J Relig Health (2012) 51:460467

DOI 10.1007/s10943-012-9568-y
ORIGINAL PAPER

Commentary: Why Do Research on Spirituality

and Health, and What Do the Results Mean?
Harold G. Koenig

Published online: 19 January 2012

 Springer Science+Business Media, LLC 2012

Abstract I address two related questions in this article. First, why conduct research on
religion/spirituality (R/S) and health? Second, what are the dangers of misinterpreting or
misapplying the results from such research? If relationships are found, so what? What is
the practical value or clinical relevance of such information? Why should investigators
spend time and scarce financial resources to explore such connections? What might health
care professionals do differently as a result? How would people live their lives differently
in light of such information? Questions like these need solid answers for the field to
continue to move forward. Related to the So what? question is the issue of how results
from research in this area are translated into popular understanding and application. After
discussing why conducting research on religion and health is important, I identify a
recently published research report that focuses on the relationship between R/S and selfcontrol, an article that received considerable media press coverage. I present the results
reported by the authors of this study and then examine a column written about the study
that appeared in the New York Times. Finally, I explore what the findings mean, how the
media portrayed the findings, and problems that might result depending on how people
applied those findings.
Keywords

Religion
Spirituality
Research
Media
Interpretation

Prior to the year 2000, over 1000 studies had quantitatively examined relationships
between religion/spirituality (R/S) and health (Koenig et al. 2001). By the middle of 2010,
at least 2,000 additional quantitative studies had appeared in the literature, resulting in over
3,000 original data-based reports on associations between R/S and mental health, physical
health, and use of health services. These reports included cross-sectional studies,
H. G. Koenig (&)
Center for Spirituality, Theology and Health, Duke University Medical Center,
Box 3400, Durham, NC 27710, USA
e-mail: koenig@geri.duke.edu
H. G. Koenig
King Abdulaziz University, Jeddah, Saudi Arabia

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Search terms: religion, religious, religiosity, religiousness, spirituality (2/20/09)

14
12

Thousands of Articles

PsycINFO

10
8
Medline

6
4
2
0
1965-69

1970-74

1975-79

1980-84

1985-89

1990-94

1995-99

2000-4

2005-9

Year
Fig. 1 Religion/spirituality articles per 5-year period (non-cumulative) (Koenig 2011)

prospective cohort studies, experimental studies, and randomized clinical trials (Koenig
et al. 2012). The volume of such research has been increasing rapidly in recent years (see
Fig. 1). Some health professionals have expressed concern about both the quality (Sloan
et al. 1999) and the clinical application (Sloan et al. 2000) of research findings on R/S and
health. Mainstream theologians also have concerns about the instrumental use of R/S with
the expressed purpose of maintaining or improving health (Shulman and Meador 2002).
Thus, the research field of R/S and health is getting criticism from both sides. This raises
two important issues: the value of such research and the interpretation of what the research
findings actually mean.

Why Do Research on R/S-Health?

Given the rapid increase in research in this area, it is time to carefully re-examine the role of
such research in understanding health and health care. Why spend valuable time and scarce
resources examining such relationships? What, if any, clinically useful information or
important societal implications can come out of such research? Is there really need for this
kind of research? These are questions that reviewers at the National Institutes of Health,
National Science Foundation, and private foundations such as the Templeton Foundation
often ask when deciding on whether to fund a research project in this area (Koenig 2011).
I would argue that there are numerous practical reasons for conducting religion
health research, and many of those are the same reasons used to justify the spending of
billions of dollars on research that examines other psychological, social, and behavioral
factors related to health. Here are five reasons, and these are not exhaustive.

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First, research on R/S and health might uncover certain R/S beliefs or behaviors that
could be used to help identify those at higher or lower risk of disease, allowing easier
identification of high-risk individuals to whom health resources could be directed so that
disease could be diagnosed early or prevented entirely. This is one reason why scientists
study such factors as race, ethnicity, gender, age, or sexual preference. For example, older
black men are at higher risk for cardiovascular disease than young white women. If an
older black man comes into the office with chest pain, doctors will be more likely to
suspect that the symptom is related to his heart than if a young white woman comes in with
the same complaint. Similarly, if a sexually active young homosexual male comes in with
fatigue and cough, then the physician is likely to test them for HIV and screen them for
pneumocystis carinii. Clinicians would not attempt to alter any of these individual characteristics, yet research that identifies which of these factors mark individuals at high risk
can be very useful to public health experts and clinicians. If certain R/S beliefs or practices
place persons at higher or lower risk for a particular disease or mortality in general, then
doctors need to know about it.
Second, information on the relationship between R/S and health might also be important
in terms of planning ahead for health services needed by the public. Today, two-thirds of
Americans indicate that religion is an important part of daily life (The Gallup Poll 2009).
However, trends toward secularization in developed countries such as the United States
suggest that R/S involvementparticularly attendance at religious servicesmay not be as
common in 2030 years as it is today (Bruce 1992). If R/S involvement is related to better
health, greater longevity, and less need for health services, then secularization may increase
the health care needs of the population, not to mention the rates of alcohol and drug abuse,
delinquency and crime, teenage pregnancy, and other social problems that affect health and
health care costs (Koenig et al. 2012). Furthermore, if found to foster better health, faith
communities could be identified as providers of health care, natural sites using their
resources to complement existing secular resources. For example, faith communities could
serve as sites for disease screening and health education (prevention) and/or for providing
psychological and instrumental support to sick persons living in the community.
Third, R/S involvement is common in the United States and most countries around the
world. If it is related to better health, and studies show that R/S interventions improve
health, then there is no reason why those interventions couldnt be used to enhance and
support treatment in those who indicate religion is an important part of their daily life.
Clinicians need not prescribe religion to those who are not religious (nor is there likely to
be any scientific basis for doing so). However, there may be many reasons for inquiring
about the role that R/S plays in a persons life and whether he/she would prefer an
intervention that utilizes their R/S resources in treatment. For example, 7783% of adults
aged 55 or older with depression and comorbid chronic medical illness prefer to include
religion in their psychotherapy (Stanley et al. 2011). In other words, if effective and
beneficial (and not dangerous), there is no reason not to place secular therapies within a
R/S framework for patients who desire this.
Fourth, many patients have spiritual needs when hospitalized with serious medical illness,
and they often go unmet with significant consequences in terms of quality of life, satisfaction
with care, and desire for sometimes futile health care services (Balboni et al. 2007, 2010;
Williams et al. 2011). Some of those spiritual needs involve religious or spiritual struggles
for example, feeling punished by God or abandoned by their faith community. When spiritual
struggles of this type are present, there is evidence that mortality increases significantly,
independent of social, psychological, and physical health factors (Pargament et al. 2001).
Does addressing spiritual needs like this and others by a trained chaplain affect the course of

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the medical illness after discharge? If that were the case, then this has enormous practical
implicationsimplications in terms of health professionals screening for spiritual needs,
hiring chaplains to meet those needs [3646% of US hospitals have no paid chaplain staff
(Cadge et al. 2008)], and following up after discharge on spiritual needs identified during
hospitalization (and perhaps addressed through the faith community).
Finally, the public deserves to know whether there are certain beliefs or behaviors that
influence their health and well-being. This is one reason why we pay taxes. We believe that
our government is operating in our interests, and one of those interests is keeping us
informed about beliefs and attitudes, social relationships, and behaviors or lifestyles that
influence our mental and physical health. This is one reason why our government supports
research in the behavioral and social sciences. The mission of the National Institutes of
Health (part of the Department of Health and Human Services) is to: seek fundamental
knowledge about the nature and behavior of living systems and the application of that
knowledge to enhance health, lengthen life, and reduce the burdens of illness and disability (National Institutes of Health 2011). We may or may not decide to change how we
believe or live, but at least having some objective information about factors that influence
our health can help us make informed decisions.
Thus, conducting research on religion, spirituality, and health has many potential
applications and is not that different from other mainstream areas of scientific research that
explore social and behavioral influences on health. This research has direct implications for
early disease detection, disease prevention, medical outcomes (psychological and physical), ability to function, and health care practices.

What Do Research Results Mean?

To what extent are the results from research in this area accurately interpreted and
transmitted to the public? How does the popular media translate research findings on
religion, spirituality, and health to the public to facilitate their understanding, and what are
the dangers of misinterpretation or misapplication? Topics at the intersection of religion
and empirical science, especially religion and health, often drive public interest and
therefore, the media focus. Indeed, the popular media has had a field day with many of
studies in religion and health, often making sweeping (and often incorrect) conclusions
about what the studies find and what the results mean. Media coverage often makes it
difficult to separate useful, clinically or personally relevant results from exaggeration and
hype. A recent example of such media dramatization was a study that reported an association between religious involvement and size of the hippocampus (part of the brain that
plays an important role in memory). In this study, investigators found significantly greater
atrophy of the hippocampus in older adults (57% depressed, 43% non-depressed controls)
reporting a life-changing religious experience or indicating that they were born-again
Protestants (vs. mainline Protestants) (Owen et al. 2011). While there were many possible
scientific explanations for these findings and several practical implications, the casual
reader would never have suspected that from the media reports. In the Christian Century, a
mainline Protestant magazine, a comment on the study appeared under the headline,
Study suggests born again believers have smaller brains (Shimron 2011). Even a
popular article in Scientific American was titled Religious experiences shrink part of the
brain (Newberg 2011). Neither of these claims came anywhere near the truth of what was
actually found in this observational study. Thus, even in some of the most credible popular
publications, the truth often gets distorted.

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Religion and Self-Control

As an example of media misapplication, I focus here on an important research report that
examined the relationship between R/S and self-control. Following its publication, a
commentary on the study appeared in the New York Times. McCullough and Willoughby
(2009) comprehensively reviewed and provided original research exploring the relationship
between religiousness and self-control or self-regulation (McCullough and Willoughby
2009). The investigators used Carver and Scheiers theory of self-regulation to explore six
hypotheses. First, they proposed that religion is related to self-control; second, they
hypothesized that religion is related to how goals are pursued; third, they predicted that
religion promotes self-monitoring; fourth, they projected that religion enhances the ability
to self-regulate; fifth, they proposed that religion promotes self-regulatory behaviors; and
sixth, they suggested that some of religions effects on health result from this enhanced
ability to self-regulate. New cross-sectional data were presented on relationships between
religion, personality, and self-control, as well as data on relationships between personal
religiosity, self-control, and future criminal activity.
Based on the results of their review and new data, researchers concluded that there is (1)
strong evidence that religion is positively related to self-control, as well as to agreeableness
and conscientiousness; (2) supportive evidence that religion influences goal selection, goal
pursuit, and goal management; (3) mixed evidence that religiousness promotes selfmonitoring; (4) reasonable evidence that religious rituals promote self-regulation; and (5)
some evidence that religions ability to promote self-control could explain some of religions associations with health, well-being, and social behavior.
The first line in the New York Times commentary, written by John Tierney on December
30, is If Im serious about keeping my New Years resolutions in 2009, should I add
another one? Should the to-do list include, Start going to church? (Tierney 2008). The
writer goes on to summarize the research report above, stating that [the authors] have
reviewed eight decades of research and concluded that religious belief and piety promote
self-control. Mr. Tierneys response to this finding: This sounded to me uncomfortably
similar to the conclusion of the nuns who taught me in grade school Toward the end of
the article, the writer states, Does this mean that nonbelievers like me should start going
to church? Even if you dont believe in a supernatural god, you could try improving your
self-control by at least going along with the rituals of organized religion.

Comment
Is the New York Times writer correct in his interpretation of the research by McCullough
and Willoughby that attending church will help him keep his New Years resolutions since
religious belief and piety promote self-control? People reading this article are likely to
think that becoming more religious will increase their self-control. Perhaps doctors should
start prescribing religious involvement to patients who have problems with self-control. I
would argue that prescribing religion to non-religious patients with self-control issues is
neither ethical nor indicated based on what Drs. McCullough and Willoughby or any other
researchers have found.
As noted earlier, there are many valuable reasons for conducting research like this on
religion and self-control. The NYT writer above, however, discussed none of them
except the one implication that is probably not true, that is, that going to church by itself
will increase self-control. Rather, the research reported by McCullough and Willoughby

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points out the potential value of R/S practices without prescribing them. The relationship
between R/S and self-control is valuable for the public to know about, but the interpretation should not go beyond what the data actually say. What those data say is that based
largely on observational research, not clinical trials, there is a connection between R/S and
self-control. This does not mean that R/S causes self-control and that going to church will
increase your self-control.
An equally valid explanation of the research findings is that people with self-control are
more likely to go to church. In other words, attending church has nothing to do with
developing self-control. Instead, churches attract people into their membership who
already have it. While attending religious services may lead to exposure to sermons and
religious teachings that advocate self-control and provide a supportive social environment
that is conducive to self-control, it is also possible that persons who are genetically
endowed with good self-control are attracted to church settings where their self-control is
rewarded. This, in turn, makes them feel comfortable and good about themselves and
makes them want to continue to participate in religious activities. In contrast, those without
self-control may not be welcome in church settings because they are disruptive and a threat
to the solid citizens who make up the membership (bad examples for children, etc.).
If a randomized clinical trial were done and people were randomized to church attendance or no church attendance and followed up, and self-control was found to significantly
increase in those assigned to the church attendance group compared to the non-attendees,
then we could indeed conclude that religious attendance led to, resulted in, or caused more
self-control. The research summarized and new data reported by Drs. McCullough and
Willoughby, however, did not do that.
Another problem with the interpretation of observational data like most of that reported
by Drs. McCullough and Willoughby is that it doesnt say how long one must go to church
(or how often) before the benefits to self-control begin to accrue. Nor does it say what
religious denomination enables the fastest accrual of self-control or the particular practices
that are especially potent in this regard. Nor do we know whether going to church only in
order to achieve greater self-control will actually accomplish that goalsince the research
reported by McCullough and Willoughby was conducted on people who presumably were
involved in religious practices for religious reasons, not to gain more self-control. Thus,
research often raises more questions than it answers. And it may be difficult or impossible
to answer some of those questions due to the difficulty or cost of designing a study to
answer them.

Problems with Misinterpretation

What if people who read the NYT article concluded that going to church would increase
their ability to control themselves and keep their New Years resolutions? Would that be all
bad? It might be harmless for some, but not so harmless for others. Some people might
benefit in other ways from attending religious services, even though they started going for
the wrong reason (i.e., to help them keep their New Years resolutions). Indeed, after
hearing a sermon or two, they may be motivated to change their lifestyle, discover new
purpose and meaning in life, develop a deeper relationship with God, or make new friends
in the congregation, and develop close supportive social relationships. Their self-control
may or may not improve, but their lives would improve and perhaps also their spirituality.
For others, the results may not be so benign. These people may go to church and find
after several months of attending that they were not increasing in self-control, but feeling

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very guilty about their lack of self-control and becoming discouraged about their inability
to live controlled lives like other members of the congregation. They might then stop going
altogether, concluding that religion just doesnt work and become disillusioned with
religion altogether not realizing that religion may serve other purposes besides the
development of self-control (but self-control was all they were looking for, based on the
NYT article). This is one reason why many theologians are concerned about religion and
health research. If people use religion for the primary purpose of achieving certain health
goals, then this is a misuse of religion for non-religious goals and could ultimately lead to
disillusionment and the abandonment of religion. In the Judeo-Christian tradition, this
application of the research findings on religion and health (self-control) would lead to
idolatry, where health becomes ones god and religion is used only as a means to it.

Conclusions
There are many logical completely rationale reasons for conducting research on R/S and
health, and the justification for doing so is just as strong as for any other psychological,
social, or behavioral factors that social and behavioral scientists study because those
factors influence our health and well-being. Much may be learned about the human
potential by studying the powerful package of psychological, social, and behavioral forces
that make up religion (one of the few things that people believe intensely enough in to
sacrifice their lives for). How can scientists ignore such a force in society, one that is
important to the lives of the vast majority of Americans and the vast majority of people on
this planet? They cant, but it is essential that the results of such research be interpreted and
applied by both researchers and the popular media in ways that are justified by what the
research actually finds and means.
Acknowledgment Thanks to Dan G. Blazer, M.D., Ph.D., for his review and comments on this article.
Conflict of interest The author has no conflicts of interest.

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