Research and Theory

Religion and Spirituality in Coping

With Stress
Stephanie Graham, Susan Furr, Claudia Flowers, and
Mary Thomas Burke
Relations among and between religion, spirituality, and the ability to cope
with stress were examined using a sample of 1 15 graduate students in coun-
seling. Religion and spirituality positively correlatedwith coping with stress.
Counselingstudents who expressedspirituality through religious beliefs had
greater spiritual health and immunity to stressful situations than counseling
students who identified themselves as spiritual but not religious. Counsel-
ing students with a religious/spiritual affiliationindicated more discomfort
counseling clients hostile to religion compared with counseling students
with a spiritual-only affiliation.The results have implications for preparing
counseling students to work with clients with religious/spiritual issues.

I ndividuals striving to understand the meaning of and purpose for their

struggles often look for guidance in the spiritual or religious realms. For
example, most Americans have a religious faith, and many individuals
rely on their religious faith to cope with their problems (Worthington, 1989).
It is estimated that more than 90% of indwiduals living in the United States have
a belief in God (Kroll& Sheehan, 1989).On the basis of these statistics, counseling
professionals are Uely to come in contact with clients who bring their religious
faith or spirituality or both, into the counseling session.
The differences between religion and spirituality need to be distinguished.
Although some individuals express their spirituality through their religious faith,
others do not. Religion generally refers to an integrated set of beliefs and activities
(Corbett, 1990) whereas spirituality is seen as the meaning gained from life
experiences (May, 1982),which may or may not be theistic in nature (Richards &
Bergin, 1997; Shafranske& Gorsuch, 1984).Abelief in God can be integrated with
meaningful life experiences, but individuals without a belief in God or a higher
power can also have spiritual and meaningful experiences in life (Stoll, 1989).
~ ~~ ~

Stephanie Graham is the human services coordinator for the Catawba Community Mental Health
Center in Rock Hill, South Carolina. Susan Furr is an assistant professor, and Mary Thomas Burke
is a professor, both in the Department of Counseling, Special Education, and Child Development at
the University of North Carolina at Charlotte. Claudia Flowers i s an associate professor in the De-
partment of Educational Administration, Research, and Technology, also at the University of North
Carolina at Charlotte. Correspondence regarding this article should be sent to Susan Furr, CSPC,
University of North Carolina at Charlotte, Charlotte, NC 28223 (e-mail: srfurr@email.uncc.edu).

2 Counseling and Values rn October 2001 rn Volume 46

 Religion has been seen as providing resources for coping with situations that
are perceived as harmful or threatening by affecting how individuals assess
their situations and their ability to cope (Pargament, 1990).Spilka, Shaver, and
Kirkpatrick (1985) defined three roles that religion serves in the coping pro-
cess: (a) It offers meaning to life, (b) it provides the individual with a greater
sense of control over his or her situations, and (c) it builds self-esteem. For
many individuals, religious institutions serve the purpose of providing mem-
bers with a sense of community and family, particularly for members who have
moved away from their families (Pargament, 1990).Religion may also provide
a sense of identity because religion offers a set of beliefs, rituals, symbols, and
traditions that define various aspects of the individual (Hammond, 1988).
Studies show that religion plays an important role in coping with stress. Prayer
and faith in God have been cited as two of the most common coping resources
(Belavich,1995).Other coping resources include guidance from clergy and talking
to God in prayer about how to deal with a particular stressful situation (Belavich,
1995).Hathaway and Pargament (1992)reported that when faced with a problem,
religious individuals use a variety of religious coping resources that are drawn
from spiritual, cognitive, behavioral, and social aspects of an individual‘s faith.
Individuals who have a positive spiritualidentity feel connected to God’s love,
feel self-worth, have meaning and purpose in life, and are better able to fulfill
their greatest potential (Richards & B e r p , 1997). In contrast, individuals who
do not have a positive spiritual identity do not feel God’s love in their life and
lack purpose and meaning to life (Bergin et al., 1994; Richards & Potts, 1995).
Research of the authorsjust cited led them to believe that having a positive spiri-
tual identityis necessary for healthy developmentand life functioning. Individuals
with a positive spiritual identity cope more efficiently on an interpersonal,emo-
tional, and spirituallevel. Evidence shows that religious individualswho receive
support for their sense of worth and spiritual identity heal at a faster rate and are
able to establish healthier lifestyles (Bergin et al., 1994; Richards & Potts, 1995).
According to a survey of counselors affiliated with the American Counsel-
ing Association, counselors viewed religion and spirituality as important
components of mental health. The survey showed that 64% had a belief in
God and that 70% were involved in a religious organization. The majority of
the respondents stated that the spirituality behind their religious beliefs
was valued more highly than the religious beliefs themselves (Kelly, 1995).
Only recently has spirituality received increased attention in the counsel-
ing field as an important component in the counseling relationship and in
counselor training programs (Ingersoll, 1994).For many mental health pro-
fessionals, the work setting may influence how a counselor responds to the
religious/spiritual dimensions of a client (Worthington & Scott, 1983).Most
counseling occurs in secular settings, such as colleges, universities, private
practices, and human service agencies. Because religion and spirituality are
not the main themes in these various settings, counselors may be reluctant
to address these issues with the client (Kelly, 1994; Sansone, Khatain, &
Rodenhauser, 1990;Shafranske & Malony, 1990).However, the spiritual aspect

Counseling and Values October 2001 = Volume 46 3

of a client should be addressed in the counseling process when appropriate
(Chandler & Holden, 1992).
Counselor educators recognize the importance of addressing religion and
spirituality in their courses (Kelly, 1994; Pate & Bondi, 1992); however,
few educators have incorporated this in the counseling curricula (Burke et al.,
1999).For example, Kelly (1994)conducted a surveyof 341 accredited and nonac-
credited counseling programs and found that only 25% of these programs
reported including religion and spirituality as part of their course curricula. Pate
and High (1995) conducted a survey of 60 programs accredited by the Council
for Accreditation of Counseling and Related Educational Programs (CACREP)
and found that 60% reported having a religious/spiritual component in their
counseling curricula in the Social and Cultural Foundations area of CACREP.
The results of these surveys seem to suggest that a sigruficantnumber of counsel-
ing curricula are not preparing counselors in the religious/spiritual dimensions
of counseling. Given thisinformation, counseling students may not be receiving
the knowledge and training needed to counsel clients who bring religious/
spiritual issues into the counseling relationship.
We examined three questions in this study. First, does the religious/spiritual
affiliation of counseling students influence their comfort level regarding coun-
selingclients with religious/spiritual issues?Second, does the religious or spiritual
affiliation of counseling students influence their own spiritual health and their
own level of coping with stress? Third, is there a relationship between the
spiritual health of counseling students and their level of coping with stress?

Method
Sample
The sample consisted of students enrolled in counseling classes from a 60-
hour, CACREP-accreditedmaster’s level counseling program at a large south-
eastern university. Questionnaires were distributed to 148 students with
115 responses resulting in a 78% response rate. Questionnaires were collected
within a 4-week period. The mean age of the participants was 31.9 years ( S D =
8.92), ranging from 22 to 60 years of age. The group of participants consisted of
77.4% women and 17.4%men; 73.9% were Caucasian, 13%African American,
3.5%Asian, and 3.5% represented other ethnic/racial backgrounds, including
Native American and biracial. Of the students, 28% were enrolled in a practicum
or internship course. The number of hours that participants had completed in
the counseling program prior to the semester when this study was conducted
ranged from 0 to 60 hours, with a mean of 16.1hours ( S D = 19.1).
Instruments
Spiritualitywas measured using the SpiritualityHealth Inventory (SHI; Veach
& Chappel, 1992)and the Religious/Spiritual Affiliation Self-Report (Koenig,
1999).The SHI is an 18-item inventory, developed by Veach and Chappel,

4 Counseling and Values rn October 2001 MVolume 46

designed to measure spiritual health. In an examination of the validity and
reliability of scores from the SHI, the relationships between the SHI and other
measures of well-being ranged from r = -.02 to .42. The reliability coefficient,
as measured by coefficient alpha, ranged from 0.49 to 0.90.
The Religious/Spiritual Affiliation Self-Report identifies a list of five
categories that describe an individual’s religious/spiritual affiliation:

1. I express my spirituality through my religious beliefs.

2. I consider myself to be a spiritual person but I do not have a set of
religious beliefs.
3. I am a religious person but I do not consider myself to be a spiritual
person.
4. I am neither a religious or spiritual person.
5. I do not know what my beliefs are regarding religion and spirituality.

The Religious/Spiritual Affiliation Self-Report is based on a scale that identifies

four categories that individuals generally fall into: (a) spiritual but not religious,
(b)religious but not spiritual, (c) both religious and spiritual, and (d) neither
religious nor spiritual (Koenig, 1999). The fifth category of the Religious/
Spiritual Affiliation Self-Report (I do not know what my beliefs are regarding
religion and spirituality)has been added for the purposes of this study.
The Preventive Coping Resources Inventory (Lambert, McCarthy, Beard,
& Carr, 2000) consists of 25 items and measures the available resources for
coping with stress. Internal consistency estimates were found for the four
factors that emerged from this analysis: self-confidence,37; acceptance, .74;
social comfort, .77, and perceived control, .84 (Lambert et al., 2000).
The Combative Coping Appraisal Inventory consists of 25 items that
measure combative coping appraisals of resources that can be used when
encountering a stressful situation. Combative coping appraisals are the ac-
tion or behavior the individual considers for use to combat the stressful
situation. The coping scales are based on the Coping Resources Inventory
for Stress (Matheny, Curlette, Aycock, Pugh, & Taylor, 1987). Research has
shown coping appraisals to be an important area to evaluate for predicting
how an individual emotionally reacts to stressful situations (McCarthy,
Lambert, & Brack, 1997).
The Comfort Level Self-Report (Kelly, 1995) provides a list of vignettes
describing “categories” of religious/spiritual clients whom counseling stu-
dents may encounter in a counseling session and addresses the comfort level
of counseling students. This self-report is based on a rating scale from 1
(very uncomfortable) to 5 (comfortable) and includes eight vignettes. The eight
vignettes describe the following individuals: (a) religiously committed client,
(b) religiously loyal client, (c) spiritually committed client, (d) spiritually/
religiously open client, (e)externally religious client, (f) spiritually/religiously
tolerant or indifferent client, (g) nonspiritual/nonreligiousclient, and (h) cli-
ent hostile to religion. This self-reportis based on eight categories of religious

Counseling and Values rn October 2001 rn Volume 46 5

and spiritual individuals (Kelly, 1995). No reliability data are available for
this measure.

Results
On the Comfort Level Self-Report, counseling students rated their comfort
in working with eight religious/spiritual types of clients. The means, stan-
dard deviations, and sample sizes for the eight vignettes are reported in
Table 1. The students reported being the most comfortable with clients who
were (a) spiritually committed (M = 4.20), (b) externally religious (M = 4.13),
(c) spiritually/religiously open (M = 4.12), and (d) spiritually/religiously
tolerant or indifferent (M = 4.08). The students were the least comfortable
with clients who were (a) nonspiritual/nonreligious (M = 3.39) and (b) hos-
tile to religion (M = 3.47).
On the Religious/Spiritual Affiliation Self-Report, 60.9%of the students
indicated that they expressed their spirituality through a religious belief,
and 33.9%expressed being spiritual but with no set of religious beliefs. Only
2.7% (3 students) indicated that they consider themselves as religious but
not spiritual, and 0.9% (1 student) indicated that he or she was neither
religious nor spiritual. None of the participants indicated that they were
unaware of their beliefs about religion and spirituality.
A series of t tests were performed to examine the differences on the com-
fort level between counseling students who expressed their spirituality
through a religious belief and those students who were spiritual without a
set of religious beliefs. The results of the t tests are reported in Table 2.
Counseling students with a religious and spiritual affiliation had a signifi-
cantly lower degree of comfort about counseling clients who were hostile to
religion compared with counseling students who were spiritual but with no
set of religious beliefs (f = 2.63, p < .01).
T tests were used to examine the differences between counseling students
who expressed their spirituality through their religious beliefs (70 students)
TABLE 1

Comfort Level of Counseling Students With Type of

Spiritual/Religious Clients

Type of Client M SD N

Religiously committed client 3.88 1.44 115

Religiously loyal client 3.93 1.35 114
Spiritually committed client 4.20 1.30 114
Spiritually/religiously open client 4.12 1.36 113
Externally religious client 4.13 1.26 112
Spirituallyheligiously tolerant or indifferent client 4.08 1.26 113
Nonspiritualhonreligious client 3.39 1.36 112
Client hostile to religion 3.47 1.41 113

6 Counseling and Values m October 2001 mVolume 46

 TABLE 2

Differences Between Religious/Spiritual Affiliation of Counseling

Students and Comfort Level of Religious/Spiritual Clients

ReligiouslSpiritual Spirltual-Only
Students Students
Type of Client M SD M SD Effect Size

Religiously committed client 4.03 1.45 3.72 1.36

Religiously loyal client 3.99 1.46 3.90 1.21
Spiritually committed client 4.04 1.40 4.41 1.14
Spiritually/religiously open client 3.93 1.53 4.36 1.04
Externally religious client 4.00 1.35 4.33 1.15
Spiritually/religiously tolerant or
indifferent client 3.94 1.36 4.34 1.10
Nonspiritualhonreligious client 3.33 1.36 3.56 1.39
Client hostile to religion 3.21'* 1.46 3.92 1.16 .54
**p < .01

and those who indicated that they were spiritual with no set of religious
beliefs (39 students) on the following inventories: (a) SHI, (b) Preventive
Coping Resources Inventory, and (c) Combative Coping Appraisal Inven-
tory. The means, standard deviation, f values, and effect sizes are contained
in Table 3. Statistically significant differences were found for the SHI and
the Preventive Coping Resources Inventory. Counseling students who indi-
cated that they expressed their spirituality through their religious beliefs
had significantly higher scores on the SHI and significantly higher cogni-
tive awareness of resources to use for preventing stress than counseling stu-
dents who indicated that they considered themselves spiritual with no set
of religious beliefs. There was a large difference between the means on the
SHI (effect size, g = 1.04) and a moderate difference for the Preventive Cop-
ing Resources Inventory (effect size, g = .43). There were no statistically
significant differences for the Combative Coping Appraisal Inventory.
Pearson product-moment correlation coefficients were calculated to de-
termine the relationship between the SHI and the two coping inventories
(i.e., Preventive Coping Resources Inventory and Combative Coping Ap-
praisal Inventory). The results showed that there was a statistically signifi-
cant positive relationship between the SHI and the Preventive Coping
Resources Inventory (Y = .29, p < .Ol) and between the SHI and the Combat-
ive Coping Appraisal Inventory (Y = .30, p ~ 0 1 ) .

Qualitative Results
Thirty-five participants responded to the open-ended questions from the
Combative Coping Appraisal Inventory and the Preventive Coping Resources
Inventory. The open-ended questions asked participants to list anything else

Counseling and Values October 2001 Volume 46 7

 TABLE 3
Means, Standard Deviations, t Values, Effect Sizes for Spiritual/
Religious and Spiritual-Only Counseling Students on the Spirituality
Health Inventory, Preventive Coping Resources Inventory, and
Combative Coping Appraisal Inventory

Inventory N M SD t 9

Spirituality Health
Inventory
Spiritual/religious 70 95.95 8.16 4.59"' 1.04
Spiritual only 39 86.56 11.24
Preventive Coping
Resources Inventory
Spiritual/religious 70 3.08 .35 2.18' .43
Spiritual only 39 2.92 .40
Combative Coping
Appraisal Inventory
Spirituallreligious 70 1.93 .37 -1.105
Spiritual only 39 2.01 .32
' p c .05.**p c .01.

that helped combat stress and to list anything else that helped to become
immune to stress. Nine themes emerged from these responses. The themes
included (a) prayer (21 participants), (b) solitary activities (11participants;
e.g., quiet time, journaling), (c) distraction from stressful situation (9 par-
ticipants; e.g., sleeping, shopping), (d) relaxation/pampering activities (8
participants; e.g., bubble baths, pedicures), (e) management of stressful situ-
ation (7 participants; e.g., time management, put problems into perspec-
tive), (f) physical health (5 participants; e.g., exercise), (g) belief in God (5
participants), (h) Christianity (3 participants), and (i)family (3 participants).
Discussion
Because counseling students indicate more discomfort counseling clients who
are at the extreme ends of religious or spiritual dimensions, counseling
programs should consider implementing discussions of this topic in counsel-
ing courses. Counseling students may benefit from developing greater aware-
ness of their discomfort and by gaining information about how to prevent this
discomfort from harming clients who bring religious/spiritual issues into the
counseling relationship. These issues may also be addressed as diversity issues
to help counseling students develop awareness of the diversity in religions and
the spiritual dimensions of cultures other than Western culture.
The results of the Comfort Level Self-Report showed that counseling stu-
dents with a religious and spiritual affiliation identify a greater level of
discomfort counseling clients who are hostile to religion compared with the
discomfort identified by counseling students with a spiritual-only affiliation.
This finding suggests a need for counseling curricula to address these issues

8 Counseling and Values October 2001 =Volume 46

with counseling students who have a religious faith to help them deal with this
discomfort when counseling clients in work settings. This finding is especially
important given that counseling professionals are identifying religion and
spirituality as important components in their own lives and view religion and
spirituality as important components of their clients’ well-being.
T-test results showed that counseling students who expressed their spiritual-
ity through their religious beliefs had greater spiritual health and greater im-
munity to stressful situationsthan counselingstudentswho identified themselves
as spiritual with no set of religious beliefs. This finding suggests that counsel-
ing students are identifying religion as an important component of coping with
stress, and it supports literature reviews and studies that have been conducted
on the impact of religion on coping with stress. Furthermore, this study indi-
cated that there were no significant differences for combating stressful situa-
tions when comparing these two groups (counseling students expressing
spirituality through religious beliefs and students indicating being spiritual
with no set of religious beliefs). The question remains about why there were
sigruficant differences for having greater immunity to stressful situations but
not for combating stressful situations. One speculation is that different coping
skills may be needed to combat stressful situations than the skills used to pre-
vent stressful situations from developing.Immunity to stressful situations may
be enhancedby using ongoing coping mechanisms; for example, calling a friend
for support or having fellowship with a support group or religious group, if
the individual has a religious affiliation, may strengthen a person’s ability to
deflect stressful events. These resources may help the person cope with stress
in daily living but may not be available or sufficient when crisis situations oc-
cur. Skills such as relaxation or cognitive/behavioral techniques, which are more
easily accessibleto the individual during a major stressful situation, may be the
resources needed for combating a stressful situation.
Regarding the relationship between counseling students’ spiritual health
and coping, a significant positive relationship exists, indicating that the more
vital one’s spiritual health is, the more numerous are the coping skills. This
finding suggests that spiritual health may play an important role in coping
with stress. Spiritual health may involve somethingbeyond tangible resources
and may include such things as talking to a friend or seeking counseling to
cope with stressful situations in life. Spiritual health may include finding
meaning and purpose in one’s life; relying on God or a higher power; expe-
riencing peace; or feeling a connection with the universe, the world, or na-
ture. Including a spirituality course in the counseling curricula might increase
counseling students’ understanding of what constitutes spiritual health and
clarlfyfor these students how they can help clients draw from their own spiritual
resources to cope with stress.
Limitations of t h e Study
Precautions should be taken when interpreting the results of this study. Most
of the participants were Caucasian women, with few men and few partici-

Counseling and Values October 2001 Volume 46 9

pants representing other ethnic backgrounds. This sample is also not repre-
sentative of the general population. If this study was conducted in another
region of the country where there is more diversity among students, the
results would likely be different. Furthermore, although the testing instru-
ments adequately measured the variables to be studied, questions about
the validity and reliability of the testing instruments should be raised be-
cause of the lack of validity and reliability information. The SHI has a large
reliability range that may have affected the results. Furthermore, the corre-
lations found in the study were statistically significant but small.
A limitation to the Comfort Level Self-Report is that participants described
confusion among the different categories, suggesting that the categories
seemed similar. Furthermore, this inventory only addresses the level of
comfort about counseling clients with religious/spiritual issues. Counsel-
ing literature suggests that therapists are interested in discussing religious/
spiritual issues with clients but do not know how to incorporate this in coun-
seling, such as conducting assessments or applying techniques and theories
(Richards & Bergin, 1997).Therefore, an instrument that measures the knowl-
edge base for counseling clients with religious/spiritual issues needs to be
developed. A limitation to the coping inventories is that these inventories
identify cognitive awareness of resources to use for coping with stressful
situations. These inventories do not identify if participants actually use these
coping resources to deal with their stressful situations.
Another factor to consider is that most of the participants in this study had
minimalcounseling experience (mean of 2.3 years) with an average of 16 hours
of classes taken in a 60-hour accredited program, which equals five classes.
Furthermore, 65.2% of the participants indicated that they were not currently
enrolled in either a practicum or an internship class in which participants receive
counseling experience as part of the program requirement. Because counseling
trainees have had limited exposure to counseling clients who bring religious/
spiritualissues into the counseling relationship, these students may overestimate
their comfort level counseling clients with religious/spiritual issues.
Regarding the SHI,there are two versions of it. The first version was used for
this study because the second version was not available at the time the study
took place. The version of the SHI we used does not give the participant the
option to list ”undecided a- neutral.” Agnostic individuals would have diffi-
culty answering the questions related to belief in God or a Higher Power.

Implications for Clinical Practice

Correlations found in this study were statistically significant but modest in
size. Thus, any conclusions are tentative. This research does support the
existence of a relationship between religion and spirituality for coping with
stress, a finding that supports various literature written on this topic. The
purpose of this study was to address the need for an inclusion of a spiritu-
ality course in counseling curricula to help counseling students become aware

10 Counseling and Values October 2001 MVolume46

of their own beliefs about religion and spirituality and the impact of these beliefs
on the counselingrelationslup.Second,counselingcurricula may benefit counsel-
ing students by providing guidance needed to assist religious/spiritual
clients in using their religious/spiritual resources for coping with stress by
helping counseling students know when to consult and when to refer clients.
When working with clients who express their spirituality through their reli-
gious beliefs, it may be beneficial for counselors to help clients draw from their
religious/spiritual resources to help them cope with stress. For example, a
fellowship group or prayer group may strengthen an individual’s ability to
deal with daily stress. When working with clients who consider themselves
spiritual with no religious faith, it may be beneficial for counselors to help
clients find meaning in their lives through other means, such as community
involvement and fellowship with others, to cope with stress. Furthermore,
counselorscan help these clients use their spiritual resources to cope with daily
stress by focusing on what spirituality means to clients and what helps them
get in touch with their spirit. The inclusion of a spirituality course in counsel-
ing curricula may be beneficial for helping counselors-in-traininglearn how to
help clients draw from their religious/spiritual resources.

Future Studies
Studies are needed to determine how individuals define religion and spiritual-
ity. For example, what does spirituality mean to the individual and how does
he or she use religion or spirituality, or both, to cope? More explorationis needed
on the differences in coping skills between individuals who express their
spirituality through their religious beliefs and individuals who define them-
selves as spiritual with no set of religious beliefs. This information would
be useful for counseling professionalsto better understand how to help clients
use their religious /spiritual resources.
Future studies involving counselors who have worked in the counseling
field for several years compared with counseling students with minimal
counseling experience would be beneficial. This research would provide
more information about comfort level and the kinds of exposure that coun-
selors have had working with clients in the religious/spiritual dimensions.
Examination of the sources of discomfort may help determine if counselors
lack knowledge and skills in addressing religious or spiritual issues or if
personal beliefs and issues create the discomfort.
Furthermore, it would be beneficial to study the underlying reasons why
counseling trainees with a religious/spiritual affiliation have a greater level
of discomfort counseling clients at the extreme ranges of religious /spiritual
beliefs (such as clients hostile to religion) compared with counseling trainees
with a spiritual-only affiliation. This knowledge could help counseling
programs prepare counseling trainees who have a religious or spiritual
orientation, or both, face the diverse religious/spiritual needs of clients in
a counseling relationship.

Counseling and Values October 2001 Volume 46 11

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