Religion as an Existential Resource: On Meaning-Making, Religious Coping and Rituals

In this paper, we make a contribution to the treatment of post-traumatic stress disorder. We show how religion can function as an existential resource. Religions enable people to perceive an underlying pattern of order and purpose below the surface of life’s incomprehensible inevitabilities such as death and suffering. Religion then works as a meaning-making system that can positively influence the individual’s mental health. Recently, the relations between religion and health have been studied particularly in the context of the ‘religious coping paradigm’. Religious coping is aiming at a ‘search for significance’. Religious coping will often occur where non-religious coping fails, especially in situations involving loss of life, health and relational embeddedness. Religious activities and acts can also enable religious coping. A crucial religious act is the ritual. What are the functions of ritual, and how can a ritual contribute to the mental health of an individual in crisis? What is, in this context, the role of myths and symbols? Several examples are given of how rituals can work as therapeutic tools in the treatment of traumatic disorders. We conclude by stating that religion, being a robust form of meaning-making, is not the sole system able to contribute to working through a trauma, and that its success is far from guaranteed. | Durch unseren Artikel möchten wir zur Behandlung der Folgen der posttraumatischen Belas- tungsstörung beitragen. Wir zeigen, wie die Religion als Kraftquelle der Existenz funktionieren kann. Die Religionen ermöglichen den Menschen, das Muster einer tieferen Ordnung und eines tieferen Sinnes in Bezug auf scheinbar unverständliche Beschaffenheiten des Lebens wie der Tod oder das Leiden, zu erblicken. Auf diese Weise funktioniert die Religion als ein Sinngebendes System, das die geistige Gesundheit positiv beeinflussen kann. Neulich wurden die Zusammenhänge zwischen Religion und Gesundheit im Rahmen des „religiösen Bewältigungsparadigmas“ geforscht. Das Ziel der religiösen Bewältigung ist die „Suche nach Bedeutung und Wichtigkeit“. Religiöse Bewältigung findet häufig dann statt, wenn die nicht-religiöse Bewältigung versagt, vor allem in Situationen, in denen Themen wie Verlust des Lebens, Gesundheit oder Beziehungen betroffen sind. Auch religiöse Taten und Handlungen können die religiöse Bewältigung ermöglichen. Eine der grundlegenden religiösen Handlungen ist das Ritual. Was sind die Funktionen des Rituals und wie kann das Ritual zur psychischen Gesundheit der in der Krise befindlichen Person beitragen? Welche Rolle spielen die Mythen und Symbole in diesem Zusammenhang? Wir zeigen zahlreiche Beispiele dafür, wie Rituale bei traumatischen Störungen zum therapeutischen Instrument werden können. Als Schlussfolgerung behaupten wir, dass die Religion – obwohl sie eine grundlegende Form der Sinngabe ist, aber doch nicht das einzige System, das zur Verarbeitung des Traumas beitragen kann und dessen Erfolg bei Weitem nicht sicher ist

Mature Religiosity Scale: Validity of a New Questionnaire

In order to validate a new questionnaire, the Mature Religiosity Scale (MRS), it was presented to a sample of 336 persons, of which 171 were parishioners and 165 outpatients of Christian mental health clinics. A first version of this questionnaire was designed by studying both psychi- atric/psychological and theological literature. Validity and reliability were studied by including other questionnaires, among them the Spiritual Well-Being Scale (SWBS), the Duke Religion Index, the Religious/Spiritual Coping (RCoPE) and the State-Trait Anxiety Inventory (STAI). The results indicate that 16 items of the 19-item questionnaire make up one factor with good internal consistency, which is measured by Cronbach’s alpha. This factor was used as the Mature Religiosity Scale in this study. out of correlations with other validated scales and correlations with characteristics of known groups this scale proved to have good validity. The Mature Re- ligiosity Scale is suitable for use in both mental healthcare and pastoral care. It is designed and validated for these two groups, giving direction to professional communication about faith and meaning of life

Shared Decision Making in Health Care Visits for CKD:Patients’ Decisional Role Preferences and Experiences

Rationale &amp; Objective: Research on shared decision making (SDM) in chronic kidney disease (CKD) has focused almost exclusively on the modality of kidney replacement treatment. We explored what other CKD decisions are recognized by patients, what their preferences and experiences are regarding these decisions, and how decisions are made during their interactions with medical care professionals. Study Design: Cross-sectional study. Setting &amp; Participants: Patients with CKD receiving (outpatient) care in 1 of 2 Dutch hospitals. Exposure: Patients’ preferred decisional roles for treatment decisions were measured using the Control Preferences Scale survey administered after a health care visit with medical professionals. Outcome: Number of decisions for which patients experienced a decisional role that did or did not match their preferred role. Observed levels of SDM and motivational interviewing in audio recordings of health care visits, measured using the 4-step SDM instrument (4SDM) and Motivational Interviewing Treatment Integrity coding tools.Analytical Approach: The results were characterized using descriptive statistics, including differences in scores between the patients’ experienced and preferred decisional roles. Results: According to the survey (n = 122) patients with CKD frequently reported decisions regarding planning (112 of 122), medication changes (82 of 122), or lifestyle changes (59 of 122). Of the 357 reported decisions in total, patients preferred that clinicians mostly (125 of 357) or fully (101 of 357) make the decisions. For 116 decisions, they preferred a shared decisional role. For 151 of 357 decisions, the patients’ preferences did not match their experiences. Decisions were experienced as “less shared/patient-directed” (76 of 357) or “more shared/patient-directed” (75 of 357) than preferred. Observed SDM in 118 coded decisions was low (median 4; range, 0 – 22). Motivational interviewing techniques were rarely used. Limitations: Potential recall and selection bias, and limited generalizability. Conclusions: We identified multiple discrepancies between preferred, experienced, and observed SDM in health care visits for CKD. Although patients varied in their preferred decisional role, a large minority of patients expressed a preference for shared decision making for many decisions. However, SDM behavior during the health care visits was observed infrequently. Plain-Language Summary: Shared decision making (SDM) may be a valuable approach for common chronic kidney disease (CKD) decisions, but our knowledge is limited. We collected patient surveys after health care visits for CKD. Patients most frequently experienced decisions regarding planning, medication, and lifestyle. Three decisional roles were preferred by comparable numbers of patients: let the clinician alone decide, let the clinician decide for the most part, or “equally share” the decision. Patients’ experiences of who made the decision did not always match their preferences. In audio recordings of the health care visits, we observed low levels of SDM behavior. These findings suggest that the preference for “sharing decisions” is often unmet for a large number of patients.</p

Predicting outcomes in chronic kidney disease:needs and preferences of patients and nephrologists

Introduction: Guidelines on chronic kidney disease (CKD) recommend that nephrologists use clinical prediction models (CPMs). However, the actual use of CPMs seems limited in clinical practice. We conducted a national survey study to evaluate: 1) to what extent CPMs are used in Dutch CKD practice, 2) patients’ and nephrologists’ needs and preferences regarding predictions in CKD, and 3) determinants that may affect the adoption of CPMs in clinical practice. Methods: We conducted semi-structured interviews with CKD patients to inform the development of two online surveys; one for CKD patients and one for nephrologists. Survey participants were recruited through the Dutch Kidney Patient Association and the Dutch Federation of Nephrology. Results: A total of 126 patients and 50 nephrologists responded to the surveys. Most patients (89%) reported they had discussed predictions with their nephrologists. They most frequently discussed predictions regarded CKD progression: when they were expected to need kidney replacement therapy (KRT) (n = 81), and how rapidly their kidney function was expected to decline (n = 68). Half of the nephrologists (52%) reported to use CPMs in clinical practice, in particular CPMs predicting the risk of cardiovascular disease. Almost all nephrologists (98%) reported discussing expected CKD trajectories with their patients; even those that did not use CPMs (42%). The majority of patients (61%) and nephrologists (84%) chose a CPM predicting when patients would need KRT in the future as the most important prediction. However, a small portion of patients indicated they did not want to be informed on predictions regarding CKD progression at all (10–15%). Nephrologists not using CPMs (42%) reported they did not know CPMs they could use or felt that they had insufficient knowledge regarding CPMs. According to the nephrologists, the most important determinants for the adoption of CPMs in clinical practice were: 1) understandability for patients, 2) integration as standard of care, 3) the clinical relevance. Conclusion: Even though the majority of patients in Dutch CKD practice reported discussing predictions with their nephrologists, CPMs are infrequently used for this purpose. Both patients and nephrologists considered a CPM predicting CKD progression most important to discuss. Increasing awareness about existing CPMs that predict CKD progression may result in increased adoption in clinical practice. When using CPMs regarding CKD progression, nephrologists should ask whether patients want to hear predictions beforehand, since individual patients’ preferences vary.</p

Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol

Contains fulltext : 96704.pdf (publisher's version ) (Open Access)BACKGROUND: Cerebral small vessel disease (SVD) is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism in some. In general, the relations are weak, and not all subjects with SVD become demented or get parkinsonism. This might be explained by the diversity of underlying pathology of both white matter lesions (WML) and the normal appearing white matter (NAWM). Both cannot be properly appreciated with conventional MRI. Diffusion tensor imaging (DTI) provides alternative information on microstructural white matter integrity. The association between SVD, its microstructural integrity, and incident dementia and parkinsonism has never been investigated. METHODS/DESIGN: The RUN DMC study is a prospective cohort study on the risk factors and cognitive and motor consequences of brain changes among 503 non-demented elderly, aged between 50-85 years, with cerebral SVD. First follow up is being prepared for July 2011. Participants alive will be included and invited to the research centre to undergo a structured questionnaire on demographics and vascular risk factors, and a cognitive, and motor, assessment, followed by a MRI protocol including conventional MRI, DTI and resting state fMRI. DISCUSSION: The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. When proven, these changes might function as a surrogate endpoint for cognitive and motor function in future therapeutic trials. Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white matter in the transition from "normal" aging to cognitive and motor decline and impairment and eventually to incident dementia and parkinsonism

Religion as an Existential Resource: On Meaning-Making, Religious Coping and Rituals

In this paper, we make a contribution to the treatment of post-traumatic stress disorder. We show how religion can function as an existential resource. Religions enable people to perceive an underlying pattern of order and purpose below the surface of life’s incomprehensible inevitabilities such as death and suffering. Religion then works as a meaning-making system that can positively influence the individual’s mental health. Recently, the relations between religion and health have been studied particularly in the context of the ‘religious coping paradigm’. Religious coping is aiming at a ‘search for significance’. Religious coping will often occur where non-religious coping fails, especially in situations involving loss of life, health and relational embeddedness. Religious activities and acts can also enable religious coping. A crucial religious act is the ritual. What are the functions of ritual, and how can a ritual contribute to the mental health of an individual in crisis? What is, in this context, the role of myths and symbols? Several examples are given of how rituals can work as therapeutic tools in the treatment of traumatic disorders. We conclude by stating that religion, being a robust form of meaning-making, is not the sole system able to contribute to working through a trauma, and that its success is far from guaranteed. | Durch unseren Artikel möchten wir zur Behandlung der Folgen der posttraumatischen Belas- tungsstörung beitragen. Wir zeigen, wie die Religion als Kraftquelle der Existenz funktionieren kann. Die Religionen ermöglichen den Menschen, das Muster einer tieferen Ordnung und eines tieferen Sinnes in Bezug auf scheinbar unverständliche Beschaffenheiten des Lebens wie der Tod oder das Leiden, zu erblicken. Auf diese Weise funktioniert die Religion als ein Sinngebendes System, das die geistige Gesundheit positiv beeinflussen kann. Neulich wurden die Zusammenhänge zwischen Religion und Gesundheit im Rahmen des „religiösen Bewältigungsparadigmas“ geforscht. Das Ziel der religiösen Bewältigung ist die „Suche nach Bedeutung und Wichtigkeit“. Religiöse Bewältigung findet häufig dann statt, wenn die nicht-religiöse Bewältigung versagt, vor allem in Situationen, in denen Themen wie Verlust des Lebens, Gesundheit oder Beziehungen betroffen sind. Auch religiöse Taten und Handlungen können die religiöse Bewältigung ermöglichen. Eine der grundlegenden religiösen Handlungen ist das Ritual. Was sind die Funktionen des Rituals und wie kann das Ritual zur psychischen Gesundheit der in der Krise befindlichen Person beitragen? Welche Rolle spielen die Mythen und Symbole in diesem Zusammenhang? Wir zeigen zahlreiche Beispiele dafür, wie Rituale bei traumatischen Störungen zum therapeutischen Instrument werden können. Als Schlussfolgerung behaupten wir, dass die Religion – obwohl sie eine grundlegende Form der Sinngabe ist, aber doch nicht das einzige System, das zur Verarbeitung des Traumas beitragen kann und dessen Erfolg bei Weitem nicht sicher ist