Spirituality and PainCaring for the Whole Person

GKCCASPMNSaturday October 24, 2015

Carmen Lile-Henry

Pain and Suffering• Pain is “an unpleasant sensory and emotional

experience”• Associated with actual or potential tissue damage

(or described as such)• Physical and/or emotional hurt• Chronic pain is “a biopsychosocial phenomenon…

that includes not just physical sensations but also our emotional responses to pain, and our emotional responses to other peoples’ emotional responses to our pain”

• “Suffering is the story we tell ourselves about our pain.”

• Pain + anxiety , anguish, worry about the future, bearing distress caused by pain

• Can feel like exile or abandonment/judgment

P/S Affects the Whole Person• Body, mind, spirit, family,

relationships, community – all are interrelated

• Self-image, self-worth, self-value, cultural definitions of power, control, autonomy, wealth, beauty, etc.

• Medical model/cure, tangible, objective data vs subjectivity of pain/suffering/spirituality

Spiritual Concerns• Chaplains watch for spiritual

struggle, distress, injury, resilience• Studies show pts w/severe pain

desire chaplaincy support (Meltzer)• Spirituality is expressed in search

for ultimate meaning and coherence

• Relationship bx spirituality and experience of pain/suffering

Spirituality, Health & Well-Being

• Qualities of being• Spiritual values• Relationship/connection to the

transcendent and to other people• Spiritual practices

Characteristics of Spirituality• A means to understand and live in

view of ultimate meaning, value and purpose

• Capacity to love, forgive, worship, see beyond current circumstances, transcend suffering

• Dynamic, changes over lifetime• Value and dignity of being, nature,

relationships, work/good deeds, being loving, seeking beauty and truth, religious activities, God-talk

Chaplaincy Interventions• Empathic listening• Non-judgmental presence• Companioning (being with)• Reflective exploration, articulation,

identification• Affirmation of coping –

past/present/future• Distraction• Meditation, relaxation, breath work

Chaplaincy lnterventions -cont.• Prayer, scripture, hymnody, music,

rites/rituals, sign-acts, blessings, symbols, sacraments, linking objects, aromatherapy, therapeutic pastoral touch

• Encouragement: compliance, self-care, • de-catastrophizing, critical thinking

(barriers, resources, options, goals)• Grief care: loss, change, transition(any

area of life, + or - )• Support family/caregivers/primary

relationships: affirmation, fatigue, apathy, stress, range of emotions

Increased Spiritual Care Can:• Decrease readmissions• Decrease perceptions of intensity of pain• Decrease overall anxiety (unless

ecclesiogenic psych)• Reduce spiritual distress (body-mind-

spirit-relationships)• Provide distraction, facilitate mediation• Assist in meaning-making/re-framing• Increase pt satisfaction (even when

chaplain not requested)

Increased Spiritual Care Can:• Increase feelings of being heard,

respected, valued, believed• Provide affirmation, validation of

coping resources• Challenge/confront maladaptive

responses to pain (spiritual/theological)

• Encourage adaptive responses

Screening for catastrophizing(13 factors)

• Worry whether pain will end• Feel I can’t go on• Terrible, never going to get better• Awful, feel overwhelmed• Feel I can’t stand it anymore• Afraid pain will worsen• Keep thinking of other painful events• Anxiously want pain to go away• Can’t get it out of my mind• Keeping thing about how much it hurts• Keeping thinking about how badly I want pain to stop• Nothing I can do to reduce pain’s intensity• Wonder whether something serious may happen

Types of Religious Struggle

• Divine: threatening view of God, feel abandoned by or angry with God

• Intrapersonal: questions, doubts about spiritual matters

• Interpersonal: family, friends, faith community• Primary, secondary, mixed

Harmful Effects of R/S Struggle

• Greater anxiety, depression, sx• Worse emotional/mental health• PSTD• Lower life satisfaction• Poorer adherence/compliance (smoking,alcohol)• More hospital days• Poorer physical functioning• QOL decline• Immunity decline• Increased mortality risk (22-33% increase)

Screening for Spiritual Struggle left unaddressed:

worsens health, shortens survival

• Wondered whether God had abandoned me• Felt punished by God by my lack of devotion• Wondered what I did for God to punish me• Questioned God’s love for me• Wondered whether my faith community had

abandoned me• Decided the Devil made this happen• Questioned the power of God

Spiritual Distress Assessment ToolSpiritual Needs Model (SDAT)

Dimensions NeedsMeaning Life balanceTranscendence ConnectionValues Acknowledgment,

maintain controlPsychosocial identity Maintain identity

Spiritual Distress Domainsunmet spiritual needs

Hope DespairWholeness BrokennessCourage AnxietyMeaningful MeaninglessGrace/forgiveness Guilt/shameEmpowerment Helplessness

Intervention goal: help patient move toward left

Spiritual Injury Scale (SIS)

• How often do you feel guilty over past behaviors?• Does anger or resentment block your peace of mind?• How often do you feel sad or experience grief?• Do you feel life has no meaning or purpose?• How often do you feel despair or hopelessness?• Do you feel God/life has treated you unfairly?• Do you worry about doubts/disbelief in God? (or

anger?)• Do your worry about or fear death?• How often do you think about death?

Spiritual Injury Issues

• Anger toward God• Felt hurt, mistreated, offended by R/S people• Felt rejected, misunderstood by R/S people• Felt other are looking down on me because of

my R/S beliefs• Had conflicts with others over R/S matters• Felt angry at organized religion

Ultimate Meaning Struggles

• Whether life really matters• Felt my life had no deeper meaning• Questioned whether my life really makes any

difference in the world• Had concerns about whether there is any

ultimate purpose to life or existence

Moral Struggle, Pain, Injury

• Wrestled with attempts to follow moral principles• Worried that actions were morally or spiritually wrong

(betrayal of what is right)• Felt torn by what I wanted and what I knew was morally

right (betrayal by authority or self)• Felt guilt for not living up to my moral standards• High stakes situations• High ideals unmet (betrayal by failed systems0• Violation of core beliefs (coerced, forced)• Cycles of victim/perpetrator (violence)

Theodicy Issues (why do the righteous suffer?)• Why is suffering allowed?• Am I being punished?• Do I deserve pain?• Is suffering redemptive?• Where is God in suffering? (divine

presence/absence)• Does God suffer?• Am I being tested?• Is there a lesson/gift/blessing?• Does God cause suffering?• Does God care?• Is God in control?• World assumptions changed/challenged/grieved?

Screening for Resilience20 factors

• Self esteem• Optimism• Self confidence• Planning • Self control • Support system• Purpose in life• Gratitude• Make a difference• Sense of humor

Resilience – cont.• Flexibility• Learning• Options • Generosity• R/S base• Life has meaning• Role models• Willing to change• Self directed• Adaptability

Grief and Pain/SufferingMyths of culture impeding healthy grieving:• Don’t feel bad• Replace the loss• Grieve alone• Be strong• Keep busy• Time heals all wounds

Grief and Pain/Suffering – cont.

• Replace guilt with regret (unless guilt is intentional, real)

• Articulate what we wish were different, better, or more…

• Never compare losses – we all grieve at 100%

• Forgiveness: letting go of the hope of a different yesterday (Friedman and James)

Grief and Pain/Suffering – cont.

• Grievers don’t need to be fixed• Grievers need safe space for

emotional/spiritual honesty• Presence of supportive, caring

person/s• Without judgment, running

commentary or advice• Hydration, nutrition, exercise• Privacy vs isolation

Therapeutic Relationship(Carl Rogers)

• Empathic understanding (how pt feels + conveying this to pt)

• Unconditional positive regard (non-judgmental attitude)

• Genuineness• Congruence of response (my

feeling/attitude is matched by my awareness of it)

The Four AgreementsDon Miguel Ruiz

• Be impeccable with your word (‘without sin’)

• Don’t take anything personally• Don’t assume anything• Always do your best

Remembering Ethical Principles

• Beneficence – do all possible good• Non-maleficence – do no harm• Respect for autonomy• Veracity – what is true?• Justice – what is fair?• THINK: true, helpful, inspiring,

necessary, kind?• Golden Rule: how we want to be

treated

Ethical Prinicples• THINK: true, helpful, inspiring,

necessary, kind?• Golden Rule: how we want to be

treated