Papers: RELIGIOUS AND SPIRITUALITY VALUES AND COPING ON HIV
RELIGIOUS
AND SPIRITUALITY VALUES AND COPING ON HIV
1.
Title: Religion and HIV: a review of
the literature and clinical implications
Author(s): Kenneth I. Pargament, Shauna McCarthy, Purvi Shah, Gene Ano,
Nalini Tarakeshwar, Amy Wachholtz, .
Source: Southern Medical Journal.
Document Type: Article
Article Preview :
Despite substantive research
documenting the connection between various religious dimensions and physical
(1,2) and mental health, (3) 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. (4) Importantly, these disenfranchised subgroups
report greater use of religion in their everyday lives. (5) 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. (6-9)
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, (10,11) to overcome their sense of guilt and
shame in engaging in risky behaviors, (8) and to find a renewed sense of
purpose in life. (13-16) 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. (17) 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.
Framework of Religious Coping
Pargament (18) has developed a
transactional model of religious coping wherein religion is viewed as
contributing to the coping process by shaping the character of life events,
coping activities, and the outcomes of events. Religion can also be a product of coping
such that people can increase their religious faith as a result of life events.
As part of an individual's general orienting system, religion influences how
individuals appraise situations, participate in activities, and develop goals
for themselves. In particular, when faced with difficult situations,
individuals have reported using a wide variety of religious coping methods,
such as benevolent religious appraisals, seeking support from clergy or church
members, seeking spiritual support, discontent with congregation and God,
negative religious reframing, and expressing interpersonal religious discontent.
(18) One parsimonious way of clustering or distinguishing these various
coping methods is to define "positive religious coping" strategies
(eg, seeking God's love and care, asking for forgiveness) and "negative
religious coping" strategies (eg, expressing anger at God, feeling
punished by God). (19) Positive religious coping methods rest on a secure
relationship with God, a belief in a larger, benevolent purpose to life, and a
sense of connectedness with a religious community. Negative religious coping methods
reflect a religious struggle that grows out of a more tenuous relationship with
God, a more ominous view of life, and a sense of disconnectedness with a
religious community. In some sense, negative religious coping occurs when major
life stressors pose a threat or challenge not only to physical and
psychological health and well-being but also to the individual's religious and
spiritual world view.
2. Spirituality and
psychosocial factors in persons living with HIV
First published: 07 July 2008
Cited by: 106
Inez Tuck, School of Nursing, Virginia Commonwealth University,
1220 East Broad Street, Richmond, VA 23298‐0567, USA. E‐mail: ituck@hsc.vcu.edu
Abstract
Spirituality and
psychosocial factors in persons living with HIV
Aim of the study. This pilot
study was designed to examine the relationships among spirituality and
psychosocial factors in a sample of 52 adult males living with human
immunodeficiency virus (HIV) disease and to determine the most reliable spirituality
measure for a proposed longitudinal study.
Background. HIV disease
is among the most devastating of illnesses, having multiple and profound
effects upon all aspects of the biopsychosocial and spiritual being. Although
research has suggested relationships among various psychosocial and spiritual
factors, symptomatology and physical health, much more research is needed to
document their potential influences on immune function, as well as health
status, disease progression, and quality of life among persons with HIV
disease.
Methods. This
descriptive correlational study explored the relationships of spirituality and
psychosocial measures. Spirituality was measured in terms of spiritual
perspective, well‐being and health using three tools: the Spiritual Perspective
Scale, the Spiritual Well‐Being Scale, and the Spiritual Health Inventory. Five
psychosocial instruments were used to measure aspects of stress and coping: the
Mishel Uncertainty in Illness Scale, Dealing with Illness Scale, Social
Provisions Scale, Impact of Events Scale, and Functional Assessment of HIV
Infection Scale. The sample was recruited as part of an ongoing funded study.
The procedures from the larger study were well‐defined and followed in this
pilot study. Correlational analyses were done to determine the relationship
between spirituality and the psychosocial measures.
Findings. The findings indicate
that spirituality as measured by the existential well‐being (EWB) subscale of
the Spiritual Well‐Being Scale was positively related to quality of life,
social support, effective coping strategies and negatively related to perceived
stress, uncertainty, psychological distress and emotional‐focused coping. The
other spirituality measures had less significant or non significant relationships
with the psychological measures.
Conclusions. The study
findings support the inclusion of spirituality as a variable for consideration
when examining the psychosocial factors and the quality of life of persons
living with HIV disease. The spiritual measure that best captures these
relationships is the EWB subscale of the Spiritual Well‐Being Scale.
3. A
Critical Review of a Spirituality Intervention
First Published February 6,
2012 Research Article
Although there is a growing interest in the topic of spirituality, there
are few reports of spiritual interventions and limited empirical data to
support their effectiveness. As health care practices become increasingly
evidence based, the reliance on empirical data is critical. This article
describes the spiritual intervention developed by the author and documents the
testing of its effectiveness with clinical and nonclinical populations. The
findings from a series of studies have been mixed. Preliminary
studies reported that the intervention positively influenced patients’
outcomes, including overall quality of life and reduced selected stress
responses. Significant positive trends were found that supported the
potential effectiveness of the intervention for a variety of populations and
clinical settings. However, subsequent testing in clinical trials indicated
limited effect of the intervention although there were several noteworthy
findings. The author discusses the implications of these findings for future
investigations.
4.
Do Positive Psychosocial Factors
Predict Disease Progression in HIV-1? A Review of the Evidence
Gail H. Ironson, MD, PhD and H’sien Hayward, BA
The
publisher's final edited version of this article is available at Psychosom Med
See
other articles in PMC that cite the published article.
Abstract
Adding to a traditional stress
perspective, behavioral medicine has been focusing increasingly on
investigating the potential impact of positive psychosocial factors on disease
course in HIV. Dispositional optimism, active coping, and spirituality show the
most evidence for predicting slower disease progression, although the data are
not entirely consistent. Findings for the role of social support are mixed,
although indications are that it may be particularly helpful at later stages of
illness. Many of the other constructs (positive affect, finding meaning,
emotional expression/processing, openness, extraversion, conscientiousness,
altruism, and self-efficacy) have only been examined in one or two studies;
results are preliminary but suggestive of protective effects. Plausible
behavioral and biological mechanisms are discussed (including health behaviors,
neurohormones, and immune measures) as well as suggestions for clinicians,
limitations, future directions, and a discussion of whether these constructs
can be changed. In conclusion, investigating the
importance and usefulness of positive psychosocial factors in predicting
disease progression in HIV is in its beginning scientific stages and shows good
initial evidence and future promise.
Keywords: opitimism, coping, spirituality, positive
psychology, meaning, HIV/AIDS, disease progression
INTRODUCTION
Despite the widespread popularity of
books such as the “Power of Positive Thinking” (1),
the research on psychosocial predictors in behavioral medicine has been focused
on the negative predictors of disease outcomes such as stressful life events,
depression, and avoidant coping (2,3).
The field of behavioral medicine is now expanding to incorporate a new
focus on positive factors that may contribute to health outcomes (4).
This paper reviews what is known about these positive psychosocial factors and
their relationship to longitudinal studies of disease progression in HIV. We
define positive psychosocial factors broadly to include such diverse
potentially helpful constructs as beliefs (optimism, finding meaning,
spirituality), positive affect, behaviors (active coping, altruistic behaviors,
expressing emotions with processing), personality dispositions (openness,
extra-version, conscientiousness), and social support. Our coverage includes
many of the commonly used constructs that are part of the positive psychology
literature (5). To ensure a comprehensive review, we
searched on the following keywords in PubMed: HIV and disease progression
crossed with optimism, positive affect, coping, spirituality, meaning,
personality, altruism, emotional expression, and social support.
CONCLUSION
CONCLUSIONS
Investigating the importance and usefulness of positive
psychosocial factors is in its beginning scientific stages and shows good
initial evidence and future promise. Positive
psychosocial factors such as positive beliefs (optimism, finding meaning,
spirituality), positive affect, positive behaviors (expressing/processing
emotions, proactive coping, adherence, etc.), active ways of interacting
(openness, extraversion), and fostering social support can help a person with
HIV to cope and to remain engaged in living. Although recognizing and
encouraging a positive attitude in patients could be helpful, healthcare
professionals must be mindful of potential pitfalls and proceed with
sensitivity. Directing the conversation toward more specific approaches for
enhancing positive ways of dealing with HIV (e.g., finding meaning, increasing
spirituality, providing skills for increasing self-efficacy) may be useful and
easier to implement. Future longitudinal studies should cast a wider net
to include positive constructs not yet investigated, and should do so with
conceptual clarity. Future intervention studies are needed to determine whether
focusing on positive states will enhance effectiveness beyond what is already
achieved.
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