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This study aimed to examine religious and post-Christian spiritual orientations, types of spiritual and ritual activities, coping strategies of patients with advanced illness and explore associations between spiritual needs, practices, well-being, quality of life, and coping styles.
Methods
One hundred and two patients completed validated instruments: Post-Christian Spirituality Scale, Spiritual Needs Questionnaire, Spiritual Practices Questionnaire, Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale, Global Quality of Life Scale, and Brief-COPE Questionnaire. Descriptive statistics summarized participant characteristics and scale distributions. Spearman correlations (Bonferroni-adjusted) examined associations between spiritual needs, practices, and coping modes. Multivariate regression analyses assessed whether ritual practices predicted spiritual needs.
Results
Inner peace (median, 1.4; IQR, 1, 2) and humanistic/prosocial practices (median, 66.6; IQR, 44.4, 83.2) were prominent spiritual needs and frequently used rituals, respectively. Strong correlations were observed between religious needs and religious rituals (rho = 0.87). Existential, inner peace, and giving/generativity needs correlated moderately with existentialistic practices (rho = 0.56–0.69). Humanistic/prosocial spiritual practices were moderately associated with giving/generativity (rho = 0.52) and inner peace needs (rho = 0.42). Emotion-focused coping, particularly acceptance and emotional support, was most consistently associated with spiritual needs and practices, reinforcing the centrality of relational and embodied forms of spirituality at the end of life. Regression analyses confirmed existentialistic practices predicted existential and inner peace needs, while humanistic practices predicted generativity needs.
Significance of results
Findings demonstrate strong alignment between spiritual needs and ritual activity, supporting development of personalized, ritual-based spiritual care frameworks. Determining individual orientations toward embodied, relational, and humanistic practices may offer an adaptable means of addressing spiritual suffering.
To explore how holistic suffering manifests and is experienced by adults with cancer through qualitative inquiry, supported by descriptive quantitative assessment.
Methods
This qualitatively driven study combined semi-structured interviews with embedded descriptive quantitative data from the Suffering Pictogram–Brazilian version (SP-BR). A total of 222 adults with cancer completed the SP-BR, and a subsample of 20 participated in interviews. The qualitative component had methodological priority and underwent thematic analysis; SP-BR scores were analyzed descriptively to contextualize self-reported levels and dimensions of suffering.
Results
Overall suffering was moderate (mean=4.44, standard deviation=3.22), with substantial variability; worry and physical discomfort were the most prominent concerns. Thematic analysis revealed 4 interrelated themes: Disruption of the self and the search for meaning after diagnosis; Anchoring suffering: faith, relationships, and the ambivalence of coping; Concealed suffering and the fragile work of acceptance; and Meaning as responsibility: enduring suffering for oneself and others. Suffering coexisted with adaptive processes, including meaning-making, relational commitment, and spiritual coping. Spirituality and social support functioned both as protective resources and, in some cases, as mechanisms for concealing distress.
Significance of results
Holistic suffering in cancer is an integrated, dynamic experience that can be understood as a nonlinear existential trajectory, in which participants moved back and forth between disruption of the self, the anchoring of faith and relationships, emotional concealment, and meaning-making. The proposed interpretive model synthesizes this trajectory and may serve as a conceptual starting point for designing interventions addressing holistic suffering.
Chapter 8 contrasts ancient, more personal forms of domination (through kings, shepherds, masters) with more impersonal, digitally enabled forms of modern domination that organize work, life, and death on a planetary scale. Confronting the mass loss of wildlife and the industrial confinement of animals – and the possibility that humans may soon share that fate – this conclusion calls for collective action to cultivate more genuinely social forms of relation, knowledge, and spirituality that affirm the intrinsic worth of all beings rather than reducing life to utility.
This study investigated the predictive relationship between self-compassion and spiritual well-being among palliative care caregivers, exploring internal resources to mitigate care burden and existential distress in end-of-life settings.
Methods
This descriptive, cross-sectional, and correlational study was conducted between March and September 2025 with 138 family caregivers in a palliative care unit. Sample size was determined via a priori power analysis ensuring 95% power. Data were obtained using the Introductory Characteristics Form, the Self-Compassion Scale (SCS), and the Spiritual Well-Being Scale. Data analysis involved descriptive statistics, Pearson correlation analysis, and simple linear regression.
Results
The mean self-compassion score was 79.94 ± 11.68, and the mean spiritual well-being total score was 109.26 ± 13.59. Subscale scores were 63.05 ± 9.93 (transcendence), 28.10 ± 3.91 (harmony with nature), and 18.11 ± 5.28 (anomie). A positive, moderate correlation existed between total self-compassion and spiritual well-being (r = 0.349, p < 0.001). Significant associations were also identified across the transcendence (r = 0.217, p = 0.011), harmony with nature (r = 0.213, p = 0.012), and anomie (r = 0.333, p < 0.001) subscales. Regression analysis confirmed that self-compassion positively predicted spiritual well-being (β = 0.349, t = 4.349, p < 0.001), accounting for 11.2% of the total variance (R2 = 0.112, F = 18.910, p < 0.001).
Significance of results
Self-compassion is a critical internal resource for finding spiritual meaning amidst end-of-life stressors. Fostering compassionate attitudes can alleviate anomie and emotional burnout among caregivers. Palliative care nurses should integrate mindfulness-based self-compassion interventions into support programs to bolster caregiver well-being and enhance care quality.
To determine the correlation between spiritual self-care practices and mindfulness among cancer patients in southeast Iran.
Methods
This descriptive, correlational, cross-sectional study was conducted on a convenience sample of 600 eligible cancer patients. Data were collected using three instruments: a demographic and clinical characteristics questionnaire, the Spiritual Self-Care Practice Scale, and the Relaxation, Meditation, and Mindfulness Trait Tracker (RMMtm 3.1). Data were analyzed using SPSS version 26, employing both descriptive and inferential statistical methods, including multivariate regression analysis.
Results
The mean total score for spiritual self-care practice among cancer patients was 3.17 ± 1.15, which was above the questionnaire’s midpoint. Mindful emotion had the highest mean score (3.78 ± 1.67), followed by mindful focus (3.20 ± 1.57) and mindful relaxation (3.14 ± 1.65). Multivariate regression analysis revealed that 63.9% of the variance in spiritual self-care was explained by variables including mindful emotion (β = 0.321, p < 0.001, 95% confidence interval [CI]: [0.122, 0.181]), mindful quiet (β = 0.213, p < 0.001, 95% CI: [0.065, 0.128]), and mindful transcendence (β = 0.163, p < 0.001, 95% CI [0.058, 0.139]). Income level, history of underlying disease, and disease stage also showed significant associations.
Significance of the results
The study findings indicate a significant relationship between spiritual self-care practice and dimensions of mindfulness. Nurses can address patients’ spiritual self-care practice needs by implementing the nursing process and empowering them through interventions that enhance mindfulness.
Islam addresses social issues extensively because it acknowledges that individuals are profoundly influenced by their societies. Individuals and societies are interdependent, requiring mutual cooperation due to differing abilities, shared goals and collective challenges. Islam emphasizes community building by deepening innate human desires for social interaction, giving them philosophical significance, sanctifying them as religious obligations and setting ethical guidelines to strengthen community bonds.
Islam views society as composed of individuals engaged in exchange and reciprocity, driven by natural human disparities and collective aspirations. It sanctifies these interactions by considering communal responsibilities as spiritual duties, reflected in concepts such as piety, trust and cooperation. Islamic teachings underscore equality among people, highlighting differences only in specialized talents, which facilitate mutual service and cohesion.
Islam consecrates relationships through cultural, faith-based, ethical and jurisprudential dimensions, promoting familial respect, neighborly duties and social justice through practices like prayer, fasting, almsgiving (zakat) and pilgrimage (hajj). These rituals reinforce social solidarity and mutual responsibility. Islam also addresses societal development dynamically, encouraging continuous interaction with both divine revelation (Qur’an) and the universe, fostering adaptive and evolving communities aligned with spiritual and moral values.
In this lecture at the American University of Beirut in 1966, Musa Sadr explores Islam’s impact on Lebanese culture, emphasizing Lebanon’s rich historical and cultural heritage influenced by Islam. The lecture highlights contributions of Lebanese religious scholars in disseminating Islamic teachings and literature, and the need to engage with Islamic terminology and historical narratives to understand Islamic principles.
Sadr addresses the interplay of Western and Eastern interpretations of Islam in Lebanon, advocating for thorough examination and appreciation of cultural contexts to comprehend religious concepts. The lecture further considers the authenticity of Islam, its unique spirituality and its focus on social welfare and development. It also presents core Islamic concepts such as tawhid (unity of God), the role of angels and Satan, the importance of prophets and the belief in Judgment Day and resurrection. Sadr also emphasizes Islam’s intervention in practical and social life, seeking to create a society better suited to faith and morality.
This chapter examines two forms of emotionlessness and asks how it is that emotionlessness can be a name for two very opposed valence-laden situations. The best-known emotionless context is sometimes expressed by the term ‘emotional numbness’. It refers to a multi-faceted mental disturbance, often quite difficult to identify unequivocally with a specific pathology; a less well-known emotionless context is referred to as a form of ‘emotional detachment’. It has been experienced along centuries by nuns, monks, and spiritual teachers as a practice of inner liberation. Shedding light on these different situations of emotionlessness, the chapter discusses what a non-emotional life tells us about human beings, if emotions are truly at the heart of human beings.
This is a study of how Christian Trinitarian understanding of monotheism has been expressed in Christian prayer and worship. It studies the emergence and development of a distinctive language of prayer within the New Testament and among some early Church Fathers, which laid the basis for later belief in and worship of the Trinity. This contemplative belief is studied in the light of Eastern and Western understandings of the Trinity, by examining certain key figures Christian history. It concludes with a discussion of the continuing mystical and contemplative traditions within Eastern and Western Christianity. This Element does not consider the development of Christian liturgy, however, which has already been considered in an earlier Element in this series. Nor does it address the varied impact of the Reformation upon the Western churches, which will be addressed by further Elements to be published in this series.
This chapter asserts that J. M. Coetzee’s ostensibly surprising turn to questions of religion in “The Jesus Novels” should have been anticipated from his trajectory of concerns since the novels of the late 1990s. Through a genetic reading of Disgrace that extensively uses Coetzee’s notebooks and drafts for the novel, I show how this work posits the reality of souls, human and nonhuman, and imagines how that reality can reorient the self away from abusive uses of others and toward practices of care. This reading of Disgrace traces how Coetzee dismantles previous forms of Western perception through an anti-epiphany, opening the way for belief in souls to produce a better form of life and seeing others. The chapter closes by considering how the Jesus novels further develop the life of spiritual contemplation that Coetzee’s late style explores.
This introduction to The New Believers begins by identifying a broader problem with the contemporary novel: that it often ends with bleak defeat or uncertain irresolution. Instead, I identify a new grouping of contemporary writers – Margaret Atwood, J. M. Coetzee, Junot Díaz, and George Saunders – who turn to spiritual beliefs, powers, and presences to offer new hope and possibilities for the contemporary novel, ones that might empower specific progressive causes. I show how this grouping is distinct from other forms of the contemporary, including writers who are hostile to religion, indifferent to it, or committed to it, and I show how the New Believers avoid the problem of oppressive totality by assessing the value of spiritual ideas by their impact on the immanent and the worldly, specifically how spiritual ideas alleviate and prevent material, bodily, and ecological suffering. This new grouping shows that the contemporary novel takes spirituality much more seriously than our critical categories have allowed.
The conclusion to The New Believers identifies how the varieties of spiritual realism newly imagined by each writer reshape our critical understanding of ontology, subjectivity, collectivity, and teleology. Because they commit to spiritual beliefs, in their public comments and in their fiction, the New Believers change the basic understanding of reality (ontology) from a materialist absence of intrinsic meaning to a world filled with spiritual meaning. Our sense of self (subjectivity) changes from completely self-created to one that is still free but responsive to forces of care and compassion, which in turn make better communities (collectivity) possible. The spiritual realism of these writers ultimately reshapes our understanding of death and the purpose of the universe (teleology) by pointing to spiritual persistence and the hope for something beyond our own material demise and the deaths of those we love, which empowers the contemporary novel in more hopeful and affirmative directions.
This chapter departs from many typical readings of Junot Díaz’s The Brief Wondrous Life of Oscar Wao, which treat that novel’s spiritual and numinous presences, practices, and powers as fantastical or magical rather than real and efficacious. Drawing on Díaz’s own statements, I show how the novel insists on the reality of supernatural forces and on how practices of prayer and the intervention of powerful spiritual forces, such as the Mongoose, can lead to resilience and survival amid the uncertainties and traumas of Caribbean dictatorship and migration to America. Díaz’s sense of cosmic vision in the novel, an insistence that there is spiritual purpose and power at work in the cosmos, shows how syncretic religious formations in the Caribbean can empower a radical hope in the face of the seemingly traumatic and impossible.
This chapter identifies in George Saunders’s earlier critiques of neoliberalism in his short stories and his critique of a conservative American version of Christian hell in his first novel, Lincoln in the Bardo, a common project with a spiritual alternative in the Buddhist order of compassion. I offer a brief history of the Christian theology of hell and American neoliberalism to show how they share a common idea of a punitive, individualistic sense of natural order, one with a common origin point in the theology of Augustine on the divine will. First tracing the public spiritual commitments expressed by Saunders across a wide range of his interviews, I then show how his sense of the potential of literature to empower a spirituality of compassion informs Lincoln in the Bardo’s rejection of the Christian hell and the novel’s alternative vision of a world where compassion is the order of the universe.
This chapter draws on Margaret Atwood’s interviews and archives to show how she is concerned to explore in her late fiction and poetry the idea of the soul as “the better story” about human and nonhuman animal life. I show how Atwood critiques not only Christian Nationalism but also, in Oryx and Crake, a materialist understanding of life. As a response to each of these extremes, Atwood turns to the soul, particularly in The Testaments and in Dearly, showing how that idea and the experienced presence of the souls of the dead can motivate endurance and hope in the face of oppressive formations of Christianity and a materialist sense of nothingness after death. Drawing on Atwood’s drafts of The Testaments, I trace how the novel became more spiritually serious as it developed and how the spiritual poetry of Dearly works together with scenes of spiritual support in Atwood’s novel.
Escalating planetary crises – manifested through climate change, biodiversity loss, socio-ecological inequality and geopolitical instability – demand new forms of environmental education that engage Earth system complexity beyond anthropocentric frameworks. Drawing on posthuman philosophy and the planetary boundaries framework, this paper explores how planetary ethics can be cultivated through innovative pedagogical practice. Using the “Posthuman Educator” course as a qualitative case study, the paper examines how post-anthropocentric, post-dualistic and care-based pedagogies reconfigure learning across technological, ecological and spiritual dimensions. Participant reflections and pedagogical practices reveal planetary ethics as an emergent, relational process enacted through lived experience, multispecies attunement and collective responsibility rather than prescriptive outcomes. The study argues that posthuman pedagogy offers powerful methodological and ethical resources for education by fostering embodied awareness, epistemic plurality and situated planetary consciousness. The paper contributes to educational scholarship by demonstrating how posthuman approaches can meaningfully engage with planetary boundaries thinking in transnational and decolonial contexts.
Advances in cardiology and cardiac surgery have significantly improved survival rates among children with CHD, but these gains come with the need for long-term care that heavily involves parents. Understanding their life situation is essential for delivering effective family-centred and holistic healthcare. The study aimed to assess the life situation of parents of children with CHD in relation to sociodemographic factors and to explore their sources of support, emotional experiences, and the role of spirituality in coping.
Materials and method:
A web-based cross-sectional survey was conducted among 117 parents of children with CHD in the Slovak Republic. Data was collected between December 2024 and January 2025 using the standardised questionnaire Life Situation of Caregivers/Parents of Children with CHD and/or Other Cardiac Diseases.
Results:
Multivariable linear regression analysis revealed that lower parental education and a history of cardiac surgeries in the child were associated with lower scores on the life situation scale. Conversely, a higher number of previous hospitalisations was linked to higher scores (p < 0.05). The most reported emotions related to the child’s illness were fear (94.87%), sadness (67.52%), and anger (38.46%). Family members were identified as the primary source of support.
Conclusions:
These results highlight the need to identify parents at heightened psychosocial risk, particularly those with lower education and those whose children have undergone cardiac surgeries. In clinical practice, family support should be supplemented with structured psychological interventions as part of comprehensive care for families of children with CHD.
The New Believers identifies a group of today's most important novelists, Margaret Atwood, J. M. Coetzee, Junot Díaz, and George Saunders, who have challenged the trend of depressing and defeatist novelistic endings by turning to spiritual beliefs, powers, and presences. Through spiritual belief, these writers use the novel to imagine more hopeful and caring ways of being in the world, ones that can challenge Christian Nationalism and neoliberal capitalism and empower leftist and liberal causes, such as women's rights, migrant rights, animal rights, and care for the environment. Through a survey of the current state of novel studies, close readings of key works by each writer, and new archival research on Margaret Atwood and J. M. Coetzee, The New Believers shows how these writers transform novelistic realism through spiritual realism and reshape the current debate about religion, secularization, and literature.
This Element introduces the Existential-Spiritual Psychotherapy framework as a promising clinical and research tool and then integrates it with the three pillars of the Multicultural Orientation framework. Section 1 presents Existential-Spiritual Psychotherapy by exploring how spirituality and religion intersect with existentialism and how all three relate to psychotherapy, psychological symptoms, well-being, and flourishing. Section 2 details the Existential-Spiritual Narrative as a roadmap that offers a process framework and introduces the integration of dynamic and culturally sensitive symbols. Section 3 explores existential-spiritual comfort, encouraging therapists' self-awareness around spiritual themes. Section 4 identifies common existential-spiritual opportunities, helping clinicians recognize and engage culturally embedded spiritual content. Section 5 discusses existential-spiritual humility, promoting a posture of humble expertise when navigating spiritual material. Throughout, the authors offer an empirically informed, culturally attuned framework while promoting a dialectical balance in integrating spirituality and religion into psychotherapy.
We present historical background, contemporary status, and potential future development of the psychology of religion (PoR) in China (Eastern traditions), beginning with its origins: the formative people, places, and various intellectual schools of thought. Writing about the current state of the topic, we reflect on influential factors that are either facilitating or inhibiting the study of PoR, including publication options, topical emphases, practitioners, orientations, methodologies, and professional organizations.
We offer opinions concerning future development topics that are emerging as important in the immediate future and/or are perennially important in order to stimulate creative and useful research including Western theoretical relevance, the extent to which Western PoR theories may or may not contain reasonable expectations and concepts for this region, contextual nuances, Indigenous theoretical concerns, collaborative research opportunities, and common faux pas – reflections on what people unfamiliar with this region commonly and incorrectly assume about conducting PoR work in this context.