Research: Area of Interest
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1. Spirituality and Addiction Recovery
Linda Hyder Ferry, MD, MPH
Associate Professor, School of Medicine and Public Health
Program Director of Preventive Medicine Residency
Chief, Preventive Medicine Section, JL. Pettis VAMC, Loma Linda, CA
President, Foundation for Innovations in Nicotine Dependence (FIND)
Area of Interest: Spirituality and Addictions Recovery
Research currently involved with:
a. Nicotine dependence
b. Genetics of nicotine and other drug use (with City of Hope)
c. Medical students personal health practices and spiritual practices (healthydoc project with Emory University)
Introduction: The relationship of spirituality and addiction is a growing topic of interest. Both Alcoholics and Narcotics Anonymous are based on spiritual principles in the recovery process of addiction. However, the relationship between spirituality and nicotine addiction is relatively unexplored. Our pilot study correlates the spiritual status and beliefs of smokers enrolled in a smoking cessation program with abstinence confirmed by exhaled carbon monoxide testing.
Methods: We will invite 100 veterans or employees from the four week smoking cessation class (20 to 70 years of age) to answer two instruments:
(a)The Religious Problem Solving Scale which identifies three problem solving styles: Collaborative (work jointly with God, the source of empowerment), Self-Directing (independent of God) and Deffering (passive acceptance of God’s miraculous work); and the (b) The Spiritual Involvement and Beliefs Scale (SIBS) which assesses spiritual involvement, activity and beliefs in one score (ranging from 25 to 125 points). Smokers were enrolled from August to November, 1998.
Subjects complete weekly monitor forms and a final report form about the subjective spiritual / religious experience during the smoking cessation period. A Pearson correlation and multiple regression analysis will be performed between the variables of spiritual indicators and smoking cessation outcome. Chronbach’s alpha will be performed to determine level of internal validity of these instruments.
Results: Our prliminary findings on the first 30 patients indicate that 60% believe that spirituality played an important role in their effort to quit smoking. Of these smokers the Collaborative style (23.8) was higher than the Deffering (19) and the Self-Directing (14.8) styles. The mean score of the SIBS was 79.3 which indicates an above average spiritual orientation (range 75-99). Results from 100 smokers will be correlated with 3 to 6 month abstinence rates.
Conclusions: A majority of veterans (60%) use spiritual resources in the recovery process form nicotine, but spirituality is seldom addressed in stop smoking instruction. If our findings demonstrate that spirituality is related to improved nicotine abstinence outcomes, more investigation may be warranted in the role of a spiritual dimension to complement clinical, behavioral and pharmacologic treatments. Measures of spirituality may be a marker of social integration and support which is related to higher abstinence outcomes.
This study is an un-funded research project conducted at the Preventive Medicine Section, Jerry L. Pettis Memorial VAMC, Loma Linda, California and F.I.N.D.
CORRESPONDING AUTHOR: Linda Hyder Ferry, MD, MPH, Foundation for Innovations for Nicotine Dependence, PO Box 2001, Loma Linda, CA 92350 LHFerry@aol.com
Recently, an interdisciplinary team of professors and students at LLU have been developing an instrument for assessment known as the Wholeness Inventory©. The purpose of this instrument is to provide an opportunity for students, faculty, and alumni to evaluate how Loma Linda University has contributed to their development toward wholeness. The work builds on the definition of wholeness that was developed during the preparation of the University's self-study for its regional accreditation in 1998 and 1999. As part of the accreditation process, the University selected wholeness as the unifying theme for its self-study. An emphasis on wholeness, including "wholistic" education for students and "wholistic" care for patients, has been a central feature of LLU's mission from its earliest days. It was only recently, however, that the University developed a campus-wide definition of wholeness. This definition affirms that wholeness, as understood by LLU, "means the lifelong, harmonious development of the physical, intellectual, emotional, relational, cultural, and spiritual dimensions of a person's life, unified through a loving relationship with God and expressed in generous service to others." Using this definition as a basis for its work, the interdisciplinary task force, headed by professor Carla Gober, associate director of the Center for Spiritual Life and Wholeness, has developed an assessment tool with approximately 60 items. This Wholeness Inventory© has been refined through the use of student focus groups and has been pilot tested with 150 students. The results of the pilot testing are now being analyzed for statistical reliability. The current plan calls for the inventory to be administered to all LLU students during the coming school year. Additional versions of the inventory are being developed for faculty and alumni. Eventually, a version for patients will also be developed. The goal of this assessment activity is to help the University better serve all members of its community in their pursuit of wholeness.
Contact: Carla Gober, MPH, MS, (currently working on her PhD at Emory University) cgober@llu.edu; Lisa Bearsley, PhD, Executive Vice President for Academic Affairs; Wil Alexander, PhD, director, Center for Spiritual Life and Wholeness, walexander@llu.edu; Gerald Winslow, PhD, dean, Faculty of Religion, gwinslow@llu.edu; For those interested in wholeness assessment in relation to nursing, please contact Kathy McMillan, RN (currently working on her MA in Clinical Ministry at LLU).
3. Witnessing in Healthcare Context
Wil Alexander, PhD, director, Center for Spiritual Life and Wholeness, walexander@llu.edu
David Felten, MD, PhD, director, Center for Neuroimmunology
Lee Berk, DrPH, associate director, Center for Neuroimmunology, lberk@llu.edu
Curtis Fox, PhD, assistant professor, Marriage and Family, cfox@llu.edu
Leigh Aveling, DMin, Chaplain, adjunct assistant professor, religion, laveling@ahs.llumc.edu
Dan Castro, MD
Johnny Ramirez, EdD
"Prayer with Patients: Can Physicians Predict Who Wants It?"
Identifying predictors of which patients desire prayer with their physician and whether physicians can identify which patient desires prayer with them. Ethnographic interviews have also been done to explore how patients might wish to have spirituality affect their medical care. All the data has been collected. We have 600 patient surveys and over 20 patient interviews. Analysis is being done, and the second phase of reporting is in progress.
Contact: Johnny Ramirez, EdD, Professor of Theology, Psychology and Culture, Loma Linda University Faculty of Religion, jramirez@llu.edu Griggs Hall Room 214, Loma Linda, CA 92350, USA: Pager: (909) 558-1717, Extension 8578, Fax: (909) 824-4856, Work: (909) 558-4300, Extension 42942
Dan Castro, Daniel.Castro@med.VA.gov
7. Pastoral Care and Depression
Siroj Sorajjakool, PhD, Associate Professor of Religion (Pastoral Psychology)
Depression and the Principle of Non-doing
My research looks at the principle of non-trying and how it can enhance the sustaining ministry of pastoral care in helping depressed persons cope with negativity. This principle helps by reducing the power of negativity to negate. In this study the first argument describes how the experience of negativity leads one to try to affirm oneself through the process of self-evaluation. There is sufficient evidence from studies based on Duval and Wicklund’s objective self-awareness theory that supports this argument. Second, I argued that self-evaluation leads to an attempt at self-affirmation through self-regulation. To support this point, I discussed research by Diener and Srull on the relationship between self-awareness and self-reinforcement in relation to personal and social standards. Other studies that provide similar support include Beanman, Klentz, Diener, and Svanum’s study on the relationship between objective self-awareness and transgression in children, and Diener and Wallbom’s study on the effects of self-awareness on anti-normative behavior. This argument is enhanced by the concept of terror management articulated by Pyszczynski and Greenberg. Terror management theory shows how the need for worth, as a buffer against the terror of non-being, and the limited definition of self trap depressed persons in a downward spiral. Finally I argued that the principle of non-trying, through emptying, stops this process of negation and allows a depressed person to exit the cycle of self-regulatory perseveration and self-criticism. This is possible because the principle of non-trying helps to shift attention away from the self and at the same time provides an alternative source of worth for depressed individuals. To Pyszczynski and Greenberg, this shifting of attention and an alternative source of worth are both important factors in lessening the effects of depression.
Questions for Further Research
This research, thus far, seeks to provide arguments supporting the application of the principle of non-trying to the sustaining ministry of pastoral care for depressed individuals. However, it remains a theoretical piece, a possibility. Will it really work? Can it truly become a tool for pastoral caregivers in helping depressed individuals cope with negativity? Further research needs to be pursued that will help ground this principle in a clinical context. The first question that needs to be addressed is the assessment tool. There is a need to arrive at a clear definition of the experience of negativity and to construct a tool for the assessment of this experience.
The second question is how we can structure the experiment using the principle of non-trying. The structure here refers to the time-frame, frequency, content, and the way this principle of non-trying can be communicated effectively.
These are questions that need further clarification. However, as a pastoral caregiver who recognizes that ministry’s aim lies in one’s soul, this dissertation raises questions for me regarding the relationship between spirituality and healing for souls in distressed. If a religious principle such as non-trying can help relieve depressed individuals from the pain of negativity, can other religious aspects provide healing for other forms of emotional distress?
In the article "Psychotherapy for the Treatment of Depression: A Comprehensive Review of Controlled Outcome Research," Leslie A. Robinson, Jeffery S. Berman, and Robert A. Neimeyer, after reviewing different approaches, suggest that the effectiveness of various therapies may lie in the fact that all therapies promote cognitive and behavioral changes. The principle of non-trying as a sustaining ministry of pastoral care is no exception. One may ask, if there is no exception, why invent it? It is not an invention or a construction. It is rather a realization. It is not the result of a mind trying to fix depression but the wondering of the soul in the midst of depression. It is the realization, much like that of sociologist David Karp who, after listening to fifty depressed individuals telling their stories, writes: "The more I weighed the personal impact of this study, the more I realized that the primary change in my thinking has less to do with sociology exactly than with a heightened respect for the value of spirituality in responding to sickness."
What is the role of spirituality in the healing process? Is there a place in religion for souls in distress? What is the relationship between religion and psychotherapy? What does Jung mean when he writes, "healing may be called a religious problem?"
Contact: Siroj Sorajjakool, Griggs Hall, Loma Linda University, Loma Linda, CA 92350
Phone: Work: (909) 558-4536 extension 83413; Email: ssorajjakool@llu.edu