Abstract
Homeless youth have particular need to develop inner resources to confront the stress, abusive environment of street life, and the paucity of external resources. Research suggests that treatment supporting spiritual awareness and growth may create a foundation for coping, relationships, and negotiating styles to mitigate distress. The current pilot study tests the feasibility, acceptability, and helpfulness of an interpersonal spiritual group psychotherapy, interpersonal psychotherapy (IPT) integrated with spiritual visualization (SV), offered through a homeless shelter, toward improving interpersonal coping and ameliorating symptoms of depression, distress, and anxiety in homeless youth. An exploratory pilot of integrative group psychotherapy (IPT + SV) for homeless young adults was conducted in a New York City on the residential floor of a shelter-based transitional living program. Thirteen young adult men (mean age 20.3 years, SD = 1.06) participated in a weekly evening psychotherapy group (55 % African-American, 18 % biracial, 18 % Hispanic, 9 % Caucasian). Measures of psychological functioning were assessed at pre-intervention and post-intervention using the General Health Questionnaire (GHQ-12), Patient Health Questionnaire (PHQ-9, GAD-7), and the Inventory of Interpersonal Problems (IIP-32). A semi-structured exit interview and a treatment satisfaction questionnaire were also employed to assess acceptability following treatment. Among homeless young adults to participate in the group treatment, significant decreases in symptoms of general distress and depression were found between baseline and termination of treatment, and at the level of a trend, improvement in overall interpersonal functioning and levels of general anxiety. High utilization and treatment satisfaction showed the intervention to be both feasible and acceptable. Offered as an adjunct to the services-as-usual model at homeless shelters serving young adults, interpersonal psychotherapy with spiritual visualization (IPT + SV) in group appears to be a feasible and potentially useful treatment option for promoting improved mental health.
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Notes
In this article, we synthesize findings across studies into a discussion of “homeless youth” to refer to unaccompanied youth under the age of 25 (Toro et al. 2007).
References
Ano, G. G., & Vasconcelles, E. B. (2005). Religious coping and psychological adjustment to stress: A meta-analysis. Journal of Clinical Psychology, 61(4), 461–480.
Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858. doi:10.1016/j.brat.2005.12.007.
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. doi:10.1093/clipsy.bpg015.
Barkham, M., Hardy, G. E., & Startup, M. (1996). The IIP-32: A short version of the Inventory of Interpersonal Problems. British Journal of Clinical Psychology, 35(1), 21–35. doi:10.1111/j.2044-8260.1996.tb01159.x.
Beauchamp, P. H., Halliwell, W. R., Fournier, J. F., & Koestner, R. (1996). Effects of cognitive–behavioral psychological skills training on the motivation, preparation, and putting performance of novice golfers. Sport Psychologist, 10, 157–170.
Benjamins, M. R., Ellison, C. G., Krause, N. M., & Marcum, J. P. (2011). Religion and preventive service use: Do congregational support and religious beliefs explain the relationship between attendance and utilization? Journal of Behavioral Medicine, 34(6), 462–476.
Bergemann, E. R., Siegel, M. W., Belzer, M. G., Siegel, D. J., & Feuille, M. (2013). Mindful awareness, spirituality, and psychotherapy. In K. I. Pargament, A. Mahoney, & E. P. Shafranske (Eds.), APA handbook of psychology, religion, and spirituality (Vol 2): An applied psychology of religion and spirituality (pp. 207–222). Washington, DC: American Psychological Association. doi:10.1037/14046-010.
Black, D. S., Milam, J., & Sussman, S. (2009). Sitting-meditation interventions among youth: A review of treatment efficacy. Pediatrics, 124(3), e532–e541. doi:10.1542/peds.2008-3434.
Boesky, L. M., Toro, P. A., & Wright, K. L. (1995). Maltreatment in a probability sample of homeless adolescents: A subgroup comparison. Paper presented at the Presented at the Annual Meeting of the American Public Health Association, San Diego, CA.
Callow, N., Hardy, L., & Hall, C. (2001). The effects of a motivational general-mastery imagery intervention on the sport confidence of high-level badminton players. Research Quarterly for Exercise and Sport, 72(4), 389–400.
Cauce, A. M., Paradise, M., Ginzler, J. A., Embry, L., Morgan, C. J., Lohr, Y., & Theofelis, J. (2000). The characteristics and mental health of homeless adolescents: Age and gender differences. Journal of Emotional and Behavioral Disorders, 8(4), 230–239. doi:10.1177/106342660000800403.
Clark, R., & Robertson, M. J. (1996). Surviving for the moment: A report on homeless youth in San Francisco. Berkeley: Alcohol Research Group.
Cobb, E., McClintock, C., & Miller, L. (2015) Mindfulness as a gateway to spiritual experience in youth (in press).
Cummings, J. P., & Pargament, K. I. (2010). Medicine for the spirit: Religious coping in individuals with medical conditions. Religions, 1(1), 28–53.
Farrow, J. A., Deisher, R. W., Brown, R., Kulig, J. W., & Kipke, M. D. (1992). Health and health needs of homeless an runaway youth. A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 13(8), 717–726.
Feitel, B., Margetson, N., Chamas, J., & Lipman, C. (1992). Psychosocial background and behavioral and emotional disorders of homeless and runaway youth. Psychiatric Services, 43(2), 155–159.
Feltz, D. L., & Landers, D. M. (1983). The effects of mental practice on motor skill learning and performance: A meta-analysis. Journal of Sport Psychology, 5(1), 25–57.
Fetzer, I. (2003). Multidimensional measurement of religiousness/spirituality for use in health research: A report of the Fetzer Institute/National Institute on Aging Working Group. Kalamazoo, MI: John E. Fetzer Institute.
Fitchett, G., Rybarczyk, B. D., DeMarco, G. A., & Nicholas, J. J. (1999). The role of religion in medical rehabilitation outcomes: A longitudinal study. Rehabilitation Psychology, 44(4), 333.
Forbes, D. (2004). Boyz 2 Buddhas: Counseling urban high school male athletes in the zone (Vol. 198). New York: Peter Lang.
Fredrickson, B. L. (2004). The broaden-and-build theory of positive emotions. Philosophical Transactions-Royal Society of London Series B Biological Sciences, 359, 1367–1378.
Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95(5), 1045.
Gall, T. L., & Guirguis-Younger, M. (2013). Religious and spiritual coping: Current theory and research. In K. I. Pargament, J. J. Exline, & J. W. Jones (Eds.), APA handbook of psychology, religion, and spirituality (vol. 1): Context, theory, and research (pp. 349–364). Washington, DC: American Psychological Association.
Gleghorn, A. A., Marx, R., Vittinghoff, E., & Katz, M. H. (1998). Association between drug use patterns and HIV risks among homeless, runaway, and street youth in northern California. Drug and Alcohol Dependence, 51(3), 219–227.
Goldberg, D. P. (1972). The detection of psychiatric illness by questionnaire: A technique for the identification and assessment of non-psychotic psychiatric illness. London: Oxford University Press.
Goldberg, D. P., Gater, R., Sartorious, N., Ustunt, T. B., Piccinelli, M., Gureje, O., & Rutter, C. (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27(01), 191–197.
Goodman, L. A., Saxe, L., & Harvey, M. (1991). Homelessness as psychological trauma: Broadening perspectives. American Psychologist, 46(11), 1219.
Gregoski, M. J., Barnes, V. A., Tingen, M. S., Harshfield, G. A., & Treiber, F. A. (2011). Breathing awareness meditation and lifeskills training programs influence upon ambulatory blood pressure and sodium excretion among African American adolescents. Journal of Adolescent Health, 48(1), 59–64.
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.
Horowitz, J. L., Garber, J., Ciesla, J. A., Young, J. F., & Mufson, L. (2007). Prevention of depressive symptoms in adolescents: A randomized trial of cognitive–behavioral and interpersonal prevention programs. Journal of Consulting and Clinical Psychology, 75(5), 693.
Horowitz, L. M., & Näswall, K. (2002). IIP: Inventory of interpersonal problems: Manual. Stockholm: Psykologiförlaget.
Hyde, J. (2005). From home to street: Understanding young people’s transitions into homelessness. Journal of Adolescence, 28(2), 171–183.
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.
Kidd, S., & Shahar, G. (2008). Resilience in homeless youth: The key role of self-esteem. American Journal of Orthopsychiatry, 78(2), 163–172. doi:10.1037/0002-9432.78.2.163.
Kipke, M. D., Montgomery, S. B., Simon, T. R., & Iverson, E. F. (1997). “Substance abuse” disorders among runaway and homeless youth. Substance Use and Misuse, 32(7–8), 969–986.
Koenig, H., King, D., & Carson, V. B. (2012). Handbook of religion and health. Oxford: Oxford University Press.
Krause, N. (2007). Longitudinal study of social support and meaning in life. Psychology and Aging, 22(3), 456.
Krause, N. (2008). The social foundation of religious meaning in life. Research on Aging, 30(4), 395–427.
Krause, N. (2010). Religious involvement, humility, and self-rated health. Social Indicators Research, 98(1), 23–39.
Krause, N., & Hayward, R. D. (2012). Religion, meaning in life, and change in physical functioning during late adulthood. Journal of Adult Development, 19(3), 158–169.
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The Phq-9. Journal of General Internal Medicine, 16(9), 606–613.
Krupnick, J. L., Green, B. L., Stockton, P., Miranda, J., Krause, E., & Mete, M. (2008). Group interpersonal psychotherapy for low-income women with posttraumatic stress disorder. Psychotherapy Research, 18(5), 497–507.
Levin, J. S., Taylor, R. J., & Chatters, L. M. (1994). Race and gender differences in religiosity among older adults: Findings from four national surveys. Journal of Gerontology, 49(3), S137–S145.
Levinson, D. (2004). Encyclopedia of homelessness (Vol. 1). Thousand Oaks, CA: Sage.
Liehr, P., & Diaz, N. (2010). A pilot study examining the effect of mindfulness on depression and anxiety for minority children. Archives of Psychiatric Nursing, 24(1), 69–71.
Linehan, M. (1993). Cognitive–behavioral treatment of borderline personality disorder. New York: Guilford Press.
Löwe, B., Unützer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004). Monitoring depression treatment outcomes with the patient health questionnaire-9. Medical Care, 42(12), 1194–1201.
Lugo, L., Stencel, S., Green, J., et al. (2008). U.S. religious landscape survey: religious affiliation—diverse and dynamic. The Pew Forum on Religion & Public Life. http://religions.pewforum.org/pdf/report-religiouslandscape-study-full.pdf.
McCaskill, P. A., Toro, P. A., & Wolfe, S. M. (1998). Homeless and matched housed adolescents: A comparative study of psychopathology. Journal of Clinical Child Psychology, 27(3), 306–319.
Mendelson, T., Greenberg, M. T., Dariotis, J. K., Gould, L. F., Rhoades, B. L., & Leaf, P. J. (2010). Feasibility and preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of Abnormal Child Psychology, 38(7), 985–994.
Merscham, C., Van Leeuwen, J. M., & McGuire, M. (2008). Mental health and substance abuse indicators among homeless youth in Denver. Colorado. Child Welfare, 88(2), 93–110.
Miller, L. (2012). Spiritual awareness psychotherapy with children and adolescents. In D. Walker & B. Hathway (Eds.), Spiritual approaches to treatment with children and adolescents (pp. 137–154). Washington, DC: American Psychological Association Press.
Miller, L. (2014). Spiritual awakening and depression in adolescence: Two sides of one coin. Bulletin of the Menninger Clinic, 77(4), 332–348.
Miller, L., Gur, M., Shanok, A., & Weissman, M. (2008). Interpersonal psychotherapy with pregnant adolescents: Two pilot studies. Journal of Child Psychology and Psychiatry, 49(7), 733–742.
Miller, L., Wickramaratne, P., Gameroff, M. J., Sage, M., Tenke, C. E., & Weissman, M. M. (2012). Religiosity and major depression in adults at high risk: A ten-year prospective study. American Journal of Psychiatry, 169(1), 89–94.
Morgan, D. (2003). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Psychotherapy Research, 13(1), 123–125.
Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2011). Interpersonal psychotherapy for depressed adolescents. New York: Guilford Press.
Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 41(1), 139–154.
Ortner, C. N., Kilner, S. J., & Zelazo, P. D. (2007). Mindfulness meditation and reduced emotional interference on a cognitive task. Motivation and Emotion, 31(4), 271–283.
Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., et al. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. The Lancet, 376(9758), 2086–2095.
Ringwalt, C. L., Greene, J. M., Robertson, M., & McPheeters, M. (1998). The prevalence of homelessness among adolescents in the United States. American Journal of Public Health, 88(9), 1325–1329.
Robertson, M. J., & Toro, P. A. (1999). Homeless youth: Research, intervention, and policy. Paper presented at the Practical lessons: The 1998 national symposium on homelessness research. Washington, DC: US Department of Housing and Urban Development and US Department of Health and Human Services.
Roemer, L., Graham, J. R., Morgan, L., & Orsillo, S. M. (2014). Mindfulness and acceptance-based behavioral therapies. In P. Emmelkamp & T. Ehring (Eds.), The Wiley handbook of anxiety disorders. Chichester: Wiley. doi:10.1002/9781118775349.ch39.
Rotheram-Borus, M. J. (1993). Suicidal behavior and risk factors among runaway youths. The American Journal of Psychiatry, 150(1), 103–107.
Rotheram-Borus, M. J., Mahler, K. A., Koopman, C., & Langabeer, K. (1996). Sexual abuse history and associated multiple risk behavior in adolescent runaways. American Journal of Orthopsychiatry, 66(3), 390–400.
Ryan, K. D., Kilmer, R. P., Cauce, A. M., Watanabe, H., & Hoyt, D. R. (2000). Psychological consequences of child maltreatment in homeless adolescents: Untangling the unique effects of maltreatment and family environment. Child Abuse and Neglect, 24(3), 333–352.
Scholz, U., Kliegel, M., Luszczynska, A., & Knoll, N. (2012). Associations between received social support and positive and negative affect: Evidence for age differences from a daily-diary study. European Journal of Ageing, 9(4), 361–371.
Schussel, L., & Miller, L. (2013). Best self visualization method with high-risk youth. Journal of Clinical Psychology, 69(8), 836–845.
Seeman, T. E., Dubin, L. F., & Seeman, M. (2003). Religiosity/spirituality and health: A critical review of the evidence for biological pathways. American Psychologist, 58(1), 53–63. doi:10.1037/0003-066X.58.1.53.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness based cognitive therapy for depression—A new approach to preventing relapse. New York: Guilford Press.
Shaw, A., Joseph, S., & Linley, P. A. (2005). Religion, spirituality, and posttraumatic growth: A systematic review. Mental Health, Religion & Culture, 8(1), 1–11.
Slesnick, N., Dashora, P., Letcher, A., Erdem, G., & Serovich, J. (2009). A review of services and interventions for runaway and homeless youth: Moving forward. Children and Youth Services Review, 31(7), 732–742.
Smollar, J. (1999). Homeless youth in the United States: Description and developmental issues. New Directions for Child and Adolescent Development, 1999(85), 47–58.
Spitzer, R. L., Kroenke, K., Williams, J. B., & P. H. Q. P. C. S. Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA, 282(18), 1737–1744.
Spitzer, R. L., Williams, J. B., Kroenke, K., Hornyak, R., & McMurray, J. (2000). Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric–gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics–Gynecology Study. American Journal of Obstetrics and Gynecology, 183(3), 759–769.
Sullivan, P. M., & Knutson, J. F. (2000). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse and Neglect, 24(10), 1257–1273.
Taylor, H., Stuttaford, M., & Vostanis, P. (2007). Short-term outcome of young homeless people in contact with a designated mental health service. The European Journal of Psychiatry, 21(4), 268–278.
Toro, P. A., Dworsky, A., & Fowler, P. J. (2007). Homeless youth in the United States: Recent research findings and intervention approaches. Paper presented at the National symposium on homelessness research.
Toro, P., Lesperance, T. M., & Braciszewski, J. M. (2011). The heterogeneity of homeless youth in America: Examining typologies. Washington, DC: National Alliance to End Homelessness.
Turner, R. J., & Brown, R. L. (2010). Social support and mental health. In T. L. Scheid & T. N. Brown (Eds.), Handbook of the sociology of mental health: Social contexts, theories, and systems (2nd ed., pp. 200–212). New York, NY: Cambridge University Press.
Uchino, B. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29(4), 377–387.
Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119(3), 488.
Unger, J. B., Kipke, M. D., Simon, T. R., Johnson, C. J., Montgomery, S. B., & Iverson, E. (1998). Stress, coping, and social support among homeless youth. Journal of Adolescent Research, 13(2), 134–157.
Unger, J. B., Kipke, M. D., Simon, T. R., Montgomery, S. B., & Johnson, C. J. (1997). Homeless youths and young adults in Los Angeles: Prevalence of mental health problems and the relationship between mental health and substance abuse disorders. American Journal of Community Psychology, 25(3), 371–394.
Verdeli, H., Clougherty, K., Onyango, G., Lewandowski, E., Speelman, L., Betancourt, T. S., et al. (2008). Group interpersonal psychotherapy for depressed youth in IDP camps in Northern Uganda: Adaptation and training. Child and Adolescent Psychiatric Clinics of North America, 17, 605–624.
Vieweg, B. W., & Hedlund, J. L. (1983). The General Health Questionnaire (GHQ): A comprehensive review. Journal of Operational Psychiatry, 14(2), 74–81.
Weissman, M., Markowitz, J., & Klerman, G. L. (2007). Clinician’s quick guide to interpersonal psychotherapy. Oxford: Oxford University Press.
Weissman, M. M., Markowitz, J. C., & Klerman, G. (2008). Comprehensive guide to interpersonal psychotherapy. London: Basic Books.
Whitbeck, L. B. (2011). Mental health and emerging adulthood among homeless young people. New York: Psychology Press, Taylor & Francis Group.
Whitbeck, L. B., Johnson, K. D., Hoyt, D. R., & Cauce, A. M. (2004). Mental disorder and comorbidity among runaway and homeless adolescents. Journal of Adolescent Health, 35(2), 132–140.
Williams, D. R., & Sternthal, M. J. (2007). Spirituality, religion and health: Evidence and research directions. Medical Journal of Australia, 186(10), S47.
Yadav, S. (2010). Perceived social support, hope, and quality of life of persons living with HIV/AIDS: A case study from Nepal. Quality of Life Research, 19(2), 157–166.
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.
Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with youth: A meta-analysis. Mindfulness, 6(2), 290–302.
Acknowledgments
Research presented herein was conducted within the Youth Rising Program, funded by generous donations from Goldman Sachs Gives.
Conflict of interest
In the past 3 years, one of the authors has received funding from Goldman Sachs Gives, Oxford University Press, and St. Martins Press. The study was approved by Institutional Review Boards at Teachers College, Columbia University (12-008). All data were collected intermittently between March 5, 2012, and July 15, 2012.
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Mastropieri, B., Schussel, L., Forbes, D. et al. Inner Resources for Survival: Integrating Interpersonal Psychotherapy with Spiritual Visualization with Homeless Youth. J Relig Health 54, 903–921 (2015). https://doi.org/10.1007/s10943-015-0044-3
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DOI: https://doi.org/10.1007/s10943-015-0044-3