How Does One Learn to be Spiritual Neglected Role of Spiritual Modeling in Health

1. How Does One Learn to be Spiritual? Neglected Role of Spiritual Modeling in Health Doug Oman, Ph.D. School of Public Health University of California, Berkeley 27th Annual Meeting, Society of Behavioral Medicine: Pre-Conference Event Spirituality, Science and Health: What�s Going On and Why? March 22, 2006

2. OUTLINE Social Learning Theory Spiritual Modeling Application to Interventions

3. Social Learning Theory How do we learn anything? Much is osmosis, apprenticeships, role models, etc. Relying only on trial/error would be excruciating! �Most human behavior is learned observationally through modeling� (Bandura, 1986)

4. We Learn from Other People Face to face observation Through media Oral Print Electronic

5. Social Cognitive Theory Bandura�s (1986) theory: Fullest scientific account of Observational Learning (OL) OL seen as central to all learning OL functions partly via Self-efficacy ------ [confidence in specific skills]

6. Social Cognitive Theory  Areas of Application Education Physical health Mental health Athletics Organizational functioning

7. Documented power of Observational Learning �One can get people to behave altruistically, volunteer their services, delay or seek gratification, show affection, behave punitively, prefer certain foods and apparel, converse on particular topics, be inquisitive or passive, think innovatively or conventionally, and to engage in almost any course or action by having such conduct exemplified.� (Bandura, 1986)

8. Observational Learning Four major underlying processes Attention Retention Reproduction in Behavior Motivation

9. Applying to Spirituality Observational Learning ?well-studied Spirituality ?wide emerging interest ?Why not Connect the Dots??

10. Spiritual Modeling Learning spiritually relevant skills or behaviors through observing other persons. (Oman & Thoresen, 2003)

11. From Whom...do we learn spiritually relevant behaviors? Spiritual Models may be... Persons in the Community Family School Spiritual/Religious Organization etc. Famous persons RS tradition Media (books, electronic, etc.)

12. What is Learned? (I) Almost any RS-relevant belief / behavior RS beliefs Existence/nature of God/higher being Human nature / purpose Coping assistance [from within/above] Spiritual Practices Prayer/Meditation Virtues [e.g., Forgiveness/Love/Faith] Selfless service

13. What is Learned?(continued) Identities of Revered Spiritual Models ? Jesus ? Mother Teresa ? Buddha ? Mahatma Gandhi ? Martin Luther King ? Dalai Lama

14. Spiritual modeling occursThrough what Processes? Same as for all social learning Attention Retention Reproduction in Behavior Motivation Claim Religions historically foster all four, systematically (Oman & Thoresen, 2003)

15. The Spiritual Modeling Perspective Factors affecting learning from spiritual examples (including from spiritual �data banks�) may have consequences!

16. Application to Health The Spiritual Modeling Perspective suggests refinements in theories of how spirituality affects health

23. Summary of Model Learning from spiritual models is theorized to foster health... via mechanisms of Social support Health behaviors Mental health/Character strengths/Virtues in concert (synergistically) with Spiritual Practices Beliefs / Experiences / etc.

25. Spiritual Models:Concept Summary The Spiritual Modeling... Perspective Spirituality is more than only beliefs+practices. Also includes: Factors affecting learning from �data banks� of spiritual models Health Effects Model Spiritual models affect health via multiple pathways, in concert with other RS dimensions Empirical Support Social Cognitive Theory extremely supported Preliminary support for spiritual application

26. Practical Application to Healthof Spiritual Modeling Perspectives Is there a problem? Response strategies Intervention 1: Spiritual meditation (I) Intervention 2: Cue words Intervention 3: Supportive assessments Intervention 4: Spiritual meditation (II)

27. Are people satisfied with their opportunities to learn from spiritual models? �When [US high school] students were asked to give examples of individuals who exemplified the various [character] strengths, they were more likely to name biblical figures or civil rights leaders from the 1960s rather than exemplars from contemporary society.... One male student observed: �We just don�t see many people today who are wise or honest or whatever because those sorts of things aren�t valued as much in our society.�� (Steen, Kachorek & Peterson, 2003) Steen, T. A., Kachorek, L. V., & Peterson, C. (2003). Character strengths among youth. Journal of Youth & Adolescence, 32, 5-16. Quote is from page 11.Steen, T. A., Kachorek, L. V., & Peterson, C. (2003). Character strengths among youth. Journal of Youth & Adolescence, 32, 5-16. Quote is from page 11.

28. Compartmentalized CultureExtreme Example: Modern Medicine Modern Western medicine, "shorn of every vestige of mystery, faith, or moral portent, is actually an aberration in the world scene� Academic Medicine (Barnard, Dayringer & Cassell, 1995)

29. Moving Lives from Radical to Manageable Compartmentalization Help people to draw on spiritual perspectives and resources in all compartments of life Provide tools(practices) to help individuals... More deeply assimilate spiritual models [attend, retain] Integrate spiritual life throughout the day [retain, reproduce in behavior]

30. Interventions: Spiritual Modeling Perspectives The following interventions don�t work only via spiritual models Spiritual modeling perspectives sensitize us to key features (often cognitive) key processes key questions to study

31. Intervention 1:Spiritual Meditation (I) In college students (N=46), Wachholtz and Pargament (2005) compared Meditating on ?a spiritual focus (e.g., �God is joy�) Meditating on a secular focus (e.g., �I am joyful�) This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.

32. Findings(randomized design) Compared to a secular focus (e.g., �I am joyful�) ? Meditating on a spiritual focus (e.g., �God is joy�) was associated with... ? reduced anxiety ? improved mood ? increased pain tolerance (Wachholtz and Pargament, 2005) Note: recently replicated This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.This study was conducted with college age students (N=46, mean age=19, 68% female) Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369-384.

33. Mechanisms?A spiritual focus might... Make spiritual resources / models more mentally accessible through the day, e.g., more able to: Remember spiritual models Enact virtues (forgiveness, etc.) Use RS coping methods (�Associative network theory�, Collins & Loftus, 1975) ? reduced stress From Wachholtz and Pargament (2005), page 380 (bold added): �Of the three treatments, only the Spiritual Meditation condition imposed a focused time on the participants to consider their spirituality. This could lead to two conclusions. First, individuals may be more likely to interpret everyday occurrences through a spiritual lens when they participate in spiritual meditation. Second, when individuals set aside time to focus on their spirituality, they may be more open to subjective spiritual experiences. Further, perhaps people are generally looking to improve their spiritual lives, yet in their rushed lifestyles, they are unable to find the time to expand their spirituality. The quiet time mandated by this study may have provided some outlet for that spiritual desire, diverting attention from the external �noise� of daily life to the inner spiritual life From Wachholtz and Pargament (2005), page 380 (bold added): �Of the three treatments, only the Spiritual Meditation condition imposed a focused time on the participants to consider their spirituality. This could lead to two conclusions. First, individuals may be more likely to interpret everyday occurrences through a spiritual lens when they participate in spiritual meditation. Second, when individuals set aside time to focus on their spirituality, they may be more open to subjective spiritual experiences. Further, perhaps people are generally looking to improve their spiritual lives, yet in their rushed lifestyles, they are unable to find the time to expand their spirituality. The quiet time mandated by this study may have provided some outlet for that spiritual desire, diverting attention from the external �noise� of daily life to the inner spiritual life

34. Implications RS effects are not reducible to RS practices Impact of RS cognitive factors is predicted by a spiritual modeling perspective Question: Does spiritual meditation foster better daily mental recall of spiritual models?

35. Intervention 2:Spiritual Cue Words Many RS traditions teach repeating a holy name/mantram at many times throughout the day Holy names and mantrams may evoke spiritual models

36. Empirical Study Bormann et al (2005, 2006) taught holy name / mantram repetition to veterans, VA staff (N=66) Participants encouraged to use a cue word from a tradition throughout the day ?�Jesus� ?�Rama� ?�Barukh Attai Adonai� ?�Om mani padme hum� ?�Ave Maria�

37. Cue Word Findings Most participants (55/66=83%), reported incidents when holy name/mantram was helpful for coping Used for managing... emotions such as impatience, anger, frustration (51%) stress (24%), insomnia (13%) unwanted thoughts (12%).

38. Implications Spiritual practices may foster drawing upon spiritual models throughout the day Question: Does mantram use foster mental recall of spiritual models?

39. Intervention 3:Supportive Assessment In Academic Medicine, Barnard et al (1995) wrote that �An important task of care for the physician is to elicit patients' explanatory frameworks, and to seek accommodations where necessary (and where possible) between medical and nonmedical interpretations....�

40. Semi-Structured Protocol Kristeller and colleagues (2005) taught oncologists to use a 5-7 minute semi-structured interview Interviews with oncology patients (N=118) Inquired about spiritual resources Offered assistance as appropriate

42. Empirical Findings Most patients (76%) felt inquiry was somewhat/very useful. At 3 weeks, the intervention group had ? Depression (p<.01) ? Quality of Life (p<.05) ? Sense of interpersonal caring from their physician (p<.05)

43. Implications Supportive spiritual assessments are feasible and appreciated Health professionals can exemplify (model) a limited reintegration of spirituality and healthcare

44. Intervention 4:Spiritual Meditation (II) Historically, RS traditions systematically foster all four processes Attention Retention Reproduction in behavior Motivation (Oman & Thoresen, 2003) Can health interventions also support all these processes?

45. Spiritual Models in Meditation Interventions Oman and Beddoe (2005) reviewed spiritual modeling support offered by previously studied meditation forms

46. Passage Meditation (choose own passages from a spiritual wisdom figure or tradition)

47. Eight Point Program for Spiritual Growth (Easwaran, 1991/1978) Eight Point Program, more info: http://www.easwaran.orgEight Point Program, more info: http://www.easwaran.org

48. Randomized Controlled Trial Oman, Thoresen et al (in press) studied Health Professionals (N=58) Randomized, wait-list-controlled Assessed: Pre-intervention, post-intervention, 8-week FU 19-week FU

49. Resultsstandardized by pretest SD

50. Do Passages Make a Difference? Compared to a comprehensive meditation program offering less spiritual modeling support (MBSR): Stress and well-being outcomes were SIMILAR [2 mo FUp] However�Passage meditators had more gains in: Pre-1900 spiritual models Spiritual modeling self-efficacy

51. Implications Similar effects remind us that spiritual models work in concert with practices Question: What are long-term implications of extra spiritual models?

52. Reflection on Interventions Nonsectarian interventions that support spiritual modeling are feasible Theory and preliminary evidence support health effects� in concert with practices but not reducible to practices

53. OverallSummary/Conclusion Scientific theory + spiritual traditions each affirm: spiritual modeling is central to spiritual learning Theoretically: Models/practices/beliefs reciprocally affect each other, and affect health in concert Empirically promising interventions exist that reflect spiritual modeling perspectives