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Towards a Biopsychosocial–Spiritual Approach in Health Psychology: Exploring Theoretical Orientations and Future Directions

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The current status of the “biopsychosocial” model in health psy- chology is contested and arguably exists in a stage of infancy. Despite original goals, researchers have developed theoretical inte- grations across biopsychosocial domains only to a limited extent. In addition, the marginalization of “spirituality” in contempo- rary biopsychosocial health perspectives is questionable. This article addresses these issues by providing evidence that supports the inclu- sion of spirituality within current perspectives while at the same time discussing implications this inclusion bears on the concept of health. Overall, a biopsychosocial–spiritual or “holistic” perspective is advanced for use within health psychology, provided it can be approached from a multilevel integrative analysis. In the end, some clinical implications are discussed.
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Towards a Biopsychosocial–Spiritual
Approach in Health Psychology:
Exploring Theoretical Orientations and
Future Directions
Andrew R. Hatala a
a Department of Psychology , University of Saskatchewan ,
Saskatoon , Canada
Published online: 02 Oct 2013.
To cite this article: Andrew R. Hatala (2013) Towards a Biopsychosocial–Spiritual Approach in Health
Psychology: Exploring Theoretical Orientations and Future Directions, Journal of Spirituality in Mental
Health, 15:4, 256-276, DOI: 10.1080/19349637.2013.776448
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Journal of Spirituality in Mental Health, 15:256–276, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1934-9637 print/1934-9645 online
DOI: 10.1080/19349637.2013.776448
Towards a Biopsychosocial–Spiritual Approach
in Health Psychology: Exploring Theoretical
Orientations and Future Directions
ANDREW R. HATALA
Department of Psychology, University of Saskatchewan, Saskatoon, Canada
The current status of the “biopsychosocial” model in health psy-
chology is contested and arguably exists in a stage of infancy.
Despite original goals, researchers have developed theoretical inte-
grations across biopsychosocial domains only to a limited extent.
In addition, the marginalization of “spirituality” in contempo-
rary biopsychosocial health perspectives is questionable. This article
addresses these issues by providing evidence that supports the inclu-
sion of spirituality within current perspectives while at the same
time discussing implications this inclusion bears on the concept of
health. Overall, a biopsychosocial–spiritual or “holistic” perspective
is advanced for use within health psychology, provided it can be
approached from a multilevel integrative analysis. In the end, some
clinical implications are discussed.
KEYWORDS spirituality, health, biopsychosocial model,
medicine, holistic
Health psychology emerged as a distinct subfield of psychology when the
American Psychological Association’s (APA) Task Force on Health Research
(1976) was commissioned to address concerns over increasing rates of “pre-
ventable” diseases in the United States. During a 50-year span between
1920 and 1970, the prevalence of acute infectious diseases like influenza,
measles, and tuberculosis declined in the United States while what have been
termed “preventable” conditions have substantially increased, including car-
diovascular disease, drug and alcohol abuse, and lung cancer (Matarazzo,
Address correspondence to Andrew R. Hatala, Department of Psychology, University of
Saskatchewan, Arts Building, Room 154, 9 Campus Dr., Saskatoon, SK, S7N 5A5, Canada.
E-mail: andrew.hatala@usask.ca
256
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A Biopsychosocial–Spiritual Model 257
1982; Weiss, 1982). After some success in applying psychological theory
and practice to the promotion of physical health, health psychology for-
mally became Division 38 of the APA in 1978. Today, Division 38 has over
6,000 formal members, one of the largest in the association, and includes
several rigorous research programs, involving: associations among clinically
diagnosable mental disorders and the pathogenesis of physical ailments such
as cardiovascular disease (clinical health psychology; Baum & Poslunsny,
1999; Salomon, Clift, Karlsdottir, & Rottenberg, 2009); effective health inter-
vention, promotion and prevention of disease and illness in schools, work
sites, and “daily living” (public health psychology; Nicassio, Meyerowitz,
& Kerns, 2004; Michie & Abraham, 2004); community health justice and
social action (community health psychology; Brydon-Miller, 2000; Estacio,
2006; Marks et al., 2005; Murray & Poland, 2006); the identification and
comparison of major etiological agents of illness in a variety of cultures (cul-
tural health psychology; Kazarian & Evans, 2001; Kirmayer, 2004; Shweder,
Much, Mahapatra, & Park, 1997); critiques of mainstream Western approaches
to and understandings of health and illness (critical health psychology;
Chamberlain & Murray 2009; Marks, 2002; Murray, 2004; Prilleltensky &
Prilleltensky, 2003); psychneuroimmunology (Kemeny, 2007); and biological
models linking the social world and physical health (Cacioppo & Berntson,
2007; Hatala, 2012; Miller, Chen, & Cole, 2009; Sarafino, 2006), to name a few.
Underlying this multifarious collection of research within health psychol-
ogy is the position that biological (e.g., genetic predisposition), psychological
or behavioral (e.g., lifestyles, explanatory styles, and health beliefs), and
social factors (e.g., family relationships, socioeconomic status [SES], and
social support) are all implicated in the various stages of pathogenesis and
health etiology. This position is termed the biopsychosocial model (BPS)
and has gradually emerged in consort with related scientific developments
in medicine. During the evolution of medical science from the Renaissance
to the late 19th and early 20th centuries, advances in biology, anatomy,
and physiology eventually crystallized into what is now referred to as a
biomedical model. This perspective yielded a shared set of assumptions (i.e.,
reductionism, naturalism, and mind-body dualism), which relegated illness
and healing primarily to a physiological framework with limited attention to
social, moral or political dimensions (Cohen, McChargue, & Collins , 2003).
It is during this time in the late 1970s that psychiatrist George L. Engel at the
University of Rochester, as well as other clinicians and researchers, began to
enunciate the limitations of biomedicine and a need for a biopsychosocial
perspective.1Engel (1977) in particular observed a “medical crisis” that he
thought “derives from adherence to a model of disease no longer adequate
for the scientific tasks and social responsibilities of either medicine or psy-
chiatry” (p. 129), and that medical practitioners and researchers “should take
into account the patient, the social context, the physician’s role and the
health care system” (p. 132). Engel’s (1977) articulation of a biopsychosocial
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258 A. R. Hatala
perspective was therefore an important attempt to incorporate the patient’s
psychological experiences and the social or cultural context into a more
comprehensive framework for understanding disease, illness, and health.
Since its introduction, the BPS model has been widely embraced within
medical sciences and health psychology. Presently, the American Psychiatric
Association and the American Board for Psychiatry and Neurology, as well
as several medical schools, psychiatry residencies, and health psychology
graduate programs across North America and Europe officially endorse a
biopsychosocial approach (Ghaemi, 2009; Tavakoli, 2009). Furthermore, sev-
eral health psychologists in particular consider the BPS model to be a guiding
framework for contemporary research and practice (Adler, 2009; Schwartz,
1982; Sarafino, 2006; Taylor, 1990). In the context of chronic pain, for exam-
ple, Gatchel (2004) and Gatchel, Bo Pang, Peters, Fuchs, and Turk (2007)
argued that the connections among biological changes, psychological status,
and the sociocultural context should all be considered in trying to understand
an individual’s perception of pain. A psychiatric intervention or treatment
approach, Gatchel (2004) further argued, “that focuses on only one of
these core sets of factors will be incomplete” (p. 797). Leventhal, Weinman,
Leventhal, and Phillips (2008) painted a similar picture for addictions, smok-
ing, and alcohol use. To understand these complex “health risk behaviors,”
these authors suggested researchers must investigate one’s cultural, peer, and
family environments; one’s propensity to risk taking and emotional reactiv-
ity; as well as one’s genetic and biological predispositions. Underestimating
any of these three domains will limit a practitioner or researcher’s ability to
predict the likelihood of initiation, rapidity of addiction, and the difficulty of
cessation (Leventhal et al., 2008).
The status of the BPS model, its use and general acceptance within
health psychology, however, is not free from contestation. Several authors
over the years have expressed concerns regarding its limitations, specifically
including: problems with dichotomizing between biology, psychology, and
society (Tavakoli, 2009); problems with its ambiguous status as an actual
“scientific model” (McLaren, 1998, 2009; Stam, 2004); problems of mask-
ing an underlying biomedical approach (Alonso, 2003; Marks et al., 2005;
Stam, 2000); difficulties with the complexity of outlining linkages or prior-
itizing among its subsystems (Ghaemi, 2009; McLaren, 2002; Pilgrim, 2002;
Suls & Rothman, 2004); and a pervasive individualistic focus (Kazarian &
Evans, 2001; MacLachlan, 2000; Marks, 1996; Murray, 2004). In addition, the
marginalized role of spirituality within the BPS model represents another
prominent limitation that is somewhat surprising and unwarranted, not only
because of the surmounting empirical evidence linking health outcomes, for
better or worse, with spiritual or religious factors (Contrada et al., 2004;
Enstrom & Breslow, 2008; Gillum, King, Obisesan, & Koenig, 2008; Idler,
2010; Maltby, 2005; McCullough, Hoyt, Larson, Koenig, & Thoresen, 2000; W.
Miller & Thoresen, 1999; Oman & Thoresen, 2003; Perez et al., 2009; Plante
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A Biopsychosocial–Spiritual Model 259
& Sherman, 2001; Siegel & Schrimshaw, 2002; Sloan, Bagiella, & Powell,
1999; Sloan & Bagiella, 2002), but also because the majority of people from
diverse cultural systems around the world believe in some kind of “higher
power” or faith system (Baetz, Larson, Marcoux, Ruzica, & Bowen, 2002;
Noss, 2003; Pargament, 1997), especially during times of experienced illness
or disease (Baetz et al., 2006; Becker, 1997; Koenig, 2008; Krause, 2006;
Sulmasy, 2002). The absence of a spiritual domain, therefore, represents a
significant limitation of the current BPS model as employed within health
psychology particularly and medical research and practice more generally.
The current article addresses this central limitation by providing evi-
dence that supports the inclusion of spirituality within the current biospy-
chosocial metatheoretical framework. Thus, it is argued that biopsychosocial–
spiritual or holistic perspectives are useful to guide future research and
practice in health psychology provided that the four domains are approached
from what several developmental psychopathologists and researchers refer
to as a multilevel integrative analysis (Cacioppo, Berntson, Sheridan, &
McClintock, 2000; Cacioppo & Berntson, 2007; Hatala, 2011). This ana-
lytic perspective is inherently multidisciplinary and multiparadigmatic and
assumes equality within all levels of analysis thereby attempting to dismantle
conceptual borders between nature and nurture, biology and psychology, or
science and spirituality.
To meet these ends, this article first examines and reviews con-
temporary literature wherein associations between spirituality and health
are highlighted. Following this the concept of health is reviewed and
critiqued by drawing on previously cited works. Finally, a case for a
biopsychosocial–spiritual model is presented and some clinical implications
are discussed.
RELATIONS BETWEEN SPIRITUALITY AND HEALTH
Common values underlying research and practice in psychology, which often
transmute into naturalism, materialism or a “cult of empiricism” (Nelson &
Slife, 2006; Toulmin, 1992), suggest it unusual to address spirituality within
the realm of disease, illness and health. If, however, we begin to consider
healing not only in light of its original intent, but also in light of surmount-
ing empirical research (McCullough et al., 2000; W. Miller & Thoresen, 1999;
Oman, & Thoresen, 2002), it becomes evident that in fact, there are important
relationships that exist—ones that contemporary health psychology in par-
ticular has all too often neglected. But perhaps what is even more surprising
is the neglect of spirituality within “critical” health psychology (Murray, 2004;
Prilleltensky & Prilleltensky, 2003). In failing to mention religion and spiri-
tuality as a widely available cultural resource for empowerment and health,
Oman and Thoresen (2003) argued that critical health psychology risks “a de
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260 A. R. Hatala
facto collaboration with mainstream psychology in propagating and legiti-
mating cultural disempowerment akin to what Illich long ago termed cultural
iatrogenesis” (p. 224). Thus, important relationships between spirituality and
health may not only exist at an individual level, but amidst broader sociopo-
litical processes such as group identity, community resilience and collective
empowerment as well. Before exploring these relationships in detail and
building a case for biopsychosocial–spiritual (BPS-S) perspectives in health
psychology, we must first ask what spirituality is.
Not surprisingly, defining spirituality is wrought with complications. For
instance, of the eleven studies that Chen and Koenig (2006) analyzed in
their review, the term spirituality was operationalized in 10 different ways.
Many definitions center on issues of transcendence, where spirituality was
related to a sensed relationship with powers transcending the present con-
text of reality. Others, however, defined spirituality as a particular and distinct
experience, as for example, when one becomes absorbed in the present and
ceases to be preoccupied with the past or the future (Chen & Koenig, 2006).
Furthermore, there are also growing trends to define “individual” spirituality
in contrast to “collective” religion. In these instances spirituality becomes an
individual, subjective, emotional phenomenon; whereas, religion becomes
solely institutional, formal, and doctrinal. Although this distinction is often
held, some researchers contest the bifurcation of religion and spirituality
because most individuals in society do not experience these “inner” and
“outer” aspects as separate (Emmons & Paloutzian, 2003; Hall, Koenig, &
Meador, 2008; Hill & Pargament, 2003; King et al., 2005). Indeed, for our
purposes of exploring spirituality across biopsychosocial domains, which
necessarily engenders both individual and collective experiences, spirituality
is defined as a search for the sacred, or a process through which people
(i.e., individuals and groups) seek to discover, hold on to, and, when nec-
essary, transform whatever they hold sacred in their lives (Pargament, 1997,
2002).
The relations between spirituality and health are attracting researchers
from diverse areas such as medicine, public health, psychology and sociol-
ogy (Idler, 2010). Special issues focusing on spirituality and health research
have appeared, for example, in scientific journals including, the Annals of
Behavioral Medicine (Mills, 2002); the Psychological Bulletin (Worthington,
Kurusu, McCullough, & Sandage, 1996); and the American Journal of
Physical Medicine and Rehabilitation (Underwood-Gordon, Peters, Bijur, &
Fuhrer, 1997). To highlight some key aspects of this research, and for our
current purposes of working towards BPS-S or holistic perspectives, spiritual-
ity’s demonstrated relation to health is explored through biological pathways
(Contrada et al., 2004; Idler et al., 2009); social integration and support (Idler,
2010; Krause, 2006; Oman & Thoresen, 2003); health behaviors (Enstrom &
Breslow, 2008; Gillum et al., 2008; Strawbridge, Shema, Cohen, & Kaplan,
2001); a deeper meaning and purpose within illness experiences (Chen &
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A Biopsychosocial–Spiritual Model 261
Koening, 2006; Kaye & Raghavan, 2002); and negative health effects (Dein
& Littlewood, 2005; Sloan & Bagiella, 2002).
Biological Pathways
Contemporary research on spirituality has observed the many positive
effects on patients’ wellbeing and healing effectiveness. Arndt Büssing,
chair of Medical Theory and Complementary Medicine, University of
Witten/Herdecke in Germany, for example, analyzed the attitudes of patients
with life-threatening or life-altering illnesses and found that when patients
embraced spiritual themes (i.e., looking for the positive aspects of a chal-
lenging situation, turning to prayer in times of need), they experienced an
increased ability to cope and recover from their illness experiences when
compared to nonspiritual controls (Büssing, Ostermann, & Matthiessen,
2005). Similarly, Nalini Tarakeshwar and collegues (2006) observed that the
use of positive spiritual coping mechanisms, such as belief in the benevolent
purpose of existence, were repeatedly associated with a better overall quality
of life for cancer patients, as well as shorter recovery periods following sur-
gical procedures. Matheis, Tulsky, and Matheis (2006) also showed through
structured interviews and regression analysis that significant positive corre-
lations between measures of self-efficacy and multidimensional measures of
religion and spirituality were apparent in their research among individuals
suffering from spinal cord injuries. Taken together, these studies show how
individuals who embraced spiritual themes, practices or beliefs, displayed
marked increases in healing effectiveness and reduced recovery times after
surgeries.
Previous research also suggests that spiritually inclined individuals may
be more “susceptible” to positive psychological states (i.e., joy, hope, com-
passion), when compared to non-spiritual controls (Koenig et al., 2001;
Pargament, 1997); which, in turn, leads to improved physical health through
enhanced immune and endocrine function (Kiecolt-Glaser & Glaser, 1995),
or reduced allostatic stress load (McEwen, 1998). In a recent study published
in Health Psychology investigating the impact of religious or spiritual striv-
ing on patients recovering from heart surgery, for example, Contrada et al.
(2004) observed that “stronger religious beliefs were associated prospec-
tively with fewer surgical complications and shorter hospital stays” (p. 234),
and that “religiousness predicted surgical recovery with statistical control
of other psychosocial factors” (p. 235). These researchers suggest that reli-
gious beliefs and practices (i.e., prayer, reading scripture, attending worship
services, etc.) may influence cognitive appraisals or coping strategies acti-
vated during pre and postsurgical periods that have modulating effects on
neuroendocrine and immunological activity, which, in turn, bolster recovery
(Contrada et al., 2004). The inverse of these enhanced recovery effects have
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262 A. R. Hatala
also been shown with clinically depressed individuals in delayed healing
of experimentally administered wounds and increased inflammatory activity
via immuno-suppressive alterations (Bosch, Engeland, Cacioppo, & Marucha,
2007; Miller et al., 2009). Spiritual inclinations, therefore, may not only pro-
tect against these ill effects but also add additional modulating effects as well.
In a related manner, Idler et al. (2009) suggested that attendance at spiritual
or religious gatherings act as “exposure variables” or markers for “multidi-
mensional experiences” that activate and integrate sensory, cognitive, and
somatic processes leading to “holistic” spiritual psychosomatic states con-
nected with health outcomes. These holistic experiences, Idler et al. (2009)
observed, typically occur in congregate settings wherein individual effects
are amplified by synchronized performance and action with others. Thus,
in addition to operating along biological pathways, spirituality also impacts
health through increased social integration, networking or social support.
Social Integration and Support
It is well documented that spiritually inclined individuals have greater access
to and contact with co-spiritualists. Indeed, Putnam (2000) argued, “faith
communities in which people worship together are arguably the single most
important repository of social capital in America” (p. 66). This enhanced
sense of community, in turn, leads to larger and stronger social networks and
greater availability of social support, both of which are robust predictors of
salutary health effects (Idler, 2010). In addition, actual and anticipated social
support is correlated with enhanced recovery from heart surgery (Contrada
et al., 1994) and more adaptive psychological states, such as optimism
(Krause, 2006; Pargament, 1997). Aside from these individual factors, Oman
and Thoresen (2003) question whether spirituality and religion can produce
health benefits at group levels by fostering collective empowerment. These
authors review a large amount of social justice literature and conclude that in
several social movement cases—in North America and around the world—
spirituality has served as an important, if not primary, source of motivation,
guidance and sustenance. When reflecting on recent calls to address health
issues at macro socio-political levels, and thereby align health psychology
with social justice initiatives (Estacio, 2006; Murray & Poland, 2006), Oman
and Thoresen (2003) urged researchers to consider how spirituality and reli-
gion can be used to foster health and empowerment—issues of “power”
in particular being an important agenda proposed in 2003 by Prilleltensky
and Prilleltensky. Previous research suggests, then, that spirituality fosters
health both through individual social support as well as collective community
empowerment—important considerations for health researchers.
Another aspect of spirituality as a source of social integration and sup-
port relies in its ability to engender altruism. Altruism in this context is
generally understood as the human capacity to give one’s self to a goal
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A Biopsychosocial–Spiritual Model 263
or purpose that is greater than one’s self, usually to the service and devotion
of others (Frankl, 1984; Hatala, 2011). Several studies observed that service
to others not only bestows psychological benefit on the practicing individ-
ual, but also, and perhaps more importantly, serves to link the individual
to the broader social world. Rachman, (1979), for instance, suggested that
individuals who helped others by caring for their immediate needs follow-
ing collective traumatic events, were characterized with a “survivor mission”
that was associated with decreased trauma-related mood and anxiety symp-
toms. Furthermore, by turning tragedies into opportunities for activism, these
individuals who adopt a survivor mission where seen to be the most psy-
chologically resilient during the 9/11 attacks on New York as well as more
adept to find a deeper meaning within the face of adversity (Bonanno, 2006;
Rachman, 1979). Thus, altruistic behaviors that are promoted and often sus-
tained by spiritual practices can foster positive health responses through
psychological states such as hope, a sense of achievement and optimism,
while at the same time serving as a means by which greater connections to
the social world are constructed and nurtured (Hatala, 2011).
Health Behaviors
Another way in which spirituality is associated with health is through the
simultaneous promotion of health-enhancing behaviors and the restriction
of health-impairing behaviors. During the middle of the 20th century, several
epidemiological studies began to document the significantly lower rates of
all-cause mortality, cancer and cardiovascular disease among highly obser-
vant sectarian groups (i.e., Seventh-Day Adventests, Mormons, Amish) when
compared to the general population (Idler, 2010). It was thought that these
groups discouraged smoking, drinking and other negative behaviors as well
as encouraged healthy diets largely on the premise that the body was seen
as an instrument of God’s service. In one classic study, for example, Fuchs
(1974) observed a stark difference between child and adult mortality when
comparing Utah and Nevada. Although many important characteristics are
similar between states, such as income, health care status, climate and popu-
lation density, all-cause mortality in Nevada for males between 40 and 50 was
55% higher than Utah in 1973. Moreover, deaths due to respiratory cancer
and cirrhosis of the liver were 111% higher in Nevada. Fuchs (1974) conclu-
sion was that differing life styles were largely responsible for the variance
since Utah’s population, in contrast to Nevada’s, consists of 70% abstinent,
nonsmoking Mormons who generally live stable productive lives. Similar
findings have been replicated more recently. During a 24-year follow-up
study, for instance, Enstrom and Breslow (2008) found a 45% lower stan-
dardized morality ratio (SMR) for religiously active Mormon females, and
a 55% lower SMR for males, compared to a nationally representative sam-
ple. Similarly, Strawbridge et al. (2001) followed 2,500 adults in California
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264 A. R. Hatala
over 29 years and found that more frequent religious activities (e.g., wor-
ship attendance or daily prayer) were significantly related to the adoption of
positive health behaviors, such as commitment to close social relationships,
regular exercise, and decreased alcohol abuse. Finally, another recent nine
year follow-up study found that in a U.S. national cohort of people over 40
(N=8,450), all-cause mortality for those who attended religious services
more than weekly was over 30% lower than for those who never attended
(Gillum et al., 2008). Taken together, these studies point to the importance
of spirituality and religion in health promotion, and should be considered
more closely by health psychologists working to improve health status at
individual or community levels.
Meaning and Purpose in Illness
Spiritual aspirations have long since been understood to provide individuals
with a sense of meaning, hope and purpose in life. Fromm (1964) postu-
lated that spiritual systems potentially satisfy one of the five basic human
needs: a frame of orientation or the need to understand the world and our
place within it.2In effect, Fromm suggested that humans desire answers to
questions about their life’s purpose, existence after death, and their origin,
which only spiritual systems may appropriately address. When the need for
a frame of orientation is satisfied, hope through adversity is strengthened
and well-being ensues. Similarly, Geertz (1973) and Frankl (1984) suggested
that sacred conceptions of life foster hope as well as make moral sense of
negative experiences (i.e., inequality and injustice), by relating them to a
wider sphere of reality within which they become meaningful. In this way,
psychological resilience springs from the spiritual re-interpretation of one’s
sufferings and the realization that meanings can be found in and constructed
from distressing life events.
Theories about spirituality as a source of meaning and purpose and its
connection to hope, healing, and resilience are increasingly being empiri-
cally investigated. For example, in an extensive meta-analysis investigating
42 samples of some 126,000 people, McCullough et al. (2000) reported
that spiritual inclinations have protective impact on emotional and phys-
ical well-being, can enhance coping for individuals suffering with severe
medical illnesses, and are associated with lower odds of death. In exploring
the relations between spirituality and health, several researchers have also
looked at the importance of spirituality in the midst of and during nega-
tive or disruptive illness experiences. Berger (1990) observed that spirituality
can offer a source of comfort, meaning, and purpose for those experienc-
ing extremely difficult and negative life events. Similarly, Chen and Koenig
(2006) suggested that spirituality serves to integrate seemingly incomprehen-
sible traumas into a “sacred order,” ultimately providing the knowledge that
even traumatizing events have a place within a larger purposeful universe
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A Biopsychosocial–Spiritual Model 265
(p. 372). Kaye and Raghavan (2002) also observed that spirituality relates
to coping and facilitates the process of transcending perceptions of help-
lessness. In a way, perceptions of God being in control of the overall
universe—when an illness has resulted in loss of function and control within
one’s current life—may help, these authors suggested, transcend feelings of
helplessness (Kaye & Raghavan, 2002). Along these lines, Idler et al. (2009)
suggested:
Religious traditions offer frameworks of meaning built on symbols, rituals,
and liturgies for making sense of the painful, threatening, and ultimate
experiences of illness and dying. There is evidence that these frameworks
are sought out, that they may affect behavior in critical decisions, and that
they may provide benefits in the form of quality of life and emotional
adjustment. (p. 145)
Moreover, spiritual traditions for many centuries have provided the-
ories of human nature and strategies for wellness, whether explicit or
implicit, within dogma, practices, ritual, or sacred texts (Koenig et al., 1998;
McCullough & Larson, 1999; Spilka & Bridges, 1989). Prayer and meditation,
for instance, are often cited as valuable resources that reduce stress while
fostering resilience and healing (Baetz Bowen, Jones, & Koru-Sengul, 2006;
Hatala, 2008, 2011; Shapiro, 2009). Indeed, Baetz et al. (2006) examined the
relation between worship frequency and psychiatric disorders by examin-
ing a diverse Canadian data set from 37,000 individuals from the Canadian
Community Health Survey (CCHS). Overall, these researchers report that
worship frequency or regular devotion was significantly associated with
lower odds of lifetime, current, and past depression, mania, and social
phobia (Baetz et al., 2006). Meditation as a regular spiritual practice, in par-
ticular, is considered to be a primary mechanism by which the previous
positive results occur. In a recent review by Shapiro (2009), meditation has
been associated with positive physiological findings such as stress reduction,
enhanced immune efficiency and positive psychological findings such as
improved memory and intelligence, enhanced creativity, strengthened hope,
advanced attention and concentration, general happiness, increased empa-
thy for others, optimism, self-actualization, self-compassion, moral maturity,
and relapse prevention. Overall, these perspectives suggest that spirituality
can assist individuals to transcend suffering and regain or redefine a sense
of purpose—to find meaning or sense making within the context of illness
experiences.
Negative Health Effects
No study of the relation between spirituality and health would be com-
plete without commenting on spirituality’s potential for ill effects. Miller and
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266 A. R. Hatala
Thoresen (2003) stated that researchers must acknowledge the abuses within
various spiritual or religious systems—just as they would for any major
social institution—and that it is highly probably that certain spiritual prac-
tices or beliefs are related to negative health effects. Indeed, regarding the
ill effects of spirituality, Idler (2010) outlines the tendency for some spir-
itually inclined individuals to make less use of health services, to engage
in fewer positive health behaviors, to interact negatively with other mem-
bers of a congregation, to hold destructive and prejudicial attitudes towards
minority groups, and to struggle with issues of sin or anger, to name a few.
Dein and Littlewood (2005) also remind us of the large sociocultural disrup-
tions that occur during and after “fanatical” mass suicides such as those of
Jonestown, Waco, or Heaven’s Gate. At a more individual level, Pargament
(1997) observed significant health outcome differences between his three
types of “religious coping orientations,” or the ways that people draw on
religion or spirituality during times of stress. Those individuals with “defer-
ring” orientations, wherein God is expected to somehow resolve all of the
individuals’ problems with little effort required on behalf of the individual,
is consistently shown to have the poorest overall health outcomes, both
psychologically and physically (Pargament, 1997).
In the end, it is clear from these examples that religion and spirituality
can both impair and promote health (Sloan & Bagiella, 2002). Rather than
dismissing these negative health effects, it is suggested that they ultimately
add weight to arguments for the inclusion of spirituality into BPS perspec-
tives insofar as they further document a relation that can and does exist
between spirituality and health. Just as research in health psychology looking
into sociocultural, biological or psychological factors attempts to understand
the situations and contexts that both promote and impede health, so too
examinations into spirituality need to consider its potential ill and positive
effects.
THE CONCEPT OF HEALTH
The concept of health can be defined from many different perspectives
and has important implications for theory, policy, and health promotion.
Biomedical perspectives of health are critiqued because of their reductive,
materialistic, naturalistic, and dichotomistic tendencies, wherein disease is
conceptualized largely as somatic pathology. Health from this perspective,
then, becomes the state in which somatic signs and symptoms are not
present (Engel, 1977). In contemporary literature, the biopsychosocial cri-
tique of these perspectives suggests that health is best understood as a state
of physical, mental and social well-being and not merely the absence of dis-
ease or infirmity (Cohen et al., 2003; Sarafino, 2006). Upon further reflection,
however, and despite good intentions, researchers that do attempt to define
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A Biopsychosocial–Spiritual Model 267
health from BPS perspectives essentially retain many of the assumptions that
underlie and inform biomedicine (Alonso, 2003; Marks et al., 2005; Stam,
2000). Indeed, in reviewing the concept of health and its use within medical
fields, Alonso (2003) suggested that there are essentially no changes in the
conceptualization of health in medical research articles written 20 years ago
and now and that “the spreading of the biopsychosocial model in other con-
texts has not been substantially reflected in the practical areas of medicine”
due to “the still deep-rooted dominance of the biomedical model” (p. 243).
According to Marks et al. (2005), many of the underlying assumptions in
biomedicine—such as moral discourses centered on autonomy and individ-
ual rights—can be observed within contemporary health psychology and
perspectives of health espoused therein. Although research in medicine and
health psychology pays “political lip service” to biopsychosocial perspectives
(Tavakoli, 2009), the deep rooted cultural contours of biomedicine and its
assumptions of individualism and materialism still pervade as a kind of “folk
model” or “cultural imperative” in both research and practice (Engel, 1977;
Hatala, 2008, 2012).
Moreover, since many underlying Western assumptions of autonomy
and individualism still influence contemporary discourse in health psy-
chology, researchers and practitioners risk a de facto impression of these
assumptions on those with whom they work (Harvey, 2008; Kirmayer, 2007;
Marks et al., 2005). Indeed, Kazarian and Evans (2001) noted that the conse-
quences of a Western bias in the concept of health can manifest as, among
others: the neglect of cultural and linguistic demographics; the lack of con-
sideration of cultural diversity in health service planning, implementation,
and evaluation; the creation of discriminatory health service practices and
disparities in health care access, utilization and outcome; and the marginal-
ization of a diverse array of indigenous health structures, belief systems, and
practices. Many of these issues are clearly exposed in Fadiman’s (1997) nar-
rative wherein several Hmong peoples in the United States are observed to
struggle with contemporary medical approaches—at the core of which lies
differing conceptions of health. Can a holisitc perspective of health address
some of these issues?
In an article that looks at the meaning of healing and a concept of health
from holistic perspectives, Egnew (2005) reminds us that linguistically, the
term to heal means “to make sound or whole” and stems from the root,
haelan, the condition or state of being hal, or whole, while hal also has
the root of “holy,” meaning “spiritually pure” (p. 258). From this perspective,
Egnew (2005) suggested that illness was a threat to the existential integrity
of personhood or identity as conceived within a “whole” relation to physical
(i.e., body functioning), mental (i.e., psychological well-being), social (i.e.,
interpersonal or family relations), or spiritual (i.e., connections with God or
the transcendent) experiences. Health and healing occur, then, by removing
threats to any of these experiences in order to allow for the reinstatement of
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268 A. R. Hatala
the patient’s sense of personhood. Egnew (2005) understood, for example,
that removing a threat might entail curing a specific disease itself, but not
exclusively. Healing may also involve overcoming psychological barriers to
personhood related to the illness experience, from fears of how others will
perceive the illness, to fears of death and dying, or even to fears related to
being a burden on loved ones. Removing a threat may also include address-
ing sociocultural disruptions, such as those related to economic constraints
surrounding an illness. As such, Egnew (2005) proposed that individuals can
transcend suffering when a circumstance is invested with meaning that fos-
ters a reinterpretation of personal wholeness, and concludes by providing a
comprehensive definition of health and healing as “the personal experience
of the transcendence of suffering” (p. 58).
Adding to these perspectives, Sulmasy (2002) suggested that sickness
was primarily a disruption of “right” relationships. Even at the heart of
biomedical concepts of health and healing, Sulmasy (2002) observed are the
concepts of relations. This is seen, for example, when a physician attempts
to lower one’s blood pressure so that the heart can be in a proper relation-
ship with other vital organs. Sulmasy (2002) continued by suggesting that
illness experiences often disrupt more than relationships within the body,
they “disrupts families, and workplaces and raise questions about one’s
relationship with the transcendent and one’s own self” (p. 26). Health is
therefore a term that refers to a condition of being in right relations in all its
variations:
A human person is a being in relationship—biologically, psychologically,
socially, and transcendentally. Illness disrupts all of the dimensions of
a relationship that constitute the patient as a human person, and there-
fore only a biopsychosocial–spiritual model can provide a foundation for
treating patients holistically. (Sulmasy, 2002, p. 32)
It is important to note, in addition, that from these perspectives one level
of orientation may be “out of balance” yet the overall functioning of the
individual still can remain in a state of health (Sulmasy, 2002). For example,
people can find meaning and purpose within a serious biological condition,
which allows them to lead healthy and productive lives despite disrupted
relations at the biological level (Becker, 1997; Hatala, 2011). Similarly, indi-
viduals struggling with existential questions can report illness experiences in
the absence of any physiological conditions (Kirmayer, 2004). Health, then,
from a more holistic perspective, is more than the absence of disease and
includes social and spiritual factors such as meaning and purpose in life,
ability to contribute to the social well-being of others, and the quality of
intimate personal relationships.
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A Biopsychosocial–Spiritual Model 269
TOWARDS A BIOPSYCHOSOCIAL–SPIRITUAL MODEL
At its inception, there was minimal empirical evidence supporting the impor-
tance of a biopsychosocial approach to health promotion (Engel, 1977). After
several decades of research in health psychology and related health fields,
however, the support for a biopsychosocial perspective is growing. In the
previously reviewed studies, spirituality was seen to enhance, foster or aug-
ment already existing pathways in biopsychosocial domains, such as social
support, behavior, and psychosomatics. In other cases spirituality was seen as
an independent domain that potentially has its own beneficial characteristics
such as a meaning and purpose within illness experiences, the importance
of ritual and reading from scared texts, or prayer and meditation. Overall,
following a multilevel integrative analysis (Cacioppo et al., 2000; Cacioppo,
& Berntson, 2007; Hatala, 2011)—which takes into account multiple levels of
orientation—it is suggested that health and successful mental health promo-
tion necessarily involves the dynamic interaction of biological, psychological,
social and spiritual domains. Figure 1 extends on Gatchel’s (2004) previous
work by adding a spiritual perspective.
FIGURE 1 A Biopsychosocial–Spiritual Interactive Processes Involved in Health and Illness.
Adapted from Gatchel, R. J. (2004). Comorbidity of chronic mental and physical health conditions:
The biopsychosocial perspective. American Psychologist, 59, 792–805. Copyright 2004 by the American
Psychological Association.
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270 A. R. Hatala
In terms of clinical implications, this review suggests that future health
intervention programs and research should focus on the holistic interaction
between these four domains rather than addressing them as separate aspects
of the individual or environment. The continual maturing of the BPS model
may also depend upon the extent to which any and all of these levels (genet-
ics, biology, psychology, sociality, ecology, and spirituality) are involved and
overlap within even the simplest of interventions (Kirmayer, 2004). Future
research could examine the effectiveness of these claims in the context of
clinical practice, explore the concept of health from these perspectives, and
how these perspectives may influence current trends in the promotion of
health, mental health and well-being.
NOTES
1. Ghaemi (2009) observed that the biopsychosocial concept was actually coined by Roy Grinker
in the 1950s. Other medical researchers such as Knowles (1977), Leigh and Reiser (1977), and Lipowski
(1977) also supported and outlined a biopsychosocial position. Engel (1977), however, is still largely
responsible for its popularization in medical science and health psychology.
2. Erich Fromm (1964) postulated five basic human needs: (a) relatedness, relationships with oth-
ers, care, respect, knowledge; (b) transcendence, creativity, developing a loving and interesting life; (c)
rootedness, a feeling of belonging; (d) sense of identity, to see ourselves as a unique person and part of
a social group; and (e) a frame of orientation, the need to understand the world and our place in it.
REFERENCES
Adler, R. (2009). Engel’s biopsychosocial model is still relevant today. Journal of
Psychosomatic Research,67, 607–611.
Alonso, Y. (2003). The biopsychosocial model in medical research: The evolu-
tion of the health concept over the last two decades. Patient Education and
Counseling,53, 239–244.
American Psychological Association. (1976). Task force on health research.
Contributions of psychology to health research: Patterns, problems, and
potentials. American Psychologist,31, 263–274.
Baetz, M., Bowen, R., Jones, G., & Koru-Sengul, T. (2006). How spiritual values and
worship attendance relate to psychiatric disorders in the Canadian population.
Canadian Journal of Psychiatry,51(10), 652–661.
Baetz, M., Larson, D., Marcoux, G., Ruzica, J., & Bowen, R. (2002). Religious psy-
chiatry. The Canadian experience. The Journal of Nervous and Mental Disease,
190(8), 557–559.
Baum, A., & Poslunsny, D. (1999). Health psychology: Mapping biobehavioral
contributions to health and illness. Annual Review of Psychology,50, 137–163.
Becker, G. (1997). Disrupted lives: How people create meaning in a chaotic world.
Berkeley, CA: University of California Press.
Berger, P. L. (1980). The heretical imperative: Contemporary possibilities of religious.
affirmation. Garden City, NY: Doubleday.
Downloaded by [University of Saskatchewan Library] at 12:19 03 October 2013
A Biopsychosocial–Spiritual Model 271
Bosch, J. A., Engeland, C. G., Cacioppo, J. T., & Marucha, P. T. (2007).
Depressive symptoms predict mucosal wound healing. Psychosomtic Medicine,
69, 597–605.
Brydon-Miller, M. (2004). Using participatory action research to address community
health issues. In M. Murray (Eds.), Critical health psychology (pp. 187–202).
New York, NY: Palgrave Macmillian.
Büssing A., Ostermann T., & Matthiessen P. F. (2005). The role of religion and spir-
ituality in medical patients in Germany. Journal of Religion and Health,44(3),
321–338.
Cacioppo, J., & Berntson, G. (2007). The brain, homeostasis, and health: balancing
the demands of the internal and external milieu. In H. Friedman & R. Cohen
(Eds.), Foundations of health psychology (pp. 73–91). Oxford, England: Oxford
University Press.
Cacioppo, J. T., Berntson, G. C., Sheridan, J. F., & McClintock, M. K. (2000). Multilevel
integrative analyses of human behavior: Social neuroscience and the comple-
menting nature of social and biological approaches. Psychological Bulletin,
126(6), 829–843.
Chamberlain, K., & Murray, M. (2009). Critical health psychology. In D. Fox, I.
Prilleltensky, & S. Austins (Eds.), Critical psychology: An introduction (2nd ed.,
pp. 144–158). London, England: Sage.
Chen, Y. Y., & Koenig, H. G. (2006). Traumatic stress and religion: Is there a rela-
tionship? A review of empirical findings. Journal of Religion and Health,45(3),
371–381.
Contrada, R. J., Goyal, T. M., Cather, C., Rafalson, L., Idler, E., & Krause, T. J. (2004).
Psychosocial factors in outcomes of heart surgery: The impact of religious
involvement and depressive symptoms. Health Psychology,23(3), 227–238.
Cohen, L. M., McChargue, D. E., & Collins, F. L., Jr. (Eds.). (2003). The health psychol-
ogy handbook: Practical issues for the behavioral medicine specialist. Thousand
Oaks, CA: Sage.
Dein, S., & Littlewood, R. (2005). Apocalyptic suicide: From a pathological to an
eschatological interpretation. International Journal of Social Psychiatry,51,
198–210.
Egnew, T. R. (2005). The meaning of healing: Transcending suffering. Annals of
Family Medicine,3(3), 255–262.
Emmons, R., & Paloutzian, R. (2003). The psychology of religion. Annual Review of
Psychology,54, 377–402.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine.
Science,96, 129–136.
Enstrom, J. E., & Breslow, L. (2008). Lifestyle and reduced mortality
among active California Mormons, 1980–2004. Preventative Medicine,46,
133–136.
Estacio, E. (2006). Going beyond the rhetoric: The movement of critical health
psychology towards social action. Journal of Health Psychology,11(3), 347–350.
Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her
American doctors, and the collision of two cultures. New York, NY: Farrar, Straus
and Giroux.
Frankl, V. E. (1984). Man’s search for meaning. New York, NY: Pocket Books.
Downloaded by [University of Saskatchewan Library] at 12:19 03 October 2013
272 A. R. Hatala
Fromm, E. (1964). The heart of man, its genius for good and evil.NewYork,NY:
Harper & Row.
Fuchs, V. F. (1974). Who shall live? Health, economics, and social choice.NewYork,
NY: Basic Books.
Gatchel, R. J. (2004). Comorbidity of chronic pain and mental health: The
biopsychosocial perspective. American Psychologist,59, 792–794.
Gatchel, R. J., Bo Pang, Y., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007).
The biopsychosocial approach to chronic pain: Scientific advances and future
directions. Psychological Bulletin,133(4), 581–624.
Geertz, G. (1973). The interpretation of cultures. New York, NY: Basic Books.
Ghaemi, N. S. (2009). The rise and fall of the biopsychosocal model. The British
Journal of Psychiatry,195, 3–4.
Gillum, R. F., King, D. E., Obisesan, T. O., & Koenig, H. G. (2008). Frequency of
attendance at religious service and mortality in a US national cohort. Annals of
Epidemiology,18, 124–129.
Hall, D., Koenig, H., & Meador, K. (2008). Hitting the target: Why existing measures
of “religiousness” are really reverse-scored measures of “secularism.” Explore,
4(6), 368–372.
Harvey, T. S. (2008). Where there is no patient: An anthropological treatment of a
biomedicial category. Culture, Medicine, & Psychiatry, 32, 577–606.
Hatala, R. A. (2012). The status of the “biopsychosocial” model in health psychology:
Towards an integrated approach and a critique of cultural conceptions. Open
Journal of Medical Psychology, 1, 51–62.
Hatala, R. A. (2011). Resilience and healing amidst depressive experiences: An
emerging four-factor model from emic/etic perspectives. Journal of Spirituality
in Mental Health,13(1), 27–51.
Hatala, R. A. (2008). Spirituality and aboriginal mental health: An examination of
the relationship between aboriginal spirituality and mental health. Advances in
Mind Body Medicine,23(1), 6–12.
Hill, P., & Pargament, K. (2003). Advances in the conceptualization and measurement
of religion and spirituality: Implications for physical and mental health research.
American Psychologist,58(1), 64–74.
Idler, E. (2010). Health & religion. In W. Cockerham (Eds.), The new Blackwell
companion to medical sociology (pp. 133–158). Malden, MA: Blackwell.
Idler, E. L., Boulifard, D. A., Labouvie, E., Chen, Y. Y., Krause, T. J. & Contrada,
R. J. (2009). Looking inside the black box of “attendance at services”: New
measures for exploring an old dimension in religion and health research. The
International Journal for the Psychology of Religion,19, 1–20.
Kaye, J., & Raghavan, S. K. (2002). Spirituality in disability and illness. Journal of
Religion and Health,41(3), 231–242.
Kazarian, S., & Evans, D. (2001). Health psychology and culture: Embracing the
21st century. In S. Kazarian & D. Evans (Eds.), Handbook of cultural health
psychology (pp. 3–43). San Diego, CA: Academic Press.
Kemeny, M. (2007). Psychneuroimmunology. In H. Friedman & R. Cohen (Eds.),
Foundations of health psychology (pp. 92–116). Oxford, England: Oxford
University Press.
Downloaded by [University of Saskatchewan Library] at 12:19 03 October 2013
A Biopsychosocial–Spiritual Model 273
Kiecolt-Glaser, J. K., & Glaser, R. (1995). Psychoneuroimmunology and health
consequences: Data and shared mechanisms. Psychosomatic Medicine,57(3),
269–274.
King, M., Jones, L., Barnes, K., Low, J., Walker, C., Wilkinson, S., Tookman, A.
(2005). Measuring spiritual belief: Development and standardization of Beliefs
and Values Scale. Psychological Medicine,36 , 417–425.
Kirmayer, L. J. (2004). The cultural diversity of healing: meaning, metaphor and
mechanism. British Medical Bulletin,69, 33–48.
Kirmayer, L. J. (2007). Psychotherapy and the cultural concept of the person.
Transcultural Psychiatry, 44(2), 232–257.
Knowles, J. H. (1977). The responsibility of the individual. In J. H. Knowles (Ed.),
Doing better and feeling worse: Health in the United States.NewYork,NY:
Norton.
Koenig, H. G. (2008). Medicine, religion & health: Where science and spirituality
meet. West Conshohocken, PA: Templeton Foundation Press.
Koenig, H. G., Georg, L. K., & Peterson, B. L. (1998). Religiosity and remission of
depression in medically ill older patients. American Journal of Psychiatry,155,
536–542.
Krause, N. (2006). Church-based social support and change in health over time.
Review of Religious Research,48, 125–140.
Leigh, H., & Reiser, M. F. (1977). Major trends in psychosomatic medicine: The
psychiatrists evolving role in medicine. Annals of Internal Medicine,87 ,
233–239.
Leventhal, H., Weinman, J., Leventhal, E., & Phillips, A. (2008). Health psychol-
ogy: The search for pathways between behavior and health. Annual Review of
Psychology,59, 477–505.
Lipowski, Z. J. (1977). Psychosomatic medicine in the seventies: An overview.
American Journal of Psychiatry,134, 233–244.
MacLachlan, M. (2004). Culture, empowerment and health. In M. Murray, (Eds.),
Critical health psychology (pp. 101–118). New York, NY: Palgrave Macmillian.
Maltby, (2005). Protecting the sacred and expressions of rituality: Examining the
relationship between extrinsic dimensions of religiosity and unhealthy guilt.
Psychology and Psychotherapy: Theory, Research and Practice,78, 77–93.
Marks, D. F. (2002). Freedom, responsibility and power: Contrasting approaches to
health psychology. Journal of Health Psychology,7(1), 5–19.
Marks, D. F. (1996). Health Psychology in context. Journal of Health Psychology,1,
7–21.
Marks, D. F., Murray, M., Evans, B., Willig, C., Woodall, & Sykes, C. (2005). Health
psychology: Theory, research and practice (2nd ed.). Thousand Oaks, CA: Sage.
Matarazzo, J. D. (1982). Behavioral health’s challenge to academic, scientific, and
professional psychology. American Psychologist,37 , 1–14.
Matheis, E. N., Tulsky, D. S., & Matheis, R. J. (2006). The relation between spirituality
and quality of life amoung individuals with spinal cord injury. Rehabilitation
Psychology,51(3), 265–271.
McCullough, M., Hoyt, W., Larson, D., Koenig, H., & Thoresen, C. (2000). Religious
involvement and mortality: A meta-analytic review. Health Psychology,19(3),
211–222.
Downloaded by [University of Saskatchewan Library] at 12:19 03 October 2013
274 A. R. Hatala
McCullough, M. E., & Larson, D. B. (1999). Prayer. In W. R. Miller (Ed.),
Integrating spirituality into treatment (pp. 85–110). Washington, DC: American
Psychological Association.
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New
England Journal of Medicine,338(3), 171–179.
McLaren, N. (1998). A critical review of the biopsychosocial model. The Australian
and New Zealand Journal of Psychiatry,32(1), 86–96.
McLaren, N. (2002). The myth of the biopsychosocial model. Australian and New
Zealand Journal of Psychiatry,36 (5), 701–703.
McLaren, N. (2009). Humanizing psychiatry. Ann Arbor, MI: Loving Healing Press.
Michie, S., & Abraham, C. (Eds.). (2004). Health psychology in practice. London,
England: BPS Blackwells.
Miller, W., & Thoresen, C. (2003). Spirituality, religion, and health: An emerging
research field. American Psychologist,58(1), 24–35.
Miller, G., Chen, E., & Cole, S. (2009). Health psychology: Developing biologically
plausible models linking the social world and physical health. Annual Review
of Psychology,60, 501–524.
Mills, P. J. (2002). Spirituality, religiousness, and health: From research to clinical
practice. Annals of Behavioral Medicine,24, 1–2.
Murray, M. (2004). Conclusion: Towards a critical health psychology. In M. Murray,
(Ed.), Critical Health Psychology (pp. 222–229). New York, NY: Palgrave
Macmillian.
Murray, M., & Poland, B. (2006). Health psychology and social action. Journal of
Health Psychology,11(3), 379–384.
Nelson, J. M., & Slife, B. D. (2006). Philosophical issues in psychology and religion:
An introduction. Journal of Psychology & Theology,34(3), 191–192.
Nicassio, P. M., Meyerowitz, B. E., & Kerns, R. D. (2004). The future of health
psychology interventions. Health Psychology,23(2), 132–137.
Noss, D. (2003). A history of the world’s religions (11th ed.). New York, NY: Prentice
Hall.
Oman, D., & Thoresen, C., (2002). “Does Religion Cause Health?”: Differing Inter-
pretations and Diverse Meanings. Journal of Health Psychology,7(4), 365–380.
Oman, D., & Thoresen, C., (2003). Without spirituality does critical health psychology
risk fostering cultural iatrogenesis? Journal of Health Psychology,8(2), 223–229.
Pargament, K.I. (1997). The psychology of religion and coping.NewYork,NY:
Guilford.
Pargament, K.I. (2002). The bitter and the sweet: An evaluation of the costs and
benefits of religiousness. Psychological Inquiry,13(3), 168–181.
Perez, J., Chartier, M., Koopman, C., Vosvick, M., Gore-Felton, C., & Spiegel, D.
(2009). Spiritual striving, acceptance coping, and depressive symptoms among
adults living with HIV/AIDS. Journal of Health Psychology,14(1), 88–97.
Pilgrim, D. (2002). The biopsychosocial model in Anglo-American psychiatry: Past,
present and future. Journal of Mental Health,11(6), 585–559.
Plante, T. G., & Sherman, A. C. (Eds.). (2001). Faith and health: Psychological
perspectives. New York, NY: Guilford Press.
Prilleltensky, I., & Prilleltensky, O. (2003). Towards a critical health psychology.
Journal of Health Psychology,8(2), 197–210.
Downloaded by [University of Saskatchewan Library] at 12:19 03 October 2013
A Biopsychosocial–Spiritual Model 275
Putnam, R. D. (2000). Bowling alone: The collapse and revival of American
community. New York, NY: Simon & Schuster.
Rachman, S. (1979). The concept of required helpfulness. Behavioral Research
Theory, 17, 1–6.
Salomon, K., Clift, A., Karlsdo´ttir, M., & Rottenberg, J. (2009). Major depressive
disorder is associated with attenuated cardiovascular reactivity and impaired
recovery among those free of cardiovascular disease. Health Psychology,28(2),
157–165.
Sarafino, E. (2006). Health psychology: Biopsychosocial interactions (5th ed.).
Hoboken, NJ: John Wiley & Sons.
Schwartz, G. E. (1982). Testing the biopsychosocial model: The ultimate chalange
facing behavioral medicine? Journal of Consulting and Clinical Psychology,50,
1040–1053.
Shapiro, S. (2009). Meditation and positive psychology. In S. J. Lopez & C. R. Snyder
(Eds.), Oxford handbook of positive psychology (2nd ed., pp. 601–610). Oxford,
England: Oxford University Press.
Shweder, R. A., Much, N. C., Mahapatra, M., & Park, L. (1997). The big three of
moralisty (autonomy, community, divinity) and the big three explanations of
suffering. In A. M. Brandt & P. Rozin (Eds.), Morality and health (pp. 119–172).
London, England: Routledge.
Siegel, K., & Schrimshaw, E. W. (2002). The perceived benefits of religious and spir-
itual coping among older adults living with HIV/AIDS. Journal for the Scientific
Study of Religion,41, 91–102.
Sloan, R., & Bagiella, E., (2002). Claims about religious involvement and health
outcomes. Annals of Behavioral Medicine,24, 14–21.
Sloan, R. P., Bagiella, E., & Powell, T. (1999). Religion, spirituality and medicine.
Lancet,353, 664–667.
Spilka, B., & Bridges, R. A. (1989). Theology and psychological theory: Psychological
implications of some modern theologies. Journal of Psychology and Theology,
17, 343–351.
Stam, H. J. (2000). Theorizing health and illness: functionalism, subjectivity and
reflexivity. Journal of Health Psychology,5, 273–284.
Stam, H. (2004). A sounds mind in a sound body: A critical historical analysis of
health psychology. In M. Murray (Ed.), Critical health psychology (pp. 15–30).
New York, NY: Palgrave Macmillian.
Strawbridge, W. J., Shema, S. J., Cohen, R. D., & Kaplan, G. A. (2001). Religious
attendance increases survival by improving and maintaining good health prac-
tices, mental health, and stable marriages. Annals of Behavioral Medicine,23(1),
68–74.
Sulmasy, D. P. (2002). A biopsychosocial–spiritual model for the care of patients at
the end of life. The Gerontologist,42(3), 24–33.
Suls, J., & Rothman, A. (2004). Evolution of the biopsychosocial model: Prospects
and challenges for health psychology. Health Psychology,23(2), 119–125.
Tarakeshwar, N., Vanderwerker, L. C., Paulk, E., Pearce, M. J., Kasl, S. V., & Prigerson,
H. G. (2006). Religious coping is associated with the quality of life of patients
with advanced cancer. Journal of Palliative Medicine,9(3), 646–657.
Tavakoli, H. R. (2009). A closer evaluation of current methods in psychiatric assess-
ments: A challenge for the biopsychosocial model. Psychiatry,6(2), 25–30.
Downloaded by [University of Saskatchewan Library] at 12:19 03 October 2013
276 A. R. Hatala
Taylor, S. E. (1990). Health psychology: The science and the field. American
Psychologist,45, 40–50.
Toulmin, S. (1992). The cult of empiricism in psychology, and beyond. In S. Koch &
D. Leasry (Eds.), A century of psychology as science (pp. 594–617). New York,
NY: McGraw-Hill.
Underwood-Gordon, L., Peters, D. J., Bijur, P., & Fuhrer, M. (1997). Roles of reli-
giousness and spirituality in medical rehabilitation and the lives of persons
with disabilities. American Journal of Physical Medicine and Rehabilitation,76 ,
255–157.
Weiss, S. (1982). Health psychology: The time is now. Health Psychology,1(1), 81–91.
Worthington, E. L., Kurusu, T. A., McCullough, M. E., & Sandage, S. J. (1996).
Empirical research on religion and psychotheraputic processes and outcomes:
A 10-year review and research prospectus. Psychological Bulletin,119(3),
468–487.
Downloaded by [University of Saskatchewan Library] at 12:19 03 October 2013
... Full-text articles excluded, with reasons n = 5 not in English language n = 3 untraceable studies n = 25 narrative reviews, commentaries, books n = 14 not related to spiritual care n = 10 duplicates n = 21 not inclusive of dietetic practice Studies included in narrative synthesis (n = 13) of these were position statements from the American Academy of Nutrition and Dietetics that developed over time (O'Sullivan Maillet et al., 1995, 2002, 2013 the first was in consideration of permanently unconscious patients and the latter two broadened to consider this ethical dilemma across the lifespan. The first was based on law, judicial cases, ethical theories and consideration of various religious viewpoints; by 2013 the guidelines included judicial case from over 30 years, as well as clinical studies on physiological change to feeding and withdrawing at the end of life. ...
... Of the 13 included studies, four studies contained details of patients with spiritual needs that were accessing dietetic services (Aitaoto et al., 2015;Bertran et al., 2017;Dickenson, 2009;Hamilton & Kroska, 2019), and six studies discussed how spiritual care does or should occur in practice (Maeyama et al., 2003;O'Sullivan Maillet et al., 2002, 2013Rong et al., 2017;Schwartz et al., 2014;Sohi et al., 2015). Three studies discussed both spiritual needs in dietetic clinics and how spiritual care is addressed (Druml et al., 2016;Pathy et al., 2011;O'Sullivan Maillet et al., 1995). ...
Article
Full-text available
Registered dietitians assess, diagnose and treat nutritional problems. Although integral to healthcare, their role in spiritual care is unknown. We conducted a systematic review of spiritual needs and spiritual care in nutrition and dietetic practice. Subject Headings and keywords were used to search Medline, CINAHL, PsycINFO and AMED for studies exploring spiritual care and nutrition or dietetic practice. From 1433 records, 13 studies were included. Medium quality evidence showed unmet spiritual needs among dietetic patients suffering from cancer, COPD, heart failure and diabetes. Unmet needs occurred in patients from a variety of ethnicities, religions and none. However, dietitians were only involved in spiritual care regarding nutrition and hydration at the end of life. Integrating spiritual screening and sign-posting within dietetic practice is prudent, but clinical trials are needed to evaluate its effectiveness.
... The combination of these factors meant stepping away from a Western derived biological focus on chronic mental illness and adapting our approach to what we, as a team, were learning about working together. As will be discussed, an Anishinaabek understanding of mental wellness differs greatly from the biopsychosocial models that dominate much of the current research on chronic mental illness (Engel 1977), even including what has been referred to as a biopsychosocial-spiritual approach (Hatala 2013). In addition, the relationship-based approach means stepping away from the traditional researchparticipant power role. ...
... By expanding on a global mental health approach on the one hand, and cultural psychiatry on the other, we refer to this framework as Global Mental Wellness, a collaborative and interdisciplinary agenda that demands a better understanding of core concepts such as spirituality, religion, and faith, their role in supporting mental wellness amidst chronicity, their potentials for harms and increased forms of distress, as well as an appreciation of their cultural interconnectedness and respective limits. Moreover, this framework also implies that researchers and practitioners adopt a biopsychosocial-spiritual perspective of wellness in their care that is beyond a typical biomedical vision of health and illness underlying chronic conditions, global health promotion, and mental illness (Hatala 2013;Manderscheid et al. 2010), and at the same time, legitimize the inclusion of a spiritual domain in epidemiologic discourse on the global determinants of chronicity, mental health, wellness, and healing (Jakovljevic et al. 2019;Levin 2003). ...
Book
Full-text available
This book explores how people draw upon spiritual, religious, or faith-based practices to support their mental wellness amidst forms of chronicity. From diverse global contexts and spiritual perspectives, this volume critically examines several chronic conditions, such as psychosis, diabetes, depression, oppressive forces of colonization and social marginalization, attacks of spirit possession, or other forms of persistent mental duress. As an inter- and transdisciplinary collection, the chapters include innovative ethnographic observations and over 300 in-depth interviews with care providers and individuals living in chronicity, analyzed primarily from the phenomenological and hermeneutic meaning- making traditions. Overall, this book depicts a modern global era in which spiritualty and religion maintain an important role in many peoples’ lives, underscoring a need for increased awareness, intersectoral collaboration, and practical training for varied care providers. This book will be of interest to scholars of religion and health, the sociology and psychology of religion, medical and psychological anthropology, religious studies, and global health studies, as well as applied health and mental health professionals in psychology, social work, cultural psychiatry, and medicine.
... integrative practices (Mills et al., 2017). MBLM is an example of a more holistic approach based on classical yoga and ayurvedic medicine, which blends into recent developments of secondgeneration mind-body intervention and fourth-wave psychotherapy that are resource-oriented, strengthen self-efficacy, and are directed toward flourishing (Garcia-Toro & Aguirre, 2007;Hatala, 2013). ...
Article
Full-text available
Objective Depression is a global key challenge in mental health care. The implementation of effective, low‐risk and cost‐effective interventions to reduce its disease burden is a necessity. The aim of this study was to investigate the efficacy of the new Meditation‐Based Lifestyle Modification (MBLM) program, a “second‐generation” mindfulness‐based intervention, in depressive outpatients. Methods Eighty‐one patients with mild to moderate depression were randomized into three groups: intervention group (MBLM), control group (CONTROL), and treatment as usual group (TAU). The primary outcome was the change of depressive symptoms as administered by the Beck Depression Inventory‐II (BDI‐II) after 4 and 8 weeks. Secondary outcome variables included the Brief Symptom Checklist‐18 and the Perceived Stress Scale‐10. A 6‐month follow‐up was conducted. Results A greater reduction of depressive symptoms was found in MBLM participants compared to CONTROL (p < .001, ηp² = 0.11, d = 0.70) and TAU (p < . 001 , η p 2 = 0 . 10 , d = 0 . 67 $p\lt .001,{\eta }_{{\rm{p}}}^{2}=0.10,d=0.67$) with a 13.15 points reduction of BDI‐II score versus 1.71 points (CONTROL) and 3.34 points (TAU) after 8 weeks. Between‐group post hoc tests for all secondary outcomes and at follow‐up also yielded significant between‐group differences with medium to large effect sizes in favor of MBLM. Conclusions Study results showed beneficial effects of MBLM in depressed outpatients. Further high‐quality controlled clinical studies including qualitative research are needed to investigate the specific and unspecific effects of the MBLM program in depression and other medical conditions.
... A key concern here, then, is that by addressing global rates of chronic illness and mental disorder through universalizing and Western-centric therapeutic frames that are not necessarily locally relevant and culturally consonant can have potential unintended negative consequences, including inappropriate rates of overdiagnoses and intervention, pharmaceuticalization of mental health and social suffering, displacement of local knowledge and expertise, increased stigma, or poorer health outcomes overall (Dumit 2012; Ecks respective limits. Moreover, this framework also implies that researchers and practitioners adopt a biopsychosocial-spiritual perspective of wellness in their care that is beyond a typical biomedical vision of health and illness underlying chronic conditions, global health promotion, and mental illness (Hatala 2013;Manderscheid et al. 2010), and at the same time, legitimize the inclusion of a spiritual domain in epidemiologic discourse on the global determinants of chronicity, mental health, wellness, and healing (Jakovljevic et al. 2019;Levin 2003). ...
Chapter
Full-text available
This chapter explores the context of global mental health (GMH), and the need for a global approach to protect and promote health, wellness, and mental health, as well as reducing the burden of chronic conditions and mental disorders. It is well recognized that global health promotion represents complex endeavors assisting people to promote their mental health at individual, national, and global levels; however, we argue this is done without taking spiritual determinants of chronicity into account, despite significant numbers of religious, spiritual and faith-based practitioners globally. The concept of spiritual geographies of care is introduced and described, as it resonates throughout the collection. This chapter explores key themes that emerged in each chapter, reflecting on the practice and benefit of spirituality for wellness, and we propose this includes biopsychosocial- spiritual perspectives despite living with chronic illness. Drawing attention to particular aspects of care and mental wellness, embedded in the framework of chronicity, this chapter also explores tensions and opportunities as they are offered by our authors both for individual strategies and community approaches. What emerges in conclusion is a proposal for a Global Mental Wellness (GMW) agenda that seeks deeper collaborations and working relationships across biomedically-informed mental health care professionals and religious, spiritual or faith-based practitioners.
... Research in this field considers potential benefits for people with specific health conditions, as well the broader impact on Quality of Life, defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns" (World Health Organization, 2014). Overlapping communication, health, and wellbeing issues suggest the value of a holistic, person-centred framework, such as Engel's (1977) biopsychosocial model (Gick, 2011), later expanded to include spirituality (Hatala, 2013) or, in our bicultural New Zealand context, the related indigenous framework, Te Whare Tapa Whā (Durie, 1985;Purdy, 2020). ...
Article
https://www.musictherapy.org.nz/journal/2021-2/ Community singing offers an enjoyable form of social engagement and has also been applied in therapeutic contexts for people with a range of health needs. Internationally and in New Zealand, practitioners and researchers have shown considerable interest in the potential of singing to support people with communication difficulties resulting from a range of acquired neurological conditions. The terminology and approaches of aphasia choirs, Parkinson’s choirs, and dementia (or memory) choirs are well established internationally. However, in New Zealand many choirs are not diagnosis specific, but cater for people with a range of conditions, and are often described as neurological choirs. Neurological choir protocols are often termed choral singing therapy, although the practices of individual choirs vary. This research aimed to analyse interview data collected from current and potential leaders of choirs and singing groups for people with communication difficulties. Participants were registered music therapists, speech-language therapists and community musicians who facilitated neurological choirs or were interested in doing so, and other representatives of organisations providing or considering choral singing therapy. The purpose was to gauge the availability, interest and training needs of facilitators for future research, such as a multi-site randomised controlled trial. Thirty-three participants took part in individual or (when requested by participants who worked together) small group interviews, either in person or via Skype. Interviews were transcribed by the interviewer and sent to interviewees for participant checking. As the research aimed to answer specific questions, thematic analysis of the interview transcripts predominantly used deductive coding, based on the themes of the interview questions. Many participants expressed interest in future research opportunities, but current practitioners’ investment in existing approaches, including co-facilitation, highlighted the need for further exploration of current practice before considering a trial requiring facilitator training and protocol fidelity.
... Based on our findings, we conclude that shamanic models of psychedelic facilitation, which have developed over hundreds or thousands of years, may have much to offer Western treatment models that are often narrowly focused on symptoms within the individual to the exclusion of the psychodynamic, systemic, or environmental/contextual etiology of their symptoms. One model that may be capable of incorporating at least some of the nuance of shamanic models is the biopsychosocial-spiritual model, with its inclusion of individual, interpersonal, spiritual, and social factors (Hatala, 2013). Clinical trials of ayahuasca in the treatment of depression have already occurred in Brazil, where researchers have attempted to include some of these aspects, such as having an ayahuasca church brew the ayahuasca used in the study, setting up the research space to have a living room-like feel, incorporating the use of music, and offering psychological support (Palhano-Fontes et al., 2019). ...
Article
Ayahuasca has gained the attention of researchers over the past decade as psychedelic-assisted therapy for MDMA and psilocybin have progressed through FDA approved clinical trials. In spite of the increase in research, there are relatively few clinical studies of ayahuasca and little qualitative research on the therapeutic or healing uses of psychedelics in general. The present study included 41 Western participants who were interviewed about their participation in facilitated group ayahuasca experiences (e.g., in shamanic, neoshamanic, spiritual, and religious settings). Participants were interviewed about their intentions for participating, along with the perceived impact of the experiences. In particular, we focused on impacts that participants perceived to be sustained and enduring. We identified an impressive range of beneficial impacts, including improvements in areas that are often a focus of psychotherapy, such as mental health and substance use, health behaviors, interpersonal relationships, sense of self, attitude. Extratherapeutic effects were also observed in areas such as changes in creativity, somatic sensations, physical health/pain, sense of connection to nature, spirituality, and concern for the greater good. Two participants also reported problematic experiences, apparently related to set and setting. Implications for research and practice, along with a humanistic framework for interpreting these findings is provided.
... Based on our findings, we conclude that shamanic models of psychedelic facilitation, which have developed over hundreds or thousands of years, may have much to offer Western treatment models that are often narrowly focused on symptoms within the individual to the exclusion of the psychodynamic, systemic, or environmental/contextual etiology of their symptoms. One model that may be capable of incorporating at least some of the nuance of shamanic models is the biopsychosocial-spiritual model, with its inclusion of individual, interpersonal, spiritual, and social factors (Hatala, 2013). ...
Preprint
Full-text available
Ayahuasca has gained the attention of researchers over the past decade as psychedelic-assisted therapy for MDMA and psilocybin have progressed through FDA approved clinical trials. In spite of the increase in research, there are relatively few clinical studies of ayahuasca and little qualitative research on the therapeutic or healing uses of psychedelics in general. The present study included 41 Western participants who were interviewed about their participation in facilitated group ayahuasca experiences (e.g. in shamanic, neoshamanic, spiritual, and religious settings). Participants were interviewed about their intentions for participating, along with the perceived impact of the experiences. In particular, we focused on impacts that participants perceived to be sustained and enduring. We identified an impressive range of beneficial impacts, including improvements in areas that are often a focus of psychotherapy, such as mental health and substance use, health behaviors, interpersonal relationships, sense of self, attitude. Extratherapeutic effects were also observed in areas such as changes in creativity, somatic sensations, physical health/pain, sense of connection to nature, spirituality, and concern for the greater good. Two participants also reported problematic experiences, apparently related to set and setting. Implications for research and practice, along with a humanistic framework for interpreting these findings is provided.
... Spiritual support outlines an alternative discursive framework unrelated to either psychological or biomedical discourses, which promotes a spiritual lifestyle as a way out from depression. While this topic seems to be distant from the mainstream discussion, it could be the indicator of the presence of a biopsychosocial-spiritual model in lay discussions (Hatala, 2013;Saad el al., 2017). Besides the monologues and interactions, a few miscellaneous topics were also detected. ...
Article
Full-text available
Background One of the most comprehensive approaches to depression is the biopsychosocial model. From this wider perspective, social sciences have criticized the reductionist biomedical discourse, which has been dominating expert discourses for a long time. As these discourses determine the horizon of attributions and interventions, their lay interpretation plays a central role in the coping with depression. Methods In order to map these patterns, online depression forums are analyzed with natural language processing methods, where computational tools are complemented with a qualitative approach. Latent Dirichlet Allocation topic model of depression-related posts from the most popular English-speaking online health discussion forums (N=∼70 000) reveals the monolog (attributions and self-disclosures) and interactive (consultations and quasi-therapeutic interactions) patterns. Results Following the evaluation of various models 18 topics were differentiated: attributions referring to health, family, partnership and work issues; self-disclosures referring to contemplations, introducing the experience of suffering and well-being, along with diaries of everyday activities and hardships; consultations about psychotherapies, classifications, drugs and the experience; and quasi-therapeutic interactions relying on unconditional positive regards, recovery helpers experience or spirituality. These topics were evaluated from the perspective of the biopsychosocial model: the weight of each dimension was measured along with the discursive function. Conclusions Biomedical discourse is underrepresented in lay discussions, while psychological discourse plays an overall dominant role. Even if actors are initially aware of the social mechanisms contributing to depression, they neglect these factors when it comes to considering the countermeasures.
... Mentally unhealthy can be caused by various factors, such as biological, social, and psychological [9]. Based on various studies that take into account the role of the spiritual dimension in relation to health, it was found that health and successful promotion of mental health must involve dynamic interactions of the biological, psychological, social and spiritual domains (Cacioppo et al, 2000;Cacioppo, & Berntson, 2007;Hatala, 2011in Hatala, 2013 [10]. Therefore, it can be interpreted that spiritual is one of the important factors in improving the welfare of an individual's life [11]. ...
Article
Indonesia is the 14th country with the highest suicide rate in the world and the 8th highest country in ASEAN. Yogyakarta is the city that places the second rank in Indonesia with the highest child and adolescent suicide rates. The purpose of this study is to analyze spirituality and depression with suicidal tendencies in adolescents in Gunung Kidul, Yogyakarta. The method used is of quantitative research using multiple regression. This study found that there is a significant relationship between depression and suicidal tendencies. This study suggests that the need for the role of counselling guidance teachers to improve their guidance and counselling as well as the role of community nurses to optimize their nursing care, especially in adolescents.
Article
Despite the enthusiasm to promote mental health in Ghana, and sub-Saharan Africa more generally, the models and frameworks that underpin research and practice in these settings have focused exclusively on understanding and treating mental disorders, to the neglect of the mental health needs of the general, non-clinical population. We discuss the limitations of the bipolar and biomedical models as frameworks for (mental) health research and practice in the current paradigm. Using Ghana as a case example, we identify gaps in the mental health research priorities in sub-Saharan Africa, and discuss the limitations of the revised Mental Health Policy of Ghana in ensuring a mentally healthy population. Drawing on a consilience of evidence from the literature, we contend that although important and laudatory, the current research approach and priorities, which remain overwhelmingly fixated on alleviating and treating symptoms of mental disorders, are insufficient to buffer against psychopathology and bolster positive mental health. We argue for the adoption of more global and empirically-tested frameworks and population-based approaches to complement clinical approaches to reduce the population burden of mental health problems.
Article
Based on his presidential address delivered to the Division of Health Psychology in 1980, the author (1) reviews factors responsible for the current state of issues affecting health and illness; (2) assesses the future of health research, clinical application, training, and employment opportunities; and (3) discusses 3 modulator issues that may determine effectiveness and capacity to meet the future health challenges. Three major themes emerge that are affecting health issues: Costs are out of control; chronic illness has become the greatest concern; and the development of consumerism and self-management strategies are affecting health care. The author discusses commitment, ethics, and the concept of the health model as they affect health psychology. (15 ref)
Article
Objective Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders. Method In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors. Results Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding life's difficulties) had higher odds of most psychiatric disorders. Conclusion This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.
Article
Presents the Annual Report of the American Psychological Association's Policy and Planning Board for 1975. The report is to be viewed as a progress report of the board's activities, which in 1975 included planning for the production of our five-year report, which was to be released toward the end of 1976. Consequently, much of the Board's effort in 1975 was centered upon conceptualizing the five-year report and planning in some detail how it should proceed and what it should include.