J Relig Health DOI 10.1007/s10943-014-9888-1 ORIGINAL PAPER
Religiosity and Proactive Coping with Social Difficulties in Romanian Adolescents Nicoleta Ra˘ban-Motounu • Ileana Loredana Vitalia
Springer Science+Business Media New York 2014
Abstract Even though medical and psychological sciences and services evolved so much, in many cases, the healing process has its mystery, and some recoveries seem to be entirely magical. Especially in such cases, religion seems to play an important role, as it helps people face the ‘‘mystery’’ of the healing process and integrate it. Religion has helped people face potentially traumatic events with minimum consequences for their health, or, moreover, to use these experiences for personal development, making them more prepared for life challenges. Adolescents with developed proactive coping skills are less socially inhibited or non-assertive, and those that are less cold/distant or more selfsacrificing have stronger spiritual values. Keywords
Spiritual values Proactive coping Interpersonal problems Adolescents
Introduction Some of the greatest mysteries of life, including illness and healing, the charm and the suffering given by human interactions, and a person’s relationship with the elements in the universe, find their special place in the religious life. A profound religious life involves accepting and living with such mysteries, searching and finding a meaning in the life experiences according to these mysteries, which makes people more prepared for life. According to new perspectives in stress effects research, personal agency is a construct that needs to be reconsidered (Thoits 2006). In personal agency theory, individuals appear as ‘‘architects of their lives, motivated to avoid unpleasant experiences or solve the problems that cause them and to pursue meaningful and rewarding alternative role involvements’’ (Thoits 2006, p. 316). The personal agency can be used to explain the
N. Ra˘ban-Motounu (&) I. L. Vitalia Faculty of Socio-Humanistic Sciences, University of Pites¸ ti, Str. Taˆrgu din Vale, Nr.1, Corp I, 110040 Pitesti, Arges¸ , Romania e-mail: [email protected]
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buffering effects of perceived social support on stress factors: Those that exert a higher level of personal agency actively seek social support and strive to solve interpersonal conflict. For many years, researchers had tried to control this variable or to connect it with the notion of transformatory coping. Personal agency mediates the connection among status, identity and health in a sequential manner, being expressed at different levels: personal choice and decision, deliberate and intentional action, action plan making and following it, establishing personal goals and trying to accomplish them, in the interaction between the person and her environment, as it presents more or less constraints. By personal agency, the person forms a personal model of the world and the same time she transforms it, giving an answer to the changing problems created by the situation, in a continuous interaction. In this perspective, personal agency may have a stronger connection with proactive coping, another new tendency in stress—coping, and resilience research. In proactive coping, people relate to future threats and challenges which are mostly certain, but without realizing negative appraisals. It is centered on developing resources in order to minimize the effect of stressful future events, thus promoting challenging goals and personal growth. Among these resources are psychological qualities, but also a supportive, and extended social network, or attaining a socioeconomic status. It is considered to have its origins not in state anxiety, but at the level of trait anxiety (or the tendency to experience worry) suggesting a path of reconverting it from a vulnerability into a resource. It involves having a vision that contains almost certain challenges and developing resources to face them, this way giving life a meaning, orienting toward a goal, turning stress management into goal management, a possible threat into a strong possibility to live the success satisfaction (Schwazer and Knoll 2003). As it involves giving life a meaning by orienting personal actions toward a challenging or a personally significant goal, proactive coping does not differ significantly according to gender or education (Solla´r and Solla´rova´ 2009). There is no significant difference between adolescent boys and girls in the use of proactive coping skills. Slovak boys with more developed proactive coping skills obtain lower scores on neuroticism and higher scores on extraversion, openness and consciousness. In girls proactive coping has even more significant correlations with neuroticism (negative correlation), extraversion and consciousness (positive correlations) (Fickova´ 2009). The use of proactive coping varies with age: The lowest level is for people between 18 and 34 years, the higher level for those over 35 (Solla´r and Solla´rova´ 2009). The difference between these age groups may have two explanations: Either a person uses different coping strategies according to the age characteristics, or the participants in the categories in the study are subject to generation differences introduced by the society which values certain strategies at different historical moments. Halama and Bakosˇova´ (2009) investigated the moderating effect of meaning in life between perceived stress and coping strategies in university students. In Slovak adolescents, types of coping form three distinctive clusters: adaptive coping that includes seeking of instrumental social support and seeking of emotional support, positive reinterpretation, acceptance and active coping; avoidant coping; and emotion-based coping, with turning to religion, focus on and venting of emotions. Perceived stress is associated with emotionbased coping and avoidant coping. Meaning in life had a moderator effect only for avoidant coping: The higher meaning in life, the lower the tendency to use avoidant coping strategies. The path to symptoms of illness is different for corporate people and for university students. In corporate participants, it starts with hardiness and for the university group with avoidance coping (Soderstrom et al. 2000). Hardiness is the personality characteristic of the person who sees change as a challenge to personal development, who
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is committed, who finds meaning in her work and relationships, and she has the sense of control within reasonable limits. The term comes from the existential point of view, and it has connections with proactive coping and interpersonal problems at conceptual level. Watts (2010) considers healing from a holistic perspective which involves more than medical treatments: A subtle interplay between psychological and spiritual can be observed. Spiritual aspects of healing can vary from spiritual practices used in the treatment, for example, mindfulness techniques (Lebow 2006), creative meditation (Mitrofan 2004; Ra˘ban-Motounu 2010, 2011), gratitude training (Digdon and Koble 2011), involvement of spiritual aspects of the person as in the search for meaning in a religious aspect, and the healing through divine action (Watts 2010). Spiritual beliefs and practices are forces that promote resilience, and healthy coping depends upon the capacity to create meaning for experience (Green and Elliott 2010). Spirituality, besides being a transcendent aspect of life that gives meaning, includes a grounded, centered connection to community and moral standards. Jung saw the healing as the result of the action of the transcendent function, which allows the creative expression of opposites, and the religious symbols as result of this function. The religious symbols and rituals, not only in the Christian religion, seek to stimulate or to create situations for the person to use her symbolic function to be in contact with her profound Self, and thus, they favor health or healing. The opposed function is the diabolic function, which means a progressive split at different levels of Self, the totality archetype, corresponding to different illness situations (Jung 1996, 1998, 1999a, b, 2000, 2003, 2005; Minulescu 2001; Watts 2010; Wilber 2005). Several studies have examined the relationship between religion and the ability to cope with mental health issues (Plante et al. 2001). An extensive literature base has demonstrated connections between religious/spiritual involvement and better mental and physical health (e.g., lower rates of morbidity and mortality; less stress, anxiety, depression, substance abuse and suicide). Such evidence implies that the provision of basic religious/ spiritual assessment and intervention is an appropriate and desirable activity for mental health professionals (Menagi et al. 2008; Mrdjenovich et al. 2012; Plante et al. 2001). It suggests that (a) the beliefs and practices of religious/spiritual clients could be well utilized in their treatment and recovery and (b) knowledge concerning the mechanisms by which religion/spirituality influences health could be applied to the benefit of non-religious/nonspiritual clients within a secular framework. In either case, it will be important to respect clients’ autonomy and personal preferences in the area of religion/spirituality and to ensure that counseling services are grounded in informed consent and targeted toward relevant treatment goals. Larson et al. (2001) cite over 350 studies which point to the religion as the forgotten factor in physical and mental health. Research shows that religion reduces the impact of stress through providing coping skills, social support, a coherent world view, meaning, a sense of control and a less risky life style. So, independent of the religious affiliation, religious activities and social support, religious people report better health and happiness, those with liberal religious beliefs being healthier, but less happy than people with specific beliefs (Green and Elliott 2010). Levin (2001) has found over 250 studies showing the health benefits of spiritual practices and religion. Hirschberg and Barasch (1995) studied four dozen patients who survived diagnosed fatal illness and 61 % identified faith as significant in their recovery. Meyerstein (2005) suggested spiritual study/discussion groups to strengthen patients’ perceived coping with illness. The groups introduce a spiritual perspective, provide emotional support and offer a variety of ‘‘spiritual coping tools’’ utilizing traditional and contemporary resources. Preliminary evaluations suggest that a ‘‘healing’’ time and space is created through the provision of comfort, connection, support
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and inspiration. Social support has been examined as one possible mechanism through which religion improves general health outcomes (Menagi et al. 2008). Individuals who belong to religious communities perceive greater social support. The perceived social support provided by religious involvement has the potential to act as a protective mechanism or buffer against negative health outcomes during stressful events. For example, among college women, seeking social support may be a protective coping mechanism against drinking. Religiosity was investigated as a component of resilience in children at risk of depression—biological offspring of depressed parents. They are at significantly increased odds to experience major depression in the next 10 years or other mood or psychiatric disorder and to confront with negative life events compared with children of non-depressed parents, highlighting the importance of finding resilience dimensions for the first category of people, arguing in favor of the continuum of life trajectory for them. First, children of depressed parents significantly attend less religious services, and they assess religiosity as less important than those coming from non-depressed parents. Attendance is related to significant lower odds for any psychiatric disorder only in offspring of nondepressed parents. When the parents’ psychiatric history is ignored, attendance significantly reduces odds for mood disorders, or any psychiatric disorder, with the exception of major depression. People without major depression in antecedents have significantly lower odds for disorders in relation to attendance and importance. The associations are no longer present in offspring of depressed parents: For them no aspect of religiosity—disorder association was found. Attendance moderates the associations between exposure to negative life events and major depression, mood or any other psychiatric disorder, and importance moderates the relationship between exposure to negative life events and mood disorders: Religious attendance and importance reduce odds for a disorder when confronted with a negative life event. Religiosity importance is associated with significantly reduced odds for mood disorder only among offspring of depressed parents who have confronted with negative life events (Kasen et al. 2012). The study was a longitudinal one, on 20 years, but it did not consider also physical illness. It is true that its authors mention that several participants could not be contacted for all assessments because they died, without any cause being mentioned, though. The previous literature also mentions negative religious coping besides positive religious coping. In women who survived breast cancer, the relationship between psychological well-being and religiosity depends on their beliefs prior to the illness situation. Although strong spiritual belief seems to be a strong resource when confronted with such a disease as cancer, coping by turning toward God without a previous significant connection with Him or minimum spiritual behaviors results in a diminished well-being. Moreover, challenging the beliefs system and trying to change them in early survivors also negatively affect their well-being (Schreiber and Brockopp 2012). Those that see the illness situation or difficulties as sign of God’s punishment or abandonment have an increased mortality risk. They feel either guilty or angry at God, and this way they increase the mortality risk (Larson et al. 2001; Pargament et al. 2001). Adolescent girls use religion as a coping strategy significantly more than adolescent boys (Fickova´ 2009). According to the literature (Meyerstein 2005), a key factor in the organism’s response to illness is the patient’s ‘‘‘horizon level,’’ resulting from family individuation and differentiation process. The more social support, self-esteem and coping skills are, the lower the incidence of dysfunction is (Albee 1982; Rogers 1951). Social support (family, friends, social networks and institutional connections) have long been shown to operate as a buffer to stress, promoting health and preventing illness. Some authors describe love as a salutary
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health factor that breaks down isolation, suggesting that people fare better when connected. In other studies, social support is described as fostering agency (a family’s capability to make meaningful choices) and communion (a family’s sense of connection to each other and community). Adolescent girls use significantly more emotional social support and instrumental social support. Emotional support seeking has a very significant correlation with neuroticism (negative correlation), agreeableness and extraversion (positive correlations) for adolescent girls. In adolescent boys, it has a low negative correlation with neuroticism and a very strong positive correlation with extraversion (Fickova´ 2009). Objective to study the associations among the three variables: spiritual beliefs, proactive coping strategies and interpersonal problems, in adolescents. Hypothesis H1
People with more developed proactive coping skills have stronger spiritual beliefs.
H2 There are associations between proactive coping skills and certain interpersonal problems. • People with developed proactive coping skills are less socially inhibited. • People with developed proactive coping skills are less non-assertive. H3
There are associations between spiritual beliefs and certain interpersonal problems.
• People with stronger spiritual beliefs are less cold/distant. • People with stronger spiritual beliefs are more self-sacrificing.
Method A correlational study was realized to test the hypothesis. Psychometric and statistical– mathematical methods were used (especially the Pearson’s correlation coefficient). Participants The participants in the study were 152 subjects randomly selected from students in the first year at different faculties from University of Pitesti, other than theology. They were 18–19 years old, 20 (13.158 %) males and 132 (84.842 %) females. Instruments Proactive Coping Scale (PCS, Greenglass et al. 1999b) The PCS was created by Greenglass et al. (1999a) as part of the proactive coping inventory, being the only scale addressing exclusively to the construct of proactive coping. It has an internal consistency estimated by Cronbach’s alpha of .86 on Romanian population, comparable with that of the English form and higher than that of the Slovak form of .81 (Fickova´ 2009). As validity, a positive correlation with perceived self-efficacy and a negative correlation with job burnout resulted. The instrument has 14 items, each of them with four answer variants (form ‘‘not at all true’’ to ‘‘completely true’’). The sum of scores for each item gives the final score, after reversing the answering scale for the negative items.
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Inventory of Interpersonal Problems Circumplex Scales short form (IIP SC, Soldz et al. 1995) measures interpersonal problems as an expression of recurrent difficulties in relationship to others. It can evaluate the difficulties of some specified type and also the general tendency to experience difficulties in interpersonal relationships (a general factor). The instrument has 32 items, divided into two, describing types of difficulties in relating to others, and the respondent has to establish for each item how accurate it describes him. The internal consistency by Cronbach’s alpha for the entire scale was 0.868, for Romanian population, with good values for all eight scales. Starting from the two dimensions, dominance and affiliation, that characterize individual behaviors, dispositions and problems, the plan described by those axes covers eight types of interpersonal difficulties: (PA) domineering/controlling, (NO) intrusive/needy, (BC) vindictive/self-centered, (DE) cold/ distant, (LM) self-sacrificing, (FG) socially inhibited, (JK) overly accommodating and (HI) non-assertive. Beliefs and Values Scale (BVS King et al. 2006) is an instrument destined to assess ‘‘spirituality that goes beyond conventional religious beliefs’’ in psychological and health research, given the previous association found between higher levels of religious involvement and a good state of health. The spiritual conceptions were obtained after a qualitative study involving patients diagnosed with cancer or in palliative care, nurses, students and other persons without cancer and with different occupational backgrounds. They identified the following themes: the search for a meaning, in relationship to others and in the personal circumstances; ideas about God, religion meditation, pray and life after death; reactions to the environment, especially the nature’s beauty and grandeur. After several qualitative and factorial analyses, a final form with 20 items was obtained. It has an internal consistency of 0.94 for the English version and 0.89 for the Romanian participants. The criterion validity was calculated for each item in relation to Intrinsic Religious Motivation Scale. For each item affirmation, the subject chooses one of the variants: strongly agree (4), agree (3), neither agree nor disagree (2), disagree (1) and total disagree (0). The total scores lay between 0 and 80, with higher scores indicating stronger spiritual beliefs. Procedure The three questionnaires were filled in by the subjects at the beginning of a course, in group, with the psychologist present, so that she could answer their questions. They were assured of the confidentiality of their responses, and their results were communicated to them afterward.
Results The descriptive statistics for the distributions of scores on the three questionnaires were as follows: for PCS, M = 40.526, SD = 6.612; for BVS, M = 53.855, SD = 9.970; and for IIP SC, M = 1.114, SD = .325 (for its factors—FG: M = 0.95, SD = 0.637; NO: M = 1.335, SD = .709; HI: M = 1.313, SD = .660; JK: M = 1.161, SD = .582; DE: M = .680, SD = .530; BC: M = .884, SD = .524; LM: M = 1.727, SD = .687; PA: M = .865, SD = 557). To test the hypothesis, Pearson’s correlation coefficient was determined. A positive correlation was observed between proactive coping skills and spirituals beliefs and values: r = .161, p = .048 (see Fig. 1). This way the first hypothesis was confirmed: People with more developed proactive coping skills have stronger spiritual beliefs.
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PCS Fig. 1 The association between BVS (Beliefs and Values Scale) and PCS (Proactive Coping Scale) scores
The scores on PCS also correlated positively with those on NO factor of IIP SC, r = .273, p = .001 (see Fig. 2), and negatively with those on FG factor, r = -.266, p = .001 (see Fig. 3), and with the scores on HI factor, r = -.363, p \ .001 (see Fig. 4). The results confirmed the second hypothesis: People with developed proactive coping skills are less socially inhibited and non-assertive; they were also needier. The scores on BVS correlated positively with those on LM factor from IIP SC, r = .161, p = .047 (see Fig. 5) and negatively with those on DE factor, r = -160, r = .049 (see Fig. 6). These values confirmed the third hypothesis: People with stronger spiritual beliefs are less cold/distant and more self-sacrificing. No significant correlation was found between total scores on IIP SC and scores on PCS or scores on BVS.
Discussion The subjects with more developed proactive coping skills have stronger spiritual beliefs and values. The positive correlation between spiritual beliefs and proactive coping indicates that those with higher goal management abilities and more oriented toward personal growth have stronger spiritual beliefs. Finding a meaning in life experiences, including negative ones, establishing meaningful relationships with others, profound Self and nature is related to proactive coping. Thus, discovering oneself in interactions with others, life experiences, optimizing personal resources are intimately related to spiritual growth and understanding, idea also encountered in the experiential psychotherapy of unification (Mitrofan 2004). This is supported by the Jungian theory that the image of God is, in fact, the image of the profound Self, partially conscious and partially unconscious (Jung 1998, 1999a, b, 2000). This correlation may suggest that acquiring spiritual values may be only one part of the proactive coping skills. On the other hand, it can be a natural consequence of the development of proactive coping skills. Another possibility is that they both relate
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NO
2.0 1.5 1.0 .5 0.0 -.5 20
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PCS Fig. 2 The association between PCS (Proactive Coping Scale) and NO (intrusive/needy) (from IIP SC) scores
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PCS Fig. 3 The association between PCS (Proactive Coping Scale) and FG (socially inhibited) (from IIP SC) scores
with a third variable, such as the sense of meaning in life, as the construct definitions imply. Subjects with more developed proactive coping skills consider themselves more intrusive, needy, less socially avoidant and more assertive. Being centered upon optimizing their personal resources, they tend to express their opinions, perceptions, thoughts or
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PCS Fig. 4 The association between PCS (Proactive Coping Scale) and HI (non-assertive) (from IIP SC) scores
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BVS Fig. 5 The association between BVS (Beliefs and Values Scale) and LM (self-sacrificing) (from IIP SC) scores
feelings more openly, but non-aggressively. This way they feel comfortable in the company of others, without being overly nurturing with them. They consider life experiences as means of self discovering and enriching their vision of Self, non-Self and the relation between them. They discover themselves in the relationships they establish. Being domineering, they tend to take charge of difficult situations based on their inner
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BVS Fig. 6 The association between BVS (Beliefs and Values Scale) and DE (cold/distant) (from IIP SC) scores
vision, and sometimes become intrusive, with the risk of considering their own needs as more important. So, the others have the possibility to offer them the support they need in a difficult situation, because they know how to express their needs. They could further develop their proactive coping skills using their needs as a starting point of self-actualization and growth. It is important, though, to mention that we used self-assessment questionnaires, so there is a possibility that participants only see themselves as more intrusive or needy, and they consider this a possible interpersonal problem, perspective that helps balance the proactive coping strategies they use in a healthy life style. Subjects with stronger spiritual values and beliefs tend to be self-sacrificing and warmer in their relationships or when faced with an interpersonal difficulty or other situation. The strong values they have make them more sensitive to the needs of others. They feel such a strong connection with others, nature, cultural environment, with God that they connect their well-being with that of others previously mentioned. They overcome their personal difficulties when others need their attention and affection. They find great source of meaning in life in the affection they offer to others. There are more instruments that assess spiritual beliefs. We used BVS because of its independence of the type of religious system, but it has also a disadvantage: Some important details of their spiritual life may be missed with such a short questionnaire regarding their perspective on illness and God’s will and action. The procedure followed when conceived may raise another problem: Persons in palliative care or with cancer were used, and, as we mentioned in the introduction, spiritual beliefs have differentiated effects for them depending on the image of God, previous religious life, actual questions and the answers they reach to or they get from others on the theme. A very interesting and challenging study conducted by Schilder et al. (2004) on people with malignant tumors in different parts of the organism evidenced by objective methods initially and after a period, and who spontaneously recovered, showed that they became more independent than the others, who did not recover. The fact that part of the construction procedure for BVS involved especially persons with cancer or in palliative care may explain the correlation
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observed between scores on this instrument and the self-sacrificing type of interpersonal problems, in the light of the study cited above. Previously was found that, in the case of depression, informal helping and volunteer work has a detrimental effect, while formal volunteer activity has a beneficial influence (Li and Ferraro 2005). Those engaged in formal volunteer activities also provide more informal helping. This means that they do not see helping others as overbearing or as excessively self-sacrificing, the interpersonal problem assessed by the IIP SC, but as an activity that has social, personal and spiritual rewards, based on intrinsic religiosity, as described by Maltby (2005). In the case of depression, helping others in a formal framework compensates depressive mechanisms. In psychological support programs for people, who consider themselves as over selfsacrificing, reconverting this issue into a resource is possible, based on this compensation mechanism. This idea also indicates the fact that another important element to be considered in patients’ coping with illness is that religion or spiritual beliefs are rarely static and are flexibly reviewed and utilized by clients. The findings may indicate resources to base on in psychotherapy when confronted with different types of personality disorders, given their association with a line running from intrusive (NO) to socially avoidant (FG) (Soldz 1997), that is establishing an equilibrium between dependency and independency (for those with high proactive coping skills), and between offering and receiving (for those with strong spiritual values). The personal agency theory offers a framework for the observed relationships and for integrating the mentioned polarities into a creative life perspective. Because spirituality is an essential component of personal identity, it can frequently serve as a source of therapeutic strength and courage and it may provide a stable foundation for the personal and spiritual growth that follows. This certainly is consistent with the idea that we each have within us an element of the divine, a voice that guides us to develop our potentialities, to find meaning in life. There is a spiritual core, a spiritual self, that promotes human resilience, and it is this resilience, this ability to transcend, that perhaps reflects the presence of God (Barrett 2009). The Self is the bridge between the anguished individual and the divine, and it is from the Self that our inspired direction and determination emerges.
Conclusion There is a possibility of converting certain interpersonal problems into resources given the associations we found. Certain interpersonal difficulties experienced before can be used as a starting point for internal restructuring and growth (also a component of proactive coping skills). In the light of previous studies, working on developing the assertiveness, the dominance and increasing the openness to social relationships helps persons proactively cope with stressful potentially traumatic situations, without significant costs for their health. When these resources lack or they are insufficiently developed, and health problems have already occurred, stronger spiritual beliefs and values help fully living loving relationships, a condition that promotes health. A greater openness toward Self would seem to help individuals get the best from the two resources taken into consideration: proactive coping and spiritual beliefs. So, self-acceptance and the sense of meaning would be two variables to be taken into consideration when studying these relations in further research.
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J Relig Health Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2001). Religious struggle as a predictor of mortality among medically ill elderly patients: A two-year longitudinal study. Archives of International Medicine, 161(15), 1881–1885. doi:10.1001/archinte.161.15.1881. Plante, T., Saucedo, B., & Rice, C. (2001). The association between strength of religious faith and coping with daily stress. Pastoral Psychology, 49(4), 291–300. doi:10.1023/A:1004819505286. Ra˘ban-Motounu, N. (2010). Mechanisms involved in group or individual unification psychotherapy with persons with depressive disorder. Revista de Psihoterapie Experient¸ iala˘, 1(49), 43–47. Ra˘ban-Motounu, N. (2011). Individual experiential psychotherapy of unification for treatment of depression. Revista de Psihoterapie Experient¸ iala˘, 2(54), 23–29. Rogers, C. R. (1951). Client-centered psychotherapy: Its current practice, implications and theory. Boston: Houghton Mifflin Company. Schilder, J. N., de Vries, M. J., Goodkin, K., & Antoni, M. (2004). Psychological changes preceding spontaneous remission of cancer. Clinical Case Studies, 3(4), 288–312. doi:10.1177/ 1534650103259631. Schreiber, J. A., & Brockopp, D. P. (2012). Twenty-five years later—What do we know about religious spirituality and psychological well-being among breast cancer survivors? A systematic review. Journal of Cancer Survivorship, 6(1), 82–94. doi:10.1007/s11764-011-0193-7. Schwazer, R., & Knoll, N. (2003). Positive coping: Mastering demands and searching for meaning. In S. J. Lopez & C. R. Snyder (Eds.), Handbook of positive psychological assessment (pp. 393–410). Washington, DC: American Psychological Association. Soderstrom, M., Dolbier, C., Leiferman, J., & Steinhardt, M. (2000). The relationship of hardiness, coping strategies, and perceived stress to symptoms of illness. Journal of Behavioral Medicine, 23(3), 311–328. doi:10.1023/A:1005514310142. Soldz, S. (1997). The interpersonal circumplex as a structural model in clinical research: Examples from group psychotherapy, interpersonal problems, and personality disorders. In R. Plutchik & H. R. Conte (Eds.), Circumplex models of personality and emotions (pp. 411–429). Washington, DC: American Psychological Association. Soldz, S., Budman, S. H., Demby, A., & Merry, J. (1995). A short form of the inventory of Interpersonal Problems Circumplex Scales. Assessment, 2(1), 53–63. doi:10.1177/1073191195002001006. Solla´r, T., & Solla´rova´, E. (2009). Proactive coping from the perspective of age, gender and education. Studia Psychologica, 51(2–3), 161–165. Thoits, P. A. (2006). Personal agency in the stress process. Journal of Health and Social Behavior, 47, 309–324. doi:10.1177/002214650604700401. Watts, F. (2010). Spiritual and psychological aspects of healing. Presented at spirituality, theology, & mental health. Theory & healing power. St. John’s College, Durnham University, 13–16 September. Wilber, K. (2005). No boundary: Eastern and western approaches to personal growth (Fa˘ra˘ granit¸ e. Aborda˘ri orientale s¸ i occidentale ale dezvolta˘rii personale), Bucures¸ ti: Elena Francisc Publishing.
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Religiosity and Proactive Coping with Social Difficulties in Romanian Adolescents Nicoleta Ra˘ban-Motounu • Ileana Loredana Vitalia
Springer Science+Business Media New York 2014
Abstract Even though medical and psychological sciences and services evolved so much, in many cases, the healing process has its mystery, and some recoveries seem to be entirely magical. Especially in such cases, religion seems to play an important role, as it helps people face the ‘‘mystery’’ of the healing process and integrate it. Religion has helped people face potentially traumatic events with minimum consequences for their health, or, moreover, to use these experiences for personal development, making them more prepared for life challenges. Adolescents with developed proactive coping skills are less socially inhibited or non-assertive, and those that are less cold/distant or more selfsacrificing have stronger spiritual values. Keywords
Spiritual values Proactive coping Interpersonal problems Adolescents
Introduction Some of the greatest mysteries of life, including illness and healing, the charm and the suffering given by human interactions, and a person’s relationship with the elements in the universe, find their special place in the religious life. A profound religious life involves accepting and living with such mysteries, searching and finding a meaning in the life experiences according to these mysteries, which makes people more prepared for life. According to new perspectives in stress effects research, personal agency is a construct that needs to be reconsidered (Thoits 2006). In personal agency theory, individuals appear as ‘‘architects of their lives, motivated to avoid unpleasant experiences or solve the problems that cause them and to pursue meaningful and rewarding alternative role involvements’’ (Thoits 2006, p. 316). The personal agency can be used to explain the
N. Ra˘ban-Motounu (&) I. L. Vitalia Faculty of Socio-Humanistic Sciences, University of Pites¸ ti, Str. Taˆrgu din Vale, Nr.1, Corp I, 110040 Pitesti, Arges¸ , Romania e-mail: [email protected]
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buffering effects of perceived social support on stress factors: Those that exert a higher level of personal agency actively seek social support and strive to solve interpersonal conflict. For many years, researchers had tried to control this variable or to connect it with the notion of transformatory coping. Personal agency mediates the connection among status, identity and health in a sequential manner, being expressed at different levels: personal choice and decision, deliberate and intentional action, action plan making and following it, establishing personal goals and trying to accomplish them, in the interaction between the person and her environment, as it presents more or less constraints. By personal agency, the person forms a personal model of the world and the same time she transforms it, giving an answer to the changing problems created by the situation, in a continuous interaction. In this perspective, personal agency may have a stronger connection with proactive coping, another new tendency in stress—coping, and resilience research. In proactive coping, people relate to future threats and challenges which are mostly certain, but without realizing negative appraisals. It is centered on developing resources in order to minimize the effect of stressful future events, thus promoting challenging goals and personal growth. Among these resources are psychological qualities, but also a supportive, and extended social network, or attaining a socioeconomic status. It is considered to have its origins not in state anxiety, but at the level of trait anxiety (or the tendency to experience worry) suggesting a path of reconverting it from a vulnerability into a resource. It involves having a vision that contains almost certain challenges and developing resources to face them, this way giving life a meaning, orienting toward a goal, turning stress management into goal management, a possible threat into a strong possibility to live the success satisfaction (Schwazer and Knoll 2003). As it involves giving life a meaning by orienting personal actions toward a challenging or a personally significant goal, proactive coping does not differ significantly according to gender or education (Solla´r and Solla´rova´ 2009). There is no significant difference between adolescent boys and girls in the use of proactive coping skills. Slovak boys with more developed proactive coping skills obtain lower scores on neuroticism and higher scores on extraversion, openness and consciousness. In girls proactive coping has even more significant correlations with neuroticism (negative correlation), extraversion and consciousness (positive correlations) (Fickova´ 2009). The use of proactive coping varies with age: The lowest level is for people between 18 and 34 years, the higher level for those over 35 (Solla´r and Solla´rova´ 2009). The difference between these age groups may have two explanations: Either a person uses different coping strategies according to the age characteristics, or the participants in the categories in the study are subject to generation differences introduced by the society which values certain strategies at different historical moments. Halama and Bakosˇova´ (2009) investigated the moderating effect of meaning in life between perceived stress and coping strategies in university students. In Slovak adolescents, types of coping form three distinctive clusters: adaptive coping that includes seeking of instrumental social support and seeking of emotional support, positive reinterpretation, acceptance and active coping; avoidant coping; and emotion-based coping, with turning to religion, focus on and venting of emotions. Perceived stress is associated with emotionbased coping and avoidant coping. Meaning in life had a moderator effect only for avoidant coping: The higher meaning in life, the lower the tendency to use avoidant coping strategies. The path to symptoms of illness is different for corporate people and for university students. In corporate participants, it starts with hardiness and for the university group with avoidance coping (Soderstrom et al. 2000). Hardiness is the personality characteristic of the person who sees change as a challenge to personal development, who
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is committed, who finds meaning in her work and relationships, and she has the sense of control within reasonable limits. The term comes from the existential point of view, and it has connections with proactive coping and interpersonal problems at conceptual level. Watts (2010) considers healing from a holistic perspective which involves more than medical treatments: A subtle interplay between psychological and spiritual can be observed. Spiritual aspects of healing can vary from spiritual practices used in the treatment, for example, mindfulness techniques (Lebow 2006), creative meditation (Mitrofan 2004; Ra˘ban-Motounu 2010, 2011), gratitude training (Digdon and Koble 2011), involvement of spiritual aspects of the person as in the search for meaning in a religious aspect, and the healing through divine action (Watts 2010). Spiritual beliefs and practices are forces that promote resilience, and healthy coping depends upon the capacity to create meaning for experience (Green and Elliott 2010). Spirituality, besides being a transcendent aspect of life that gives meaning, includes a grounded, centered connection to community and moral standards. Jung saw the healing as the result of the action of the transcendent function, which allows the creative expression of opposites, and the religious symbols as result of this function. The religious symbols and rituals, not only in the Christian religion, seek to stimulate or to create situations for the person to use her symbolic function to be in contact with her profound Self, and thus, they favor health or healing. The opposed function is the diabolic function, which means a progressive split at different levels of Self, the totality archetype, corresponding to different illness situations (Jung 1996, 1998, 1999a, b, 2000, 2003, 2005; Minulescu 2001; Watts 2010; Wilber 2005). Several studies have examined the relationship between religion and the ability to cope with mental health issues (Plante et al. 2001). An extensive literature base has demonstrated connections between religious/spiritual involvement and better mental and physical health (e.g., lower rates of morbidity and mortality; less stress, anxiety, depression, substance abuse and suicide). Such evidence implies that the provision of basic religious/ spiritual assessment and intervention is an appropriate and desirable activity for mental health professionals (Menagi et al. 2008; Mrdjenovich et al. 2012; Plante et al. 2001). It suggests that (a) the beliefs and practices of religious/spiritual clients could be well utilized in their treatment and recovery and (b) knowledge concerning the mechanisms by which religion/spirituality influences health could be applied to the benefit of non-religious/nonspiritual clients within a secular framework. In either case, it will be important to respect clients’ autonomy and personal preferences in the area of religion/spirituality and to ensure that counseling services are grounded in informed consent and targeted toward relevant treatment goals. Larson et al. (2001) cite over 350 studies which point to the religion as the forgotten factor in physical and mental health. Research shows that religion reduces the impact of stress through providing coping skills, social support, a coherent world view, meaning, a sense of control and a less risky life style. So, independent of the religious affiliation, religious activities and social support, religious people report better health and happiness, those with liberal religious beliefs being healthier, but less happy than people with specific beliefs (Green and Elliott 2010). Levin (2001) has found over 250 studies showing the health benefits of spiritual practices and religion. Hirschberg and Barasch (1995) studied four dozen patients who survived diagnosed fatal illness and 61 % identified faith as significant in their recovery. Meyerstein (2005) suggested spiritual study/discussion groups to strengthen patients’ perceived coping with illness. The groups introduce a spiritual perspective, provide emotional support and offer a variety of ‘‘spiritual coping tools’’ utilizing traditional and contemporary resources. Preliminary evaluations suggest that a ‘‘healing’’ time and space is created through the provision of comfort, connection, support
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and inspiration. Social support has been examined as one possible mechanism through which religion improves general health outcomes (Menagi et al. 2008). Individuals who belong to religious communities perceive greater social support. The perceived social support provided by religious involvement has the potential to act as a protective mechanism or buffer against negative health outcomes during stressful events. For example, among college women, seeking social support may be a protective coping mechanism against drinking. Religiosity was investigated as a component of resilience in children at risk of depression—biological offspring of depressed parents. They are at significantly increased odds to experience major depression in the next 10 years or other mood or psychiatric disorder and to confront with negative life events compared with children of non-depressed parents, highlighting the importance of finding resilience dimensions for the first category of people, arguing in favor of the continuum of life trajectory for them. First, children of depressed parents significantly attend less religious services, and they assess religiosity as less important than those coming from non-depressed parents. Attendance is related to significant lower odds for any psychiatric disorder only in offspring of nondepressed parents. When the parents’ psychiatric history is ignored, attendance significantly reduces odds for mood disorders, or any psychiatric disorder, with the exception of major depression. People without major depression in antecedents have significantly lower odds for disorders in relation to attendance and importance. The associations are no longer present in offspring of depressed parents: For them no aspect of religiosity—disorder association was found. Attendance moderates the associations between exposure to negative life events and major depression, mood or any other psychiatric disorder, and importance moderates the relationship between exposure to negative life events and mood disorders: Religious attendance and importance reduce odds for a disorder when confronted with a negative life event. Religiosity importance is associated with significantly reduced odds for mood disorder only among offspring of depressed parents who have confronted with negative life events (Kasen et al. 2012). The study was a longitudinal one, on 20 years, but it did not consider also physical illness. It is true that its authors mention that several participants could not be contacted for all assessments because they died, without any cause being mentioned, though. The previous literature also mentions negative religious coping besides positive religious coping. In women who survived breast cancer, the relationship between psychological well-being and religiosity depends on their beliefs prior to the illness situation. Although strong spiritual belief seems to be a strong resource when confronted with such a disease as cancer, coping by turning toward God without a previous significant connection with Him or minimum spiritual behaviors results in a diminished well-being. Moreover, challenging the beliefs system and trying to change them in early survivors also negatively affect their well-being (Schreiber and Brockopp 2012). Those that see the illness situation or difficulties as sign of God’s punishment or abandonment have an increased mortality risk. They feel either guilty or angry at God, and this way they increase the mortality risk (Larson et al. 2001; Pargament et al. 2001). Adolescent girls use religion as a coping strategy significantly more than adolescent boys (Fickova´ 2009). According to the literature (Meyerstein 2005), a key factor in the organism’s response to illness is the patient’s ‘‘‘horizon level,’’ resulting from family individuation and differentiation process. The more social support, self-esteem and coping skills are, the lower the incidence of dysfunction is (Albee 1982; Rogers 1951). Social support (family, friends, social networks and institutional connections) have long been shown to operate as a buffer to stress, promoting health and preventing illness. Some authors describe love as a salutary
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health factor that breaks down isolation, suggesting that people fare better when connected. In other studies, social support is described as fostering agency (a family’s capability to make meaningful choices) and communion (a family’s sense of connection to each other and community). Adolescent girls use significantly more emotional social support and instrumental social support. Emotional support seeking has a very significant correlation with neuroticism (negative correlation), agreeableness and extraversion (positive correlations) for adolescent girls. In adolescent boys, it has a low negative correlation with neuroticism and a very strong positive correlation with extraversion (Fickova´ 2009). Objective to study the associations among the three variables: spiritual beliefs, proactive coping strategies and interpersonal problems, in adolescents. Hypothesis H1
People with more developed proactive coping skills have stronger spiritual beliefs.
H2 There are associations between proactive coping skills and certain interpersonal problems. • People with developed proactive coping skills are less socially inhibited. • People with developed proactive coping skills are less non-assertive. H3
There are associations between spiritual beliefs and certain interpersonal problems.
• People with stronger spiritual beliefs are less cold/distant. • People with stronger spiritual beliefs are more self-sacrificing.
Method A correlational study was realized to test the hypothesis. Psychometric and statistical– mathematical methods were used (especially the Pearson’s correlation coefficient). Participants The participants in the study were 152 subjects randomly selected from students in the first year at different faculties from University of Pitesti, other than theology. They were 18–19 years old, 20 (13.158 %) males and 132 (84.842 %) females. Instruments Proactive Coping Scale (PCS, Greenglass et al. 1999b) The PCS was created by Greenglass et al. (1999a) as part of the proactive coping inventory, being the only scale addressing exclusively to the construct of proactive coping. It has an internal consistency estimated by Cronbach’s alpha of .86 on Romanian population, comparable with that of the English form and higher than that of the Slovak form of .81 (Fickova´ 2009). As validity, a positive correlation with perceived self-efficacy and a negative correlation with job burnout resulted. The instrument has 14 items, each of them with four answer variants (form ‘‘not at all true’’ to ‘‘completely true’’). The sum of scores for each item gives the final score, after reversing the answering scale for the negative items.
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Inventory of Interpersonal Problems Circumplex Scales short form (IIP SC, Soldz et al. 1995) measures interpersonal problems as an expression of recurrent difficulties in relationship to others. It can evaluate the difficulties of some specified type and also the general tendency to experience difficulties in interpersonal relationships (a general factor). The instrument has 32 items, divided into two, describing types of difficulties in relating to others, and the respondent has to establish for each item how accurate it describes him. The internal consistency by Cronbach’s alpha for the entire scale was 0.868, for Romanian population, with good values for all eight scales. Starting from the two dimensions, dominance and affiliation, that characterize individual behaviors, dispositions and problems, the plan described by those axes covers eight types of interpersonal difficulties: (PA) domineering/controlling, (NO) intrusive/needy, (BC) vindictive/self-centered, (DE) cold/ distant, (LM) self-sacrificing, (FG) socially inhibited, (JK) overly accommodating and (HI) non-assertive. Beliefs and Values Scale (BVS King et al. 2006) is an instrument destined to assess ‘‘spirituality that goes beyond conventional religious beliefs’’ in psychological and health research, given the previous association found between higher levels of religious involvement and a good state of health. The spiritual conceptions were obtained after a qualitative study involving patients diagnosed with cancer or in palliative care, nurses, students and other persons without cancer and with different occupational backgrounds. They identified the following themes: the search for a meaning, in relationship to others and in the personal circumstances; ideas about God, religion meditation, pray and life after death; reactions to the environment, especially the nature’s beauty and grandeur. After several qualitative and factorial analyses, a final form with 20 items was obtained. It has an internal consistency of 0.94 for the English version and 0.89 for the Romanian participants. The criterion validity was calculated for each item in relation to Intrinsic Religious Motivation Scale. For each item affirmation, the subject chooses one of the variants: strongly agree (4), agree (3), neither agree nor disagree (2), disagree (1) and total disagree (0). The total scores lay between 0 and 80, with higher scores indicating stronger spiritual beliefs. Procedure The three questionnaires were filled in by the subjects at the beginning of a course, in group, with the psychologist present, so that she could answer their questions. They were assured of the confidentiality of their responses, and their results were communicated to them afterward.
Results The descriptive statistics for the distributions of scores on the three questionnaires were as follows: for PCS, M = 40.526, SD = 6.612; for BVS, M = 53.855, SD = 9.970; and for IIP SC, M = 1.114, SD = .325 (for its factors—FG: M = 0.95, SD = 0.637; NO: M = 1.335, SD = .709; HI: M = 1.313, SD = .660; JK: M = 1.161, SD = .582; DE: M = .680, SD = .530; BC: M = .884, SD = .524; LM: M = 1.727, SD = .687; PA: M = .865, SD = 557). To test the hypothesis, Pearson’s correlation coefficient was determined. A positive correlation was observed between proactive coping skills and spirituals beliefs and values: r = .161, p = .048 (see Fig. 1). This way the first hypothesis was confirmed: People with more developed proactive coping skills have stronger spiritual beliefs.
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PCS Fig. 1 The association between BVS (Beliefs and Values Scale) and PCS (Proactive Coping Scale) scores
The scores on PCS also correlated positively with those on NO factor of IIP SC, r = .273, p = .001 (see Fig. 2), and negatively with those on FG factor, r = -.266, p = .001 (see Fig. 3), and with the scores on HI factor, r = -.363, p \ .001 (see Fig. 4). The results confirmed the second hypothesis: People with developed proactive coping skills are less socially inhibited and non-assertive; they were also needier. The scores on BVS correlated positively with those on LM factor from IIP SC, r = .161, p = .047 (see Fig. 5) and negatively with those on DE factor, r = -160, r = .049 (see Fig. 6). These values confirmed the third hypothesis: People with stronger spiritual beliefs are less cold/distant and more self-sacrificing. No significant correlation was found between total scores on IIP SC and scores on PCS or scores on BVS.
Discussion The subjects with more developed proactive coping skills have stronger spiritual beliefs and values. The positive correlation between spiritual beliefs and proactive coping indicates that those with higher goal management abilities and more oriented toward personal growth have stronger spiritual beliefs. Finding a meaning in life experiences, including negative ones, establishing meaningful relationships with others, profound Self and nature is related to proactive coping. Thus, discovering oneself in interactions with others, life experiences, optimizing personal resources are intimately related to spiritual growth and understanding, idea also encountered in the experiential psychotherapy of unification (Mitrofan 2004). This is supported by the Jungian theory that the image of God is, in fact, the image of the profound Self, partially conscious and partially unconscious (Jung 1998, 1999a, b, 2000). This correlation may suggest that acquiring spiritual values may be only one part of the proactive coping skills. On the other hand, it can be a natural consequence of the development of proactive coping skills. Another possibility is that they both relate
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NO
2.0 1.5 1.0 .5 0.0 -.5 20
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PCS Fig. 2 The association between PCS (Proactive Coping Scale) and NO (intrusive/needy) (from IIP SC) scores
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PCS Fig. 3 The association between PCS (Proactive Coping Scale) and FG (socially inhibited) (from IIP SC) scores
with a third variable, such as the sense of meaning in life, as the construct definitions imply. Subjects with more developed proactive coping skills consider themselves more intrusive, needy, less socially avoidant and more assertive. Being centered upon optimizing their personal resources, they tend to express their opinions, perceptions, thoughts or
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PCS Fig. 4 The association between PCS (Proactive Coping Scale) and HI (non-assertive) (from IIP SC) scores
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BVS Fig. 5 The association between BVS (Beliefs and Values Scale) and LM (self-sacrificing) (from IIP SC) scores
feelings more openly, but non-aggressively. This way they feel comfortable in the company of others, without being overly nurturing with them. They consider life experiences as means of self discovering and enriching their vision of Self, non-Self and the relation between them. They discover themselves in the relationships they establish. Being domineering, they tend to take charge of difficult situations based on their inner
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BVS Fig. 6 The association between BVS (Beliefs and Values Scale) and DE (cold/distant) (from IIP SC) scores
vision, and sometimes become intrusive, with the risk of considering their own needs as more important. So, the others have the possibility to offer them the support they need in a difficult situation, because they know how to express their needs. They could further develop their proactive coping skills using their needs as a starting point of self-actualization and growth. It is important, though, to mention that we used self-assessment questionnaires, so there is a possibility that participants only see themselves as more intrusive or needy, and they consider this a possible interpersonal problem, perspective that helps balance the proactive coping strategies they use in a healthy life style. Subjects with stronger spiritual values and beliefs tend to be self-sacrificing and warmer in their relationships or when faced with an interpersonal difficulty or other situation. The strong values they have make them more sensitive to the needs of others. They feel such a strong connection with others, nature, cultural environment, with God that they connect their well-being with that of others previously mentioned. They overcome their personal difficulties when others need their attention and affection. They find great source of meaning in life in the affection they offer to others. There are more instruments that assess spiritual beliefs. We used BVS because of its independence of the type of religious system, but it has also a disadvantage: Some important details of their spiritual life may be missed with such a short questionnaire regarding their perspective on illness and God’s will and action. The procedure followed when conceived may raise another problem: Persons in palliative care or with cancer were used, and, as we mentioned in the introduction, spiritual beliefs have differentiated effects for them depending on the image of God, previous religious life, actual questions and the answers they reach to or they get from others on the theme. A very interesting and challenging study conducted by Schilder et al. (2004) on people with malignant tumors in different parts of the organism evidenced by objective methods initially and after a period, and who spontaneously recovered, showed that they became more independent than the others, who did not recover. The fact that part of the construction procedure for BVS involved especially persons with cancer or in palliative care may explain the correlation
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observed between scores on this instrument and the self-sacrificing type of interpersonal problems, in the light of the study cited above. Previously was found that, in the case of depression, informal helping and volunteer work has a detrimental effect, while formal volunteer activity has a beneficial influence (Li and Ferraro 2005). Those engaged in formal volunteer activities also provide more informal helping. This means that they do not see helping others as overbearing or as excessively self-sacrificing, the interpersonal problem assessed by the IIP SC, but as an activity that has social, personal and spiritual rewards, based on intrinsic religiosity, as described by Maltby (2005). In the case of depression, helping others in a formal framework compensates depressive mechanisms. In psychological support programs for people, who consider themselves as over selfsacrificing, reconverting this issue into a resource is possible, based on this compensation mechanism. This idea also indicates the fact that another important element to be considered in patients’ coping with illness is that religion or spiritual beliefs are rarely static and are flexibly reviewed and utilized by clients. The findings may indicate resources to base on in psychotherapy when confronted with different types of personality disorders, given their association with a line running from intrusive (NO) to socially avoidant (FG) (Soldz 1997), that is establishing an equilibrium between dependency and independency (for those with high proactive coping skills), and between offering and receiving (for those with strong spiritual values). The personal agency theory offers a framework for the observed relationships and for integrating the mentioned polarities into a creative life perspective. Because spirituality is an essential component of personal identity, it can frequently serve as a source of therapeutic strength and courage and it may provide a stable foundation for the personal and spiritual growth that follows. This certainly is consistent with the idea that we each have within us an element of the divine, a voice that guides us to develop our potentialities, to find meaning in life. There is a spiritual core, a spiritual self, that promotes human resilience, and it is this resilience, this ability to transcend, that perhaps reflects the presence of God (Barrett 2009). The Self is the bridge between the anguished individual and the divine, and it is from the Self that our inspired direction and determination emerges.
Conclusion There is a possibility of converting certain interpersonal problems into resources given the associations we found. Certain interpersonal difficulties experienced before can be used as a starting point for internal restructuring and growth (also a component of proactive coping skills). In the light of previous studies, working on developing the assertiveness, the dominance and increasing the openness to social relationships helps persons proactively cope with stressful potentially traumatic situations, without significant costs for their health. When these resources lack or they are insufficiently developed, and health problems have already occurred, stronger spiritual beliefs and values help fully living loving relationships, a condition that promotes health. A greater openness toward Self would seem to help individuals get the best from the two resources taken into consideration: proactive coping and spiritual beliefs. So, self-acceptance and the sense of meaning would be two variables to be taken into consideration when studying these relations in further research.
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