Why Mindfulness and not Spirituality?
Mindfulness is a widely used intervention to reduce stress, increase performance, and in some cases address pain (Hardison and Roll, 2016). The research of the positive impact of mindfulness is consistent and a large component of mindfulness is a connection with one’s present self to ward off the negative effects of anxiety surrounding thoughts of past or future situations. In occupational therapy, the usage of mindfulness in clinical practice is not questioned because mindfulness is largely secular. However, a large component of mindfulness centers on letting go of what is outside of one’s control and focusing on what can be controlled to address the needs of the client—usually to address anxiety, pain, or function. This mindset mirrors spirituality in many ways, yet spirituality is not an activity that is utilized in occupational therapy despite being an Instrumental Activity of Daily Living.
Spirituality, an IADL
Despite being defined in the OTPF-4 as an occupation, spirituality is underutilized and rarely addressed in the field. In the OTPF-4 spirituality is categorized as “religion and spiritual expression” and defined as “Engaging in religious or spiritual activities, organizations, and practices for self-fulfillment…establishing a connection with a divine power, such as is involved in attending a church, temple, mosque, or synagogue…may also include giving back to others, contributing to society or a cause, and contributing to a greater purpose.” (AOTA, 2020, p. 31).
Impact of Spirituality on Health Outcomes
Research has shown the positive impact of spirituality on client health outcomes. Researchers have demonstrated that the active practice of prayer, along with a positive attitude, healthy lifestyle, and substantial physical and emotional support of the community, significantly improves medical outcomes (Benson, 1996; Koenig, 1999; Matthews, 1998; McCullough & Larson, 1999; Meyers, 1999; WHOQOL SRPB Group, 2006 as cited by Drench et al. 2012).
The following are documented health benefits that have been found among adults who practice spiritual beliefs on a regular basis (Drench et al., 2012):
• Significantly reduced blood pressure • Stronger immune systems • Fewer health problems • Fewer hospitalizations • Shorter lengths of stay when hospitalized • Stronger social support systems • Stronger family ties • Stronger and healthier marriages • Stronger sense of well-being and acceptance • Lower rates of depression.
Implementing Spirituality in Occupational Therapy Practice
Therefore, the use of spirituality as part of an intervention has mental and physical health benefits with the potential to increase the quality of life of a client. While spirituality is an IADL in the OTPF-4 and has been found to benefit the mental and physical health of a client following a recent medical issue, occupational therapy practitioners are hesitant to bring spirituality into their practice. However, addressing the spirituality of clients does not have to be controversial and our clients can benefit from the positive effects of spirituality on the healing process.
In Part II, we will look at the viewpoints of occupational therapy practitioners around spirituality, the reasons for hesitation to use spirituality during interventions, client views of using spirituality during intervention sessions, and ways to successfully implement spirituality in practice.
How do you feel about using spirituality in occupational therapy practice? Do you see a difference in outcomes with clients that focus on spirituality as part of their intervention compared to clients that prefer to not use spirituality as part of their intervention?
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001
Drench, M.E., Noonan, A.C., Sharby, N.E., & Ventura, S.H. (2012). Psychosocial aspects of healthcare (3rd ed.). Pearson.
Hardison, M. E., & Roll, S. C. (2016). Mindfulness interventions in physical rehabilitation: A scoping review. American Journal of Occupational Therapy, 70, 7003290030. http://dx.doi.org/10.5014/ajot.2016.018069