Over 90% of American adults cite religion and spirituality as being important in their lives (Gallup & Lindsay, 1999
). When individuals confront adverse experiences, religious and spiritual resources can become especially salient as they are recruited to provide a framework for accepting and attributing meaning to those experiences (Park, 2005a
), and they are often shown to be helpful. For example, a meta-analysis of 147 studies revealed an inverse relationship between religiosity/spirituality and depressive symptoms in individuals facing stressful events (Smith, McCullough, & Poll, 2003
). However, the effects of religiousness and spirituality are complex; religion and spirituality are not invariably linked with better adjustment to stressful experiences (e.g., Park, 2005b
; Roff, Durkin, Sun, & Klemmack, 2007
; Tix & Frazier, 2005
). They may even prompt feelings of anger and disappointment, such as when one experiences events that violate one’s views of a loving God (Exline & Rose, 2005
; Nelson, Rosenfeld, Breitbart, & Galietta, 2002
). The overarching goal of the current set of studies was to investigate whether two specific facets of spirituality (i.e., faith and meaning/peace), as well as their joint effects, predict psychological adjustment in individuals who have faced cancer.
The cancer experience provides a unique opportunity for the study of spirituality and its relation to psychological outcomes in the face of adversity. In addition to experiencing the emotions attendant upon facing a life-threatening disease, cancer patients often are burdened by additional challenges, such as side effects of arduous treatments and fears of recurrence (Andrykowski, Curran, & Lightner, 1998
; Baker, Denniston, Smith, & West, 2005
; Cella, Lai, Chang, Peterman, & Slavin, 2002
). When confronted with such stressors, many cancer patients find comfort in religion/spirituality, which in some cases is associated with positive psychological outcomes (e.g., Feher & Maly, 1999
; Rippentrop, Altmaier, & Burns, 2006
). Overall, however, the literature demonstrates an inconsistent relationship of religion and spirituality with salutary outcomes in individuals with cancer (for reviews, see Stefanek, McDonald, & Hess, 2005
; Thuné-Boyle, Stygall, Keshtgar, & Newman, 2006
). One reason for disparate findings may be the range of ways in which religion and spirituality have been conceptualized and measured (Stefanek et al., 2005
). Researchers have variously assessed religious coping (i.e., how the individual is making use of religion to manage stressors), religious practices (i.e., engagement in faith-related traditions), and spiritual beliefs (e.g., beliefs in a power superior to oneself). Spirituality is a multidimensional construct, and therefore it is important to examine its component parts within the same study.
One potentially useful way to conceptualize spirituality is to regard it as independent of commitment to a specific religion or doctrine (Zinnbauer et al., 1997
). Peterman, Fitchett, Brady, Hernandez, and Cella (2002)
developed a self-report scale designed to measure spirituality in individuals with chronic disease. The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) assesses spiritual well-being based on two dimensions: meaning/peace reflects one’s sense of meaning and purpose in life, whereas faith involves perceived comfort derived from a connection to something larger than the self. Peterman et al. (2002)
found that the Faith subscale was correlated with existing measures of religiosity and spirituality (e.g., religious activity, intrinsic religiousness). In contrast, the Meaning/Peace subscale was not related to measures of religion but rather to measures that assessed peace and purpose in life, lending support to the argument that the Meaning/Peace subscale captures a facet of spirituality that is not strongly related to religiosity per se. Thus, this measure offers an approach to assessing both the religious and existential domains of spirituality.
Cross-sectional studies employing these scales in individuals with cancer have demonstrated that spirituality, and particularly the Meaning/Peace subscale, is associated with better quality of life (Brady, Peterman, Fitchett, Mo, & Cella, 1999
; Edmondson, Park, Blank, Fenster, & Mills, 2008
). Two studies revealed that overall spirituality was related to fewer depressive symptoms and better quality of life in individuals living with cancer or other illnesses (Krupski et al., 2006
; Nelson, et al., 2002
). Yet, when researchers examined the two domains of spirituality in regression analyses, higher meaning/peace was related to better quality of life, whereas higher faith was unrelated to outcomes (Krupski et al., 2006
; Nelson et al., 2002
). Thus, it appears that the ability to find and sustain meaning and peace amidst major health-related adversity is more protective against maladjustment than is religious faith (Krupski et al., 2006
; Nelson et al., 2002
). However, to determine causal priority in the links between specific aspects of spirituality and adaptive outcomes, longitudinal studies are critical.
The purpose of the current set of longitudinal studies was to investigate whether specific aspects of spirituality function as a resource for cancer survivors. In line with previous research, which suggests that the existential components of spirituality predict positive outcomes (Krupski et al., 2006
; Laubmeier, Zakowski, & Bair, 2004
; Nelson et al., 2002
), we hypothesized that a sense of meaning and peace would be more strongly linked to improvements in adjustment following cancer than would faith. We also sought to extend previous research by examining how meaning/peace and faith may operate jointly to predict adjustment to cancer. Perhaps attaining meaning and peace empowers individuals to transcend the stress associated with cancer, and religious faith promotes a reliance on their beliefs to help them through the disease (Bekelman et al., 2007
), such that high endorsement of both facets of spirituality would foster favorable outcomes. Another possibility is that a sole reliance on faith when confronting a stressful life event may eventually lead individuals to harbor negative beliefs toward their faith for allowing suffering (Exline & Rose, 2005
; Gall, 2004
; Gall & Cornblat, 2002
), prompting them to experience religious conflict or to feel disenchanted by their faith. Further, if high reliance on faith does not serve as a vehicle for successful attainment of meaning in life, then endorsement of faith might represent an unsatisfied search for a sense of meaning and peace (Steger, Frazier, Oishi, & Kaler, 2006
). Faith may be useful only to the extent that meaning/peace ultimately is achieved, leading us to hypothesize that high meaning/peace or the combination of high meaning/peace and high faith would be more likely to facilitate adjustment than would high faith in the context of low meaning/peace. We also explored whether change over time in meaning/peace or faith would predict change in adjustment, reasoning that an increase in spirituality would carry adaptive utility.