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Religious and Spiritual Struggles and Their Links to Psychological Adjustment: A Meta-Analysis of Longitudinal Studies

March 2021
Psychology of Religion and Spirituality 14(3)

March 2021
14(3)

DOI:10.1037/rel0000400

Authors:

Margaret Feuille Bockrath

Serena Wong

Lawson Health Research Institute

Valencia Harriott

Case Western Reserve University

Show all 8 authorsHide

In light of a growing body of longitudinal research on religious and spiritual (r/s) struggles and adjustment, a meta-analysis was conducted in order to synthesize literature on whether r/s struggles predict decrements in psychological adjustment over time. Multiple databases were searched for journal articles and dissertations reporting on studies that met inclusion criteria. For each study, necessary statistical information was extracted to calculate or estimate the standardized regression coefficient predicting follow-up psychological adjustment from baseline r/s struggles, controlling only for autoregressive effects. The search and screening process yielded 32 studies meeting inclusion criteria for which the necessary statistics were able to be extracted or obtained from study authors. Results indicated that r/s struggles significantly predicted increases in negative psychological adjustment (32 studies), Zr = 0.08, 95% CI [0.04, 0.10]. Results for positive psychological adjustment were non-significant (12 studies), Zr = −0.04, 95% CI [−0.11, 0.03]. These findings are consistent with a primary r/s struggles model in which r/s struggles lead to worsening psychological adjustment. This study underscores the importance of attending to spiritual struggles within clinical practice. Future studies on this topic could add to our understanding by examining longer time frames and testing secondary and complex models of the longitudinal relationship between r/s struggles and psychological adjustment.

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Religious and Spiritual Struggles and Their Links to Psychological Adjustment:

A Meta-Analysis of Longitudinal Studies

Margaret F. Bockrath

, Kenneth I. Pargament

, Serena Wong

, Valencia A. Harriott

, Julie M. Pomerleau

Steffany J. Homolka

, Zyad B. Chaudhary

, and Julie J. Exline

Mercy Health Family Medicine Residency Program, Toledo, Ohio, United States

Department of Psychology, Bowling Green State University

Department of Psychiatry, Psychology Division, Harbor-UCLA Medical Center

John D. Dingell VAMC, Detroit, Michigan, United States

Children’s Advocacy Center of Greater West Texas, San Angelo, Texas, United States

Department of Psychological Sciences, Case Western Reserve University

In light of a growing body of longitudinal research on religious and spiritual (r/s) struggles and adjustment, a

meta-analysis was conducted in order to synthesize literature on whether r/s struggles predict decrements in

psychological adjustment over time. Multiple databases were searched for journal articles and dissertations

reporting on studies that met inclusion criteria. For each study, necessary statistical information was

extracted to calculate or estimate the standardized regression coefﬁcient predicting follow-up psychological

adjustment from baseline r/s struggles, controlling only for autoregressive effects. The search and screening

process yielded 32 studies meeting inclusion criteria for which the necessary statistics were able to be

extracted or obtained from study authors. Results indicated that r/s struggles signiﬁcantly predicted

increases in negative psychological adjustment (32 studies), Z

=0.08, 95% CI [0.04, 0.10]. Results

for positive psychological adjustment were non-signiﬁcant (12 studies), Z

=−0.04, 95% CI [−0.11, 0.03].

These ﬁndings are consistent with a primary r/s struggles model in which r/s struggles lead to worsening

psychological adjustment. This study underscores the importance of attending to spiritual struggles within

clinical practice. Future studies on this topic could add to our understanding by examining longer time

frames and testing secondary and complex models of the longitudinal relationship between r/s struggles and

psychological adjustment.

Keywords: religion, spirituality, psychological adjustment, meta-analysis, longitudinal studies

Introduction

Although many studies of religion and spirituality (r/s) have

linked a variety of r/s expressions to indicators of psychological

adjustment (e.g., Koenig, King, & Carson, 2012), some aspects of

r/s may be more problematic. In the last 25 years, a growing body of

research has focused on one such form of r/s: r/s struggles. Many

studies have demonstrated robust ties between higher levels of r/s

struggles and lower levels of psychological adjustment (e.g., Abu-

Raiya, Pargament, Krause, et al., 2015;Currier et al., 2017;Ellison

& Lee, 2010;McConnell et al., 2015;Ogden et al., 2011). The

majority of this research, however, has been cross-sectional in

design, leaving unanswered questions about whether r/s struggles

may contribute to poorer adjustment over time. In this paper, we

present the results of a meta-analysis that focuses speciﬁcally on

longitudinal studies of r/s struggles and considers the degree to

which r/s struggles measured at baseline are predictive of changes in

adjustment over time.

Deﬁning and Measuring R/S Struggles

R/s struggles have been deﬁned as tensions, conﬂicts, and nega-

tive emotions around sacred matters (Exline, 2013;Pargament,

2007;Pargament et al., 2005). More speciﬁcally, r/s struggles

may be supernatural, intrapsychic, or interpersonal in nature; that

is, they may center around conﬂicts with supernatural forces, such as

God and the demonic, tensions within oneself about moral issues,

doubts about religion, questions of ultimate meaning, and conﬂicts

with other people about r/s issues.

A number of measures have been used to assess r/s struggles.

Some of these scales focus on speciﬁc types and contexts of r/s

struggles (e.g., struggling with particular life stressors). For exam-

ple, the Religious Conﬂict Scale assesses doubts about one’s

religion (Funk, 1958). The Penn Inventory of Scrupulosity

(Abramowitz et al., 2002) measures fears about having committed

sins and being punished by God. The Inventory of Complicated

Spiritual Grief (Burke et al., 2014) measures r/s struggles with the

divine and other people in the context of bereavement. Other scales

assess a wider range of r/s struggles. Bryant and Astin (2008)

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

This article was published Online First March 29, 2021.

Margaret F. Bockrath https://orcid.org/0000-0002-1616-4347

Serena Wong https://orcid.org/0000-0002-7837-6468

Valencia A. Harriott https://orcid.org/0000-0001-9654-3031

We are grateful for funding support from the John Templeton Foundation,

grants #36094 and #59916.

Correspondence concerning this article should be addressed to Margaret

F. Bockrath, Mercy Health Family Medicine Residency Program, 2200

Jefferson Avenue, Toledo, OH 43604, United States. Email: mfeuill@

bgsu.edu

Psychology of Religion and Spirituality

ISSN: 1941-1022 https://doi.org/10.1037/rel0000400

283

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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Although religion and spirituality often bring comfort and hope, people can also experience religious/spiritual (r/s) struggles in multiple domains: divine, demonic, moral, interpersonal, doubt-related, and ultimate meaning. This chapter explores how these types of r/s struggles could relate to challenges and opportunities associated with various aspects of the self-forgiveness process. Our primary aim is to provide a conceptual overview and to generate testable hypotheses, with the broader aim of providing a foundation for more systematic empirical work in the future. We will focus on three aspects of the self-forgiveness process: acknowledging one’s perceived wrongdoing and accepting responsibility, apology/repentance and making amends, and releasing unhelpful negative thoughts and emotions. Although there are many possible ways that challenges with self-forgiveness might lead to r/s struggles and vice versa, successful attempts to work through these challenges could promote relational healing and personal growth.