Spirituality, Religion and Health: Evidence Base and Implications for Global Well-Being Presenter Doug Oman, Ph.D. School of Public Health University of California, Berkeley : [email protected] Colloquium Dyson College Center for Global Psychology: Pace University, New York, USA April 19, 2017 Slides posted on Talks tab at: http://dougoman.org Todays Talk OUTLINE Theme 1. Why Religion and Spirituality? Why Now? as factors in well-being
2. Cross-cultural Perspectives 3. Implications: Practice in Health, Education 4. Policy + Conclusions 2 1. Religion/Spirituality and Health: A Close Connection? Health and Holy: Both derived from Old English root hal, meaning entire or complete* (Marks, 2012) *and from Proto Indo-European *kailowhole, uninjured, of good omen 3 1. Rise, Fall, & Rise of R/S in Psychology 1902 William James: Varieties of Religious Experience Universal approach, Healthy + unhealthy
1907 Freud denigrated religion as a universal obsessional neurosis 1913- 2017 4 Behaviorism & decline of interest in R/S 20+ APA-published books on R/S 2-volume APA Handbook on R/S vol. 2 is Applied Science 2009- 2 APA-published journals on R/S 2013 (2 vol.) 2014- What Happened? Unlike Freud, people examined Empirical evidence 5
1. Increased Empirical Study of R/S-Health R/S-health empirical literature: 1200+ studies in 20th century 2000+ additional studies from 2000 to 2009 118 systematic reviews (33 meta-analyses) WHY RELIGION & SPIRITUALITY MATTER FOR PUBLIC HEALTH: Koenig et al (2001). EVIDENCE, IMPLICATIONS, AND RESOURCES Handbook of Religion and Health. Oxford University Press. 6 DOUG OMAN (ED.)
Koenig et al (2012), second edition (Oxford) Oman (2017), forthcoming (Springer) 1. Rediscovery of R/S-Health: Major Findings Religion and Spirituality (R/S) are mostly associated with better physical & mental health R/S (some dimensions) have at times been associated with worse health: Extreme R/S beliefs (e.g., refuse medical care) R/S struggles (persistent conflicts related to R/S) 7
1. Sample Findings: Health Outcomes from Meta-Analyses Hummer &c (1999), N>20,000 +7 years US adults Heavy smoking (RH) +14 years African Americans Physical Health R/S (mostly western samples) longevity (18% less risk of death, HR=0.82, p <0.001) kMA=36 (Chida et al, 2009) lower rates of cardiovascular diseases, cancer, pulmonary disease, dementia, and disability (Koenig et al, 2012) Mental Health R/S less depression kMA=147 (Smith &c, 2003) R/S better mental health kMA=35 (Hackney &c, 2003) R/S-accommodative therapies outperform both
no-treatment controls (d=.45) & alternate secular therapies (d=.26) (Worthington &c, 2011) 8 1. Pathways: How might R/S affect health? (what mechanisms?) R/S Coping Spirituality & Religion R/S Meditation Physical Health Mental Health / Character Strengths
reduced stress (allostatic load) 9 Moderated by Sociocultural CONTEXT (Koenig, Larson & McCullough, 2001) (Oman & Thoresen, 2002, 2007) 1. Sample Findings: Pathways from Meta-Analyses Health Behaviors R/S less youth risk behavior kMA=75 (Yonker &c, 2012) R/S less youth substance abuse kMA=22
(Yeung &c, 2009) Social Connections R/S marital stability kMA=94 (Mahoney &c, 2001) Religious/Spiritual Coping R/S coping better adjustment kMA=49 (Ano & Vasconcelles, 2005) 10 2. Many Empirical Studies are Based in USA So is there Cross-Cultural Corroboration? 11 2. Cross-Cultural Corroboration: Sites
R/S smoking*? Poland, Central America, Mexico, Iran, Israel, Lebanon, South Africa R/S alcohol*? Australia, Finland, Hungary, Poland, Spain, United Kingdom, Brazil, the Caribbean, Central America, Mexico, Israel, Lebanon, Thailand, Turkey, South Africa R/S risky sexual activity*? Australia, Slovakia, the Caribbean, Iran, Israel, Kenya, Malawi, Nigeria R/S depression*? Netherlands, Yugoslavia, Mexico, Iran, Israel, Palestine, Afghanistan, Taiwan R/S anxiety*? Germany, Israel, Afghanistan, Japan, Sri Lanka
R/S adult well-being? Uruguay, Kuwait, India, Malaysia, Pakistan, 140+ worldwide R/S youth well-being? Australia, Ukraine, United Kingdom, India, Thailand, Cameroon R/S hypertension*? R/S self-rated health? Greece, Italy, Netherlands, United Kingdom, West Indies, Egypt, Israel, Kuwait, Turkey, India, Japan, Taiwan, Thailand, South Africa Bosnia, Denmark, Finland, Italy, Poland, Scotland, Caribbean, Latin America, Mexico, Israel, Taiwan *reduced 12 3.
Implications for Practice (Generic) ___USA___ 1. Clinicians can proactively support and acknowledge R/S as coping resource a. Mental healthcare b. Medical care Competencies (Vieten &c, 2016) APA books R/S accommodative Txs Spiritual histories Structured protocols to talk (Kristeller &c, 2005) c. Accrediting Organizations (The Joint Commission JCAHO) INTERNATIONAL Apply similar principles 13 Require capacity to assess R/S Require assessments on intake Focus + editors:
UK, Australia, USA Oxford Textbook of Spirituality in Healthcare (Cobb &c, 2012) 3. Implications for Practice (Generic) ___USA___ 2. Encourage or Teach Evidence-Supported R/S Practices (w/o endorsing R/S beliefs) a. Meditation (sitting) (both spiritual, secular) Diverse methods + benefits (Oman, 2010; Sedlmeier &c, 2012) Spiritual added value possible (Wachholtz &c, 2008) Supports/activates R/S coping Mental health benefits b. Mantram or holy name
repetition (portable) (Bormann &c, 2007, 2012) Portable usable with little leisure (poor) at Veterans Administration INTERNATIONAL Similar 14 Meditation in all major R/S traditions (Goleman, 1988; Plante, 2010) Cross-culturally widespread Ramanama (health program for masses) 3. Implications:
Common Ground Strategy Proactively support coping that aligns: Support NOT require insights from professional expertise ( outsider or etic) with spiritual traditions &/or perspectives ( insider or emic) Ethical respect for R/S diversity (+ agnostic, atheist) Common Ground Strategy 15 4. More Applications:
Globally and Locally? Apply common ground strategy across diverse sectors in society? Mental healthcare Medical care Public health 16 Natural resource management Education Etc. Common Ground Approaches 4. 1. Public health a. Task: Promote health of populations b. R/S functions: Ignore Passive conduit Active partner International Agencies IATF-FBO UN Inter-Agency Task Force on Engaging FBOs for Development
PaRD International Partnership on Religion and Sustainable Development JLIFLC Joint Learning Initiative on Faith and Local Communities [http://jliflc.com] 17 USA: South Africa: Campbell &c (2007) cultural tailoring (surface, deep) Cochrane Schmid, Cutts (2011) religious health& assets 4. Common Ground Approaches 2. Education
Teach R/S-derived practices that foster well-being? Meditation &/or mindfulness? USA Contemplative Pedagogy (Simmer Brown &c, 2011) Strengths + weaknesses Superficial? Bleaches out spiritual and triggers/links to R/S coping (not common ground?)? 18 Issue #2 One Meditation Size Doesnt Fit All Over 7 years, Burke (2012) taught four modes of meditation to students (n=247) in rotating order: Only 31.6% preferred Mindfulness Many methods have specific ways of tying meditation to R/S cognitions and access to R/S modes of coping
Method First choice (%) Mantra 31.6 Mindfulness 31.6 Qigong 22.0 Zen 14.8 19 4. Common Ground Approaches 2. Education
Teach R/S-derived practices that foster well-being? Meditation &/or mindfulness? USA Contemplative Pedagogy (Simmer Brown &c, 2011) Strengths + weaknesses Superficial? Bleaches out spiritual and triggers/links to R/S coping (not common ground?)? 20 Indian Psychology Movement (2002-) Recover indigenous psychologies Indian model curricula (2016) Flexibly teach contemplative practices Paranjpe &c (2016) report Prototype for other nonwestern countries? 4. Middle Path Challenge: Healthcare + Education
How balance pluralism + depth? What role for meditation / mindfulness in Different people prefer healthcare + education? different methods (Burke, 2012) Three approaches, each flawed 1. Teach single method in-depth (e.g., TM or MBSR) 2. Sampler method-of-the-week 3. Outsource to community diversity + community expertise (Sarath, 2003) Perhaps only solvable at level of institution, not level of class? (Oman, 2016) 21 Summary Enormous empirical base on R/S-well-being cross-cultural corroboration
Strategy: Build on common ground ideally evidence-supported in diverse sectors: Mental healthcare Natural resource management Medical care Education Public health Etc. THANK YOU Slides posted on Talks tab at: http://dougoman.org 22
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