Abstract
Women diagnosed with breast cancer often suffer from illness-related issues, which negatively impact their illness perception and inner strength following diagnosis and/or during treatment. An investigation of the effectiveness of religious–spiritual psychotherapy based on the Twelver Shia Sects of Islam (RSP-TSS) was conducted among hospitalized cancer patients to determine whether it improved their disease perception and inner strength. Forty-five women (ages 31–58) diagnosed with breast cancer in Iran were randomly assigned to RSP-TSS (n = 15), attention control (n = 15) and untreated control groups (n = 15). To meet the needs of hospitalized participants, the manualized RSP-TSS protocol was adapted to consist of ten sessions, each lasting 90 min. Sessions were conducted once weekly for 10 weeks. Primary outcome measures were the Revised Illness Perception Questionnaire (IPQ-R) and the Inner Strength Questionnaire (ISQ). Data were collected in pre-intervention, post-intervention, and 4 months following the intervention. Repeated MANOVA measures showed that, as compared with the attention control and untreated control groups, the RSP-TSS group achieved significant improvements in illness perception and inner strengths, and those gains were maintained during the 4-month follow-up. By reframing illness perception and building inner strength, spiritual and religious-based interventions may improve patients coping with cancer and improve the quality of life for women hospitalized with breast cancer. These promising results warrant further investigation into the efficacy of spiritual and religious-based interventions to remediate illness perception and inner strength problems in women diagnosed with serious medical illnesses.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahmad, F., Muhammad, M., & Abdullah, A. A. (2011). Religion and spirituality in coping with advanced breast cancer: Perspectives from Malaysian Muslim women. Journal of Religion and Health, 50(1), 36–45. https://doi.org/10.1007/s10943-010-9401-4
Ahoei, K., Faramarzi, M., & Hassanzadeh, R. (2017). The relationship between spiritual intelligence and psychological well-being in women with breast cancer. Shiraz E-Medical Journal, 18(10), e15103. https://doi.org/10.5812/semj.15103
Alpers, L. M., Helseth, S., & Bergbom, I. (2012). Experiences of inner strength in critically ill patients—a hermeneutical approach. Intensive & Critical Care Nursing, 28(3), 150–158. https://doi.org/10.1016/j.iccn.2011.10.004
Ayubi, E., Mansournia, M. A., Motlagh, A. G., Mosavi-Jarrahi, A., Hosseini, A., & Yazdani, K. (2017). Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic. Epidemiology and Health, 39, e2017021. https://doi.org/10.4178/epih.e2017021
Bartz, J. D. (2009). Theistic existential psychotherapy. Psychology of Religion and Spirituality, 1(2), 69–80. https://doi.org/10.1037/a0014895
Borges, M., Caldeira, S., Loyola-Caetano, E., Magalhães, P., Areco, F., & Panobianco, M. (2017). Spiritual/religious coping of women with breast cancer. Religions, 8(11), 254. https://doi.org/10.3390/rel8110254
Broadbent, E., Wilkes, C., Koschwanez, H., Weinman, J., Norton, S., & Petrie, K. J. (2015). A systematic review and meta-analysis of the Brief Illness Perception Questionnaire. Psychology & Health, 30(11), 1361–1385. https://doi.org/10.1080/08870446.2015.107085
Büssing, A., & Surzykiewicz, J. (2015). Interpretation of illness in patients with chronic diseases from Poland and their associations with spirituality, life satisfaction, and escape from illness—Results from a Cross Sectional Study. Religions, 6(3), 763–780. https://doi.org/10.3390/rel6030763
Büssing, A., Ostermann, T., & Matthiessen, P. F. (2007). adaptive coping and spirituality as a resource in cancer patients. Breast Care, 2(4), 195–202. https://doi.org/10.1159/000104172
Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy-Heltzel, S. E., & Worthington, E. L., Jr. (2018). Integrating clients’ religion and spirituality within psychotherapy: A comprehensive meta-analysis. Journal of Clinical Psychology, 74(11), 1938–1951. https://doi.org/10.1002/jclp.22681
Dempster, M., & McCorry, N. K. (2012). The factor structure of the revised Illness Perception Questionnaire in a population of oesophageal cancer survivors. Psycho-Oncology, 21(5), 524–530. https://doi.org/10.1002/pon.1927
Dingley, C., & Roux, G. (2014). The role of inner strength in quality of life and self-management in women survivors of cancer. Research in Nursing & Health, 37(1), 32–41. https://doi.org/10.1002/nur.21579
Fallah, R., Golzari, M., Dastani, M., & Akbari, M. E. (2011). integrating spirituality into a group psychotherapy program for women surviving from breast cancer. Iranian Journal of Cancer Prevention, 4(3), 141–147.
Ford, D., Zapka, J., Gebregziabher, M., Yang, C., & Sterba, K. (2010). Factors associated with illness perception among critically ill patients and surrogates. Chest, 138(1), 59–67. https://doi.org/10.1378/chest.09-2124
Garlick, M., Wall, K., Corwin, D., & Koopman, C. (2011). Psycho-spiritual integrative therapy for women with primary breast cancer. Journal of Clinical Psychology in Medical Settings, 18(1), 78–90. https://doi.org/10.1007/s10880-011-9224-9
Ghiasvand, R., Bahmanyar, S., Zendehdel, K., Tahmasebi, S., Talei, A., Adami, H. O., & Cnattingius, S. (2012). Postmenopausal breast cancer in Iran; risk factors and their population attributable fractions. BMC Cancer, 12, 414. https://doi.org/10.1186/1471-2407-12-414
Giannousi, Z., Manaras, I., Georgoulias, V., & Samonis, G. (2010). Illness perceptions in Greek patients with cancer: A validation of the Revised-Illness Perception Questionnaire. Psycho-Oncology, 19(1), 85–92. https://doi.org/10.1002/pon.1538
Gonçalves, J. P., Lucchetti, G., Menezes, P. R., & Vallada, H. (2015). Religious and spiritual interventions in mental health care: A systematic review and meta-analysis of randomized controlled clinical trials. Psychological Medicine, 45(14), 2937–2949. https://doi.org/10.1017/S0033291715001166
Ha, S., & Ryu, E. (2021). Perceived new normal and inner strength on quality of life in breast cancer patients receiving adjuvant endocrine Therapy. Asia-Pacific Journal of Oncology Nursing, 8(4), 377–384. https://doi.org/10.4103/apjon.apjon-2081
Hopman, P., & Rijken, M. (2015). Illness perceptions of cancer patients: Relationships with illness characteristics and coping. Psycho-Oncology, 24(1), 11–18. https://doi.org/10.1002/pon.3591
Hoseini, L., Lotfi Kashani, F., Akbari, S., Akbari, M. E., & Sarafraz Mehr, S. (2016). Model development of illness perception and consequences in breast cancer patients. Asian Pacific Journal of Cancer Prevention (APJCP), 17(S3), 185–190. https://doi.org/10.7314/apjcp.2016.17.s3.185
Hulett, J. M., & Armer, J. M. (2016). A systematic review of spiritually based interventions and psychoneuroimmunological outcomes in breast cancer survivorship. Integrative Cancer Therapies, 15(4), 405–423. https://doi.org/10.1177/1534735416636222
Jafari, N., Farajzadegan, Z., Zamani, A., Bahrami, F., Emami, H., Loghmani, A., & Jafari, N. (2013). Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: A randomized controlled trial. Evidence-Based Complementary and Alternative Medicine (eCAM), 2013, 353262. https://doi.org/10.1155/2013/353262
Jenkinson, A., & Cantrell, M. A. (2017). Inner strength in women with chronic illness. Chronic Illness, 13(2), 100–116. https://doi.org/10.1177/1742395316664961
Jim, H. S., Pustejovsky, J. E., Park, C. L., Danhauer, S. C., Sherman, A. C., Fitchett, G., Merluzzi, T. V., Munoz, A. R., George, L., Snyder, M. A., & Salsman, J. M. (2015). Religion, spirituality, and physical health in cancer patients: A meta-analysis. Cancer, 121(21), 3760–3768. https://doi.org/10.1002/cncr.29353
Kaptein, A. A., Schoones, J. W., Fischer, M. J., Thong, M. S., Kroep, J. R., & van der Hoeven, K. J. (2015). Illness perceptions in women with breast cancer - a systematic literature review. Current Breast Cancer Reports, 7(3), 117–126. https://doi.org/10.1007/s12609-015-0187-y
Khodayarifard, M., Rahiminezad, A., Ghobari Bonab, B., & Shokoohiyekta, M., Faghihi, A. N., & Azarbayjani, M. (2009). Preparing religiosity scale and assessing religiosity rates of various social levels in Iran (Research Report). University of Tehran, Tehran, Iran.
Koenig, H. G. (2015). Religion, spirituality, and health: A review and update. Advances in Mind-Body Medicine, 29(3), 19–26.
Koenig, H. G., Zaben, F. A., & Khalifa, D. A. (2012). Religion, spirituality and mental health in the West and the Middle East. Asian Journal of Psychiatry, 5(2), 180–182. https://doi.org/10.1016/j.ajp.2012.04.004
Koenig, H. G. (2013). Religion and spirituality in coping with acute and chronic illness. In K. I. Pargament, A. Mahoney, & E. P. Shafranske (Eds.), APA handbooks in psychology®. APA handbook of psychology, religion, and spirituality (Vol. 2): An applied psychology of religion and spirituality (pp. 275–295). American Psychological Association. https://doi.org/10.1037/14046-014.
Lerdal, A., Hofoss, D., Gay, C. L., & Fagermoen, M. S. (2019). Perception of illness among patients with heart failure is related to their general health independently of their mood and functional capacity. Journal of Patient-Reported Outcomes, 3(1), 55. https://doi.org/10.1186/s41687-019-0142-1
Lewis, K. L., & Roux, G. (2011). Psychometric testing of the Inner Strength Questionnaire: Women living with chronic health conditions. Applied Nursing Research (ANR), 24(3), 153–160. https://doi.org/10.1016/j.apnr.2009.06.003
Lowe, R., & Norman, P. (2017). Information processing in illness representation: Implications from an associative-learning framework. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 36(3), 280–290. https://doi.org/10.1037/hea0000457
Lundman, B., Aléx, L., Jonsén, E., Norberg, A., Nygren, B., Santamäki Fischer, R., & Strandberg, G. (2010). Inner strength–a theoretical analysis of salutogenic concepts. International Journal of Nursing Studies, 47(2), 251–260. https://doi.org/10.1016/j.ijnurstu.2009.05.020
Merath, K., Palmer Kelly, E., Hyer, J. M., Mehta, R., Agne, J. L., Deans, K., Fischer, B. A., & Pawlik, T. M. (2020). Patient perceptions about the role of religion and spirituality during cancer care. Journal of Religion and Health, 59(4), 1933–1945. https://doi.org/10.1007/s10943-019-00907-6
Miner, M., Ghobary, B., Dowson, M., & Proctor, M.-T. (2014). Spiritual attachment in Islam and Christianity: Similarities and differences. Mental Health, Religion & Culture, 17(1), 79–93. https://doi.org/10.1080/13674676.2012.749452
Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology & Health, 17(1), 1–16. https://doi.org/10.1080/08870440290001494
Mustafa Ali, M., Moeller, M., Rybicki, L., & Moore, H. (2017). Prevalence and correlates of patient-reported symptoms and comorbidities in breast cancer survivors at a tertiary center. Journal of Cancer Survivorship: Research and Practice, 11(6), 743–750. https://doi.org/10.1007/s11764-017-0612-5
Pargament, K. I., Exline, J. J., & Jones, J. W. (Eds.). (2013). APA handbook of psychology, religion, and spirituality (Vol. 1): Context, theory, and research. American Psychological Association. https://doi.org/10.1037/14045-000.
Park, C. L., Sherman, A. C., Jim, H. S., & Salsman, J. M. (2015). Religion/spirituality and health in the context of cancer: Cross-domain integration, unresolved issues, and future directions. Cancer, 121(21), 3789–3794. https://doi.org/10.1002/cncr.29351
Peteet, J. R., & Balboni, M. J. (2013). Spirituality and religion in oncology. CA: A Cancer Journal for Clinicians, 63(4), 280–289. https://doi.org/10.3322/caac.21187.
Qureshi, N. A., Khalil, A. A., & Alsanad, S. M. (2020). Spiritual and religious healing practices: Some reflections from Saudi National Center for complementary and alternative medicine, Riyadh. Journal of Religion and Health, 59(2), 845–869. https://doi.org/10.1007/s10943-018-0677-0
Richards, P. S., & Bergin, A. E. (2005). A spiritual strategy for counseling and psychotherapy (2nd ed.). American Psychological Association. https://doi.org/10.1037/11214-000.
Roger, K. S., & Hatala, A. (2017). Religion, spirituality & chronic illness: A scoping review and implications for health care practitioners. Journal of Religion & Spirituality in Social Work: Social Thought, 37(1), 24–44. https://doi.org/10.1080/15426432.2017.1386151
Roux, G., Lewis, K., Younger, J., & Dingley, C. (2003). Development and testing of the inner strength questionnaire. Journal of Cultural Diversity, 10(1), 4–5.
Rufener, D. (2011). Inner Strength in Cancer Survivors: The Role of Spirituality in Establishing Connectedness (Master’s thesis). The Ohio State University, Columbus, Ohio, United States.
Saritas, S. C., & Özdemir, A. (2018). Identification of the correlation between illness perception and anxiety level in cancer patients. Perspectives in Psychiatric Care, 54(3), 380–385. https://doi.org/10.1111/ppc.12265
Sawyer, A. T., Harris, S. L., & Koenig, H. G. (2019). Illness perception and high readmission health outcomes. Health Psychology Open, 6(1), 2055102919844504. https://doi.org/10.1177/2055102919844504
Thomas, J., & Barbato, M. (2020). Positive religious coping and mental health among christians and muslims in response to the COVID-19 pandemic. Religions, 11(10), 498. https://doi.org/10.3390/rel11100498
Thuné-Boyle, I. C., Stygall, J., Keshtgar, M. R., Davidson, T. I., & Newman, S. P. (2013). Religious/spiritual coping resources and their relationship with adjustment in patients newly diagnosed with breast cancer in the UK. Psycho-Oncology, 22(3), 646–658. https://doi.org/10.1002/pon.3048
Van Der Spek, N., Vos, J., Van Uden-Kraan, C. F., Breitbart, W., Cuijpers, P., Holtmaat, K., Witte, B. I., Tollenaar, R., & Verdonck-de Leeuw, I. M. (2017). Efficacy of meaning-centered group psychotherapy for cancer survivors: A randomized controlled trial. Psychological Medicine, 47(11), 1990–2001. https://doi.org/10.1017/S0033291717000447
Acknowledgements
Our sincere appreciation goes to all the dear patients and all those involved in this research. Also, we are very thankful to Graduate Studies in the Department of Semnan University for the approval of this work as a doctoral thesis, Number 7332.
Funding
This study has not received financial support from any organization.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Date and place of the study: Omid Chemotherapy and Radiotherapy Center and specialized cancer clinics in Bandar Abbas, Bandar Abbas City, Iran. October 2016 to July 2017.
Rights and permissions
About this article
Cite this article
Davari, S., Boogar, I.R., Talepasand, S. et al. The Effect of Religious–Spiritual Psychotherapy on Illness Perception and Inner Strength among Patients with Breast Cancer in Iran. J Relig Health 61, 4302–4319 (2022). https://doi.org/10.1007/s10943-022-01594-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10943-022-01594-6