Abstract
Interest in spirituality and aging has increased recently, owing to overwhelming evidence of positive health outcomes linked to spirituality and religious participation. Increasing longevity in modern society puts spiritual needs of older adults at the forefront of societal priorities. Understanding individual spiritual perspectives becomes increasingly important, given the issues of loss, physical illness and mortality that are confronted in old age. There are multiple barriers to the proper assessment of spirituality in clinical practice and research (e.g., the lack of professional training for healthcare professionals, shortage of time and comfort for healthcare providers when discussing spiritual issues and needs). Integrating an individual’s spiritual practice into their healthcare can help shape personalized medical care for older adults and improve health outcomes. This article reviews literature and research on spirituality, as well as spiritual interventions and their putative neurobiological mechanisms in relation to aging, mental and physical health, and coping with death and dying.
Papers of special note have been highlighted as: • of interest •• of considerable interest
Bibliography
- 1 Koenig HG, McCullough ME, Larson DB: Handbook of Religion and Health. Oxford University Press, NY, USA (2001).
- 2 Dalby P: Is there a process of spiritual change or development associated with ageing? A critical review of research. Aging Ment. Health10,4–12 (2006).
- 3 Koenig HG: Research on religion and aging: an annotated bibliography. Westport CT (Ed.). Greenwood Press, Buckinghamshire, UK (1995).
- 4 Religion and Aging, in Gerontology: Perspectives and Issues. Moberg DO, Ferraro FK (Eds). Springer Publishing Co., NY, USA, 193–220 (1997).
- 5 Moberg DO: Research in spirituality, religion and aging. J. Gerontol. Soc. Work45,11–40 (2005).
- 6 Moberg DO: Aging and Spirituality: Spiritual Dimensions of Aging Theory, Research, Practice, and Policy. The Haworth Pastoral Press. Binghampton, NY, USA (2006).
- 7 Gallup G: Assessing religion in US on three levels. Emerging Trends21,2–4 (1999).
- 8 Miller WR, Thoresen CE: Spirituality, religion, and health. An emerging research field. Am. Psychol.58,24–35 (2003).
- 9 Gallup G, Bezilla R: The Religious Life of Young Americans. Gallup International Institute Princeton, NJ, USA (1992).
- 10 Astrow AB, Puchalski MC, Sulmasy DP: Religion, spirituality, and healthcare: social, ethical, and practical considerations. Am. J. Med.110,283–287 (2001).
- 11 Mohr WK: Spiritual issues in psychiatric care. Perspect. Psychiatr. Care42,174–183 (2006).
- 12 King DE, Bushwick B: Beliefs and attitudes of hospital inpatients about faith healing and prayer. J. Fam. Pract.39,349–352 (1994).
- 13 Daaleman TP, Nease DE Jr: Patient attitudes regarding physician inquiry into spiritual and religious issues. J. Fam. Pract.39,564–568 (1994).
- 14 Matthews DA, Clark C: The Faith Factor: Proof of the Healing Power of Prayer. Viking (Penguin-Putnam), NY, USA (1998).
- 15 Armbruster CA, Chibnall TJ, Legett S: Pediatrician beliefs about spirituality and religion in medicine: associations with clinical practice. Pediatrics111,e227–e235 (2003).
- 16 Ellis MR, Vinson CD, Ewigman B: Addressing spiritual concerns of patients: family physicians’ attitudes and practices. J. Fam. Pract.48,105–109 (1999).
- 17 Sapp S: What have religion and spirituality to do with aging? Three approaches. Gerontologist50(2),271–275 (2010).
- 18 Atchley R: Everyday mysticism: spiritual development in later adulthood. J. Adult Dev.2,123–124 (1997).
- 19 Carstensen L, Isaacowitz DM, Charles ST: Taking time seriously: a theory of socioemotional selectivity. Am. Psychol.54,165–181 (1999).
- 20 Jung C: The Basic Writings of Jung. Oxford: Modern Library, Oxford, UK (1959).
- 21 Cummings E, Henry WE: Growing Old: The Process of Disengagement. Basic Books, NY, USA (1961).
- 22 Blazer D, Palmore E: Religion and aging in a longitudinal panel. Gerontologist16,82–85 (1976).
- 23 Kalish RA: The new ageism and the failure models: a polemic. Gerontologist19,398–402 (1979).
- 24 Bianchi EC: Aging As a Spiritual Journey. Crossroad Publishing Co., NY, USA (1984).
- 25 Atchley R: Spirituality and Aging. John Hopkins University Press, MD, USA (2009).
- 26 Tornstam L: Gerotranscendence – a theory about maturing into old age. J. Aging Identity37–50 (1996).
- 27 Adams KB: Depressive symptoms, depletion, or developmental change? Withdrawal, apathy, and lack of vigor in the geriatric depression scale. Gerontologist41,768–777 (2001).
- 28 Ruth JE, Coleman P: Personality and aging: coping and management of the self in later life. In: Handbook of the Psychology of Aging (4th Edition). Birren JE, Schaie KW (Eds). Academic Press, CA, USA, 308–322 (1996).
- 29 Tornstam L: Gero-transcendence: a reformulation of the disengagement theory. Aging (Milano)1,55–63 (1989).
- 30 Wadensten B, Carlsson M: Theory-driven guidelines for practical care of older people, based on the theory of gerotranscendence. J. Adv. Nurs.41,462–470 (2003).
- 31 Braam AW, Bramsen I, van Tilburg TG, van der Ploeg HM, Deeg DJ: Cosmic transcendence and framework of meaning in life: patterns among older adults in the Netherlands. J. Gerontol. B Psychol. Sci. Soc.61,S121–S128 (2006).
- 32 Atchley R: Incorporating spirituality into professional work in aging. Aging Today20,17 (1999).
- 33 MacKinlay EB, Trevitt C: Spiritual care and ageing in a secular society. Med. J. Aust.186,S74–S76 (2007).
- 34 Crowther MR, Parker MW, Achenbaum WA, Larimore WL, Koenig HG: Rowe and Kahn’s model of successful aging revisited: positive spirituality – the forgotten factor. Gerontologist42,613–620 (2002).
- 35 Rogers T: Manifestations of religiosity and the aging process. J. Relig. Edu.71,405–415 (1976).
- 36 McFadden S: Religion and well-being in aging persons in an aging society. J. Soc. Issues51,161–175 (1995).
- 37 Seifert L: Toward a psychology of religion, spirituality, meaning-search, and aging: past research and a practical application. J. Adult Dev.9,61–70 (2002).
- 38 MacKinlay E: The spiritual dimension of caring: applying a model for spiritual tasks of aging. J. Relig. Gerontol.12,151–166 (2001).
- 39 Hill PC, Pargament KI: Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research. Am. Psychol.58,64–74 (2003).
- 40 Religion, spirituality, and aging. In: Religion, Spirituality, and Aging. McFadden S, Birren J, Schaie K (Eds). Academic Press, London, UK (1996).
- 41 Ortiz L, Langer N: Assessment of spirituality and religion in later life: acknowledging clients’ needs and personal resources. J. Gerontol. Soc. Work37,5–21 (2002).
- 42 Aponte H: Spirituality: the heart of therapy. J. Fam. Psychother.13,13–27 (2002).
- 43 Holmes UT: Spirituality for Ministry. Harper and Row, CA, USA (1982).
- 44 Moberg DO: Spiritual well-being: background and issues. In: White House Conference on Aging. US Government Printing Office, Washington, DC, USA (1971).
- 45 NICA: Spiritual Well-Being National Interfaith Coalition on Aging. NICA, Athens, Greece (1975).
- 46 Brennan CL: Personal and institutionalized religiosity of the elderly. In: Spiritual Well-Being of the Elderly. Thorson JA, Cook TC Jr (Eds). Charles C Thomas, Springfield, IL, USA 92–99 (1980).
- 47 Zinnbauer BJ, Pargament IK: Capturing the meanings of religiousness and spirituality: one way down from a definitional Tower of Babel. Research in the Social Scientific Study of Religion13,23–54 (2002).
- 48 Zinnbauer BJ, Pargament IK, Cole B et al.: Religion and spirituality: unfuzzing the fuzzy. J. Sci. Study Relig.36,549–564 (1997).
- 49 Erikson EH: Childhood and Society (Second Edition). Norton, NY, USA (1963).
- 50 Fowler JW: Stages of Faith: the Psychology of Human Development and the Quest for Meaning. Harper & Row, CA, USA (1981).
- 51 Fowler JW: Weaving the New Creation: Stages of Faith and the Public Church. Harper & Row, CA, USA (1991).
- 52 Koenig H: Aging & God. The Haworth Pastoral Press, NY, USA (1994).
- 53 Moberg DO: Aging & Spirituality: Spiritual Dimensions of Aging Theory, Research, Practice, and Policy. The Haworth Press, Inc., NY, USA (2001).
- 54 Koenig HG: Religion, spirituality, and medicine: how are they related and what does it mean? Mayo Clin. Proc.76,1189–1191 (2001).
- 55 Mindel CH, Vaughan CE: A multidimensional approach to religiosity and disengagement. J. Gerontol.33,103–108 (1978).
- 56 Hummer RA, Rogers RG, Nam CB, Ellison CG: Religious involvement and US adult mortality. Demography36,273–285 (1999).
- 57 Braam A, Beekman AT, Deeg DJ, Smit JH, Van Tilburg W: Religiosity as a protective factor in depressive disorder. Am. J. Psychiatry156,809 (1999).
- 58 Kune GA, Kune S, Watson LF: Perceived religiousness is protective for colorectal cancer: data from the Melbourne Colorectal Cancer Study. J. R. Soc. Med.86,645–647 (1993).
- 59 Berntson GG, Norman GJ, Hawkley LC, Cacioppo JT: Spirituality and autonomic cardiac control. Ann. Behav. Med.35,198–208 (2008).
- 60 Oxman TE, Freeman DH Jr, Manheimer ED Jr: Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly. Psychosom. Med.57,5–15 (1995).
- 61 Ball J, Armistead L, Austin BJ: The relationship between religiosity and adjustment among African–American, female, urban adolescents. J. Adolesc.26,431–446 (2003).
- 62 Brown CM: Exploring the role of religiosity in hypertension management among African Americans. J. Healthcare Poor Underserved11,19–32 (2000).
- 63 McCullough ME, Hoyt WT, Larson DB, Koenig HG, Thoresen C: Religious involvement and mortality: a meta-analytic review. Health Psychol.19,211–222 (2000).
- 64 Oman D, Kurata JH, Strawbridge WJ, Cohen RD: Religious attendance and cause of death over 31 years. Int. J. Psychiatry Med.32,69–89 (2002).
- 65 Contrada RJ, Goyal TM, Cather C, Rafalson L, Idler EL, Krause TJ: Psychosocial factors in outcomes of heart surgery: the impact of religious involvement and depressive symptoms. Health Psychol.23,227–238 (2004).
- 66 Hodges SD, Humphreys SC, Eck JC: Effect of spirituality on successful recovery from spinal surgery. South Med. J.95,1381–1384 (2002).
- 67 Rasanen J, Kauhanen J, Lakka TA, Kaplan GA, Salonen JT: Religious affiliation and all-cause mortality: a prospective population study in middle-aged men in eastern Finland. Int. J. Epidemiol.25,1244–1249 (1996).
- 68 Van Poppel F, Schellekens J, Liefbroer AC: Religious differentials in infant and child mortality in Holland, 1855–1912. Population Studies (Camb.)56,277–289 (2002).
- 69 Koenig H, Larson D, Matthews D: Religion and psychotherapy with older adults. J. Geriatr. Psychiatry29,155–184 (1996).
- 70 Koenig HG, Smiley M, Gonzales JA: Religion, Health and Aging: a Review and Theoretical Integration. Westport CT (Ed.). Greenwood Press, Buckinghamshire, UK (1988).
- 71 Armstrong B, van Merwyk AJ, Coates H: Blood pressure in Seventh-Day Adventist vegetarians. Am. J. Epidemiol.105,444–449 (1977).
- 72 Walsh A: Religion and hypertension: testing alternative explanations among immigrants. Behav. Med.24,122–130 (1998).
- 73 Koenig HG: Is Religion Good for Your Health? The Effects of Religion on the Physical and Mental Health. The Haworth Press, NY, USA (1997).
- 74 Corliss R: The power of yoga. Time157,54–63 (2001).
- 75 van Montfrans GA, Karemaker JM, Wieling W, Dunning AJ: Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study. BMJ300,1368–1372 (1990).
- 76 Comstock GW, Partridge KB: Church attendance and health. J. Chronic Dis.25,665–672 (1972).
- 77 Byrd RC: Positive therapeutic effects of intercessory prayer in a coronary care unit population. South Med. J.81,826–829 (1988).
- 78 Harris WS, Gowda M, Kolb JW et al.: A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Arch. Intern. Med.159,2273–2278 (1999).
- 79 Ai AL, Dunkle RE, Peterson C, Bolling SF: The role of private prayer in psychological recovery among midlife and aged patients following cardiac surgery. Gerontologist38,591–601 (1998).
- 80 Grundmann E: Cancer morbidity and mortality in USA Mormons and Seventh-Day Adventists. Arch. Anat. Cytol. Pathol.40,73–78 (1992).
- 81 Fraser GE: Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-Day Adventists. Am. J. Clin. Nutr.70,S532–S538 (1999).
- 82 Poulson RL, Eppler MA, Satterwhite TN, Wuensch KL, Bass LA: Alcohol consumption, strength of religious beliefs, and risky sexual behavior in college students. J. Am. Coll. Health46,227–232 (1998).
- 83 Hasnain M: Cultural approach to HIV/AIDS harm reduction in Muslim countries. Harm. Reduct. J.2,23 (2005).
- 84 Autiero A: The interpretation of pain: the point of view of Catholic theology. Acta Neurochir. Suppl. (Wien)38,123–126 (1987).
- 85 Foley DP: Eleven interpretations of personal suffering. J. Relig. Health27,321–328 (1988).
- 86 Patel SS, Shah VS, Peterson RA, Kimmel PL: Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis. Am. J. Kidney Dis.40,1013–1022 (2002).
- 87 Koenig HG, George LK, Peterson BL: Religiosity and remission of depression in medically ill older patients. Am. J. Psychiatry155,536–542 (1998).
- 88 Heath AC, Madden PA, Grant JD, McLaughlin TL, Todorov AA, Bucholz KK: Resiliency factors protecting against teenage alcohol use and smoking: influences of religion, religious involvement and values, and ethnicity in the Missouri Adolescent Female Twin Study. Twin Res.2,145–155 (1999).
- 89 Donahue MJ: Intrinsic and extrinsic religiousness: review and meta-analysis. J. Pers. Soc. Psychol.48,400–419 (1985).
- 90 Lichtenstein B: Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: issues of race, gender and poverty. Soc. Sci. Med.57,2435–2445 (2003).
- 91 Madru N: Stigma and HIV: does the social response affect the natural course of the epidemic? J. Assoc. Nurses AIDS Care14,39–48 (2003).
- 92 Ofran Y, Lavi D, Opher D, Weiss TA, Elinav E: Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol l-1): a disorder linked to female gender and psychiatric disorders. J. Intern. Med.256,525–528 (2004).
- 93 Mueller PS, Plevak DJ , Rummans TA: Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin. Proc.76,1225–1235 (2001).
- 94 Musick M, Traphagan J, Koenig H, Larson D: Spirituality in physical health and aging. J. Adult Dev.7,73–86 (2000).
- 95 Kimble M: Beyond the biomedical paradigm: Generating a spiritual vision of ageing. J. Relig. Gerontol.12,31–41 (2001).
- 96 Anderson RS: On being human: the spiritual saga of a creaturely soul. In: Whatever Happened to the Soul? Scientific and Theological Portraits of Human Nature. Brown WS, Murphy N, Molonly HN (Eds). Fortress Press, MN, USA 175–194 (1998).
- 97 Malony HN: Wholeness and Holiness: Reading in the Psychology/Theology of Mental Health. Baker Book House, MI, USA (1983).
- 98 Langer N: The importance of spirituality in later life. Gerontol. Geriatr. Educ.20,41–50 (2000).
- 99 Williams DR, Larson DB, Buckler RE, Heckmann RC, Pyle CM: Religion and psychological distress in a community sample. Soc. Sci. Med.32,1257–1262 (1991).
- 100 Coward DD: Self-transcendence and emotional well-being in women with advanced breast cancer. Oncol. Nurs. Forum.18,857–863 (1991).
- 101 Markides KS, Levin JS, Ray LA: Religion, aging, and life satisfaction: an eight-year, three-wave longitudinal study. Gerontologist27,660–665 (1987).
- 102 Coke MM: Correlates of life satisfaction among elderly African Americans. J. Gerontol.47,P316–P320 (1992).
- 103 Yoon DP, Lee EK: The impact of religiousness, spirituality, and social support on psychological well-being among older adults in rural areas. J. Gerontol. Soc. Work48,281–298 (2007).
- 104 Richards PS, Bergin AE: A Spiritual Strategy for Counseling and Psychotherapy. American Psychological Association Press, Washington, DC, USA (1997).
- 105 Badawi MA, Eaton WW, Myllyluoma J, Weimer LG, Gallo J: Psychopathology and attrition in the Baltimore ECA 15-year follow-up 1981–1996. Soc. Psychiatry Psychiatr. Epidemiol.34,91–98 (1999).
- 106 Idler EL: Cohesiveness and coherence: religion and the health of the elderly. Garland Publishing, Inc., NY, USA (1994).
- 107 Corsentino EA, Collins N, Sachs-Ericsson N, Blazer DG: Religious attendance reduces cognitive decline among older women with high levels of depressive symptoms. J. Gerontol. A Biol. Sci. Med. Sci.64,1283–1289 (2009).
- 108 Boey KW: Religiosity and psychological well-being of older women in Hong Kong. Int. J. Psychiatr. Nurs. Res.8,921–935 (2003).
- 109 Braam AW, Beekman AT, Deeg DJ, Smit JH, van Tilburg W: Religiosity as a protective or prognostic factor of depression in later life; results from a community survey in The Netherlands. Acta Psychiatr. Scand.96,199–205 (1997).
- 110 Gartner J, Larson DB, Vacher-Mayberry CD: A systematic review of the quantity and quality of empirical research published in four pastoral counseling journals: 1975–1984. J. Pastoral Care44,115–129 (1990).
- 111 Nisbet PA, Duberstein PR, Conwell Y, Seidlitz L: The effect of participation in religious activities on suicide versus natural death in adults 50 and older. J. Nerv. Ment. Dis.188,543–546 (2000).
- 112 Neeleman J, Lewis G: Suicide, religion, and socioeconomic conditions. An ecological study in 26 countries, 1990. J. Epidemiol. Community Health53,204–210 (1999).
- 113 Propst LR, Ostrom R, Watkins P, Dean T, Mashburn D: Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. J. Consult. Clin. Psychol.60,94–103 (1992).
- 114 Azhar MZ, Varma SL: Religious psychotherapy in depressive patients. Psychother. Psychosom.63,165–168 (1995).
- 115 Azhar MZ, Varma SL, Dharap AS: Religious psychotherapy in anxiety disorder patients. Acta. Psychiatr. Scand.90,1–3 (1994).
- 116 Razali SM, Hasanah CI, Aminah K, Subramaniam M: Religious – sociocultural psychotherapy in patients with anxiety and depression. Aust. NZ J. Psychiatry32,867–872 (1998).
- 117 Koenig HG, Cohen HJ, Blazer DG et al.: Religious coping and depression among elderly, hospitalized medically ill men. Am. J. Psychiatry149,1693–1700 (1992).
- 118 Kastenbaum RJ: Death, Society, and Human Experience (Third Edition). Columbus OH (Ed.). Charles E Merrill Publishing Company, NY, USA (1986).
- 119 Blesky JK: The Psychology of Aging (Second Edition). Brooks/Cole Publishing Company, CA, USA (1990).
- 120 Feifel H, Branscomb AB: Who’s afraid of death? J. Abnorm. Psychol.81,282–288 (1973).
- 121 Templer DI: Death anxiety as related to depression and health of retired persons. J. Gerontol.26,521–523 (1971).
- 122 Kalish R: Death, Grief, and Caring Relationships (Second Edition). Brooks/Cole Publishing Company, CA, USA (1985).
- 123 Bianchi EC: Aging as a Spiritual Journey. Crossroad Publishing Company, NY, USA (1982).
- 124 Feifel H: New Meanings of Death. McGraw-Hill Book Company, NY, USA (1977).
- 125 Johnson R: Forgiveness: our bridge to peace. Liguorian80,44–45 (1992).
- 126 Thibault JM: A Deepening Love Affair: the Gift of God in Later Life. Upper Room Books, TX, USA (1993)
- 127 Fischer K: Winter Grace. Upper Room Books, TX, USA (1998).
- 128 Schenck DP, Roscoe LA: In search of a good death. J. Med. Humanit.30,61–72 (2009).
- 129 Balboni TA, Vanderwerker LC et al.: Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J. Clin. Oncol.25,555–560 (2007).
- 130 Puchalski C, Ferrell B, Virani R et al.: Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J. Palliat. Med.12,885–904 (2009).•• Important position statement – spiritual care in the palliative care settings.
- 131 La Pierre LL: JCAHO safeguards spiritual care. Holist. Nurs. Pract.17,219 (2003).
- 132 Kutz I: Samson, the bible, and the DSM. Arch. Gen. Psychiatry59,565; author reply 565–566 (2002).
- 133 Turner RP, Lukoff D, Barnhouse RT, Lu FG: Religious or spiritual problem. A culturally sensitive diagnostic category in the DSM-IV. J. Nerv. Ment. Dis.183,435–444 (1995).
- 134 Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V. Peteet JR, Lu FG, Narrow WE (Eds). American Psychiatric Publishing, Inc., VA, USA (2010).
- 135 Stefanek M, McDonald PG, Hess SA: Religion, spirituality and cancer: current status and methodological challenges. Psychooncology14,450–463 (2004).
- 136 Kuhn CC: A spiritual inventory of the medically ill patient. Psychiatr. Med.6,87–100 (1988).
- 137 Lo B, Ruston D, Kates LW et al.: Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA287,749–754 (2002).
- 138 Morse JM, Proctor A: Maintaining patient endurance. The comfort work of trauma nurses. Clin. Nurs. Res.7,250–274 (1998).
- 139 Puchalski C, Romer AL: Taking a spiritual history allows clinicians to understand patients more fully. J. Palliat. Med.3,129–137 (2000).
- 140 Anandarajah G, Hight E: Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am. Fam. Physician63,81–89 (2001).
- 141 Maugans TA: The SPIRITual history. Arch. Fam. Med.5,11–16 (1996).
- 142 Puchalski CM: Spirituality and medicine: curricula in medical education. J. Cancer Educ.21,14–18 (2006).• Good review of the priorities in developing medical school curricula on spirituality.
- 143 Koenig HG, George LK, Titus P: Religion, spirituality, and health in medically ill hospitalized older patients. J. Am. Geriatr. Soc.52,554–562 (2004).
- 144 Moberg DO: Assessing and measuring spirituality: confronting dilemmas of universal and particular evaluative criteria. J. Adult Dev.9,47–60 (2002).
- 145 Measures of Religiosity. Hill PC, Hood RW (Eds). Religious Education Press, AL, USA (1999).•• Comprehensive review of measures of spirituality/religiosity.
- 146 Fetzer Institute/National Institute on Aging Working Group, Multidimensional measurement of religiousness /spirituality for use in health research. In Report of the Fetzer Institute/ NIA Working group. Fetzer Insitute, Kalamazou, MI, USA (1999).• Review of the assessment instruments and measures of spirituality/religiosity.
- 147 Koenig HG: Concerns about measuring ‘spirituality’ in research. J. Nerv. Ment. Dis.196,349–355 (2008).
- 148 Paloutzian RF, Ellison CW: Loneliness, Spiritual Well-Being and the Quality of Life, in Loneliness: a Sourcebook of Current Theory, Research and Therapy. Peplau LA, Perlman DE (Eds). Wiley Interscience, NY, USA 224–237 (1982).
- 149 Belcher AE, Dettmore D, Holzemer SP: Spirituality and sense of well-being in persons with AIDS. Holist. Nurs. Pract.3,16–25 (1989).
- 150 Reed PG: Spirituality and well-being in terminally ill hospitalized adults. Res. Nurs. Health10,335–344 (1987).
- 151 Stewart C, Koeske GF: A preliminary construct validation of the multidimensional measurement of religiousness/spirituality instrument: a study of southern USA samples. Int. J. Psychol. Relig.16,181–196 (2006).• Helpful review of the multidimensional assessment of spirituality and instrument validation.
- 152 Underwood LG, Teresi JA: The daily spiritual experience scale: development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Ann. Behav. Med.24,22–33 (2002).
- 153 Gesser G, Wong PTP, Reker GT: Death attitudes across the life span: development and validation of the death attitude profile. Omega18,113–128 (1987).
- 154 Van de Creek L, Benes S, Nye C: Assessment of pastoral needs among medical outpatients. J. Pastoral. Care47,44–53 (1993).
- 155 Van de Creek L, Frankowski D, Ayres S: Use of the threat index with family members waiting during surgery. Death Stud.18,641–648 (1994).
- 156 Fortin AH, Barnett KG: Medical school curricula in spirituality and medicine. JAMA291,2883 (2004).
- 157 Lee BY, Newberg AB: The Interaction of Religion and Health, in Integrative Psychology. Monti DA, Beitman BD (Eds). Oxford University Press, NY, USA 408–444 (2009).• Good review of the interaction of religion and health.
- 158 Townsend M, Kladder V, Ayele H, Mulligan T: Systematic review of clinical trials examining the effects of religion on health. South Med. J.95,1429–1434 (2002).
- 159 Powell LH, Shahabi L, Thoresen CE: Religion and spirituality. Linkages to physical health. Am. Psychol.58,36–52 (2003).
- 160 Tanyi RA: Towards clarification of the meaning of spirituality. J. Adv. Nurs.39,500–509 (2002).
- 161 Berry D: Methodological pitfalls in the study of religiosity and spirituality. West. J. Nurs. Res.27,628–647 (2005).
- 162 Boehnlein JK: Psychiatry and Religion: the Convergence of Mind and Spirit. American Psychiatric Press, DC, USA (2000).
- 163 Poloma MM, Pendleton BF: The effects of prayer and prayer experience on measures of general well-being. J. Psychol. Theol.19,71–83 (1991).
- 164 Jantos M, Kiat H: Prayer as medicine: how much have we learned? Med. J. Aust.186,S51–S53 (2007).
- 165 Benson H: Timeless Healing: the Power and Biology of Belief. The Gale Group, NY, USA (1997).
- 166 Nigosian SA: World Faiths (Second Edition). St Martin’s Press, NY, USA (1994).
- 167 Finnegan DG, McNally EB: Defining God or a Higher Power: the Spiritual Center of Recover, in Spirituality and Chemical Dependency. Kus RJ (Ed.). The Haworth Press, NY, USA 39–48 (1995).
- 168 Pearce MJ, Rivinoja CM, Koenig HG: Spirituality and health: empirically based reflections on recovery. Recent Dev. Alcohol18,187–208 (2008).
- 169 Galanter M: Spirituality, evidence-based medicine, and alcoholics anonymous. Am. J. Psychiatry165,1514–1517 (2008).
- 170 Latovich MA: The Clergyperson and the Fifth Step, in Spirituality and Chemical Dependency. Kus RJ (Ed.). The Haworth Press, NY, USA 79–89 (1995).
- 171 Eisenberg DM, Davis RB, Ettner S et al.: Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA280,1569–1575 (1998).
- 172 Ivanovski B, Malhi GS: The psychological and neurophysiological concomitants of mindfulness forms of meditation. Acta Neuropsychiatrica19,76–91 (2007).
- 173 McLemore C: The Scandal of Psychotherapy. Tyndale House, IL, USA (1982).
- 174 Solberg EE, Berglund KA, Engen O, Ekeberg O, Loeb M: The effect of meditation on shooting performance. Br. J. Sports Med.30,342–346 (1996).
- 175 Domino G: Transcendental meditation and creativity: an empirical investigation. J. Appl. Psychol.62,358–362 (1977).
- 176 Allen NB, Chambers R, Knight W: Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations. Aust. NZ J. Psychiatry40,285–294 (2006).
- 177 Rothwell N: The different facets of mindfulness. J. Rat. Emot. Cog. Behav. Ther.24,79–86 (2006).
- 178 Kabat-Zinn J: Mindfulness meditation: what is, what it isn’t and its role in healthcare and medicine. In: Comparative and Psychological Study on Meditation. Haruki Y (Ed.). Eubron, The Netherlands (1996).
- 179 Kabat-Zinn J: Wherever You Go, There You Are. Hyperion, NY, USA (1994).
- 180 Shapiro SL, Carlson LE, Astin JA, Freedman B: Mechanisms of mindfulness. J. Clin. Psychol.62,373–386 (2006).
- 181 Ledesma D, Kumano H: Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology18,571–579 (2009).
- 182 Fang CY, Reibel DK, Longacre ML, Rosenzweig S, Campbell DE, Douglas SD: Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity. J. Altern. Complement. Med.16(5),531–538 (2010).
- 183 Koszycki D, Benger M, Shlik J, Bradwejn J: Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behav. Res. Ther.45,2518–2526 (2007).
- 184 Plews-Ogan M, Owens JE, Goodman M, Wolfe P, Schorling J: A pilot study evaluating mindfulness-based stress reduction and massage for the management of chronic pain. J. Gen. Intern. Med.20,1136–1138 (2005).
- 185 Ernst S, Welke J, Heintze C et al.: Effects of mindfulness-based stress reduction on quality of life in nursing home residents: a feasibility study. Forsch Komplementmed15,74–81 (2008).
- 186 Roth B, Robbins D: Mindfulness-based stress reduction and health-related quality of life: findings from a bilingual inner-city patient population. Psychosom. Med.66,113–123 (2004).
- 187 Forge RL: Aligning mind and body: exploring the disciplines of mindful exercise. ACSM Health Fitness J.9,7–14 (2005).
- 188 Khalsa SB: Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J. Physiol. Pharmacol.48,269–285 (2004).
- 189 Chou KL, Lee PW, Yu EC et al.: Effect of Tai Chi on depressive symptoms amongst Chinese older patients with depressive disorders: a randomized clinical trial. Int. J. Geriatr. Psychiatry19,1105–1107 (2004).
- 190 Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ et al.: Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J. Affect Disord.57,255–259 (2000).
- 191 Lavey R, Sherman T, Mueser TK, Osborne DD, Currier M, Wolfe R: The effects of yoga on mood in psychiatric inpatients. Psychiatr. Rehabil. J.28,399–402 (2005).
- 192 Meeks TW, Wetherell JL, Irwin MR, Redwine LS, Jeste DV: Complementary and alternative treatments for late-life depression, anxiety, and sleep disturbance: a review of randomized controlled trials. J. Clin. Psychiatry68,1461–1471 (2007).
- 193 Rani NJ, Rao PVK: Impact of yoga training on body image and depression. Psychol. Stud.50,98–100 (2005).
- 194 Rohini V, Pandey RS, Janakiramaiah N, Gangadhar BN, Vedamurthachar A: A comparative study of full and partial Sudarshan Kriya Yoga (SKY) in major depressive disorder. Nimhans J.18,53–57 (2000).
- 195 Sharma VK, Das S, Mondal S, Goswampi U, Gandhi A: Effect of Sahaj Yoga on depressive disorders. Indian J. Physiol. Pharmacol.49,462–468 (2005).
- 196 Tsang HW, Fung KM, Chan AS, G Lee, Chan F: Effect of a qigong exercise programme on elderly with depression. Int. J. Geriatr. Psychiatry21,890–897 (2006).
- 197 Tsang HW, Mok CK, Au Yeung YT, Chan SY: The effect of qigong on general and psychosocial health of elderly with chronic physical illnesses: a randomized clinical trial. Int. J. Geriatr. Psychiatry18,441–449 (2003).
- 198 Pilkington K, Kirkwood G, Rampes H, Richardson J: Yoga for depression: the research evidence. J. Affect Disord.89,13–24 (2005).
- 199 Sjosten N, Kivela SL: The effects of physical exercise on depressive symptoms among the aged: a systematic review. Int. J. Geriatr. Psychiatry21,410–418 (2006).
- 200 Rogers CE, Larkey LK, Keller C: A review of clinical trials of Tai Chi and qigong in older adults. West. J. Nurs. Res.31,245–279 (2009).
- 201 Chattha R, Nagarathna R, Padmalatha V, Nagendra HR: Effect of yoga on cognitive functions in climacteric syndrome: a randomised control study. BJOG115,991–1000 (2008).
- 202 Young JD, Taylor E: Meditation as a voluntary hypometabolic state of biological estivation. News Physiol. Sci.13,149–153 (2001).
- 203 Jevning R, Wallace RK, Beidebach M: The physiology of meditation: a review. A wakeful hypometabolic integrated response. Neurosci. Biobehav. Rev.16,415–424 (1992).
- 204 Cahn BR, Polich J: Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychol. Bull.132,180–211 (2006).
- 205 Rai UC, Seti S, Singh SH: Some effects of Sahaja Yoga and its role in the prevention of stress disorders. J. Int. Med. Sci.19–23 (1988).
- 206 Solberg E, Ingjer F, Ekberg O, Holen A, Standal PA, Vikman A: Blood pressure and heart rate during meditation. J. Psychosom. Res.48,283–1283 (2000).
- 207 Sudsuang R, Chentanez V, Veluvan K: Effect of Buddhist meditation on serum cortisol and total protein levels, blood pressure, pulse rate, lung volume and reaction time. Physiol. Behav.50,543–548 (1991).
- 208 Travis F, Tecce JJ, Guttman J: Cortical plasticity, contingent negative variation, and transcendent experiences during practice of the transcendental meditation technique. Biol. Psychol.55,41–55 (2000).
- 209 Peng CK, Mietus JE, Liu Y, Khalsa G, Douglas PS, Benson H, Goldberger AL: Exaggerated heart rate oscillations during two meditation techniques. Int. J. Cardiol.70,101–107 (1999).
- 210 Solberg EE, Holen A, Ekeberg O, Osterud B, Halvorsen R, Sandvik L: The effects of long meditation on plasma melatonin and blood serotonin. Med. Sci. Monit.10,CR96–CR101 (2004).
- 211 Solberg EE, Ekeberg O, Holen A, Osterud B, Halvorsen R, Vikman A: Melatonin and serotonin during meditation. J. Psychosom. Res.48,268–269 (2000).
- 212 Harinath K, Malhotra AS, Pal K et al.: Effects of Hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J. Altern. Complement. Med.10,261–268 (2004).
- 213 Massion AO, J Teas, Hebert JR, Wertheimer MD, Kabat-Zinn J: Meditation, melatonin and breast/prostate cancer: hypothesis and preliminary data. Med. Hypotheses44,39–46 (1995).
- 214 Tooley GA, Armstrong S M, Norman TR, Sali A: Acute increases in night-time plasma melatonin levels following a period of meditation. Biol. Psychol.53,69–78 (2000).
- 215 Walton KG, Pugh ND, Gelderloos P, Macrae P: Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism. J. Altern. Complement. Med.1,263–283 (1995).
- 216 Bujatti M, Riederer P: Serotonin, noradrenaline, dopamine metabolites in transcendental meditation-technique. J. Neural. Transm.39,257–267 (1976).
- 217 Chiesa A, Serretti A: A systematic review of neurobiological and clinical features of mindfulness meditations. Psychol. Med.40,1239–1252 (2010).
- 218 Rubia K, Smith AB, Halari R et al.: Disorder-specific dissociation of orbitofrontal dysfunction in boys with pure conduct disorder during reward and ventrolateral prefrontal dysfunction in boys with pure ADHD during sustained attention. Am. J. Psychiatry166,83–94 (2009).
- 219 Brefczynski-Lewis JA, Lutz A, Schaefer HS, Levinson DB, Davidson RJ: Neural correlates of attentional expertise in long-term meditation practitioners. Proc. Natl Acad. Sci. USA104,11483–11488 (2007).
- 220 Aftanas LI, Golocheikine SA: Human anterior and frontal midline theta and lower a reflect emotionally positive state and internalized attention: high-resolution EEG investigation of meditation. Neurosci. Lett.310,57–60 (2001).
- 221 Aftanas LI, Golocheikine SA: Non-linear dynamic complexity of the human EEG during meditation. Neurosci. Lett.330,143–146 (2002).
- 222 Aftanas LI, Golocheikine SA: Linear and non-linear concomitants of altered state of consciousness during meditation: high resolution EEG investigation. Int. J. Psychophysiol.45,158–1158 (2002).
- 223 Newberg A, Alavi A, Baime M, Pourdehnad M, Santanna J, d’Aquili E: The measurement of regional cerebral blood flow during the complex cognitive task of meditation: a preliminary SPECT study. Psychiatry. Res.106,113–122 (2001).
- 224 Aftanas LI, Golocheikine SA: Changes in cortical activity in altered states of consciousness: the study of meditation by high-resolution EEG. J. Hum. Physiol.29,143–151 (2003).
- 225 Farb NA, Segal ZV, Mayberg H, Bean J, McKeon D,Fatima Z, Anderson AK: Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Soc. Cogn. Affect Neurosci.2,313–322 (2007).
- 226 Lou HC, Kjaer TW, Friberg L, Wildschiodtz G, Holm S, Nowak M: A 15O-H2O PET study of meditation and the resting state of normal consciousness. Hum. Brain Mapp.7,98–105 (1999).
- 227 Kjaer TW, Bertelsen C, Piccini P, Brooks D, Alving J, Lou HC: Increased dopamine tone during meditation-induced change of consciousness. Brain Res. Cogn. Brain Res.13,255–259 (2002).