The Assessment of Spirituality and Religious Sentiments (ASPIRES) scale: Its value for Research and Practice Ralph L. Piedmont, Ph.D. Loyola University Maryland April 11, 2016 A New Approach That will allow you to: 1. 2. 3. Make inferences about patients regardless of your role Make interventions tailored to patients needs
Use an empirically sound approach that supports research Why Do We Study Spirituality? 1. 2. 3. It relates to so many important medical outcomes, such as response to treatment, general health, quality of life It serves as a protective factor for illnesses both physical and psychiatric It is a very salient issue in any health crisis situation, such as: Palliative Care
Cancer Treatment Any end-of-life or life threatening situation Conceptualizing Spirituality 1. There are 3 ways to understand spirituality from a scientific perspective: 2. 3. Demographically Spiritual Screener Culturally Spiritual History
Organismically -- Spiritual Assessment It is this last approach that will be the focus of this talk Spirituality and Religiousness as basic motivational qualities of the person Current Status of Numinous Assessment 1. 2. No consensual definition of constructs Numerous technical issues in need of attention: a. b. c. e.
Controlling for acquiescence No observer rating forms: no control for solipsism In health care, most measures are interview-based (e.g., FICA and SPIRIT), mostly descriptive in nature Many measures lack normative information A New Approach to Scale Development Rational (theoretical) approaches have not been successful in defining the numinous, Perhaps an empirical approach would be better a. b.
c. d. See the numinous as a psychological variable A universal motivational source A nondenominational, non-theological construct Use the FFM as the empirical scaffolding for developing the construct. What is the Five-Factor Model of Personality? A comprehensive, taxonomic model of individual difference traits traditionally assumed as personality
Developed out of the English lexicon, it represents adaptively significant qualities of people Dimensions found to be genetically heritable, structurally stable, predictively valuable, and cross-culturally valid Dimensions are: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness What is the Five-Factor Model of Personality? Perhaps the most important aspect of this model is that it represents a taxonomy of personality traits The value of a taxonomy is that it allows one to classify things, and the location of an object tells you much about what that object is and how it should relate to other objects The FFM is to a psychometrist what latitude and longitude are to a cartographer: a way to organize and
understand information N e W Anxiety Mysticism O Ex hi bi
ti on E ng i e B ll Com pas sion A
SelfDiscipline C Personalis In Cognita Ch ar ac te r Five Empirical Criteria for Establishing the Construct Validity of a Numinous Scale
5 Empirical Criteria 1. 2. 3. 4. 5. Numinous construct should be INDEPENDENT of the Five Factor Model (FFM) Have comparable generality as existing five and be sufficiently broad to encompass multiple facets Be recoverable across information sources (e.g., cross-observer validity) Evidence incremental validity over FFM in predicting important outcomes Demonstrate cross-faith, cross-cultural generalizability 5 Empirical Criteria
1. 2. 3. By meeting these criteria a numinous scale would present itself as an empirically useful scale. The content of the scale, having shown relationships to both psychosocial and spiritual/religious criteria, would provide an empirical operationalization of what the numinous is, and what it is NOT. Such a construct would be able to move from mere description to a more inferential perspective ASPIRES Development 1. Roundtable Experience
a. b. c. d. e. Diverse religious traditions What do all faiths call people to? Identified relevant dimensions (e.g., both/and thinking, tolerance of contradictions) Wrote items to reflect these universal qualities Applied the empirical approach noted above ASPIRES Development 2. Identified a single dimension labeled, Spiritual Transcendence Defined as, A motivational drive to create a broad sense of personal meaning within an eschatological context; it represents a
capacity to understand ones life within a broader sense that goes beyond a persons immediate sense of time and place. ASPIRES Development 3. This single dimension was found to be multi-faceted, having 3 subdimensions: Prayer Fulfillment: the ability to create a personal space that enables one to feel a positive connection to a larger transcendent reality Universality: the belief in a larger meaning and purpose to life; that life is unfolding in a coherent, logical process; that there is an inherent connection among all living creatures Connectedness: feelings of belonging to and responsibility for a larger human social reality that cuts across generations and groups ASPIRES Development 4. Later work, building on findings from the research literature, added two new dimensions: a. Religious Involvement: how actively involved a person is in
performing various religious rituals and activities b. Religious Crisis: the extent to which a person may be experiencing problems, difficulties of conflicts their God and/or faith community Overview of ASPIRES Long form contains 35 items (short form 12) Cover sheet asks for Demographics Second page, items 1 8 Religious Involvement; items 9 -12 Religious Crisis Third page contains the 23 Spiritual Transcendence items Overview of ASPIRES There is an Excel scoring program available for the ASPIRES Entering the information in the provided spreadsheet, will generate a 4 page report Scores are normed on age and gender
Creates T-scores where M = 50 and S = 10 Allows one to understand the expectancies and motivations of the patient ASPIRES Development 5. These dimensions have been found to be independent of the domains of the FFM, across faith groups, cultures, and languages Has been recovered in a variety of cultures and languages (e.g., Korean, Tagalog, Spanish, Czech, Hungarian, Polish, Chinese) ASPIRES Development 6. Also developed was a rater version of the scale, which has also been shown to be reliable and valid a. correlations between self and observer ratings provides strong evidence of consensual validity to the qualities being
assessed by the scale ASPIRES Development 7. These dimensions have also been shown to evidence significant incremental validity in predicting a wide range of psychosocial criteria, and these findings have been replicated across faith groups, cultures, and languages ASPIRES Development 8. Important Interpretive Features include: ASPIRES scale is valid for use with individuals across the spectrum of religious faiths, including those without any religious commitments Normative data that controls for age and gender, creates an interpretive
context for understanding scores A causal influence on psychological functioning Case Example Robert D. is a 26 yr old White male. Indicates that he is an atheist/agnostic. Diagnosed with non-Hodgkins lymphoma in 2009. In July, 2011, received an auto transplant, then April, 2012 received an allo transplant, which created many complications. Completed ASPIRES in May, 2012 while in Intermediate Care Unit experiencing severe liver and kidney complications. He was also assessed independently by a clinical social worker. T-Scores 80 70
60 50 40 30 20 ASPIRES T-Score Profile Social Worker Ratings Very Little
Some Much Very Much
None Overall, how much pain has the patient experienced in the previous 24 hours? Overall, how much physical discomfort has the patient experienced within the past 24 hours? In the past 24 hours, how much contact has the patient had with family? Rate the overall quality of care patient has received in past 24 hours Rate the overall quality of patients current life experiences Rate the overall quality of the patients
life Rate the overall quality of patients relationship with God Rate the overall quality of patients relationship with his/her family Very High High Neutral Low Very Low
T-Scores 80 70 60 50 40 30 20 ASPIRES T-Score Profile
Case Example Bobby T. is a 42 year old Caucasian male, alcoholic. While he has been in and out of treatment for many years, currently he has been consistently involved in AA for approximately 8 months. Currently he is unmarried and has been living in a rescue mission for men, where he is involved in a Christian-based treatment for addiction. ASPIRES T-Score Profile T-Scores 80 70 60
50 40 30 20 Medical Use of the ASPIRES Quick and easy to give Patients easily accept completing it; although can also be given to knowledgeable informant Inclusive, appropriate for all populations Different aspects to spirituality that one needs to consider when responding to patients Surplus meaning of scores
Obtained scores can be used in research examining role of spirituality Questions - Contact me at: [email protected] Th an k
