RESEARCH ARTICLE Written prayers and religious coping in a paediatric hospital setting

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1 Mental Health, Religion & Culture Vol. 14, No. 5, June 2011, RESEARCH ARTICLE Written prayers and religious coping in a paediatric hospital setting Daniel H. Grossoehme a *, C. Jeffrey Jacobson b, Sian Cotton c, Judith R. Ragsdale d, Rhonda VanDyke e and Michael Seid f a Department of Pulmonary Medicine, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, USA; b Department of Anthropology, University of Cincinnati, 481 Braunstein Hall, PO Box , Cincinnati, USA; c Department of Family Medicine, University of Cincinnati, P.O.Box , Cincinnati, 45267, USA; d Department of Pastoral Care, Cincinnati Children s Hospital Medical Center, 3244 Burnet Avenue, MLC 5022, Cincinnati, USA; e Department of Biostatistics & Epidemiology, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, USA; f Department of Pulmonary Medicine and Health Policy & Clinical Effectiveness, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, USA (Received 22 May 2009; final version received 9 March 2010) Hospitalised children represent a threatened future to parents. Such stressors call forth people s coping styles. Some individuals cope religiously or spiritually, and religious coping through prayer may be utilised. A sample of prayers written in a paediatric hospital chapel was coded by styles of religious coping evident within them. Styles associated with coping to gain control of their situation and with coping by seeking comfort from God were present. Seeking to cope for gaining control of a situation was more common than seeking comfort from God during the event. Written prayers did not contain evidence of coping by making meaning. Regression analysis showed that the probability of writing a prayer to gain control decreased over time and a trend towards increasing probability of writing a prayer expressing coping by seeking God s comfort. Clinical implications are discussed. Future research should include a larger sample and cognitive interviews with prayer writers. Keywords: prayer; paediatric; religious coping Lord, please don t take N. yet, he has a full life. I want to watch him live. Please hold him and make his heart strong... God...I trusted and I waited just like you said. Now what? We were truly blessed to see him sit up and play with a toy yesterday... Thank you Lord, for staying with N. and answering all of our prayers. I am sorry I ever doubted you Introduction The hospitalisation of a child represents a threatened future and can be a crisis that calls forth people s coping skills. A large number of people draw on their religious or spiritual *Corresponding author. daniel.grossoehme@cchmc.org ISSN print/issn online ß 2011 Taylor & Francis DOI: /

2 424 D.H. Grossoehme et al. beliefs to cope with stressors. Religious coping is defined as people s ways of understanding and dealing with negative life events that are related to the sacred (Pargament & Raiya, 2007). While not employed by everyone, 42% 79% of individuals in various studies have reported using religious beliefs to cope with their illness (Harrison, Koenig, Hays, Eme-Akwari, & Pargament, 2001). Those religious beliefs arise out of a person s basic orienting system. In his model, Pargament assumes that people have an orienting system of beliefs, experiences and practices by which they live. A stressor triggers the primary and secondary appraisal, which in turn leads to actions or thoughts to remove or balance the stressor. In their secondary appraisal process, some individuals will turn to proximal religious variables, which include spirituality, sanctification of the body and religious coping. Pargament (1997) suggested that religious coping is probably more helpful to some people than others (and maybe more helpful to some religious groups than others) when people feel pushed beyond their normal capacities for coping. For example, Tix and Frazier (1998) found that while religious coping was associated with better adjustment following kidney transplant, it was more effective for Protestants than for Roman Catholic persons. Religious coping may also be affected by cultural factors. Studies have examined both religious coping and generic coping and found that religious coping is not functionally redundant with non-religious (generic) coping there are unique effects of religious coping, (Burker, Evon, Sedway, & Egan, 2005; Tix & Frazier, 1998). However, due to the primarily cross-sectional nature of studies to date, it is not usually possible to infer causality between religious coping and improved or worsened health outcomes (Pargament & Raiya, 2007). Religion is a multi-dimensional construct, and individuals seek multiple ends through their religion. Pargament described five ends of religion through which people seek to cope with their experience (Pargament, Koenig, & Perez, 2000). Religion offers means through which individuals can regain a sense of mastery or efficacy in the midst of chaotic events. Examples of religious coping for control include: a partnership with God to solve problems; actively surrendering control to God; passively waiting for God to control an outcome; pleading for God s direct intervention or seeking control entirely through one s own initiative without relying on God. Religion provides a means for experiencing comfort or intimacy with others through its social nature; at its most basic level religion is a means of seeking comfort or intimacy with the Divine. Styles of coping for comfort or intimacy with God include: searching for comfort or reassurance through God s care; engaging in religious activities to shift focus away from a stressor, searching for spiritual cleansing through religious actions; experiencing a sense of connectedness that transcends the individual; confusion or dissatisfaction with God s relationship to the individual; clearly distinguishing acceptable and non-acceptable religious behaviour within religious boundaries. Coping by seeking intimacy with other people and closeness to God can include attempts to provide spiritual support and comfort to others; seeking comfort or reassurance through the love and care of congregation members and clergy or expressing dissatisfaction with one s relationship with congregational members or clergy. Religious faith provides a framework and vocabulary for understanding and describing difficult or stressful experiences. Styles of religious coping by which one seeks to do this include the following: redefining the stressor through religion as benevolent and potentially beneficial; redefining the stressor as a punishment from God for one s sins; redefining the stressor as an act of the Devil or redefining God s power to influence a stressful situation. Religion may be a means of facilitating change in one s lifestyle, priorities and values. Examples of this end of religious coping include: looking to religion for help in shifting from anger, hurt and fear associated with an offence to peace or looking to religion for a radical life change.

3 Mental Health, Religion & Culture 425 Numerous studies have sought to determine a relationship between religious coping styles and health outcomes (e.g. Mickley, Pargament, Brant, & Hipp, 1998). A meta-analytic study by Ano and Vasconcelles (2005) of 49 studies supported the relationship between positive religious coping and positive psychological adjustment to stress. However, not all of the relationships between religious coping and health are positive. Negative religious coping was associated with a significantly greater risk of death in the next two years (controlling for other variables such as illness severity, mental health status and demography) of 176 elderly medical patients (Pargament, Koenig, Tarakeshwar, & Hahn, 2001). Negative religious coping also linked with poorer mental health outcomes (Exline, Yali, & Lobel, 1999; Fitchett, Rybarczyk, DeMarco, & Nicholas, 1999; McConnell, Pargament, Ellison, & Flannelly, 2006). One way in which some individuals cope religiously is by praying to a higher power, frequently divine. Prayer is known throughout nearly all cultures and peoples, and many claim positive effects. Research on coping strategies of caregivers of seriously ill children suggests that prayer may be particularly valuable for managing the distress associated with serious childhood illness. Studies of coping strategies of parents whose children have cystic fibrosis, sickle cell disease or autism spectrum disorders have reported the helpfulness of prayer in coping with their situations (Cotton et al., 2009; Grossoehme, Ragsdale, Wooldridge, Cotton, & Seid, 2010). Research on prayer is, however, problematic for two reasons. The first problem arises because there is no single definition to which everyone ascribes. Breslin and Lewis (2008) noted the lack of standardised definitions of what researchers consider prayer, as well as the lack of standardised measurement techniques across the various studies and which therefore make comparisons across studies difficult. Dein and Littlewood assert that William James definition of prayer is the best functional definition and it reads,...every kind of inward communion or conversation with the power recognized as divine... (Dein & Littlewood, 2008). At the other extreme, French sociologist Marcel Mauss defines prayer narrowly as a religious rite which is oral and bears directly on the sacred (2003). If researchers struggle with articulating how to define prayer, theologians have not offered a single clear answer, either. Barrett notes that little theological guidance is given by liberal Protestant churches to adherents about what constitutes prayer (Barrett, 2001). Researchers have not generally looked to religious institutions, who have traditional categories describing different types of prayer, but rather have developed theoretical or empirical categories (Poloma & Pendleton, 1989; Spilka, Ladd, McIntosh, & Milmoe, 1996). The second issue which makes the study of prayer problematic is the difficulty of obtaining objective data about what is done or said when someone prays. One way in which some researchers have sought to work with objective data is by studying prayers which have been written down, either in an experimental setting (VandeCreek, Janus, Pennebaker, & Binau, 2002) or a spontaneous one (Cadge & Daglian, 2008; Grossoehme, 1996; Hancocks & Lardner, 2007; O Reilly, 1994). Open-format prayer books are very commonly found in American hospital chapels and are an under-utilised means of studying the meaning and function of prayer because they offer objective data through their spontaneously written words. O Reilly focused on prayers which were spontaneously written in an open-format notebook placed in a hospital chapel (O Reilly, 1994). She suggested that at least one function of such prayer books was the creation of a sense of community among fellow-sufferers and the decrease of their sense of isolation. Another work examined actual prayer texts from a paediatric hospital chapel (Grossoehme, 1996). This descriptive study reported a majority of intercessory prayers and prayers of thanksgiving were addressed to God (rather than Jesus) and lacked specificity about

4 426 D.H. Grossoehme et al. the situation. A significant portion (24%) were addressed not to the Deity but other (future) readers of the prayer book. A study in Yorkshire, England (Hancocks & Lardner, 2007) reported generally similar results to Grossoehme s 1996 study. In their study, fewer prayers were addressed either to God or to Jesus. Hancocks and Lardner (2007) reported that the prayers in their study contained substantially fewer prayers of thanksgiving compared to those in Grossoehme s study. They reported a broadly similar finding of 18% of the British prayers being addressed not to God but to future readers of the prayer book (compared with the 24% noted above). Most recently, Cadge and Daglian (2008) examined prayers written in open notebook at Johns Hopkins University Hospital. They reported some similar findings: prayers were written primarily to thank God, make requests of God for one s self (petitionary prayer) or on behalf of another (intercessory prayer). A tendency to be more specific in the language used in prayers of petition than in prayers of thanksgiving was noted. The majority of prayers in that study imagined a God who is accessible, listening and a source of emotional and psychological support. This study also found that, rather than focus on discrete outcomes that could be verified, the writers tended to frame their prayers broadly, and in abstract psychological language, which allowed for multiple interpretations about the outcomes or efficacy of the prayer. Prayer can be an expression of religious coping (Pargament, 1997) yet there are no studies of prayer in terms of religious coping. Our goal is to understand the meaning and function of prayer in order to guide clinicians in facilitating the use of this religious resource by persons experiencing significant health events. The objective of this study is to understand how prayer functions as part of a person s religious coping during the stress of a child s hospitalisation. We hypothesise that (1) people use prayer to cope primarily to make meaning, gain comfort or intimacy with God or gain control over their situation and (2) to determine if use of prayer to cope religiously changes over the course of a child s hospitalisation. This study will contribute to understanding prayer as a religious coping style and may suggest possible clinically relevant interventions. This study had the following specific aims: (1) document if written prayers in a hospital chapel notebook are most frequently expressions of seeking to control their situation, to seek comfort or intimacy with God, or to make meaning and (2) determine if styles of religious coping through written prayers change over the period of a child s hospitalisation. Methods Prayer texts For this study, the Institutional Review Board of the paediatric hospital approved the study design and determined that ongoing IRB oversight was unnecessary due to the public nature of the prayer notebook in the hospital chapel. Prayers from a six-month period were collected, which were then transcribed, with all identifying information removed. To ensure that a sufficient amount of text to make reliable judgments about what coping styles were evident, series of prayers written by a single individual over a period of time were selected for analysis, resulting in a total of 237 prayers written by 58 individuals. The mean number of days between a writer s first and final prayer was 33 days (SD ¼ 47; range days). Coding procedures Coding was done by at least two of four doctoral-level investigators with experience in religious coping research and coding qualitative data. We created a codebook using the

5 Mental Health, Religion & Culture 427 definitions and example statements developed by Pargament (Pargament et al., 2000), to which prayer statements were compared. If they were judged consensually by the coders to be consistent with either of the definition, they were coded to that religious coping style. Some prayers showed evidence of more than one style, in which case all styles were coded. Analytic methods The probability that a subject exhibited a particular typology was modelled using a marginal logistic regression. Robust parameter estimates were obtained using generalised estimating equations. An exchangeable correlation structure was specified to account for repeated measures. Deviance and Pearson statistics were used to assess goodness of fit. To examine how subjects transitioned from one typology to another, frequency tables were calculated counting the number of times each pair of typologies were observed in successive prayers. Markov Models were not constructed due to the small counts for some of the typologies. Results Multiple forms of religious coping were evident in this sample of prayers, and even evident in the course of writing a single prayer. Of the five ends of religious coping identified by Pargament et al. (2000), there were no prayers of coping by personal transformation. The remaining three categories were represented by a variety of prayers, as show in Table 1. Qualitative analyses Coping to make meaning An example of a prayer used to cope by making meaning is the following: Please Dear Lord, heal my beautiful little boy. Please clear his entire body of all infection...please let him live through all of this so that we may be witnesses of the good works of God... This benevolent religious reappraisal finds meaning in the potential this parent and child have of becoming witnesses of the good works of God. Another mother wrote, Thank you Father, in Jesus name, for loaning me Emmylou to love and learn by. The disease she has has made me strong. I learned to love and trust... Coping to gain control Some writers of prayers deferred all control of the situation to God, as in the following, Please Lord, heal Ashton s lungs and his heart. Please heal all of Ashton. Please let his surgery go very well today. Thank you for easing his withdrawal a little. Amen. In some cases writers recognised that some events were beyond their control and actively surrendered control to God: I place N. in your hands, Lord. Please take care of him and correct this new problem. In Jesus name I ask. Amen. A mother wrote the following prayer in the book in which she outlined her collaboration with God: Lord, Please, please help N. It is so hard to see her in such pain. I pray you can help her see the hope she needs to recover. Give all those working with her the skill and compassion...i pray for continued strength for all of us. Please help us find the best treatment and help it to be

6 428 D.H. Grossoehme et al. Table 1. Religious coping styles demonstrated in paediatric hospital prayer book. Religious coping style Frequency Gain control Collaborative 50 Deferring 182 Active surrender 29 Pleading 213 Gain comfort or closeness to God Spiritual connection 17 Spiritual discontent 1 Seeking spiritual support 23 Religious purification 9 Meaning-making Benevolent religious Reappraisal 4 Demonic reappraisal 4 Reappraisal of God s power 10 successful...please give this beautiful, sweet young lady a good, long, happy life. I will do all I can - please help me to make the best choices even when they re hard... Prayers in which writers pleaded for God to intervene or provide a miracle were the most common. One example is: Lord I know you are doing everything that you can for our little N. Please Lord keep her in your arms. She will be your miracle child. Just please heal my baby. Thank you Lord for your ear. One writer pleaded for a miracle even while standing metaphorically toe to toe with God: We waited almost 40 days for you to part the waters God. It has to happen now or we have no hope. I trusted and I waited just like you said. Now what? Coping for comfort or intimacy with God One means of coping by seeking comfort and closeness with God is through religious purification. There were two prayers of confession, one of which is, I would like to say I m sorry to the Lord and ask for forgiveness in taking his name in vain for all those I have offended I am truly sorry... An example of religious coping by seeking spiritual support is, Lord, thank you so much for being there for me... Some writers sought spiritual support, as in the following example,...i pray someone understanding who she can relate to is there for her tonight. Please help us all to be strong. Give us guidance...please continue to guide her and all those helping her so she can fully recover. Please help us make the right care decisions. There are tough choices to make, but I pray she ll continue to improve... Quantitative analyses Logistic regression analysis of this sample of prayers showed that styles of religious coping did change somewhat over the course of time as individuals wrote their prayers. The probability model for writing prayers expressing religious coping styles to gain control of a situation resulted in an estimated correlation between prayers was Deviance and Chi-Square values were close to one ( and , respectively), indicating sufficient model fit to the data. Intercept and slope estimates were significantly different from zero

7 Mental Health, Religion & Culture 429 ( p and p ¼ , respectively). Corresponding estimates (SE) were (0.2507) and (0.0022). The model suggested that subjects became less likely to express religious coping styles to gain control in their prayers as time since the first prayer increased. Modelling the probability of writing prayers that contained statements of religious coping styles to gain comfort produced an estimated correlation between prayers was Respective deviance and Chi-Square values were and The intercept estimate was significantly different from zero (estimate: ; SE: ; p ); the slope estimate was positive and had a trend towards statistical significance (estimate: ; SE: ; p ¼ ). Although this result did not achieve statistical significance, we believe that it would become significant with a larger sample size (due to the confidence limits). Discussion This mixed-methods study presents data on the prevalence of religious coping styles evident in a sample of written prayers from a paediatric hospital chapel. The prayers in this study suggest that writing prayers serves as a means of religious coping to gain control. In particular, they seem to express most frequently religious coping styles of Deferral and Pleading. This may be a manifestation of the inverse relationship between coping by prayer and feelings of personal mastery (Ellison & Taylor, 1996). If so, then those who wrote prayers the most were those who had limited sense of personal mastery over their situation and deferred the ability to act to God (or pleaded with God to act in a situation in which they felt powerless). Although the person has delegated problem-solving to the Almighty, the person has not given up, and retains the ability to address and attempt to sway God towards a desired outcome. Pargament himself argues that Deferral may be one of the most empowering choices one can make when person control is impossible (Pargament, 1997). Deferral is not necessarily a passive form of coping, although some categorise it in that way (Baenziger, VanUden, & Janssen, 2008). This form of coping has, with one exception noted by Pargament, been associated with positive health outcomes. The very format of the open prayer book in the Chapel may appeal primarily to those who cope by pleading their case, or deferring problem-solving to God. People who cope-to-gain-control by other means (e.g. self-directed, active surrender or collaborative styles) may enact those coping skills in the Chapel (or elsewhere) without using the book as a means of expression. The floor plan of the Hospital is such that that the act of going to the Chapel itself was an act of seeking spiritual support and connection. The Chapel of the Holy Child is located on the ground floor of one of the two main inpatient buildings (one of seven inpatient, outpatient, clinic and office buildings on campus), accessed through two wooden doors and at the end of the a lengthy hallway. In other words, some effort is required to search out and travel to the Chapel, locate it and go all the way inside. In that sense each of the prayers could have been coded for either or both spiritual connection, (defined as experiencing a sense of connectedness with forces that transcend ) or seeking spiritual support (defined as searching for comfort and reassurance through God s love and care ). Although we chose to code only when there was an explicit text expressing that search, we believe it is implicitly present in each of the prayer text writers. They were driven by some need to search out, connect with and communicate with God, and in some cases, with other people.

8 430 D.H. Grossoehme et al. The low occurrence of the various types of religious coping by reappraisal (reappraising God as punishing; redefining the stressor as beneficial or positive; redefining the stressor as the work of the Devil; redefining God s power) is interesting. Coping by reappraisal might have created a sense of increased comfort for the individual. Given that the prayers analysed were series of multiple prayers written over a six-month period of time, it is unlikely that whatever event led to them to pray remained so critical that they did not have time to develop a sense of perspective and reappraise their situation. Reappraisals involving attributions to punishing God or the work of the Devil may come readily to members of some Christian traditions. For others, such attributions may be very difficult or impossible for them to make theologically (e.g. understanding what God s will or power might mean if it appears not to be used to cure the child). It may also be that reappraisals occur in the context of dialogue, and that written prayers, which are essentially short monologues, are not conducive to facilitating the reappraising an event. The results indicate that there is a subtle shift in how religious coping as evident in written prayers changes over the course of a child s hospitalisation. If people expressed religious coping to gain control over the situation in their first prayer, they were likely to continue to do so. However, they became less likely to express control in their prayers as the time since the first prayer increased. As time since the first prayer increased they were more likely to cope religiously by seeking comfort from God. It appears that people use religious coping to achieve different ends at different times. In the beginning it appears that gaining control of a situation is important, and once some measure of control has been achieved, seeking to gain comfort from God becomes an increasingly common goal. Perhaps their first spiritual need is to determine what the shape of their experience in the Hospital is and then they seek to be comforted by God while they move through their experience. The low frequency of written prayers to cope by making meaning could suggest that making meaning is not perceived by the writers as being needful early in their hospital experience. Clinicians would likely provide more beneficial assistance early in a child s hospitalisation if interventions that sought to help persons use their religious beliefs and practices to gain control of the situation were employed and transitioning to helping people seek and experience divine comfort only later. How and when that transition is made is part of what is meant by the art of the healing professions. It is important to take into account where a person is on any given day, as change is possible. While this is intuitively understood by many clinicians, it bears proactive attention in some form of assessment at each clinical encounter. This study has several limitations to bear in mind. Our sample of prayers is relatively small to perform well-powered quantitative analyses. As noted above, it is impossible to determine motivation or causality for these prayers, as they were collected up to six months after being written and because there was no means of interviewing the prayers (even if that could be done without influencing the content of their prayers). Thus, we can offer a description of what is written and how they appear to function, but cannot infer a mechanism concerning the use of written prayer. As noted in Methods, this study is based upon sets of multiple prayers by a number of authors. There could, however, be a qualitative difference between the single-prayer writers and the multiple-prayer writers. Perhaps those who write only one time are employing different religious coping styles. Our descriptions and tentative conclusions apply only to those who had both the time and made the effort to write multiple times. On the surface, having the time to write multiple prayers suggests longer lengths-of-stay in the Hospital, which implies chronic diseases rather than acute illnesses, even though children tend to become acutely ill more often

9 Mental Health, Religion & Culture 431 than chronically. This may be means of biasing the sample towards those who face a particular kind of situation a child s chronic illness and may not necessarily apply to anyone writing in such a prayer book. All of these suggest the need for further research on the actual content of prayers. In particular, potential differences between prayers written in paediatric and adult hospitals bear further investigation. Nevertheless, important conclusions can be drawn. As noted by Ano and Vasconcelles (Baenziger et al., 2008), these prayers reveal religious coping styles, some of which may be red flags that suggest the need for further attention, and we suggest that healthcare professionals consider using them in this way, and develop relationships with professional healthcare chaplains or other such professionals with the expertise to probe the issue more deeply with an individual. When a healthcare professional assesses that an individual copes religiously by writing, they may take the open-format notebook concept a step further and suggest that individuals write prayers rather than merely say them in one s mind. A related clinical implication for healthcare professionals is the apparent focus upon coping to control a situation, leading to interventions aiming to empower persons. A conservative use of reappraisal through prayer may also be in order. The change over time of religious coping styles also suggests that this construct is malleable and that it may be feasible to intervene in such a way as to promote helpful forms of religious coping and or to ameliorate the red flag styles of religious coping. References Ano, G.G., & Vasconcelles, E.B. (2005). Religious coping and adjustment to psychological distress. Journal of Clinical Psychology, 61, Baenziger, S., VanUden, M., & Janssen, J. (2008). Prayer and coping: The relation between variables of praying and religious coping styles. Mental Health, Religion & Culture, 11(1), Barrett, J.A. (2001). How ordinary cognition informs petitionary prayer. Journal of Cognition and Culture, 1(3), Breslin, M.J., & Lewis, C.A. (2008). Theoretical models of the nature of prayer and health: A review. Mental Health, Religion & Culture, 11(1), Burker, E.J., Evon, D.M., Sedway, J.A., & Egan, T. (2005). Religious and non-religious coping in lung transplant candidates: Does adding God to the picture tell us more? Journal of Behavioral Medicine, 28(6), Cadge, W., & Daglian, M. (2008). Blessings, strength, guidance: Prayer frames in a hospital prayer book. Poetics, 36, Cotton, S., Grossoehme, D., Rosenthal, S.L., McGrady, M.E., Roberts, Y.H., Hines, J., et al. (2009). Religious/spiritual coping in adolescents with sickle cell disease: A pilot study. Journal of Pediatric Hematology Oncology, 31(5), Dein, S., & Littlewood, R. (2008). The psychology of prayer and the development of the Prayer Experience Questionnaire. Mental Health, Religion & Culture, 11(1), Ellison, C.G., & Taylor, R.G. (1996). Turning to prayer: Social and situational antecedants of religious coping among African-Americans. Review of Religious Research, 38(2), Exline, J.J., Yali, A.M., & Lobel, M. (1999). When God disappoints. Journal of Health Psychology, 4(3), 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), Grossoehme, D.H. (1996). Prayer reveals belief: Images of God from hospital prayers. Journal of Pastoral Care, 50(1),

10 432 D.H. Grossoehme et al. Grossoehme, D.H., Ragsdale, J., Wooldridge, J.L., Cotton, S., & Seid, M. (2010). We can handle this: Parents use of religion in the first year following their child s diagnosis with cystic fibrosis. Journal of Health Care Chaplaincy, in press. Hancocks, G., & Lardner, M. (2007). I ll say a little prayer for you: What do hospital prayers reveal about people s perceptions of God? Journal of Health Care Chaplaincy, 8, Harrison, M.O., Koenig, H.G., Hays, J.C., Eme-Akwari, A.G., & Pargament, K.I. (2001). The epidemiology of religious coping: A review of recent literature. International Review of Psychiatry, 13(2), Mauss, M. (2003). On prayer. New York: Durkheim Press. McConnell, K.M., Pargament, K.I., Ellison, C.G., & Flannelly, K.J. (2006). Examining the links between spiritual struggles and symptoms of psychopathology in a national sample. Journal of Clinical Psychology, 62(12), Mickley, J.R., Pargament, K.I., Brant, C.R., & Hipp, K.M. (1998). God and the search for meaning among hospice caregivers. Hospital Journal, 13(4), O Reilly, J. (1994). A community of strangers: Finding solidarity through prayer request journals. The Caregiver Journal, 11(2), Pargament, K.I. (1997). The psychology of religious coping. New York: The Guilford Press. Pargament, K.I., Koenig, H.G., & Perez, L.M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), Pargament, K.I., Koenig, H.G., Tarakeshwar, N., & Hahn, J. (2001). Religious struggle as a predictor of mortality among medically ill elderly patients: A 2-year longitudinal study. Archives of Internal Medicine, 161(15), Pargament, K.I., & Raiya, H.A. (2007). A decade of research on the psychology of religion and coping. Psyke & Logos, 28, Poloma, M.M., & Pendleton, B.F. (1989). Exploring types of prayer and quality of life: A research note. Review of Religious Research, 31(1), Spilka, B., Ladd, K.L., McIntosh, D.N., & Milmoe, S. (1996). The content of religious experience: The roles of expectancy and desirability. International Journal for the Psychology of Religion, 6(2), Tix, A.P., & Frazier, P.A. (1998). The use of religious coping during stressful life events: Main effects, moderation, and mediation. Journal of Consulting and Clinical Psychology, 66(2), VandeCreek, L., Janus, M.-D., Pennebaker, J.W., & Binau, B. (2002). Praying about difficult experiences as self-disclosure to God. International Journal for the Psychology of Religion, 12(1),

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