Steven Pirutinsky

A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community, delivered via the Internet

OBJECTIVE This study evaluated the efficacy of a spiritually integrated treatment (SIT) for subclinical anxiety in the Jewish community. METHOD One hundred and twenty-five self-reported religious Jewish individuals with elevated levels of stress and worry received SIT (n=36), progressive muscle relaxation (PMR, n=42), or a waitlist control condition (WLC, n=47). SIT and PMR participants accessed Internet-based treatment on a daily basis for a period of 2 weeks. All participants completed self-report assessments at pre-treatment (T1), post-treatment (T2), and 6-8-week follow-up (T3). RESULTS SIT participants reported large improvements in primary (stress and worry) and secondary (depression and intolerance of uncertainty) outcomes, and moderate improvements in spiritual outcomes (positive/negative religious coping; trust/mistrust in God). SIT participants reported greater belief in treatment credibility, greater expectancies from treatment and greater treatment satisfaction than PMR participants. SIT participants also reported better improvements in both primary outcomes (stress and worry), one of two secondary outcomes (intolerance of uncertainty), and two of four spiritual outcomes (positive religious coping and mistrust in God) compared to the WLC group, whereas PMR and WLC participants did not differ on most outcomes. CONCLUSIONS Results of this investigation offer initial support for the efficacy of SIT for the treatment of subclinical anxiety symptoms among religious Jews. Results further suggest that it is important to incorporate spiritual content into treatment to help facilitate the delivery of psychotherapy to religious individuals.

Grateful to God or just plain grateful? A comparison of religious and general gratitude

Psychological science has consistently highlighted links between gratitude and religion, however mediating pathways by which religion relates to gratitude remain ambiguous. Further, it is unclear whether religious gratitude (e.g., gratitude to God) is more related to well-being than general gratitude. To address these gaps, we assessed for both religious and general dimensions of gratitude alongside measures of religious commitment and mental/physical well-being in a diverse sample of n = 405 adult individuals. Consistent with previous research, gratitude was positively correlated with religious commitment (r = 0.45, p < 0.001). This relationship, however, was fully mediated by gratitude towards God. Using hierarchical linear regression, results further found that the interaction of religious commitment and religious gratitude added unique variance in predicting mental well-being, over and above general gratitude. This suggests that being grateful to God enhances the psychological benefits of gratitude in accordance with ones level of religious commitment.

Do medical models of mental illness relate to increased or decreased stigmatization of mental illness among orthodox Jews

Research suggests that attributing mental illness to moral causes and perceiving it as dangerous relates to greater stigma, whereas belief in biomedical factors is associated with less. Within the family-centric Orthodox Jewish community, mental illness is perceived as a risk to family functioning and future generations, and is therefore stigmatizing of the individual and their family. Since biomedical models may exacerbate these concerns, we hypothesized that unlike within the general population, biological causal attributions would relate to increased stigma among Orthodox Jews. Consequently, we also examined the attitudinal correlates of stigmatization of obsessive-compulsive disorder within the Orthodox community, as measured by both social distance and family/marriage concerns. Results indicated that, unlike previous research, biological models were associated with greater marriage/family stigma, and did not predict less social distance. This suggests that biomedical approaches may increase salient aspects of stigma within the Orthodox community, and clinical practice should be sensitive to these concerns.

Does social support mediate the moderating effect of intrinsic religiosity on the relationship between physical health and depressive symptoms among Jews

Previous research in the general population suggests that intrinsic religiosity moderates (mitigates) the effect of poor physical health on depression. However, few studies have focused specifically on the Jewish community. We therefore examined these variables in a cross-sectional sample of 89 Orthodox and 123 non-Orthodox Jews. Based on previous research suggesting that non-Orthodox Judaism values religious mental states (e.g., beliefs) less and a collectivist social religiosity more, as compared to Orthodox Judaism, we hypothesized that the moderating effect of intrinsic religiosity would mediated by social support among non-Orthodox but not Orthodox Jews. As predicted, results indicated that the relationship between physical health and depression was moderated by intrinsic religiosity in the sample as a whole. Furthermore, this effect was mediated by social support among non-Orthodox Jews, but not among the Orthodox. The importance of examining religious affiliation and potential mediators in research on spirituality and health is discussed.

Jewish Spirituality, Depression, and Health: an Empirical Test of a Conceptual Framework

BackgroundLittle is known about the links between spirituality and mental health among Jews.PurposeThis study assessed trust/mistrust in God and religious coping and examined their relationships to depressive symptoms and physical health. Religious affiliation and intrinsic religiousness were examined as moderating variables and religious coping was examined as a mediator.MethodAnonymous internet surveys were completed by 208 Jewish women and men of diverse denominations who resided primarily in the USA.ResultsTrust in God and positive religious coping were associated with lower levels of depressive symptoms and mistrust in God and negative religious coping were associated with greater depressive symptoms. Intrinsic religiosity showed a small moderation effect for mistrust in God and negative religious coping in relation to depressive symptoms and for trust in God in relation to physical health. Further, positive religious coping fully mediated the link between trust in God and less depressive symptoms and negative religious coping fully mediated the relationship between mistrust in God and greater depressive symptoms.ConclusionThe data lend themselves to a possible integrative cognitive-coping model, in which latent core beliefs about the Divine activate coping strategies during times of distress, which in turn impact psychological health. The findings highlight the potential clinical significance of spirituality to mental health among Jews and provide a basis for future longitudinal, experimental, and treatment outcome research.

Does Religiousness Increase Self-Control and Reduce Criminal Behavior? A Longitudinal Analysis of Adolescent Offenders

Previous research suggests that religiousness correlates with less criminal behavior and that this relationship is partially mediated by higher self-control. Because most studies are cross-sectional, causality remains uncertain as stable between-subject factors may influence self-control, religiousness, and offending, confounding their relationships. Moreover, directionality may be reversed with higher self-control leading to both higher religiousness and less offending. The current research aimed to directly exclude these possibilities using longitudinal data from 1,354 adolescents participating in the Pathways to Desistance Study. Results indicated that short-term, within-subject increased religiousness predicted decreased future criminal behavior and that this effect was partially mediated by increased self-control. A reversed model in which past self-control predicted future religiousness was not significant. These findings suggest that religiousness may be causally related to offending, and self-control is likely one of multiple mediating processes. Additional research in this area appears warranted and may yield effective strategies for reducing criminal behavior and improving self-control.

Incorporating spiritual beliefs into a cognitive model of worry

Cognitive theory and research have traditionally highlighted the relevance of the core beliefs about oneself, the world, and the future to human emotions. For some individuals, however, core beliefs may also explicitly involve spiritual themes. In this article, we propose a cognitive model of worry, in which positive/negative beliefs about the Divine affect symptoms through the mechanism of intolerance of uncertainty. Using mediation analyses, we found support for our model across two studies, in particular, with regards to negative spiritual beliefs. These findings highlight the importance of assessing for spiritual alongside secular convictions when creating cognitive-behavioral case formulations in the treatment of religious individuals.

A Brief Measure of Core Religious Beliefs for Use in Psychiatric Settings

Results from several national studies in the United States suggests that: (1) religious beliefs and practices are highly prevalent; (2) spirituality and religion are statistically and clinically relevant to mental health and symptoms; and (3) many patients have a preference for spiritually integrated care. However, existing protocols that assess for salient religious themes in psychiatric settings are time-consuming to administer, relevant only to specific populations (e.g., Christians), and have poor psychometric properties. Further, evidence suggests that religious beliefs can take on a positive and negative valence, and both of these dimensions are worthy of assessment. We, therefore, developed a brief (six-item) self-report measure of positive and negative core beliefs about God which is uniquely suited for use with a broad range of religious patients. Across three studies, we evaluated its psychometric properties and ability to predict symptoms of anxiety and depression. Results provide support for the validity and reliability of our measure and further highlight the salience of both positive and negative religious beliefs to psychiatric symptoms. It is hoped that this measure will help to decrease the burden of spiritual assessment in psychiatric and medical settings, and further have research utility for this area of study.

Religious coping moderates the relationship between emotional functioning and obesity.

OBJECTIVE Prospective research indicates that poor emotional functioning predicts obesity. The maladaptive coping hypothesis proposes that unhealthy eating is used to regulate emotion, leading to obesity. Given research suggesting that many utilize religion to cope with distress, we hypothesized that positive and negative religious coping would moderate links between emotional functioning and obesity. In addition, previous research focused on Christians and the relevance of religious coping to the Jewish context, where obesity may be of particular concern, was examined. METHOD 212 Jewish participants completed self-report health and emotional functioning measures as well as the Jewish Religious Coping scale. RESULTS Moderation analysis indicated that negative coping had no effect, while positive coping was a significant moderator. Specifically, poor emotional functioning predicted increased obesity among those with low, but not high, positive religious coping. This effect remained even after several possible confounding factors were controlled for, and the effect was large. CONCLUSIONS These findings further support the maladaptive coping hypothesis, indicating that religious coping may provide an alternative strategy to maladaptive eating. They also illustrate a possible mechanism by which religiosity correlates with better health and support the relevance of religious coping to the Jewish context.

Family Functioning Among Returnees to Orthodox Judaism in Israel

The role of religious conversion in marriages and family functioning has been little explored. The current study examined family functioning and parenting stress among returnees to Orthodox Judaism with adolescent children. Possible explanatory factors for difficulties, such as attachment insecurity, religious discord in families, and poor community integration, were also explored. Randomly selected samples of returnee and nonreturnee Orthodox Jews with adolescent children (N = 1632) completed measures of attachment, community integration, marital functioning, and parenting stress. Results indicate that returnees report greater family disengagement (lack of warmth), family chaos (lack of control), and parenting stress. They also reported higher religious discord, higher attachment insecurity, and poorer community integration, which all correlated with higher parenting stress, family disengagement (lack of warmth), and family chaos (lack of control). Moreover, differences between returnees and nonreturnees on family functioning and parenting stress were largely mediated by differences in the explanatory factors. These results substantiate previous anecdotal reports and suggest possible avenues for intervention among Orthodox returnees with family difficulties. They also support the relevance of religious factors in family functioning.