1
Spiritual resources and physical health
Irena Heszen
Warsaw School of Social Psychology
Address for correspondence:
Irena Heszen-Niejodek
Bankowa 12a m. 4
40-007 Katowice
E-mail: [e-mail]
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Spiritual resources and physical health
Abstract
A growing interest in the problems of human spirituality has been noted in psychology in the
past few decades. This refers particularly to health psychology, where quite substantial
evidence has been collected indicating a positive influence of spirituality as an individual
attribute on physical health. The paper presents an attempt to conceptualize spirituality from
the psychological viewpoint, as well as to develop a new questionnaire for the measurement
of spirituality as human dimension. Moreover, a series of studies using the questionnaire are
reported, with almost 600 participants (in that number over 400 patients with various clinical
health problems). The research was focused on seeking psychological factors that might
mediate the effect of spirituality on physical health. Higher levels of spirituality were fund to
be associated with better adjustment to illness, higher readiness to health-promoting
behaviors, and more effective coping with stress.
Keywords: coping with illness, health-related lifestyle, positive emotions, negative emotions,
spirituality
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Spiritual resources and physical health
The notion of spirituality has had a long and varied career. Being one of the  key words in
such disciplines as theology and philosophy, it penetrated to psychology during the past
decade. The spiritual domain of human-being, distinguished both in the foreign (e.g. Girardin,
2000; Miller, 1998) and Polish psychological literature (e. g. Kościelska, 2000; Straś-
Romanowska, 1992), is considered also from the developmental perspective (Helminiak,
1987; Pietrasiński, 1990; Socha, 2000).
In health psychology spirituality is associated with some forms of psychotherapy
(spiritual therapy), certain illness-related problems (such as spiritual needs of patients), and
finally, with health itself (spiritual health). The importance of spirituality in health psychology
is evidenced by inclusion of the spiritual domain in the concept of health as its fourth
dimension (besides physical, psychological and social sphere) (Harris, Thoresen, McCullough
& Larson, 1999; Hatch, Burg, Naberhaus & Hellmich, 1998; Sartorius, 2000). There is a
growing body of evidence that spirituality is related to physical (somatic) health.
This paper presents a preliminary attempt to conceptualize spirituality from the
psychological viewpoint and outlines possible mechanisms of this dimension relationship
with somatic health. Moreover, a questionnaire developed by the author and her co-workers to
measure spirituality is described, and results of preliminary studies are reported. In
conclusion, suggestions for further research are proposed.
1. Spirituality in the psychological perspective
Spirituality as an interdisciplinary concept may be considered from the perspective of various
disciplines that bring their specific insight and enrich our understanding of spirituality, but
also have some limitations resulting from their subject matter and adopted methodological
approach. This refers to psychology as well, if psychology is regarded as one of the branches
dealing with spirituality1
Within the strictly interpreted limits of psychology, spirituality should be dealt with only
as an attribute of man. Moreover, taking into consideration the methodology of psychological
research, spirituality should be defined without any assumptions concerning the existence of a
Supreme Being and supernatural forces (Chlewiński, 1982), since such assumptions cannot be
verified using the methodological approach developed and used in psychology. Spirituality as
a psychological concept has the status of a latent (theoretical) construct and does not differ in
this respect from such basic psychological terms as e.g. personality, intelligence, coping style
and many others. All these are dispositions to certain kinds of activity and/or experience.
Thus, a question arises what is the specificity of spirituality as a human disposition?
According to such disciplines as theological and philosophical anthropology that in
comparison to psychology have longer traditions in conceptualizing spirituality, the essence of
the spiritual domain is transcendence. Thus, spirituality may be defined in psychology as a
disposition for transcendence. This disposition is expressed in specific forms of activity and
experience. Transcendence in the psychological sense means transgression of the actually
experienced ego. The direction of transcendence is determined by non-material values. In
other words, not every movement beyond the present ego is regarded as transcendence, but
only that upwards, toward growth and development.
1
A controversy concerning spirituality as a psychological term should be noted here. Some
authors, e.g. Popielski (1999) and StraÅ›-Romanowska (1992), suggest that the debate on
spirituality should be left to cultural anthropologists.
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The goal of transcendence may be external (e.g. God) but also internal (e.g. personal
development). Besides, transcendence may be directed toward another human being, if his or
her good is valued higher than that of the individual s, as in the mother-child relation.
According to this approach, spirituality is relational being a transcendent relationship with an
object that is highly valued, located beyond or within the self (Miller & Thoresen, 2003). This
view corresponds well with a tendency present in the contemporary psychology to formulate
its phenomena as relations either between the individual and the surrounding world, or within
the individual.
A brief comment on the relation between spirituality and religion (religiousness) is
needed, as this relationship is a source of confusion and controversy. Using the psychological
perspective, we conceptualize spirituality at the individual s level, i.e. as an attribute of the
human being. Religion is an institutional, societal phenomenon, but religiousness may be
conceptualized also at that individual level. While religiousness is defined in relation to
religion, some aspects of spirituality may be of a different origin. On the other hand, no
spiritual experience is involved in the so-called extrinsic religiosity consisting only in a
formal adherence to practices proposed by a religious institution. Therefore, spirituality and
religiousness can be described as mutually non-exclusive constructs that may overlap or exist
separately. This view is shared by many authors (e. g. King, Speck, & Thomas, 1994; Miller
& Thoresen, 2003; Thoresen & Harris, 2002: Wulff, 1999).
Interestingly, the above-presented view on the relationship between spirituality and
religion was confirmed by studies investigating the English and Polish usage and common
knowledge of the subject. Using a semi-structured interview Woods and Ironson (1999)
examined 65 patients suffering from a severe medical condition. Five respondents who denied
any spiritual or religious beliefs were eliminated from the study. Out of the remaining 60
twenty-six (43%) identified themselves as spiritual (reporting also religious experiences), 22
(37%) described themselves as religious, and 12 (20%) as both. In a study carried out by our
research group, 151 students were asked to answer two questions: What is spirituality? And:
What is religiousness? Religious beliefs were included in the notion of spirituality by 52
(34%) of the respondents. Some aspects of spirituality (e.g. inner coherence and depth) were
never mentioned by 40 (26%) respondents in their definitions of religiousness, and vice versa,
some aspects of religiousness (e.g. attendance at religious services) were excluded from the
concept of spirituality by 57 (38%) of the respondents (Piegrzyk, 2003).
Admittedly, although efforts are made to clarify the spirituality religiousness relation, it
remains a controversial issue. Some authors depict spirituality and religiousness as two
overlapping circles; some consider religiousness to be a more general concept, while others
regard spirituality as the more inclusive term. The concepts themselves are multidimensional
and defy simple clear-cut boundaries (Hill & Paramagnet, 2003; Hill et al., 2000). In the
literature and research reports spirituality and religiousness are referred to collectively as
religiousness/spirituality (abbreviated as RS), which allows for overcoming, or rather
overlooking these controversies.
2. Mechanisms underlying the influence of spirituality on physical health
More and more extensive research on the relationship between spirituality and physical
health has been carried out mostly in the US during the past decade. Diverse methodological
approaches are used, from epidemiological surveys through correlation studies up to
experimental interventions aimed at the spiritual domain. Just as diverse are both
conceptualization and operationalization of the spirituality notion. On the one hand, formal
behavioral manifestations of religiousness are assumed as indicators of spirituality, while on
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the other, this dimension is assessed on the grounds of personal, subjective concepts of
spirituality obtained in clinical interviews.
Since empirical data collected in these studies are discussed in the English language
literature (e.g. a review by Thoresen & Harris, 2002) and in earlier publications by the present
author (Heszen-Niejodek, 2003; Heszen-Niejodek & Gruszczyńska, 2004), they will not be
reported here. Generally, empirical evidence suggests a positive relationship between
spirituality and physical health, but no cause-effect inferences can be made since most of the
research is correlation-based. However, the results of well-controlled longitudinal or
experimental studies indicate a beneficial effect of spirituality on health. Mechanisms of this
effect remain unknown so far and can be considered in hypothetical terms only.
Namely, a relationship can be expected between spirituality and certain emotional
experiences and behaviors that had been proven to influence somatic health. Moreover,
spirituality seems likely to moderate ways of coping with stress, thus to some extent
preventing its health-compromising effects. Finally, spirituality shapes the individual s
relations with the environment so that they are favorable to health. Therefore, spirituality can
be hypothesized to affect physical health via the following channels:
1) Spirituality includes emotional experiences of a certain type, e.g. optimism, hope,
inner peacefulness (serenity), a sense of harmony. Research findings accumulated
so far evidence their health-promoting quality.
2) On the other hand, the transgressive nature of spirituality, i.e. its going beyond the
present  self in the direction opposite to egocentrism may enhance the
individual s resistance to negative emotionality. The latter including e.g.
impatience, hostility, worrying, anger and anxiety was found in psychosomatic
research to increase the risk of various diseases.
3) Spirituality, particularly if defined in terms of affiliation with religious groups or
communities pursuing practices that enhance spiritual development (e.g.
meditation), may be associated with intensification of health-promoting behaviors
such as adherence to hygienic principles or an appropriate diet. This results from
compliance with certain norms prescribed by the groups in question.
4) For the same reasons and in the same way spirituality may prevent some health-
compromising behaviors, e.g. tobacco smoking, alcohol abuse, or overeating.
5) A high level of spirituality may be assumed to be associated with more effective
coping strategies, including the individual s attempts to find some meaning in
suffering and in negative life events, regarding stressful situations as a source of
growth and development, or forgiving.
6) Spirituality in the form of religiousness provides the individual with specific
coping strategies referred to in the literature as  religious coping (Koenig,
Pargament & Nielsen, 1998), e.g. prayer or entrusting oneself to God. Religious
coping is especially useful in critical situations where the source of stress is
uncontrollable, e.g. in severe illness with a poor prognosis.
7) Spirituality is aids the development of a health-promoting environment, by
facilitating harmonious relations with others and contact with nature.
To make the picture complete, the possibility of a negative effect of spirituality on health
should be considered as well. Cases are known of neglecting health to the point of its total
exhaustion due to the individual s concentration on non-material values and seeking mystic
experiences. However, any more extensive discussion of this aspect is beyond the scope of
this article, the more so that such cases are rather rare and as a rule historical, having occurred
in a distant past. Some forms of religious coping associated with health risks seem to be more
frequent  e.g. passive entrusting one s health to God s and abandoning any own efforts in this
respect, or limiting oneself to prayer for immediate God s help and care. Religious
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interpretation of causes of one s illness may lead to negative emotions such as guilt feelings,
bitterness, anger, or fear of God.
3. Development of a questionnaire for the measurement of spirituality
Investigation of the relationship between spirituality and health requires that credible
indicators of spirituality level be developed. At present the measurement of spirituality seems
to be an extremely difficult task. The notion of spirituality is associated with something
transient and intangible, inaccessible to cognition. Nevertheless, attempts at measurement of
this sphere have been made in the past few decades, also in Poland. Initially they dealt with
religious attitudes regarded as an important aspect of spirituality. The Religious Attitudes
Scale by Prężyna (1968) may serve as a Polish example.
The growing interest in spirituality in the late 1990s was accompanied by a revival of
work on the construction of instruments for the assessment of this dimension. In
epidemiological studies the focus remained on the measurement of religiousness, in an
oversimplified way - i.e. in terms of behavioral indicators such as frequency of attendance at
religious services. At the same time new attempts at conceptualization of spirituality have
appeared, together with questionnaires aimed at measurement of spirituality as a
multidimensional construct - e.g. the Multidimensional Measurement of
Religiousness/Spirituality for Use in Health Research, developed by the Fetzer
Institute/National Institute on Aging Working Group (1999). The authors of the most recent
generation of questionnaires for the measurement of spirituality strive for the required
psychometric parameters of their tools, which turns out to be quite difficult to attain.
Usefulness of foreign-language questionnaires for research carried out in Poland seems to
be doubtful due to their embedding in a different socio-cultural context. Apart from the
already mentioned Scale by Prężyna, a Noo-dynamics Test was construed in the 1980s in
Poland by K. Popielski (1994). The latter instrument, originating from the existential-
humanist concept of spirituality based in the logotheory by Frankl, serves to measure the
noetic dimension of personality, called also a spiritual dimension.
The concept of spirituality considered by the present author as a multidimensional
disposition responsible for a specific range of human activity fits another theoretical context,
namely the cognitive paradigm. Consequently, in the research group under the author s
supervision an attempt was made to develop a questionnaire for the measurement of
spirituality. Like other instruments for the measurement of theoretical constructs in
psychology, it was meant to be a self-report tool using spirituality indicators accessible to self-
observation. The indicators deal with both overt behavior and inner experience. According to
our assumption (shared by many authors referred to in the preceding pages), spirituality is a
multidimensional construct. This required that spirituality dimensions should be defined first
and foremost. They can be quite clearly defined on the grounds of the transcendence
directions outlined above  namely, transcendence may be directed at the realization of
standards concerning the self, at a Supreme Being or Energy, at another person to whom a
special value is ascribed, or at the Universe (cf. Hill et al., 2000, p. 57). In this approach four
dimensions of spirituality are proposed. However, it is too abstract to serve as the grounds for
the construction of a questionnaire contents.
More concrete signs of spirituality were sought for in the relevant psychological literature
(Hill et al., 2000, Thoresen, Harris, 2002, Socha, 2000), and discussed during a seminar for
the author s PhD and MA students. A list of main self-observable manifestations of
spirituality was developed. The final structure of the questionnaire was to be specified on the
grounds of factor analysis. The list below was arranged as far as possible in accordance with
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the directions of transcendence referred to earlier (the self, God, other people, the world), and
includes to following categories:
Development and growth. Self-realization and self-perfection, utilization of new
experiences, spontaneity, originality and creativity of daily activities.
Inner freedom. Using one s own standards to choose goals and means, to evaluate
outcomes of one s activity, without inner compulsion in behavior.
Openness. Acceptance of changes, new experiences, and life events (also negative),
spontaneity.
Religious attitudes. Attitude toward God, religious experiences, importance of such
experiences in daily life, their influence on moral choices and behavior.
Ethical sensitivity. A high rank of ethical values in the individual s hierarchy of values,
striving to act in accordance with moral standards, a tendency to ethical reflection.
Objection against evil. Objecting against violence, injustice, harm to others.
Attitudes toward others. Empathy, tolerance, respectfulness, readiness to serve others,
ability to forgive, altruism.
Involvement. A sense of community, participation, responsibility, generalized love.
Meaningfulness. Seeking the meaning of life in general and in particular, also negative,
life events, as well as the meaning of one s activity in the world, seeking a general rule
governing the world.
Harmony. Seeking harmony in one s relations with the world, inner orderliness, and
coherence of various forms of one s own activity.
The next step in the questionnaire development consisted in construing items that would
describe the above-listed manifestations of spirituality. For each of the categories at least 10
items were produced. Thus, a pilot version of the tool consisted of 123 items. Further work
was aimed at producing an instrument that would meet psychometric requirements.
Simultaneously, empirical research was started to investigate relationships between
spirituality and health, using a preliminary version of the questionnaire, with unknown
psychometric properties. This version, i.e. the Self-Report Questionnaire I, consisted of 10
subscales of 7 most salient items each, covering the 10 categories listed above. Each item was
to be assessed on a 5-point Likert-type rating scale. The minimal score on each subscale was 7
points, with the maximum of 35 points. The raw sum of subscale scores ranging from 70 to
350 was regarded as a global spirituality score. As regards its psychometric properties, the
Self-Report Questionnaire I is characterized by face validity only, and the scope of the
reported research was rather modest. Nevertheless, the findings turned out to be promising
and will be presented in what follows.
In order to develop a questionnaire with requested psychometric properties the full version
including 123 items was used to examine a group of 506 respondents differentiated in respect
of demographic characteristics. A preliminary statistical analysis of the obtained data by A.
Metlak in her M.A. thesis (2002) yielded a tool of 111 items, with subscales based on factor
analysis with the number of factors constrained to 10. Their content corresponded to the
above-listed categories, and so the factors were interpreted in these terms. Four factors
explaining less than 2% of variance were excluded. Additionally another group of 116
subjects was examined twice at a 2-week interval, to asses the test-retest stability of results
(Heszen-Niejodek, 2003). This stage of work resulted in an 84-item questionnaire with the
following 6 subscales: religious attitudes, ethical sensitivity, harmony, inner freedom, sense of
meaningfulness, and lack of acceptance of self and one s own life. The global spirituality
score being a raw sum of the subscale scores could range from 84 to 420 points. The tool,
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called Self-Report Questionnaire II, had satisfactory psychometric properties and was used in
several studies.2
Both versions of the Self-Report Questionnaire outlined above originated from the same
initial pool of items. Over a half of the 70 items included in the Self-Report Questionnaire I
(to be precise, 40 items) were included in the Self-Report Questionnaire II. This seems to
justify a joint synthetic description of the results obtained from both versions of the
questionnaire, the more so that the analyses presented in the article were based on global
spirituality scores.
4. Results of preliminary Polish studies on somatic illness and its treatment in the context
of spirituality
Research on the relationship between spirituality and somatic health have been conducted in
the research group under direction of the author for some years now. The focus of the research
is the hitherto neglected problem of factors mediating the beneficial influence of spirituality
on health. The data obtained so far deal with the relationship between spirituality and:
adaptation to some physical diseases, negative emotionality in various clinical groups, such
important health-related factors as health locus of control and health behaviors, as well as
coping with stress in the context of spirituality level.
4.1. Relationship between spirituality level and indicators of successful adjustment to illness
-------------------------
Insert Table 1 about here
------------------------
Table 1 presents studies investigating the relationship between spirituality and adjustment to
illness in two groups of patients, suffering either from cancer or from asthma. In order to
compare patients differing in spirituality level, the cancer group was half split by the median
spirituality score into those scoring higher and lower on the Self-Report Questionnaire I. Data
obtained from the semi-structured interview developed by the author of the study were
compared using Ç2. The following statistically significant differences between the two
subgroups were found: patients scoring higher on spirituality rated their current subjective
health higher, ascribed to themselves more influence on the course of their illness, and more
often declared optimism concerning the further course of their disease. In the group of asthma
patients a general measure of adjustment to illness was used - namely, their self-reported
quality of life. A not very high, but clear-cut and statistically significant positive correlation
was noted between the patients spirituality and their quality of life ratings. The findings fit a
consistent pattern leading to a preliminary inference that spirituality is associated with better
adjustment to a chronic physical illness. Patients with higher spirituality scores are
characterized by a treatment-facilitating attitude toward their illness, i.e. a belief that their
disease is controllable, and optimism about its further course.
4.2. Relationship between spirituality level and negative emotionality
------------------------
Insert Table 2 about here
-------------------------
2
2
The explained variance was 39.5%. Internal consistency as assessed by the Cronbach Ä… was
0.94 for the whole questionnaire, ranging from 0.6 to 0.95 in its subscales. Stability r of the
tt
whole questionnaire was 0.80, and in particular subscales ranged from 0.67 to 0.84.
9
Studies shown in Table 2 are concerned with the relationship between spirituality and
negative emotionality. Various clinical groups participated in the studies: the cancer patients
discussed earlier, participants of alcohol treatment programs, and two groups of maternity
ward patients after the delivery. Patients with cancer were divided, as same as in the previous
study, into those with a higher or lower spirituality level. The former, as compared to the
latter, scored lower on the state anxiety and depression scales. In the next two groups, i.e. in
alcohol dependent respondents and maternity ward patients, a negative correlation was found
between spirituality and trait anxiety  the higher the spirituality level, the weaker tendency to
respond with anxiety. The correlation was moderate in the group of alcoholics, and low, but
statistically significant in the maternity ward patients. Moreover, in the latter group a
statistically significant, but rather low negative correlation between spirituality and state
anxiety was noted. In the second maternity ward group a moderate negative correlation
between spirituality and postnatal depression was obtained.
Thus, a preliminary inference can be made that similarly to the earlier-discussed
patients positive states and ratings, also negative emotionality demonstrates a consistent
relationship with spirituality, but the relation is reversed  the higher is the patients
spirituality, the less intense is their negative emotionality. The direction of this relationship
requires a comment.
A majority of factors investigated in the context of their association with spirituality in
the reported studies have the nature of a state, i.e. are characterized by situationally
determined variability. This pertains to all the factors shown in Table 1, including current
subjective health or quality of life with illness, as well as to some of those listed in Table 2,
such as state anxiety and postnatal depression. Since spirituality was assumed to be a
relatively stable individual disposition that may manifest itself across various situations, it
seems justified to tentatively consider this dimension as a determinant of situationally variable
factors that had been found to be related to it. The matter looks different with trait anxiety that
has the status of an individual disposition, similar to that of spirituality. In this case any
inferences about causality are groundless.
4.3. Connection between spirituality level and health-related attitudes
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-----------------------
Insert Table 3 about here
------------------------
Relationships between spirituality on the one hand and health locus of control and health
behaviors on the other are shown in Table 3. As can be seen, a positive relationship was found
between spirituality and both internal health locus of control and ascribing control to medical
staff by female patients with cancer. These relationships may be interpreted as indicating a
more marked involvement in the treatment process in patients higher on the spirituality
dimension. Moreover, ascribing control over their health to medical staff may facilitate the
patients compliance with prescribed medical procedures, while their belief about their own
control over their health  may aid implementation of their own ideas concerning treatment. In
the study in question no such relationships were found in the control group of healthy women
characterized by a generally lower spirituality level than that of cancer patients (Siwy, 2003).
It can be hypothesized then that an appropriately high spirituality level is a prerequisite of this
dimension health-promoting effect. At the same time the threat resulting from illness may lead
to an intensification of spiritual life (i.e. increased spirituality).
Relationships between spirituality and health behaviors were investigated also in the
longitudinal study of patients after myocardial infarction (MI). Soon after the MI they were
asked to assess their pre-morbid spirituality level and health behaviors, as well as their
intention to stick to a health-promoting lifestyle in the future. At a 3-month follow-up the
patients reported their actual health behaviors in the period following MI. The MI group was
half-split by their median spirituality score into those with a higher and lower spirituality
level. The former intended to adopt a more health-promoting lifestyle after MI, and in
accordance with the declaration their lifestyle at the follow-up turned out to be more health-
promoting, even though the difference between the two subgroups reached only a statistical
tendency level.
4.4. Relationship between spirituality level and coping
-------------------------
Insert Table 4 about here
-------------------------
The following three groups of respondents exposed to stress of various origin and intensity
were examined: women experiencing home violence, parents of disabled children, and
students in the situation of academic stress. The first of the three groups rated the frequency of
over 30 negative emotional states related to their home situation (called  psychological costs
in the questionnaire). The higher spirituality level was found to be associated with less
frequent negative emotions.
In the group of parents of disabled children coping with stress resulting from their
child s illness was studied. As can be seen in Table 4, spirituality level turned out to be
correlated with several coping strategies. Higher spirituality was associated with a higher
intensity of the following strategies: fight, positive reframing, and at the level of statistical
tendency  planned problem solving. All these strategies can be regarded as adaptive in the
difficult situation of parenting a disabled child. In some respects this situation can be changed
in the desired direction  and in this context such strategies as planned problem solving and
fight can be useful. Nevertheless, some aspects of the situation require adjustment from the
parents, who can use positive reframing for the purpose. Parents representing a higher
spirituality level had also a more marked tendency to use wishful thinking, the only strategy
considered by Lazarus (1993) as definitely ineffective in the light of hitherto obtained
research findings. However, this strategy may bring immediate relief in the stressful situations
related to the child s disability that cannot be solved despite the greatest efforts.
11
The last study listed in Table 4 dealt with emotional and somatic consequences of stressful
factors of moderate intensity, related to academic life. Higher spirituality was found to be
associated with better emotional state and less severe somatic symptoms in two purposely
selected groups of economy and theological seminar students. This finding suggests greater
resistance to stressful factors in individuals with higher spirituality levels. However, it can be
inferred from a more detailed analysis that this buffering effect of spirituality is limited to
theology students, who  as compared to economy students - were generally higher on the
spirituality dimension (Knapik, 2002). Thus, spirituality can be hypothesized to protect the
individual s emotional and physical health from negative consequences of stress, but only if
spirituality level is sufficiently high.
5. Summary and further research perspectives
The paper presents major findings of 10 studies aimed at finding out how spirituality
influences physical health. In the studies earlier versions of the Self-Report Questionnaire
developed under the author supervision for the measurement of spirituality were used.
Although the tool did not allow for an accurate assessment, the research results seem
promising and encouraging further study.
The total of 600 respondents participated in the studies, in that number over 400
patients with various clinical problems. The remaining participants were healthy persons
coping with various types of stress: victims of home violence, parents of disabled children,
and students. In each of the studies discussed above the presence of factors that mediate the
beneficial effect of spirituality on somatic health was found. Namely, higher spirituality levels
were associated with:
1) Better subjective health, optimism, belief in one s own ability of controlling
illness, higher self-rated quality of life with illness, and at the same time 
less intense negative emotionality. Generally, patients with higher
spirituality levels manifested better adjustment to their illness and their
attitude was more favorable for the treatment outcome.
2) More readiness to health-promoting behaviors: internal health locus of
control, ascribing control over own health to medical staff, and intention to
introduce health-promoting lifestyle changes, implemented later on in the
form of a healthier lifestyle.
3) More resistance to stressful factors of either high or moderate intensity. The
resistance was expressed in terms of smaller psychological costs of exposure
to stressful situations in women experiencing home violence, as well as in a
better emotional state and less severe physical symptoms in students.
4) More adaptive coping strategies used by parents of disabled children, that
might prevent health-compromising consequences of stress.
An intriguing result was obtained from studies that investigated groups of participants
coming probably from populations differing in spirituality level (i.e. economy and theological
seminar students; or healthy women and female patients suffering from cancer). In the studies
a health-promoting effect of spirituality was found only in groups with higher baseline
spirituality levels. Many authors regard spirituality as an effect of the individual s
development that is attained last, in contradistinction to earlier and more basic constituents of
the human nature. Perhaps this dimension acquires regulatory power only on reaching certain
intensity. However, this inference should be verified by further research.
At present our studies are continued using the most recent version of the Self-Report
Questionnaire developed without any arbitrary assumptions as to the number of latent
variables (i.e. without pre-established number of factors), which allowed establishing an
12
optimal structure of the tool. Moreover, its psychometric characteristics were improved
(Heszen & Gruszczyńska, 2004). It would be interesting to use clinical methods (including
interview and projection techniques) in further research. Such studies representing the
phenomenological approach might provide evidence concerning an individual differentiation
of spiritual experiences, their sources and associations with other kinds of inner experience,
and thus enrich scientific concepts of spirituality.
Finally, there seems to be a possibility of practical application of the discovered
relationships between spirituality and factors important for physical health. In the course of
our research the patients, especially those suffering from the most severe conditions,
manifested their need of talking about spiritual issues. It seems worthwhile to devote some
time for this type of contact with the sick person, hoping that it might not only stimulate
his/her spiritual experiences, but also support the standard treatment.
Author s Notes
I am indebted to two reviewers for their valuable comments on the first version of the
manuscript.
13
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Table 1
Spirituality and indicators of successful adjustment to illness
Source Sample Method Results
Grudzień 60 oncology Semi-structured Patients with higher spirituality
2002 patients interview developed by scores:
the author 1) reported they felt better (Ç2 =
1.92; df = 1; p <.10).
2) ascribed to thmeselves a
higher level of control over
their illness (Ç2 = 6.00; df =
1; p <.01).
3) demonstrated more optimism
regarding further course of
their illness (Ç2 = 2.90; df =
1; p<.05).
Jurczyk 60 patients with The Asthma Quality of A positive relationship between
2002 asthma Life Questionnaire spirituality and quality of life
(AQLQ), Juniper (r = .35; p <.01)
(Source: Heszen-Niejodek, 2003)
Note: Spirituality was measured using the Self-Report Questionnaire I. The statistical
analyses were based on global spirituality scores. Statistical significance of the
indicators was assessed by means of one-tailed tests.
17
Table 2
Spirituality and negative emotionality
Source Sample Method Results
Grudzień, 60 oncology 1) The Beck Patients with higher spirituality
2002a patients Depression levels had lower mean scores of
Inventory (BDI) trait anxiety (x = 40.7; x = 47.8;
1 2
2) The State-Trait t = 2.32; p <.02) and depression
Anxiety Inventory (x = 9.96; x = 17.56; t = 3.74; p
1 2
(STAI), <.001)
part x-1
Bzowska, 118 alcoholics in The State-Trait Anxiety Negative relationship between
2002 a treatment Inventory (STAI), spirituality and trait anxiety
part x-2 (r = -.58; p <.01)
Szpak, 67 maternity The State-Trait Anxiety Negative relationship between
2002 a ward patients Inventory (STAI), spirituality and both types of
anxiety:
1) trait (r = -.31; p <.01)
2) state (r = -.28; p <.05)
Gargas 36 maternity The Edinburgh Negative relationship between
2003 b ward patients Postnatal Depression spirituality and postnatal
Scale (EPDS) depression (r = -.53; p <.01)
a
Spirituality was measured using the Self-Report Questionnaire I.
b
Spirituality was measured using the Self-Report Questionnaire II.
The statistical analyses were based on global spirituality scores.
18
Table 3
Spirituality and attitudes toward health
Source Sample Method Results
Siwy 40 female Multidimensional Health 1) Positive relationship
2003 oncological Locus of Control Scale by between spirituality and
patients Walston, Walston and internal locus of control
DeVellis in the Polish (r =.48; p <.001)
adaptation by Juczyński 2) Positive relationship
(2001) between spirituality and
ascribing control to
medical staff
(r =.37; p <.01)
Mateusiak 43 patients after Health-related Behavior Patients with higher
2003 the first Inventory (Juczyński, spirituality scores:
myocardial 2001); a longitudinal 1) declared their intention
infarction study with a 3-month to have a more health-
follow-up promoting lifestyle after
the MI (x = 95.9; x =
1 2
78.2; t =2.593; p <.01).
2) really reported such
lifestyle at the 3-month
follow-up (x1 = 76.3; x 2
=67.9; t = 1.471; p
<.10).
Note: Spirituality was measured using the Self-Report Questionnaire II.
The statistical analyses were based on global spirituality scores.
19
Table 4
Spirituality and coping with stress
Source Sample Method Results
Laskowska 60 women with the Psychological Costs Negative relationship
2003 b experience of home Questionnaire by between spirituality and
violence Wróblewska frequency of experiencing
psychological costs
(r = -.36; p <.01)
Mazurek 44 parents of The Ways of Coping Positive relationship
2003b disabled children Questionnaire (WCQ) by between spirituality and
Folkman and Lazarus, in the the following strategies:
Polish adaptation by 1) fighting
Heszen-Niejodek and (r =.30; p = .05)
Gwozdecka (1989) 2) positive reframing
(r =.41; p =.005)
3) planned problem
solving (r =.20; p = .06)
4) wishful thinking
(r =.41; p =.005)
Knapik 30 students of 1) Emotionality 1) Positive relationship
2002a economy and 30 Questionnaire by between spirituality and
theological seminary Heszen-Niejodek emotional state
students 2) Somatic Symptomato- (r = .39; p < .01)
logy Scale (Popielski, 2) Negative relationship
1994) between spirituality and
physical symptoms
(r = -.41; p <.01)
Note as in Table 2.