This qualitative study aims to explore how clinical psychologists in Singapore integrate religious or spiritual (R/S) factors into the case formulation of R/S clients. In-depth interviews were conducted with 12 clinical psychologists working across various child and adult mental health services in Singapore. Participants completed at least a 2-year master's program in clinical psychology and are eligible for registration as practitioner psychologists with the Singapore Psychological Society. Participants were allowed to self-select into the study if they had prior experience working with R/S clients who identified as Buddhists, Christians, Muslims, Hindus, or were spiritual but without religious affiliation. Interviews were transcribed and analyzed using the reflexive thematic analysis approach and three themes were identified: (a) working through personal discomfort with R/S integration, (b) weighing functional trade-offs of clients' R/S beliefs and practices, and (c) leveraging clients' R/S resources in treatment planning, which include thought reframing, behavioral activation, and deference to R/S leaders and the community for more specific R/S knowledge. This study has implications for which R/S domains psychologists should consider critical for case formulation and the R/S competencies needed in psychology graduate curricula.
Muslims living in the United States (MLUS) are a heterogeneous group, but few studies have examined whether experiences related to their race contribute to psychological distress. Expectancy violation theory postulates that when information about an individual violates stereotype-based expectations, reactions from others are often more extreme. As less than 3% of Black persons in the United States are Muslim, being Black and Muslim might violate others' expectations and lead to more discrimination. This study investigated whether MLUS who identify as Black, Afro-Caribbean, or African report experiencing greater discrimination and Islamophobia, and consequently greater distress, relative to South Asian and Middle Eastern/North African MLUS. Participants included 203 MLUS recruited via Qualtrics who identified as Black (n = 70), Middle Eastern/North African (n = 47), or South Asian (n = 86). Primary analyses utilized path analysis. Supporting expectancy violation theory and our hypotheses, Black Muslims reported experiencing more discrimination (on the Everyday Discrimination Scale) and Islamophobia (on the Perceived Islamophobia Scale) compared with South Asian and Middle Eastern/North African Muslims, when controlling for gender, age, and immigration status. Interestingly, being Black was not directly associated with distress, but being Black was associated with distress indirectly through discrimination and Islamophobia. Our findings suggest that Black MLUS experience heightened discrimination and Islamophobia that places them at heightened risk for experiencing psychological distress compared with their non-Black Muslim counterparts. Future research should aim to better understand the nuanced interplay between racial identity, discrimination, and mental health among Muslims.
Religious value imposition is characterized by coercion or deception to alter a client's religious or spiritual beliefs/values, representing a violation of client autonomy. It should therefore be avoided by all psychotherapists. At the same time, much of the literature has arguably been overly cautious and conservative in its injunctions around avoiding imposition, breaching the content of religious and spiritual discussions and interventions in psychotherapy, rather than simply the context or tone. This has led to the discouragement of practices that are not inherently coercive or deceptive, such as using religious or spiritual interventions without the client's prior consent or discussing religion and spirituality before the client posits the topic. Such warnings arguably represent a double standard compared with other topics and may inhibit clinicians to the detriment of client welfare and multicultural sensitivity. Suggestions are given for more balance when addressing religion and spirituality.
The guidelines of the American Psychological Association (2017a, 2017b) discuss the importance of cultural competence when working with individuals of spiritually/religiously diverse backgrounds. However, little empirical research exists to determine whether some psychologists may be more competent to assess religious issues than others. This study seeks to determine whether the religious backgrounds of clinical psychologists affect their ability to accurately assess ritualistic behaviors in a highly religious group, Orthodox Jews. Ritualistic behaviors can occur both in the context of obsessive-compulsive disorder and in the context of normative religious observance. Therefore, psychologists' own religious backgrounds/religious knowledge may affect their abilities to accurately assess ritualistic behaviors in a religious context. Eighty-seven licensed clinical psychologists were recruited via Psychology Today and American Psychological Association's Division 42 LISTSERV. The psychologists were categorized in one of four groups: self-identified orthodox Jew, self-identified secular Jew, self-identified religious non-Jew, and self-identified secular non-Jew. Participants read three vignettes detailing obsessive-compulsive disorder, religious-based obsessive-compulsive disorder, and normative religious ritualistic behavior and answered questions exploring their diagnostic assessment of the individual. There was no significant difference in the accuracy of assessing obsessive-compulsive disorder and normative religious ritualistic behavior vignettes between groups. However, secular non-Jewish psychologists, as compared with religious non-Jewish psychologists, showed a significantly decreased ability to assess religious-based obsessive-compulsive disorder. Religious psychologists may have a greater ability to accurately assess religious issues and have greater religious competence than secular psychologists.
Core transformation (CT) is a manualized transdiagnostic intervention based on the assumption that all behavior arises from a person's positive intention that may lead them to a deep, meditative core state through a specific sequence of questions. Although CT does not require a person to have any spiritual beliefs, many people describe their encounter with core states as a spiritual experience. Our multicultural study evaluated the effectiveness of the CT protocol delivered via an online training scheme using a delayed treatment control. Using a quasiwaitlist control design, 25 trainee CT coaches led participants (N = 219) through two sessions of the CT protocol. Participants completed measures of emotional stability, positive and negative affect, depression, anxiety, stress, and spirituality at multiple time points, including at baseline and several weeks posttreatment. All outcome variables significantly improved over time, demonstrating the effectiveness of the CT protocol. CT also compared favorably with the results of other transdiagnostic interventions, including the universal protocol of cognitive behavioral therapy. Thus, CT is expected to be highly effective with clinical populations. Our findings suggest that CT accesses a secular analog of deep spiritual experience to transform unwanted thoughts, feelings, and behaviors in a counterconditioning model.
The study explored the impact of Quranic recitation as a spiritually based intervention on maternal anxiety and related outcomes in Muslim women undergoing cesarean section. Seventy full-term pregnant self-identified Muslim women were randomly assigned to either an intervention group or a control group (n = 35 each). The intervention group listened to a recitation of Surah Maryam, chosen for its relevance to childbirth and spiritual resonance within Islamic teachings, via headphones during surgery. The control group received standard care without any additional auditory input. Outcome measures included maternal anxiety (assessed using the State-Trait Anxiety Inventory and Visual Analog Scale for Anxiety), hemodynamic stability, maternal satisfaction, neonatal Apgar scores, and select biological markers. Compared to the control group, the intervention group showed significantly reduced anxiety (State-Trait Anxiety Inventory: 41.71 vs. 55.45; Visual Analog Scale for Anxiety: 2.97 vs. 7.51; both p < .001), greater hemodynamic stability, higher maternal satisfaction (p < .001), and improved neonatal Apgar scores at 5 min (p = .03). No significant differences were observed in the biological markers. These findings support the effectiveness of Quranic recitation as a culturally congruent, nonpharmacological strategy to alleviate maternal anxiety and enhance delivery outcomes for self-identified Muslim women undergoing cesarean section through religious identity activation.
This article describes the qualitative responses to a national survey of 762 mental health educators concerning their experiences with integrating their personal religion/spirituality (RS) with their professional identity. The four overarching themes highlighting their experiences include (a) personal RS connecting to their role as a mental health professional/educator, (b) perceived support from their profession as it relates to RS, (c) challenges or considerations about integrating RS and professional identity, and (d) how their formal RS background ties into their professional identity. Implications for professional and curriculum development to support mental health educators' intersection of personal RS with professional identity are discussed.
The present study examined faculty development (FD) opportunities from a national online survey of full-time mental health graduate faculty teaching in accredited social work, psychology, marriage and family therapy, and counseling programs. This study utilized descriptive analyses and logistic regression to describe FD offerings in religious and spiritual (RS) competencies among faculty members' departments or universities and to identify programmatic and personal factors related to engagement in RS-related FD. Findings indicate nearly 85% of mental health educators do not receive RS-related FD and therefore must pursue these types of opportunities on their own. Further, the strongest predictor of receiving FD was taking a RS continuing education course of some kind, thereby highlighting the pivotal role of training in engagement with RS in professional contexts. Considerations for creating RS-related FD are discussed based on the preferences of the mental health educators included in the present study.
Religiosity and spirituality (R/S) are widely prevalent in the global population and have been associated with mental health outcomes. However, the R/S of mental health professionals and its implications for clinical practice remain understudied. To investigate the R/S of Brazilian psychologists and factors that predict professional beliefs and practice regarding R/S, a national online survey was conducted. Most of the 4,300 participants reported a religious affiliation (78.3%), belief that religion is beneficial for mental health (62%), and that they do consider R/S relevant to the treatment (65%). Only 24.2% of the sample reported having received training in R/S, but 68.3% want it. Psychologists' personal R/S and prior training influenced the recognition and handling of R/S in clinical practice. These results provide insight into the current state of R/S integration in psychological practice in Brazil.
Adversity impacts people not only psychologically, socially, and physically but spiritually as well. In times of stress, many people experience spiritual struggles, defined as tensions, strains, and conflicts about spiritual matters within oneself, with other people, and/or with the supernatural. In well over 100 empirical studies, spiritual struggles have been robustly linked to psychological problems. However, because much of the research on this topic has been cross-sectional, a key question remains: Are spiritual struggles the cause of psychological problems (the primary model of spiritual struggles), the effect of psychological problems (the secondary model of spiritual struggles), or both a cause and an effect of psychological problems (the complex model of spiritual struggles)? This article reviews emerging longitudinal research that examines this causal question and, more specifically, the three models of the causal relationship between spiritual struggles and psychological problems. The findings show the strongest support for the primary model of spiritual struggles (the model that has been tested most often). Research has also shown modest support for the secondary and complex models of spiritual struggles; however, more studies are needed before firm conclusions can be drawn. The article concludes with a discussion of the implications of these findings for further study and for practical work with people who are struggling spiritually.
This study introduces the Traditional Inventory of Islamic Virtues (TIIV), a psychometric tool developed to assess character grounded in classical Islamic virtue ethics. The TIIV builds upon the traditional Islamic virtues model (Keshavarzi et al., 2024), which provides a reorganization of al-& Imacr;j & imacr;'s 14th-century classification of virtues into five cardinal virtue: wisdom, temperance, valor, justice, and spirituality with 31 associated subvirtues. Data were collected from a diverse sample of 1,324 adults (M = 34 years, SD = 12) across 70 countries via an online survey. Using confirmatory factor analysis (CFA), two studies were conducted to evaluate the internal consistency and factor structure of the TIIV, as well as its convergent and divergent validity with the Values in Action (VIA) Inventory. The final model retained five factors with 121 items across 31 subvirtues. All five virtue domains demonstrated acceptable to excellent fit indices comparative fit index (CFI = .94-.98; root-mean-square error of approximation [RMSEA] = .05-.07) and acceptable to strong internal consistency (omega = .71-.89). Convergent validity was supported by significant correlations with 26 of 28 hypothesized VIA subscales. The TIIV appears to be a valid and reliable instrument for assessing virtues within an Islamic framework. While still in its initial stages, it offers a culturally grounded complement to existing character assessments and supports the integration of Islamic concepts in psychological research and practice.
Obsessive-compulsive disorder is often accompanied by shame, which can hinder disclosure and treatment. This is true for scrupulosity, a subtype of obsessive-compulsive disorder involving religious obsessions and compulsions, which affects 25% of those with obsessive-compulsive disorder, with 8% citing it as their primary concern. Treating scrupulosity is complex due to its varied manifestations, religious influences, and associated shame. Social support is linked to improved mental health and reduced shame, yet its role in scrupulosity remains unclear. This study examined how social support relates to scrupulosity through its impact on shame. Using a cross-sectional design, we collected online survey data from 355 religious individuals. Results of a mediation analysis indicated that social support is indirectly related to lower scrupulosity through lower levels of shame. Findings suggest that utilizing social support in the treatment of scrupulosity may be indirectly beneficial if it lowers shame. Clinicians should assess shame and consider how and when it is appropriate to incorporate social support into treatment.
Following interpersonal trauma, researchers have found that forgiveness plays an important yet nuanced role in promoting growth. While existing research has explored forgiveness in relationship to posttraumatic growth (PTG), the relationship between PTG and each of the three dimensions of forgiveness-to self, to others, and to situation-is underexplored. The purpose of this study was to examine the predictive nature of dispositional forgiveness as measured by three dimensions of forgiveness on PTG in order to better understand the growth process of interpersonal trauma. In this cross-sectional study, five hundred thirty-five adults from a community sample who reported experiencing interpersonal trauma completed the Posttraumatic Growth Inventory and the Heartland Forgiveness Scale to measure dispositional forgiveness with three subscales: forgiveness of self, others, and situations. Using a multiple linear regression analysis, forgiveness of self (p = .010, beta = .158) and situational forgiveness (p < .001, beta = .223) were both statistically significant predictors of PTG. However, forgiveness of others (p = .166, beta = .067) was not statistically significant. These findings highlight the importance of intentionally fostering forgiveness of self and situational acceptance in therapeutic interventions to promote clients' growth during trauma recovery. Mental health clinicians can better guide their clients toward PTG by encouraging self-compassion, situational understanding, and healthy relational choices, thereby empowering individuals to thrive after trauma.
Spiritual and religious (S/R) competence refers to the necessary knowledge, attitudes, and skills which mental health professionals need to acquire to work effectively and ethically with diverse clients. S/R competence is a growing area of research across mental health care fields, including applied clinical practice in psychology. The purpose of this scoping review was to collect and evaluate all available research studies investigating training in S/R competence, understand their effectiveness, and propose directions for future research of S/R competence training. There were a total of 15 studies that met the inclusion criteria for the review. The studies varied in terms of their target population (e.g., psychologists, counselors, social workers, and interprofessional) use of in-person versus online modalities, time length, content coverage, incorporation of established S/R competencies, assessment method, and outcomes across S/R knowledge, attitudes, skills, and satisfaction with training. Based on the available empirical studies, we provide a set of principles to guide future training and research of S/R competence in mental health care.
Obsessive-compulsive disorder (OCD) is a psychological disorder in which the presentation can be affected by cultural factors. The presentation of OCD involving religious or moral symptoms is termed scrupulosity. Because individuals with scrupulosity may have thoughts and feelings similar to thoughts and feelings that they believe come from deity, individuals with scrupulosity may experience significant confusion and distress. In this article, these constructs will be termed religious prompting confusion (RPC) and religious prompting distress (RPD). The purpose of this article is to examine the relationships between scrupulosity, RPC, RPD, general distress, and religiosity in a cross-sectional mediation model. A university sample (n = 720) completed measures through Sona Systems. To assess relationships between variables, bivariate correlations and two separate regression analyses were conducted. Scrupulosity obsessions and compulsions were associated with higher levels of RPC (obsessions: r = .49, p < .001; compulsions: r = .54, p < .001) and RPD (obsessions: r = .50, p < .001; compulsions: r = .62, p < .001). Contrary to hypotheses, only religiosity (beta = -.25, p < .001) and scrupulosity obsessions (beta = .53, p < .001) were significant predictors of distress. Finally, RPC was found to partially mediate the relationship between scrupulosity compulsions and RPD (indirect beta = .28, p < .001, 95% CI [.23, .33]) and fully mediate the relationship between scrupulosity obsessions and RPD (indirect beta = .18, p < .001, 95% CI [.14, .23]). The results of this study highlight the importance of RPC and RPD in understanding and treating scrupulosity, highlight important differences between scrupulosity obsessions and compulsions and RPD and general distress, and clarify the relationship between scrupulosity, religiosity, and general distress.
This study aimed to compare the effectiveness of Islamic trauma-focused cognitive behavioral therapy (ITF-CBT) and standard trauma-focused cognitive behavioral therapy (TF-CBT) in reducing posttraumatic stress disorder (PTSD) symptoms among Muslim survivors of the 2023 Kahramanmara & scedil; earthquakes. A controlled design was employed, with 45 participants randomly assigned to one of three groups: ITF-CBT (n = 15), TF-CBT (n = 15), and a control group (n = 15). Participants underwent 12 weekly one-on-one online therapy sessions. PTSD symptoms were assessed at three time points (pre-, mid-, and postintervention) using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PCL-5). Exploratory analyses examined the influence of age, gender, education, and employment status on therapeutic outcomes. A repeated measures analysis of variance revealed a significant Time x Group interaction (p < .001), indicating that symptom reduction patterns differed across treatment conditions. Both ITF-CBT and TF-CBT groups showed significant reductions in PTSD symptoms over time, while the control group showed minimal change. Descriptive effect size estimates suggested a large effect when comparing ITF-CBT to TF-CBT (Cohen's d = -1.66) and a very large effect when comparing ITF-CBT to the control group (Cohen's d = -4.39). Exploratory analysis suggested that gender, education, and employment status may moderate symptom reduction, with females, higher educated, and employed participants showing more pronounced improvements. These findings support the utility of culturally adapted trauma interventions, with ITF-CBT appearing particularly beneficial for highly religious Muslim populations in postdisaster settings.
We assessed religious belief salience and its association across multicultural competencies, social justice, and faith maturity within a graduate trainee population to understand its impact on therapeutic implications. Participants (N = 227) were recruited through training directors of accredited American Psychological Association, Council for Accreditation of Counseling and Related Educational Programs, and Masters in Psychology and Counseling Accreditation Council programs. The Religious Belief Salience Scale (Blaine & Crocker, 1995), Multicultural Counseling Knowledge and Awareness Scale (Ponterotto et al., 2002), Social Justice Scale (SJS; Torres-Harding et al., 2012), and Horizontal Subscale of the Faith Maturity Scale (Benson et al., 1993) all reached acceptable alpha and omega levels. Using regression procedures, religiosity was found to be significantly related with Multicultural Counseling Knowledge and Awareness Scale awareness (p < .001, R-2 = .08), SJS attitudes (p < .001, R-2 = .06), SJS perceived behavioral control (p = .003, R-2 = .04), and SJS intentions (p < .001, R-2 = .06). However, the results indicated little practical significance. Religiosity was, also, found to not be significantly related to faith maturity (p = .414), yielding no practical significance. Findings suggest further research is needed to observe the murkiness across religiosity, social behavior, and prejudice.
Substance addiction represents a multifaceted and widespread issue that impacts individuals across diverse cultural and social contexts. While extensive research has been conducted to elucidate the etiological factors and intervention strategies for addiction, there has been a relative dearth of scholarly work that has employed a Buddhist framework to explore this phenomenon. This is noteworthy given that Buddhism, as a religion, psychology, and philosophy, influences millions of individuals worldwide. To address this gap, the present article investigates early Buddhist scriptures, specifically the Pali Canon, to develop two conceptual models for understanding addiction from a Buddhist perspective. The first model, the "Clinging Model of Addiction," is derived from the core Buddhist teachings regarding the root causes of suffering, namely, the tendency to cling to a sense of self. The second model, the "Purification and Environment Model of Addiction Intervention," outlines a Buddhist approach to intervention, emphasizing the dual processes of purifying the internal environment through ethical, mental, and wisdom-based practices, as well as harnessing the empowerment derived from the external environment. By integrating these contemplative insights and frameworks from the Buddhist tradition, the authors propose that novel perspectives and directions for research and clinical practice in the addiction domain may be uncovered. This endeavor holds promise for enhancing our understanding and treatment of substance use disorders through the lens of key Buddhist principles, such as nonself, impermanence, and compassion.
Anomalous experiences-perceived in many cultures as extraordinary, transcendental, or paranormal events-are increasingly approached through the practice of "normalization" within academic and clinical settings. This reflection essay draws on a critical review of pertinent social scientific literature on these experiences to examine the risks associated with this trend and argue that while different forms of normalization can reduce stigma, it might also undermine the subjective significance of percipients' accounts, stifle scientific inquiry, and perpetuate cultural biases. Treating these reports primarily as psychological or sociocultural phenomena risks invalidating percipients' interpretations and potentially alienating them. Moreover, such framing limits the exploration of anomalous experiences as data that could challenge existing scientific paradigms, constraining innovation, and reinforcing Western materialist views over diverse cultural perspectives. On a clinical level, normalization can also paradoxically delay or obscure diagnoses and thus prevent individuals from receiving effective interventions for distressing or pathological conditions. A balanced approach is recommended via a proposed "From Stigma to Support Decision-Tree" that integrates cultural sensitivity with clinical vigilance and maintaining openness to the potentially profound implications of anomalous experiences, thereby fostering a more comprehensive understanding of their meaning for human consciousness and well-being.
