6 - (IOP 40) Addressing the Dark Side of Spirituality in Mental Health: A Longitudinal Investigation of Methods and Outcomes of Attending to Spiritual Struggles in Psychotherapy

Background/aims: Religion and spirituality (R/S) can be a powerful component of mental health in promoting meaning and connection, shaping health behaviors, and providing adaptive coping strategies (Pargament, 2007). On the other hand, R/S can be a source of strain and struggle, and numerous studies have demonstrated the deleterious impact of spiritual struggles on psychopathology (Pargament & Exline, 2022). Additionally, the presence of spiritual struggles at the beginning of treatment are predictive of worse outcomes and a slower rate of symptom improvement in treatment (Currier et al., 2019; Pearce & Koenig, 2016). Thus, it is important to understand and address spiritual struggles in psychotherapy to improve treatment outcomes. While a number of spiritually-integrated treatments and protocols to incorporate R/S strengths and struggles in treatment exist, the effects of specific interventions and outcomes for spiritual struggles have not been explored. Thus, this study aimed to identify effective interventions for spiritual struggles in psychotherapy that can be integrated into existing evidence-based treatments.

Methods: A national sample of adults were assessed within the first month of starting individual outpatient psychotherapy and at 3-month follow-up (N=175). Participants were assessed for symptoms of depression (PHQ-8), anxiety (GAD-7), positive well-being (Mental Health Continuum Short Form; MHC-SF), religious/spiritual struggles (Religious and Spiritual Struggles Scale; RSS-14), and types of interventions their clinician utilized to address spiritual struggles. 71% of the participants were cis female and 73% identified as heterosexual. 65% identified as White, 25% as Black, and 10% as Asian. The majority of participants identified as Christian (61%) with the next highest group identified as spiritual but not religious (14%).

Results: In total, 54.3% of the sample scored above clinical cutoff for depression or anxiety symptoms at Time 1. Bivariate analyses revealed that participants with spiritual struggles had greater depressive symptoms, anxiety, and lower rates of well-being at the 3-month time point. In particular, interventions such as exploring the relationship between S/R and presenting problems were associated with lower levels of spiritual struggles at the 3-month time point.

Conclusion: These results further support the need to address religious/spiritual issues in treatment, particularly to address relevant spiritual struggles in psychotherapy to improve treatment outcomes.