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Spiritual Wellness: A Comparison of Models and Consideration of Applications in College Health. Paul Myers, Ph.D. University of Portland Spirituality, Religion and Student Health Coalition of ACHA. Objectives. Identify and describe models of spiritual health UCLA HERI prevalence data

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spiritual wellness a comparison of models and consideration of applications in college health

Spiritual Wellness: A Comparison of Models and Consideration of Applications in College Health

Paul Myers, Ph.D.

University of Portland

Spirituality, Religion and Student Health Coalition of ACHA

  • Identify and describe models of spiritual health
  • UCLA HERI prevalence data
  • Correlates of health risk and spiritual health
  • Proposals for the future
  • Do not prove existence of God
  • Religious matters can make scientists and clinicians uncomfortable
  • Do not prove one religion is better than another
  • Cannot perform random assignment to faith tradition or belief system
  • Still there are interesting things to consider given religious diversity of students
correlational studies of spirituality religion and student health
Correlational Studies of Spirituality/Religion and Student Health
  • Correlation not necessarily causation
  • Variance accounted for is often small
  • Challenges in operationalization of referent constructs
  • Prejudices in academe about doing research on matters related to religion
  • Complex co-variates
models of spiritual health
Models of Spiritual Health

What is Health?

  • Old English word hale, meaning Whole
  • W.H.O.’s 1948 Definition:

“health is a complete [whole] state of physical, mental, and social well-being and not merely the absence of disease or infirmity.”

whole health as
Whole Health as …

Promotion of health in mind, body and spirit.

But what do we mean by health of the spirit?

What does spirit contribute to overall health?

models of spiritual health1
Models of Spiritual Health

A religious view in contrast to a health promotion view: Spiritual Health is the wholeness and completeness of one’s relationship with the divine, and the divine’s creation.

traditional models of spiritual health wholeness
Traditional Models of Spiritual Health (Wholeness)

What is spiritual?

  • Things of God (gods): Human-Divine Relationship
  • Things of meaning and purpose: Alpha and Omega
  • Things of life and animation: “Breath of Life”
  • Things of motivation and passion: of the spirits of darkness and light (good and evil)
religious causal models of healing illness action
Religious Causal Models of Healing (Illness) Action
  • Nature has God-installed restorative processes
  • People learn how to alter God’s natural laws to influence restorative processes
  • People ask for case-specific Divine intervention
  • God intervenes without request to teach
  • Some combination of the above (all of above)
  • None of the above
the spiritual popular models in the media
The Spiritual: Popular Models In the Media
  • Serving others promotes better health
  • Dietary alterations create health
  • Meditation and breathing practices cure, heal and prevent
  • Social support groups
  • Sampling from eastern religions: cleansing, focusing, emptying, fasting
research models of spirituality and religion
Research Models of Spirituality and Religion
  • Religion is an organized system of beliefs, practices, rituals and symbols designed (a) to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality) and (b) to foster an understanding of one’s relationship and responsibility to others in living together in a community.
  • Spirituality is the personal quest for understanding answers to ultimate questions about life, about meaning, and about relationship to the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of community.

(From: Handbook of Religion and Health, p. 18)


Definition of Terms

From Koenig, McCullough, & Larson (2001)

koenig mccullough and larson s 2001 12 measurement approaches to religiosity




Religious experience/conversion

Organizational religiosity



Subjective religiosity

Religious quest

Religious well being

Religious coping

Religious consequences

Koenig, McCullough and Larson’s (2001) 12 Measurement Approaches to Religiosity
koenig mccullough and larson s 2001 5 approaches to spirituality
Koenig, McCullough and Larson’s (2001) 5 Approaches to Spirituality

Five categories of spirituality

  • Moored Western type II (moderated) (60%)
  • Moored Western type I (fundamental) (25%)
  • Humanistic (6%) (agnostic or atheistic)
  • Unmoored (6%) (power, nature, energy)
  • Moored Eastern type (<3%)
spiritual practices
Spiritual Practices
  • Meditation
  • Prayer
  • Chant
  • Prostration practices (e.g., bow, genuflect)
  • Doctrines to remind and organize
  • Sacred stories to inspire and instruct
  • Sacred meals to remind and focus
  • Sacred role models to know and emulate
ways that spiritual or religious factors influence health
Ways that Spiritual or Religious Factors Influence Health:

Health Behaviors

Psychological States

Coping Strategies

Social and Emotional Support

  • From Spirit, Science and Health: How the spiritual mind fuels physical wellness. Plante and Thoreson (Eds.) (2007)
what religions say about health risk behaviors
What Religions Say about Health Risk Behaviors:
  • What to eat, when to eat, how to prepare food
  • Sexual behavior expectations
  • Cleanliness expectations
  • Meaning of suffering and sacrifice
  • Alcohol and or tobacco use/prohibitions
  • Pro-Social expectations (e.g., alms, service, loan interest, tithing, honesty, pilgrimage, work/rest)
  • Punishment, various rejection for sins
  • Aspirational/purposeful teachings about the future
  • Prohibitions against suicide, homicide, violence
  • Prayer, centering, perspective taking, social virtues

Health Risk Studies Then:

Negative Correlations between Church Attendance and substance use, sexual behavior, tobacco use.

World Health Organization Study of Adolescents and Religion found participation in religious community decreased substance use, increased school success and delayed sexual activity

psychological states balance and well being
Psychological States: Balance and Well-Being
  • Relaxation Response, Meditation, Mindfulness, Breathing Exercises, Yoga, Chant, Prayer
  • Purification rituals (cleansing)
  • Alms giving, service to others
  • Value of aesthetics--beauty

Physiological mechanisms involved in religiosity/spirituality & health

Religious meditation/prayer →

↑ blood flow in frontal cortices (focused attention)

↓ blood flow in the parietal cortices (reports of “oneness” with the transcendent)

↑ levels of GABA, melatonin, serotonin, ↑ left hemisphere activity (positive affect, elevated immune responses, antibody titers, natural killer cell activity)

Possible regulation of autonomic nervous functions→↑ability to cope with stress

prevalence of prayer as alternative health intervention
Prevalence of Prayer as Alternative Health Intervention

43% prayed for their own health

24% had prayer from others for one’s own health

9% participate in prayer group for one’s own health

7% Meditate for health


  • Meaning of suffering
  • Meaning and purpose of life
  • Meaning of relationships to self, others or God
  • Strategies and tactics to mitigate suffering, redirect attention, and build connection
prayer styles and health
Prayer Styles and Health

Poloma, MM & Pendleton, BF (1991). The effects of prayer and prayer experiences on measures of

general well-being. Journal of Psychology and Theology, 19, 71-93.

(cited in Plante and Thoresen 2007)

social and emotional support
Social and Emotional Support
  • Correctives for egotism, pride, selfishness, greed, fear
  • Correctives toward meaning, purpose, structure, otherness
  • Connect the isolated and increase positive interactions
  • Love and compassion toward self and toward others, and toward our environment
ucla higher education research institute college student spirituality study
UCLA Higher Education Research InstituteCollege Student Spirituality Study


higher education research institute study of college student spirituality
Higher Education Research Institute: Study of College Student Spirituality
  • What proportion of students from which tradition?
  • How are the traditions similar or different?
  • How are religious or spiritual variables related to health or well-being?

Spirituality in Higher Education

  • Attended relig. services, past yr. 80%
  • Discuss religion with friends/fam 79%
  • Pray 66%
  • Believe in God 79%
  • Very important to follow religion 40%
  • every day
  • HERI study at UCLA (2005)

Spirituality in Higher Education

  • Believe in sacredness of life 83%
  • Have interest in spirituality 80%
  • Search for meaning/purpose 76%
  • Discuss meaning/purpose 74%
  • Spirituality is source of joy 64%
  • Seek opps to grow spiritually 47%
  • HERI study at UCLA (2005)

Spirituality in Higher Education

  • Roman Catholic 28%
  • Mainline Protestant 17%
  • No Religion 17%
  • Baptist 13%
  • Other Christian 11%
  • Other non-Christian approx. 14%
  • (also 26% self describe as born-again)
  • From: Higher Education Research Institute at UCLA (2005)
higher education research institute heri factor analysis
Higher Education Research Institute (HERI) Factor Analysis
  • Religious Factors: commitment, engagement, skepticism, struggle & social conservatism
  • Spirituality Factors: spirituality, spiritual quest, & equanimity
  • Combined Factors: charitable involvement, compassionate self-concept, ethic of caring & ecumenical world view

Spirituality in Higher Education

  • Two clusters of religions based on students’ response patterns:
    • Strongly spiritual, religious, religiously/socially conservative, little religious skepticism
      • Mormon, 7th Day Adventists, Baptists, and “Other”
    • Low on religiousness and high on religious skepticism
      • Unitarians, Buddhists, Hindus, Episcopalians, Eastern Orthodox and Jewish students
  • HERI study at UCLA (2005)

Spirituality in Higher Education

  • Roman Catholics tend to score below the overall average on religious commitment, religious engagement, religious/social conservativism,
  • and religious skepticism
  • HERI study at UCLA (2005)

Spirituality in Higher Education

  • “Adhering to religious and spiritual beliefs and practices plays a role in students’ psychological and physical well-being. While spirituality and religiousness generally related to physical well-being, the relationships with psychological health are nuanced and complex.”
  • http://www.spirituality.ucla.edu/spirituality/reports/FINAL_EXEC_SUMMARY.pdf

Religiosity/spirituality and substance use

  • Studies generally show that religiosity decreases use of alcohol and other substances – current studies focus on mechanisms of effect
  • Study of 516 college students showed that religious involvement was inversely related to alcohol consumption via social influences and negative beliefs about alcohol with social influences having the most effect. Religious struggle was associated with alcohol problems via spiritual well-being and social motives.
    • Johnson TJ, Sheets VL, Kristeller JL (2008) Identifying mediators of the relationship between religousness/spirituality and alcohol use. Journal for Study of Alcohol Drugs 69(1): 160-70.

Effects of religiosity on sexual minority youth and substance use

  • Longitudinal study of 764 adolescents over 6 years found that religiosity at baseline had no effect on past-year substance use in sexual minority young adults 6 years later. For heterosexual young adults each unit increase in religiosity reduced the odds of binge drinking by 9%, marijuana use by 20% and cigarette smoking by 13%.
  • Rostosky SS, Danner, F, Riggle EDB (2007) Is religiosity a protective factor against substance use in young adulthood? Only if you’re straight!

Spirituality and Health Risk Behaviors

  • Study of 211 African American college students showed low spiritual well-being increased odds of smoking and alcohol use but had no effect on drug or sexually risky behavior
  • Turner-Musa, J & Lipscomb, L (2007) Spirituality and Social Support on Health Behaviors of African American Undergraduates, Am J Health Behav, 31(5), 495-501.

Religiosity and sexual behaviors

  • Sample of 205 college students found religious behavior associated with sexual abstinence but not with age of first intercourse or condom use. Frequent church attendance was associated with decreased perceived vulnerability to HIV and increased perceived barriers to using condoms.
  • Lefkowitx, ES, Gillen, MM, Shearer, CL, Boone, TL (2004) Religiosity, sexual behaviors, and sexual attitudes during emerging adulthood, J Sex Res, 41(2): 150-9.
national research consortium of counseling centers in higher education
National Research Consortium of Counseling Centers in Higher Education

N=26,000 students

70 institutions

Demographics comparable to NCHA

HLM analyses showed significantly lower rates for life time and past 12 month rates of serious suicidal ideation among those religiously affiliated.

future proposals
Future Proposals
  • Increase in Diversity Workshops that Include Religious and Spiritual Differences
  • Increased training in comparative religion
  • Increased research into the health links to spirituality and religion
  • Training relative to the ethical issues attendant with religion and health care
  • I offer this prayer: that we all may have more complete and fulfilling relationships with our God, with our fellow human beings and with ourselves. And may these deeper and richer relationships inspire whole health in one another and in ALL of our students. Amen.

Diversity of Measures –Measures of General Religiousness

  • A trend away from descriptive measures to functional measures which give quantitative data
  • Intrinsic/extrinsic religiosity measures – religious motivation. Intrinsic Religious Motivation Scale (Hoge, 1972)
  • Santa Clara Strength of Religious Faith Questionnaire (Plante & Boccaccini, 1997) – strength of religious faith
  • Duke Religious Index (Koenig, Meador & Parkerson, 1997) – organizational religious expression, non organizational religious expression and intrinsic religiosity
is religion a negative factor
Is Religion a Negative Factor?
  • Some studies show not only no effect, some indicate a negative effect on health outcomes.
  • What predicts a negative relationship?
    • Small sample sizes, complex covariate relationships related to SES, social and educational opportunities, harmful experiences that occur in religious context, etc.

Diversity of Measures – Measures of Religious Coping

  • Coping Orientations of Problems Experienced (COPE) (Carver, Scheier & Weintaub, 1989) – coping patterns
  • RCOPE (Pargament, Keonig & Perez, 2000) – religious approaches to coping
  • Brief RCOPE (Pargament, Smith, Koenig & Perez, 1998) – positive and negative religious coping

Diversity of Measures – Measures of Spiritual Well-Being

  • McGill Quality of Life Questionnaire (Cohen et al., 1997) – existential well-being
  • Spiritual Well-Being Scale (Ellison, 1983) – Religious and existential well-being
research references of interest
Research References of Interest
  • Adams, T.B., Besner, J.R., Drabbs, M.E., Zambarano, R.J., Steinhardt, M.A. (2000). Conceptualization and measurement of the spiritual and psychological dimensions of wellness in a college population. Journal of American College Health, 48, 165-173.
  • Hill, P.C. & Pargament, K.I. (2003). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. American Psychologist, 58, 64-74.
  • Miller, W.R. & Thoreson, C.E. (2003). Spirituality, Religion and Health: An emerging research field. American Psychologist, 58, 24-35.
  • Muller, S.M. & Dennis, D.L. (2007). Life change and spirituality among a college student cohort. Journal of American College Health, 56, 55-59.
  • Peteet, J. (2007). Selected annotated bibliography on spirituality and mental health. Southern Medical Journal, 100 (6), 654-659.

Other resources:

  • Journal for the Scientific Study of Religion
  • APA Division 36, Psychology and Religion
websites worth a visit
Websites Worth A Visit
  • http://www.indstate.edu/psych/cshrs/presentation-copies.htm
  • http://www.dukespiritualityandhealth.org/
  • http://www.scu.edu/ecppm/shi/
  • http://www.gwish.org/index.htm
  • http://www.spiritualityandhealth.ufl.edu/default.asp

Koenig, H., McCullough, D. & Larson, D. (2001). Handbook of Religion and Health.

Marty, M.E. & Vaux, K.L. (Eds.) (1982). Health/Medicine and the Faith Traditions: An Inquiry Into Religion and Medicine. Philadelphia: Fortress Press.

Mauk, K.L. & Schmidt, N.K. (Eds.) (2004). Spiritual Care in Nursing Practice. New York: Lippencott Williams & Wilkins

Neihardt, J.G. (1932/1959). Black Elk Speaks. New York: Washington Square Press.

O’Brien, M.E. (2008). Spirituality in Nursing: Standing on Holy Ground, 3rd Edition. Boston: Jones & Bartlett.

Plante, T.G. &, C.E. (2007) Spirit, Science and Health: How the spiritual mind fuels physical wellness. Westport, CT: Praeger.