Data from 98 patients with end-stage congestive heart failure (CHF) at a cardiology practice in Cincinnati, Ohio, completed a battery of measures consisting of items from Fetzer's Daily Spiritual Experience Scale (re: religious comfort), Exline & Yali's Spiritual Strain Scale (re: religious struggle [--but see NOTE #1, below]), and the Death and Dying Subscale of the World Health Organization's Quality of Life Measure (re: death concerns [--but see NOTE #2, below]), the Center for Epidemiological Studies Depression Scale (re: depression), and single items asking about belief in an afterlife and the extent to which the patient considered himself/herself a religious person.

Among the findings: death concerns mediated the effect of both religious struggle and religious comfort on depression, yet there was no support for alternate models whereby religious struggle or religious comfort mediated the relationship between death concerns and depression. The authors write: "Our conclusions regarding the relationships among these variables are also supported by converging evidence from experimental studies suggesting that people may rely on religious worldviews in the face of mortality salience…, but are buffered from death concerns only if these worldviews are fully functioning (i.e., provide meaning and value…)" [p. 757]. Moreover, the results showed that "a primary mechanism by which religious struggle affects depression in terminally ill CHF patients is through increased concerns about personal mortality," and suggest that "the expectation of literal immortality is a significant aspect of the comfort that religious worldviews provide individuals near death" [p. 757]. In sum:

These findings lend further support to the idea that religious worldviews serve a terror management function and, more generally, provide external validation for the fundamental assertions of TMT. Our findings suggest that properly functioning religious worldviews offer comfort by buffering the individual against death concerns near life's end, but that the breakdown of these worldviews (i.e., the experience of religious struggle) leaves the individual vulnerable to the terror of death. [p. 757]

For clinical chaplains, this study raises at least a couple of questions. First, might it be important specifically to assess for beliefs in an afterlife for patients who indicate religious struggle in the face of the prospect of dying? Second, might there be particular value in assessing for death concerns, especially where there is some indication of depression? The researchers here assessed for death concerns by asking the degree to which patients "worried about (a) death, (b) 'the thought of not being able to die the way you would want to,' and (c) 'how and where you will die'…" [p. 755 --but also see NOTE #2, below]. For chaplain researchers, the study raises the broad question of whether Terror Management Theory holds promise as a construct to guide investigation. [For more on TMT, see Related Items of Interest, below.] The researchers here claim that it is a valid theory for work with patients "under conditions of chronic and extreme mortality salience" [p. 757].

NOTE #1: The authors state that Religious Struggle was measured by the Spiritual Strain Scale and give as a reference for that measure a 2000 article by Julie J. Exline and Ann Marie Yali. However, the scale does not precisely appear in the cited reference. Donald Edmondson has personally confirmed that the scale used consisted of six items: 1) Feel angry at God, 2) Feel abandoned by God, 3) See God’s actions as unfair, 4) Feel that God has let you down, 5) View God as unkind, and 6) Feel loved by God. In subsequent personal communication from Julie J. Exline, the scale version used by Edmondson, et al. is said to have continued to evolve and is now in the form of a nine-item Attitudes Toward God scale, measuring anger toward God and feeling comforted by God. This latest version has been made available to the Research Network by Dr. Exline [--click HERE (PDF)], but it should not be used without first contacting the developers, since its formal publication is still in process.

While it is not necessary for students to be accomplished at statistics in order to read the article, they might want to discuss the basic concept of a mediator variable in a model that seeks to explain the effect of one thing upon another. The most straightforward representation of this type of model is:

Lykins, E. L., Segerstrom, S. C., Averill, A. J., Evans, D. R. and Kemeny, M. E. "Goal shifts following reminders of mortality: reconciling posttraumatic growth and terror management theory." Personality & Social Psychology Bulletin 33, no. 8 (August 2007): 1088-1099. [(Abstract:) Research findings within posttraumatic growth (PTG) and terror management theory (TMT) currently appear contradictory. Following confrontations with mortality, PTG research demonstrates intrinsic goal shifts, whereas TMT suggests extrinsic shifts. The current studies examine factors contributing to these inconsistent results. Study 1 demonstrates that perceived death threat is associated with PTG effects. Study 2 illuminates the importance of duration of death processing. Study 3 demonstrates that existing goal values and duration and type of processing all interact in determining ultimate goal structure, with a match between level of goals and processing producing the most psychologically advantageous outcomes. Although previous research suggests that short-term confrontations with death may lead to defensiveness, the current studies suggest that encountering death over a longer period or in a manner consistent with goal structure may lead individuals to transcend defensiveness and maintain intrinsic goals or become more intrinsically oriented.]

[ADDED 3/22/10]: Vail, K. E. 3rd., Rothschild, Z. K., Weise, D. R., Solomon, S., Pyszczynski, T. and Greenberg, J. "A terror management analysis of the psychological functions of religion." Personality & Social Psychology Review 14, no. 1 (February 2010): 84-94. [(Abstract:) From a terror management theory (TMT) perspective, religion serves to manage the potential terror engendered by the uniquely human awareness of death by affording a sense of psychological security and hope of immortality. Although secular beliefs can also serve a terror management function, religious beliefs are particularly well suited to mitigate death anxiety because they are all encompassing, rely on concepts that are not easily disconfirmed, and promise literal immortality. Research is reviewed demonstrating that mortality salience produces increased belief in afterlife, supernatural agency, human ascension from nature, and spiritual distinctions between mind and body. The social costs and benefits of religious beliefs are considered and compared to those of secular worldviews. The terror management functions of, and benefits and costs associated with, different types of religious orientation, such as intrinsic religiosity, quest, and religious fundamentalism, are then examined. Finally, the TMT analysis is compared to other accounts of religion.