Spirituality as a Means of Coping with Chronic Illness
A few years back I was told by a couple people whom I assumed cared about me, that they thought I was useless or didn't want to deal with a sick person. I turned to the one entity who I knew would never abandon me.
When you have a disability or chronic illness, many times there is nothing you can do about curing yourself - but there is plenty you can do about coping.
M. Michelle Rowe
Individuals with chronic illnesses often deal with intense physical and psychological stressors as a consequence of living with an illness. The purpose of this study was to explore the relationship between spirituality and coping ability. Participants with various chronic illnesses completed the Spiritual Involvement and Belief Scale (SIBS), the Coping Styles Scale, and a demographics questionnaire. A significant positive correlation was found between spirituality and the ability to cope. However, only one coping style, Intrusive Positive Thoughts, was found to be a significant predictor of spirituality. These results suggest that individuals who measure high in spirituality also tend to have a stronger and more diverse coping style and also tend to cope using a more positive outlook.
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Holistic approaches to health care focus upon the relationships between a patient's mind, body, and spirit as necessary components of well-being. However, the spiritual dimension of this complex relationship is often left unattended (Miller, 1985). Yet, spiritual care to help patients cope with the psychosocial stress associated with illness is thought to be an important strategy among healthcare professionals, though research on the relationship between spirituality and coping ability remains relatively scarce. Consequently, it is important to explore the relationship between spirituality and the ability to cope with illness to aid healthcare professionals in developing useful interventions.
Patients with chronic illnesses often face an array of difficulties and stressors, such as pain, feelings of uncertainty, and changes in body image, because these illnesses cannot be cured, only managed. These kinds of stressors can lead to changes in well-being, to spiritual distress, and to the struggle with existential questions such as "what is the meaning of life?" (O'Neill & Kenny, 1998).
The inability to resolve such conflicts may then lead to greater psychological distress, such ms depression and anxiety.
How individuals cope with chronic illnesses is quite important to functioning and quality of life. Coping, defined as the process through which individuals try to understand and deal with significant personal or situational demands in their lives (Folkman, & Lazarus, 1988), can greatly impact ones perceptions about his/her own chronic illness. According to Folkman & Lazarus (1988), two general types of coping are thought to be active in the coping response.
Problem Solving Efforts include strategies to do something active or constructive about the situation that is perceived by the individual as threatening, harmful, or challenging. An example of this type of coping is seeking direct help from others in order to cope with illness.
Emotion-focused Coping is more passive and involves strategies to gain emotional control or understanding of a stressful event. For example, individuals who focus upon acceptance of chronic illness are using emotion-focused coping.
For centuries, philosophers have examined the various dimensions of spirituality. Smith, Stefanek, Joseph, Verdieck, Zabora & Fetting (1993) have described spirituality as an underlying dimension of the conscious in which an individual strives for meaning, union with the universe and all things, and stresses the notion that spirituality extends to a power beyond us. This definition utilizes a subconscious or instinctual component to the human psyche, which drives an individual to seek meaning in his/her life. This definition also explains an individual's striving for a union with all creation and a belief in a power beyond one's control, possibly to a being or beings. In contrast, O'Neill and Kenny (1998) have proposed that when spirituality involves an individual's relationship with a higher being in connection with others, it takes on more of a 'religious' context. In this definition, a person's religion is the motivating factor in all aspects of his// her life, and spirituality emerges from religion. Hunglemann, Kenkel-Rossi, Klassen, & Stollenwerk (1996) have found spirituality to be a kind of growth process, which leads to a realization of the ultimate purpose and meaning of life. This definition is important because it suggests that spirituality is a process by which a person can grow and learn from both good and bad experiences in life.
It is important not to confuse the concept of spirituality with that of religion, because religion is a very complex variable in its own right and reflects its own distinct aspects. Religion and spirituality are said to overlap but are not conceptually the same. More specifically, religion refers to the external expression of faith, that is the inner beliefs or values that relate to God or any higher being. It is composed of beliefs, ethical codes, and worship practices that unite an individual with a moral community (Pargament & Jenkins 1995). Religion is a type of spiritual experience, which is part of an organized belief system, practices, and knowledge. These experiences are regarded as an expression of spirituality (O'Neill & Kenny, 1998). Spirituality, however, is broader than religion, and an individual can be spiritual without being religious. For example, those who participate in the Alcoholics Anonymous (AA) program participate in the spiritual aspects of the program, but are not, in many cases, religious at all (Hatch, Burg, Naberhaus, & Hellmich, 1998; Spalding, & Metz, 1997).
Some of the earlier research exploring the relationships between coping and religion, in which spirituality was a minor component, revealed mixed results because of the lack of an appropriate measure for religion. In fact, early research on religious coping is lacking because it failed to take into account all of the complex dimensions of religion (Hathaway & Pargament, 1991). Examples of these studies include those in which religiosity has been simplistically measured according to the frequency of church visits (Ventura & Boss, 1983) or the number of times per day a individual prays (Zuckerman, Kasl, & Ostfeld, 1984). While these two studies were quite important to the development of research in this area, they lack exploration of the many components of religious practice, beliefs, and behavior.
More recent research on coping and spirituality involved the combination of both spirituality and religion as interchangeable concepts. This research, for the most part, has found religion to be an important resource for coping. Aspects of religion, such as religious beliefs, practices, and relationships, are often used to assist individuals in coping with physical and psychosocial stress (Hathaway & Pargament, 1991). Pargament (1990) discussed different ways that religious coping efforts potentially assist those coping with stressful experiences. First, religion may be an element of coping through one's interpretation (e.g. a tragic situation is part of God's plan). Second, religion may affect coping by shaping the coping process (e.g. religious background may help an individual to fight addiction). Third, religion may be shaped by the coping process (e.g. a near-death experience may lead an individual to seek out organized religion). Pargament (1990) also defined three different types of religious coping. The Self-directing Style seeks to solve religious problems without God, the Collaborative Religious Coping Style involves both the individual and God solving a problem, and the Deferring Style is passive, whereas the individual waits for God to intervene in some way. Research evaluating the relationship between religion and coping in patients with cancer has identified significant correlations between religiousness and management of symptoms. Specifically, the presence of strong religious beliefs has been related to decreased levels of pain, hostility, and social isolation, as well as high levels of life satisfaction (Acklin, Brown, & Manger, 1983), and less depression (Bickel, Ciarrocchi, Sheers, Estadt, Powell, & Pargament, 1998).
Research on the concept of spirituality has provided evidence that it is an important coping strategy in its own right. A study by Fehring, Brennan, & Keller (1987) investigated the relationship between spirituality mad psychological mood states in response to changes in life. In this study college students who were making the transition to living away from home for the first time completed the Spiritual Well-Being scale, a spiritual maturity scale, a life change scale, and a depression scale. Results suggested an inverse relationship between negative mood states and spiritual well-being, existential well-being, and spiritual outlook. Similarly, Gurklis & Menke (1988) illustrated die importance of spirituality in coping with a chronic illness. Participants completed a hemodialysis stressor scale, a coping scale, and a general stressor scale, and it was found that prayer, faith in God, and maintaining purpose in life were critical components of coping with illness. Further, Landis (1996) found a negative relationship between spiritual well-being and uncertainty; and a positive relationship between psychosocial adjustment and spiritual well-being. Smith, et. al. (1993) demonstrated that those who viewed death as a normal part of life also experienced less psychosocial distress. Additional research has noted die importance of spirituality in helping individuals cope with the anxiety associated with chronic illnesses. Kaczorowski (1989) found that in individuals with cancer, anxiety is lower in people who are highly spiritual.
These studies provide direct evidence of a potentially significant relationship between spirituality and an enhanced ability to cope with symptoms like anxiety, depression, and other forms of psychosocial distress associated with chronic illness. Consequently, the purpose of the present study was to explore the relationship between spirituality and coping with chronic illnesses in individuals with a variety of different chronic disorders. Results of this study may be important to assist health educators in the development and use of interventions in healthcare programs, which focus upon the stress associated with chronic illness.
*****
As predicted, a positive correlation between spirituality and the ability to cope was found. This correlation provides evidence that spirituality may be an important coping tool because it involves the use of several different coping styles. In particular, individuals who measured high in spirituality tended to show higher overall coping scores, which demonstrates more complete and diverse coping methods using all four coping styles. These findings are consistent with previous research on spirituality as a tool for coping with stress relative to chronic illness (Gurklis & Menke, 1988; Miller, 1985; Smith et al., 1993; Kaczorowski, 1989). The results of the present study also provide evidence for the success of one particular type of coping style, Intrusive Positive Thoughts, as a significant predictor of spirituality for individuals living with a chronic illness. This method of coping involves managing a stressful situation through a positive outlook. These findings indicate that, for individuals living with a chronic illness, spirituality may be very influential to psychological well-being. Finally, the results of this study demonstrated a significant correlation between spirituality and age. This relationship may imply that spirituality increases as a function of age, possibly as a way to cope with the realization of one's own mortality (Hunglemann et al., 1996; Reed, 1991).
The results of the present study should be interpreted in light of several potential limitations. First, although all of the participants in the study reported having some sort of chronic illness, only a small percentage perceived his/her illness to be very debilitating. Future research should attempt to replicate this study using a more debilitated sample of individuals. Second, minorities were not well represented in this particular sample. Clearly, it is important to address ethnicity and culture relative to spirituality and coping with chronic illnesses. Third, the specific religions of the subjects were relatively homogeneous and it would be important to evaluate the impact of various types of religion on spirituality and coping. Finally, subjects in this sample had a fairly large range of chronic illnesses. It would be important in subsequent research to explore the relationships between spirituality and coping with individual who have the same or similar chronic illnesses.
The results of this study are noteworthy and may have some practical implications to healthcare professionals helping individuals cope with chronic illnesses, especially for those who provide patient education and/ or counseling, those who teach disease management skills, and those who conduct patient and/or fatally support groups. Any strategy or coping method that can help patients find a sense of purpose in life and connectedness to others has the potential to improve the quality of life and satisfaction for those who must cope regularly with chronic illnesses. Clearly, spirituality has a significant impact on coping and healthcare professionals may help patients better cope through the development of spirituality.
(For the full article click on the title above)
Individuals with chronic illnesses often deal with intense physical and psychological stressors as a consequence of living with an illness. The purpose of this study was to explore the relationship between spirituality and coping ability. Participants with various chronic illnesses completed the Spiritual Involvement and Belief Scale (SIBS), the Coping Styles Scale, and a demographics questionnaire. A significant positive correlation was found between spirituality and the ability to cope. However, only one coping style, Intrusive Positive Thoughts, was found to be a significant predictor of spirituality. These results suggest that individuals who measure high in spirituality also tend to have a stronger and more diverse coping style and also tend to cope using a more positive outlook.
**********
Holistic approaches to health care focus upon the relationships between a patient's mind, body, and spirit as necessary components of well-being. However, the spiritual dimension of this complex relationship is often left unattended (Miller, 1985). Yet, spiritual care to help patients cope with the psychosocial stress associated with illness is thought to be an important strategy among healthcare professionals, though research on the relationship between spirituality and coping ability remains relatively scarce. Consequently, it is important to explore the relationship between spirituality and the ability to cope with illness to aid healthcare professionals in developing useful interventions.
Patients with chronic illnesses often face an array of difficulties and stressors, such as pain, feelings of uncertainty, and changes in body image, because these illnesses cannot be cured, only managed. These kinds of stressors can lead to changes in well-being, to spiritual distress, and to the struggle with existential questions such as "what is the meaning of life?" (O'Neill & Kenny, 1998).
Often these individuals search for relevant meaning and purpose in life, which may, in turn, bring out unresolved conflicts with other people and regret about certain life choices.
The inability to resolve such conflicts may then lead to greater psychological distress, such ms depression and anxiety.
How individuals cope with chronic illnesses is quite important to functioning and quality of life. Coping, defined as the process through which individuals try to understand and deal with significant personal or situational demands in their lives (Folkman, & Lazarus, 1988), can greatly impact ones perceptions about his/her own chronic illness. According to Folkman & Lazarus (1988), two general types of coping are thought to be active in the coping response.
Problem Solving Efforts include strategies to do something active or constructive about the situation that is perceived by the individual as threatening, harmful, or challenging. An example of this type of coping is seeking direct help from others in order to cope with illness.
Emotion-focused Coping is more passive and involves strategies to gain emotional control or understanding of a stressful event. For example, individuals who focus upon acceptance of chronic illness are using emotion-focused coping.
For centuries, philosophers have examined the various dimensions of spirituality. Smith, Stefanek, Joseph, Verdieck, Zabora & Fetting (1993) have described spirituality as an underlying dimension of the conscious in which an individual strives for meaning, union with the universe and all things, and stresses the notion that spirituality extends to a power beyond us. This definition utilizes a subconscious or instinctual component to the human psyche, which drives an individual to seek meaning in his/her life. This definition also explains an individual's striving for a union with all creation and a belief in a power beyond one's control, possibly to a being or beings. In contrast, O'Neill and Kenny (1998) have proposed that when spirituality involves an individual's relationship with a higher being in connection with others, it takes on more of a 'religious' context. In this definition, a person's religion is the motivating factor in all aspects of his// her life, and spirituality emerges from religion. Hunglemann, Kenkel-Rossi, Klassen, & Stollenwerk (1996) have found spirituality to be a kind of growth process, which leads to a realization of the ultimate purpose and meaning of life. This definition is important because it suggests that spirituality is a process by which a person can grow and learn from both good and bad experiences in life.
It is important not to confuse the concept of spirituality with that of religion, because religion is a very complex variable in its own right and reflects its own distinct aspects. Religion and spirituality are said to overlap but are not conceptually the same. More specifically, religion refers to the external expression of faith, that is the inner beliefs or values that relate to God or any higher being. It is composed of beliefs, ethical codes, and worship practices that unite an individual with a moral community (Pargament & Jenkins 1995). Religion is a type of spiritual experience, which is part of an organized belief system, practices, and knowledge. These experiences are regarded as an expression of spirituality (O'Neill & Kenny, 1998). Spirituality, however, is broader than religion, and an individual can be spiritual without being religious. For example, those who participate in the Alcoholics Anonymous (AA) program participate in the spiritual aspects of the program, but are not, in many cases, religious at all (Hatch, Burg, Naberhaus, & Hellmich, 1998; Spalding, & Metz, 1997).
Some of the earlier research exploring the relationships between coping and religion, in which spirituality was a minor component, revealed mixed results because of the lack of an appropriate measure for religion. In fact, early research on religious coping is lacking because it failed to take into account all of the complex dimensions of religion (Hathaway & Pargament, 1991). Examples of these studies include those in which religiosity has been simplistically measured according to the frequency of church visits (Ventura & Boss, 1983) or the number of times per day a individual prays (Zuckerman, Kasl, & Ostfeld, 1984). While these two studies were quite important to the development of research in this area, they lack exploration of the many components of religious practice, beliefs, and behavior.
More recent research on coping and spirituality involved the combination of both spirituality and religion as interchangeable concepts. This research, for the most part, has found religion to be an important resource for coping. Aspects of religion, such as religious beliefs, practices, and relationships, are often used to assist individuals in coping with physical and psychosocial stress (Hathaway & Pargament, 1991). Pargament (1990) discussed different ways that religious coping efforts potentially assist those coping with stressful experiences. First, religion may be an element of coping through one's interpretation (e.g. a tragic situation is part of God's plan). Second, religion may affect coping by shaping the coping process (e.g. religious background may help an individual to fight addiction). Third, religion may be shaped by the coping process (e.g. a near-death experience may lead an individual to seek out organized religion). Pargament (1990) also defined three different types of religious coping. The Self-directing Style seeks to solve religious problems without God, the Collaborative Religious Coping Style involves both the individual and God solving a problem, and the Deferring Style is passive, whereas the individual waits for God to intervene in some way. Research evaluating the relationship between religion and coping in patients with cancer has identified significant correlations between religiousness and management of symptoms. Specifically, the presence of strong religious beliefs has been related to decreased levels of pain, hostility, and social isolation, as well as high levels of life satisfaction (Acklin, Brown, & Manger, 1983), and less depression (Bickel, Ciarrocchi, Sheers, Estadt, Powell, & Pargament, 1998).
Research on the concept of spirituality has provided evidence that it is an important coping strategy in its own right. A study by Fehring, Brennan, & Keller (1987) investigated the relationship between spirituality mad psychological mood states in response to changes in life. In this study college students who were making the transition to living away from home for the first time completed the Spiritual Well-Being scale, a spiritual maturity scale, a life change scale, and a depression scale. Results suggested an inverse relationship between negative mood states and spiritual well-being, existential well-being, and spiritual outlook. Similarly, Gurklis & Menke (1988) illustrated die importance of spirituality in coping with a chronic illness. Participants completed a hemodialysis stressor scale, a coping scale, and a general stressor scale, and it was found that prayer, faith in God, and maintaining purpose in life were critical components of coping with illness. Further, Landis (1996) found a negative relationship between spiritual well-being and uncertainty; and a positive relationship between psychosocial adjustment and spiritual well-being. Smith, et. al. (1993) demonstrated that those who viewed death as a normal part of life also experienced less psychosocial distress. Additional research has noted die importance of spirituality in helping individuals cope with the anxiety associated with chronic illnesses. Kaczorowski (1989) found that in individuals with cancer, anxiety is lower in people who are highly spiritual.
These studies provide direct evidence of a potentially significant relationship between spirituality and an enhanced ability to cope with symptoms like anxiety, depression, and other forms of psychosocial distress associated with chronic illness. Consequently, the purpose of the present study was to explore the relationship between spirituality and coping with chronic illnesses in individuals with a variety of different chronic disorders. Results of this study may be important to assist health educators in the development and use of interventions in healthcare programs, which focus upon the stress associated with chronic illness.
*****
As predicted, a positive correlation between spirituality and the ability to cope was found. This correlation provides evidence that spirituality may be an important coping tool because it involves the use of several different coping styles. In particular, individuals who measured high in spirituality tended to show higher overall coping scores, which demonstrates more complete and diverse coping methods using all four coping styles. These findings are consistent with previous research on spirituality as a tool for coping with stress relative to chronic illness (Gurklis & Menke, 1988; Miller, 1985; Smith et al., 1993; Kaczorowski, 1989). The results of the present study also provide evidence for the success of one particular type of coping style, Intrusive Positive Thoughts, as a significant predictor of spirituality for individuals living with a chronic illness. This method of coping involves managing a stressful situation through a positive outlook. These findings indicate that, for individuals living with a chronic illness, spirituality may be very influential to psychological well-being. Finally, the results of this study demonstrated a significant correlation between spirituality and age. This relationship may imply that spirituality increases as a function of age, possibly as a way to cope with the realization of one's own mortality (Hunglemann et al., 1996; Reed, 1991).
The results of the present study should be interpreted in light of several potential limitations. First, although all of the participants in the study reported having some sort of chronic illness, only a small percentage perceived his/her illness to be very debilitating. Future research should attempt to replicate this study using a more debilitated sample of individuals. Second, minorities were not well represented in this particular sample. Clearly, it is important to address ethnicity and culture relative to spirituality and coping with chronic illnesses. Third, the specific religions of the subjects were relatively homogeneous and it would be important to evaluate the impact of various types of religion on spirituality and coping. Finally, subjects in this sample had a fairly large range of chronic illnesses. It would be important in subsequent research to explore the relationships between spirituality and coping with individual who have the same or similar chronic illnesses.
The results of this study are noteworthy and may have some practical implications to healthcare professionals helping individuals cope with chronic illnesses, especially for those who provide patient education and/ or counseling, those who teach disease management skills, and those who conduct patient and/or fatally support groups. Any strategy or coping method that can help patients find a sense of purpose in life and connectedness to others has the potential to improve the quality of life and satisfaction for those who must cope regularly with chronic illnesses. Clearly, spirituality has a significant impact on coping and healthcare professionals may help patients better cope through the development of spirituality.
(For the full article click on the title above)
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