JAMIE D. ATEN, ALICE SCHRUBA,
DAVID N. ENTWISTLE, EDWARD B. DAVIS,
JENN RANTER, JENNY HWANG, JOSHUA N. HOOK,
DAVID C. WANG, DON E. DAVIS, AND
DARYL R. VAN TONGEREN
Across the globe, natural disasters (e.g., floods, storms, and earthquakes) and human-caused disasters (e.g., technological disasters, terrorist incidents, and mass shootings) have increased in their frequency, scope, and human impact. For example, from 1985 to 1994, there were 2,334 natural disasters and 34,112 terrorist incidents worldwide, while from 2005 to 2014, there were almost twice as many: 4,050 natural disasters and 64,708 terrorist incidents. Since 1995 there have been nearly 18,000 natural and technological disasters worldwide, collectively affecting 6 billion people and causing 2.2 million deaths, injuring another 6.4 million people, and leaving 128.8 million people homeless (Guha-Sapir, Below, & Hoyois, n.d.; START, 2015). Also, in the United States alone, from 1983 to 2012 there were 78 mass shootings, causing 547 deaths and injuring another 476 people (Bjelopera, Bagalman, Caldwell, Finklea, & McCallion, 2013). The economic impact of disasters has also increased. Since 1995 natural and technological disasters have collectively caused $2.7 trillion in damage (Guha-Sapir et al., n.d.), and the United Nations Office for Disaster Risk Reduction (UNISDR) estimates that the worldwide annual economic losses from disasters is between $250 billion and $300 billion (UNISDR, 2015).*1
The psychological impact of disasters can be tremendous too. Adult disaster survivors often experience mental health difficulties such as depression, anxiety disorders, general/nonspecific psychological distress, suicidality, substance use disorders, or posttraumatic stress symptoms (PTSSs) or disorder (PTSD; Galea, Nandi, & Vlahov, 2005; Norris et al., 2002). For instance, among directly affected adult survivors of human-caused disasters, the prevalence rate of disaster-related PTSD ranges from 30% to 60%, and for adult survivors of natural disasters, the prevalence rate of disaster-related PTSD ranges from 5% to 60% but usually falls in the lower half of that range (Galea et al., 2005). Alternatively, natural and human-caused disasters can catalyze perceived posttraumatic growth, such as increased personal resilience (e.g., life satisfaction, meaning and purpose in life, self-efficacy, and coping skills) and enhanced social and community resilience (e.g., family connectedness, perceived social support, prosocial behavior, and civic engagement; Cook, Aten, Moore, Hook, & Davis, 2013).
Disasters can also significantly affect survivors’ religious/spiritual (R/S) lives, both for good or ill (e.g., Aten & Boan, 2016). On the one hand, religion/spirituality can serve as a potent resilience factor (Pargament & Cummings, 2010), helping survivors successfully cope, make meaning, adapt, and even grow following a disaster (e.g., Chan & Rhodes, 2014). On the other hand, disasters can lead to the loss or decline of survivors’ faith (Sibley & Bulbulia, 2012; Stratta et al., 2013), and they can lead survivors to experience R/S struggles that can fuel the aforementioned disaster-related mental health difficulties (e.g., Park, 2016).
Thus, in this chapter, we seek to equip Christian mental health providers to help disaster survivors navigate issues of faith. First, we review the empirical literature on faith and disaster mental health. Then we explore Christian theological perspectives on suffering. Finally, we offer recommendations for providing disaster spiritual and emotional care in clinical practice.
Over the last two decades, a growing number of researchers have examined the intersections of faith and mental health in disaster contexts. In this section, we summarize this empirical literature, focusing first on the impact of disasters on faith and next on the impact of faith on postdisaster well-being.
Influence of religious/spiritual appraisal. Research has demonstrated relationships between religious and spiritual appraisal and disaster reactions. Kroll-Smith and Couch (1987) examined religious attributions and coping in a community affected by a 23-year-long mine fire that eventually led to calamity. They found that most participants attributed this technical disaster to human failure rather than to God. Ai, Cascio, Santangelo, and Evans-Campbell (2005) found similar reactions to human-made disasters in their study of survivors of 9/11. However, their data revealed additional insight into another possible difference in how people respond across disasters, noting that negative coping was associated with defense or retaliation patterns of reaction to 9/11, in effect creating an “in-group” versus “out-group” difference based on religious ideology.
Likewise, Pargament et al. (1994) conducted a longitudinal study of the Gulf War crisis in which they learned that negative religious coping was significantly tied to psychological distress. Conversely, survivors of natural disasters (sometimes referred to as “acts of God”), appear to more readily incorporate spiritual and religious meaning into their interpretation of the disaster, as well as their responses and coping mechanisms. For instance, survivors of the 2010 Haiti earthquake referenced God as the author of the earthquake and cited prophetic references from the Bible to make sense of the event (O’Grady, Rollison, Hanna, Schreiber-Pan, & Ruiz, 2012). Additionally, Smith, Pargament, Brant, and Oliver (2000) found that positive religious coping strategies had a positive effect on postflood spiritual growth, in addition to leading to the reduction of psychological distress for survivors of a Midwest flood.
How survivors view and experience God. The way people view the Divine is influenced by a number of factors including traumatic life experiences. Likewise, certain views of God or the Divine have been demonstrated in the research to affect psychological functioning during and after trauma events, including large-scale disasters (Moriarty & Davies, 2012; Richards & O’Grady, 2007). After 9/11 Briggs, Apple, and Aydlett (2004) found that this tragic event appeared to increase participants’ connection with transcendence. O’Grady et al. (2012) found that 80% of earthquake survivors agreed or strongly agreed with the statement “My faith in a God/a higher power has grown since the earthquake.” However, 23% of participants agreed or strongly agreed that they felt more distant from God/a higher power since the earthquake, and 20% indicated that they were less spiritual since the earthquake. Overall, people’s daily spiritual experiences with God, their perceptions of God’s awareness of them, and their sense of “specialness” to God predicted their degree of spiritual transformation above and beyond the amount of loss they experienced in the earthquake.
Aten, Madison, Rice, and Chamberlain (2008) found that Hurricane Katrina survivors often held a multifaceted view of God that existed on a continuum from a loving and caring parental figure to a judging and even punishing figure. Newton and McIntosh (2009) found that Jewish survivors of Hurricane Katrina held more positive and benevolent views of God than Christian survivors, who were more apt to report feeling as though God was sending punishment. According to the Conservation of Resources (COR) stress theory, “loss is the primary operating mechanism driving stress reactions” (Hobfoll, Freedy, Green, & Solomon, 1996, p. 324). After Hurricane Katrina, Aten, Bennett, Davis, Hill, and Hook (2012) found that increased levels of resource loss were related to a more negative God concept, as well as viewing God as less in control.
Survivor religion/spirituality and well-being. Religion and spirituality may moderate the impact of disaster on individuals’ well-being. Research suggests that religion and spirituality serve as a buffer for the potential deleterious effects of disasters and/or a contributor to psychological distress following disasters. After 9/11, Ai et al. (2005) discovered stronger faith, hope, and spirituality to be inversely correlated with depression and anxiety related to the exposure of direct and indirect 9/11 trauma. Further, researchers found that religious comfort helped to protect participants from negative emotional and physical health outcomes commonly associated with resource loss and was also associated with posttraumatic growth.
Religious strain, however, was linked to poorer emotional and physical health outcomes following disaster resource loss (Cook et al., 2013). Likewise, Johnson, Aten, Madson, and Bennett (2006) surveyed approximately 600 residents of Mississippi who survived Hurricane Katrina. In this study, those individuals who possessed positive religious and spiritual beliefs (e.g., God concept, religious coping strategies, religious support, meaning making) were shown to be less affected by the effects of exposure to hurricanes as well as the degree of resource loss (i.e., material and interpersonal). These individuals also experienced reduced rates of PTSD symptoms, depression, and alcohol use.
Taken as a whole, this body of burgeoning research may indicate that it is not so much how religious or spiritual one is but rather how one uses one’s faith (i.e., positive religious coping versus negative religious coping strategies) that appears to have the most significant impact on well-being outcomes. Of course, the reader must be cautious in drawing conclusions since much of this research is correlational in nature. It is equally likely, for example, that there is an underlying mental health or personality factor at work in both faith and response to significant life events.
Spirituality/religion and posttraumatic transformation. Disasters can create psychological and spiritual transformation in individuals. Depending on the resources in place in people’s lives, the transformation can be toward decline, such as (but not limited to) PTSD, or toward growth (Calhoun & Tedeschi, 2006; Roberts & Ashley, 2008). For example, a study of Haitian earthquake survivors found that those who relied on their spirituality for meaning making and coping evidenced greater resilience during and after the trauma than those who did not do so. Participants also attributed their description of posttraumatic growth to positive framing—a sense of a larger purpose or of order amidst disaster. Some saw the disaster as a potentially growth-stimulating experience for Haiti (e.g., a chance to rebuild a better country; O’Grady et al., 2012). Jang and LaMendola (2007) studied 607 survivors of a major earthquake in Taiwan and found that survivors’ spirituality had a direct link with posttraumatic growth, and that the community’s collective spiritual narratives about suffering contributed to the psychological growth following the earthquake.
Now that we have surveyed some of the psychological research on spiritual appraisals of disasters and how they may affect mental health symptoms after a disaster, we now turn to perspectives of suffering within Christianity that are relevant for people helping disaster survivors. Theodicy (i.e., the problem of evil in the world) is a complex theological concept (see chap. 2 in this volume). Our goal in this section is to draw some practical principles from the Bible, starting first with the book of Job.
Within the broad testimony of Christian Scripture, one can scarcely think of suffering without considering the story of Job. In the biblical account, Job was a righteous man whom God allowed to suffer greatly at the hand of Satan. In a single day, marauders stole Job’s donkeys and oxen and killed all but one of the servants that oversaw them. All his sheep and more servants were then killed by fire from heaven. All his camels were stolen by another raiding party who killed more of his servants. Moreover, his seven sons and three daughters were killed when a windstorm caused a house to collapse on them.
Here we have two major categories of suffering illustrated: natural disasters and disasters produced by human activity. In both cases, God is characterized as allowing these tragedies to occur. On yet another day, God allows Satan himself to strike Job: “So Satan went out from the presence of the LORD and afflicted Job with painful sores from the soles of his feet to the crown of his head” (Job 2:7).
Although Job’s story is a classic example of events that raise questions regarding theodicy, it is also an interesting study in disaster response. Job is visited by three friends (and a fourth character who appears later in the book). Their initial response to Job is one of shared grief and a ministry of presence:
When Job’s three friends . . . heard about all the troubles that had come upon him, they set out from their homes and met together by agreement to go and sympathize with him and comfort him. When they saw him from a distance, they could hardly recognize him; they began to weep aloud, and they tore their robes and sprinkled dust on their heads. Then they sat on the ground with him for seven days and seven nights. No one said a word to him, because they saw how great his suffering was. (Job 2:11-13)
This scripture passage reveals a lesson: our first task in responding to suffering is to enter into relationship with survivors and to be present in their suffering. But suffering inevitably raises questions such as “Where is God?” Another common question that is raised is “Do those who suffer somehow bring it upon themselves?” Recall the disciples’ question when they encountered a man who was born blind: “Rabbi, who sinned, this man or his parents, that he was born blind?” (Jn 9:2). It is all too easy to blame the victim (Ryan, 1976), but we see that Christ rebukes this type of response and instead points to the natural order of living in a fallen world.
As Job’s friends shift from a ministry of presence to debating the source of Job’s suffering, they increasingly point their fingers at Job. Chapter by chapter, Job’s frustration grows. In chapter 16 he retorts:
I have heard many things like these;
you are miserable comforters, all of you!
Will your long-winded speeches never end?
What ails you that you keep on arguing?
I also could speak like you,
if you were in my place;
I could make fine speeches against you
and shake my head at you.
But my mouth would encourage you;
comfort from my lips would bring you relief. (Job 16:1-5)
Job himself recognized that it is easy to “make fine speeches” against those who suffer, but he instead commends bringing comforting words. As it is, his friends have become “miserable comforters”—something, no doubt, that Christian mental health professionals ought to avoid doing. Unfortunately, Job’s friends still failed to learn that it was not their place to assign blame, leading Job to cry out:
How long will you torment me
and crush me with words?
Ten times now you have reproached me;
shamelessly you attack me.
If it is true that I have gone astray,
my error remains my concern alone.
If indeed you would exalt yourselves above me
and use my humiliation against me,
then know that God has wronged me
and drawn his net around me. (Job 19:2-6)
Here we see another subtle risk to those who seek to help crisis-affected persons: exalting ourselves above those who suffer. Humility, along with the knowledge that our situations could easily be reversed, is a necessary posture for effective disaster response. Indeed, the Gospels provide examples of self-sacrifice to help people in need: “Greater love has no one than this: to lay down one’s life for one’s friends” (Jn 15:13).
But why respond to disaster at all? In some ways, the response of Job’s friends seems reasonable. Of the 124 times the Bible uses the word disaster (all, incidentally, in the Old Testament), the vast majority are in the context of prophecies about God bringing disaster on the unrighteous. Yet even here there are hints that a personal or societal crisis is not always to be seen as the judgment of God. When Haman hatched a plot to kill all the Jews, Mordecai told Esther that her royal position could not protect her: “And who knows but that you have come to your royal position for such a time as this?” (Esther 4:14). When David was pursued by Saul and hiding in caves, he cried out to God, “Have mercy on me, my God, have mercy on me, / for in you I take refuge. / I will take refuge in the shadow of your wings / until the disaster has passed” (Ps 57:1). Crying out to God in the midst of suffering is a common theme scattered throughout the Psalms and the Prophets (e.g., Jer 17:17). Thus, there is good precedent for Christian mental health professionals to support spiritually oriented disaster survivors in turning their pleas of suffering to God instead of stifling such cries (or condemning them, as Job’s friends did).
But what about those biblical occasions when the Bible depicts suffering as a clear consequence of spiritual rebellion? Even in those instances we are warned against delighting in adversities. For example, Edom was chastised for its haughtiness in the face of the suffering of its Jewish brothers (Obad 1:10). The Bible also warns against reveling in the misfortunes of others: “Whoever mocks the poor shows contempt for their Maker; / whoever gloats over disaster will not go unpunished” (Prov 17:5). Condemnation, ridicule, delight, and the naive assumption that we are immune from suffering not only are unhelpful but typically reflect poorly on the state of our own souls. It is clear that we must reject our tendency toward judgment and instead embrace humility. This does not mean hearing about tragedy and only expressing concern by praying—at least not when we are in a position to do more. Throughout the Scriptures, we are pictured as responsible for one another. We see this very early in the creation story: “It is not good for the man to be alone. I will make a helper suitable for him” (Gen 2:18). Part of the design of creation is that we are to help one another.
Families, of course, can be expected to pull together in times of crisis—“A friend loves at all times, and a brother is born for a time of adversity” (Prov 17:17)—but they do not always do this well. Even when families pitch in to the best of their ability, distance and lack of resources may render such efforts impotent. Hence, the author of Proverbs tells us, “Do not forsake your friend or a friend of your family, / and do not go to your relative’s house when disaster strikes you— / better a neighbor nearby than a relative far away” (Prov 27:10).
Throughout the biblical narrative, we see the theme of God’s active work of redemption, as God repeatedly demonstrates that God is not the kind of being who just brought creation into existence and then was uninvolved. Rather, we see repeated examples of a God who is capable of, interested in, and committed to intervening. We see a God who promises in Revelation 21:4 that “God shall wipe away all tears” (KJV) from those who suffer—if not in this life, then in the new creation.
Thus, when considering how to respond to disasters, we must ensure that our theology of disasters is coherent with the larger biblical narrative and with scriptural truths. In contrast to the Old Testament, examples of disasters in the New Testament suggest that disasters are not so much manifestations of divine wrath sent to a particular group of persons; rather, disasters are evidence of the creation moaning for liberation from the effects of humanity’s sin (Rom 8:18-23). Moreover, we see the example of God’s ultimate sacrifice, love, and commitment, reflected in God’s choice to enter human suffering and suffer personally even to the point of death, yet with the promise of new life and redemption. Thus, we are challenged to see beyond the present suffering to the world as God intended it to be—a redeemed and restored new creation that reflects and glorifies the Creator.
In fact, in themselves disasters often reflect the four-phase biblical metanarrative of creation, sin, salvation, and redemption. Throughout the Bible, God promises to be with us and to walk with us through times of suffering. As Christians, we too are called to minister to and with those people who suffer, including disaster survivors.
Christian mental health professionals are in a unique position to help disaster survivors address both mental health and spiritual issues, as well as to collaborate with the church during times of disaster. In this section we build on the psychological research and biblical framework above by offering examples of both microlevel (person focused) and macrolevel (community focused) interventions that are key to successful disaster spiritual and emotional care. We conclude the section by considering the ways in which having Christian mental health professionals involved in disaster spiritual and emotional care may help shape future Christian integrative efforts.
Disaster church-psychology collaboration. Christian mental health professionals should take steps to engage key gatekeepers within faith communities to build collaborative relationships that can be leveraged in response to disasters. Church leaders often act as gatekeepers in their respective faith communities, and they are more willing to refer members to professionals when they have an established relationship (e.g., Aten, 2004). Therefore, Christian mental health professionals should make a strategic effort to build partnerships with church leaders in their community prior to disasters so that a relationship is already in place if and when a disaster strikes (Evans, Kromm, & Sturgis, 2008; Roberts & Ashley, 2008). These partnerships will help pave the way for greater church-psychology collaboration in response to disasters.
Church leaders are the experts about their communities, so Christian mental health professionals should use a dialogical (i.e., two-way) rather than didactic (i.e., one-way) approach to collaboration. When meeting with such gatekeepers, Christian mental health professionals should seek to maintain a humble, learning posture, especially as it applies to the dynamics of specific faith communities and cultural contexts, so that church leaders and mental health practitioners together can create a community-specific and culturally sensitive approach to disaster preparedness and response (O’Grady et al., 2012).
Psychological First Aid (PFA) for community religious professionals. When disaster strikes, the impact may be moderated by early intervention. Prior to 2002, Critical Incident Stress Debriefing (CISD) was the modal intervention strategy employed internationally in the immediate aftermath of trauma (Litz, 2008). CISD is a specific, seven-phase, small-group, supportive crisis intervention process. However, subsequent empirical research has cast doubt on some of the supposed benefits of CISD and even demonstrated a potential for it to cause more harm than good (Emmerik, Kamphuis, Hulsbosch, & Emmelkamp, 2002). Because of these controversies, CISD became part of a more comprehensive intervention protocol known as Critical Incident Stress Management (CISM; Everly & Mitchell, 1999, 2011). Currently, CISM involves seven core components: (1) pre-crisis preparation, (2) demobilization and staff consult, (3) defusing, (4) CISD, (5) individual crisis intervention, (6) family CISM, and (7) follow-up referral (Everly & Mitchell, 1999). Despite these revisions, the debriefing component of CISM continues to raise concerns about its effectiveness as a flexible and adaptable tool for early intervention. In light of such concerns, most practice guidelines (such as the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration and the Departments of Veterans Affairs and Defense) now recommend Psychological First Aid (Litz, 2008).
The purpose of PFA is to provide children, adults, and families with support that decreases risk factors and increases resilience factors to trauma (Vernberg et al., 2008). PFA is an evidence-informed intervention for survivors of natural and human-caused disasters. Compared to traditional psychotherapy, it is less clinically oriented in nature and primarily focuses on addressing the immediate mental health needs of disaster survivors. PFA consists of nine core actions: (1) contact and engagement, (2) safety and comfort, (3) stabilization, (4) information gathering, (5) current needs and concerns, (6) practical assistance, (7) connection with social supports, (8) information on coping, and (9) linkage with collaborative services (Forbes et al., 2011). PFA has more of a triage focus, with the goal of helping to enhance and stabilize the psychological well-being of disaster survivors. As a result, PFA has been adapted for a wide range of community professionals to be able to deliver this intervention.
Of particular relevance to the current chapter, PFA has also been contextualized for community religious professionals. In Psychological First Aid: Field Operations Guide for Community Religious Professionals (Brymer et al., 2006), the authors introduce a variation of Psychological First Aid that addresses religious and spiritual themes, including (a) clarifying religious, spiritual, and existential terminology; (b) how to worship with someone of a different faith; and (c) talking to children and adolescents about their spiritual/religious concerns and involving them in religious activities. Christian mental health professionals could use this resource to train clergy and church leaders in this intervention, thereby increasing a community’s capacity to provide disaster spiritual and emotional care. Christian mental health professionals are encouraged to acquire this spiritually focused resource to enhance their own clinical practice.
Consultation, outreach, and advocacy. Christian mental health professionals can also promote disaster spiritual and emotional care through consultation, outreach, and advocacy efforts. Aten, Topping, Denney, and Hosey (2011) developed a three-tier consultation and outreach model to provide mental health training for clergy and churches. In tier one, Christian mental health professionals provide basic disaster mental health information to local clergy. In tier two, Christian mental health professionals and church leaders work together to help educate their congregation members. In tier three, congregation members reach out to their local communities to provide information on topics such as common reactions and problems, as well as information on when and where help can be found locally.
Similarly, on behalf of churches, Christian mental health professionals can advocate for resources by applying the best science and information available to address disaster needs and policy. In this role, Christian mental health professionals can work with local churches and organizations to identify needs and gaps in services and help them bring those needs to light (Aten et al., 2008). For example, after Hurricane Katrina, several churches were concerned that local authorities were planning to use relief dollars to expand a local port used for industry rather than fund low-income housing. In this case, several local Christian psychologists collaborated with churches to help them develop a policy-influencing “voice” and refine their message. Empirical data were provided to faith leaders to help support their arguments and thereby enhance their ability to influence policy. Overall, successful consultation, outreach, and advocacy interventions are characterized by (a) establishing relationships with local community and religious leaders, (b) striving to be culturally appropriate, (c) fostering bidirectional collaboration, (d) promoting a cyclical approach (e.g., implementation, evaluation, and refinement), (e) being contextualized to the community, and (f) helping organize resources (Aten et al., 2013; Milstein, Manierre, & Yali, 2010).
Clinical services. In addition to preparedness and community-level interventions, Christian mental health professionals may have the opportunity to develop psychotherapeutic relationships with individuals and families affected by a disaster. As noted earlier, support interventions like PFA are recommended for early response. However, there is a general consensus suggesting that traditional psychotherapy may be better suited for helping survivors at intermediate and long-term phases of disaster recover (e.g., six weeks to several months or longer after the disaster) following proper clinical assessment (Raphael & Wooding, 2006). Postdisaster therapy interventions include exploring and understanding how survivors’ ways of thinking, feeling, and behaving are affecting their acute postdisaster adjustment. In many cases, these interventions are more change-oriented than support-oriented and are intended to help people either change or accept their postdisaster circumstances.
For example, research evidence strongly supports the usefulness and effectiveness of cognitive behavioral therapy (CBT) to treat disaster survivors (Aten, 2012a, 2012b). Specifically, symptoms of distress, posttraumatic stress, depression, and anxiety decrease following the implementation of CBT techniques (Hamblen, Gibson, Mueser, & Norris, 2006; Hamblen et al., 2009; Taylor & Weems, 2011). Common CBT techniques used with disaster survivors include psychoeducation concerning potential trauma responses to disasters, deep breathing techniques, muscle relaxation techniques, and prolonged imaginal or in vivo exposure (Bryant, Moulds, & Nixon, 2003; Hamblen et al., 2009; Stein et al., 2003; Taylor & Weems, 2011).
Researchers from the National Center for PTSD (2015) developed CBT for Post-Disaster Distress utilizing many of the aforementioned techniques, which are designed to challenge maladaptive disaster-related beliefs (Hamblen et al., 2009). This intervention seeks to mitigate “cognitive, emotional, and behavioral reactions to disaster, including symptoms of PTSD, depression, stress vulnerability, and functional difficulties” (Hamblen et al., 2009, p. 207). For children and adolescents, programs such as StArT (Taylor & Weems, 2011) and Cognitive Behavioral Intervention for Trauma in Schools (CBITS; Stein et al., 2003) have similarly adapted cognitive behavioral techniques in order to reduce children’s and teens’ symptoms of trauma, depression, and anxiety through the use of games, presentations, workbooks, and developmentally appropriate examples.
Although not yet empirically supported for use within a disaster context, there is strong empirical support for Christian accommodative adaptations of CBT (Aten, 2012a, 2012b). In working with survivors’ long-term situations, the integration of spiritual and religious themes into treatment has been found to be helpful in enhancing treatment effectiveness. Thus, when religious and existential issues present in the context of psychotherapy for disaster survivors, Christian mental health professionals may find it useful to merge elements from CBT for Post-Disaster Distress and Christian accommodative CBT (Aten, 2012a, 2012b).
According to Worthington, Johnson, Hook, and Aten (2013), Christian accommodative CBT for disaster survivors might involve 8–12 sessions consisting of three parts or phases: psychoeducation, anxiety management techniques, and cognitive restructuring. During the psychoeducation phase, the psychotherapist would discuss common postdisaster psychological problems (e.g., depression, anxiety, substance abuse, PTSD) and R/S problems such as R/S struggles (e.g., anger toward God) and discrepancies between how people view God theologically and how they are experiencing God emotionally (e.g., I believe God is loving and powerful, but I am experiencing God as distant and unable or unwilling to protect me; Moriarty & Davis, 2012).
In the next phase, anxiety management techniques can be used to enhance survivors’ disaster-related coping efforts. Here, in addition to encouraging the use of traditional anxiety management methods such as breathing techniques, muscle relaxation, and positive self-talk, the psychotherapist might also discuss the use of positive religious coping methods (Worthington et al., 2013). Such coping methods might involve seeking R/S support (e.g., from clergy and congregational members), religious purification/forgiveness, collaborative religious coping, spiritual connection, benevolent religious reappraisal, religious direction/conversion, religious helping, religious focus, active religious surrender, and marking religious boundaries (Pargament, Koenig, & Perez, 2000). Lastly, during the cognitive restructuring phase, the psychotherapist can challenge faith-relevant cognitive distortions (e.g., between survivors’ beliefs and biblical truths), reinforce adaptive thinking, and assign homework utilizing religious practices such as journaling, Christian imagery, healing prayer, and other religious coping strategies. To determine if such an approach might be psychotherapeutically beneficial to clients, Christian mental health professionals may do a thorough assessment that includes inquiring about clients’ religious and spiritual history and commitments (Worthington et al., 2013).
Other scholars encourage the use of pastoral counseling to help disaster survivors. For example, Harris et al. (2008) recommended that survivors utilize pastoral counseling and related services following a disaster. Harris et al. (2008) emphasized that such services are needed to provide disaster survivors with additional strategies and guidance on the utilization of R/S resources before, during, and after a disaster.
Research has shown that for many disaster survivors, religion and spirituality play an important role in the recovery process. The purpose of this chapter has been to review the current research on the psychology of religion/spirituality and disasters, provide an overview of Christian responses to suffering, introduce examples of disaster interventions, and highlight how disaster psychology might affect the future of Christian integrative efforts in psychology.
Overall, Christian mental health professionals working with disaster survivors have the potential to facilitate individual and community healing in the aftermath of disasters by integrating spiritual care with the best of what professional psychology and counseling have to offer. When Christian mental health professionals build their work on a strong theological foundation coupled with both micro- and macrolevel approaches to their work, they will be better positioned to provide holistic spiritual and emotional care to disaster survivors.
Furthermore, Christian mental health professionals who integrate spiritual care into their disaster mental health services will also be better positioned to encourage adaptive church preparedness activities and responses that will promote effective disaster spiritual and emotional care. Our hope is that, within the fields of professional psychology and counseling, this chapter will help raise interest in pursuing the practice and research of disaster spiritual and emotional care and will help inform the practice of such care from a uniquely Christian perspective.
Ai, A. L., Cascio, T., Santangelo, L. K., & Evans-Campbell, T. (2005). Hope, meaning, and growth following the September 11, 2001, terrorist attacks. Journal of Interpersonal Violence, 20(5), 523-48.
Aten, J. D. (2004). Improving understanding and collaboration between campus ministers and college counseling center personnel. Journal of College Counseling, 7, 90-96. doi:10.1002/j.2161-1882.2004.tb00263.x
Aten, J. D. (2012a). Disaster spiritual and emotional care in professional psychology: A Christian integrative approach. Journal of Psychology & Theology, 40, 131-35.
Aten, J. D. (2012b). More than research and rubble: How community research can change lives (including yours and your students’). Journal of Psychology and Christianity, 31, 314-19.
Aten, J. D., Bennett, P. R., Davis, D., Hill, P. C., & Hook, J. N. (2012). Predictors of God concept and God control after Hurricane Katrina. Psychology of Religion and Spirituality, 4, 182-92.
Aten, J. D., & Boan, D. (2016). Disaster ministry handbook. Downers Grove, IL: InterVarsity Press.
Aten, J. D., Boan, D. M., Hosey, J. M., Topping, S., Graham, A., & Im, H. (2013). Building capacity for responding to disaster emotional and spiritual needs: A clergy, academic, and mental health partnership model (CAMP). Psychological Trauma: Theory, Research, Practice, & Policy, 10, 1-10.
Aten, J. D., Madison, M. B., Rice, A., & Chamberlain, A. K. (2008). Postdisaster supervisor strategies for promoting supervisee self-care: Lessons learned from Hurricane Katrina. Training and Education in Professional Psychology, 2, 75-82.
Aten, J. D., O’Grady, K. A., Milstein, G., Boan, D., Smigelsky, M., Schruba, A., & Weaver, I. (2014). Providing spiritual and emotional care in response to disaster. In D. F. Walker, C. A. Courtois, & J. D. Aten (Eds.), Spiritually oriented psychotherapy for trauma (pp. 189-210). Washington, DC: American Psychological Association.
Aten, J. D., Topping, S., Denney, R., & Hosey, J. (2011). Helping African American clergy and churches address minority disaster mental health disparities: Training needs, model, and example. Psychology of Religion and Spirituality, 3, 15-23.
Bjelopera, J. P., Bagalman, E., Caldwell, S. W., Finklea, K. M., & McCallion, G. (2013). Public mass shootings in the United States: Selected implications for federal public health and safety policy. CRS Report for Congress No. R43004. Congressional Research Service 7-5700. Retrieved from www.crs.gov
Briggs, M. K., Apple, K. J., & Aydlett, A. E. (2004). Spirituality and the events of September 11: A preliminary study. Counseling and Values, 48(3), 174-82.
Bryant, R. A., Moulds, M. L., & Nixon, R. V. D. (2003). Cognitive behavior therapy of acute stress disorder: A four-year follow-up. Behavior Research and Therapy, 41, 489-94.
Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., . . . Watson, P. (2006). Psychological First Aid: Field operations guide for community religious professionals. National Child Traumatic Stress Network and National Center for PTSD. Retrieved from www.nctsnet.org/nctsn_assets/pdfs/pfa/CRP-PFA_Guide.pdf
Calhoun, L. G., & Tedeschi, R. G. (2006). The foundations of post-traumatic growth: An expanded framework. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of posttraumatic growth: Research and practice (pp. 1-23). Mahwah, NJ: Lawrence Erlbaum.
Chan, C. S., & Rhodes, J. E. (2014). Measuring exposure in Hurricane Katrina: A meta-analysis and an integrative data analysis. PLoS ONE, 9, 1-15.
Cook, S., Aten, J., Moore, M., Hook, J., & Davis, D. (2013). Resource loss, religiousness, health, and posttraumatic growth following Hurricane Katrina. Mental Health, Religion & Culture, 16, 352-66.
Emmerik, A. A., Kamphuis, J. H., Hulsbosch, A. M., & Emmelkamp, P. M. (2002). Single session debriefing after psychological trauma: A meta-analysis. Lancet, 360, 766-71. doi:10.1016/S0140-6736(02)09897-5
Evans, D., Kromm, C., & Sturgis, S. (2008, August). Faith in the Gulf: Lessons from the religious response to Hurricane Katrina. Retrieved from www.southernstudies.org/sites/default/files/Gulf%20Report-Faith.pdf
Everly, G. S., Jr., & Mitchell, J. T. (1999). Critical Incident Stress Management (CISM): A new era and standard of care in crisis intervention (2nd ed.). Ellicott City, MD: Chevron.
Everly, G. S., Jr., & Mitchell, J. T. (2011). A primer on Critical Incident Stress Management. Retrieved from www.icisf.org/a-primer-on-critical-incident-stress-management-cism/
Forbes, D., Lewis, V., Varker, T., Phelps, A., O’Donnell, M., Wade, D., . . . Creamer, M. (2011). Psychological First Aid following trauma: Implementation and evaluation framework for high-risk organizations. Psychiatry, 74, 224-39.
Galea, S., Nandi, A., & Vlahov, D. (2005). The epidemiology of post-traumatic stress disorder after disasters. Epidemiologic Reviews, 27, 78-91.
Guha-Sapir, D., Below, R., & Hoyois, P. (n.d.). EM-DAT: The CRED/OFDA international disaster database [Data file]. Université Catholique de Louvain, Brussels, Belgium. Retrieved from www.emdat.be
Hamblen, J. L., Gibson, L. E., Mueser, K. T., & Norris, F. H. (2006). Cognitive behavioral therapy for prolonged postdisaster distress. Journal of Clinical Psychology, 62, 1043-52.
Hamblen, J. L., Norris, F. H., Pietruszkiewicz, S., Gibson, L. E., Naturale, A., & Louis, C. (2009). Cognitive behavioral therapy for postdisaster distress: A community based treatment program for survivors of Hurricane Katrina. Administration and Policy in Mental Health and Mental Health Services Research, 36, 206-14.
Harris, J. I., Erbes, C. R., Engdahl, B. E., Olson, R. H., Winskowski, A. M., & McMahill, J. (2008). Christian religious functioning and trauma outcomes. Journal of Clinical Psychology, 64, 17-29. doi:10.1002/jclp.20427
Hobfoll, S. E., Freedy, J. R., Green, B. L., & Solomon, S. D. (1996). Coping in reaction to extreme stress: The roles of resource loss and resource availability. In M. Zeidner & N. S. Endler (Eds.), The handbook of coping: Theory, research, applications (pp. 322-49). New York, NY: John Wiley & Sons.
Jang, L., & LaMendola, W. (2007). Social work in natural disasters: The case of spirituality and post-traumatic growth. Advances in Social Work, 8(2), 305-16.
Johnson, T. J., Aten, J., Madson, M., & Bennett, P. (2006). Alcohol use and meaning in life among survivors of hurricane Katrina. Paper presented at the 4th Biennial International Conference on Personal Meaning: Addiction, Meaning, & Spirituality, Vancouver, British Columbia.
Kroll-Smith, J. S., & Couch, S. R. (1987). A chronic technical disaster and the irrelevance of religious meaning: The case of Centralia, Pennsylvania. Journal for the Scientific Study of Religion, 26(1), 25-37.
Litz, B. T. (2008). Early intervention for trauma: Where are we and where do we need to go? A commentary. Journal of Traumatic Stress, 21, 503-6. doi:10.1002/jts.20373
Milstein, G., Manierre, A., & Yali, A. M. (2010). Psychological care for persons of diverse religions: A collaborative continuum. Professional Psychology: Research and Practice, 41, 371-81.
Moriarty, G. L., & Davis, E. B. (2012). Client God images: Theory, research, and clinical practice. In J. Aten, K. O’Grady, & E. Worthington, Jr. (Eds.), The psychology of religion and spirituality for clinicians (pp. 131-60). New York, NY: Routledge.
National Center for Posttraumatic Stress Disorder. (2015, August 14). Disaster mental health treatment. Retrieved from www.ptsd.va.gov/public/treatment/therapy-med/disaster_mental_health_treatment.asp
Newton, A. T., & McIntosh, D. N. (2009). Associations of general religiousness and specific religious beliefs with coping appraisals in response to hurricanes Katrina and Rita. Mental Health, Religion & Culture, 12(2), 129-46.
Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: Part I, an empirical review of the empirical literature, 1981–2001. Psychiatry: Interpersonal and Biological Processes, 65, 207-39.
O’Grady, K. A., Rollison, D. G., Hanna, T. S., Schreiber-Pan, H., & Ruiz, M. A. (2012). Earthquake in Haiti: Relationship with the sacred in times of trauma. Journal of Psychology & Theology, 40, 289-301.
Pargament, K. I., & Cummings, J. (2010). Anchored by faith: Religion as a resilience factor. In J. W. Reich, A. J. Zautra, & J. S. Hall (Eds.), Handbook of adult resilience (pp. 193-210). New York, NY: Guilford Press.
Pargament, K. I., Ishler, K., Dubow, E., Stanik, P., Rouiller, R., Crowe, P., . . . Royster, B. J. (1994). Methods of religious coping with the Gulf War: Cross-sectional and longitudinal analyses. Journal for the Scientific Study of Religion, 33, 347-61.
Pargament, K. I., Koenig, H. G., & Perez, L. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56, 519-43.
Park, C. L. (2016). Meaning making in the context of disasters. Journal of Clinical Psychology. doi:10.1002/jclp.22270
Raphael, B., & Wooding, S. (2006). Longer-term mental health interventions for adults following disasters and mass violence. In E. C. Ritchie, P. J. Watson, & M. J. Friedman (Eds.), Interventions following mass violence and disasters: Strategies for mental health practice (pp. 174-92). New York, NY: Guilford Press.
Richards, P. S., & O’Grady, K. A. (2007). Theistic counseling and psychotherapy: Conceptual framework application to counselling practice. Counseling and Spirituality, 26(2), 79-102.
Roberts, S. B., & Ashley, W. C., Sr. (Eds.). (2008). Disaster spiritual care: Practical clergy responses to community, regional, and national tragedy. Woodstock, VT: SkyLight Paths.
Ryan, W. (1976). Blaming the victim (2nd ed). New York, NY: Vintage Books.
Sibley, C. S., & Bulbulia, J. (2012). Faith after an earthquake: A longitudinal study of religion and perceived health before and after the 2011 Christchurch New Zealand earthquake. PLOS ONE, 7(12): e49648. doi:10.1371/journal.pone.0049648
Smith, B., Pargament, K., Brant, C., & Oliver, J. (2000). Noah revisited: Religious coping by church members and the impact of the 1993 midwest flood. Journal of Community Psychology, 28, 168-86.
START (National Consortium for the Study of Terrorism and Responses to Terrorism; 2015). Global Terrorism Database [Data file]. Retrieved from www.start.umd.edu/gtd
Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence: A randomized controlled trial. Journal of the American Medical Association, 290, 603-11.
Stratta, P., Capanna, C., Riccardi, I., Perugi, G., Toni, C., Dell’Osso, L., & Rossi, A. (2013). Spirituality and religiosity in the aftermath of a natural catastrophe in Italy. Journal of Religious Health, 52, 1029-37.
Taylor, L. K., & Weems, C. F. (2011). Cognitive-behavior therapy for disaster-exposed youth with posttraumatic stress: Results from a multiple-baseline examination. Behavior Therapy, 42, 349-63.
United Nations Office for Disaster Risk Reduction. (2015). The human cost of weather related disasters: 1995–2015. Geneva, Switzerland: Author. Retrieved from www.unisdr.org/2015/docs/climatechange/COP21_WeatherDisastersReport_2015_FINAL.pdf
Vernberg, E., Steinberg, A., Jacobs, A., Brymer, M., Watson, P., Osofsky, J., . . . Ruzek, J. I. (2008). Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice, 39, 381-88.
Worthington, E. L., Johnson, E. L., Hook, J. N., & Aten, J. D. (Eds.). (2013). Evidence-based practices for Christian counseling and psychotherapy. Downers Grove, IL: IVP Academic.