The efficacy of a manualized group treatment protocol for changing god image, attachment to god, religious coping, and love of god, others, and self.
Rasar, Jacqueline D. ; Garzon, Fernando L. ; Volk, Frederick 等
This study compared the efficacy of a manualized group treatment
protocol on God image and attachment to God to a manualized Christian
Bible study and a waiting list control group in a sample of
undergraduate college students attending a Christian college. Thirty
students were randomly assigned to one of the treatment conditions and
assessed with measures of God attachment, God image, religious coping,
and general spiritual outcomes. It was hypothesized that significant God
image and attachment change would occur among the God image treatment
group participants only. In addition, it was hypothesized that
significant religious coping and spiritual outcome change would occur
within both groups compared to the waiting list control group. The
results supported significant spiritual outcome changes in both groups
but no significant God image/attachment change or religious coping
change. Feedback from group participants informed how manualized God
image/attachment protocols may be modified in future research to improve
outcomes for young college-age Christian participants.
For many years, God image development has been a topic in the
psychology of religion literature (Rizzuto, 1974; Rizzuto, 1979;
McDargh, 1986; Hall, 2004; Peloso, 2008). God attachment has also become
a major area of exploration (Birky & Ball, 1988; Kirkpatrick &
Shaver, 1992; Kirkpatrick, 1992; Kirkpatrick, 1999; Granqvist &
Hagekull, 1999; McDonald, Beck, Allison, & Norsworthy, 2005; Beck,
2006; Hall, Fujikawa, Halcrow, Hill, & Delaney, 2009). While much
theoretical development has occurred in understanding these constructs,
true experimental studies examining how individual or group therapy can
impact these constructs are limited.
The purpose of this study was to assess the effects of a manualized
group treatment protocol on God image and attachment to God in a sample
of undergraduate college students attending a conservative Christian
college. The treatment group manual (entitled "Discovering
God") was designed to help individuals within the Christian
tradition to experience God in a manner more congruent with their
cognitive understanding and included psychoeducational,
dynamic-interpersonal, cognitive interventions, bibliotherapy, and
art/music interventions (also used in a pilot study by Thomas et al.,
2011). The Bible Study group manual (entitled "Spiritual Life
Group") was designed as a spiritual formation-focused Bible study
and included psychoeducational, dynamic-interpersonal, cognitive
interventions, bibliotherapy, and art/music interventions (Rasar, 2010).
Definitions and Development
Definitions
As a psychological construct, God images are persons'
affect-laden mental representations that underlie their embodied,
emotional experiences in relationship with God (Davis, 2010). They
involve implicit relational knowledge that guides how people experience
God at a largely nonverbal, emotional, physiological, and frequently
implicit level (Moriarty & Davis, in press; cf. Hall, 2004). God
images thus may be conceptualized as attachment filters that mediate
people's emotional experience with God (Hall, 2007). The God image
is a psychological construct concerned with how an individual feels
toward God and one's impression of how God feels about him or her
(Grimes, 2007). People vary greatly in their God images. For example,
some may experience God as loving and kind while others inwardly
experience Him as harsh, judgmental, or distant.
God image stands in contrast to God concept, which is best defined
as a person's belief-laden, intellectual, understanding of God. It
includes the personality traits and qualities that an individual
cognitively ascribes to God which mediate one's theological ideas
and abstract thoughts about God (Thomas et al., 2011; cf. Davis, 2010).
God concepts mainly derive from formal and informal learning (Hoffman,
2005). For example, people from the Christian tradition generally are
taught and believe that God is creator, omnipresent, omnipotent, and
omniscient. God attachment as a construct draws from Bowlby's
(1969, 1982) work. Kirkpatrick (1999) asserts that foundational concepts
of the attachment theory--the presence of an available and responsive
attachment figure, who serves as a secure base, and separation from whom
results in distress--are fundamental dynamics of Christianity;
therefore, a relationship with God can be explained as an attachment
bond. Consistent with Bowlby's ideas, which have been expanded by
Ainsworth (1985), God may serve positively as a secure base in which He
is a safe haven in times of distress and a solid inner foundation to
explore one's environment. Conversely, insecure attachment to God
can create spiritual and emotional distress (Kirkpatrick, 1999). Some
research has correlated both secure attachment to a primary caregiver
with a secure attachment to God (Birky & Ball, 1988), and insecure
attachment to a primary caregiver with an insecure attachment to God
(McDonald, Beck, Allison, & Norsworthy, 2005). Nevertheless, those
with an anxious, avoidant, or ambivalent type of insecure attachment to
parents may at times still develop a secure attachment with God in which
God compensates for the lack of secure parental attachment (Kirkpatrick
& Shaver, 1990).
God Image and God Attachment Development
For a comprehensive review of God image development, see Moriarty
and Davis (in press). Object relations theory (e.g., Klein, 1930/1964)
and attachment theory (e.g., Bowlby, 1969) provide the theoretical
underpinnings tor God image and God attachment. Both of these theories
have a solid research foundation in general. In particular, God image
development (Rizzuto, 1979; Hall, 2004) and God attachment development
(Kirkpatrick, 1992) begins in childhood and persists throughout the
lifespan; yet, God image and God attachment change are theoretically
possible through treatment (Rizzuco, 1974; Jacques, 1998; Fosshage,
2003; Garzon, 2007; Sperry, 2005; Schore, 2002).
Hall's (2004) implicit relational knowledge correspondence
hypothesis conceptualizes God image development and is based on five
central organizing principles, including (a) people are motivated by and
develop in emotionally significant relationships, (b) emotional
information processing provides the framework for shaping patterns in
relationships with God, self, and others, (c) implicit relational
representations are encoded in the mind and serve as the implicit
relational knowledge of how significant relationships work, (d) early
relationships with caregivers shape appraisal and meaning of subsequent
relationships, and (e) these implicit relational representations form
the foundation of one's knowledge of self and are processed
automatically (pp. 68-74). Further research by Hall and his colleagues
(Hall, Halcrow, Hill, & Delaney, 2005) suggests implicit relational
knowledge informs and corresponds with one's implicit religious or
spiritual functioning, which is the emotional relationship with God.
People have both implicit religious/spiritual functioning and explicit
religious/spiritual functioning (i.e religious/spiritual behaviors), but
implicit relational knowledge is not reflected in the latter (Hall et
al., 2005).
Many theoretical articles have postulated the potential effects of
individual psychotherapy on God images (Jacques, 1998; Fosshage, 2003;
Garzon, 2007; Sperry, 2005; Schore, 2002); however, actual empirical
studies are few. Two models relating to God as an attachment figure are
the correspondence model and the compensatory model (Hall, 2007). The
correspondence model suggests that attachment patterns among people are
reflected in attachment patterns to God. The compensatory model states
that God functions as a substitute attachment figure for those with an
insecure attachment pattern. Beck and MacDonald (2004) have attempted to
tie the two competing theories together in a more cohesive fashion,
suggesting they are both valid, but each becomes more prominent under
certain circumstances. Due to inconsistent research findings on these
models, the implicit relational knowledge correspondence hypothesis
(Hall et al., 2005) has provided some additional clarity for both God
image and God attachment development.
God Image and God Attachment Treatment and Change
Experimental studies examining how individual or group therapy can
impact these constructs are limited and preliminary. Key (1995) explored
the impact of inpatient psychiatric treatment on self-esteem, object
relations maturity and God image, followed by outpatient therapy in a
sample of 30 adult individuals. Improved self esteem, object relations
maturity, and God image were maintained at a 12-month follow-up. Tisdale
et al. (1997) used a religiously-adapted object relations therapy aimed
at improving self-esteem and God image in 99 inpatient participants.
Results indicated improved self-esteem. Cheston, Piedmont, Eanes, and
Lavin (2003) investigated the change in images of God in 30 individuals
in the treatment group engaged in outpatient individual therapy that was
not explicitly religious or spiritual. Compared to a waiting list
control group (n = 68), the treatment group reported a decrease in
psychological symptoms and an increase in positive experiences of God.
This study suggests God image change may be indirectly impacted by
psychotherapy.
Empirical studies have supported group therapy as efficacious for a
variety of presenting problems (McDermut, Miller, & Brown, 2001;
Gorey, Richter, & Snider, 2001; Barlow, Burlingame, & Fuhriman,
2000). Group therapy specifically aimed at improving God images has
shown promising preliminary results (O'Hare, 2003; Thomas et al.,
2011). O'Hare's (2003) pilot study on six individuals
indicated that group work may improve the God image.
Thomas et al. (2011) tested the effect of a manualized group
treatment protocol on God image. Results supported significant increases
in the emotional experience of God as intimate, accepting, and
supportive. Also, significant decreases in experiencing God as discant,
harsh, and disapproving were noted. The participants also reported a
significantly more secure and less avoidant and less anxious attachment
to God. There was a lack of a control group and a mixed nature of
participant treatment (ten participants were engaged in individual
therapy for at least a portion of the study) with presenting problems
including depression, anxiety, and bipolar disorder.
Thomas et al. (2011) confirmed the potential group work has for
improving the God image; however, no study in the God attachment
literature (individual or group therapy-focused) utilized random
assignment, a comparable group, and a control group. Accordingly, the
current study begins to address this gap in the literature. Applying the
same manualized protocol as was used in the Thomas et al. (2011) study,
we sought to assess the effects of a manualized group treatment
protocol. We compared the treatment group to a manualized Bible study
control group and a wait-list control group on God image and attachment
to God in a sample of undergraduate college students attending a
conservative Christian college. We hypothesized that the Thomas et al.
(2011) group protocol would demonstrate improved God image and
attachment compared to the manualized Bible study and wait-list control
groups. We also hypothesized that both the group treatment and the Bible
study would reflect improved religious coping and improved general
spiritual outcomes compared to the wait-list control group.
Method
Participants
After Institutional Review Board (IRB) approval, participants were
solicited from a Baptist-affiliated college student community. The
inclusion criteria were as follows: (a) participants must be between the
ages of 18 and 29; (b) enrolled as an undergraduate college student at
the college; (c) not currently a Spiritual Life Leader (a campus
leadership role which includes facilitating prayer groups with peers);
and (d) self-reported to be within the Christian tradition. Exclusion
criteria included: (a) presence of significant psychological distress or
pathology; this information came from the Client Demographic Form and
the screening interview; and (b) limited capacity for insight that is
needed for this type of treatment. The screening interview assisted in
making this determination.
Of the 96 students who completed the study materials, 36 were
identified as eligible participants and volunteered for the study.
Thirty participants completed the nine-week study. The dropout rate
overall for this study was 16.6%. Attrition resulted from general life
issues that arose in the life of some participants resulting in a
decision to not complete the study.
The participants had a mean age of 20 years and a mean education
level of college sophomore. Twelve participants were male and 18 were
female. Ninety-seven percent of the participants were single.
Eighty-seven percent of the participants had an annual income ranging
from $0 to $10,000. Ninety-three percent of the participants were
White/Caucasian.
Design and Procedure
A randomized control group pretest-posttest design was used in this
study. The study was promoted through chapel services, campus wide
e-mails, and personal communication with students who met the inclusion
criteria. It was presented to the student population as an optional
group process designed to help people compare and contrast their
emotional and theological ideas of God.
The student body was given the opportunity to take the Attachment
to God Inventory (AGI; Beck & McDonald, 2004) at the conclusion of a
weekly chapel service (n = 96). They could also opt out. It was
emphasized that there were no "correct" answers to the survey
questions; rather, the project was to get a sense of their genuine
experience. Students who revealed problems related to their emotional
experience of God on the AGI were specifically targeted as potential
participants (n = 40) and were given a screening interview if they
endorsed interest on the survey. This interview consisted of an informed
consent procedure and an inclusion criteria interview to determine
whether he or she was appropriate for group therapy aimed at improving
God image and attachment to God. Thirty-six were deemed eligible.
The consenting participants (N = 30) were randomly assigned to one
of three groups--the treatment group (n = 11), the Bible study group (n
= 10), and the wait-list control group (n = 9)--by a randomized block
design procedure to ensure that each group had an approximately equal
pre-test mean.
The treatment group and Bible study group met for nine 55-minute
sessions. Absences from the group were strongly discouraged, but in the
case of an absence, the group member met individually with one of the
group leaders for an individual session that covered the content of the
missed session. The wait list control group met twice, primarily for
assessment purposes. The first meeting was during week one of the other
two groups. The second meeting was during week nine of the other two
groups. The members of the Bible study group and wait list control group
were given the option of participating in the treatment group protocol
following the conclusion of this study. Group members were given a
debriefing form at the conclusion of the group process. The same
instruments were administered to the participants following the last
group session, excluding the Indiscriminate Proreligiousness Scales
Personal Form (IPS).
Setting
This study was conducted at a Baptist-affiliated college in the
South. At the present time, students pursue undergraduate degrees in
ministry (pastoral training, youth ministry, Christian education, and
missions) and non-ministry programs (teacher education, psychology,
business, pre-nursing, history, music, and English). Every student,
regardless of degree program, is required to give personal testimony and
accompanying references attesting to personal Christian faith and
pursues a Bible major. The 2010-2011 student body was comprised of 280
students from fourteen states and five foreign countries. The school
presents itself to prospective and current students as a Christian
community of faith and learning.
Therapists
The individuals who served as co-leaders for the groups for this
study were experienced in group therapy. One co-leader was a Licensed
Clinical Pastoral Therapist in Tennessee, and the other co-leader was a
doctoral student and primary researcher tor this study. The group
leaders had adequate time to become appropriately skilled in the use of
the group treatment manuals. Each gained further experience with these
manuals by leading a pilot study comprised of local church volunteer
participants. Throughout the duration of the study the group leaders met
together for a weekly 20-minute debriefing session.
Treatment
Manuals that specify the procedures for each of the nine 55-minute
group sessions were developed for the treatment group (Thomas et al.,
2011) and the Bible study group (Rasar, 2010). The Discovering God
manual used by the treatment group is specifically geared toward God
image and attachment to God in content and homework assignments. The
group time also included psychoeducational components and discussion.
The Spiritual Life Group manual used by the Bible study group was meant
to replicate the peer led group process in which all students at the
college engage as a part of their college experience called Spiritual
Life Group. These groups focus on passages of scripture over the
academic term, utilize group discussion, scripture memorization, and
incorporate spiritual formation activities. The only differences in the
Bible study group for this study were that it was nine weeks to match
the treatment protocol and was led by two co-leaders (a licensed
therapist and a doctoral student clinician).
The integrity of the treatments was evaluated through audio taped
sessions and weekly debriefing sessions with the primary researcher. The
primary researcher listened to the audio taped sessions each week. The
sessions took place on the college campus. Adherence to the group
manuals was emphasized, but the leaders had some freedom and flexibility
for personal style. This flexibility did not deviate beyond the scope of
the manual and the study itself.
Measures
Six measures were used in this study: the Attachment to God
Inventory (Beck & McDonald, 2004), God Image Scales (Lawrence,
1997), Spiritual Assessment Inventory (Hall & Edwards, 2002), Brief
Measure of Religious Coping Scale (Pargament et al., 1998), Theistic
Spiritual Outcomes Survey (Richards et al., 2005), and Indiscriminate
Proreligiousness Scale (Pargament et al.,1987). These measures were
specifically selected because they assess components of the hypotheses
in this study, they demonstrate acceptable psychometrics, and the
combined item total enhanced the likelihood of reliable participant
responses.
Attachment to God Inventory. Beck and McDonald (2004) developed a
scale to operationalize the attachment to God construct. Two Attachment
to God Inventory subscales are Avoidance of Intimacy and Anxiety about
Abandonment. Research has demonstrated good internal consistency for
both of these subscales. The Cronbach's alphas were .86 for the
Avoidance of Intimacy subscale and .87 tor the Anxiety about Abandonment
subscale (Cooper, Bruce, Harman, & Boccaccini, 2009). The AGI is a
28-item measure with items such as, "I worry a lot about my
relationship with God" and "I am uncomfortable allowing God to
control every aspect of my life." The items are rated on a 7-point
Likert scale, with a response of 1 meaning disagree strongly and a 7
meaning agree strongly. Scale scores for each Avoidance ot Intimacy and
Anxiety about Abandonment can range from 14 to 98.
God Image Scales. The God Image Scales (GIS; Lawrence, 1997)
measure a persons God image using six subscales, including Presence
(Cronbach's a = .95), Challenge (Cronbachs a = .81), Acceptance
(Cronbach's [alpha] = .83), Benevolence (Cronbach's [alpha] =
.84), Influence (Cronbach's [alpha] = .89), and Providence
(Cronbach's ([alpha] = .89). The 72-item measure includes items
such as, "I can talk to God on an intimate basis," "God
keeps asking me to try harder," and "God loves me
regardless." Each item is rated on a 4-point Likert scale using the
terms strongly agree, agree, disagree, and strongly disagree. Scale
scores for each of the GIS subscales can range from 12 to 48.
Spiritual Assessment Inventory. Hall and Edwards (2002) designed
the Spiritual Assessment Inventory (SAI) to assess awareness of God and
quality of relationship with God. These dimensions of the SAI include
five subscales (Awareness, Realistic Acceptance, Disappointment,
Grandiosity, and Instability). For the purposes of this study, the
Instability (SAI-I; Cronbach's [alpha] = .84) and Awareness (SAI-A;
Cronbach's [alpha] = .95) subscales were selected to administer to
the participants. The 9-item Instability subscale and the 19-item
Awareness subscale are rated on a 5-point Likert scale, with a response
of 1 meaning not at all true and 5 meaning very true. Instability scale
scores can range from 9 to 45. Items such as, "I am afraid that God
will give up on me," and "There are times when I feel that God
is punishing me," are included in the Instability subscale.
Awareness scale scores can range from 19 to 95. Items such as,
"God's presence feels very real to me," and "I have
a sense of the direction in which God is guiding me," are included
in the Awareness subscale.
Brief Measure of Religious Coping Scale. The Brief Measure of
Religious Coping Scale (Brief RCOPE; Pargament et al., 1998) is a
14-item measure that assesses positive and negative patterns of
religious coping methods. The positive pattern is an expression of a
sense of spirituality, a secure relationship with God, the belief that
there is meaning in life, and spiritual connectedness with others. The
negative pattern is a less secure relationship with God, an ominous view
of the world, and a religious struggle in the search for significance.
In the instructions tor this scale the respondent is asked to think of a
recent struggle in his or her life and to identify how much the items
were used in coping. Items such as, "I looked for a stronger
connection with God," and "I questioned Gods love tor
me," are rated on a 4-point Likert scale, with a response of 0
meaning not at all and 3 meaning a great deal. Validity for the scale
has proved to be good, with unique variance accounted for by each
subscale. The Cronbach's alphas were .87 and .78 for the positive
pattern and negative pattern, respectively. Scores for each of these
scales can range from 0 to 21.
Theistic Spiritual Outcomes Survey. The Theistic Spiritual Outcomes
Survey (TSOS; Richards et al., 2005) is a 17-item measure with items
such as, "I felt God's love," "I felt forgiveness
towards others," and "I loved myself," that assesses
spiritual outcomes of psychotherapy from a theistic spiritual
perspective. Three TSOS subscales are Love of God (Cronbach's
[alpha] = .93), Love of Others (Cronbach's [alpha] = .80), and Love
of Self (Cronbach's [alpha] = .80). The individual is asked to read
each item and answer how he or she felt in the past week. The items are
rated on a 5-point Likert scale, with potential responses of never;
rarely, sometimes, frequently, and almost always. Scores on the six-item
Love of God subscale can range from 6 to 30. Scores on the six-item Love
of Others subscale can also range from 6 to 30. Scores on the five-item
Love of Self subscale can range from 5 to 25.
Indiscriminate Proreligiousness Scale. The Indiscriminate
Proreligiousness Scale (IPS; Pargament et al., 1987) was developed to
measure religion expressed through personal channels (Pro-P subscale).
This subscale was validated on church going students. "In
discriminate proreligiousness is operationally defined here as a
positive response to religious material regardless of its
plausibility" (Pargament et al., 1987, p. 185). When this
orientation is present, it tends to interfere with the measurement of
religious constructs. It was used as a covariate to control for a type
of social desirability in this study. The Pro-P subscale consists of 12
items (Cronbach's [alpha] = .75). Items such as, "I am always
inspired by the sermon topics," and "Praying always brings me
inner peace," are included on the Pro-P scale. The items are rated
as either true or false.
Results The participants (N = 30) were randomly assigned to three
groups; a treatment group (n = 11), a Bible study group (n = 10), and a
wait-list control group (n = 9). A data integrity check was completed
for each participant, by a colleague of the primary researcher. The
normality of the sample was checked via histograms, Shapiro-Wilks tests
of normality, and skewness and kurtosis statistics for each group and
for the sample as a whole. Even with a relatively small sample size (N =
30), most of the dependent variables were normal (p > .05). Out of
the 32 subscales completed by the participants, those that were not
normal were within appropriate skewness (+/-2) and kurtosis (+/-3)
parameters. MANCOVA and ANCOVA are both robust statistics to manage
these minor violations of normality (Tabachnick & Fidell, 2006).
Table 1 displays the means and standard deviations for each group for
the pre-tests and post-tests for each subscale of each measure used in
the study, including the Indiscriminate Proreligiousness Scale which
served as the covariate.
TABLE 1
Pre-Test and Post-Test Scores
Variable Group Pre-test M(SD) Post-test M(SD)
AGI_Anxiety Treatment 60.20 (8.7) 62.58 (7.9)
Bible Study 60.20 (14.1) 55.44 (14.7)
WLC 59.64 (11.4) 60.76 (15.7)
AGI_Avoidance Treatment 43.40 (13.7) 47.04 (12.5)
Bible Study 46.34 (14.7) 38.22 (11.3)
WLC 49.14 (7.1) 51.24 (13.5)
GIS_Presence Treatment 27.48 (4.6) 25.56 (4.0)
Bible Study 23.64 (6.7) 20.16 (5.1)
WLC 23.64 (7.0) 25.32 (7.1)
GIS_Challenge Treatment 21.84 (3.7) 20.28 (2.8)
Bible Study 20.16 (3.8) 17.52 (2.3)
WLC 20.04 (3.5) 20.88 (4.9)
GIS_Acceptance Treatment 25.68 (4.7) 24.60 (4.7)
Bible Study 22.20 (4.8) 18.84 (3.7)
WLC 20.76 (5.9) 23.40 (7.1)
GIS_Benevolence Treatment 21.24 (3.6) 20.76 (3.1)
Bible Study 18.96 (3.1) 17.64 (2.6)
WLC 21.00 (4.3) 21.84 (6.2)
GIS_Influence Treatment 27.60 (4.5) 26.76 (3.3)
Bible Study 25.20 (4.4) 23.04 (4.0)
WLC 26.88 (5.7) 26.88 (6.9)
GIS_Providence Treatment 29.88 (3.0) 2.8.56 (3.5)
Bible Study 27.24 (5.3) 24.96 (2.9)
WLC 29.04 (4.2) 27.84 (5.6)
SAI_Instability Treatment 26.91 (6.0) 26.82 (6.0)
Bible Study 25.20 (5.9) 25.38 (6.6)
WLC 25.92 (6.0) 25.56 (7.6)
SAI_Awareness Treatment 54.53 (15.0) 61.75 (13.0)
Bible Study 63.65 (14.6) 76.00 (14.2)
WLC 63.27 (14.4) 60.80 (18.9)
RCOPE_Positive Treatment 13.02 (3.6) 15.19 (2.3)
Bible Study 12.39 (2.5) 16.17 (2.9)
WLC 15.54 (4.3) 15.68 (1.5)
RCOPE_Negative Treatment 6.30 (4.4) 6.09 (5.0)
Bible Study 5.88 (4.3) 6.23 (3.7)
WLC 5.11 (6.0) 6.65 (4.9)
TSOS_Love of God Treatment 17.70 (3.1) 21.00 (2.6)
Bible Study 20.82 (6.0) 25.50 (4.3)
WLC 21.00 (2.8) 20.64 (4.5)
TSOS_Love of Others Treatment 22.56 (2.1) 24.00 (3.8)
Bible Study 22.62 (3.2) 27.12 (2.8)
WLC 22.02 (3.4) 23.22 (3.4)
TSOS_Love of Self Treatment 14.45 (2.6) 15.10 (2.7)
Bible Study 15.00 (3.4) 18.00 (4.3)
WLC 18.55 (2.1) 14.90 (3.8)
IPS_Pro-P Total Sample 17.90 (1.4)
Note. Treatment Group. n = 11; Comparable Group n = 10; Wait List
Control (WLC) Group, n = 9; IGI = Attachment to God Inventory; GIS
= God Image Scales; SAI = Spiritual Assessment Inventory; RCOPE =
Brief Measure of Religious Coping Scales; TSOS = Theistic Spiritual
Outcome Survey. The score range for each 14 item AGI subscale was I
i to 98. The score range for each 12 item GIS subscale was 12 to
48. The score range for the 19 item SAI_Awareness subscale was 19
to 95. The score range for the 9 item SAI_Instability subscale was
9 to 45. The score range for each 7 item RCOPE subscale was zero to
21. The score range for the six item TSOS_Love of God and the six
item TSOS_Love of Others subscales was 6 to 30. The score range for
the five item TSOS_Lovc of Self subscale was 5 to 25. The score
range for the 12 item IPS_Pro P Subscale was 12 to 24. The IPS-Pro
P was used as a covariate.
We hypothesized that the Thomas, et al. (2011) group protocol would
demonstrate improved God image and attachment to God compared to the
manualized Bible study and wait-list control group. This hypothesis was
not supported in its entirety. The MANCOVA results did not indicate a
significant decrease in avoidant attachment to God (p = .11) or anxious
attachment to God (p = .71) as measured by the AGI in the treatment
group. The MANCOVA results did not indicate significantly more positive
God images as measured by the combined GIS, SAI-I, and SAI-A scales in
the treatment group (p = .17).
Given the number of univariate ANCOVAs analyzed and the potential
for false positives, p was set at [less than or equal to] .01 for
significance. The results of a univariate ANCOVA indicated a trend
toward more positive awareness of God (p < .05) as measured by the
SAI-A in the treatment group compared to the wait-list control group.
The results of a univariate ANCOVA also indicated a trend toward more
positive God images as measured by the GIS for two of the subscales in
the manualized Bible study group compared to the waitlist control group:
Gods presence (p < .05), Gods influence (p < .05), and a
significant increase in awareness of God (p < .01). Table 2 displays
MANCOVA results tor each hypothesis, and Table 3 displays ANCOVA results
and mean group differences for each hypothesis.
TABLE 2
MANCOVA Post Results
Variable Group M F p Partial
[[eta].sup.2]
AGI_Anxiety Total Sample .34 .71 .03
Treatment 4.23
Bible Study 4.14
WLC 4.43
AGI_Avoidance Total Sample 2.43 .11 .17
Treatment 3.36
Bible Study 2.83
WLC 3.54
GIS_Presence Total Sample 4.84 .02 .35
Treatment 1.93
Bible Study 1.76
WLC 2.26
GIS_Challenge Total Sample 2.60 .10 .22
Treatment 1.60
Bible Study 1.48
WLC 1.83
GIS_Acceptance Total Sample 3.26 .06 .27
Treatment 1.90
Bible Study 1.61
WLC 2.09
GIS_Benevolence Total Sample 2.2 .13 .20
Treatment 1.62
Bible Study 1.53
WLC 1.89
GIS_Influence Total Sample 3.79 .04 .30
Treatment 2.08
Bible Study 1.95
WLC 2.40
GIS_Providence Total Sample 1.48 .26 .14
Treatment 2.25
Bible Study 2.16
WLC 2.39
SAI_Instability Total Sample .11 .89 .01
Treatment 2.91
Bible Study 2.80
WLC 2.96
SAI_Awareness Total Sample 8.23 .00 .48
Treatment 3.64
Bible Study 3.88
WLC 2.86
RCOPE_Positive Total Sample .88 .43 .07
Treatment 2.19
Bible Study 2.36
WLC 2.16
RCOPE_Negative Total Sample .15 .87 .01
Treatment .82
Bible Study .93
WLC .97
TSOS_Love of Total Sample 5.74 .01 .33
God
Treatment 3.75
Bible Study 4.24
WLC 3.15
TSOS_Love of Total Sample 4.04 .03 .26
Others
Treatment 3.96
Bible Study 4.56
WLC 3.87
TSOS_Love of Total Sample 6.70 .01 .37
Self
Treatment 3.13
Bible Study 3.84
WLC 2.57
Note. AGI = Attachment to God Inventory; GIS God Image Scales; SAI
Spiritual Assessment Inventory; RCOPE = Brief Measure of Religious
Coping Scale; TSOS = Theistic Spiritual Outcome Survey. Total
Sample. N = 30; Treatment Group, n = 11; Comparable Group n = 10;
Wait List Control (WLC) Group, n = 9; df= 2. Covariate appears in
the model.
TABLE 3
ANOVA Results of Post Mean Group Differences
Variable Group (I) Group (J) Mean Difference (I-J) p
AGI_Anxiety Treatment Bible Study .09 .99
Wait List -20 .93
Bible Study Treatment -.09 .99
Wait List -.29 .81
WLC Treatment .20 .93
Bible Study .29 .81
AGI_Avoidance Treatment Bible Study .54 .35
Wait List -.18 .94
Bible Study Treatment -.54 .35
Wait List -.72 .12
WLC Treatment .18 .94
Bible Study .72 .12
GIS_Presence Treatment Bible Study .17 .57
Wait List -.33 .20
Bible Study Treatment -.17 .57
Wait List -.51 * .02
WLC Treatment .33 .20
Bible Study .51 * .02
GIS_Challenge Treatment Bible Study .11 .79
Wait List -.22 .43
Bible Study Treatment -.12 .79
Wait List -.34 .10
WLC Treatment .23 .43
Bible Study .34 .10
GIS_Acceptance Treatment Bible Study .29 .31
Wait List -.18 .77
Bible Study Treatment -.29 .31
Wait List -.47 .08
WLC Treatment . 1 8 .77
Bible Study .47 .08
GIS_Benevolence Treatment Bible Study .09 .92
Wait List -.27 .39
Bible Study Treatment -.09 .92
Wait List -.36 .14
WLC Treatment .27 .39
Bible Study .36 .14
GIS_Influence Treatment Bible Study .13 .77
Wait List -.32 .23
Bible Study Treatment -.13 .77
Wait List -.46 * .04
WLC Treatment .32 .23
Bible Study .46 * .04
GIS_Providence Treatment Bible Study .08 .87
Wait List -.14 .68
Bible Study Treatment -.08 .87
Wait List -.22 .28
WLC Treatment .14 .68
Bible Study .22 .28
SAI_Instability Treatment Bible Study .11 .98
Wait List -.05 .99
Bible Study Treatment -.11 .98
Wait List -.16 .96
WLC Treatment .05 .99
Bible Study .16 .96
SAI_Awareness Treatment Bible Study -.25 .65
Wait List .78 * .03
Bible Study Treatment .25 .65
Wait List 1.03 ** .00
WLC Treatment -.78 * .03
Bible Study -1.03 ** .00
RCOPE_Positive Treatment Bible Study -.16 .65
Wait List .04 .99
Bible Study Treatment .16 .65
Wait List .20 .55
WLC Treatment -.04 .99
Bible Study -.20 .55
RCOPE_Negative Treatment Bible Study -.11 .97
Wait List -.15 .94
Bible Study Treatment .11 .97
Wait List -.04 .99
WLC Treatment .15 .94
Bible Study .04 .99
TSOS_God Treatment Bible Study -.49 .25
Wait List .60 .23
Bible Study Treatment .49 .25
Wait List 1.08 ** .01
WLC Treatment -.60 .23
Bible Study -1.08 ** .01
TSOS_Others Treatment Bible Study -.59 .07
Wait List .09 .99
Bible Study Treatment .59 .07
Wait List .68 .08
WLC Treatment -.09 .99
Bible Study -.68 .08
TSOS_Self Treatment Bible Study -.71 .09
Wait List .55 .38
Bible Study Treatment .71 .09
Wait List 1.27 ** .01
WLC Treatment -.55 .38
Bible Study -.12 ** .01
Note. AGI = Attachment to God Inventory; GIS = God Image Scales; SAI
= Spiritual Assessment Inventory; RCOPE = Brief Measure of Religious
Coping Scale; TSOS = Theistic Spiritual Outcome Survey. Based on
estimated marginal means. df 2.
a. Adjustment for multiple comparisons: Sidak.
* The mean difference suggests a trend at the .05 level.
** The mean difference is significant at the .01 level.
We also hypothesized that both the treatment group and the Bible
study would reflect improved religious coping and improved general
spiritual outcomes compared to the wait-list control group. This
hypothesis was partially supported. The MANCOVA results indicated a
significant increase in love of God, others, and self as measured by the
TSOS (p = .05). Furthermore, significance was also indicated for two of
the TSOS subscales and a trend towards significance in the third: Love
of God (p = .01), Love of Others (p = .05), and Love of Self (p = .01).
The MANCOVA results did not indicate a significant difference in
positive patterns of religious coping as measured by the Brief RCOPE (p
= .74).
In summary, in this study there was an indication that those who
participated in the treatment group and Bible study group experienced an
overall significant increase in love of God, others, and self compared
to the wait list control group. Also, the mean group differences
indicated a significant increase in three God images; God's
presence, God's influence, and awareness of God by the participants
of the manualized Bible study group, and an increase in awareness of God
by the treatment group. Overall, the Bible study group showed more
change than the treatment group.
Discussion This study randomized participants into a God image
treatment protocol, manualized Bible study, and a wait-list control
group to compare their efficacy in regards to changing God image, God
attachment, religious coping, and general spiritual outcomes such as
increasing one's love of God, others, and self. No significant
changes in God attachment (measured by AGI), God image (measured by CIS
and SAI), or religious coping (measured by Brief RCOPE) were noted in
the treatment protocol compared to the Bible study. An increase in
general spiritual outcomes (love of God, others, and self as measured by
the TSOS) was observed in both the treatment protocol and the manualized
Bible study compared to the wait-list control group. Review of the
pre-test and post-test means suggest that changes were likely greater in
the Bible study group compared to the treatment group.
Essentially, this study suggests common core elements in
spiritually-focused groups may produce positive spiritual outcomes but
the question of how to produce positive God attachment change remains
unanswered. Moreover, the value of small group spiritual
formation-focused Bible studies in general in the Christian college and
university environments is supported since both groups exhibited
significant changes compared to the wait-list control group that did not
improve on any of this study's measures.
The results are not congruent with the Thomas et al. (2011) study.
Although both studies incorporated the same treatment manual, this study
had several methodological improvements. The current study was
randomized, included a manualized Bible study comparison group, and had
a wait-list control group. The Thomas et al. study included some
participants that were simultaneously engaged in individual therapy and
die group treatment, while this study excluded potential participants
that were currently in individual therapy. Furthermore, this study
utilized multiple quantitative measures, as opposed to Thomas'
study, which utilized only the Attachment to God Inventory. Since the
results of this study contradict the Thomas et al. (2011) study, perhaps
God attachment change may be harder to realize than anticipated.
This study's design improvements strengthen the
interpretability of its results compared to the Thomas et al. study;
however, other factors may also contribute to the differences in
results. Specifically, the treatment protocol used may need to be
revised based on age cohort and developmental differences in the samples
studied. For example, the mean age in the Thomas study was 30 and the
mean age in this study was 20. Perhaps the treatment group manual is
better suited tor an adult population that is not in an undergraduate
college setting.
Observations of the group counselors seem to support the role of
cohort differences compared to the Thomas et al. (2011) study. The age
difference (mean of 20 in this study and 30 in the Thomas et al. study),
developmental differences, educational level, spiritual maturity, and
peer-led spiritual life group context compared to the clinical context
ot the Thomas et al. (2011) study may have all contributed to the
different findings.
Two different treatment protocol responses compared to the Thomas
et al. (2011) study will be noted. First, the initial four treatment
protocol sessions were primarily experiential and the last four utilized
more rational emotive interventions. Group member engagement appeared to
decrease when the treatment group manual shifted away from the
experiential components. In the second example, the reading of C.S.
Lewis' book, The Horse and His Boy, was noted by Thomas et al. as
having meaningful impact on their participants. It did not seem to have
the same positive impact on the participants in this study. We surmise
that assigned bibliotherapy with young college age students may not be
as effective as it is with other populations due to the number of books
they are already reading in their academic endeavors.
Additional treatment protocol enhancements may likewise benefit
future studies. More emphasis on comparing and contrasting the group
members' families of origin and their experiences with their
parents may profit participants. While the treatment protocol used in
this study included a family of origin component, time was limited for
detailed group discussion on this topic. In another example, one session
included an exercise in which the participants were asked to visualize a
time in their lives that involved regret, with a homework exercise
asking participants to write a letter to themselves "from
God." Time was limited for much group discussion on this activity,
but group members indicated they would have liked this part of the group
process to fill an entire session. Finally, the treatment protocol may
have benefited from the incorporation of contemplative prayer, spiritual
formation exercises, inner healing prayer, and perhaps longer time
length to permit better processing of new information.
The nature of the Bible study group also may have had an impact on
the results. The entire Bible study group protocol emphasized just one
passage of scripture (Psalm 8), included ample time for group
discussion, and incorporated homework assignments that were primarily
spiritual formation exercises. The interpersonal and experiential
aspects of this type of Bible study may have contributed to the
intriguing positive spiritual outcomes on the TSOS. To our knowledge,
this is the first preliminary empirical support for the efficacy of
small group, spiritual formation-focused Bible studies.
Future research using a revised treatment group manual and
replicating the randomization and Bible study group design is
recommended to strengthen the understanding of the impact of group
treatment on God image and God attachment change. Also, future studies
might consider the efficacy of short-term groups compared to long-term
groups or individual therapy in regards to God image and God attachment
change.
Limitations
There were several limitations in this study that should be
considered in interpreting its results. The scope of this study was
intentionally limited to the Bible college context and non-clinical
population. Peer prayer groups were a common element of the community
from which participants were drawn, so the motivation of participants
could have varied. While motivation appeared good to the researchers,
this context could contribute to the limited results for the treatment
group. The sample size was quite small (N = 30) and included only
college students attending a Christian university. Future research with
larger samples, greater ethnicity and age diversity, and beyond the
context of a Christian college would amplify the knowledge base on God
image and attachment to God treatment and change. Finally, a
longitudinal outcomes component would provide further insight into the
maintenance of any God image, God attachment, and religious coping
change.
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Glendon L. Moriarty
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Author Information
RASAR, JACQUELINE D. Ph.D. Address: 114 Tamarisk St., Redlands, CA
92373. Email:
[email protected]. Title: Adjunct Instructor, Liberty
University, Lynchburg, VA. Degree: PhD (Professional Counseling)
GARZON, FERNANDO L. Psy.D. Address: Center for Counseling and
Family Studies, 1971 University Blvd., Liberty University, Lynchburg,
Virginia 24515.
MORIARTY, GLENDON L. Psy.D. Address: School of Psychology and
Counseling, Doctoral Program in Clinical Psychology, Regent University,
Virginia Beach, Virginia 23464;
VOLK, FREDERICK. Address: Center for Counseling and Family Studies.
Liberty University, 1971 University Blvd. Lynchburg, Virginia 24515;
O'HARE, CARMELLA A. Address: Center for Counseling and Family
Studies, Liberty University, 1971 University Blvd, Lynchburg, Virginia
24515.
