K. Facilitate Social and Spiritual Support

BACKGROUND

Social support will be critical for helping the individual cope after a trauma has occurred. It may be necessary to identify potential sources of support and facilitate support from others (e.g., partners, family, friends, work colleagues, and work supervisors).
Hunter (1996) notes the need for integrated care for PTSD: “given the complex range of PTSD symptomatology, a successful treatment program will address not only the emotional issues that characterize the disorder but also its psychophysiological, cognitive, and interpersonal processes and existential meanings.”

The terms “religious” and “spiritual” are both used in the clinical literature to refer to beliefs and practices to which individuals may turn for support following a traumatic event? Some researchers have attempted to differentiate between organized practices such as “attendance at services and other activities” and non-organized practices, including “prayer and importance of religious and spiritual beliefs” (Strawbridge et al., 1998). Because the terms are so closely related, and because researchers in this area have not consistently differentiated between the two concepts, the reader should assume that in the discussion below we refer to religion/spirituality in the general sense and not in any specific terms.

RECOMMENDATION

1. Preserve an interpersonal safety zone protecting basic personal space (e.g., privacy, quiet, personal effects).
2. Provide nonintrusive ordinary social contact (e.g., a "sounding board," judicious use of humor, small talk about current events, silent companionship)
3. Provide opportunities for grieving for losses. Provide access to religious/spiritual resources when sought. (Providing space and opportunities for prayers, mantras, rites and rituals and end-of-life care as determined important by the patient).
4. Consider providing direct spiritual care or ensuring patient access to spiritual care when sought.

DISCUSSION

Religion may provide a framework by which survivors of trauma construct a meaningful account of their experience, and may be a useful focus for intervention with trauma survivors.

Religion-seeking is an observed post-traumatic phenomenon:

There is a large body of anecdotal literature documenting the propensity of individuals to seek religious/spiritual comfort following a traumatic event. The terrorist attacks of September 11, 2001 provide a recent instance of this phenomenon. Bell Meisenhelder (2002) notes “the events of September 11, 2001 triggered a widespread national response that was two-fold: a posttraumatic stress reaction and an increase in attendance in religious services and practices immediately following the tragic events.” Schuster and his colleagues performed a nationwide phone survey of 569 adults within a week of the event (2001), and found that “forty-four percent of the adults reported one or more substantial stress symptoms; 91 percent had one or more symptoms to at least some degree. Respondents throughout the country reported stress syndromes. They coped by talking with others (98 percent), turning to religion (90 percent).”

The role of the Chaplain:

Recent research on cognitive processes in victimization indicates that major changes in an individual’s basic life assumptions may occur following a traumatic event. These assumptions involve the security and meaningfulness of the world and the individual’s sense of self-worth in relation to perception of the environment (Janoff-Bulman, 1979). Specifically, these assumptions are: (1) that one’s environment is physically and psychologically safe; (2) that events are predictable, meaningful and fair; (3) that one’s own sense of self-worth is positive in relation to experiences with other people and events (Hunter, 1996).

The Chaplain may play an important role in helping individuals regain a sense that their basic life assumptions are true. Chaplains receive training in a wide variety of supportive techniques, and they stand ready to assist all individuals, including those who do not subscribe to an organized religion. Chaplains may provide assistance in one or more of the following ways:

• Organizing and mobilizing community action
• Providing education and consultation with advice for leaders
• Assisting in the mobilization of action plans and recovery processes
• Offering facilitation of adaptation and mastery in social change
• Assisting in the development of community networks
• Supporting the development of a positive recovery organization
• Serving as a source of communication
• Fostering community theater and art geared to encouraging working through and recovery from the trauma.

Providing space and opportunities for prayers, mantras, rites and rituals and end-of-life care as determined important by the patient is another important contribution of the Chaplain. (Canda and Phaobtong, 1992; Lee, 1997).

Demonstrated benefits of the practice: religious/spiritual care:

Baldacchino and Draper (2001) conducted a literature review of 187 articles on spirituality and health published between 1975 and 2001. They found that while most of the studies presented only anecdotal evidence, five studies did focus on spiritual coping strategies used in various illnesses. They conclude, “research suggests that spiritual coping strategies, involving relationship with self, others, Ultimate other/God or nature were found to help individuals to cope with their ailments. This may be because of finding meaning, purpose and hope, which may nurture individuals in their suffering.” They further conclude, “the onset of illness may render the individual, being a believer or nonbeliever to realize the lack of control over his/her life. However the use of spiritual coping strategies may enhance self-empowerment, leading to finding meaning and purpose in illness.” While these studies did not specifically address PTSD, this condition is often characterized by a feeling of lack of control, and thus spirituality may be seen to be an appropriate control-seeking response.

Humphreys et al. (2001) surveyed a convenience sample of 50 women in a battered women’s shelter; 39% of whom had been diagnosed with PTSD. They report “when we analyzed biopsychosocial variables, we saw beneficial effects of support (financial, social, spiritual). These findings reinforce the need to enhance the resources of battered women, to help them identify existing opportunities, and to fortify self-caring strategies that give them strength.” Calhoun et al. (2000) designed a study to examine “the degree to which event related rumination, a quest orientation to religion, and religious involvement is related to posttraumatic growth.” In this descriptive study of 54 young adults who had experienced a traumatic event, “the degree of rumination soon after the event and the degree of openness to religious change were significantly related to Posttraumatic Growth. Congruent with theoretical predictions, more rumination soon after the event, and greater openness to religious change were related to more posttraumatic growth.”

Nixon et al. (1999) conducted a descriptive study of 325 Oklahoma City firefighters following the bombing of the Alfred P. Murrah Federal Building. They report “of particular importance in this analysis was the finding that support from ‘faith’ was a primary predictor of positive outcome and positive attitude over the one-year period.” They did find, however, that the helpful effect of faith was more pronounced among younger firefighters. Thus it remains to be seen whether religious/spiritual counseling is equally effective for all age groups.

Not all researchers have found religiosity/spirituality to be helpful in stressful situations. Strawbridge and his colleagues used a large public health survey to investigate “associations between two forms of religiosity and depression as well as the extent to which religiosity buffers relationships between stressors and depression” (1998). The authors defined “non-organizational religiosity” as including prayer and spiritual beliefs, while “organizational religiosity” includes attendance at formal services and other activities. Strawbridge et al. found that “non-organizational religiosity” was not helpful in easing depression, and it exacerbated associations with depression for child problems. “Organizational religiosity” had a weak association with worsened depression, and it too exacerbated family-related problems. The authors conclude that “religiosity may help those experiencing non-family stressors, but may worsen matters for those facing family crises.”

It should be noted that none of the studies above provide direct evidence for religious/spiritual practices in reducing PTSD symptoms. The studies do, however, suggest that patients may find comfort and a sense of control resulting from religion/spirituality, and this may lead to an eventual reduction in PTSD symptoms.