Journal of Traumatic Stress, Vol. 16, No. 4, August 2003, pp.

391398 ( C 2003)

Changes in Religious Beliefs Following Trauma

Sherry A. Falsetti,1 Patricia A. Resick,2 and Joanne L. Davis3,4

Information processing theorists propose that traumatic events can lead to disruptions in the processing of information and to changes in beliefs. This study examined the relationships among trauma, posttraumatic stress disorder (PTSD), and religious beliefs. Participants included 120 individuals from community and clinical samples who participated in the DSM-IV Field Trial Study on PTSD. Results indicated that the PTSD group was more likely to report changes in religious beliefs following the rst/only traumatic event, generally becoming less religious. PTSD status was not related to change in religious beliefs following the most recent event. Intrinsic religiosity was related to multiple victimization, but not PTSD. Results are discussed in terms of understanding the function of religiosity in participants lives and future directions for research.
KEY WORDS: trauma; posttraumatic stress disorder; religion; spirituality; information processing.

Many researchers and theorists working in the eld of trauma hypothesize that an individuals beliefs develop through her/his interactions with the environment (i.e., interaction-based beliefs; Decker, 1993). Information processing theorists have proposed that traumatic events can lead to disruptions in the processing of information (Chemtob, Roitblat, Hamada, Carlson, & Twentyman, 1988; Foa, Steketee, & Rothbaum, 1989) as well as to changes in beliefs or schema (McCann & Pearlman, 1990; Resick & Schnicke, 1993). When individuals are confronted with new information that does not t their belief system, such as being confronted by a traumatic experience, they may become overwhelmed by this information and its accompanying emotions (Resick & Schnicke, 1993). Resick and Schnicke (1990), based on the work of Hollon and Garber (1988), have proposed that trauma

1 University

Family Health Center, College of Medicine at Rockford, University of Illinois at Chicago, Rockford, Illinois. 2 Center for Trauma Recovery, University of MissouriSt. Louis, St. Louis, Missouri. 3 Department of Psychology, University of Tulsa, Tulsa, Oklahoma. 4 To whom correspondence should be addressed at Department of Psychology, University of Tulsa, Tulsa, Oklahoma 74104; e-mail: joanne-davis@utulsa.edu.

victims attempt to integrate the new information regarding the traumatic experience through either assimilation, accommodation, or overaccommodation. When information contrary to an individuals belief system is assimilated, it is proposed that the individual changes the information to t the schema. An example of assimilation would be a woman whose rape schema consists of stereotypes about rape, such as most rapes are committed by strangers. If she is raped by an acquaintance, she may then assimilate this event by attempting to change the information to the belief that, what happened to me must not have been a rape. Conversely, if she were to accommodate the new information by changing her rape schema to include acquaintance rape, she might believe that most rapes involve attacks by strangers, however it is possible to be raped by a friend or acquaintance. Unfortunately, however, because of the traumatic nature of the event, victims often overaccomodate information related to the trauma. For instance, instead of believing that the perpetrator of the rape is a dangerous man, victims may alter their schema to reect a belief that all men are dangerous or that the world is a totally unsafe place. Resick, Schnicke, and Markway (1991) investigated beliefs of trauma victims and found changes in the areas of 391
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2003 International Society for Traumatic Stress Studies

392 safety, trust, power, esteem, and intimacy. Given changes in these areas as well as the tendency to believe in a just world (i.e., that good things happen to good people and bad things happen to bad people; Lerner & Miller, 1978), it seems likely that victimization may also lead to disruptions in religious or spiritual beliefs. The religious questions and disruptions encountered by trauma victims may be evidenced in a number of ways. For instance, individuals may engage in transformational coping by seeking new sources of meaning and signicance (Pargament, 1996). They may ask, Why is God punishing me?, and conclude that they must have done something to deserve this. Others claim that they no longer believe in God, because God would not allow such horrible things to happen. Alternatively, individuals may use conservational coping and hold on to their beliefs (Pargament, 1996). For example, they may claim that without their faith they could not have survived the pain they suffered as a result of their victimization experiences. It is unclear what factors contribute to the type of religious coping an individual will utilize, however, the importance of ascertaining the function of religiosity or spirituality in trauma victims lives, particularly as it relates to how they interpret or nd meaning in their experiences, seems apparent. Numerous investigations have found that religious means of coping are among the most common forms of coping utilized by individuals in times of stress (e.g., Koenig, George, & Siegler, 1988; McRae, 1984; Pargament et al., 1990). Several studies have investigated the effect of trauma on the religiosity of trauma victims. The results have been equivocal with some studies nding that traumatic experiences have a negative effect on religious beliefs and behaviors (e.g., Finkelhor, Hotaling, Lewis, & Smith, 1989; McLaughlin, 1994; Rosetti, 1995) and others nding a positive effect (e.g., Carmil & Breznitz, 1991; Valentine & Feinauer, 1993), suggesting a complex relationship between the experience of a trauma and ones religion or spirituality. It is unclear how this change in religiosity may effect or be effected by the individuals functioning in other areas. Donahue (1985) found that involvement in religious practices generally has a positive association with both mental and physical health. If ones religious beliefs are altered, however, this may contribute to either an exacerbation or amelioration of the impact of a traumatic event. Decker (1993) suggested that the symptoms comprising posttraumatic stress disorder (PTSD) may be the result of conicted belief systems. The basic assumptions about oneself, the world, and others that one has may no longer make sense when one is confronted by events involving horror and/or threat to life or physical integrity (Janoff-Bulman, 1985). Few studies have examined the

Falsetti, Resick, and Davis relationship between PTSD and change in religious beliefs. Astin, Lawrence, and Foy (1993) conducted a study on battered women and found different results based on the measure used to diagnose PTSD. When the Impact of Event Scale was regressed on battering specic variables, pretrauma variables, and posttrauma variables, results indicated that intrinsic religiosity was negatively related to PTSD intensity scores. When the PTSD Symptom Checklist was regressed on the same variables, results indicated that intrinsic religiosity was positively related to PTSD intensity scores. The authors attribute the difference to the use of a one-item measure of intrinsic religiosity and differences in the aspects of symptomatology that are measured by the two scales. A second study investigating the relationship between PTSD and religious beliefs found that combat veterans who were diagnosed with PTSD scored lower than average on measures of religious orientation and were less likely to use religion to obtain social support (Kennedy, 1989, cited in Drescher & Foy, 1995). The above-mentioned studies examining the association between religious beliefs and trauma have primarily focused on one type of trauma, excluding the unique and cumulative impact of other types of traumatic experiences. Further, studies have not typically focused on the relationship between changes in religious beliefs following traumatic events and potential relationships of such changes to PTSD. If trauma and/or PTSD inuence spiritual beliefs in ways similar to beliefs about such issues as interpersonal relationships, individual power and control, and safety, then the inclusion of an exploration of spiritual beliefs into therapeutic interventions may prove benecial for victims of trauma (Garbarino, 1996). Finally, previous studies have used limited measures of intrinsic religiosity. Intrinsic religiosity was chosen as we were interested in changes in internal belief systems as opposed to extrinsic religious behaviors. Further, evidence suggests that intrinsic religiosity may be a good indicator of personal religiousness (Hathaway & Pargament, 1990). The aim of this study is to add to the limited information regarding the association between trauma and religious beliefs by further investigation of the following questions. First, what is the prevalence of disruptions in religious beliefs for people who have experienced PTSD criterion A traumatic events? Second, are changes/ disruptions in religious beliefs more likely to be associated with multiple trauma than a single traumatic incident? Third, are changes/disruptions in religious beliefs associated with PTSD? Fourth, are religious beliefs viewed as helpful in coping with traumatic events? And nally, are there differences in intrinsic religiosity between people with and without PTSD?

Religious Beliefs and Trauma Method Participants A total of 120 participants were included in this study. All participants were part of a larger study, the DSM-IV Field Trial Study on PTSD (Kilpatrick et al., 1998). The DSM-IV Field Trial Study was conducted to examine potential revisions of the PTSD criteria for DSM-IV and to answer specic questions of the DSM-IV PTSD committee (Kilpatrick & Resnick, 1993). The larger study gathered information from 400 individuals seeking mental health treatment at one of ve mental health treatment sites and 128 individuals from one of two communities who were not seeking mental health services (see Kilpatrick et al., 1998, for a full description of the PTSD Field Trials methodology). All participants included in the analyses presented here had experienced a high magnitude stressor as dened by DSM-III-R. These data were collected on participants at the St. Louis Site and are from treatment (n = 56) and community samples (n = 64). Treatment participants were identied through sequential admissions to a psychology clinic at the University of MissouriSt. Louis. Community participants were identied through a random digit dialing procedure and were screened for trauma history and asked to schedule a time to conduct an inperson interview. According to Kilpatrick and Resnick (1992), random digit dialing covers approximately 96% of households, the same percentage with telephones, and includes unlisted numbers. Further, this method has been successfully used in research efforts involving inquiring about various sensitive issues including victimization and drug use (see Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). All interviews were conducted by psychology graduate students trained to conduct the interviews. The assessment protocol was the same for the treatment and community samples. The focus of this study is on the impact of traumatic events and PTSD status on religious beliefs, thus, individuals from the treatment and community samples were combined to form two groups based on PTSD status. Overall, 46.7% (n = 57) of the sample met DSM-III-R criteria for current PTSD and 58.2% (n = 71) met criteria for lifetime PTSD. One participant (0.8%) did not provide any demographic data. More women participated in the study (66.9%) than did men (32.2%). The majority of the sample was Caucasian (81.8%) and 17.4% was African American. The mean age of the participants was 36.57 (SD = 14.09; range = 1875). In terms of marital status, 40.5% of the sample was married, .8% widowed, 14% divorced, 5% separated, and 38.8% never married. Measures Potential Stressful Events Interview

393

The Potential Stressful Events Interview (Kilpatrick, Resnick, & Freedy, 1991) is a structured interview that assesses for lifetime history of completed rape, other sexual assault, serious physical injury, other violent crime, homicide of family members or close friends, serious accidents, disasters, and military combat. The most common rst or only trauma reported was sexual assault (32%), followed by experiencing a natural disaster (14%), and witnessing someone being seriously injured (8%). Sixtyeight percent of the sample reported multiple traumas. The most frequently reported most recent trauma was sexual assault (17%), followed by being in an accident (12%) and physical assault (12%). Participants also responded to questions about the worst traumatic event. The most frequently reported events were as follows: sexual assault (16%), accident (3%), and witnessing someone being seriously injured (3%). Structured Diagnostic Interview for DSM-III-R (SCID) The SCID (Spitzer et al., 1987) is a structured diagnostic interview designed to assess DSM-III-R psychiatric disorders. The PTSD module was the only portion of the SCID used in this study. This instrument has sound psychometric properties and has been used in several other studies with victims of crime. Intrinsic Religious Motivation Scale The Intrinsic Religious Motivation Scale (IRMS; Hoge, 1972) was included to assess depth of religious beliefs and is appropriate for different cultural and religious traditions. The scale was designed to assess Allports conceptualization of intrinsic religiosity (Allport, 1950, Allport & Ross, 1967), which according to Donahue (1985, p. 400) is dened as, a meaning-endowing framework in terms of which all of life is understood. Factor analyses of this scale indicated that it is a unidimensional scale (Thorson & Powell, 1990). There are 10 items that are rated on a scale from 0 (lowest) to 4 (highest), with a possible range of 040. Cronbachs alpha for the scale in the current study was .92. Changes in Religious Beliefs The Changes in Religious Beliefs Scale (Falsetti, 1992) was developed for this study to assess changes in

394 religious beliefs subsequent to trauma. The questions were asked in a structured interview format. Items included open-ended questions about religious beliefs prior to traumatic experiences, forced choice questions about changes in beliefs following trauma including whether the individual became more religious, less religious, or did not change. Open- and close-ended questions about current religious beliefs and the helpfulness of religious beliefs in coping with the traumatic events were also asked. Those individuals who reported no change in their religious beliefs following either the rst/only or most recent traumatic event were also asked additional questions regarding their beliefs. On the basis of the participants responses to the additional questions, two independent assessors categorized them into one of two categories: their beliefs never changed or their beliefs were not important to them. The assessors agreed on 85% of the cases. The 15% that were not agreed upon were deleted from further analyses. Of the remaining 69 individuals who reported no change in their beliefs, 59% were categorized as having never changed beliefs and 41% were categorized as the beliefs were not important to them. Those whose beliefs were not important to them were not included in the analyses evaluating change in religious beliefs.

Falsetti, Resick, and Davis

Table 1. Demographic Information for PTSD Positive and PTSD Negative Participants PTSD Positive PTSD Negative (n = 57) (n = 63) % (n ) Sample type Treatment sample Community sample Gender Male Female Race White, non-Hispanic Black, non-Hispanic Education level 1st12th grade Graduated high school/graduate Equivalency degree Some college/2-year college 4-year college Some/completed graduate school Age (years)
p

% (n ) 14.29 (9) 85.71 (54) 47.62 (30) 52.38 (33) 80.95 (51) 19.05 (12) 1.59 (1) 23.81 (15) 34.92 (22) 22.22 (14) 17.46 (11) M = 41.30 SD = 15.33

82.46 (47) 17.54 (10) 15.79 (9) 84.21 (48) 84.21 (48) 15.78 (9) 10.52 (6) 10.52 (6) 38.59 (22) 22.81 (13) 17.54 (10) M = 31.33 SD = 10.42

55.88 13.82 0.22

14.49 F = 16.99

< .001.

Data Analysis This study is primarily a descriptive and exploratory examination of the relationship among trauma, religiosity, and change in religious beliefs. General relationships were established through univariate analyses and statistical signicance below p values of .05 was considered an indication of areas to explore further. Variables identied through univariate analyses as signicantly related to the dependent variable of interest were included in a multivariable logistic or linear regression to determine the unique contributions of the independent variables. Participants were categorized into two groups, PTSD positive and PTSD negative, and were compared on the remaining variables of interest.

itive group comprised about 84% women, whereas the PTSD negative group was more evenly divided between men and women. The PTSD positive group was also, on average, 10 years younger than the PTSD negative group. Overall, 49 (41%) participants had experienced a second traumatic event. Univariate analyses were conducted to determine general associations between demographic variables (i.e., gender, age, and sample type), PTSD status and number of traumatic events (i.e., single or multiple). Analyses revealed signicant associations between number of traumatic events and PTSD status (Odds Ratio [OR] = 3.76, Condence Interval [CI] = 1.628.75), sample type (OR = 0.15, CI = .06.39), and age, F (1, 118) = 4.97, p < .05. Being PTSD positive, from the treatment sample, and younger were associated with experiencing multiple traumatic events. Intrinsic Religiosity

Results Table 1 presents an overview of demographic information by diagnostic status. Demographically, the current PTSD positive and negative groups were similar in terms of educational level and race, but were signicantly different in terms of gender and age. Gender, age, and sample source (e.g., treatment or community) were subsequently controlled for in the remaining analyses. The PTSD posThe Intrinsic Religious Motivation Scale was administered to assess depth of religious beliefs. The mean sum score for the total sample on the IRMS was 21.09 (SD = 11.07). Univariate and bivariate correlation analyses assessed the association of demographic variables (i.e., gender, age, sample source), PTSD status, and number of traumas with IRMS total scores. Results indicated that only number of traumas, F (1, 105) = 4.94, p < .05, and

Religious Beliefs and Trauma

Table 2. Linear Regression Predicting Intrinsic Religious Motivation Scale Scores Predictor variable Participants age Number of traumas (0 = single, 1 = multiple)
p

395
Table 3. Logistic Regression Predicting Change Following the First/ Only Traumatic Event Predictor variable Participant age PTSD status (0 = negative, 1 = positive)
p

B 0.19 6.28

SE B

R 2 Overall F .12 7.04 B 0.03 1.45 SE B 0.03 0.63 Odds ratio 0.97 4.27

95% Condence interval 0.921.02 1.2514.52

0.07 0.26 2.15 0.27

< .01. p < .001.

< .05.

participant age, r = 0.22, p < .05, were related to IRMS. Number of traumas and age were entered into a linear multivariable regression to predict IRMS scores. Results indicated that both variables remained signicant predictors when controlling for the other (see Table 2). Further examination of the data revealed that older participants reported higher intrinsic religiosity than younger participants. Individuals reporting multiple traumas reported higher scores on intrinsic religiosity ( M = 22.83, SD = 10.92) than the single victimization group ( M = 17.95, SD = 10.79). One-way ANOVAs were conducted to compare the single and multiple trauma groups on individuals IRMS items. The multiple victimization group scored signicantly higher on the following individual items than the single victimization group: My faith involves all of my life, F (1, 106) = 5.67, p < .05, In my life I experience the presence of the Divine, F (1, 106) = 9.89, p < .001, and One should seek Gods guidance when making every important decision, F (1, 106) = 3.89, p < .05.

Change in Religious Beliefs Fourteen individuals did not respond to questions regarding change in religious beliefs and were not included in the following analyses. The majority of individuals in the total sample (69.7%) reported no change in religious beliefs following the rst/only traumatic event, 16.7% reported becoming less religious, and 13.6% reported becoming more religious. Univariate analyses were conducted to assess potential associations between change in religious beliefs following the rst/only event and demographic variables, PTSD status, and number of traumas. Results indicated that respondents age, F (1, 63) = 4.71, p < .05, and PTSD status (OR = 5.44, CI = 1.6717.73) were associated with change in religious beliefs after the rst/only event. A logistic regression was conducted to determine the contributions of each variable to change in religious beliefs (see Table 3). Only PTSD status remained a signicant predictor when controlling for age. Further examination of the data revealed that almost 30% of those with PTSD reported becoming less religious after their

rst/only trauma compared to 6% of the PTSD negative group. In addition, about 20% of the PTSD positive group reported becoming more religious compared to 9% of the PTSD negative group. For those individuals who reported multiple traumas and were not excluded from the analyses, as described above, 42% reported no change following either the rst or the second event, 31% reported change following the rst event and no change following the second event, 8% became less religious following the second event and 19% became more religious. Univariate analyses were conducted to assess potential associations between change in religious beliefs following the most recent event and demographic variables and PTSD status. Results indicated that only sample source was associated with change in religious beliefs following the most recent traumatic event (OR = 1.55, CI = 1.092.19). Further examination of the data revealed that 42% of the treatment sample and 100% of the community sample reported a change in religious beliefs following the most recent event. In sum, analyses of changes in beliefs after the rst/ only event indicated that change in beliefs was associated with PTSD status. Roughly, 48% of people with PTSD became either more or less religious following the rst/only event. Following the most recent trauma, however, only the sample source was related to change in religious beliefs. Specically, the community sample was more likely to report a change in religious beliefs compared to the treatment sample. We next sought to determine whether PTSD status or multiple victimization was related to the manner in which individuals utilized religious beliefs or coping currently, including assessing whether those individuals who reported changing their beliefs returned to their original beliefs or if their beliefs remained changed.

Current Beliefs and Coping Overall, when asked about current religious beliefs, the majority of the sample reported that their beliefs had

396 never changed (39%) or were not that important to them (38%). Twenty-two percent reported that their beliefs had changed following a traumatic event and remained changed, and 2% reported their beliefs changed following a traumatic event, but returned to what they were before the trauma(s). Further analyses were not conducted due to the small cell sizes. Finally, participants were asked, Have religious beliefs helped you to cope with your traumatic event(s)? Over half of the participants (56%) reported that their beliefs were helpful, 24% reported they were not helpful, and 20% reported they did not use religion to help them cope. Univariate analyses were conducted to assess the relationship between use of religion in coping (was or was not helpful) and demographic variables, PTSD status, and number of traumas. Results revealed no signicant associations with use of religion in coping.

Falsetti, Resick, and Davis of coping with signicant life events; and (c) individuals use a general system of both religious and nonreligious beliefs, practices. that are translated to specic activities and goals to cope with life events. This study partially assessed religions inuence on how individuals cope with trauma and the inuence of events on religion. Future investigations also need to explore other variables shown to effect posttrauma functioning including trauma-specic variables, family of origin variables, and posttrauma variables to determine those factors that may help to explain why some individuals turn toward religion in times of crisis whereas others turn away from religion. These ndings appear to suggest at least two important points with regard to information processing theory. It is important to note that overall, the majority of individuals either did not change their religious beliefs or stated that their religious beliefs were not important to them. However, for those individuals who did report a change in religious beliefs, as with changes in other belief systems following trauma, it is not trauma alone that is related to changes in religious beliefs, but rather PTSD appears to be an important factor to consider. For the most part, those individuals who had experienced a traumatic event but did not have PTSD did not report substantial changes/disruption in their religious beliefs. This may be due to the inuence of PTSD on beliefs. If someone believes that God was punishing them, for instance, they would be less likely to turn to religion, whereas someone else may say to themselves that without Gods help, I wouldnt even have made it through this event or be here today, and then would be more likely to turn towards religion. What is not yet clear and requires further investigation is whether PTSD in part results from the disruption or changes in beliefs or if the belief changes are in part a result of PTSD. For instance, it is possible that a rape victim who is able to successfully accommodate the rape, may engage in conservational coping (Pargament, 1996) and never question Gods role in the event, or experience any discrepancy between her religious beliefs and the event, and thus her beliefs do not change, nor does she develop PTSD. Perhaps for another victim, however, her beliefs about the world are shattered by the trauma and she engages in transformational coping in search of the signicance of the event. For this victim it could be that symptoms such as fear, ashbacks, and arousal symptoms result in questioning religious beliefs, or it could be that the discrepancy between her beliefs and what actually happened to her are at such odds, that she was forced to change her beliefs. However, if she had not had the adverse effects of PTSD following the trauma, we do not know that she would have ever experienced a disruption or change in

Discussion The results of this study are consistent with previous research indicating that ones beliefs about spiritual or religious issues may be altered or disrupted following the experience of traumatic events. This study examined a particular mechanism that might help explain the varying results of previous studies, specically, the role of PTSD. Overall, signicantly more participants who met criteria for PTSD reported a change in their religious beliefs following the rst or only traumatic event than did those individuals without PTSD. The direction of the change was not consistent across participants, however. Following the rst trauma, more participants reported becoming less religious as opposed to more religious. PTSD was not a signicant contributor to change following the most recent traumatic event, however. Thus, as has been seen across other studies examining change in religious beliefs, it appears that an initial or only trauma may have a signicant inuence on ones religious beliefs, particularly if the individual meets criteria for PTSD. The beliefs, however, can either become stronger or weaker, suggesting that other factors are inuencing peoples beliefs. Alternatively, this could suggest that like other trauma-related beliefs, these events can be assimilated or accommodated in ways that can change beliefs in many different directions. Future research needs to more comprehensively investigate aspects of religion and religiosity as they relate to healing from trauma. Indeed, Pargament et al. (1990, 1992) suggest a multifaceted role of religion in coping processes. They suggest that (a) religion may serve to inuence life events and how individuals cope with such events; (b) religion may be inuenced through the process

Religious Beliefs and Trauma her beliefs. In other words, the chronology of changes in beliefs and PTSD needs further examination. The second important nding of this study is that in direct contrast to the ndings with PTSD and changes in beliefs, there were not changes in beliefs associated with multiple victimization independent of PTSD status. Also in contrast, was the nding that higher intrinsic religiosity scores were associated with multiple victimization, but not with PTSD. Further, the use of religion in coping with the traumatic event was not associated with either PTSD or multiple victimization. Thus, it appears that although a change in beliefs is associated with PTSD, the experience of more than one traumatic event is associated with stronger intrinsic religious beliefs. The reasons for this complex relationship remain unclear. One possible explanation may be that multiple victimization, regardless of whether or not one develops PTSD, seems less random, thus results in more questioning about ones life and how trauma could happen not just once, but two or more times. Such questioning may not necessarily lead to changes or disruptions in beliefs, but could lead to a strengthening of existing intrinsic religious beliefs in an attempt to make sense of the event, or to create some semblance of something good or positive in life. Victims of multiple traumas may look to religion/god/higher power as the one constant in their lives and the only aspect of their world that they can trust, that provides the inner strength to go on in the midst of chaos. Multiple victimization may also highlight the precariousness of life more than a single victimization. Perhaps a deepening of intrinsic religious beliefs serves to reduce existential anxiety by appearing to make life more meaningful and/or less precarious and random. For instance, in our interviews, some people described taking life for granted and not fully realizing that I would die some day, before a traumatic event, and seeing how precious life is or realizing I had to use my time in a meaningful way, because anything can happen, after victimization. It would seem that multiple victimization would further serve to highlight such notions. Perhaps, aside from the pathology of PTSD, many victims, particularly those who have experienced multiple trauma, must grapple with the meaning of what happened to them and the meaning of their lives and try to make sense of it within a larger framework. However, these hypotheses require further investigation before any rm conclusions can be made. Several limitations in the present study need to be acknowledged. First, it should be cautioned that the sample size in this study was relatively small. Thus further research is needed with larger samples. Second, these data were collected as part of the DSM-IV eld trial, but PTSD diagnosis were based on DSM-III-R diagnoses, thus the

397 rates of PTSD may shift slightly if DSM-IV criteria for PTSD are used. Lastly, this study did not include a nonvictim group for comparison, and so it is unclear how religious beliefs would change in a normal comparison sample across the life span. The results of this study clearly show the importance of assessing for changes in, as well as the function of spirituality in trauma survivors lives. This may be particularly salient if individuals meet criteria for PTSD or have had more than one victimization experience. Mental health workers have not typically considered the exploration of religious or spiritual beliefs to fall within the bounds of therapy. Indeed, Decker (1995) cautions psychologists about integrating unfamiliar spiritual or religious practices into therapy. As with the use of any therapeutic method that one has not been adequately trained in, utilizing spiritual or religious teachings and methods without the appropriate education and guidance may create more obstacles to recovery for the client. If professionals are uncomfortable with incorporating spiritual issues into therapy, they might consider enlisting assistance of the clergy or others more knowledgeable of spiritual matters. For those interested in utilizing spiritual or religious methods, however, several authors have written about techniques and interventions to use with clients targeting spiritual issues (Drescher & Foy, 1995; GanjeFling & McCarthy, 1996). Unfortunately, however, no empirical data exists upon which to determine their effectiveness. Future investigations should include more in-depth assessment of spiritual issues as relates to experiencing a traumatic event and assess the therapeutic value of including interventions targeted at these issues.

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