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How Does One Learn to be Spiritual Neglected Role of Spiritual Modeling in Health

Spiritual/Religious Organization. etc. Famous persons. RS tradition. Media (books, ... The Spiritual Modeling Perspective suggests refinements in theories ...

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How Does One Learn to be Spiritual Neglected Role of Spiritual Modeling in Health

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    Slide 1:How Does One Learn to be Spiritual? Neglected Role of Spiritual Modeling in Health

    Doug Oman, Ph.D. School of Public Health University of California, Berkeley 27th Annual Meeting, Society of Behavioral Medicine: Pre-Conference Event Spirituality, Science and Health: What’s Going On and Why? March 22, 2006

    Slide 2:OUTLINE

    Social Learning Theory Spiritual Modeling Application to Interventions

    Slide 3:Social Learning Theory How do we learn anything?

    Much is osmosis, apprenticeships, role models, etc. Relying only on trial/error would be excruciating! “Most human behavior is learned observationally through modeling” (Bandura, 1986)

    Slide 4:We Learn from Other People

    Face to face observation Through media Oral Print Electronic

    Slide 5:Social Cognitive Theory

    Bandura’s (1986) theory: Fullest scientific account of Observational Learning (OL) OL seen as central to all learning OL functions partly via Self-efficacy ------ [confidence in specific skills]

    Slide 6:Social Cognitive Theory Areas of Application

    Education Physical health Mental health Athletics Organizational functioning

    Slide 7:Documented power of Observational Learning

    “One can get people to behave altruistically, volunteer their services, delay or seek gratification, show affection, behave punitively, prefer certain foods and apparel, converse on particular topics, be inquisitive or passive, think innovatively or conventionally, and to engage in almost any course or action by having such conduct exemplified.” (Bandura, 1986)

    Slide 8:Observational Learning

    Four major underlying processes Attention Retention Reproduction in Behavior Motivation

    Slide 9:Applying to Spirituality

    Observational Learning ?well-studied Spirituality ?wide emerging interest ?Why not Connect the Dots??

    Slide 10:Spiritual Modeling

    Learning spiritually relevant skills or behaviors through observing other persons. (Oman & Thoresen, 2003) Spiritual Modeling Perspective Spiritual Observation Health Effects Model

    Slide 11:From Whom ...do we learn spiritually relevant behaviors?

    Spiritual Models may be... Persons in the Community Family School Spiritual/Religious Organization etc. Famous persons RS tradition Media (books, electronic, etc.)

    Slide 12:What is Learned? (I)

    Almost any RS-relevant belief / behavior RS beliefs Existence/nature of God/higher being Human nature / purpose Coping assistance [from within/above] Spiritual Practices Prayer/Meditation Virtues [e.g., Forgiveness/Love/Faith] Selfless service

    Slide 13:What is Learned? (continued)

    Identities of Revered Spiritual Models ? Jesus ? Mother Teresa ? Buddha ? Mahatma Gandhi ? Martin Luther King ? Dalai Lama “When religions are sifted” for their best qualities, “they begin to look like data banks that house the winnowed wisdom of the human race” (Huston Smith, 1991)

    Slide 14:Spiritual modeling occurs Through what Processes?

    Same as for all social learning Attention Retention Reproduction in Behavior Motivation Claim Religions historically foster all four, systematically (Oman & Thoresen, 2003)

    Slide 15:The Spiritual Modeling Perspective

    Factors affecting learning from spiritual examples (including from spiritual “data banks”) may have consequences!

    Slide 16:Application to Health

    The Spiritual Modeling Perspective suggests refinements in theories of how spirituality affects health

    Common Model for How Spirituality Affects Physical Health Spirituality & Religion ? ? ? Physical Health (Koenig, Larson & McCullough, 2000) (Oman & Thoresen, 2002) ? reduced stress ? Spirituality & Religion Refining the Model: What’s inside Spirituality? Spirituality has (at Least) Three Components With Reciprocal Influence ? Facilitate learning / emulation (4+ processes) ?Motivate ?Guide ?Confirm / refine ?Motivate ?Identify ?Trust / commit Experiences ? Facilitate learning / emulation (4+ processes) More amenable To intervention (can give tools) Spiritual Observation Health Effects Model Context Norms ? Routines ? ? ? Spiritual Observation Health Effects Model Spiritual Observation Health Effects Model ? ? ? Physical Health

    Slide 23:Summary of Model

    Learning from spiritual models is theorized to foster health... via mechanisms of Social support Health behaviors Mental health/Character strengths/Virtues in concert (synergistically) with Spiritual Practices Beliefs / Experiences / etc.

    Spiritual Observation Health Effects Model Preliminary Empirical Support ? ? ? Valid Measurement (test/retest r=.82) SMILE College Students (N ˜ 1000) ?Associations: Same approx. strength as Religious Attendance ? With Life Satisfaction: Stronger assoc. than RA Spirituality/Religion

    Slide 25:Spiritual Models: Concept Summary

    The Spiritual Modeling... Perspective Spirituality is more than only beliefs+practices. Also includes: Factors affecting learning from “data banks” of spiritual models Health Effects Model Spiritual models affect health via multiple pathways, in concert with other RS dimensions Empirical Support Social Cognitive Theory extremely supported Preliminary support for spiritual application

    Slide 26:Practical Application to Health of Spiritual Modeling Perspectives

    Is there a problem? Response strategies Intervention 1: Spiritual meditation (I) Intervention 2: Cue words Intervention 3: Supportive assessments Intervention 4: Spiritual meditation (II)

    Slide 27:Are people satisfied with their opportunities to learn from spiritual models?

    “When [US high school] students were asked to give examples of individuals who exemplified the various [character] strengths, they were more likely to name biblical figures or civil rights leaders from the 1960s rather than exemplars from contemporary society.... One male student observed: ‘We just don’t see many people today who are wise or honest or whatever because those sorts of things aren’t valued as much in our society.’” (Steen, Kachorek & Peterson, 2003) Is there a problem? Steen, T. A., Kachorek, L. V., & Peterson, C. (2003). Character strengths among youth. Journal of Youth & Adolescence, 32, 5-16. Quote is from page 11.Steen, T. A., Kachorek, L. V., & Peterson, C. (2003). Character strengths among youth. Journal of Youth & Adolescence, 32, 5-16. Quote is from page 11.

    Slide 28:Compartmentalized Culture Extreme Example: Modern Medicine

    Modern Western medicine, "shorn of every vestige of mystery, faith, or moral portent, is actually an aberration in the world scene“ Academic Medicine (Barnard, Dayringer & Cassell, 1995) Is there a problem?

    Slide 29:Moving Lives from Radical to Manageable Compartmentalization

    Help people to draw on spiritual perspectives and resources in all compartments of life Provide tools(practices) to help individuals... More deeply assimilate spiritual models [attend, retain] Integrate spiritual life throughout the day [retain, reproduce in behavior] Response Strategy

    Slide 30:Interventions: Spiritual Modeling Perspectives

    The following interventions don’t work only via spiritual models Spiritual modeling perspectives sensitize us to key features (often cognitive) key processes key questions to study

    Slide 31:Intervention 1: Spiritual Meditation (I)

    In college students (N=46), Wachholtz and Pargament (2005) compared Meditating on ?a spiritual focus (e.g., “God is joy”) Meditating on a secular focus (e.g., “I am joyful”) This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.

    Slide 32:Findings (randomized design)

    Compared to a secular focus (e.g., “I am joyful”) ? Meditating on a spiritual focus (e.g., “God is joy”) was associated with... ? reduced anxiety ? improved mood ? increased pain tolerance (Wachholtz and Pargament, 2005) Note: recently replicated 1. Spiritual Meditation (I) This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.

    Slide 33:Mechanisms? A spiritual focus might...

    Make spiritual resources / models more mentally accessible through the day, e.g., more able to: Remember spiritual models Enact virtues (forgiveness, etc.) Use RS coping methods (“Associative network theory”, Collins & Loftus, 1975) ? reduced stress 1. Spiritual Meditation (I) From Wachholtz and Pargament (2005), page 380 (bold added): “Of the three treatments, only the Spiritual Meditation condition imposed a focused time on the participants to consider their spirituality. This could lead to two conclusions. First, individuals may be more likely to interpret everyday occurrences through a spiritual lens when they participate in spiritual meditation. Second, when individuals set aside time to focus on their spirituality, they may be more open to subjective spiritual experiences. Further, perhaps people are generally looking to improve their spiritual lives, yet in their rushed lifestyles, they are unable to find the time to expand their spirituality. The quiet time mandated by this study may have provided some outlet for that spiritual desire, diverting attention from the external “noise” of daily life to the inner spiritual life From Wachholtz and Pargament (2005), page 380 (bold added): “Of the three treatments, only the Spiritual Meditation condition imposed a focused time on the participants to consider their spirituality. This could lead to two conclusions. First, individuals may be more likely to interpret everyday occurrences through a spiritual lens when they participate in spiritual meditation. Second, when individuals set aside time to focus on their spirituality, they may be more open to subjective spiritual experiences. Further, perhaps people are generally looking to improve their spiritual lives, yet in their rushed lifestyles, they are unable to find the time to expand their spirituality. The quiet time mandated by this study may have provided some outlet for that spiritual desire, diverting attention from the external “noise” of daily life to the inner spiritual life

    Slide 34:Implications

    RS effects are not reducible to RS practices Impact of RS cognitive factors is predicted by a spiritual modeling perspective Question: Does spiritual meditation foster better daily mental recall of spiritual models? 1. Spiritual Meditation (I)

    Slide 35:Intervention 2: Spiritual Cue Words

    Many RS traditions teach repeating a holy name/mantram at many times throughout the day Holy names and mantrams may evoke spiritual models

    Slide 36:Empirical Study

    Bormann et al (2005, 2006) taught holy name / mantram repetition to veterans, VA staff (N=66) Participants encouraged to use a cue word from a tradition throughout the day ?“Jesus” ?“Rama” ?“Barukh Attai Adonai” ?“Om mani padme hum” ?“Ave Maria” 2. Spiritual Cue Words

    Slide 37:Cue Word Findings

    Most participants (55/66=83%), reported incidents when holy name/mantram was helpful for coping Used for managing... emotions such as impatience, anger, frustration (51%) stress (24%), insomnia (13%) unwanted thoughts (12%). 2. Spiritual Cue Words

    Slide 38:Implications

    Spiritual practices may foster drawing upon spiritual models throughout the day Question: Does mantram use foster mental recall of spiritual models? 2. Spiritual Cue Words

    Slide 39:Intervention 3: Supportive Assessment

    In Academic Medicine, Barnard et al (1995) wrote that “An important task of care for the physician is to elicit patients' explanatory frameworks, and to seek accommodations where necessary (and where possible) between medical and nonmedical interpretations....”

    Slide 40:Semi-Structured Protocol

    Kristeller and colleagues (2005) taught oncologists to use a 5-7 minute semi-structured interview Interviews with oncology patients (N=118) Inquired about spiritual resources Offered assistance as appropriate 3. Supportive Assessment

    Outline of Semi-Structured Interviews (Kristeller et al, 2005) _______________________________________________________________________ I. INTRODUCE ISSUE IN NEUTRAL INQUIRING MANNER. “When dealing with a serious illness, many people draw on religious or spiritual beliefs to help cope. It would be helpful to me to know how you feel about this.” II. INQUIRE FURTHER, ADJUSTING INQUIRY TO PATIENT’S INITIAL RESPONSE a. Positive-Active Faith Response: “What have you found most helpful about your beliefs since your illness?” b. Neutral-Receptive Response: “How might you draw on your faith or spiritual beliefs to help you?” c. Spiritually Distressed Response (e.g., anger or guilt): “Many people feel that way…what might help you come to terms with this?” d. Defensive/Rejecting Response: “It sounds like you’re uncomfortable I brought this up. What I’m really interested in is how you are coping…can you tell me about that?” III. CONTINUE TO EXPLORE FURTHER AS INDICATED. “I see. Can you tell me more (about….)?” IV. INQUIRE ABOUT WAYS OF FINDING MEANING AND A SENSE OF PEACE. “Is there some way in which you are able to find a sense of meaning or peace in the midst of this?” V. INQUIRE ABOUT RESOURCES. “Whom do you have to talk to about this/these concerns?” VI. OFFER ASSISTANCE AS APPROPRIATE AND AVAILABLE. “Perhaps we can arrange for you to talk to someone…”; “…there’s a support group.” VII. BRING INQUIRY TO A CLOSE. “I appreciate you discussing these issues with me. May I ask about it again?” RS beliefs may include reverence for models 3. Supportive Assessment

    Slide 42:Empirical Findings

    Most patients (76%) felt inquiry was somewhat/very useful. At 3 weeks, the intervention group had ? Depression (p<.01) ? Quality of Life (p<.05) ? Sense of interpersonal caring from their physician (p<.05) 3. Supportive Assessment

    Slide 43:Implications

    Supportive spiritual assessments are feasible and appreciated Health professionals can exemplify (model) a limited reintegration of spirituality and healthcare 3. Supportive Assessment

    Slide 44: Intervention 4: Spiritual Meditation (II)

    Historically, RS traditions systematically foster all four processes Attention Retention Reproduction in behavior Motivation (Oman & Thoresen, 2003) Can health interventions also support all these processes?

    Slide 45:Spiritual Models in Meditation Interventions

    Oman and Beddoe (2005) reviewed spiritual modeling support offered by previously studied meditation forms 4. Spiritual Meditation (II)

    Slide 46:Passage Meditation (choose own passages from a spiritual wisdom figure or tradition)

    Memorize / Recite silently in mind for 30 mins 4. Spiritual Meditation (II)

    Slide 47:Eight Point Program for Spiritual Growth (Easwaran, 1991/1978)

    4. Spiritual Meditation (II) Eight Point Program, more info: http://www.easwaran.orgEight Point Program, more info: http://www.easwaran.org

    Slide 48: Randomized Controlled Trial

    Oman, Thoresen et al (in press) studied Health Professionals (N=58) Randomized, wait-list-controlled Assessed: Pre-intervention, post-intervention, 8-week FU 19-week FU 4. Spiritual Meditation (II)

    Slide 49:Results standardized by pretest SD

    +p<.10 *p<.05 **p<.01 ***p<.001 4. Spiritual Meditation (II) Treatment Control

    Slide 50:Do Passages Make a Difference?

    Compared to a comprehensive meditation program offering less spiritual modeling support (MBSR): Stress and well-being outcomes were SIMILAR [2 mo FUp] However…Passage meditators had more gains in: Pre-1900 spiritual models Spiritual modeling self-efficacy 4. Spiritual Meditation (II)

    Slide 51:Implications

    Similar effects remind us that spiritual models work in concert with practices Question: What are long-term implications of extra spiritual models? 4. Spiritual Meditation (II)

    Slide 52:Reflection on Interventions

    Nonsectarian interventions that support spiritual modeling are feasible Theory and preliminary evidence support health effects… in concert with practices but not reducible to practices

    Slide 53:Overall Summary/Conclusion

    Scientific theory + spiritual traditions each affirm: spiritual modeling is central to spiritual learning Theoretically: Models/practices/beliefs reciprocally affect each other, and affect health in concert Empirically promising interventions exist that reflect spiritual modeling perspectives

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