rehabilitation Population

PURPOSE To determine relationships between the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS; i.e., positive/negative spirituality, forgiveness, religious practices, positive/negative congregational support) and physical and mental health (Medical Outcomes Scale-Short Form 36; SF-36) for individuals with chronic disabilities. RESEARCH METHOD A cross-sectional analysis of 118 individuals evaluated in outpatient settings, including 61 with traumatic brain injury (TBI), 32 with cerebral vascular accidents (CVA), and 25 with spinal cord injury (SCI). RESULTS Three of 6 BMMRS factor scores (i.e., positive spiritual experience, forgiveness, negative spiritual experience) were significantly correlated with the SF-36 General Health Perception (GHP) scale, and only 1 of 6 BMMRS factor scores (i.e., negative spiritual experience) was significantly and negatively correlated with the SF-36 General Mental Health (GMH) scale. BMMRS scales did not significantly predict either physical or mental health in hierarchical multiple regressions. CONCLUSIONS Positive spiritual experiences and willingness to forgive are related to better physical health, while negative spiritual experiences are related to worse physical and mental health for individuals with chronic disabilities. Future research using the BMMRS will benefit from using a 6-factor model that evaluates positive/negative spiritual experiences, religious practices, and positive/negative congregational support. Interventions to accentuate positive spiritual beliefs (e.g., forgiveness protocols, etc.) and reduce negative spiritual beliefs for individuals with chronic disabilities are suggested.

Memory functioning following traumatic brain injury in children with premorbid learning problems.

This study examines the memory functioning of 25 children who sustained a traumatic brain injury (TBI) and who had prior learning problems, 48 children with TBI who did not have prior learning problems, and 23 noninjured controls. The children with TBI and prior learning problems displayed significantly worse memory abilities than both the control participants and the children with TBI and no prior learning problems. They differed significantly from these 2 groups on measures of general memory, verbal memory, sound-symbol learning, and attention. The results suggest that children with premorbid learning problems who sustain TBI have less cognitive reserve and a lower threshold for the expression of cognitive impairments in areas that reflect preexisting learning and language problems, compared to children without premorbid learning problems.

Comprehensive assessment of memory functioning following traumatic brain injury in children

This study examined specific memory functions in 52 children with mild‐moderate or severe traumatic brain injury (TBI) and 29 noninjured controls using the Wide Range Assessment of Memory and Learning (WRAML). Childrens recall varied as a function of injury severity and task demands. The participants with severe brain injuries performed worse than controls on global measures of visual memory, learning, and general memory functioning, as well as on specific subtests measuring recall of contextual verbal information. Children with mild‐moderate brain injuries performed similarly to controls except for poorer performance on 2 subtests measuring sound‐symbol learning and recall of geometric designs. Results suggest that the WRAML provides clinically useful information and that specific aspects of memory processing need to be evaluated following childhood TBI.

Differentiating the Impact of Spiritual Experiences, Religious Practices, and Congregational Support on the Mental Health of Individuals With Heterogeneous Medical Disorders

This study evaluated the relationships that exist between the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the mental health of individuals with heterogeneous medical disorders. The participants were 168 individuals with heterogeneous medical disorders (i.e., 61 brain injury, 32 stroke, 25 spinal cord injury, 25 cancer, 25 primary care). The measures were BMMRS subscales (conceptualized as spiritual experiences, religious practices, and congregational support), Medical Outcomes Scale–Short Form 36 General Mental Health scale. Pearson correlations indicated that, in general, mental health is positively correlated with positive spiritual experiences and positive congregational support but negatively correlated with negative spiritual coping and negative congregational support. Mental health was not correlated with private religious practices (e.g., prayer). Hierarchical regressions indicated that congregational support was the only BMMRS scale to predict mental health, explaining 6% of the variance beyond the 14% explained by demographic factors. The mental health of individuals with significant medical conditions appears to be primarily related to positive spiritual beliefs and especially congregational support. Mental health does not appear to be related to religious practices such as prayer, which is likely related to the fact that many individuals with serious medical conditions increase prayer with declining mental health status. These results stress the need for active congregational support and spiritual interventions to improve the mental health of persons with serious medical conditions.