R/S Related to Specific Types of Trauma and Populations

Military personnel and veteran trauma

Author (date)	Baroody (2011)
Focus	R/S and trauma among veterans
Type of document	Book chapter; conceptual
Abstract highlights	Redefines the nature of the religious experiences of combat veterans; explores the religious nature of the personality changes within the soldiers; seeks to provide alternative interventions that may assist them in recovering a renewed sense of self, reintegrating back into the family system, and normalizing life within their home culture. Seeks to infuse hope into the therapeutic process, which can lead to resilience and a greater sense of well-being (shalom). Of 10 therapists working with Iraq veterans, none could recall when the subject of religion became a therapeutic issue or when clients talked about their faith in relationship to either primary or secondary trauma experienced as a result of deployments; typically, therapy centers on the effects of traumatic stress on their lives and the lives of their families. Explores why and how talk of or about religion in these sessions would be beneficial.

Author (date)	Bormann, Hurst, & Kelly (2013)
Focus	Mantram (sacred word) repetition and veterans with PTSD
Type of document	Empirical (qualitative)
Abstract highlights	Describes ways in which a Mantram Repetition Program (MRP) was used for managing PTSD symptoms in 65 outpatient veterans with PTSD who reported a total of 268 triggering events. Program included six weekly group sessions (90 min/wk) on how to (1) choose and use a mantram, (2) slow down thoughts and behaviors, and (3) develop one-pointed attention for emotional self-regulation. Interviews were conducted at three months post intervention as part of a larger randomized clinical trial; results indicated that the MRP was helpful in managing a wide range of emotional reactions. Content analysis of the reported outcomes resulted in 12 discreet categories, including relaxing and calming down, letting go of negative feelings, thinking clearly and rationally, diverting attention away from triggering events, focusing attention, refining mantram skills, dealing with sleep disturbances, coming back from flashbacks, slowing down, communicating thoughts and feelings more effectively, feeling in touch spiritually, and letting go of physical pain.

Author (date)	Bormann, Thorp, Wetherell, Golshan, & Lang (2013)
Focus	Meditation-based mantram intervention for veterans with PTSD
Type of document	Empirical (quantitative)
Abstract highlights	Explored the efficacy of a portable, private, meditation-based mantram intervention for veterans with chronic PTSD. Prospective, single-blind randomized clinical trial was conducted with 146 outpatient veterans diagnosed with military-related PTSD. Randomly assigned to either (a) medication and case management alone (i.e., tx-as-usual [TAU]), or (b) TAU augmented by a six-week group mantram repetition program (MRP + TAU). Total of 136 veterans (66 in MRP + TAU; 70 in TAU) completed posttreatment assessments; indicated significantly greater symptom reductions in self-reported and clinician-rated PTSD symptoms in the MRP + TAU compared with TAU alone; also reported significant improvements in depression, mental health status, and existential spiritual well-being. This is a nonpharmacological treatment that does not focus on trauma and has potential as a facilitator of exposure-based therapy or to enhance spiritual well-being.

Author (date)	Currier, Drescher, & Harris (2014)
Focus	Spiritual functioning among veterans seeking residential tx for PTSD
Type of document	Empirical (quantitative)
Abstract highlights	788 persons (194 Vietnam veterans in the VA; 194 matched men; 200 Iraq/Afghanistan veterans with PTSD; 200 younger but demographically matched controls) completed the Brief Multidimensional Measure of Religiousness and Spirituality (BMMRS). Compared to their control group counterparts, veterans from the two clinical samples endorsed weaker spirituality across nearly all dimensions assessed in the study (daily spiritual experiences, forgiveness, private practices, religious coping, organizational religiousness, values); veterans from these two eras largely did not differ from one another in their spiritual functioning. Spirituality factors were also generally correlated with PTSD symptom severity at the start of tx; greater forgiveness problems were uniquely linked with more symptomatology across both eras.

Author (date)	Currier, Kuhlman, & Smith (2015)
Focus	R/S and risk for suicide among veterans and other military populations
Type of document	Conceptual
Abstract highlights	Given the troubling suicide rates among military veterans and active-duty personnel and the potential for inclusion of R/S in treatment, there has been limited research and discussion of ethical challenges involved in integrating spirituality into preventive and tx interventions. Briefly summarizes supporting evidence for addressing spirituality in preventive and tx interventions with military populations, and introduces several ethical concerns that providers may need to consider as they attend to spiritual concerns among veterans and other military personnel who might be at risk for prematurely ending their lives.

Author (date)	Decker (2007)
Focus	Tx for combat trauma from a mystical/spiritual perspective
Type of document	Conceptual
Abstract highlights	Recovery from combat trauma may depend on discovering a personal meaning in the traumatic experience, in the war, and in civilian life. The term spirituality is traditionally reserved for the experience of prayer and worship but can be understood more broadly. Presents a rationale for the integration of the spirituality of combat and civilian life into the clinical tx of traumatic sequelae via a mystical perspective; spirituality may be viewed as either immanent or transcendent.

Author (date)	Flowers (2015)
Focus	Christian spirituality, PTG, and veterans
Type of document	Dissertation; empirical (qualitative)
Abstract highlights	Discusses the research question “What is it like for veterans who experience PTG in the aftermath of trauma through Christian spirituality?” Interviews with 10 war veterans focused on 7 patterns and 16 subpatterns as part of the process of PTG through Christian spirituality. Describes PTG as a continuous process, in which it took deliberate effort to move forward in positive ways; participants were self-directed and in constant search of complete wholeness and holistic healing; stated they needed the inclusion of Christian spirituality as part of the PTG process, and it was the key element in their moving forward.

Author (date)	Foy & Drescher (2015)
Focus	R/S, honor, moral injury, and trauma tx for military personnel and their families
Type of document	Conceptual; case study
Abstract highlights	When faced with combat experiences involving personal injury or the deaths of fellow soldiers and civilians, warriors may experience spiritual struggles about their combat traumas even while turning to God or a higher power for support. R/S can serve an important resource for making meaning of their own war experiences, as well as honoring fallen friends who made the ultimate personal sacrifice; however, for others R/S will become a casualty of their war experiences when morally injurious events are encountered in combat; moral injury refers to the psychosocial-spiritual consequence of involvement in events that violate deeply held moral beliefs. The concept of moral injury is useful in improving understanding of the negative spiritual consequences of combat and in tailoring spiritually based interventions to address them; identifies key R/S issues, both positive and negative; describes a spirituality and trauma group therapy module followed by a case study illustrating an approach to addressing combat-related changes in R/S.

Author (date)	Gubkin (2016)
Focus	R/S and the traumatizing experiences of combat
Type of document	Conceptual; case study
Abstract highlights	Combat demands significant levels of adaptation and resilience. Spirituality may be challenged by these experiences, and the soldier may be left both psychologically and spiritually wounded as a result. Incorporating spirituality into the healing process may help mend the wounds of combat soldiers, especially within an integrative tx framework. Spirituality and the impact of traumatizing combat experiences are discussed from a cultural perspective using the experiences of an Israeli soldier as an example.

Author (date)	Harris et al. (2011)
Focus	Spiritually integrated intervention for veterans exposed to trauma
Type of document	Empirical (quantitative)
Abstract highlights	Building Spiritual Strength (BSS) is an eight-session, spiritually integrated group intervention designed to address religious strain and enhance religious meaning making for military trauma survivors. Assesses the intervention’s effectiveness with veterans who have histories of trauma; participants were randomly assigned to a BSS group (n = 26) or a waitlist control group (n = 28). BSS participants showed statistically significant reductions in PTSD symptoms based on self-report measures.

Author (date)	Hasanovic & Pajevic (2015)
Focus	Religious moral beliefs (RMB), trauma severity, and PTSD among Bosnia and Herzegovina war veterans
Type of document	Empirical (quantitative)
Abstract highlights	Sought to determine the correlation of the level of RMB with trauma experiences and PTSD severity. 120 Bosnian war veterans divided into two equal groups, one with and one without PTSD. Religious moral beliefs were inversely related to trauma severity and presented PTSD symptoms. RMB may have a protective role in the mental health stability of severely traumatized war veterans.

Author (date)	Lanham & Pelletier (2013)
Focus	Christian R/S and healing from war trauma
Type of document	Book chapter; conceptual
Abstract highlights	Explores emotional healing from trauma, utilizing the application of spiritual interventions, positive coping strategies, and specific approaches for engaging the often emotionally guarded veteran; includes quotes from those who have made the conscious decision to add spiritual interventions into their healing experience. Discusses the benefit of reconnecting with “spiritual roots” and integrating one’s renewed spirituality with the reality of the past, resulting in a “new normal” for emotional stability and improvement in quality of life.

Author (date)	Oman & Bormann (2015)
Focus	PTSD, mantram repetition, and self-efficacy in veterans
Type of document	Empirical (quantitative)
Abstract highlights	Many military veterans with PTSD refuse or drop out of commonly used trauma-focused, evidence-based txs; research supports the value of spiritual components in diverse types of health care interventions. Investigated the effects of the Mantram Repetition Program (MRP) on self-efficacy for managing PTSD symptoms with 132 veterans with PTSD who were randomly assigned to case management plus MRP or to case management alone. MRP participants chose a short, sacred phrase from a spiritual tradition (e.g., “Jesus,” “Barukh attah Adonai,” “Om mani padme hum”), repeating the phrase silently throughout the day to interrupt unwanted thoughts and behaviors and to improve concentration and attention. MRP group self-efficacy means as well as tx effects showed linear weekly increases from baseline to post-intervention; tx effects on self-efficacy were significant and mediated tx effects on depression, mental health, spiritual well-being, satisfaction with physical health, and both self-reported and clinician-assessed PTSD symptoms.

Author (date)	Sherman, Harris, & Erbes (2015)
Focus	R/S, PTSD symptoms, and assessment of veterans
Type of document	Conceptual; case study
Abstract highlights	Many clinicians do not routinely assess or incorporate the R/S domain of functioning in psychological services. Describes a model for conceptualizing how trauma can affect spirituality by reviewing the possible consequences of each PTSD symptom cluster on clients’ belief systems and spiritual practices; specific implications for tx are described for each symptom cluster.

Author (date)	Tait, Currier, & Harris (2016)
Focus	Prayer, coping, and trauma disclosure in deployed US veterans of the Iraq and Afghanistan conflicts
Type of document	Empirical (quantitative)
Abstract highlights	Within six months of returning from combat zones, 110 veterans (80% men, average age 31, 93% Caucasian white, 53% Protestant and 29% Catholic, with an average 14.2 years of education) were assessed in terms of the ways in which the veterans utilized prayer as a means of coping with difficulties in life. Indicated that prayer for assistance was associated with fewer PTSD symptoms; prayer for calm and focus was inversely related to depressive symptoms; defer/avoid prayer was positively associated with depressive symptoms. Supports emerging ideas about prayer as a form of trauma disclosure and highlights the relevance of this approach in coping for veterans as they readjust to civilian life.

Author (date)	Tran, Kuhn, Walser, & Drescher (2012)
Focus	R/S, PTSD, and depressive symptoms in veterans
Type of document	Empirical (quantitative)
Abstract highlights	Community samples have identified positive and negative associations between R/S and depression; however, research on religiosity is lacking in the area of PTSD. Significant associations between religiosity, PTSD, and depressive symptoms were observed in veterans enrolled in PTSD residential treatment; contrary to the hypothesis, higher levels of extrinsic-social religious motivation were associated with lower severity of PTSD and depressive symptoms. A more negative concept of God was associated with higher severity of PTSD and depressive symptoms, whereas a more positive concept of God was associated with lower severity of depressive symptoms and was not significantly associated with PTSD symptoms.

Author (date)	Vujanovic, Niles, Pietrefesa, Schmertz, & Potter (2013)
Focus	Mindfulness, PTSD, and the tx of military veterans
Type of document	Conceptual
Abstract highlights	How might a practice that has its roots in contemplative traditions, seeking heightened awareness through meditation, apply to trauma-related mental health struggles among military veterans? Clinicians and researchers are increasingly using mindfulness in Western mental health tx programs; mindfulness is about bringing an attitude of curiosity and compassion to present experience. Discusses the integration of mindfulness with current empirically supported txs for PTSD.

Author (date)	Worthington & Langberg (2012)
Focus	Self-forgiveness in treating complex trauma and moral injury in former soldiers
Type of document	Conceptual
Abstract highlights	Being in the military, especially if deployed in combat or combat-potential settings, can create opportunities for self- condemnation occurring through moral injury or apart from and within the context of complex trauma. Moral injury is internal conflict due to doing or witnessing acts not in line with one’s morals. Complex trauma involves a prolonged history of subjection to totalitarian control and involves danger, stress, and inability to escape from the situation (e.g. combat situations). Military deployment might lead to self-condemnation due to moral failures by wrongdoing or when soldiers let down their peers and themselves. Active wrongdoing, moral failure, and failures of church- and culture-created religious expectations contribute. Soldiers need the skill of self-forgiveness through secular and religiously tailored programs delivered via psychoeducational groups, workbooks, or online.

Interpersonal trauma

Author (date)	Ahrens, Abeling, Ahmad, & Himman (2010)
Focus	R/S coping, well-being, and recovery from sexual assault
Type of document	Empirical (quantitative)
Abstract highlights	Examines predictors and outcomes of positive and negative religious coping among 100 sexual assault survivors who believed in God. African American survivors were more likely to use both forms of religious coping than were survivors from other ethnicities. Suggested that positive religious coping is related to higher levels of psychological well-being and lower levels of depression, whereas negative religious coping is related to higher levels of depression regardless of ethnicity. Only outcome where ethnicity makes a difference is PTG with a stronger relationship between positive religious coping and PTG among Caucasian survivors.

Author (date)	Barrett (2009)
Focus	Healing and relational trauma
Type of document	Book chapter; empirical (qualitative; longitudinal)
Abstract highlights	Exit and follow-up interviews of participants in a tx program based on the Collaborative Stage Model. Asked what they believed had changed in their lives and to what they attributed this change. Followed up six months and one year later, again asking whether they had maintained their changes and, if so, to what they attributed their changes. Some participants have been interviewed as long as 20 years after they left the program.

Author (date)	Baty (2012)
Focus	R/S in PTG of sexual trauma survivors
Type of document	Dissertation; empirical (qualitative)
Abstract highlights	Spirituality has been influential in the achievement of PTG for some survivors through meaning-making processes. A hermeneutic phenomenological method was used to gain understanding of how and why spirituality is helpful for some female CSA survivors and not others, and to gain knowledge about how spirituality is experienced as a key-contributing factor of PTG. 8 female CSA survivors (ages 30–70) participated in 30 days of daily prayer/meditation, journaling, and weekly focus group attendance (for 4 weeks) using the Being Delivered spirituality framework. All participants experienced spirituality-influenced PTG; 25% experienced most spirituality-related growth in the domain of connection with others; 25% experienced most growth in the domain of personal strength; 12.5% experienced growth in appreciation of life; 37.5% experienced most growth in spiritual change.

Author (date)	Bowland, Edmond, & Fallot (2013)
Focus	R/S coping and trauma symptoms in older survivors
Type of document	Empirical (quantitative)
Abstract highlights	43 spiritually distressed older women (ages 55–83) who had survived multiple types of interpersonal trauma participated in a spiritually focused group intervention designed to address spiritual struggles related to earlier abuse and to enhance spiritual coping. Hypothesized that the intervention would increase spiritual well-being and that R/S coping would mediate the relationship between the intervention and the outcomes of depression, posttraumatic stress, anxiety, somatic symptoms, and spiritual well-being. Results provide strong initial support for the importance of understanding the effect of negative R/S coping on depression and anxiety symptoms.

Author (date)	Bryant-Davis, Ullman, Tsong, & Gobin (2011)
Focus	Sexual assault, social support, and R/S coping in the recovery of African American women
Type of document	Empirical (quantitative)
Abstract highlights	Investigates the relationship between social support and R/S coping strategies and posttrauma symptoms in a sample of 413 African American female sexual assault survivors. Indicated that survivors with greater social support were less likely to endorse the symptoms of depression and PTSD; conversely, increased use of religious coping was related to greater endorsement of depression and PTSD symptoms.

Author (date)	Bryant-Davis & Wong (2013)
Focus	R/S coping and interpersonal trauma recovery
Type of document	Conceptual
Abstract highlights	Religious coping, spirituality, and faith-based approaches to trauma recovery include endorsement of beliefs, engagement in behaviors, and access to support from faith communities. Compared with negative religious coping, spirituality and positive religious coping have been associated with decreased psychological distress for survivors of child abuse, sexual violence, intimate partner violence, community violence, and war; research demonstrates increased use of positive religious coping among some survivors with higher rates of PTSD.

Author (date)	Elliott (1994)
Focus	Christian faith and the prevalence and sequelae of sexual abuse
Type of document	Empirical (quantitative)
Abstract highlights	Examines the impact of religious faith on the prevalence and long-term sequelae of CSA in a sample of 2,964 professional women. Examines impact of parents’ religious faith on prevalence rate; impact of sexual abuse on adult religious practices; religion as a mediating factor related to adult symptomatology.

Author (date)	Fallot & Blanch (2013)
Focus	R/S dimensions of IPV
Type of document	Conceptual
Abstract highlights	Explores a definition of trauma in the context of interpersonal violence and the impact of interpersonal trauma on psychological well-being. Explores R/S in the aftermath of trauma, including the place of R/S resources in trauma recovery and healing. Considers relationships between religious contexts and interpersonal violence, including the impact of religious abuse and the role of religious involvement in violence prevention. Recommendations are given for developing trauma-informed services and communities that reflect knowledge about religion, spirituality, violence, and trauma recovery.

Author (date)	Fowler & Hill (2004)
Focus	Social support, R/S, and coping among African American women survivors of IPV
Type of document	Empirical (quantitative)
Abstract highlights	Examines partner abuse, mental health, and coping in a sample of African American women survivors of partner abuse (N = 126). Investigates mediating effects of social support and spirituality, as culturally relevant factors in coping, on the relationships between partner abuse and both depression and PTSD symptoms. PTSD symptoms are significantly related to partner abuse after controlling for the effects of social support and spirituality.

Author (date)	Gall (2006)
Focus	R/S coping and life stress among adult survivors of CSA
Type of document	Empirical (quantitative)
Abstract highlights	101 adult survivors of CSA participated. Data on abuse descriptions, coping resources of social support, and general cognitive appraisal, spiritual coping, and current distress; spiritual coping was assessed in relation to a current negative life event. Spiritual coping predicted the current distress of adult survivors beyond the contribution of demographics, severity of abuse, cognitive appraisal, and support satisfaction; self-directed, active surrender and passive deferral significantly contributed to the prediction of anxious mood, while only spiritual discontent predicted depressive mood beyond the contribution of other factors. Negative forms of spiritual coping (e.g., spiritual discontent) tend to be related to greater distress, while more positive forms of spiritual coping (e.g., spiritual support) were related to less distress. Highlights the importance of making a distinction between negative and positive forms of spiritual coping when investigating the role of spirituality in current life functioning.

Author (date)	Gall, Basque, Damasceno-Scott, & Vardy (2007)
Focus	R/S and current adjustment of adult survivors of CSA
Type of document	Empirical (quantitative)
Abstract highlights	Sample of 101 men and women survivors of CSA completed questionnaires on spirituality (relationship with God or higher power), person factors (blame attributions, self-acceptance, hope), and current adjustment (mood, personal growth, resolution of the abuse). Indicated that relationship with a benevolent God or higher power is related to the experience of less negative mood and a greater sense of personal growth and resolution of the abuse. Relationship with a higher power is related to other person factors such as self-acceptance and hope. Relationship with a benevolent God appears to have an indirect link to depressive mood and resolution of abuse through the mediating pathways of hope and self-acceptance; in contrast, relationship with God appears to have a more direct association to the outcome of personal growth for these survivors.

Author (date)	Ganje-Fling, Veach, Kuang, & Houg (2000)
Focus	CSA and spiritual well-being
Type of document	Empirical (quantitative)
Abstract highlights	43 individuals receiving psychotherapy for CSA and 34 clients who sought psychotherapy for other reasons were compared on several aspects of spiritual functioning. The two groups did not differ significantly in spiritual well-being; both groups scored lower than samples of medical outpatients and hospice workers. Most participants reported initiating and discussing spiritual issues during therapy, were satisfied and comfortable with these discussions, rated spirituality as important to problem resolution, and listed several obstacles to spiritual development.

Author (date)	Glenn & Trice (2014)
Focus	R/S and resilience with adult childhood trauma survivors
Type of document	Conceptual
Abstract highlights	Identifies gaps in resilience research as it relates to spiritual meaning making and childhood trauma survivor development. Explores the influence of sacred text interpretations on resilience. Addresses contextual considerations for pastoral counseling with emerging adult childhood trauma survivors. Discussion of the complex relationship between spiritual coping, theological conflict, and survivor adjustment.

Author (date)	Grossman, Sorsoli, & Kia-Keating (2006)
Focus	Meaning making by male survivors of CSA
Type of document	Empirical (qualitative)
Abstract highlights	How 16 resilient male survivors of serious CSA, representing a range of racial, ethnic, and socioeconomic backgrounds, made meaning from their abuse experiences. Three types of meaning-making styles were identified in the narratives: meaning making through action (e.g., helping others), using cognitive strategies (e.g., developing a psychological framework for understanding the abuser), and engaging spirituality. The more experience these men had with specialized trauma therapy, the more likely they were to make meaning by attempting to understand their perpetrators.

Author (date)	Hall (1995)
Focus	Spiritual effects of CSA in adult Christian women
Type of document	Empirical (quantitative)
Abstract highlights	Religious Status Inventory was completed by 75 women divided into three groups: 33 abused clinical subjects, 20 nonabused clinical subjects, and 22 nonabused nonclinical subjects. Abused group demonstrated significantly lower spiritual functioning than both of the other groups on the total score as well as on four of eight subscales; no significant differences were found between the nonabused clinical group and the nonclinical control group. Sexual abuse adversely affects spiritual functioning in three broad areas: a sense of being loved and accepted by God, a sense of community with others, and trust in God’s plan and purpose for the future.

Author (date)	Jacobs (2015)
Focus	R/S and depression in young adult survivors of CSA
Type of document	Dissertation; empirical (quantitative)
Abstract highlights	Investigates the relationship between religiosity and depression in adult survivors of childhood physical and sexual abuse across several religious and spiritual dimensions. Suggests that high religious event attendance and high religious faith importance are protective against a diagnosis of depression, while high spiritual life importance, having a religious experience, childhood physical abuse, and childhood sexual abuse are associated with a depression diagnosis.

Author (date)	Kennedy & Drebing (2002)
Focus	Abuse and religious experience in religiously committed evangelical adults
Type of document	Empirical (quantitative)
Abstract highlights	Two hypotheses were tested: (1) experience of abuse is related to more frequent (a) religious behavior, such as prayer, church attendance, and Bible reading, and (b) religious experiences, such as religious visions, healings, and speaking in tongues; (2) abuse is also associated with evidence of alienation from God, as noted in more frequent reports of God as distant and more frequent religious doubting. Survey data from 3,424 adults attending one of four new evangelical-movement churches was controlled for socioeconomic and religious socialization variables. Self-report of the frequency of abuse was positively associated with frequency of reported transcendent religious experiences and with feelings of distance from God; a significant relationship between abuse and more conventional religious behavior was not found. Provides mixed support for the idea that abuse results in ambivalent responses toward religion and God.

Author (date)	Krejci et al. (2004)
Focus	Sexual trauma, spirituality, and psychopathology
Type of document	Empirical (quantitative)
Abstract highlights	71 sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder Examination, the PTSD Symptom Scale, and the SCID-I/P. Groups did not differ in terms of spiritual well-being; sexual trauma status was associated with most of the psychopathology outcomes; however, its impact on psychopathology was largely unmoderated by spirituality; the level of spiritual well-being did not alter the probability of current psychopathology; however, increased spiritual well-being was generally associated with lower psychopathology for the entire sample.

Author (date)	Levitt, Horne, Wheeler, & Wang (2015)
Focus	IPV within religious contexts
Type of document	Book chapter; conceptual; case studies
Abstract highlights	Focuses on the personal and community interactions and messages that reinforce IPV in faith-based families, and explores the psychological literature on the role of R/S in the experience of survivors of IPV. Case studies are used to describe ways to address the potentially destructive aspects of religion that perpetuate IPV against women.

Author (date)	Marotta-Walters (2015)
Focus	R/S meaning making and clergy-perpetrated sexual abuse
Type of document	Conceptual; case material
Abstract highlights	Meaning making is a cognitive and affective change in the way an individual perceives a painful experience; following exposure to trauma, meaning making is a psychotherapeutic factor that promotes adaptation, as well as a process that is closely related to R/S. Explores how psychospiritual development of an adult is shaped by exposure to clergy-perpetrated sexual abuse in childhood, how the trauma might be processed through current empirically informed tx models for adults, and how tx strategies and techniques vary depending on the stage of tx at which meaning making might occur.

Author (date)	Murray-Swank & Pargament (2005)
Focus	Spiritually-integrated intervention for sexual abuse
Type of document	Empirical (case studies)
Abstract highlights	An eight-session, spiritually integrated, manualized individual intervention for two female survivors of sexual abuse with spiritual struggles (Solace for the Soul: A Journey Towards Wholeness). An interrupted time-series design included daily measurements of positive and negative religious coping, spiritual distress, and spiritual self-worth, as well as comprehensive measures of spiritual well-being, religious coping, and images of God pre- and post-intervention and one to two months later. Both clients showed an increase in positive religious coping, spiritual well-being, and positive images of God. In addition, ARIMA intervention analyses revealed significant changes during the course of the intervention (e.g., increased daily use of positive religious coping).

Author (date)	Murray-Swank & Waelde (2013)
Focus	R/S and sexual trauma
Type of document	Book chapter; conceptual, case material
Abstract highlights	Considers both Western and Eastern spiritual perspectives. Empirical review of the relationships between spirituality, religion, and sexual trauma. Highlights research on a manualized, spiritually integrative program for sexual abuse survivors. Considers theoretical frameworks and various strategies for integrating spirituality in sexual trauma work. Focuses on meditation and mindfulness in sexual trauma work.

Author (date)	Rardin (2014)
Focus	Recovery process of second-generation adult cult survivors
Type of document	Dissertation; empirical study
Abstract highlights	Narrative study of the role of spirituality in the healing journey and integration into the mainstream of second-generation adult survivors of cults or fundamentalist religions. Participants were asked about their attitude toward spirituality and, if spirituality was present, whether it was positive, negative, or neutral during their recovery process. For survivors of religious cults, spirituality is the source of their trauma, a unique circumstance where the trauma is rooted in what would otherwise be a coping mechanism. Examines cult survivors’ methods for reclaiming their spirituality.

Author (date)	Reinert & Edwards (2009)
Focus	Attachment theory, childhood mistreatment, and religiosity
Type of document	Empirical (quantitative)
Abstract highlights	Explores the relationship of verbal, physical, and sexual mistreatment to attachment to God as well as to concepts of God. Each form of mistreatment was related adversely to the religiosity measures. Attachment to parents mediated the relationship between two maltreatment variables (verbal and physical) and attachment to God, as well as the concept of God as loving and as distant; however, attachment to parents did not mediate the relationship between attachment to God and the sexual abuse variable. Sexual abuse was strongly related to difficulties with attachment to God and one’s concept of God; secure attachment to parents provided the necessary context for socialization into religion.

Author (date)	Rossetti (1995)
Focus	Clergy-perpetrated CSA and attitudes toward God and the Catholic Church
Type of document	Empirical (quantitative)
Abstract highlights	Explores the effects of CSA by priests and other perpetrators on victims’ trust in the Catholic Church, the priesthood, and their relationship to God. Adult Catholics in the United States and Canada were separated into three groups: those who reported no CSA (n = 1,376), those who had been sexually abused as children but not by a priest (n = 307), and those who had been sexually abused by priests (n = 40). Found a significant decline from those “not abused” to those “abused by a priest”; slight decline in trust for those “abused but not by a priest”; however, the results were statistically inconclusive. 347 victims were then separated into two groups based on their having received psychotherapy; the “tx” group (n = 152) reported significantly less trust in the priesthood, the church, and their relationship to God than the “no tx” group (n = 194). Highlights the possible spiritual damage caused by CSA, particularly if the perpetrator was a religious leader, and supported the need to assess the religious impact of the victim’s abuse and to include a process of spiritual healing.

Author (date)	Sinha & Rosenberg (2013)
Focus	Trauma interventions and religion among youth exposed to community violence
Type of document	Research review
Abstract highlights	13 studies focused on R/S factors and were reviewed to explore the promise of school- and community-based solutions in reducing the impact of exposure to violence and chronic traumatic events. Included five intervention studies, five cross-sectional studies, and three nonexperimental studies; six of the studies included R/S as a measured variable. Review confirmed significant associations between rates of exposure to chronic community violence and presence of PTSD symptoms; five intervention studies confirmed the effectiveness of cognitive behavioral therapy or group therapy in reducing trauma symptoms; two cross-sectional studies identified R/S factors as moderating the impact of chronic community violence; one study revealed higher rates of spirituality/creativity among adolescents with more exposure to traumatic events.

Author (date)	Thanh-Tu, Bellehumeur, & Malette (2014)
Focus	R/S in a trauma and recovery model for women survivors of sex trafficking
Type of document	Conceptual
Abstract highlights	It is crucial to understand the pain underlying the journeys of survivors, who undergo helplessness, meaninglessness, and disconnection as a result of their traumatic experiences. Used Herman’s (1992, 1997) model of safety, remembrance/mourning, and reconnection to respond to survivors’ experiences. In addition, R/S can be included as part of the meaning-making process; survivors can use spirituality to cope in a manner that contributes to their recovery.

Author (date)	Walker, McGregor, Quagliana, Stephens, & Knodel (2015)
Focus	Changes in R/S after child abuse
Type of document	Book chapter; conceptual; case studies
Abstract highlights	Considers ways of responding to child abuse survivors’ changes in faith after trauma; reviews research that relates various forms of traumas to spiritual outcomes. Differentiates individuals who use their spirituality to cope with and make meaning of their faith, those who experience damage to specific aspects of faith, and those who experience simultaneous increases and damage to different aspects of faith. Includes clinical recommendations for responding in psychotherapy to changes in faith after traumatic events; case studies demonstrating psychotherapeutic responses to changes in faith among trauma survivors.

Author (date)	Walker, Reid, O’Neill, & Brown (2009)
Focus	Changes in R/S during and after childhood abuse
Type of document	Literature review
Abstract highlights	Identified 34 studies of child abuse as they relate to R/S; included information on a total of 19,090 participants. Studies were classified according to both the form of abuse and the form of R/S. Majority of studies indicated either some decline in R/S (n = 14) or a combination of both growth and decline (n = 12). Seven studies gave preliminary indications that R/S can moderate the development of posttraumatic symptoms or symptoms associated with other disorders.

Disasters and trauma

Author (date)	Aten (2012)
Focus	Disaster spiritual and emotional care in professional psychology
Type of document	Conceptual
Abstract highlights	A Christian integrative approach to disaster spiritual and emotional care in professional psychology. Practice guidelines are offered, as well as diverse examples of faith-based disaster interventions. Theological and integrative implications are discussed, as well as thoughts on how disaster spiritual and emotional care will contribute to the future of integration.

Author (date)	Aten, Bennett, Davis, Hill, & Hook (2012)
Focus	Predictors of God concept and God control after Hurricane Katrina
Type of document	Empirical (quantitative)
Abstract highlights	Examined hurricane-related resource loss predictors on God concepts and God control among Hurricane Katrina survivors (N = 142) from Mississippi Gulf Coast communities approximately five months after the storm. Increased levels of resource loss predicted a more negative conceptual portrayal of God; greater object resource loss predicted perceptions of less God control over the outcome of events. Strongest individual predictor of a God concept that was more negative and in less control of event outcomes was the loss of food and water, suggesting the importance of critical resource loss on how one conceives of God. For many people who self-identify as R/S, resources may be the one explanatory system that is uniquely capable of helping disaster survivors to understand traumatic events, to have a sense of control of such events, and, in the process, to still maintain a healthy picture of one’s self.

Author (date)	Aten & Boan (2016)
Focus	Church-based disaster ministry handbook
Type of document	Book; conceptual
Abstract highlights	When disasters happen, people turn to local churches as centers for response and assistance; in such cases, knowing what to do can be the difference between calm and chaos, courage and fear, life and death; however, few churches plan in advance for what they should do when the storm hits. Provides a practical guide for disaster preparedness and suggests that disaster ministry is a critically important work of the church: preparing for the unthinkable, providing relief to survivors, caring for the vulnerable, and helping communities recover.

Author (date)	Aten et al. (2013)
Focus	Clergy, academic, and MHP partnerships in disaster emotional and spiritual care
Type of document	Conceptual
Abstract highlights	Introduces a clergy, academic, and mental health partnership (CAMP) model that has been used to respond to emotional and spiritual needs that developed in the wake of several disasters affecting the southeast Gulf Coast region. Intended to build capacity and infrastructure for facilitating (a) disaster emotional and spiritual care training, (b) a clergy and MHP network, (c) emotional support/resiliency experiences for clergy and MHPs, (d) community outreach, and (e) direct services to vulnerable populations.

Author (date)	Aten et al. (2015)
Focus	Spiritual and emotional care in disasters
Type of document	Book chapter; conceptual
Abstract highlights	Reviews current research on R/S and disasters. Disaster trauma is unique in its collective dimension (as opposed to individual trauma). Offers practice guidelines for MHPs regarding spiritual and emotional care in response to disaster. R/S helps buffer disaster survivors from negative emotional and physical consequences commonly experienced in the aftermath of a disaster (e.g., depression, psychosomatic symptoms). MHPs need to focus on the loss of community and resources and activate resilience capacities within the client. MHPs can serve as consultants to religious organizations.

Author (date)	Aten, Topping, Denney, & Hosey (2011)
Focus	African American clergy and churches and minority disaster mental health disparities
Type of document	Empirical (qualitative)
Abstract highlights	Conducted participatory action research by interviewing 41 African American clergy one year after Hurricane Katrina in severely affected areas of southern Mississippi. How can MHPs work with African American clergy and their churches by providing training that targets minority disaster mental health disparities? Offers a three-tier training model for equipping African American clergy and churches to respond to disasters in hopes of reducing minority disaster mental health disparities. Provides sample outreach and educational training project designed to equip African American clergy and churches in their response to minority disaster mental health disparities.

Author (date)	Cook, Aten, Moore, Hook, & Davis (2013)
Focus	Resource loss, religiousness, health, and PTG following Hurricane Katrina
Type of document	Empirical (quantitative)
Abstract highlights	Examined associations among resource loss, religiousness (including general religiousness, religious comfort, and religious strain), PTG, and physical and mental health among a sample of Mississippi university students. Resource loss was negatively associated with health but positively associated with PTG; religious comfort was associated with positive outcomes, and religious strain was associated with negative outcomes; religious comfort buffered the negative effects of resource loss on emotional health; ancillary analyses indicated that associations between resource loss and health were mediated by religious strain.

Author (date)	Drescher et al. (2012)
Focus	Perceived meaning in life and self-efficacy after the Gulf oil spill
Type of document	Empirical (qualitative)
Abstract highlights	In 2010 the Deepwater Horizon oil platform exploded, releasing five billion barrels of oil into the Gulf of Mexico over five months, affecting Gulf Coast communities, harming both sea and land wildlife, damaging the fishing industry, and destroying natural resources. Following the spill, 361 individuals seeking clinical services on the Mississippi Gulf Coast revealed that the perceived effects of the spill were only weakly related to life satisfaction; perceived meaning in life and self-efficacy were much more predictive of satisfaction with life, with perceived meaning in life serving as the most important predictor. Provides initial support for models that emphasize the role of coping mechanisms in the wake of ecological disasters.

Author (date)	Evans, Kromm, & Sturgis (2008)
Focus	Religious responses to Hurricane Katrina
Type of document	Empirical (qualitative)
Abstract highlights	Examines associations among resource loss, religiousness (including general religiousness, religious comfort, and religious strain), PTG, and physical and mental health among a sample of Mississippi university students soon after Hurricane Katrina in 2005. Resource loss was negatively associated with health but positively associated with PTG; religious comfort was associated with positive outcomes, and religious strain was associated with negative outcomes; religious comfort appeared to buffer the negative effects of resource loss on emotional health.

Author (date)	Feder et al. (2013)
Focus	Coping and PTSD symptoms after the 2005 Pakistani earthquake
Type of document	Empirical (quantitative)
Abstract highlights	Conducted three years after the 2005 Pakistan earthquake; goal was to identify potentially protective psychosocial factors associated with lower PTSD and depressive symptom levels. Adult earthquake survivors (N = 200) completed self-report questionnaires measuring PTSD and depressive symptoms, positive and negative affect, and four psychosocial variables (purpose in life, positive and negative religious coping, and social support). 65% of participants met criteria for PTSD; purpose in life was associated with lower symptom levels and higher positive emotions. A form of negative religious coping (feeling punished by God for one’s sins or lack of spirituality) was associated with higher symptom levels and negative emotions; higher perceived social support was associated with higher positive emotions.

Author (date)	Furman et al. (2016)
Focus	Collective trauma, faith, and service delivery to victims of terrorism and natural disaster
Type of document	Conceptual
Abstract highlights	Spiritual assessment and helping activities in work with victims of natural disasters and terrorism. Based on international survey research and the authors’ own experiences as victims of natural disaster and terrorism regarding the topics of R/S in the helping relationship. Discusses the appropriateness of 21 generic, spiritually based helping strategies for potential use in the helping relationship following a disaster.

Author (date)	McIntosh, Poulin, Silver, & Holman (2011)
Focus	R/S and physical and mental health after collective trauma
Type of document	Empirical (quantitative, longitudinal)
Abstract highlights	Associations of R/S with physical and mental health were examined in a national sample (N = 890) after the September 11, 2001, terrorist attacks (9/11). Health information was collected before 9/11, and health, religiosity, and spirituality were assessed longitudinally during six waves of data collection over the next three years. Religiosity (i.e., participation in religious social structures) predicted higher positive affect, fewer cognitive intrusions, and lower odds of new onset mental and musculoskeletal ailments. Spirituality (i.e., subjective commitment to spiritual or religious beliefs) predicted higher positive affect, lower odds of new onset infectious ailments, more intrusions, and a more rapid decline in intrusions over time. Religion and spirituality independently predict health after a collective trauma, controlling for pre-event health status; they are not interchangeable indices.

Author (date)	O’Grady, Rollison, Hanna, Schreiber-Pan, & Ruiz (2012)
Focus	Relationship with the sacred after the Haiti earthquake
Type of document	Empirical (quantitative)
Abstract highlights	Investigates the impact of the Haitian people’s relationship with the divine on their psychospiritual transformation following the Haiti earthquake in 2010. Frequency of R/S factors and predictors of PTG and spiritual transformation are described.

Author (date)	Park (2016)
Focus	Meaning making in disasters
Type of document	Conceptual
Abstract highlights	Little attention has been paid to successful coping processes in recovering from natural and technological disasters. Factors underlying adaptive psychological responses and recovery after disasters have important implications for intervention and prevention efforts. A meaning-making perspective can help survivors successfully adapt after disasters.

Author (date)	Ramsay & Manderson (2011)
Focus	R/S, resilience, PTG, and extreme weather events
Type of document	Book chapter; conceptual
Abstract highlights	Faith-based communities are among the first on the ground at times of sudden disaster. Need to consider R/S factors in managing suffering and supporting resilience. Discusses the principles of positive psychology, Frankl’s work on logotherapy, and the more recent work of psychologists Tedeschi, Calhoun, and Janoff-Bulman regarding PTG, meaning making, and resilience. Examines the role of religious communities in providing care, along with the current humanitarian guidelines on religion in disasters, specifically extreme weather events.

Author (date)	Ren (2012)
Focus	R/S and community in indigenous trauma therapy following the 2008 China earthquake
Type of document	Case report
Abstract highlights	Focuses on survivors of the 2008 earthquake in China in order to understand how Chinese spirituality may be involved in the process of psychological rehabilitation. MHPs tend to view an individual who has experienced tremendous trauma as simply suffering from PTSD, depression, or grief. Encourages MHPs to appreciate the deeply personal and cultural spiritual resonances that clients present with in the aftermath of trauma. Understands the meaning of spirituality in the context of Chinese culture, a culture in which spirituality in community serves as a deep bond between the family system and the culture and faith system.

Author (date)	Roberts & Ashley (2008)
Focus	Clergy responses to community, regional, and national tragedy
Type of document	Book; conceptual
Abstract highlights	Integrates the classic foundations of pastoral care with the unique challenges of disaster response on community, regional, and national levels. Offers the latest theological perspectives and tools, along with basic theory and skills from the best disaster-response literature, research, and concepts. A comprehensive explanation of a disaster’s life cycle and how spiritual care changes following a disaster.

Author (date)	Sibley & Bulbulia (2012)
Focus	R/S and perceived health after the 2011 Christchurch, New Zealand, earthquake
Type of document	Empirical (quantitative, longitudinal)
Abstract highlights	Explores how a natural disaster of this magnitude affected deeply held commitments and global ratings of personal health depending on earthquake exposure. Consistent with the Religious Comfort Hypothesis, religious faith increased among the earthquake-affected, despite an overall decline in religious faith elsewhere in the country; offers the first population-level demonstration that secular people turn to religion at times of natural crisis. Found no evidence for superior buffering regarding subjective ratings of personal health from having religious faith. Among those affected by the earthquake, a loss of faith was associated with significant subjective health declines, whereas those who lost faith elsewhere in the country did not experience similar health declines. Suggests that religious conversion after a natural disaster is unlikely to improve subjective well-being, yet upholding faith might be an important step on the road to recovery.

Author (date)	Smith, Pargament, Brant, & Oliver (2000)
Focus	R/S coping by church members after the 1993 Midwest flood
Type of document	Empirical (quantitative)
Abstract highlights	Questionnaires were distributed through churches in flood-affected communities in Missouri and Illinois; questionnaire was completed by 209 adults six weeks after the flood, and a follow-up was completed by 131 respondents six months after the flood. Religious dispositions, attributions, and coping activities were related to psychological and religious outcomes; religious attributions and coping activities predicted psychological and religious outcomes at both six weeks and six months after controlling for flood exposure and demographics. Positive religious coping may mediate the relationship between religious dispositions and psychological and religious outcomes.

Author (date)	Stratta et al. (2013)
Focus	R/S in the aftermath of a natural catastrophe in Italy
Type of document	Empirical (quantitative)
Abstract highlights	Assesses the influence of R/S and psychological traumatic effects on a population that had been exposed to an earthquake compared with a control population that had not been exposed. 901 people were evaluated, and their self-perceptions of R/S were used to distinguish between spiritual and religious, spiritual-only, religious-only, and neither spiritual nor religious dimensions. Sample that experienced the earthquake showed lower scores on the spiritual dimension; a weakening of spiritual religiosity in people having difficulty coping with trauma is a consistent finding. Religious-only sample of those who were exposed to the earthquake demonstrated reexperiencing and arousal domain scores similar to the population that was not exposed; religious dimension helped to buffer the community against psychological distress caused by the earthquake; religiosity dimension can positively affect the ability to cope with traumatic experiences.

Author (date)	Taylor (2001)
Focus	R/S and personal values as neglected components of trauma tx
Type of document	Conceptual
Abstract highlights	Experiences with disaster casualties raise questions about the neglect of spiritual factors in the appraisal of victims. The WHO definition of health and well-being takes patterns of belief/value systems into account. The outcome, it is argued, should more closely approximate the reality of human reactions seen after catastrophe, indicate more of the support systems available sometimes to assist in the recovery of casualties, and encourage academic psychologists to reconsider the place of values in human behavior.

Author (date)	Ting (2016)
Focus	Resiliency among post-earthquake Tibetans’ religious community
Type of document	Case report
Abstract highlights	More awareness of a culturally sensitive approach to psychological relief work during emergencies and disasters has been raised locally and internationally. In the aftermath of the 2010 earthquake that shook the Tibetan community of Yushu in Qinghai, China, anthropological data was gathered on the survivors’ healing process as they dealt with loss and poverty. Four vignettes are narrated to highlight the Tibetan “openhearted” attitude as a way to celebrate life and embrace grief. Suggests that modern psychologists have much to learn from the life-celebrating and resilience of this ethnic community in China. When providing psychological relief aid, a new paradigm of care is needed, and religion could play a pivotal role in recovering the strengths of the suffering individuals.

Author (date)	Worthington et al. (2016)
Focus	Forgiveness and psychological, physical, and spiritual resilience in disasters
Type of document	Conceptual
Abstract highlights	Resilience may necessitate forgiveness—of perpetrators of interpersonal harms (e.g., Rwandan Genocide in 1994), of inadequate responder assistance (e.g., Hurricane Katrina), or in situations where community members perceive themselves as victims of offense by virtue of their group affiliation (e.g., survivors of school shootings); victims may experience unforgiveness toward others in human-caused disasters and may deal with unforgiveness toward God in natural disasters. A meta-analysis of forgiveness interventions and an empirical study of awareness-raising campaigns on college campuses are utilized to estimate the effects of forgiveness on public health, public mental health, relationships, and spirituality across society after disasters.

Violent and collective trauma

Author (date)	Connor, Davidson, & Li-Ching (2003)
Focus	R/S, resilience, and anger in survivors of violent trauma
Type of document	Empirical (quantitative)
Abstract highlights	Evaluates the relationship between R/S, resilience, anger and health status, and posttraumatic symptom severity in trauma survivors. Community sample (N = 1,200) completed an online survey that included measures of resilience, spirituality (general beliefs and reincarnation), anger, forgiveness, and hatred. Survivors of violent trauma (n = 648) measures were evaluated with respect to their relationship to physical and mental health, trauma-related distress, and posttraumatic symptom severity. General spiritual beliefs and anger emerged in association with each outcome, whereas resilience was associated with health status and posttraumatic symptom severity only. Forgiveness, hatred, and beliefs in reincarnation were not associated with outcome.

Author (date)	Gone (2009)
Focus	Community-based tx for Native American historical trauma
Type of document	Empirical (qualitative)
Abstract highlights	19 staff and clients in a Native American healing lodge were interviewed regarding the therapeutic approach used to address the legacy of Native American historical trauma. Interviewees believe that such pain must be confessed in order to purge its deleterious influence and neutralize the pathogenic effects of colonization; cathartic expression of such pain was said to inaugurate lifelong habits of introspection and self-improvement, including a reclamation of indigenous heritage, identity, and spirituality. Need to partner with indigenous programs in the exploration of locally determined therapeutic outcomes for existing culturally sensitive interventions that are maximally responsive to community needs and interests.

Author (date)	Grayshield, Rutherford, Salazar, Mihecoby, & Luna (2015)
Focus	Historical trauma of Native American elders
Type of document	Empirical (qualitative)
Abstract highlights	Phenomenological study of 11 Native American elders addressed three research questions: (a) the effect of historical trauma on self, family, and community; (b) how historical trauma currently affects Native people and their communities; and (c) what they would recommend that counselors and therapists do in addressing issues of historical trauma for native and tribal people. Participants spoke of historical trauma in terms of loss of tribal language and culture; Native people themselves have the answers to healing and wellness for their own people. Recommendations for nontribal people who work with Native people and communities.

Author (date)	Hecker, Barnewitz, Stenmark, & Iversen (2016)
Focus	Pathological spirit possession and trauma-related symptoms
Type of document	Empirical (qualitative)
Abstract highlights	Spirit possession is considered an idiom of distress entailing dissociative symptoms and frequently associated with trauma exposure and trauma-related disorders; study explored subjective disease models and the relationship between spirit possession and trauma-related disorders. 73 (formerly) possessed persons in the Eastern Democratic Republic of the Congo, referred by traditional and spiritual healers, were interviewed about their experiences of pathological spirit possession, trauma exposure, PTSD symptoms, depressive symptoms, shame and guilt, psychotic symptoms, somatic complaints, and the impairment of psychosocial functioning. Significant correlations were found between spirit possession over the lifetime and PTSD symptom severity, feelings of shame and guilt, depressive symptoms, somatic complaints, and psychotic symptoms; spirit possession during the preceding four weeks was associated with PTSD symptom severity, impairment of psychosocial functioning, and psychotic symptom severity. Pathological spirit possession is a broad explanatory framework for various subjectively unexplainable mental and physical health problems including but not limited to trauma-related disorders.

Author (date)	Lee, Connor, & Davidson (2008)
Focus	Eastern and Western spiritual beliefs and violent trauma
Type of document	Empirical (quantitative)
Abstract highlights	Examined the associations between R/S beliefs and trauma history, and R/S beliefs and PTSD symptoms. Online survey in 2001 from community samples that were representative of the US adult population (N = 1,969). Measured R/S concepts and beliefs familiar to both Western and Eastern cultures; Eastern R/S beliefs, but not Western R/S beliefs, were associated with a history of violent trauma. Among those who had experienced violent traumas, agreement with both types of R/S beliefs were related to more severe PTSD symptoms; however, the mechanism of acquisition and effects of beliefs remain unknown. If inquiry into the R/S beliefs of a client is indicated, it may be of value to keep in mind that differences between belief types may exist and to take these differences into account in tx.

Author (date)	Maeland (2010)
Focus	Reintegration of female child soldiers in Northern Uganda
Type of document	Book; conceptual
Abstract highlights	The reintegration of thousands of formerly abducted children from the Lord’s Resistance Army back to their families and communities in northern Uganda represents tremendous challenges. Cultural and religious complexities that surround young females, often accompanied by their own children, is examined through an understanding of the religious and ritually rich Acholi and Northern Ugandan context and culture. Consists of contributions from diverse fields such as anthropology, psychology, moral philosophy, religious studies, and theology.

Author (date)	Neuner et al. (2012)
Focus	Spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda
Type of document	Empirical (quantitative)
Abstract highlights	Phenomena of spirit possession have been documented in many cultures, but quantitative studies that report the prevalence of spirit possession and provide evidence for its validity as a psychopathological entity are lacking. Epidemiological study was conducted in 2007–2008 with N = 1113 youths and young adults aged between 12 and 25 years in war-affected regions of Northern Uganda. Participants were interviewed using a scale of cen (local equivalent of spirit possession), measures of psychopathology (PTSD and depression), as well as indicators of functional outcome on suicide risk, daily activities, perceived discrimination, physical complaints, and aggression. Cen was more common among former child soldiers than among subjects without a history of abduction; cen was related to extreme levels of traumatic events and uniquely predicted functional outcome even when the effects of PTSD and depression were controlled for. Long-lasting war that is accompanied by the proliferation of spiritual and magical beliefs and propaganda can lead to high levels of harmful spirit possession; provides evidence for the incremental validity of spirit possession as a trauma-related psychological disorder in this context.

Additional types and populations

Author (date)	Adedoyin et al. (2016)
Focus	R/S coping strategies among traumatized African refugees in the United States
Type of document	Conceptual
Abstract highlights	Most African refugees are from war-torn or natural disaster–affected countries with ethnic, religious, and political conflict. Religious coping strategies are often utilized by traumatized African refugees; attending religious activities and membership in religious congregations are common. Such strategies result in marked improvements in overcoming traumatic experiences; in addition, personalized religious undertakings empowered African refugees to effectively address traumatic memories and acculturation stressors.

Author (date)	Bell, Jacobson, Zeligman, Fox, & Hundley (2015)
Focus	R/S coping and resilience in individuals with dissociative identity disorder
Type of document	Empirical (quantitative)
Abstract highlights	Review of existing literature related to R/S, resilience, and dissociative identity disorder (DID). Study examined the relationships between these constructs and individuals with DID (N = 52). Implications of the findings for counselors treating individuals with DID.

Author (date)	Blakey (2016)
Focus	R/S in helping African American women with histories of trauma and substance abuse
Type of document	Empirical (case study)
Abstract highlights	Discusses how 26 African American women with histories of trauma and substance abuse used R/S during the recovery process. Components include (1) reclaiming spirituality, (2) finding meaning, (3) trusting the process, and (4) active faith. R/S can be an effective tool that promotes and facilitates recovery, but MHPs need to recognize that not all women want to develop and nurture a spiritual life and that they must take their lead from them.

Author (date)	Bowland, Edmond, & Fallot (2012)
Focus	Spiritually focused intervention with older trauma survivors
Type of document	Empirical (quantitative)
Abstract highlights	Evaluated the effectiveness of an 11-session, spiritually focused group intervention with older women survivors (age 55 years and older) of interpersonal trauma (child abuse, sexual assault, or domestic violence) in reducing trauma-related depressive symptoms, posttraumatic stress, and anxiety. 43 women survivors of interpersonal trauma were randomized into tx (n = 21) or control (n = 22) groups and participated in group psychotherapy. Tx group had significantly lower depressive symptoms, anxiety, and physical symptoms at posttest compared to the control group; posttraumatic stress symptoms also dropped significantly in the tx group, and gains were maintained at three-month follow-up.

Author (date)	Denney, Aten, & Leavell (2011)
Focus	PTG and R/S growth among cancer survivors
Type of document	Empirical (qualitative)
Abstract highlights	How does having cancer affect the spiritual growth of cancer survivors across a multidimensional conceptualization of spirituality? The posttraumatic spiritual growth of 13 cancer survivors was examined using phenomenological data analysis. Participants reported experiencing spiritual growth across the following domains of spirituality: (a) general spirituality, (b) spiritual development, (c) spiritual social participation, (d) spiritual private practices, (e) spiritual support, (f) spiritual coping, (g) spirituality as a motivating force, (h) spiritual experiences, and (i) spiritual commitment. Growth was not endorsed in the following three domains of spirituality outlined in the model: (a) spiritual history, (b) spiritual beliefs and values, and (c) spiritual techniques for regulating and reconciling relationships.

Author (date)	Fallot (2007)
Focus	R/S in recovery from serious mental health problems
Type of document	Empirical (qualitative)
Abstract highlights	Reviews a variety of discussion groups and consultations, published literature, consumer perceptions, and MHPs and religious professionals. Both potentially supportive and burdensome roles of R/S in recovery were noted; MHPs report both hope for and discomfort with these domains in the context of mental health services. Recommendations regarding the appropriate place of R/S in psychiatric rehabilitation and related supports.

Author (date)	Gall, Charbonneau, & Florack (2011)
Focus	R/S factors and perceived growth following breast cancer diagnosis
Type of document	Empirical (quantitative)
Abstract highlights	Investigates the role of religious salience, God image, and religious coping in relation to perceived growth following a diagnosis of breast cancer. 87 breast cancer patients were followed from prediagnosis up to 24 months post surgery. Provided limited support for the role of positive aspects of spirituality in relation to perceived growth. While some forms of positive religious coping demonstrated positive associations, others evidenced no relationship or negative relationships with growth. Underscores the need to attend to negative aspects of spirituality from early on in the process of cancer adjustment, for such expressions may have implications for women’s ability to develop and maintain a positive perspective in their coping over the long-term.

Author (date)	Hoover (2016)
Focus	R/S among adolescents and young adults affected by trauma
Type of document	Dissertation; empirical (qualitative)
Abstract highlights	Examined the moderating effects of R/S coping based on two types of religious coping: positive and negative. Also examined subjective experiences of religious coping in response to traumatic events in a sample of 23 adolescents and young adults (ages 18–26 years) Indicated that participants used both positive and negative religious coping and that more methods of positive religious coping were reported; both positive and negative religious coping were associated with more trauma symptoms, but neither association was significant. Negative religious coping explained greater variance in trauma symptoms than did positive religious coping.

Author (date)	Janas (2012)
Focus	R/S beliefs and trauma symptoms in firefighters
Type of document	Empirical (quantitative)
Abstract highlights	Firefighters cope with chronic stress, but do those with R/S beliefs report fewer symptoms of trauma? 60 participants revealed that spirituality does not act as a protective factor in the reduction of trauma symptoms; however, the number of traumatic events experienced was a predictor for spiritual beliefs, suggesting that the firefighters can experience PTG. Following trauma, firefighters can experience a change in philosophy of life involving a deepening existential, or R/S, dimension.

Author (date)	Langman & Chung (2013)
Focus	Forgiveness, R/S, traumatic guilt, and PTSD among people with addiction
Type of document	Empirical (quantitative)
Abstract highlights	Spirituality and forgiveness have been shown to be associated with psychological well-being, whereas guilt has been associated with poor health; however, little is known about the relationship between forgiveness, spirituality, guilt, PTSD, and psychological comorbidity among people in recovery from addiction. Studied 81 people in recovery from addiction and 83 non-addicts from a city in the United Kingdom. 54% of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems, and depression; they described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty forgiving themselves. Spirituality predicted psychological comorbidity, and feelings of guilt predicted PTSD symptoms and psychological comorbidity; unexpectedly, forgiveness did not predict outcomes. People with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms; posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality.

Author (date)	Lev (2015)
Focus	Transpersonal experiences and improved well-being in trauma-based dissociative disorders
Type of document	Dissertation; empirical (quantitative)
Abstract highlights	Spirituality is generally considered protective to mental health, but there is limited research measuring the effect spirituality has on individuals with more severe mental health diagnoses. Examined the relationship between transpersonal experiences and psychological well-being in 79 individuals diagnosed with trauma-based dissociative disorders. Showed a significant positive correlation between transpersonal experiences and psychological well-being. Recognizing the value of transpersonal experiences for well-being in those with dissociative disorders may prove beneficial for clinical tx.

Author (date)	Luna Pendleton (2013)
Focus	Ecuadorian shamanic perspectives on trauma and spirituality
Type of document	Dissertation; empirical (qualitative)
Abstract highlights	The broader topic of trauma, spirituality, and healing was explored through the narratives of two indigenous Ecuadorian shamans and two North American women who had experienced indigenous shamanic healing. A shamanic understanding of trauma is embedded within a profound and sacred cosmological context. The shaman’s understanding of trauma is intrinsically tied to spirituality, and thus the relationship between the experience of trauma and of the numinous is entwined. It offers psychology an expansive perspective that supports the inclusion of complementary approaches to the clinical tx of trauma; this includes therapeutic modalities such as spiritual stories, metaphors, ritual, and ceremony.

Author (date)	Miller (2002)
Focus	Integrated approach to addictions and trauma recovery
Type of document	Conceptual
Abstract highlights	Co-occurrence of addiction with trauma-based mental health problems forms a toxic feedback loop, creating assessment and tx challenges. Traditional separation of addiction and mental health tx has contributed to a high level of recidivism among clients challenged by trauma and addiction problems. ATRIUM, a tx model rooted in an understanding of trauma reenactment, integrates cognitive behavioral and relational tx through an approach that stresses mind, body, and spiritual health.

Author (date)	Morgan (2009)
Focus	Trauma, addiction, and spirituality
Type of document	Conceptual
Abstract highlights	Discusses prevalence of trauma, substance use disorders, and their co-occurrence in both clinical and community populations. Deeper understanding of these phenomena is providing new and promising tx modalities. Spiritual development and growth complement these emerging txs.

Author (date)	Newmeyer et al. (2016)
Focus	R/S and compassion fatigue among trauma therapists in Romania
Type of document	Empirical (qualitative)
Abstract highlights	Among trauma therapists, R/S may (a) buffer against compassion fatigue, secondary traumatic stress, and burnout, as well as (b) bolster spiritual growth and compassion satisfaction. Replicated a previous finding in which trauma therapists who endorsed a strong spiritual orientation reported increased compassion satisfaction when engaged in short-term, cross-cultural trauma work. Short-term (one to two weeks) trauma therapists were compared to equally trained professionals working in the same context for two to five months (intermediate-term) and six months to one year (long-term). Statistically significant increases in secondary trauma in both the intermediate- and long-term trauma therapists were observed. However, on pre- and post-measures the long-term trauma therapists reported statistically significant increases in resilience, which implies that the presence of the short-term therapists was beneficial to the long-term therapists.

Author (date)	Park, Edmondson, & Blank (2009)
Focus	R/S pathways to stress-related growth in cancer survivors
Type of document	Empirical (qualitative)
Abstract highlights	Examined the linkages between personal religiousness, religious control appraisals for the cancer, and religious coping with subsequent stress-related growth, and compared them with a parallel secular pathway defined as hope, self-control appraisals, and active coping. 172 young to middle-aged adult survivors of a variety of types of cancer who had been diagnosed approximately 2.5 years prior were assessed twice across a one-year period. Both pathways predicted stress-related growth, but the religious pathway was a much stronger predictor of subsequent stress-related growth than was the secular pathway. More attention should be given to the influence of multiple dimensions of R/S on growth to better understand the transformative processes reported by many survivors.

Author (date)	Prout, Gerber, & Gottdiener (2015)
Focus	Trauma, defenses, religious engagement, and substance use
Type of document	Empirical (quantitative)
Abstract highlights	Evaluated the potential moderating roles of defense mechanisms and religious coping on the already-established relationship between trauma symptoms and substance abuse. Sample of 340 college students; trauma symptoms were associated with increased substance use and abuse. Use of immature defenses was significantly associated with trauma and substance use; increased substance abuse was also associated with higher rates of negative religious coping; individuals who endorsed trauma symptoms were also more likely to use positive and negative religious coping; defenses and coping did not moderate the relationship between trauma and substance use.

Author (date)	Roland (2016)
Focus	Meaning, PTG, and PTSD symptoms among teachers in El Salvador
Type of document	Dissertation; empirical (quantitative)
Abstract highlights	Studied 257 violence-exposed teachers from educational departments throughout El Salvador (a highly religious country) and the roles of theistic and nontheistic spiritual experiences, as well as meaning made of salient stressors from their lives, perceptions of PTG, and PTSD symptomatology. (1) Nontheistic spiritual experiences uniquely predicted greater meaning made in the presence of control variables; (2) theistic and nontheistic experiences jointly explained variance in perceived PTG, with neither approach emerging as a unique predictor; and (3) nontheistic experiences predicted lower PTSD symptom severity, and theistic experiences were uniquely linked with more trauma-related symptomatology. Supports the importance of spirituality as a protective factor in persons exposed to pervasive trauma and the importance of developing interventions for this population.

Author (date)	Santoro, Suchday, Benkhoukha, Ramanayake, & Kapur (2016)
Focus	Adverse childhood experiences and R/S in emerging adolescents in India
Type of document	Empirical (quantitative)
Abstract highlights	Examined childhood adversity and R/S in a sample of adolescents from Hyderabad, India. 139 adolescents reported that adversity and existential well-being were significantly and inversely related; boys endorsed a greater number of adverse childhood experiences, except physical abuse, which was endorsed at comparable rates by gender; girls reported greater degrees of well-being and religiosity; however, no gender differences were found on daily spiritual experiences and religious coping. Well-being was significantly associated with religiosity, daily spiritual experiences, and religious coping for girls; adversity was associated with greater desire to connect with a higher power in boys and increased religious coping in girls.

Author (date)	Shinall & Guillamondegui (2015)
Focus	R/S and end-of-life care among trauma patients
Type of document	Empirical (quantitative)
Abstract highlights	Evidence suggests that religiousness is associated with more aggressive end-of-life (EOL) care among terminally ill patients. Offers retrospective review of all trauma patients surviving at least two days but dying within 30 days of injury over a three-year period at a major academic trauma center. Examines the association of religious affiliation and request for chaplain visit with aggressive EOL care among critically injured trauma patients. Controlling for social factors, severity of injury, and medical comorbidities, religious affiliation was associated with a 43% increase in days until death; controlling for these same variables, chaplain request was associated with a 24% decrease in time until death.

Author (date)	Smedley (2016)
Focus	Negative spiritual responses to trauma from urban ministry workers
Type of document	Dissertation; empirical (qualitative)
Abstract highlights	Urban community settings are often filled with community violence, including violence in the home or school; urban settings are often composed of minority groups who live near the poverty line and experience issues of social and racial oppression; minority groups are often religious and utilize R/S as a means to cope with stress. Utilized the literature and data taken from focus groups with urban ministry workers to better understand themes of why people distance themselves from their R/S upon experiencing trauma. Three major themes, several subthemes, and additional community descriptions were all coded for the purpose of describing the experience of families in the urban setting.

Author (date)	Ting & Watson (2007)
Focus	Religious persecution among Chinese pastors
Type of document	Empirical (qualitative)
Abstract highlights	Nine Chinese pastors were interviewed about their experiences during persecution using a hermeneutic phenomenology method. Eight themes emerged as unique ways to respond and cope during the suffering: experiencing God’s presence, letting go and surrender to God, identification with the passion of Christ and his disciples, preparing to suffer, normalizing their suffering, worshiping and reciting Scriptures, fellowship and family support, and believing in a greater purpose. Four themes regarding posttraumatic transformation emerged. Christian counselors are encouraged to explore the meaning and emotion of suffering in therapy, as well as to use culturally sensitive coping mechanisms.

Author (date)	Vis & Battistone (2014)
Focus	Trauma and spiritual-based strategies for adolescent students
Type of document	Conceptual
Abstract highlights	Review of the trauma literature identifies the significance of both community and faith-based intervention in positive posttraumatic recovery. While a link has been identified between the use of Christian strategies and a decreased risk of posttraumatic symptoms, the literature suggests that adolescents may avoid the use of Christian strategies during their recovery. Spiritually based strategies are discussed in an effort to effectively respond to the spiritual and psychological needs of adolescents in faith-based schools on the occasion of a traumatic event.

Author (date)	Weiss-Ogden (2014)
Focus	Trauma and spiritual well-being of women with substance use disorders
Type of document	Dissertation; empirical (quantitative)
Abstract highlights	Trauma experiences are often at the core of co-occurring substance abuse and mental health disorders, and spirituality is a mitigating factor in recovery from co-occurring trauma and substance use disorders. Study examined the relationship between trauma and the spiritual well-being of women with substance use disorders. Participants included 108 adult female residents of a two-year modified therapeutic community who met DSM-IV criteria for a substance use disorder and reported a lifetime history of at least one traumatic occurrence. Women who experienced sexual molestation had significantly lower Spiritual Well-Being scores than those who had not experienced this trauma. As the age at first occurrence increased, so did Spiritual Well-Being scores; or the younger the participant was at the age of each of these trauma occurrences, the lower her Spiritual Well-Being scores. No significant relationship was found between the total number of traumatic occurrences and Spiritual Well-Being scores of women with substance use disorders.

Author (date)	Wilson (2015)
Focus	Trauma, coping, and pregnant couples’ biopsychosocial-spiritual health
Type of document	Dissertation; empirical (quantitative)
Abstract highlights	Pregnancy and trauma are each complex biopsychosocial-spiritual processes with implications for the couple relationship. Includes a systematic review of literature published on the impact of traumatic stress on obstetric, neonatal, and postnatal outcomes, and a study of couples’ experiences with traumatic stress, pregnancy coping, and the couple relationship. Maternal trauma can affect obstetric physical and mental health, fetal prenatal health, and maternal postnatal outcomes. Maternal and partner pregnancy stress, trauma, and relationship report are related; discusses patterns of moderation and indirect effects between the variables; recommendations are made for medical family therapy researchers and practitioners.

Author (date)	Yedlin (2012)
Focus	R/S, trauma exposure, PTSD, and alcohol use in emerging adults
Type of document	Dissertation; empirical (quantitative)
Abstract highlights	Study of 1,660 college students between the ages of 18 and 25. Explored the role of R/S in relation to interpersonal trauma frequency, PTSD, and alcohol use in emerging adults. Religious identity, frequency of prayer, and spiritual beliefs moderated the relation between interpersonal trauma frequency and PTSD. No significant moderational role of R/S in the relation between PTSD and alcohol use. Slight mediation by PTSD of the relation between interpersonal trauma frequency and alcohol use. Use of R/S in interventions and txs following interpersonal trauma.