Keywords

The time for a positive psychology of religion and spirituality has arrived, for at least two reasons. First, scholarly interest in the influence of religiousness and spirituality on health and well-being has shown a marked increase in recent decades (Koenig et al., 2012; Miller, in press; Paloutzian & Park, 2013; Pargament, 2013). Second, empirical and theoretical developments in positive psychology have characterized religiousness and spirituality both as drivers and expressions of well-being (Lee et al., 2021; Vittersø, 2016). Because these two subdisciplines have similar aims (Davis et al., Chap. 1, this volume) and have been said to go “hand in hand” (Barton & Miller, 2015, p. 829), movement toward the formalization of a positive psychology of religion and spirituality seems warranted (see Davis et al., Chap. 31, this volume).

For a positive psychology of religion and spirituality to make meaningful scientific progress, it is important to take inventory of the work that has been done. There is a particular need to consolidate knowledge and clarify possible directions for theory and inquiry. With this in mind, the purpose of this chapter is to provide an overview of some available theories and models related to individual-levelFootnote 1 religiousness, spirituality, health, and well-being. I emphasize theories whose core constructs are operationalized with measurement tools or have a strong empirical foundation tied to a naturalistic scientific stance. Due to space limitations, only select theories are discussed, but readers are encouraged to explore the many other promising theories out there (e.g., Dodge et al., 2012; Lee et al., 2021; see also Davis et al., Chap. 18, this volume).

Definitions

To facilitate clarity of expression, it is worthwhile to provide some working definitions of this chapter’s main concepts. In this chapter, the term religiousness will be used rather than religion. As argued by Paloutzian and Park (2021), the term religiousness is more in line with a scientific psychology because it can be “understood as human behavior, including its affective, attitudinal, and cognitive aspects” (p. 3). Following their lead, religiousness is defined as “an individual’s or group’s understanding, enacting, and being vis-à-vis religion” (Paloutzian & Park, 2021, pp. 3–4). Spirituality is considered to be a broad, multidimensional, and unique domain of human functioning that is superordinate to, but inclusive of, religiousness (MacDonald, 2017; MacDonald et al., 2015). More precisely, spirituality is defined as

a natural aspect of human functioning [that] relates to a special class of non-ordinary experiences and the beliefs, attitudes, and behaviors that cause, co-occur, and/or result from such experiences. The experiences themselves are characterized as involving states and modes of consciousness [that] alter the functions and expressions of self and personality and impact the way in which we perceive and understand ourselves, others, and reality as a whole. (MacDonald et al., 2015, p. 5)

There are numerous definitions and conceptualizations of health, well-being, and related terms (see Appendix 5.S1, Table 5.S1). In this chapter, health and well-being are framed in positive psychological terms and are defined as positive appraisal of one’s quality of life and capacity for self-determination and self-fulfillment, as applied to all domains of functioning (e.g., physical, psychological, social, and spiritual). Although arguments might be made that health and well-being should be treated as distinct constructs, available factor analytic research suggests that measures of such concepts and related terms (e.g., wellness) tend to contribute to the same factors or components (see MacDonald, 2018). Thus, it appears defendable on empirical grounds to use these concepts as synonyms in this chapter, except where needed to describe a theory.

Theories of Health and Well-Being

A perusal of the literature suggests that extant theories of health/well-being may be organized into two loose categories. In the first, the theories involve defining and elucidating health/well-being specifically within the domain of spirituality (i.e., spiritual well-being). In essence, these are theories that start with spirituality and then broaden the concept to include health/well-being, as it relates to the unfolding and manifestation of spirituality developmentally. In the second category, spirituality is conceptualized as an aspect or facet of broader conceptualizations of health/well-being (i.e., it is viewed as one of several expressions of health and well-being). The following discussion is organized accordingly.

Spirituality as Well-Being

As noted by Moberg (1984), interest in spiritual well-being (SWB) effectively started 50 years ago thanks to the 1971 White House Conference on Aging. Participants in this conference and its technical committee aimed to provide a theoretical framework for SWB that could be used to facilitate policy development and support inquiry in a variety of areas including but not limited to religious research, quality of life, and holistic health (Moberg, 1971). At the core of this framework is the committee’s definition of the term spiritual, which they defined as a person’s “inner resources especially [their] ultimate concern, the basic value around which all other values are focused, the central philosophy of life—whether religious, anti-religious, or nonreligious—which guides a person’s conduct, the supernatural and nonmaterial dimensions of human nature” (Moberg, 1971, p. 3). Extending from this definition, SWB was seen as a dynamic and lifelong process of spiritual growth that involves addressing basic human needs to cope with suffering, adversity, existential uncertainty, and psychosocial and personological change across the lifespan. Moberg (1984) elaborated that, within this framework, SWB is considered to be (a) multidimensional, (b) related to but distinct from religiousness, and (c) manifested in all contexts of life and not just within institutional religious settings. It is noteworthy that Moberg also affirmed the definition of SWB developed by the National Interfaith Coalition on Aging (1975). In this definition, SWB was defined as “the affirmation of life in a relationship with God, self, community, and the environment that nurtures and celebrates wholeness” (quoted from Moberg, 1984, p. 352). In both cases, Moberg (1984) opined that although these definitions may have some practical value, they are too broad to permit their use in empirical research on SWB. He therefore called for the development of assessment tools that would measure the various facets of SWB.

With respect to its facets, Moberg (1984) acknowledged that SWB has “possibly hundreds of components” (p. 352). Despite the construct’s complexity, Moberg (1984) followed through with his call by using survey data (obtained in the U.S. and Sweden) to construct several indices he proffered could be used to study SWB empirically. In particular, he took items from the survey and completed an exploratory factor analysis. Based upon observed factor loadings and analysis of item content, he labeled the factors Christian Faith, Self-Satisfaction, Personal Piety, Subjective Spiritual-Well-Being, Optimism, Religious Cynicism, and Elitism. In his interpretation, Moberg viewed the first four factors as having both theoretical value and empirical support with his data, whereas the latter three factors appeared conceptually and statistically weak and possibly mislabeled. Subsequent research using Moberg’s indices has provided evidence supporting their convergent and discriminant validity (MacDonald, 2000a).

Although the development of empirical indices is noteworthy in its own right, Moberg made other contributions as well (e.g., Moberg, 1979; Moberg & Brusek, 1978). The most significant of these is a theory he developed that serves as the basis for one of the most widely used measures of SWB, the Spiritual Well-Being Scale (Ellison, 1983; Paloutzian & Ellison, 1982). In this theory, SWB is construed in terms of vertical and horizontal dimensions. The vertical dimension is referred to as religious well-being, which is defined as well-being manifested in one’s perceived relationship to a higher power (i.e., God). The horizontal dimension is called existential well-being and refers to well-being expressed in the form of purpose, meaning in life, and life satisfaction—but without any overtly religious elements. In this model, SWB is operationalized as the combination of these two dimensions. The psychometric properties of the Spiritual Well-Being Scale have been studied extensively, and the measure has demonstrated good evidence of reliability and convergent and criterion validity (Paloutzian et al., 2021). However, evidence supporting the factorial validity of the scale—and by extension the two-dimensional model it purportedly measures—has been less favorable (Sterner et al., 2021).

Another more recently developed approach to SWB and its measurement has its roots in the 1970s, especially the National Interfaith Coalition on Aging’s (1975) definition mentioned above. This theory is the four-domain model of spiritual health and well-being that serves as the conceptual basis for the Spiritual Well-Being Questionnaire (Gomez & Fisher, 2003), Spiritual Health and Life Orientation Measure (Fisher, 2010), and 4-item Spiritual Well-Being Index (Fisher & Ng, 2017). As its name implies, the four-domain model defines SWB as consisting of four facets: Personal (i.e., relation to one’s self, with an emphasis on life meaning, purpose, and values), Communal (i.e., relation with others, involving morality, religion, culture, and a positive perception of humanity), Environmental (i.e., sense of connection, appreciation, and nurturing orientation toward nature), and Transcendental (i.e., relation of self to a transcendent power or dimension). These domains are seen as dynamic and interconnected, such that they change over time and mutually influence one another. However, the motivational core of the model, and the primary driver by which the fulfillment of SWB can be attained, is an intentional desire for self-development that is congruent with personal meaning and purpose in life. The successful realization of SWB is manifested through the experience of bliss and internal harmony (Fisher, 2010). The measures based on this conceptual model have been used in several studies and demonstrate acceptable evidence of reliability and validity (Fisher, 2010; Fisher & Ng, 2017).

Spirituality as a Component of Well-Being

Theories in this next group tend to incorporate religiousness/spirituality as one expression of multicomponential conceptualizations of health/well-being. We begin with Stoudenmire et al.’s (1985) model of optimal functioning and the measure they developed to assess it—the Holistic Living Inventory. Motivated by the desire to address ambiguities in the definition and measurement of holistic living, Stoudenmire et al. (1985) drew from theories of holism and optimal functioning adopted by different organizations, such as the American Holistic Medical Association and the Institute of Religion and Health. They constructed a four-facet model of holistic living that includes physical, emotional, mental, and spiritual dimensions. Optimal functioning was defined specific to each component. The physical dimension was defined as enhancement of physical fitness through responsible lifestyle (e.g., diet, exercise) practices and self-monitoring and regulation of one’s physical health and functioning. The emotional dimension was seen as enhancement of emotional self-satisfaction through positive and responsible behavioral choices and the avoidance or mitigation of negative emotions such as depression, anger, and anxiety. The mental dimension involved the enhancement of mental developmental potentials through intellectual pursuits, the increased appreciation of aesthetics, and the minimization of irrational attitudes. Lastly, the spiritual dimension involved fostering a sense of oneness with a higher power and actively developing and adhering to an ethical system.

Although the Holistic Living Inventory has demonstrated reasonably good evidence of validity and reliability (Stoudenmire et al., 1985), it has been criticized for its length and item complexity. This led to the development of the Mental, Physical, and Spiritual Well-Being Scale (Vella-Brodrick & Allen, 1995), which has demonstrated stronger psychometric properties and an improved theoretical foundation. For instance, the model underlying the Holistic Living Inventory does not specify how its four dimensions relate to each other to enable integrated, optimal functioning. Conversely, Vella-Brodrick and Allen (1995) not only provide clear definitions of their three identified domains of well-being but also state explicitly that holistic well-being involves “the balanced nourishment of mind, body, and spirit” (p. 661). Their introduction of balance into the conceptualization of holistic well-being makes it clear that holistic health/well-being depends on equally meaningful attention to all facets of well-being.

Another theory of interest is Adams et al.’s (1997) wellness model, which serves as the basis of their Perceived Wellness Survey (PWS). This model draws from prior theories of positive health, with an emphasis on Dunn’s (1961) systems approach and Antonovsky’s (1988) notion of salutogenesis (i.e., an approach to health that focuses on factors that contribute to well-being, particularly in the face of adversity and stress). Adams et al. (1997) conceptualize perceived wellness as “a multidimensional, salutogenic construct” (p. 209) wherein overall wellness is facilitated and maintained through the reciprocal integration and homeostasis of well-being’s dimensions. There are six dimensions that comprise the model: physical wellness (i.e., perception of, and expectations for, positive physical health), psychological wellness (i.e., expectation of positive outcomes in life), social wellness (i.e., perception of social support), emotional wellness (i.e., positive self-esteem), intellectual wellness (i.e., perception of optimal engagement in activities that are intellectually stimulating), and spiritual wellness (i.e., a sense of life purpose and belief in the existence of a unifying force). As an operationalization of the wellness model, the Perceived Wellness Survey has demonstrated evidence of acceptable reliability and validity and shown promise in research (Adams et al., 1997; Harari et al., 2005; MacDonald, 2018; Rothmann & Ekkerd, 2007).

A final set of theories are well-established in positive psychology proper and may be characterized as representing related but distinct research traditions within that subdiscipline. First are theories of eudaimonic well-being. With its roots traceable to ancient Greece and particularly the work of Aristotle (e.g., Aristotle, 2002), eudaimonia is an approach to well-being that is seen as analogous to notions of self-actualization. At its core, eudaimonic well-being is seen as living life in an authentic, self-directed, engaged, and meaningful manner. It is worth noting that in his formulation of the concept of eudaimonia, Aristotle placed primary emphasis on ethics, virtue, and wisdom and did not make overt ties to anything spiritual. However, some scholars have noted that the concept later underwent a “Christianization,” resulting in it incorporating transcendence (a widely recognized spiritual concept; Boyce-Tillman, 2020).

In positive psychology, major theories aligned with eudaimonia include psychological well-being theory (Ryff, 1989, 2018; Ryff & Keyes, 1995; Ryff & Singer, 2008), self-determination theory (Ryan et al., 2008), and eudaimonic identity theory (Waterman, 2011; Waterman et al., 2010; see Appendix 5.S1, Table 5.S2 for summaries of each of these major theories). None of these theories include much by way of overt religious or spiritual content, but each of them incorporates meaning and purpose in life, albeit to differing degrees.

Meaning and purpose is a relatively common element in definitions and measures of spirituality and/or SWB as well (e.g., Paloutzian & Ellison, 1982; see Park & Van Tongeren, Chap. 6, this volume). Given this content overlap, care must be exercised when interpreting empirical relations between spirituality and eudaimonic well-being, because correlations are likely inflated when relying on instruments that assess meaning/purpose as part of each construct (for discussions of this issue, see Garssen et al., 2016; Koenig, 2008; MacDonald, 2017, 2018). Notwithstanding such problems, scholarly attention has been given to the relation and place of spirituality within eudaimonic theory (e.g., Pargament et al., 2016), and scholars have proposed broadening eudaimonic theories to incorporate spirituality in a manner that extends beyond meaning and purpose alone (e.g., van Dierendonck, 2004).

Next, there are positive psychological theories that frame well-being in terms of values, virtues, and character. Perhaps the most influential of these is Peterson and Seligman’s (2004) Values in Action (VIA) nosology of character strengths and virtues. In developing this system, Peterson and Seligman completed an extensive survey of the literature with the intention of identifying strengths and virtues that appeared invariant across history and cultures and were universally seen as contributing to the development of good moral character. Their efforts resulted in the creation of a classification system and several associated measures, chiefly including the 240-item VIA Inventory of Strengths. The system itself provides six classes of core virtues, under which are 24 character strengths. The virtues are wisdom/knowledge, courage, humanity, justice, temperance, and transcendence. Within the last virtue (transcendence), religiousness and spirituality are placed as character strengths. It is described as involving faith and purpose and as manifesting through the adoption of a belief system regarding one’s life and the universe as having meaning. It more specifically entails having an understanding of one’s place within the universe in a manner that informs one’s conduct and serves as a source of comfort (Park et al., 2004). The VIA Inventory of Strengths and the broader scientific study of virtues and strengths have garnered a lot of attention in positive psychology (e.g., Stichter & Saunders, 2019; see also Ratchford et al., Chap. 4, this volume). There also is good evidence supporting the reliability and validity of the VIA Inventory of Strengths (Peterson & Seligman, 2004; Ruch et al., 2010) and its more recent revision (McGrath & Wallace, 2021).

One last theory deserves mention—the PERMA model of flourishing proposed by Seligman (2011). PERMA is an acronym that stands for Positive emotions, Engagement, Relationships, Meaning, and Accomplishments. Although some scholars have interpreted the model as yet another definition of well-being (e.g., Goodman et al., 2018), Seligman (2018) has argued that the model’s five elements are best understood as the building blocks of well-being and not as well-being itself per se. A measure of the elements, called the PERMA-Profiler, has been developed and exhibited satisfactory evidence of reliability and validity (Butler & Kern, 2016).

The Need for an Integrative Scientific Theory

All the theories discussed so far in this chapter were selected because of their potential to contribute to empirical research. Based upon this sampling, one might have the impression there is a more than sufficient theoretical footing to guide a positive psychology of religion and spirituality. However, this impression would not be wholly accurate for at least two key reasons. First, extant theories are disparate in terms of their underlying emphases as to the place of spirituality within well-being and vice-versa, a problem that is exacerbated by the fact the definitions of spirituality and well-being often blend in ways that create confusion as to whether spirituality is a contributor to—versus a manifestation of—well-being. This is particularly the case when it comes to meaning and purpose (MacDonald, 2017, 2018). Second and more importantly, there are indications that the psychology of religion and spirituality itself is not wholly clear on what it should study and how best to study it (Linfield, 2021). There is discussion and debate about how the subdiscipline can be brought into greater accord with psychological science. Paloutzian and Park (2021), two prominent figures in the field, have suggested that a multilevel interdisciplinary meaning systems approach holds promise for guiding such efforts.

The existing research on spirituality, religion, health, and well-being provides reasonably fertile ground for the development of testable theories that can guide a rigorous positive psychology of religion and spirituality. One current challenge is finding a way to rectify and integrate the myriad theories that are presently available. The research well-establishes the empirical links between religiousness, spirituality, and well-being. As such, we are now at a point where we need to move to the level of identifying causal influences and mechanisms that contribute to well-being outcomes. More specifically, there is a clear need to recognize and incorporate biological, social, psychological (including cognitive, affective, experiential, and personality factors), behavioral, and developmental factors into theoretical frameworks, in order to enable researchers and practitioners to understand the complexity, structure, and dynamics of religiousness and spirituality and its influence on health/well-being. Fortunately, there are some candidate theories that hold promise to serve as starting points for programmatic research. Due to space constraints, I mention three here, but the reader is encouraged to explore the literature for others (e.g., Davis et al., Chap. 18, this volume).

First, Koenig (2012) and Koenig et al. (2012) present impressively detailed theoretical models specifying causal pathways between religiousness and mental and physical health. Fig. 5.1 shows a simplified, adapted version of the model applicable to Western religions (i.e., Christianity, Judaism, and Islam) and presenting positive mental health as the outcome variable. Second is MacDonald’s (2009) bio-social-psychological model (see Fig. 5.2), which was devised using the comprehensive, five-dimensional measurement model of spirituality that was developed by MacDonald (2000a, b). In particular, after a survey of available theory and research to identify what correlates with and contributes to each of the five dimensions, MacDonald suggested that the dimensions could be configured to create a directional causal model that starts with social (religiousness) and biological (spiritual experience) determinants, which in turn influence psychological development and ultimately well-being. Finally, VanderWeele’s (2017) human flourishing theory (see Fig. 5.3) is a model of overall well-being in which well-being (which he uses synonymously with the term flourishing) is defined as “a state in which all aspects of a person’s life are good… [because the person is] doing or being well in the following five broad domains of human life: (i) happiness and life satisfaction; (ii) health, both mental and physical; (iii) meaning and purpose; (iv) character and virtue; and (v) close social relationships” (p. 8149). (Since then, a sixth domain has been added—financial and material stability [Gallup, 2021].) VanderWeele’s (2017) theory highlights four major causal pathways to these six facets of well-being: family, work, education, and religion/spirituality. VanderWeele (2017) derived this theory through a rigorous review of the longitudinal, experimental, and quasi-experimental literature, and he and Gallup (2021) have developed and refined a well-validated, cross-culturally applicable measure of it—the Global Flourishing Study Questionnaire (Gallup, 2021).

Fig. 5.1
figure 1

A simplified version of Koenig’s (2012) model of religiousness and positive mental health

Note. Figure adapted from Koenig et al. (2012). This figure shows Koenig’s model based on Western religious traditions. There are separate models based on Eastern religious and Secular Humanist traditions. All three models in their full forms can be found in Koenig et al. (2012)

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Fig. 5.2
figure 2

A visual depiction of MacDonald’s (2009) bio-social-psychological model of spirituality and well-being

Note. Figure adapted from MacDonald (2009). The top part of the figure shows a directional structural model, with the thick-lined arrows denoting the main directional pathways. The bottom part of the figure provides an alternative and more theory-informed version of the model

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Fig. 5.3
figure 3

VanderWeele’s (2017) theory of human flourishing (well-being)

Note. VanderWeele’s (2017) human flourishing theory is a model in which well-being (seen as synonymous with flourishing) is defined as “a state in which all aspects of a person’s life are good” (VanderWeele, 2017, p. 8149). Specifically, the person is “doing or being well in the following [six] broad domains of human life: (i) happiness and life satisfaction; (ii) health, both mental and physical; (iii) meaning and purpose; (iv) character and virtue; … (v) close social relationships [and (vi) financial and material stability]” (VanderWeele, 2017, p. 8149; see also Gallup, 2021). Each of these domains is theorized as being desired universally (i.e., they are applicable to all cultures), and as typically serving as an end in itself. There are four main determinants of overall well-being and its facets (domains): family, work, education, and religion/spirituality (Gallup, 2021; VanderWeele, 2017)

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In each of these three models, there are some appealing features worth mentioning. For instance, each of these theories: (a) is copasetic with naturalistic science (e.g., their variables, mechanisms, and outcomes are construed in ways that do not require the use of nebulous or metaphysically loaded concepts that are difficult to define and measure with precision; Park & Paloutzian, 2021), (b) takes culture and cultural differences into consideration with respect to how the models operate and/or apply to different populations (Gallup, 2021; Koenig, 2012; Koenig et al., 2012; MacDonald et al., 2015; VanderWeele, 2017), and (c) is testable via the use of well-validated assessment tools (Gallup, 2021; MacDonald, 2000a, b; VanderWeele, 2017). At the same time, each model offers a unique approach to the study of religiousness, spirituality, and health/well-being. For instance, Koenig’s model focuses specifically on religiousness and incorporates biological, psychological, social, and environmental influences and dynamics. By comparison, MacDonald’s model is domain-specific. Its variables have been characterized as defining the content domain of spirituality as unique from other functional domains, and the model’s biological, social, and psychological components are construed as being embedded in the variables themselves. Last, VanderWeele’s model is inclusive of many broad domains of human functioning and well-being (e.g., social, religious, spiritual, physical, psychological, and financial/material), has been developed and refined through rigorous empirical and cross-cultural research, and incorporates religiousness and spirituality as key contributors to overall flourishing and well-being.

Conclusion

For the past few decades, shared interest in religiousness, spirituality, health, and well-being has been growing in both the positive psychology and psychology of religion and spirituality fields. Given the state of the science, it appears that both subdisciplines have a lot to gain through the formalization of a positive psychology of religion and spirituality (see Davis et al., Chap. 31, this volume). It is hoped that the theories and models discussed in this chapter aid in facilitating new developments in research, practice, policymaking, and public health.