Understanding the Relationship Between Spiritual Struggles and Physical Health: a Physiological Study
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UNDERSTANDING THE RELATIONSHIP BETWEEN SPIRITUAL STRUGGLES AND PHYSICAL HEALTH: A PHYSIOLOGICAL STUDY Kavita M. Desai A Dissertation Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY August 2009 Committee: Kenneth I. Pargament, Advisor C. Carney Strange Graduate Faculty Representative Anne Gordon Annette Mahoney William O'Brien ii ABSTRACT Kenneth Pargament, Advisor Psychological research has demonstrated links between religion and physical health and well-being. Although religion is generally beneficial for individuals, spiritual struggles can be detrimental for physical health. Studies have linked spiritual struggles with poor physical health, such as declines in somatic recovery (Fitchett, Rybarczyk, DeMarco, and Nicholas, 1999) and increased risk of mortality (Pargament, Koenig, Tarakeshwar, & Hahn, 2001). Given that spiritual struggles have been tied to harmful health consequences, it is important to understand the biological mechanisms underlying this relationship. Research has demonstrated that life stress causes cardiovascular reactivity, which in turn, is related to cardiovascular problems. The present study explored whether the same mechanism holds true for spiritual struggles and health problems; specifically, whether spiritual struggles were associated with increased cardiovascular reactivity. In addition, the study investigated whether the experiences of spiritual and life struggles were associated with different levels of cardiovascular distress. Undergraduate students experiencing both spiritual and life struggles were identified. Using a counter-balanced experimental design, participants (n = 80) were prompted to talk about neutral topics, spiritual struggles, and life struggles. Cardiovascular distress, heart rate and blood pressure, were monitored continuously during the study while mood and subjective distress were assessed after each condition. The results partially supported the hypotheses, though significant order effects made it difficult to interpret the differences between spiritual struggles and life struggles. Nevertheless, the results suggest that spiritual struggles were related to increased cardiovascular reactivity, particularly blood pressure, when compared to baseline functioning. Implications for future studies and limitations of this study are discussed. iii To my parents, Harsha and Mahesh, and my sister, Armisha, who provided me with love and motivation, sprinkled with critical questions, to ensure that I found a meaningful career path iv ACKNOWLEDGMENTS First, I would like to express my deepest gratitude to my advisor, Dr. Kenneth Pargament, for your guidance and support during my years as a graduate student. Prior to starting graduate school, I did not truly understand the research process or the skills required to successfully complete research projects. The atmosphere of independence, coupled with your limitless patience, fostered my skills as a researcher. I am truly fortunate to have been able to have you as an advisor. I would also like to thank the members of my committee, Dr. Anne Gordon, Dr. Annette Mahoney, and Dr. William O’Brien. Your insight and expertise about the research process has given me invaluable experience as I continue on my path towards becoming a researcher. I am thankful for your participation and support over the years. In addition, I would like to thank Dr. Strange, my graduate college representative, for agreeing to join my dissertation committee last minute. Your flexibility in joining my committee and scheduling was much appreciated. Lastly, I would like to give personal thanks to my family and friends who have endured and supported me along the long journey towards the completion of my dissertation, and consequently, the completion of my doctorate. First, to my family, your questions and interest about my degree progress and my research demonstrated your support, love, and investment in all the endeavors that I undertake. Your love and support have enabled me to branch off the “traditional” path, allowing me to follow my own inspiration and dreams. To my husband, Nirav, for providing a mixture of study breaks and motivation needed to complete this project. In addition, I would like to thank the new part of my family, my in-laws, for your support over the past two years. And, to Toral, my sister-in-law, who witnessed my dissertation meeting with excitement and enthusiasm, which helped make the entire process more meaningful. Thank you all for your support, without it, this process may never have ended! v TABLE OF CONTENTS Page CHAPTER I. INTRODUCTION ..................................................................................... 1 Religious Coping Theory ....................................................................................... 1 Outcomes of Spiritual Struggles ............................................................................ 4 Explaining Links between Spiritual Struggles and Poorer Health .......................... 9 Present Study ...................................................................................................... 15 CHAPTER II. METHODS ............................................................................................... 18 Sample Characteristics .......................................................................................... 18 Measures ....................................................................................................... 19 Procedure ....................................................................................................... 26 CHAPTER III. RESULTS ................................................................................................ 30 General Analytic Plan ............................................................................................ 30 Preliminary Analyses ............................................................................................. 31 Main Analyses ....................................................................................................... 32 CHAPTER IV. DISCUSSION .......................................................................................... 36 CHAPTER V. LIMITATIONS AND DIRECTIONS FOR FUTURE RESEARCH ........... 41 CHAPTER VI. CONCLUSION ........................................................................................ 45 REFERENCES ....................................................................................................... 61 APPENDIX A. SCREENING STUDY ............................................................................ 67 APPENDIX B. SPIRITUAL STRUGGLES SEMI-STRUCTURED INTERVIEW .......... 71 APPENDIX C. LIFE STRUGGLES SEMI-STRUCTURED INTERVIEW ...................... 73 vi LIST OF TABLES Table Page 1 Summary of Laboratory Study ............................................................................... 46 2 Descriptive Information for Screening and Demographic Questionnaires ............... 47 3 Descriptive Information for Difference Scores ....................................................... 48 4 Descriptive Information by Order, Difference Scores............................................. 49 5 Paired Samples T-tests Examining Differences between Spiritual Struggle First Order and Life Struggle First Order for Demographic and Screening Questionnaire ....... 50 6 3 (Condition) x 2 (Order) Mixed Model ANOVA Examining Interaction Effects for Condition and Order for Physiological Variables and Relevant Post-Hoc t-tests ........ 51 7 1 (Order) x 3 (Condition) Simple Main Effects ANOVAs Examining Differences between Conditions for Participants in Spiritual Strugg les First Order and Relevant Post-Hoc T-tests ....................................................................................................... 52 8 1 (Order) x 3 (Condition) Simple Main Effects ANOVAs Examining Differences between Conditions for Participants in Life Struggles First Order and Relevant Post-Hoc T-tests ....................................................................................................... 53 9 3 (Condition) x 2 (Order) x 4(Controls) Mixed Model ANCOVA Examining Interaction Effects for Condition and Order for Physiological Variables while Controlling for Inequalities between Orders ....................................................................................................... 54 10 Paired Samples T-tests Comparing Physiological Variables for Spiritual Struggles Condition and Neutral Condition for Spiritual Struggles First Order ............................... 55 11 3 (Condition) x 2 (Order) Mixed Model ANOVA Examining Interaction Effects for Psychological Variables ................................................................................................. 56 vii 12 Post-Hoc T-tests Examining Differences between Condition for SUDS, NA .......... 57 13 1(Order) x 3(Condition) Simple Main Effects ANOVAs and Subsequent Post-Hoc Analyses Examining Differences between Conditions for Participants............................ 58 14 3 (Condition) x 2 (Order) x 4 (Control) ANCOVA Examining for Interaction between Condition and Order for Psychological Variables, while controlling for Potential Covariates ....................................................................................................... 59 15 Paired Samples T-tests Comparing Psychological Variables for Spiritual Struggles Condition and Neutral Condition for Spiritual Struggles First Order