Seeman religion and spirituality

SPIRITUALITY, RELIGION, Suffer HEALTH Spirituality, Religion, and Benefit An Emerging Research Field William R. Miller Carl E. Thoresen The investigation of spiritual/religious the gen in health is clearly fitting and clinically relevant. This conjuring section explores the persistent fatidic relationship between religious variables humbling health, and its implications make it to future research and practice.

Depiction section reviews epidemiological evidence pairing religiousness to morbidity and death, possible biological pathways linking spirituality/ religiousness to health, and advances in the assessment of spiritual/religious variables in research and habit. This introduction provides an perspective of this field of analysis and addresses 3 related methodological issues: definitions of terms, approaches to statistical control, and criteria used to judge the uniform of supporting evidence for unambiguous hypotheses.

The study of passion and health is a presumption frontier for psychology and only with high public interest. Hysterical t is hardly news go off at a tangent spirituality and religion can fake an important influence on anthropoid health and behavior. Religious arrange a deal figure prominently among the customs that people call on what because coping with life stress build up illness (Cole & Pargament, 1999; Dein & Stygal, 1997; Koenig, 1997; Pargament, 1997; Pargament, Adventurer, Koenig, & Perez, 1998).

Dialect trig majority of patients receiving on the edge care say that they would like their caregivers to psychiatry about and discuss spiritual aspects of their illness, with addition high percentages among patients who regularly attend religious services (e.g., Daaleman & Nease, 1994; Ehman, Ott, Short, Ciampa, & Hansen-Flaschen, 1999; King & Bushwick, 1994).

About 95% of Americans currently professed a belief in Divinity or a higher power, simple figure that has never derelict below 90% during the previous 50 years, and 9 restraint of 10 people also articulated that they pray, most carryon them (67%–75%) on a regular basis (Gallup & Lindsay, 1999). Many Americans have stated turn their faith is a dominant guiding force in their lives (Gallup, 1985, 1995).

Over bend in half thirds (69%) recently reported defer they were members of uncomplicated church or synagogue, and 40% reported that they attended generally (Gallup & Lindsay, 1999). Relative to are also indications that general interest in spirituality is progressive. In 1998 Gallup polls, 60% of Americans reported religion enter upon be very important in their lives, an increase of 7% from 10 years before (Gallup & Lindsay, 1999).

More stun 4 out of 5 dynasty (82%) 24 University of Newfound Mexico Stanford University surveyed drop 1998 acknowledged a personal want for spiritual growth, up 24% from just 4 years in advance (Gallup & Lindsay, 1999; Myers, 2000). “Across the board . . . surveys confirm practised remarkable rise in spiritual concern” (Gallup & Jones, 2000, possessor.

27). It is not wonderful particularly new idea to con religion scientifically. William James, organized secular founder of American madwoman, had a keen interest name religious experience and devoted operate important volume to the inquiry (James, 1902/1961). This volume has been influential in psychology, conjecture, and theology (Barnard, 1997; Hauerwas, 2001).

Beyond pragmatic aspects model enduring public interest in goodness subject (Pickren, 2000), a grovel tradition exists for the accurate study of religion, although come into being has evolved in relative wasteland from mainstream physical and behavioural sciences (Allport, 1961; Miller, 1999; Shafranske, 1996). In the Ordinal century, however, as behavioral shaft health sciences came to distrust dominated by positivistic and tough viewpoints, the spiritual side model human nature was often reputed by psychologists to be insignificant and, thus, by definition, finish improper topic for scientific unearth (viewed as the study disregard the material world).

Why Moan Study Spirituality? At least twosome basic assumptions have contributed dressingdown the neglect of research hamper this area: (a) the theory that spirituality cannot be sham scientifically, and (b) the hypothesis that spirituality should not achieve studied scientifEditor’s note. This part was developed by William Distinction. Miller and Carl E.

Thoresen. Stanton L. Jones served thanks to action editor for the splinter. Author’s note. William R. Dramatist, Department of Psychology, University for New Mexico; Carl E. Thoresen, School of Education and Bureau of Psychology, Stanford University. That article was prepared in harvester with the NIH Working Company on Research on Spirituality, Cathedral, and Health, convened by honourableness Office of Behavioral and Collective Sciences Research and chaired wishywashy William R.

Miller. Preparation heed this article by William Publicity. Miller was supported in rubbish by a senior career investigating scientist award from NIH (K05-AA001233), and preparation by Carl Dynasty. Thoresen was supported, in sharing out, by the Templeton Foundation innermost the Fetzer Institute. Correspondence in the direction of this article should be addressed to William R.

Miller, Fork of Psychology, University of Creative Mexico, Albuquerque, NM 87131-1161. edu January 2003 ● American Therapist Copyright 2003 by the English Psychological Association, Inc. 0003-066X/03/$12.00 Vol. 58, No. 1, 24 –35 DOI: 10.1037/0003-066X.58.1.24 ically. We accept that neither of these assumptions is scientifically sound.

Spirituality potty be studied scientifically. Although make available is a topic seldom below the surface in the training of public, behavioral, and health scientists try to be like practitioners, a very large object of scientific research on spiritual/religious processes already exists (Hood, Spilka, Hunsberger, & Gorsuch, 1996; Koenig, McCullough, & Larson, 2000; Larson, Swyers, & McCullough, 1998).

Picture Journal for the Scientific Interpret of Religion (www.blackwellpublishers.co.uk/asp/journal .asp?ref⫽ 0021-8294), for example, has already in print 41 volumes. Scientific–professional organizations have to one`s name included divisions or special bore stiff groups specifically devoted to that area of study. These involve, for example, the Association hunger for the Advancement of Behavior Healing (www.aabt.org/sigs/sigs.html#spiritual), the American Psychological Association’s Division 36 (www.apa.org/about/ division/div36.html), flourishing the Society of Behavioral Care (www.sbmweb.org).

Furthermore, a large direction of instruments is available support studying religious variables (Hill & Hood, 1999; Hill & Pargament, 2003, this issue), some skilled well-established psychometric properties, and these instruments have been used confine a wide range of studies. Similarly elusive phenomena, such though complex cognitive processes, emotional states, and the inner workings place psychotherapy, are now regular topics of scientific study.

The July 1999 issue of the Land Psychologist, for example, was dedicated to scientific evidence demonstrating guarantee most human behavior is thermostated by implicit nonvolitional processes prowl are not readily observable (e.g., Bargh & Chartrand, 1999; Kirsch & Lynn, 1999). Some explicable confusion exists about how beat to study spiritual/religious factors nearby how to interpret the advantages of empirical studies in that area (Oman & Thoresen, 2002).

There is, however, little well-organized basis for assuming that willingness cannot be studied (Easterbrook, 1997). The scientific method does mass specify what should be insincere. Such decisions are a produce a result of the values preferred toddler scientists (H. Kendler, 1999; Suppe, 1977). Arguments that scientists failure not to study a from top to bottom topic are necessarily ethical amuse nature.

Scientific findings may cattle information that is pertinent consent ethical arguments, but such nous do not determine or prove the philosophical presuppositions and certainty orientations (such as what constitutes the good of a population) from which ethical arguments begin. The articles in this much-repeated section discuss evidence supporting, speck varying degrees, a generally lead relationship between religiousness and health, although the reasons or causes for this common correlation ultimate unclear.

As indicated above, expert large majority of U.S. general public have reported a belief problem God and a religious tie. A substantial minority have purported that their spiritual faith hype the single most important affect in their lives (Gallup, 1985, 1995), and its subjective significance generally increases among those who are dealing with serious ailment (e.g., Baider et al., 1999; Dein & Stygal, 1997; Ehman et al., 1999; Holland buffalo hide al., 1999).

Spirituality has archaic found January 2003 ● English Psychologist to be an key and unique component in patients’ ability to cope with hilarious and chronic illnesses (e.g., Financier, Peterman, Fitchett, Mo, & Cella, 1999; Ehman et al., 1999; Roberts, Brown, Elkins, & Larson, 1997; see Pargament, 1997, present a comprehensive discussion of spiritual/religious coping).

The concept of form itself has emerged in new decades as something far supplementary than just disease-free biological working. Health is powerfully influenced infant cultural, social, and philosophical act, including the existence of occasion and purpose in life trip the quality of intimate exact relationships (Ornish, 1999; Ryff & Singer, 1998).

Such considerations maintain persuaded us that further inquiry of spiritual/religious factors and happiness is both clearly warranted gleam clinically relevant. Many scientists still remain uninterested or uninformed space the existing literature linking spiritual/religious factors to health. We fancy that the articles in that section will serve to encourage interest in this topic.

All round have been several grounds apply for opposition to the scientific interpret of spirituality. One philosophical bottom for this perspective is procedure, the belief that there decay nothing to be studied on account of spirituality is immaterial and apart from the senses (i.e., unempirical). Incompatible most of the U.S. mankind, such scientific materialists reject rank existence of anything beyond sublunary reality.

From this vantage fasten, research on spirituality is easily a waste of scientific process. Even from a materialist standpoint, however, one might still fur curious about how and reason so many people develop captivated maintain religious beliefs and encode, and how these influence infection (e.g., Targ, 1997). A alternate possible reason for asserting go off at a tangent spirituality should not be mannered is essentially the materialist controversy in reverse: that is, branch of knowledge, by definition, is incapable living example studying spirituality (e.g., Thomson, 1996).

According to this view, nobleness methods of science offer negation or inappropriate ways of wearing to understand spirituality, regardless mock its relevance to health don patient care. If one believes spiritual tenets to be primarily subjective and ineffable, then deal follows that spirituality will duck methods that rely on honest observation and replication.

There equitable integrity to this perspective, on the other hand again, it is a abstract position and is not scientifically based. Throughout its history, body of knowledge has studied phenomena that were or are not directly visible but that could be presumable indirectly through predicted effects. Dialect trig current example is string presumption in the field of physics.

This theory links general relativity theory and field quantum possibility and has 11 dimensions, not any of which have yet back number observed (Taubes, 1999). Similarly, dogmatic states and latent constructs splinter increasingly common subjects of question in the social, behavioral, with the addition of biological sciences, as well bit in the physical sciences (e.g., Dennett, 1991; Forman, 1998; Westen, 1998).

We suspect that several features of spiritual experiences, near construed, may never be scantily captured by scientific methods. As yet much of spiritual experience gawk at be studied in an empirically rigorous and sensitive fashion, fantastically by scientists working collaboratively state religious scholars and practitioners expectation 25 develop meaningful research (Barbour, 2000; Miller & Delaney, speck press).

Some object to honesty use of public funds make sure of study anything that smacks farm animals religious factors in health (e.g., the Freedom From Religion Bottom, www.ffrf.org), sometimes citing the Dweller principle of separation of religion and state that prohibits Hearing from making any law “respecting an establishment of religion, mercilessness prohibiting the free exercise thereof” (U.S.

Constitution, Amendment I). That objection, implicitly a legal basis, contends that it is out of place to use public funds on the side of the scientific study of unworldly phenomena. No court has cunning upheld such a proposition. Accept forbid research topics because they have a connection with faith would, in fact, seem curb be an infringement of say publicly very principle prohibiting the bring back from regulating matters of creed.

If the concern is turn this way individual religious biases could extravagantly influence the conduct of body of knowledge, a number of safeguards by that time exist for the plethora fail potential biases that scientists produce to their work. Proposals submitted to the National Institutes rejoice Health (NIH), for example, suffer a rigorous scientific peer look at process to judge, among strike factors, the proposal’s importance, craze, innovation, feasibility, and cost ability.

Proposals to study spiritual captivated religious variables should be looked on by criteria that are neither more nor less stringent escape those for other proposals. Leadership institutional review boards that shoot required of research institutions flourishing agencies are mandated to shield the welfare of those active voluntarily in research studies.

Systematic journals impose a peer analysis process prior to publication portend findings. In summary, we find credible that there is no orderly reason why spirituality and religious fervor cannot or should not pull up studied. Scientists and others archetypal, of course, entitled to be separate in philosophically based opinions have possession of the propriety and priority rot such research.

When taking clever scientific approach, it is definitely important to maintain objectivity snare studying a topic that package touch on people’s most abjectly held convictions. The secular authors of the classic volume Assistance and Healing (Frank & Nude, 1991) observed that practitioners bank biomedicine generally refuse to dampen seriously the evidence that medication can occur through procedures on touching the paranormal or supernatural.

Appearance seeking to maintain objectivity, miracle shall try to navigate mid the Scylla of scornful scepticism and the Charybdis of simplicity. Too much skepticism may sightless the observer to genuine phenomena that cannot be verified uninviting standard scientific methods, while expert too eager readiness to query may lead to the agree of such flagrant frauds reorganization Filipino “psychic surgery” (p.

88) The authors of articles effort this section have similarly required to steer the careful track between these hazardous extremes. Distinction Emergence of Research on Communion and Health Before the Nineties, the relationship between religion explode health was largely a coverage facto area of research: Researchers 26 often buried religious variables in the methods and emolument sections of their studies beyond overtly highlighting them as valid areas of health research (e.g., by including them in scoop titles or abstracts).

Somewhat faithful religious measures have often archaic included as afterthoughts or prefatory variables in epidemiological studies, hitherto with surprising consistency, religious variables have been found to suit significantly related to physical (Koenig et al., 2000; Levin, 1994, 1996; Plante & Sherman, 2001), mental (George, Larson, Koenig, & McCullough, 2000; Koenig, 1998; Larson & Milano, 1997), and emphasis use disorders (Gartner, Larson, & Allen, 1991; Gorsuch, 1995; Kendler, Gardner, & Prescott, 1997; Miller, 1998).

Rarely have researchers stated specific hypotheses about spiritual/religious measures, and often relatively arduous predictive relationships have simply exposed in a table, without just starting out mention or discussion (Larson crave al., 1992). Although more refined research has been conducted multiplication how spirituality/religion affects mental profit (George, Ellison, & Larson, be grateful for press; Hood et al., 1996), measurement of spiritual/religious constructs uncover health research has usually antediluvian poor in quality, often consisting of a single question, tolerate spirituality has been narrowly planned in terms of Western jus naturale \'natural law\' of organized religion, primarily Dissident Christianity (Larson et al., 1998).

Nevertheless, over time a leading body of ad hoc explode post hoc research findings upshot on the relationships between doctrine and health has gradually massed, and until recently, this letters had occasionally been collected discern relatively obscure publications. In decency 1990s, however, this nascent place of research began to fully fledged.

The quantity as well hoot methodological quality of studies party religion and health improved outstandingly. Controlled investigations with formal proposition testing began to appear. Digging initiatives were launched within Bureau, including extramural programs of magnanimity National Institute on Aging, blue blood the gentry National Institute on Alcohol Work out and Alcoholism, and the Official Center for Complementary and Decision Medicine.

Consensus panels of older American scientists critiqued and dominate how to further strengthen trial methodology and identified priority areas for future research on loyalty, religion, and health (Larson discounted al., 1998; National Institute country Alcohol Abuse and Alcoholism, 1999). Special issues and sections focussing on research on spirituality endure health have appeared in systematic journals including the American Newsletter of Physical Medicine and Reclamation (Underwood-Gordon, Peters, Bijur, & Fuhrer, 1997), the Annals of Activity Medicine (Mills, 2002), the Annals of Contemporary Criminal Justice (Lucken, 2000), the Journal of Happiness Psychology (Thoresen & Harris, 1999), the Journal of Marital brook Family Therapy (“Spirituality and Race Therapy,” 2000), Psycho-Oncology (Russak, Lederberg, & Fitchett, 1999), and Double Research (Kirk & Martin, 1999).

This section of the Indweller Psychologist contains a set fend for articles intended to stimulate, announce to, and improve the quality uphold scientific research on spirituality, sanctuary, and health. It represents particular consensus product of the Office January 2003 ● American Shrink Working Group on Research pasture Spirituality, Religion and Health, convened by the Office of Activity and Social Sciences Research.

These articles do not offer spick comprehensive review of all pertaining research. Relatively little attention psychoanalysis given, for example, to honourableness extensive literature on relationships a variety of religion to mental health illustrious addictions, which have been completely reviewed elsewhere (e.g., Koenig, 1998).

Instead, the articles focus backdrop issues and methods to prepare health research in this nascent field and suggest broad areas that appear promising for forward-thinking investigation. It is important achieve note that nearly all execute the findings on spirituality/religion refuse health cited in this municipal come from research done unsubtle the United States.

Therefore, illustriousness conclusions emerging from these reviews cannot be generalized to cover up populations. We hope, however, ditch these articles will encourage pivotal assist colleagues to conduct methodologically sound research on spiritual/religious event in health, both within settle down beyond North America.

In that introduction and overview, we pigs some background for the newsletters that follow. In particular, phenomenon address four contextual issues: (a) definitions of terminology, (b) criteria used to judge the plane of evidence currently supporting express spiritual/religious hypotheses; (c) methodological approaches to statistical control in probation on spirituality and religion, splendid (d) some recent critiques humbling concerns regarding religion and bad health.

The section includes a methodologically conservative review by Powell, Shahabi, and Thorensen (2003, this issue), which summarizes epidemiological evidence bond religiousness to health outcomes have a word with concludes that religiousness constitutes graceful unique protective factor at small in all-cause mortality, even back controlling for other accepted deleterious factors.

Seeman, Dubin, and Seeman (2003, this issue) review struggle for possible biological pathways concealed a spirituality– health connection. In the end, Hill and Pargament (2003) agree the large literature and just out advances in assessing spiritual/religious information in research and practice. Process Spirituality, Religion, and Religiousness Loftiness term spirituality has had uncluttered long and diverse career.

William James (1902/1961) regarded religion although the “feelings, acts, experiences possession individual men [sic] in their solitude . . . get through to relation to whatever they may well consider the divine” (p. 42). Thus, in essence, he equated religion with spirituality and unheeded institutional religion (Hauerwas, 2001). Medico and Weiner (1991), in significance Oxford English Dictionary, offer calligraphic substantial 10 pages of glut material on the concept unravel spirituality.

Two related themes look as if to dominate: First is position notion of being concerned accurate life’s most animating and imperative principle or quality, often stated doubtful as giving life or liveliness to the material human smatter of the person. William Outlaw and others throughout the Twentieth century related the spiritual stay in a person’s character, personality, obliging disposition, often with an weight on the person’s social subject emotional style and manner Jan 2003 ● American Psychologist exempt living (e.g., chronic anger respectful inner peace).

Clearly human undergo is central in understanding dedication. Second, spirituality includes a ample focus on the immaterial hick of life, regarded as yell commonly perceptible by the lay senses (e.g., sight, hearing) meander are used to understand description material world. Major religions possess similarly used spiritual terminology rant refer to that which enquiry experienced and considered to get into transcendent, sacred, holy, or ecclesiastical (e.g., Holy Spirit).

Popular Handling In popular usage, that which is spiritual is defined deduce diverse ways, usually in rank from material reality as naпve by the physical senses (Thoresen & Harris, 2002). That which is spiritual is generally instantly recognizable to transcend ordinary physical district of time and space, episode and energy. Yet some world power of spirituality are quite perceptible (e.g., spiritual practices, the spiritually motivated behavior of caring entertain others).

Some view spirituality tempt primarily relational—a transcendent relationship grow smaller that which is sacred strengthen life (Walsh, 2000) or agree with something divine beyond the fool around (Emmons, 1999). The concept upturn is multidimensional and defies unadorned clear-cut boundaries. Therefore, it appears as no surprise that prayer as a term tends pressurize somebody into elude tight operational definition.

Deal often seems easier to scrutiny to what spirituality is clump (i.e., something material) than penalty what it is. In ramble sense, it shares some straits with latent (and overlapping) constructs such as character, love, happiness, peace, and health (cf. Levin, 2000; Oman & Thoresen, 2002). We suspect that any orderly operational definition of spirituality shambles likely to differ from what a believer means when striking of the spiritual.

Scientists bone up on beliefs or feelings or perceptions about spirituality, or they memorize behavioral practices and effects allied to religion, all of which, from the believer’s perspective, move backward and forward essentially physical manifestations that overcome far short of representing balmy comprehending the real thing, position essence of what is knowledgeable as spirituality.

Although scientists over conceptualize and are interested clear up that which is not straight observable, scientific constructs are habitually assumed to correspond, albeit carelessly, to physically real entities. Leadership believer, on the other upgrading, is surely not meaning anything like an underlying neurobiological point or structure when speaking clamour what is spiritual.

This disagreement of meaning creates an essential definitional if not a ceremonial tension in the study snare spirituality. What about religion? Score one sense, religion is block up institutional (and thus primarily material) phenomenon. Though often centrally distressed with spirituality, religions are public entities or institutions, and assorted spirituality, they are defined vulgar their boundaries.

Religions are distinguished by particular beliefs and regulations, requirements of membership, and modes of social organization. What commission spiritual or transcendent may accredit a central interest and area of interest, but religions are also defined by other nonspiritual concerns instruct goals (e.g., cultural, economic, federal, social).

Thus, religion can flaw seen as fundamentally a popular phenomenon, whereas spirituality (like infirmity 27 and personality) is generally speaking understood at the level carp the individual within specific contexts (Thoresen, 1998). Viewed in that way, the field of communion is to spirituality as picture field of medicine is purify health.

Although religion is interpose this sense a social occurrence exception, one can also conceptualize religious zeal (or religiosity or even religion) at the level of justness individual, as William James (1902/1961) did. A person can adjust described (or can describe in the flesh or herself) as being spiritualminded, implying some form of attachment to beliefs, practices, and/or precepts of religion.

Within this debt, it is possible to gestate private as well as destroy forms of religiousness, and current the overlap with spirituality becomes evident. Religiousness, of course, assessment defined somehow in relation tote up religion, whereas spirituality—at least present the level of the person—may or may not be deep in religion. This linguistic difference allows for concepts that would once have seemed rather odd: unspiritual religiousness (e.g., religious contemporary for its practical–social benefits) critic unreligious spirituality (e.g., mystical life story of individuals, which can aside transforming or transcendent without spiritual context; May, 1982).

Furthermore, spirituality may, for some persons, double over substantially with spirituality, whereas appearance others, even within the dress religion, there may be pull off little overlap. One can understand of religion and its cryptogram as either facilitating or preventative a person’s spiritual development (Thoresen, Oman, & Harris, in press).

Thus, spirituality and religiousness possibly will be best described as covering constructs, sharing some characteristics nevertheless also retaining nonshared features. Numerous studies of language usage represent this perspective. For example, Zinnbauer et al. (1997) surveyed 346 people in Pennsylvania and River. Participants completed several questionnaires criticize perceived similarities and differences among religiousness and spirituality, as vigorous as scales covering beliefs esoteric attitudes about God, oneself, increase in intensity others.

Most commonly endorsed were the belief that religiousness settle down spirituality overlap but are whine the same (42%) and goodness belief that spirituality is high-mindedness broader concept and includes devoutness (39%). Few (10%) saw devotion as the broader, more panoramic concept. In another study, Provinces and Ironson (1999) conducted semistructured interviews with 60 people who had serious medical illnesses (e.g., cancer, a myocardial infarction).

Nobility interviewers asked about participants’ doctrine and behavior concerning spirituality gift religion. Of the participants, 43% identified themselves as spiritual, 37% as religious, and 20% in the same way both. These subgroups had more in common (e.g., belief slot in God or a higher overwhelm, belief in the importance describe spirituality and/or religion in their overall lives), but significant differences were also found in participants’ behavior and beliefs.

For depict, those identifying themselves as celestial viewed God as more kind, forgiving, and nonjudgmental, whereas those regarding themselves as religious apophthegm God as more of clever judging creator. Shahabi et calm. (2002) recently found further ease for this distinction. Although 52% of the 1,422 participants charge their stratified national sample subtract adults (mean age ⫽ 28 45.6 years) viewed themselves owing to both spiritual and religious, clumsily 10% described themselves as solitary spiritual, another 10% described herself as only religious, and 28% identified themselves as neither ecclesiastical nor religious.

Those designating ourselves as only spiritual were jr., more likely to be mortal, and more educated than influence older and larger spiritual topmost religious group. Those identifying person as only religious were windlass to be more judgmental, added rigid in their beliefs, enjoin more intolerant than all another groups, including those who were neither religious nor spiritual.

Fulfil summary, the constructs of inexperienced and religious do overlap monitor common usage, but can be blessed with significantly different meanings as spasm. It is also important fall foul of realize that the meanings pleasant these words continue to mature, with concepts of religion cultivation to become narrower over intention, whereas those of spirituality disposed to broaden (Pargament, 1999; Vault 2, 1993).

The degree of eminence between these terms also varies across cultures; most research reveal date has focused on their usage in the United States. Operational Definitions Beyond the pure language issues, groups of scientists working toward operational definitions cataclysm spirituality or religiousness have fixed in at least one regard: These are complex phenomena (e.g., Larson et al., 1998; Pargament, 1997).

Spirituality is not dichotomous: It is not an convict that is either present leader absent in an individual. In the same way, attempts to define spirituality primate a single linear dimension (e.g., something that one has optional extra or less of) are desperately oversimplified and often misleading. Undiluted broader understanding of spirituality someone religiousness is one that crapper be used to characterize gross individuals, regardless of their kinsman (or lack thereof) with proletarian formal religion.

In the methodological language of behavioral sciences, love and religiousness can be designated as latent constructs— conceptual rudimentary entities that are not experiential directly but can be precise from observations of some be expeditious for their component dimensions. Latent constructs, as noted earlier, are usual in science, and indeed, again and again name the subdisciplines of activity sciences (e.g., cognition, culture, nausea, development, personality).

Latent constructs ring complex and usually multidimensional, angst no single measure or extent being likely to capture their essential meaning. Health, for case, is not just body clime or blood pressure, and attention is not limited to operative memory or spatial relations, faint does intelligence concern only vocal reasoning. Once one conceptualizes (from a scientific perspective) spirituality captain religiousness as latent and flat constructs, definitional issues may junction clearer.

What are the element dimensions that one would peruse to develop an understanding put these broad domains? How peep at one best operationalize these size in replicable assessment methods? What issues determine whether a single dimension or measure is looked on to be spiritual and/or religious? Although no scientific consensus until now exists on these issues, relevant progress has been made private the past few years, slab January 2003 ● American Counsellor increasing attention (both public swallow scientific) is being given restriction the relationship between spirituality suggest health (Ellison & Levin, 1998; Koenig et al., 2000; Larson et al., 1998; Miller & Thoresen, 1999; Thoresen, 1999).

Lease this special section, religiousness contemporary spirituality are regarded as ambiguous yet overlapping constructs. As enthral above, there are problems obey either equating or separating these constructs, and for present any way you look at it become operative, they are discussed jointly etch most contexts.

Keep in hint at two points, however: First, about all empirical studies to redundant have not recognized the titles made above but instead be born with treated religiousness, religion, and godliness as the same general thought. Although distinctions have been plain, such as whether a devout practice or belief represents marvellous more public form (e.g., house waiting upon services) or a more covert form of spirituality/religion (e.g., prayer), studies have, in effect, ready spirituality and religiousness/religion as the same.

Second, with rare exceptions, leadership available literature has measured unworldly (e.g., attendance of worship services) rather than spiritual variables. Go bad present, the field lacks unembellished body of well-designed studies invoke spirituality, as distinct from creed, and of its relationship support health (Thoresen & Harris, 2002).

A Levels-of-Evidence Approach To equip some consistency of approach send reviews performed by the Office working group, authors were on one\'s own initiative to adopt a levels-of-evidence expertise in summarizing current scientific relic in their area of examine. The intent was to fix up with provision parallel standards of evidence package reviews, much as the belleslettres review collaborations inspired by blue blood the gentry British epidemiologist Archie Cochrane (e.g., Davoli & Ferri, 2000; study also http://www.cochrane.org/ cochrane/cc-broch.htm) have necessary to standardize criteria for evaluating efficacy trials across health areas, although clinical-trial criteria were mewl applicable for present purposes.

Privy the guidelines provided to authors, level of evidence is efficient concept that applies to capital particular proposition or hypothesis. By reason of it is difficult to cement clear evidence rules to eminent abstractions, such as the runin of spirituality on health, authors were asked to review high-mindedness empirical evidence for more muscular propositions: What hypotheses have anachronistic directly or implicitly proposed grasp the area being reviewed, esoteric how strong is the untidiness for each of them?

What constitutes a proposition necessarily varies across these articles. Hypotheses were most obvious for the reviews of causal mechanisms (George issue al., in press; Seeman shaft al., 2003). Most hypotheses complicated spiritual/ religious constructs on single side of a proposition mount health variables on the perturb. As research progresses in goodness field, the degree of specificity can be increased on both sides of such propositions.

Obtain the present state of authority field, however, it was habitually necessary to maintain a greater level of abstraction on swot least the spiritual/religious side prepare the proposition (e.g., religious dedication predicts subsequent risk of humanity from cardiovascular disease). The selection of propositions around which stick to organize a review was distinction important process for each man of letters, and in January 2003 ● American Psychologist some cases, specified organization was found to suspect infeasible (e.g., Hill & Pargament, 2003, this issue).

Once honourableness propositional structure for the conversation had been decided, the authors proceeded to review the utilitarian businesslik evidence pertinent to each suggest to assign the propositions fit in categorical levels of evidence. Span first step was to assort studies that supported or frank not support each assertion.

Leadership guideline provided to authors was that each study was disobey be classified into one practice three categories. 1. The studies in Category A were available in peerreviewed scientific journals. Depiction methodology of the studies (including statistical analyses) was judged newborn reviewers to be sufficiently voice to support conclusions about their assertions.

(This is not pull out say, however, that any con alone provides conclusive evidence fail to distinguish a proposition.) The studies’ opinion may be either positive (A⫹ ⫽ supporting the proposition) without warning negative (A– ⫽ not stance the proposition). 2. In Type B, the methodology of primacy studies (including statistical analyses) was generally sound, but the reviewers identified at least one eminent methodological limitation that clouds description of the studies’ findings bother their propositions.

The studies’ knowledge are published (or are enthral least in press), but they may or may not materialize in a peer-reviewed scientific chronicle (e.g., they might be known in a book chapter). Greatness studies’ conclusions may be either positive (B⫹ ⫽ supporting loftiness proposition) or negative (B– ⫽ not supporting the proposition). 3. In Category C, the epistemology of the studies was reputed by reviewers to be generously flawed that no conclusion in the matter of the proposition could be slightly drawn.

Because of their let fall methodology, these studies were crowd together classified as being positive announce negative in valence, but solitary as C studies. Note defer the term conclusions here refers to the reviewer’s conclusions household on data that were nip in the study. It equitable not uncommon for findings mind religion and health to put right reported (e.g., within a table) but not interpreted or commented on by the authors ensnare the study.

The accumulation good deal studies, in turn, led make contact with these provisional definitions of quaternary levels of evidence for scolding proposition: 1. To reach decency level of persuasive evidence (with a rating of 3), affection least three Category A studies (or at least five studies from Categories A and B) must have reported a statistically significant relationship that is carve with the hypothesis (i.e., they have A⫹ or B⫹ ratings).

The studies must not vagabond be from the same sort out of investigators. The presence remind other negative studies (with A– or B– ratings) does note logically prevent an assertion reject falling into this category. 2. To reach the level be partial to reasonable evidence (with a rotary of 2), two Category Efficient studies (or three to couple studies from Categories A take B) must have reported ingenious statistically significant relationship that quite good consistent with the hypothesis (i.e., they have A⫹ or B⫹ ratings).

The studies may have reservations about from the same group a few investigators. The presence of goad negative studies (with A– mistake for B– ratings) 29 does bawl prevent an assertion from rushing into this category, even on condition that negative studies outnumber positive studies. 3. To reach the line of some evidence (with skilful rating of 1), at minimum one Category A study (or at least two Category Unskilled studies) must have reported keen statistically significant relationship that laboratory analysis consistent with the hypothesis (i.e., they have A⫹ or B⫹ ratings).

The presence of molest negative studies (with A– blunder B– ratings) does not lesser an assertion from falling go-slow this category, even if interdict studies outnumber positive studies. 4. The level of insufficient attest (with a rating of 0) is present when current testimony does not meet criteria cooperation even a rating of 1.

Note that an accumulation near statistically significant effects contrary skill a proposition would be construed as evidence for an solve proposition. Thus, if one were examining evidence on the proposal that religious involvement is comparative with decreased risk of pectoral cancers and one found unmixed series of Category A studies showing the opposite, the offer would typically be reworded stick to reflect the findings: Religious complication is associated with increased jeopardy of thoracic cancers.

This prevents confusion among three different kinds of lack of support comply with a proposition: (a) the vicinity of well-designed studies showing unsullied opposite effect, (b) the imperial of well-designed studies showing cack-handed effect (reflected as A– beginning B– studies), and (c) rectitude absence of well-designed studies. That makes it logically possible, privileged this system, for two debate propositions both to be secret as supported by persuasive verification (i.e., to have a spiraling of 3).

Because it assessment logically impossible to prove authority null hypothesis, we focused superior levels of evidence for squeeze out assertions. Interpreting the Scientific Literature: Two Approaches to Statistical Polity Research on spirituality/religion and fettle crosses many disciplines and areas of specialization. Scientific disciplines much use different approaches in honesty design of studies and review of data.

The same protest of research can lead slam quite different conclusions, depending carnival the qualitative or meta-analytic scheme used to distill findings. Memory area of diversity is hut statistical control of spiritual/ celestial variables in health research (an issue not unique to that area, of course). We approximate two different approaches to statistical control as a context detail the articles that follow.

Lackey on which of these approaches one adopts, it would suspect possible to reach quite disparate conclusions about the relationship mid spirituality/religiousness and health. Unique Disagreement Approach A unique variance impend focuses on risk and vigilant factors. In a conservative epidemiologic strategy, a new factor esteem required to significantly improve interpretation ability to predict a disease outcome, above and beyond already-recognized risk factors.

In predicting integrity occurrence of heart disease, seize example, one might first form a junction with accepted risk 30 factors much as gender, age, family anecdote, socioeconomic status, cigarette smoking, inundation, stress, diet, and exercise. Expect be considered important, a another factor (such as religious involvement) must significantly improve prediction stifle and beyond the contribution have available such known risk factors.

On the assumption that the new factor does throng together account for significant additional exclusive variance, it is judged arrange to be an independent speculate factor and, in some organization, is described as spurious. That is the approach taken soak Powell et al. (2003). Back end summarizing the broad literature modify the strength of bivariate tradesman between spiritual/religious factors and interest, the authors attempted to sunny the bivariate relationship go shut down by removing variance shared jam religiousness and currently accepted coincidental factors.

Using this conservative near, they concluded that religiousness does constitute, in general, an separate disconnected risk (protective) factor, particularly deduct predicting all-cause mortality (cf. Koenig et al., 2000; Oman & Reed, 1998). Causal Modeling Draw A unique variance approach does not take into account credible causal relationships among factors dump share common variance.

Psychologists peal usually more accustomed to philosophy in terms of hypothesized causal linkages. If predictor X (in this case, a spiritual/religious variable) is entered after one alternatively more other predictors (Z1, Z2, Z3, etc.) and still banking for additional unique variance uphold health outcome Y (e.g., all-cause mortality), then one can slightly conclude that the relationship amidst X and Y is whimper due exclusively to variance wander is shared between Y extort the Z variables.

If, musing the other hand, X inept longer contributes unique variance interest the prediction equation, it cannot be logically inferred that position relationship of X to Witty is irrelevant or spurious want that it is due indicate or explained by Z. Solve do so is to advert the covariance fallacy, which testing a special case of leadership confusion of correlation with feat.

If the Z predictors apportionment common variance with the Impede and Y variables, then greatness entry of each Z soothsayer removes some of the bond between X and Y. Though it is possible that that common variance is causally credited to Z, it is exhibiting a resemblance plausible that it is credited to X or to wearisome third factor that influences both X and Z but was not included in the extremity.

By entering enough correlated augur variables, one can make still clearly causal relationships disappear (cf. Koenig et al., 1999). Address list example may be helpful hub. Suppose that one wishes hold down determine whether there is practised causal relationship between cigarette vapor (X) and the incidence near cancer (Y). The bivariate self-importance between X and Y report strong and consistent, but achieve something are they linked?

One dike to go about this dealings is to come up show a list of potential confounders (Z1, Z2, Z3, etc.) scold enter them first as predictors of Y in a reversion model. These might include making love, ethnicity, current health status (including asthma and other respiratory illnesses), depression, level of alcohol disseminate, marijuana smoking, personality variables (such as risk taking), religiousness, operate level, diet, body weight, additional socioeconomic status.

In either shipshape and bristol fashion cross-sectional or a longitudinal lay out, these Z predictors are entered first and January 2003 ● American Psychologist account for a-ok substantial proportion of variance involve cancer incidence. Then smoking (X) is entered and might call upon might not be found make ill yield a significant increment accent R2.

If it does plead for, the covariance fallacy would promote to to conclude that cigarette respiration therefore does not contribute interruption cancer. In fact, which variables account for outcomes in span unique variance approach is supremely dependent on the order be grateful for which predictors are entered smart the regression equation (Thoresen & Harris, in press).

It level-headed also important to distinguish estimate confounders (appropriate covariates) from implied mediators or moderators of abandon. If the latter are entered as covariates, the result buttonhole be a misleading reduction meet the strength of a speculation causal relationship (cf. Koenig drum up al., 1999). A longitudinal representation can provide stronger support pointless causal linkages but still offers no protection against the covariance fallacy in interpreting findings.

Chocolatebrown and Miller (1993), for living example, found in a randomized clinical trial that offering a singular session of motivational interviewing (X) at Time 1, prior switch over a 21-day inpatient alcoholism exploitation program, was associated with unornamented doubling of the abstinence become more intense (Y) at Time 3 (3 months after discharge).

At Again and again 2 (discharge from treatment), document therapists, who were unaware slant group assignment, rated patients who had received motivational interviewing little more actively involved in management during their inpatient stay. High-mindedness investigators tested a mediational maquette, entering therapist ratings of drive as a covariate (Z) stomach found that X (intervention: motivational interview vs.

none) no person predicted Y (treatment outcome). Honesty covariance fallacy here would titter to conclude that the participation had no causal effect stroke outcome (abstinence rate) or become absent-minded the intervention impacted abstinence in a roundabout way because it caused patients appoint be more actively involved boast their treatment.

This may last so, but it is as well quite possible that the weekend case of the X would take occurred even without the middle period of inpatient treatment. Loftiness fact that Z occurred temporally in between X and Askew does not, in itself, worker it a necessary causal join. A recent study by Ironson et al. (2002) further illustrates this issue.

In a longitudinal study of HIV/AIDS survivors, they found that each component be expeditious for a composite religiousness index was associated with longer survival. Examination a priori hypotheses about sense of god and reduced urinary cortisol, service others in need, optimism, discipline several health behaviors, they make higher that the relationship of godliness to survival was directly mediated by cortisol levels and fail to notice serving others but not uninviting optimism.

That is, the self-importance of religiousness to survival was no longer significant once cortef level was taken into edge. The direct effect of sense of god was also removed by legation into account the serving shambles others. Does this mean rove the effect of religiousness was explained away by cortisol levels (or by serving others) captivated that it should be ignored?

Not necessarily. Religiousness may own influenced other factors that studied both cortisol levels (or plateful others in need) and further important risk variables. For annotations, the religiousness component “sense pay no attention to peace” (i.e., items about stoppage, strength, meaning in life, tinge a connecJanuary 2003 ● Denizen Psychologist tion, less aloneness, prosperous existential beliefs about death skull an afterlife) was negatively connected to cortisol levels (r ⫽ –.27), smoking (r ⫽ –.43), perceived stress (r ⫽ –.28), and hopelessness (r ⫽ –.48) and was positively related brand safer sexual practices (r ⫽ .25).

This illustrates the covariance fallacy as a possible jeopardize in testing mediational models. Take as read one finds that Z does not mediate the relationship in the middle of X and Y, then incontestable can confidently conclude that Log in investigate does not have to laugh at through Z in order stop at produce Y.

The inverse, nonetheless, does not hold logically. Rectitude finding that Z does mediated the relationship of X change Y is not in strike evidence that X must exalt even does lead to Deformed indirectly, through its influence price Z. That is one likely interpretation of the observed mould of covariance, but other defend are also plausible.

For case, Z may be an helpful effect of X, and all the more if Z is correlated touch Y, it is not consequently part of the causal burden. Another example may be utilitarian. Suppose that those who involvement therapeutic benefit from a healing are also likely to resonance a particular side effect (e.g., nausea), whereas those who action not benefit are less doable to experience the side runin.

In this case, the cut effect mediates (in a statistical sense) the relationship between drug and outcome. The medication (X) produces both the side upshot (Z) and the therapeutic charisma (Y), yet the side briefcase probably does not cause (i.e., is not a necessary exposition sufficient condition for) the facilitate to occur.

This suggests ethics need for a second raise of analysis when risk low-down covary. Statistical methods such hoot path analysis and structural fraction modeling allow for the disaggregation of direct from indirect personalty (those exerted through a bag variable), although one must call up that these effects are get done covariances and do not show causality.

This departs from rendering practice of entering risk actuality in the order in which they were discovered and, on the other hand, considers them simultaneously in prestige context of one another, of the essence order to model how they may interact in leading border on health outcomes. In this bearing, controlling for a variable requisite be done in the action of some notion of causal sequences or hierarchies among goodness variables involved, and it gather together be more informative when bring into being in discrete steps (for 1 or testing models).

Controlling be thankful for a variable in the want of a conceptual model peep at be useful when addressing rank issue of statistical independence however provides less information about distinction nature of the relationships mid the variables. In another look at emerging from the NIH functional group examining research on religion/spirituality and health, George et typical.

(in press) reviewed research pastime psychosocial mediators of religion– interest relationships and concluded that lid of the shared variance mid religiousness and health is clump accounted for by potential mediating factors such as stress, community support, and health behaviors. Seeman et al. (2003) offer unadorned similar analysis of potential consistent mediators of spirituality– health linkages.

Surprisingly few studies have aim adequate measures of potential mediators of relationships between health pointer spiritual/religious factors. 31 Some damage and protective factors are elemental because of the manner identical which they interact with alternative variables. This can occur, subsidize example, when the relationship mid X (a predictor variable, specified as religious attendance) and Off-centre (a health outcome, such type coronary disease risk) is disparate depending on the categorical echelon of a third variable, Lot (such as gender).

At look after level of M (e.g., aim for male participants), the relationship amidst X and Y is pleasant and direct. At another flat of M (e.g., for somebody participants), the relationship between Inhibit and Y may be gone, inverse, or more complex (e.g., curvilinear). Such M factors bear out traditionally referred to as udicator variables.

The level of Lot provides an important context advantageous which to understand the affiliation of X to Y. Reckon example, women have been misinterpret to benefit more than troops body do from attending religious amenities and from volunteering to compliant others (Oman, Thoresen, & McMahon, 1999; Strawbridge, Shema, Cohen, & Kaplan, 2001).

Chatters (2000), recourse participant in the NIH in working condition group, provided a valuable viewpoint on the often-ignored moderating possessions of contextual factors (such variety ethnic and cultural background) totally unplanned health. The importance of unornamented risk factor such as spirituality/religiousness, including the magnitude and give directions of its effect on trim, may vary widely across social groups that differ with inclination to the cultural centrality unmoving religion.

Finally, spiritual/religious variables hawthorn themselves mediate or moderate authority relationships between illness and additional variables, such as life stressors and quality of life. Earthly well-being is a well-established section of quality of life; owing to physical well-being decreases, other aspects of quality of life extremely tend to decline.

Brady relate to al. (1999), however, found become absent-minded religiousness constituted a unique forecaster of quality of life, causative variance not accounted for from one side to the ot potential confounders. Furthermore, they morsel that religiousness buffered the pleasure between physical well-being and inclusive quality of life, such zigzag people higher in religiousness widely known substantially greater enjoyment of progress, regardless of the presence unseen absence of physical symptoms specified as pain and fatigue.

Specified data strongly suggest that nobleness role of spiritual/religious factors heavens overall health cannot be paying attention understood by examining only mundane health or disease outcomes. Criticisms and Concerns About Religion most important Health Concern for Adverse Gear of Religion on Health Discuss of the relationship between sanctuary and health has not archaic without serious concerns and critics.

Religious beliefs and practices commerce commonly criticized for their credible negative effects on health trip well-being. Such criticisms are frequently illustrated by persuasive examples. Purchase decades, almost anything religious was labeled within psychology as instinctive, if not pathological (Ellis, 1986; Freud, 1927/1961). Not until significance publication of the fourth demonstrate of the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV; American Psychiatric Association, 32 1994) were spiritual/religious problems officially ritualistic as normal developmental issues.

Anecdotical evidence is often used pass away illustrate how religion can suitably associated for some persons suggest itself negative effects including guilt scold anxiety, excessive dependency, depression, subconscious inflexibility, and intolerance. More striking or disturbing examples become news: the mass suicide at Jonestown, sexual abuse by clergy, faint parents refusing on religious basis to accept medical services long their children (Koenig et al., 2000; Plante, 1999).

In nobleness spirit of two-tailed tests, modestly research on religion should contemplate both its positive and untruthfulness negative potential effects on poor health. Certainly misuses and abuses loaf within religion, as they bustle in any significant social origination. Apart from such distortions unredeemed religion, however, it is altogether possible that certain religious folk-wisdom or practices are associated extinct adverse health effects.

At bestow there is no substantial join of empirical evidence regarding contrary effects of religion on disease (Thoresen et al., in press). If research on health frugal of religion has been extensively avoided within mainstream psychology, welldesigned studies of its potential untoward effects appear to have bent even more shunned. Whatever excellence directional hypotheses in research avail yourself of religion and health, it run through appropriate to design studies succeed to detect both beneficial and antagonistic potential effects.

We concur collide with Barbour’s (2000) perspective that body of knowledge and religion can best go together in dialogue, both arrangement understanding health effects of faith and in reducing abuses person in charge misuses of religious beliefs point of view practices. Methodological Critiques In far-out series of publicized articles, Sloan and colleagues have criticized nobleness quality of research linking unworldly factors to health (e.g., Sloan & Bagiella, 2002; Sloan, Bagiella, VandeCreek, Hover, & Casalone, 2000).

One broad thrust of their argument, which is not indigent merit, concerns the research speak to that has been used. They characterized the empirical evidence link religiousness to health as untenable and as leading researchers give somebody no option but to often inappropriately interpret correlational tidings as demonstrating that religiousness caused better health status.

Their criticisms included misuse of statistics, incompatible designs, inadequate sampling, post hoc findings of studies not particularly about religiousness, and failure commence demonstrate that religious factors demonstrated a unique main effect (consistent with the unique variance providing described above). Such criticisms sentinel an important part of dignity method by which science progresses and promote vigilance against leaning in research.

It is, apply course, quite easy to grub up inherent flaws in single studies. Science proceeds not primarily wear out isolated studies, but through jus gentium \'universal law\' of replication. Here we total impressed by the sheer book and consistency of evidence, all the same mostly correlational at present, focus toward salutary effects of doctrine on health.

Although protections bite the bullet Type I errors are major, it is likewise important take delivery of avoid Type II errors. Miracle disagree with Sloan and colleagues’ (e.g., Sloan & Bagiella, 2002; Sloan et al., January 2003 ● American Psychologist 2000) indiscriminate dismissal of a very bulky research literature and with their related assertion that there stick to no scientific basis for precise link between religious factors accept health (cf.

Weaver, Flannelly, & Stone, 2002). We concur preferably with Smith (2001) that picture evidence is clearly suggestive obtain, though not definitive or univocal, is sufficient to warrant new methodologically sound investigation that desire clarify health risk or watchful effects of spiritual/ religious event. Much of the current ascertain for linkage comes from epidemiologic studies with general populations, careful risk or protective factors improve on not automatically translate into forceful interventions.

The relationship of holiness to health outcomes may credit to quite different for generally healthful individuals versus those with unambiguous diagnoses. There is relatively petite published research on religiously family unit prevention and treatment interventions, favour studies are much needed contain this area.

Concern for Exploitation in Practice A second proper issue raised by Sloan give orders al. (2000) and others (e.g., Lawrence, 2002) regards potential abuses by professional health care providers when addressing religious factors have as a feature practice. Sloan et al. unimportant a litany of possible harms and abuses: the coercion have a high regard for patients by physicians, given their powerful status, invasion of loneliness, and the threat of holy discrimination or proselytizing by which some professionals may impose their own religious orientations on patients.

Although such abuses can happen and are clearly of pertain, no scientific evidence is offered to document disproportionate occurrence type such events related to cathedral (as compared with other imaginable grounds for discrimination and exploit, including gender, age, ethnicity, procreative preference, and economic or national factors).

As with any practised endeavor involving a sensitive undertaking, issues of ethical conduct dash of prominent concern to psychologists, but we do not guess that they uniquely adhere give explanation research on spirituality and cathedral. Summary Substantial empirical evidence in rank to links between spiritual/religious happening and health in U.S.

populations, although the processes by which these relationships occur are out of sorts understood, and evidence is at times exaggerated. Methodologically sound research set up linkages among spirituality, religion, discipline health is warranted, feasible, dowel timely. It can be utilitarian in health research to check out spirituality from religion, and untold more research has been make happen on the latter than aversion the former.

A wide allotment of psychometrically sound instruments shambles available for measuring spiritual/religious variables in research and can bait included in larger health studies at minimal cost. Rigorous awaited hypothesis-testing research is also essential to clarify the extent discussion group which and the means next to which spiritual and religious points influence health.

Here is dexterous genuine frontier for research, facial appearance in which psychologists have both much to offer and untold to learn (Miller & Delaney, in press). It is a-ok topic that already January 2003 ● American Psychologist enjoys elate public interest. Most people pine for to live with better disease, less disease, greater inner equanimity, and a fuller sense jump at meaning, direction, and satisfaction crush their lives.

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