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A diversity of spirituality-based approaches to mental health treatment.

The relationship between spirituality and mental health is brilliantly highlighted by Murray and Zentner (1989, p.258). They state that “The spiritual dimension tries to be in harmony with the universe, strives for answers about the infinite, and comes essentially into focus in times of emotional stress, physical (and mental) illness, loss, bereavement, and death”.

Indeed, a growing body of research shows that people turn to religion and spirituality especially in times of crisis, when they are confronted with major life stressors like loss of loved ones, divorce, natural disasters, physical and mental illness. When everything seems to fall apart spirituality helps people to cope with situations that they have little control over. These spiritual coping methods include praying and “talking” to God, forgiveness and mindfulness practices, rituals, reframing a stressful event into a meaningful and learning experience, support, and counseling from a clergy member etc.

But similar to the yin and yang symbol, spirituality has also a dark side. Empirical studies reveal that some people may have real problems in understanding God or the Higher/Supreme Intelligence, which creates inner conflicts and interrelationship problems. These spiritual struggles are linked to a decreased well-being, increased psychological distress and physical illness, and even a higher risk of mortality.

This pinboard includes…

  • A diversity of spirituality-based approaches to mental health treatment;
  • The latest research on the relationship spirituality-mental health.

… and will benefit:

  • Researchers in these two domains (spirituality & mental health);
  • Clinical psychologists and psychotherapists;
  • Anyone who wants to better understand how spirituality can enhance cognitive abilities, help with emotion regulation and maintain a better mental health and well-being.

Let’s explore together the bright side and the dark side of spirituality!


The experience of palliative patients and their families of a family meeting utilised as an instrument for spiritual and psychosocial care: A qualitative study.

Abstract: This study explores the experience of palliative patients and their family members of a family meeting model, utilised as an instrument for the provision of spiritual and psychosocial care. In doing so the study embraces a broad understanding of spirituality which may or may not include formal religious practice and a concept of psychosocial care that includes: social and emotional well-being, communication, self esteem, mental health and adaptation to illness. The meeting of spiritual and psychosocial needs is considered to be an important aspect of palliative care.This qualitative study, philosophically underpinned by hermeneutic phenomenology, investigates the participatory experience of palliative care patients and their significant family members of such a family meeting. People registered with two large metropolitan palliative care services, who met selection criteria, were referred by medical staff. Twelve of the 66 referred took part in family meetings which also included significant others invited by the patient. A total of 36 family members participated. The number of participants of individual family meetings ranged from two to eleven. After the family meeting every participant was invited to take part in an individual in-depth interview about their experience of the meeting. Forty seven interviews were conducted. These were audio recorded and transcribed.Data analysis, utilising Ricoeur's theory of interpretation, revealed seven main themes: personal experience of the meeting, personal outcomes, observation of others' experience, observation of experience and outcomes for the family unit, meeting facilitation, how it could have been different and general applicability of the family meeting. Throughout these themes were numerous references to aspects of the web of relationships which describe the concept of spirituality as it is defined for the purpose of this study.The findings indicate the potential of the type of family meeting reported for use in the spiritual and psychosocial care of people receiving palliative care and their families. However further research is needed to explore its application to more culturally diverse groups and its longer term impact on family members.

Pub.: 26 Mar '11, Pinned: 12 May '17

The role of spirituality and religious coping in the quality of life of patients with advanced cancer receiving palliative radiation therapy.

Abstract: National palliative care guidelines outline spiritual care as a domain of palliative care, yet patients' religiousness and/or spirituality (R/S) are underappreciated in the palliative oncology setting. Among patients with advanced cancer receiving palliative radiation therapy (RT), this study aims to characterize patient spirituality, religiousness, and religious coping; examine the relationships of these variables to quality of life (QOL); and assess patients' perceptions of spiritual care in the cancer care setting.This is a multisite, cross-sectional survey of 69 patients with advanced cancer (response rate = 73%) receiving palliative RT. Scripted interviews assessed patient spirituality, religiousness, religious coping, QOL (McGill QOL Questionnaire), and perceptions of the importance of attention to spiritual needs by health providers. Multivariable models assessed the relationships of patient spirituality and R/S coping to patient QOL, controlling for other significant predictors of QOL.Most participants (84%) indicated reliance on R/S beliefs to cope with cancer. Patient spirituality and religious coping were associated with improved QOL in multivariable analyses (β = 10.57, P < .001 and β = 1.28, P = .01, respectively). Most patients considered attention to spiritual concerns an important part of cancer care by physicians (87%) and nurses (85%).Limitations include a small sample size, a cross-sectional study design, and a limited proportion of nonwhite participants (15%) from one US region.Patients receiving palliative RT rely on R/S beliefs to cope with advanced cancer. Furthermore, spirituality and religious coping are contributors to better QOL. These findings highlight the importance of spiritual care in advanced cancer care.

Pub.: 18 Nov '11, Pinned: 12 May '17

"To cherish each day as it comes": a qualitative study of spirituality among persons receiving palliative care.

Abstract: Spirituality is one of the main aspects of palliative care. The concept is multidimensional and encompasses the existential realm as well as value-based and religious considerations. The aim of this study was to explore spirituality from the perspective of persons receiving palliative care and examine their experience of spirituality and its influence on their lives and well-being.Qualitative interviews were conducted with ten persons receiving palliative care from Palliative Care Services in Iceland. The interviews were tape-recorded, transcribed and analysed. The study is in the field of practical theology and used the theoretical approach of hermeneutical phenomenology.Thematic analysis found that the spiritual dimension was of significance for the participants who understood it as a vital element connected to seeking meaning, purpose and transcendence in life. Religious and non-religious aspects of spirituality were expressed including strong spiritual components of family relationships, the meaning of God/a higher being and spiritual practices which served as a key factor in giving strength, activating inner resources and motivating hope. Nine of the participants expressed their spirituality as faith.Spirituality was experienced broadly as an important dimension of how participants lived with terminal illness. Religious and non-religious characteristics were recognised which reveals the complex nature of the phenomenon. Faith was a significant part of the participants' spirituality indicating the importance of attending to this aspect of palliative care. The study suggests the potential contributions of theological approaches which are relevant for palliative care research and practice.

Pub.: 05 Jan '13, Pinned: 12 May '17

The meaning of spirituality and spiritual care among the Hong Kong Chinese terminally ill.

Abstract: This paper is a report of a study conducted to explore the phenomenon of spirituality and spiritual care among terminally ill Chinese patients.Meeting a patient's spiritual needs is a fundamental part of holistic nursing care. In the Western literature, spirituality is related to connectedness, faith, and hope. Contemporary scholars in the West suggest that spirituality is a broader term than religion.Phenomenological interviews were conducted with a convenience sample of 15 terminally ill Chinese patients in 2007.Participants found the term spirituality an abstract concept and described it as a unique personal belief which gives strength and relates to meaning of life. Spirituality is integrated with the body and mind and is a multidimensional concept. The acceptance of death as a process in life and 'letting go' leads to serenity and peace of mind. Other important themes include how the meaning of life is derived through relationships and connectedness, self-reflection of responsibilities, and obligations fulfilled. Inner spiritual well-being is attained from having faith and knowing possibilities in life and after death. Participants did not expect nurses to provide spiritual care, but when quality interpersonal care was given it gave them strength and spiritually supportive.If healthcare professionals can provide a compassionate and loving environment that facilitates acceptance and hope, the spiritual life of patients is enhanced. For dying individuals to experience love and for them to be understood as valuable even when no longer economically productive are both experiences of healing.

Pub.: 29 Apr '10, Pinned: 12 May '17

[Evolutionary Concept Analysis of Spirituality].

Abstract: This study was done to clarify attributes, antecedents, and consequences of spirituality.Rodgers's evolutionary concept analysis was used to analyze fifty seven studies from the literature related to spirituality as it appears in systematic literature reviews of theology, medicine, counseling & psychology, social welfare, and nursing.Spirituality was found to consist of two dimensions and eight attributes: 1) vertical dimension: 'intimacy and connectedness with God' and 'holy life and belief', 2) horizontal dimension: 'self-transcendence', 'meaning and purpose in life', 'self-integration', and 'self-creativity' in relationship with self, 'connectedness' and 'trust' in relationship with others·neighbors·nature. Antecedents of spirituality were socio-demographic, religious, psychological, and health related characteristics. Consequences of spirituality were positive and negative. Being positive included 'life centered on God' in vertical dimension, and among horizontal dimension 'joy', 'hope', 'wellness', 'inner peace', and 'self-actualization' in relationship with self, 'doing in love' and 'extended life toward neighbors and the world' in relationship with others·neighbors·nature. Being negative was defined as having 'guilt', 'inner conflict', 'loneliness', and 'spiritual distress'. Facilitators of spirituality were stressful life events and experiences.Spirituality is a multidimensional concept. Unchangeable attributes of spirituality are 'connectedness with God', 'self-transcendence', 'meaning of life' and 'connectedness with others·nature'. Unchangeable consequences of spirituality are 'joy' and 'hope'. The findings suggest that the dimensional framework of spirituality can be used to assess the current spiritual state of patients. Based on these results, the development of a Korean version of the scale measuring spirituality is recommended.

Pub.: 05 May '17, Pinned: 12 May '17

The effects of life review interventions on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer: A systematic review and meta-analysis of randomized controlled trials.

Abstract: Life review interventions have been used to alleviate psycho-spiritual distress in people near the end of life. However, their effectiveness remains inconclusive.To evaluate the effects of therapeutic life review on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer.A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.Five databases were searched from their respective inception through February 2017 for relevant randomized controlled trials. The effects of therapeutic life review were pooled across the trials. Standardized mean differences were calculated for the pooled effects. Heterogeneity was assessed using the I(2) test. Study quality was assessed using the Cochrane criteria.Eight randomized controlled trials met the inclusion criteria. The pooled results suggested a desirable effect of therapeutic life review on the meaning of life domain of spiritual well-being (standardized mean difference = 0.33; 95% confidence interval, 0.12 to 0.53), general distress (standardized mean difference = -0.32; 95% confidence interval, -0.55 to -0.09), and overall quality of life (standardized mean difference = 0.35; 95% confidence interval, 0.15 to 0.56) when compared to usual care only. Of the three outcomes examined, only the pooled effect on overall quality of life remained statistically significant at follow-ups up to 3 months after the intervention (standardized mean difference = 0.82; 95% confidence interval, 0.47 to 1.18).Therapeutic life review is potentially beneficial for people near the end of life. However, the results should be interpreted with caution due to the limited number of randomized controlled trials and associated methodological weaknesses. Further rigorously designed randomized controlled trials are warranted.

Pub.: 11 May '17, Pinned: 12 May '17

The Structural Model of Spirituality and Psychological Well-Being for Pregnancy-Specific Stress.

Abstract: Women experience different types of stress in their lifetime. The present study was conducted to examine the structural model of spirituality and psychological well-being for pregnancy-specific stress. The present descriptive correlational study was conducted on 450 pregnant Iranian women (150 women from each trimester) in Dehdasht city in 2015. Data were collected using the personal-social questionnaire, the pregnancy-specific stress questionnaire, the spirituality questionnaire and the psychological well-being questionnaire and were then analyzed in SPSS-16 and Lisrel-8.8 for carrying out a path analysis. The fit indices of the model indicate the good fit and high compatibility of the model and rational relationships between the variables (GFI = 0.94, NFI = 0.85, CFI = 0.94 and RMSEA = 0.048). Of the variables that affected pregnancy-specific stress through both paths, spirituality had a positive effect (B = 0.11) and the personal-social variable a negative effect (B = -0.37). Psychological well-being affected pregnancy-specific stress negatively and directly and through one path only (B = -0.59). The results obtained through the model confirm the effect of spirituality and psychological well-being in reducing pregnancy-specific stress. Given that handling stress has a major role in the quality of daily life in pregnant women, stress management skills are recommended to be promoted among pregnant women so as to mitigate stress and its negative consequences.

Pub.: 28 Apr '17, Pinned: 02 May '17

[Religious/Spiritual Needs and Psychosocial Burden of Melanoma Patients].

Abstract: Questions of meaning and purpose in life are becoming relevant during cancer. Studies have shown that most patients have spiritual needs and that religion/spirituality can be an important ressource in coping with illness. So far, only few studies examine the psychosocial burden and the role of spiritual needs during the treatment process of patients with malignant melanoma. 22 patients were included in this study and assessed for psychosocial distress and spiritual needs while being screened for cancer metastases (t1) and 8 weeks later (t2). Distress, anxiety and depression, furthermore spiritual needs and religiousness were examined with standardized assessments (HSI, DT, HADS, PHQ-2, SpNQ, SpREUK). All patients express spiritual needs independent of the time of measurement and overall burden. Important needs are the need to be complete and safe, the need for social support, for actively giving and for inner peace and the possibility to talk about anxiety and sorrow. Analyses have shown that religious patients are less distressed 8 weeks later, while there was no difference in the first time of measurement. The results show the importance to include spiritual needs in the process of treatment of cancer in a clinical and ambulatory context. Results indicate that religion/spirituality could be an important resource to cope with cancer. During the process of treatment, spiritual needs could be addressed by psychooncology and pastoral care with respect for their different approach and address this topic to support cancer patients.

Pub.: 30 Apr '17, Pinned: 02 May '17

Spiritual well‐being and spiritual distress predict adjustment in adolescent and young adult cancer survivors

Abstract: Spirituality is related to many aspects of cancer survivors' physical and psychological adjustment. Given their unique developmental issues, spiritual issues may be especially important to adolescent and young adult (AYA) survivors, yet little research has been conducted on spirituality with AYA survivors. The present study examines how two aspects of spirituality, spiritual well‐being (comprising faith and meaning/peace), and spiritual struggle relate to later post‐cancer adjustment.At Time 1 (T1), 120 AYA survivors completed questionnaires on spirituality and adjustment (fear of recurrence, post‐traumatic stress symptoms, perceived post‐traumatic growth, psychological distress, and health‐related quality of life). Eighty‐three of these participants also completed these questionnaires at Time 2 (T2), one year later.Our sample reported fairly low spiritual well‐being (meaning/peace, faith) and spiritual struggle. As expected, T1 spiritual well‐being was positively correlated with some aspects of psychological adjustment at T2, whereas T1 spiritual struggle was inversely correlated with T2 psychological adjustment. Both dimensions of T1 spiritual well‐being, but not struggle, were positively associated with perceived T2 posttraumatic growth. In general, T1 spiritual well‐being and struggle correlated with T2 psychological adjustment even when demographics and cancer‐related variables were controlled.These results suggest that while spirituality is not important to all AYA survivors, both spiritual well‐being and struggle have important associations with adjustment and may warrant clinical attention. Future research is needed to more fully understand the role of spirituality in AYA survivors' adjustment in more depth. Copyright © 2016 John Wiley & Sons, Ltd.

Pub.: 16 May '16, Pinned: 22 Apr '17

Patient versus health care provider perspectives on spirituality and spiritual care: the potential to miss the moment.

Abstract: Spirituality and spiritual care are well recognized as important facets of patient care, particularly in the palliative care population. Challenges remain, however, in the provision of such care. This study sought to compare patient and health care professional (HCP) views on spirituality/spiritual care, originally with a view to exploring a simple question(s) HCP's could use to identify spiritual distress, but evolved further to a comparison of how patients and HCPs were both concordant and discordant in their thoughts, and how this could lead to HCP's 'missing' opportunities to both identify spirituality/spiritual distress and to providing meaningful spiritual care.Patients (n=16) with advanced illnesses and HCP's (n=21) with experience providing care to those with advanced disease were interviewed using a semi-structured interview guide. Qualitative analysis distress and spiritual care, and screening for spiritual distress).Within each category there were areas of both concordance and discordance. Most notably, HCP's struggled to articulate definitions of spirituality whereas patients generally spoke with much more ease, giving rich examples. Equally, HCP's had difficulty relating stories of patients who had experienced spiritual distress while patients gave ready responses. Key areas where HCP's and patients differed were identified and set up the strong possibility for an HCP to 'miss the moment' in providing spiritual care. These key misses include the perception that spiritual care is simply not something they can provide, the challenge in defining/ recognizing spirituality (as HCP and patient definitions were often very different), and the focus on spiritual care, even for those interested in providing, as 'task oriented' often with emphasis on meaning making or finding purpose, whereas patients much more commonly described spiritual care as listening deeply, being present and helping them live in the moment.Several discrepancies in perception of spirituality, spiritual distress and spiritual care may hinder the ability of HCP's to effectively offer meaningful spiritual care. A focus on active listening, being led by the patient, and by providing presence may help limit the risk of a disconnect, or a 'miss', in the provision of spiritual care.

Pub.: 03 Mar '17, Pinned: 22 Apr '17

Religions, Vol. 7, Pages 25: Spiritual Assessment within Clinical Interventions Focused on Quality of Life Assessment in Palliative Care: A Secondary Analysis of a Systematic Review

Abstract: One of the most crucial palliative care challenges is in determining how patients’ needs are defined and assessed. Although physical and psychological needs are commonly documented in patient’s charts, spiritual needs are less frequently reported. The aim of this review was to determine which explicit, longitudinal documentation of spiritual concerns would sufficiently affect clinical care to alleviate spiritual distress or promote spiritual wellbeing. A secondary analysis of a systematic review originally aimed at appraising the effectiveness of complex interventions focused on quality of life in palliative care was conducted. Five databases were searched for articles reporting interventions focused on QoL including at least two or more QoL dimensions. A narrative synthesis was performed to synthesize findings. In total, 10 studies were included. Only three studies included spiritual wellbeing assessment. Spirituality tools used to assess spiritual wellbeing were different between studies: Hospital QoL Index 14; Spiritual Needs Inventory; Missoula-Vitas QoL Index; and the Needs Assessment Tool: Progressive Disease-Cancer. Only one study reported a healthcare professional’s session training in the use of the QoL tool. Two out of three studies showed in participants an improvement in spiritual wellbeing, but changes in spiritual wellbeing scores were not significant. Overall patients receiving interventions focused on QoL assessment experienced both improvements in their QoL and in their spiritual needs. Although spiritual changes were not significant, the results provide evidence that a spiritual need exists and that spiritual care should be appropriately planned and delivered. Spiritual needs assessment precedes spiritual caring. It is essential that interventions focused on QoL assessment in palliative care include training on how to conduct a spiritual assessment and appropriate interventions to be offered to patients to address their spiritual needs.

Pub.: 07 Mar '16, Pinned: 22 Apr '17

Determining best methods to screen for religious/spiritual distress.

Abstract: This study sought to validate for the first time a brief screening measure for religious/spiritual (R/S) distress given the Commission on Cancer's mandated screening for psychosocial distress including spiritual distress.Data were collected in conjunction with an annual survey of adult hematopoietic cell transplantation (HCT) survivors. Six R/S distress screeners were compared to the Brief RCOPE, Negative Religious Coping subscale as the reference standard. We pre-specified validity as a sensitivity score of at least 85 %. As no individual measure attained this, two post hoc analyses were conducted: analysis of participants within 2 years of transplantation and of a simultaneous pairing of items. Data were analyzed from 1449 respondents whose time since HCT was 6 months to 40 years.For the various single-item screening protocols, sensitivity ranged from 27 (spiritual/religious concerns) to 60 % (meaning/joy) in the full sample and 25 (spiritual/religious concerns) to 65 % (meaning/joy) in a subsample of those within 2 years of HCT. The paired items of low meaning/joy and self-described R/S struggle attained a net sensitivity of 82 % in the full sample and of 87 % in those within 2 years of HCT but with low net specificities.While no single-item screener was acceptable using our pre-specified sensitivity value of 85 %, the simultaneous use of meaning/joy and self-described struggle items among cancer survivors is currently the best choice to briefly screen for R/S distress. Future research should validate this and other approaches in active treatment cancer patients and survivors and determine the best times to screen.

Pub.: 08 Oct '16, Pinned: 22 Apr '17

A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer.

Abstract: Religion and spirituality (R/S) are patient-centered factors and often are resources for managing the emotional sequelae of the cancer experience. Studies investigating the correlation between R/S (eg, beliefs, experiences, coping) and mental health (eg, depression, anxiety, well being) in cancer have used very heterogeneous measures and have produced correspondingly inconsistent results. A meaningful synthesis of these findings has been lacking; thus, the objective of this review was to conduct a meta-analysis of the research on R/S and mental health. Four electronic databases were systematically reviewed, and 2073 abstracts met initial selection criteria. Reviewer pairs applied standardized coding schemes to extract indices of the correlation between R/S and mental health. In total, 617 effect sizes from 148 eligible studies were synthesized using meta-analytic generalized estimating equations, and subgroup analyses were performed to examine moderators of effects. The estimated mean correlation (Fisher z) was 0.19 (95% confidence interval [CI], 0.16-0.23), which varied as a function of R/S dimensions: affective R/S (z = 0.38; 95% CI, 0.33-0.43), behavioral R/S (z = 0.03; 95% CI, -0.02-0.08), cognitive R/S (z = 0.10; 95% CI, 0.06-0.14), and 'other' R/S (z = 0.08; 95% CI, 0.03-0.13). Aggregate, study-level demographic and clinical factors were not predictive of the relation between R/S and mental health. There was little indication of publication or reporting biases. The correlation between R/S and mental health generally was positive. The strength of that correlation was modest and varied as a function of the R/S dimensions and mental health domains assessed. The identification of optimal R/S measures and more sophisticated methodological approaches are needed to advance research.

Pub.: 11 Aug '15, Pinned: 22 Apr '17

Religion, spirituality, and mental health of U.S. military veterans: Results from the National Health and Resilience in Veterans Study.

Abstract: In the last three decades, there has been increased interest in studying the association between religion/spirituality (R/S), and mental health and functional outcomes.Using data from a contemporary, nationally representative sample of 3151 U.S. military veterans maintained by GfK Knowledge Networks, Inc., we evaluated the relation between R/S and a broad range of mental health, and psychosocial variables. Veterans were grouped into three groups based on scores on the Duke University Religion Index: High R/S (weighted 11.6%), Moderate R/S (79.7%) and Low R/S (8.7%).A "dose-response" protective association between R/S groups and several mental health outcomes was revealed, even after adjustment for sociodemographic and military variables. High R/S was associated with decreased risk for lifetime posttraumatic stress disorder (odds ratio [OR]=0.46), major depressive disorder (MDD; OR=0.50), and alcohol use disorder (OR=0.66), while Moderate R/S was associated with decreased risk for lifetime MDD (OR=0.66), current suicidal ideation (OR=0.63), and alcohol use disorder (OR=0.76). Higher levels of R/S were also strongly linked with increased dispositional gratitude, purpose in life, and posttraumatic growth.In this cross-sectional study, no conclusions regarding causality can be made. The study provides a current snapshot of the link between R/S and mental health. The study also cannot determine whether religious coping styles (negative vs positive coping) contributed to observed differences.Although the present study does not have treatment implications, our results suggest that higher levels of R/S may help buffer risk for certain mental disorders and promote protective psychosocial characteristics in U.S. military veterans.

Pub.: 18 Apr '17, Pinned: 21 Apr '17