Spirituality and Health

It always seemed natural to me, as a lifelong Christian, to think of spirituality/religiousness as a natural part of human life and personality, and something important to be considered in psychotherapy.  That was not at all the norm among American psychologists, however, who are still far less religious than the general population they serve (Delaney, Miller, & Bisonó, 2007).  In graduate training I certainly got the message that religion and spirituality were not something to be asked about or openly discussed by psychologists, nor was there much encouragement for this at first in the psychology department at UNM.  Nevertheless, working in this interface between spirituality and psychology has turned out to be one of the most rewarding and stimulating parts of my career.

            My first publication at this interface (which, you will note, appeared in the year after I was tenured) was a book that I wrote with my wife, Kathy Jackson, intended to share some practical psychology that might be useful in parish ministry (Miller & Jackson, 1985).  It survived into a second edition (Miller & Jackson, 1995) and was used not only by practicing pastors, but as a textbook on pastoral care in a number of seminaries.  I also wrote a general public book, translating cognitive therapy and the social psychology of self-fulfilling prophecies into language accessible for faith communities (Miller, 1986).   After it went out of print, I reworked and simplified it as a client resource that could be used in treatment programs (Miller, 2008).

            Translating psychology for religion was one thing, but communicating spirituality and religion to psychologists?  My first foray in this regard was initiated by John Martin, who was chairing the program committee for the Association for Advancement of Behavior Therapy (AABT).  This gave him the right to instigate one symposium, no questions asked.  It focused on behavior therapy and religion, and lest he be alone in the room, he asked me to co-chair it.  In fact, the room was packed, and the contributed papers naturally turned into an edited book (Miller & Martin, 1988).  My own paper and chapter focused on how cognitive therapy could be done in a faith-sensitive way (Miller, 1988).  This symposium led to the formation of an AABT Special Interest Group on Behavior Therapy and Religion that was still going two decades later.

Next I was invited to give the annual Leonard Ball Oration in Melbourne, Australia, and the controversial topic we negotiated was Spirituality: The Silent Dimension in Addiction Research (Miller, 1990).  This led to a series of papers and reviews over the years, discussing the role of spirituality in addiction and treatment (Miller, 1993, 1997, 1998, 2002a,b; 2003 a,b; Miller & Bogenschutz, 2007).  I also puzzled over what kind of social policy on alcohol/drug use might follow from biblical teachings, since the bible frequently mentions alcohol but of course does not address modern misused drugs (Miller, 1995), a process that was aided by my earlier participation in a national panel assembled to recommend changes in the alcohol policies of the Presbyterian Church (USA), which had not been modified since prohibition (Task Force Task Force on the Social and Health Effects of Alcohol Use and Abuse (1986).

            Based in part on this prior work, I was approached by the Templeton Foundation to participate in a project that Sir John Templeton very much wanted to accomplish in his lifetime.  They convened four panels of top scientists in each of four areas (1) mental health, (2) physical health, (3) addictions, and (4) neuroscience.  I chaired the addiction panel, and we were given free rein to select and recruit the panel members and conduct the process, by which we were directed to answer four questions:

1.  What do we already know from science about the relationship of spirituality/religiousness to health in your area?
2. What do we need to know about this, for which there are insufficient scientific data at present?
3. What are the obstacles that prevent us from gaining the needed knowledge?    And
4. How might those obstacles be overcome?

The panels met several times, leading to a capstone conference and a final report (Miller & Bennett, 1998).

I had invited, as participants on the addiction panel for the Templeton conference, two officers of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) – John Allen and Margaret Mattson.  When they returned to work, they proposed the NIAAA sponsor a national conference on research on spirituality and alcoholism.  I had already co-chaired, with Barbara McCrady, a NIAAA-sponsored conference on Research on Alcoholics Anonymous (McCrady & Miller, 1993), and I was asked to chair this meeting.  It went well, and led to a Request for Applications for grants on spirituality and alcoholism, which yielded one of the largest responses in the Institute’s history.  One byproduct of these meetings was the production of a comprehensive bibliography on spirituality and addictions, which was made available on-line (Geppert, Bogenschutz & Miller, 2007).

Meanwhile, I was working on a book on spirituality and its role in psychotherapy, a resource book for therapists.  To my surprise, I found that the American Psychological Association was interested in publishing it, and did so (Miller, 1999).

Emboldened by the success of the NIAAA conference and RFA, the NIH Office of Behavioral and Social Science Research initiated a trans-NIH study panel on spirituality and health, and again I was asked to chair it.  Once more we were able to assemble a panel of top scientists to take on some of the tough questions involved, and all NIH institutes were invited to participate.  Most of the commissioned papers from this process were published subsequently in a special issue of the American Psychologist (Miller & Thoresen, 2003).

Including measures of spiritual/religious variables in a larger study designed for other purposes is a relatively low-cost way to collect data, and we have often done so (e.g., Brown, Ashcroft & Miller, 1998; Connors, Miller & Tonigan, 2001; Tonigan, Connors & Miller, 2001).  We also initiated three controlled clinical trials on spiritual topics.  The first was a randomized trial of intercessory prayer for people in addiction treatment (Walker, Tonigan, Miller, Comer & Kahlich, 1997).  We found absolutely no beneficial impact of intercessory prayer, and one curious correlational wrinkle.  We asked clients at the beginning of the trial if they were aware anyone who was already praying for them, thinking that this might interact with the intervention.  Those who had said Yes, they knew someone praying for them, had significantly worse outcomes than those who had said No.

The other two studies were randomized trials of adding a structured spiritual guidance intervention (see Treatment Manuals) to inpatient treatment as usual for substance dependence, in a public hospital.  In the first study, the intervention was delivered by highly experienced spiritual directors, and in the second by volunteer staff of the hospital.  Contrary to the expectations of the investigators and those who delivered the interventions, we found absolutely no impact on substance use outcomes in either trial (Miller, Forcehimes, O’Leary & Lanoue, 2008).  In the first trial, in fact, those also receiving spiritual guidance showed significantly less reduction in anxiety and depression, compared to those receiving only treatment as usual.  Both studies encountered great difficulty in delivering more than a few of the intended twelve sessions of spiritual guidance, so the “dose” was low.  In neither study were we successful in increasing patients’ practice of spiritual disciplines.  What we came away with was the sense that we had been naïve to think of spiritual direction as an acute intervention for early treatment.  Spiritual formation occurs over longer spans of time, and the spiritual disciplines that we were including appear at the 11^th of the 12 Steps of Alcoholics Anonymous.   Perhaps we had delivered too little far too early.  The patients were right out of detoxification and faced a host of high-priority life problems upon discharge from the 3-week program.   We did, however, demonstrate that it is feasible to use solid scientific method and to measure the predicted impact of spiritual interventions in addiction treatment.

Publications on Spirituality and Health (in chronological order)

Miller, W. R., & Jackson, K. A. (1985).  Practical psychology for pastors: Toward more effective counseling.  Englewood Cliffs, NJ: Prentice-Hall.

Miller, W. R. (1985).  Living as if: How positive faith can change your life.  Philadelphia: Westminster Press.

Task Force on the Social and Health Effects of Alcohol Use and Abuse (1986).  Alcohol use & abuse: The social and health effects.  New York: The Program Agency, Presbyterian Church (U.S.A.).

Miller, W. R., & Martin, J. E. (Eds.) (1988).  Behavior therapy and religion: Integrating spiritual and behavioral approaches to change.  Newbury Park, CA: Sage Publications.

Miller, W. R. (1988).  Including clients’ spiritual perspectives in cognitive behavior therapy.  In W. R. Miller & J. E. Martin (Eds.), Behavior therapy and religion: Integrating spiritual and behavioral approaches to change (43-55).  Newbury Park, CA: Sage Publications.

Miller, W. R. (1990).  Spirituality: The silent dimension in addiction research.  The 1990 Leonard Ball oration.  Drug & Alcohol Review, 9, 259-266.

McCrady, B. S., & Miller, W. R. (Eds.) (1993). Research on Alcoholics Anonymous: Opportunities and alternatives.  New Brunswick, NJ: Rutgers Center of Alcohol Studies.

Miller, W. R. (1995).  Towards a biblical perspective on drug use.  Journal of Ministry in Addiction and Recovery, 2(2), 77-86.

Miller, W. R., & Jackson, K. A. (1995).  Practical psychology for pastors: Toward more effective counseling.  (2nd ed.)  Englewood Cliffs, NJ: Prentice-Hall.

Miller, W. R. (1996).  In memoriam: Howard P. Brown, Jr.  Alcoholism Treatment Quarterly, 14(3), 3-6..

Miller, W. R. (1997).  Spiritual aspects of addictions treatment and research.  Mind/Body Medicine: A Journal of Clinical Behavioral Medicine, 2, 37-43.

Walker, S. R., Tonigan, J. S., Miller, W. R., Comer, S., & Kahlich, L. (1997).  Intercessory prayer in the treatment of alcohol dependence: A pilot investigation.  Alternative Therapies, 3(6), 79-86.

Brown, J. M., Ashcroft, F. G., & Miller, W. R. (1998).  Purpose in life among alcoholics: A comparison of three ethnic groups.  Alcoholism Treatment Quarterly, 16(3), 1-11.

Miller, W. R. (1998).  Researching the spiritual dimensions of alcohol and other drug problems.  Addiction, 93, 979-990.

Miller, W. R., & Bennett, M. E. (1998).  Addictions: Alcohol/drug problems.  In D. B. Larson, J. P. Swyers, & M. E. McCullough (Eds.), Scientific research on spirituality and health: A consensus report (pp. 68-82).  Rockville, MD: National Institute for Healthcare Research.

Miller, W. R. (Ed.) (1999).  Integrating spirituality into treatment: Resources for practitioners.  Washington, DC: American Psychological Association.

Gorsuch, R. L. & Miller, W. R. (1999).  Measuring spirituality.   In W. R. Miller (Ed.), Integrating spirituality into treatment: Resources for practitioners (pp. 47-64).  Washington, DC: American Psychological Association.

Connors, G. J., Tonigan, J. S., & Miller, W. R. (2001).  Religiosity and responsiveness to alcoholism  treatments.  In R. Longabaugh & P. W. Wirtz (Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 166-175). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Tonigan, J. S., Miller, W. R., & Connors, G. J. (2001).  The search for meaning in life as a predictor of alcoholism treatment outcome.  In R. Longabaugh & P. W. Wirtz (Eds.), Project MATCH hypotheses: Results and causal chain analyses (pp. 154-165). Project MATCH Monograph Series, Vol. 8.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Miller, W. R. (2002a).  Spirituality and addiction: What research tells us.  Health and Spirituality Connection, 6(1), 3, 6-7.

Miller, W. R. (2002a).  Spirituality and the treatment of addictions.  New Directions in the Study of Alcohol, 26, 31-39.

Miller, W. R. (2003a).  Spirituality as an antidote for addiction.  Spirituality & Health, October, 34-38.

Miller, W. R. (2003b).  Spirituality, treatment and recovery.  In M. Galanter (Ed.), Recent Developments in Alcoholism (Vol. 16, Research on Alcoholism Treatment, pp. 391-404).  New York: Kluwer Academic / Plenum.

Miller, W. R., & Thoresen, C. E. (Eds.) (2003).  Special section on spirituality, religion and health.  American Psychologist, 58, 24-74.

Miller, W. R., & Thoresen, C. E. (2003).  Spirituality, religion, and health: An emerging research field.   American Psychologist, 58 24-35. 

Miller, W. R., & Thoresen, C. E. (2004).  Spirituality, health, and the discipline of psychology.  American Psychologist, 59, 54-55.

Miller, W. R., & Delaney, H. D. (2005).  Judeo-Christian perspectives on psychology: Human nature, motivation, and change.  Washington, DC: American Psychological Association.

Delaney, H. D., Miller, W. R., & Bisonó, A. (2007).  Religiosity and spirituality among psychologists: A survey of clinician members of APA.  Professional Psychology, 38, 538-546.

Geppert, C., Bogenschutz, M. P., & Miller, W. R. (2007).  Development of a bibliography on religion, spirituality and addictions.  Drug and Alcohol Review, 26, 389-395.

Miller, W. R., & Bogenschutz, M. P. (2007).  Spirituality and addiction.  Southern Medical Journal, 100, 433-436.

Miller, W. R.  (2008).  Living as if: Your road, your life.  (Client journal and facilitator guide.)  Carson City, NV: The Change Companies.

Miller, W. R., Forcehimes, A., O’Leary, M., & Lanoue, M. (2008).  Spiritual direction in addiction treatment: Two clinical trials.  Journal of Substance Abuse Treatment, 35, 434-442.