The development of the spiritual narrative questionnaire.

Moradshahi, Michael ; Hall, Todd W. ; Wang, David 等

Psychologists have been interested in the human experience of religion and spirituality (RS) for over a century. William James (1902) and Sigmund Freud (1907) were among the first to share their theoretical views about the psychological aspects of religion, and a growing number of psychologists continue to explore the subject. The quest for empirical knowledge of RS dates to the 1950s with Allport & Ross' (1967) Religious Orientation Measure, after which hundreds of self-report measures were developed to assess some aspect of religious experience, behavior, and belief (Hill & Hood, 1999; Hill & Smith, 2013).

Limitations of Self-Report Measures

Despite the strengths of self-report measures, there is increasing concern about their limitations (Edwards & Hall, 2003; Shedler, Mayman, & Manis, 1993, 2003; Slater, Hall, & Edwards, 2001). For example, participants vary in their ability and desire to understand questions, perform introspection, and answer honestly. Even if a participant is willing and able to answer accurately, responses may vary between individuals based on, for example, how much evidence is needed for an "affirmative" response, whether the individual tends to answer towards the extremes of a Likert scale or hover around the center, or how much "space" an individual envisions between the points of a scale. Furthermore, rich autobiographical data is missed when quantitative answers to yes/no or Likert scale questions are the only response options. There are many advantages to self-report scales; however, these issues show that alternative approaches are needed.

The Framework for a New Measure

A number of recent theoretical advances in spiritual assessment have set a platform from which a new measure can be created. One such advance is the development of the "Multilevel Interdisciplinary Paradigm" (MIP; Emmons & Paloutzian, 2003). This paradigm values the analysis of a given construct at multiple levels (e.g., intrapersonal, social/interpersonal, and community levels). It is also non-reductive in nature and thus open to physical, psychological, and spiritual explanations of phenomena. Finally, this paradigm posits that progress in RS research and assessment advances as various fields (e.g., neurobiology, psychology, theology) are integrated.

An example of the MIP paradigm that is making significant contributions to our understanding of RS is "relational spirituality" (Hall, 2004). Drawing from recent advances in psychoanalysis, interpersonal neurobiology, and affective neuroscience, Hall described five "central organizing principles" of relational spirituality. In short, Hall argued that early relational experiences shape an individual's "gut-sense" of how significant relationships operate and that this "implicit relational knowledge" subconsciously impacts an individual's experience of the Divine. Relational spirituality continues to be a topic of considerable interest to researchers (e.g., Hall, 2004, 2007; Leffel, 2007a, b, c; Sandage & Crabtree, 2012; Williamson & Sandage, 2009).

Assessment Within the Relational Spirituality Paradigm

Relational spirituality provides an organizational structure for researchers to use in developing new RS measures. The first measure developed out of this paradigm was the Spiritual Assessment Inventory (SAI; Hall & Edwards, 1996), a measure of spiritual maturity from an object relations framework. Following the SAI, Rowatt and Kirkpatrick (2002) developed a dimensional scale entitled the "Attachment to God Scale" for measuring attachment to God based on Kirkpatrick and Shaver's (1992) descriptions of different attachment styles. Beck and McDonald (2004) developed the Attachment to God Inventory (AGI), a measure designed to assess attachment dimensions of Avoidance of Intimacy and Anxiety about abandonment. More recently, Hall (2003) developed the Spiritual Transformation Inventory (STI) as a broad measure of spirituality designed for research and clinical use. These instruments provide a comprehensive view of spiritual functioning from a variety of theoretical perspectives.

Psychoanalytically-based narrative assessment of RS. Many researchers within the relational spirituality paradigm have integrated psychoanalytically oriented methods of assessment in hopes of accessing implicit psychospiritual functioning. one measure that has been adapted for use in RS assessment is the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1984, 1985, 1996; Main, Kaplan, & Cassidy, 1985). The AAI utilizes a unique form of narrative analysis, as Siegel (2012) explains: The AAI requires that the speaker perform the dual tasks of collaborative communication and searching for memories. The search for memories of one's own childhood while maintaining typical discourse can lead to characteristic violations of Grice's four maxims of discourse that pertain to quality, quantity, relation, and manner. violations are seen as types of incoherencies in the narrative process.. Assessment of the AAI examines how a speaker's state of mind at the time of the interview facilitates or impedes the ability to carry out a truthful/collaborative discourse while simultaneously conducting autobiographical reflections. (p. 107)

A number of measures have demonstrated the efficacy of AAI-based narrative measurement tools in measuring RS. For example, Proctor's (2006) God Attachment Interview Schedule (GAIS) encourages participants to answer freely regarding their spirituality. By analyzing the content of the interview using the AAI's coherence analysis, Proctor (2006) was able to explore how a person experienced God at an implicit level. Building on the work of Proctor (2006), Teal (2006) developed the Spiritual Experiences Interview (SEIn) in order to assign attachment styles to those who were interviewed. Fujikawa (2010) explored the level of agreement between the AAI and the SEIn and found remarkable agreement between them, demonstrating that narrative analysis can reliably assess an individual's attachment to God. Related methods of assessment have been applied by Joung (2006) and Reinhart and Edwards (2009) with similar results. These studies provide support for the use of psychoanalytically-oriented narrative methods in assessing psychospiritual functioning; however, they are lengthy to administer, transcribe, and code.

Another robust psychoanalytic measurement tool that could be adapted for use in RS measurement is the Early Memory Test (EMT; Mayman, 1968). The EMT utilizes autobiographical narratives of an individual's early experiences with primary caregivers to assess their subconsciously held attitudes and beliefs about themselves, others, and the world. Regarding the EMT, Shedler et al. (1993) wrote that the core aspect of the coding criteria is "how the person sees himself or herself in relation to the world, and whether the relations with the world are associated with good or bad feelings" (p. 1123) and indicated the importance of the criteria, saying it is "the central issue in judging between psychological health and distress" (p. 1123). While the AAI method of analysis has been applied successfully for years, the EMT criteria has yet to be adapted for use in the RS domain.

By using objective criteria to assess implicit psychological processes, both the AAI and EMT are less susceptible to problems associated with purely self-reported data and show great potential for use in RS assessment. The relational spirituality paradigm, drawing from a multilevel interdisciplinary paradigm of spiritual assessment, is poised to make use of such methods in developing a deep understanding of spirituality.

Markers of growth in emerging adults. Researchers within the relational spirituality paradigm are also making advances in understanding spiritual growth. Bailey and colleagues (Bailey, Jones, Hall, Wang, & McMartin, 2016) utilized grounded theory analysis of spiritual narratives to identify spiritual domains that helped differentiate emerging adults who were perceived by their community leaders as exemplars of spiritual maturity from those who were perceived as less mature. More specifically, Bailey et al. (2016) found that exemplars demonstrated a higher degree of faith ownership, greater intentionality in building a spiritual community, and an ability to utilize life struggles to grow in their faith. With this new understanding of spiritual development, the RS field would benefit from a measure that assesses these domains of maturity/health.

The Development of the Spiritual Narrative Questionnaire and Coding Criteria

The researchers of the present study set out to condense the research to date into a single measurement tool that takes less time to administer than current measures, requires less specialized training to score, and can compensate for the problems associated with self-report measures. The result of this endeavor is the "Spiritual Narrative Questionnaire" (SNQ). The development of the SNQ involved a literature review, question development and refinement, and coding criteria development and refinement. The literature review was used to determine domains of psycho-spiritual functioning that could be useful in detecting spiritual health (or lack thereof) from a relational spirituality perspective. Three constructs came from literature in the area of spiritual development in emerging adults: integrated faith ownership, spiritual struggles, and spiritual community. Two constructs came from literature outside of spirituality: gut-level emotional response to God (from object relations literature) and secure attachment to God.

Questions were developed to elicit narrative responses that would provide a window into the individual's explicit and implicit functioning across the domains listed above. Careful attention was paid to designing open-ended questions specific enough to elicit the desired material and vague enough to allow the test taker to demonstrate their own individuality. The test questions are therefore similar to a projective test in that they bring forth the test taker's unconscious material, such as implicit thought processes, affective material, and attitudes about their faith and God. Potential SNQ questions underwent a refinement process to enhance clarity and adjust wording in order to best elicit the desired material. The refinement process was conducted through a series of research team meetings comprised of individuals representing various disciplines: campus ministers, researchers in the area of psycho-spiritual health, and an undergraduate psychology research assistant.

The next step involved developing the rating criteria. The rating process, called Spiritual Narrative Analysis (SNA), initially included thirty-three items to rate the subjects' answers to SNQ questions in the five theoretically-derived subscales from the literature review. For each of the thirty-three SNA items, the researchers developed a five-point Likert scale (and a "not enough information" option) ranging from "spiritually immature" on the low end to "spiritually mature" on the high end. Spiritual maturity was determined based on the relational spirituality paradigm, which posits that some aspects of spiritual health can be identified through analysis of relational patterns that are (a) shaped by lived experiences, (b) at work in an individual's relationship with God, and (c) able to be assessed using established assessment methods within the field of psychology.

Once the coding items were developed, five raters from the research team coded the same three interviews as part of a pilot scoring process. A refinement process incorporated feedback from the raters, resulting in modifications to SNA items and Likert scales. The number of items was also pared down, resulting in twenty-two items across the SNQ's five sub-scales: Integrated Faith Ownership (two items), Spiritual Community (five items), Spiritual Struggles (six items), Attachment to God (four items), Gut-level Emotional Response to God (three items), and the Other Aspects category (two items). The SNQ and SNA were then considered ready for the next phases of development: psychometric testing.

Method

The SNA coding system underwent four phases of psychometric testing: inter-rater reliability, goodness of fit, internal consistency, and external validity. The first three phases were completed using scores from the instrument itself, and the fourth set of tests (for external validity) involved comparing the results of the SNQ/SNA with a well-validated test of spirituality, the Spiritual Transformation Inventory (Hall, 2003). The empirical phases of the psychometric validation process are described below.

Participants

A sample (N = 64) of traditional undergraduate students was taken from two protestant Evangelical universities in Southern California. Participants were informed of confidentiality and the voluntary aspects of their participation. Twenty-two of the sixty-four participants (34%) identified as male, and forty-two participants (66%) identified as female. A majority of the participants identified as Caucasian (61%), with smaller proportions identifying as Asian American (9%), Latino/a (6%), African American (6%), and "Other" (12%). A small percentage (5%) did not provide demographic information. The sample as a whole ranged from nineteen to twenty-seven years old, with a vast majority (76%) being between twenty years old and twenty-two years old (M = 20.98, SD = 1.42). All participants endorsed a Christian belief system. The following denominations were represented in the sample: Anabaptist, Anglican/Episcopalian, Baptist, Evangelical-Free, Holiness, Methodist, Nondenominational, Other, Pentecostal, Presbyterian, Reformed, and Roman Catholic.

Materials

Spiritual Narrative Questionnaire. The SNQ is a narrative-based assessment of psycho-spiritual health from a relational spirituality perspective. Participants are asked to write a short response to twenty-two questions about their spiritual experiences (see Appendix A for SNQ questions). Responses to these questions are then coded using the Spiritual Narrative Analysis method (see Appendix B for SNA items). The SNA scores were the subject of psychometric validation described in the remainder of this article.

Spiritual Transformation Inventory. Tests of external validity were conducted using the Spiritual Transformation Inventory (ST!; Hall, 2003). The STI was developed through a 4-year longitudinal study in which Hall, Hill, and Delaney (2005) factor analyzed numerous scales in order to identify the core underlying constructs of religion and spirituality from a relational spirituality perspective. Hall then used these results to develop the scales for the STI. Building on Hall's initial factor analysis, Sarazin (2011) ran additional psychometric tests on the STI using a large (n = 483) data set, demonstrating convergent validity and construct validity of the instrument. Overall, the STI was shown to be a comprehensive and psychometrically validated measure of spirituality.

Procedure

Participants took both the SNQ and STI. For the first three phases of psychometric validation, only the scores from the Spiritual Narrative Analysis coding method were necessary. For the tests of external validity, the participants' scores from the SNA process were compared to their STI scores.

Hypotheses

Hypotheses were developed for the tests of external validity. To compare the STI and SNQ results, two groups were created for each of the five SNQ subscales. Groups were determined by dichotomizing the scales at mid-point and assigning the labels "spiritually healthy" to those above the mid-point and "spiritually unhealthy" to those below the mid-point. Then, predictions were made regarding whether the spiritually healthy group would be higher or lower than the spiritually unhealthy group on a theoretically related STI subscale. Hypotheses are listed in Table 1.

Results

The results section below includes the four phases of psychometric testing used to assess the inter-rater reliability, goodness of fit, internal consistency, and external validity of the SNQ and SNA.

Psychometric Validation Phase 1: Inter-rater Reliability for SNA Coding Items

Three coders were asked to score four SNQs each using the refined item pool of SNA items. To enhance inter-rater reliability, specific instructions and examples were provided for each of the five points on each of the twenty-two items. Teal (2006) developed the use of both correlation and percent agreement in order to assess interrater reliability for a narrative-based, psycho-spiritual measurement tool. Drawing on uebersax's (1987) approach to psychometric validation, Teal suggested that an item's "target reliability range" would have a Pearson r coefficient of 0.5 or above or a percent agreement score of 70% or above. Any item that received a Pearson's r below 0.3 or a percent agreement below 50% would be automatically discarded. Correlations were obtained by first averaging the scores of two trainees. Then, a Pearson's Product Moment Correlation was run in SPSS between this average score and the scores of an expert rater. Percent agreement scores were obtained by comparing the scores of two trainees to the expert rater. Overall percent agreement scores for each item are listed in Table 2 alongside the Pearson's Product Moment Correlation.

Nineteen of the twenty-two items had a correlation at or above .5, thereby achieving the target range of acceptable inter-rater reliability with respect to correlational analysis. We were unable to calculate a correlation for three items (5.1, 5.2, and 5.3) due to one or more raters providing the same score on the same item for all four interviews (correlation requires variability, and without this variability the correlation statistic cannot be run). Having a two-method calculation process for inter-rater reliability allowed the researchers to utilize a percent agreement score as the determining factor for these items. Seventeen out of the twenty-two items also achieved the target range of acceptable inter-rater reliability with respect to percent agreement. None of the items were below the automatic-discard cutoff of 50% agreement. All five items that were below the 70% cutoff for percent agreement were above the .5 cutoff for correlation. All of the twenty-two items met or exceeded both correlational and percent agreement requirements for inter-rater reliability.

Psychometric Validation Phase 2: Assessing Fit of SNA Items into Subscales

For this phase, the developer of the SNQ and SNA coded sixty-four SNQs. Correlational analysis was used to evaluate the degree to which items in the theoretically-derived subscales correlated with each other. Detailed results for each subscale are described below.

Subscale 1: Integrated Ownership of Faith. Two SNA items were hypothesized to assess the degree to which individuals own their faith (SNA 1.1) and how well integrated their faith is into their life (SNA 7.1). Correlational analysis indicates a strong correlation between these two items, r (64) = .757, p < .01. These two items (1.1, 7.1) comprise the "Integrated Ownership of Faith" subscale.

Subscale 2: Spiritual Community. Initially, five items were hypothesized to assess the degree to which an individual experiences a healthy connection with their spiritual community. Item 2.1 assesses commitment to and engagement with spiritual community; item 2.2 assesses perceived safety of spiritual community; item 2.3 assesses intentionality in building a spiritual community; item 2.4 assesses overall affect tone regarding spiritual community; and item 7.3 assesses the interviewee's openness throughout the interview. Correlational analysis indicates that four out of those five items are strongly (and positively) correlated and one of the five items is moderately correlated. The four items with the strongest correlation (items 2.1, 2.2, 2.3, and 2.4) comprise the "Spiritual Community" subscale. The fifth item (7.3) was removed from the scale. The correlations for this SNA subscale are presented in Table 3.

Subscale 3: Struggles. Initially, six items were hypothesized to assess the degree to which an individual experiences struggles in a healthy way. Item 3.1 assesses openness to thinking about and describing the struggle; item 3.2 assesses connection to God's comforting presence; item 3.3 assesses outcome of the struggle; item 3.4 assesses commitment to biblical principles throughout struggle; item 3.5 assesses process of coping; and item 3.6 assesses perception of God's involvement in the resolution of the struggle. While all items were positively correlated with each other, correlational analysis suggested that three of the original six items were more strongly correlated with each other than the other three items.

An additional item (SNA item 6.1, assessing ability to coherently articulate a process of discernment of God's communication) was found to fit best conceptually and empirically with this subscale. The average correlation between 6.1 and the other three items was .640. Although the item does not specifically mention struggle, it appears to tap into a discernment process that is essential to resolving and growing through struggles. Thus, the final "Struggle" subscale included three of the original six items and an additional item that was found to fit well with the subscale (3.2, 3.3, 3.6, and 6.1). Correlations for this SNA subscale are presented in Table 4.

Subscale 4: Secure Attachment. Originally, four items were hypothesized to assess an individual's attachment style with respect to God. While all correlations were in the predicted direction, correlational analysis suggested that two of the original four items were more highly correlated with each other (item 4.2a and the reverses-cored 4.2b). Items 4.1 and 4.2c were not found to correlate as highly with the other items on this scale and were excluded from the final scale. Two items were added to this scale as a result of the analysis. SNA item 3.1 assesses openness to thinking about and describing struggle. It demonstrated a stronger correlation with the Secure Attachment scale (r[3] = .648) than the Struggles scale (r[4] = .459) and fit conceptually in that those with a secure attachment style are thought to have greater access to emotional and factual autobiographical information. SNA item 7.3 assesses the openness and completeness of answers to the Spiritual Narrative Questionnaire and also fits conceptually with Secure Attachment, in which completeness and openness are measures of coherence. In sum, analysis suggested this scale would be best utilized as a measure of secure attachment in that it would assess narratives that are coherent (4.2a), thorough (4.2b), complete (3.1), and open (7.3). Correlations for this SNA subscale are presented in Table 5.

Subscale 5: Gut-level Emotional Response to God. Three items were hypothesized to assess an individual's gut-level emotional response to God. These items were adapted from the Early Memory Test (Mayman, 1968) for use with the spiritual domain. Item 5.1 assesses the overall affect tone of the individual's relationship with God; item 5.2 assesses the degree to which God is depicted as a source of gratification; and item 5.3 assesses the degree to which God is depicted as abandoning (reverse scored). Correlational analysis confirmed that all three items included in the original scale fit well together empirically. Correlations for this SNA subscale are presented in Table 6.

In summary, Psychometric Validation Phase 2 assessed the fit of the twenty-two refined SNA coding items into their theoretically derived subscales. Of the twenty-two items included in this analysis, seventeen were retained. With the SNQ and SNA coding items finalized, the next step of development involved a test of internal consistency.

Psychometric Validation Phase 3: Test of internal consistency

A test of internal consistency was conducted in order to determine the consistency of items on each of the finalized subscales. Two individuals, the expert coder and a trainee, coded fifteen SNQs. The internal consistency of the subscales was then examined using Cronbach's Alpha to compare the scores of the raters within each scale. Cronbach's alphas for SNA subscales are presented in Table 7.

Overall, Cronbach's alphas suggest acceptable to excellent internal consistency. It should be noted that the Cronbach's alpha measure of internal consistency is affected by the number of items, with fewer items resulting in a smaller alpha. Therefore, the lower alpha scores of .651 (for subscale 1) and .656 (for subscale 2) may reflect fewer items.

Psychometric Validation Phase 4: Test of External Validity

In the final psychometric test, five ANOVA tests were run to identify the degree to which STI subscales differed significantly in the predicted direction based on groups that were either spiritually mature or spiritually immature (from a Relational Spirituality perspective) with respect to Ownership, Spiritual Community, Struggles, Secure Attachment, and Gut-level Emotional Response to God. A Bonferroni correction was used for each of the analyses, and the significance values ranged from .003 to .005. Significant results are reported in Table 8.

The external validity analysis of the SNQ revealed significant group differences in all domains of spiritual functioning tested by the STI except for Secure Attachment. In the other four SNQ subscales, a total of eighteen significant results were found, with another three approaching significance.

Results of the psychometric validation process suggest that the SNQ can be reliably scored by different raters, shows good correlation among items within the same subscale, and has good internal consistency. Regarding external validity, it is encouraging that twenty-one STI subscales differed significantly or trended towards significance in predicted directions on four SNQ subscales. This demonstrates that four of the SNQ subscales were able to measure the constructs they were designed to assess, as confirmed by the STI.

Discussion

The present study is an attempt to address problems associated with both self-report instruments and lengthy narrative instruments. A number of limitations ought to be kept in mind as the results are discussed. First, the current study was normed on a single sample of undergraduate students and the external validity is thus limited by the characteristics of the sample. Second, the SNQ would benefit from continued comparison with other validated instruments that test similar constructs. Third, external validity results of the SNQ Secure Attachment to God subscale raise questions about the ability of this scale to identify secure attachment as it was originally designed to do.

Despite these limitations, this research makes significant contributions to the existing literature base of RS assessment. Broadly speaking, in moving from "yes/no" and Likert scale responses to narrative responses, it opens the door for participants to provide valuable autobiographical data that is missed by self-report measures. Additionally, by using clinical judgment that is based on theoretically-derived and standardized scoring criteria, the SNA assessment method is less susceptible than self-report instruments to variability and error caused by individual differences in test-taking approaches. Finally, in comparison to other narrative measures that are lengthy and difficult to score, the SNQ is a paper-and-pencil (or internet-based) questionnaire that can be scored by individuals without formal graduate-level education in psychology.

Another key contribution of the SNQ is its use of implicit assessment derived from object relations theory (Mayman, 1968; Shedler et al., 1993, 2003) and attachment theory (Main et al., 1985; Fujikawa, 2010). Integrating these approaches to understand and measure spiritual health, the SNQ and SNA further demonstrated that it is possible to utilize explicit narrative material to assess implicit spiritual functioning. Moreover, this study is the first of its kind to apply the criteria of the Early Memory Test to a spiritual domain. In the present study, the EMT-based criteria was shown to be a psychometrically sound way of assessing spiritual health.

Conclusion and Future Directions

The problems associated with exclusive reliance on self-report measures have been understood for decades, and the field of RS assessment has long needed an answer to this problem. As an instrument that assesses explicit and implicit functioning, utilizes a combination of self-report and narrative-based assessment, and brings together psychoanalysis with spiritual functioning, the SNQ provides the field with a valuable tool that can be applied to advance our knowledge of RS.

There are a number of future directions for the SNQ. In terms of test development, continued psychometric validation of the instrument would be beneficial. Further development of the Secure Attachment to God subscale would be particularly important to establish its external validity. use of the SNQ with populations outside of the university student realm would also aid in establishing the SNQ as a relevant assessment tool for a broader range of emerging adults. As the SNQ is the first RS measure to adapt the EMT criteria for use in the spiritual domain, it can also be used to explore the relationship between gut-level emotional response to God and overall spiritual health.

Another exciting area of future application is in better understanding the role of defensiveness in self-reported psychospiritual health. Defensiveness is a problem that has been shown to inflate scores towards the "healthy" end of self-report measures of general mental health (Shedler et al., 1993, 2003). Many researchers within the RS field have expressed concerns about the potential impact of defensiveness on measures of spiritual health (Edwards & Hall, 2003; Slater et al., 2001). With its ability to assess both explicit and implicit spiritual functioning, the SNQ is uniquely poised to shed light on the problems associated with defensiveness in RS assessment.

Lastly, there is a practical pastoral need that is served by the SNQ and SNA method. Professionals dedicated to the spiritual growth of college students (campus pastors, spiritual directors, professors, and worship pastors) could utilize the SNQ for both program development and evaluation. That is, the five domains of spiritual health tested by the SNA were developed specifically with emerging adults in mind. As such, these domains would be valuable for use in program development for faith-based universities. For example, campus leaders could design programs with the end goal in mind of enhancing a student's faith ownership (SNQ Domain 1), healthy engagement with spiritual community (SNQ Domain 2), or ways of engaging in spiritual struggles (SNQ Domain 3). Furthermore, the SNQ would serve as a beneficial instrument for pre-test and post-test evaluations of students to determine the effectiveness of programming aimed at enhancing their spiritual growth in these areas. Given the importance of assessment in achieving and maintaining accreditation as a learning institution and the difficulty of operationalizing and measuring spiritual growth on college campuses, the SNQ's five empirically supported domains of spiritual health provide a road map, and the SNA's coding method provides a sophisticated assessment system to evaluate progress along that road.

Broadly speaking, the current study contributes to the growing body of literature assessing religion and spirituality from a relational framework. In addition to the applications listed above, there are many more ways the SNQ can help advance the field. The SNQ has passed a number of initial tests demonstrating psychometric properties and is poised to be used in future studies to further our understanding of psychospiritual health.

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Michael Moradshahi

David Wang

Todd W. Hall

Andrea Canada

Michael Moradshahi, MA. (Talbot School of Theology), Ph.D. (Rosemead School of Psychology) is a staff psychologist in the Veterans Administration at the VA Sierra Nevada Healthcare System. His research interests include the assessment and development of spiritual health in emerging adults and the integration of psychology and theology.

Todd W. Hall (PhD in Clinical Psychology, Biola University) is Professor of Psychology and Editor of the Journal of Psychology and Theology at Rosemead School of Psychology, Biola University (CA). Dr. Hall's interests include the integration of psychology and theology, spiritual development, measurement of religion and spirituality, attachment theory, relational psychoanalysis, positive psychology, and leadership and organizational development.

David C. Wang, ThM. (Regent College), Ph.D. (University of Houston) is an Assistant Professor of Psychology at the Rosemead School of Psychology, Biola University in La Mirada, CA. He is also the Associate Editor of the Journal of Psychology and Theology. His research focuses on trauma/traumatic stress, spiritual theology (spiritual dryness and the Dark Night of the Soul), multicultural psychology, and mindfulness.

Andrea L. Canada (Ph.D. Clinical Psychology, Biola University, 2000) is an Associate Professor of Psychology at Rosemead School of Psychology, Biola University, and is a licensed clinical psychologist. Dr. Canada's interests include religion and health, specifically religious/spiritual coping with chronic illness.

Correspondence regarding this article should be sent to Michael Moradshahi, Ph. D., Ioannis A. Lougaris Medical Center, Mental Health Service (116), 975 Kirman Ave., Reno, NV 89502-2597; michael.a.moradshahi@biola.edu

Appendix A: SNQ

1. Please describe how important owning your faith is to you.

2. Please describe the degree to which you feel you own your faith.

3. Please describe the process you have gone through to get where you are.

4. To what extent do you feel like you are part of a spiritual community?

5. How important is your spiritual community to you and what role does the spiritual community play in your life?

6. How safe do you feel being real in your community (you might think about how honest you are with them or if it is difficult for you to share)?

7. How did your community form?

8. Please describe a struggle [something difficult or troubling] you have experienced [in the last 6 months].

9. What do you believe caused this struggle? Why did it occur?

10. Was your relationship with God involved in this struggle? If so, please describe.

11. Please describe how the struggle was resolved (If not resolved, please describe your attempts to resolve it and how they worked). OR, if not resolved, please describe how you expect your connection to God to be impacted by this struggle?

12. Was God involved in the process of resolving the struggle? If so, please describe this.

13. How does God communicate to you and how do you know the communication is from God?

14. Please write in an adjective or phrase that describes your relationship with God.

15. You described your relationship with God using the word __. Please write down a memory or incident that illustrates why you chose this word/phrase.

[The next 4 items ask for 2 additional adjectives and memories to support them.]

16. Please describe how you imagine God feels towards you generally in the last few months (e.g., Do you imagine God is happy with you, disappointed, angry, disengaged, etc.)?

17. How do you imagine God feels towards you when you sin?

18. People sometimes experience God differently throughout their lives. How has your relationship with God changed over time?

19. When you are aware of God's presence, how do you feel (If you don't feel God's presence much, just indicate that in your answer)?

Appendix B: SNA Items

1. Priority of ownership

2. Integration of faith into all aspects of life

3. Commitment to and engagement with spiritual community

4. Perceived safety of spiritual community

5. Intentionality in building spiritual community

6. Overall affect tone regarding spiritual community

7. Connection to God's comforting presence

8. Outcome of the struggle

9. Perception of God's involvement in resolution

10. Ability to coherently articulate a process of discernment of God's communication

11. Memories make sense in light of adjectives

12. Memories are contradictory or lack detail

13. Openness to thinking about and describing struggle

14. Responses as a whole demonstrate a consistently open posture with complete answers

15. Predominant affect tone is positive

16. God is depicted as benevolent and is a source of gratification

17. God is portrayed as abandoning or under-protective Table 1 Hypothesized STIDifferences Between Spiritually Healthy and Spiritually Unhealthy on SNA Subscales STI SNQ subscales Subscales Ownership Community Struggles Awareness of God Higher Experiencing God-Spiritual Higher Practices Experiencing Higher God-Prayer Intimacy with God Higher Gratitude to God Secure Connection to God Higher Anxious Connection to God Lower Distant Connection to God Lower Forgiveness Higher Agape love Higher Spiritual self-awareness Secure Connection to Others Higher Anxious Connection to Others Lower Distant Connection to Others Lower Spiritual Friendship Higher Spiritual Community Involvement Higher Higher Secure Connection to Community Higher Higher Anxious Connection to Community Lower Lower Distant Connection to Community Lower Lower Christ Centeredness Higher Higher Prayer Frequency Higher Transformational Suffering Positive Spiritual Higher Coping Negative Spiritual Lower Coping Spiritual Openness Spiritual Perspective Spiritual Meaning Higher Service Outside Higher Higher Local Church Service to Local Higher Higher Church Evangelism Higher STI SNQ subscales Subscales Secure God Image Attachment Awareness of God Higher Experiencing God-Spiritual Higher Practices Experiencing Higher God-Prayer Intimacy with God Higher Higher Gratitude to God Higher Higher Secure Connection to God Higher Higher Anxious Connection to God Lower Lower Distant Connection to God Lower Lower Forgiveness Agape love Spiritual self-awareness Secure Connection to Others Higher Higher Anxious Connection to Others Lower Lower Distant Connection to Others Lower Lower Spiritual Friendship Spiritual Community Involvement Secure Connection to Community Anxious Connection to Community Distant Connection to Community Christ Centeredness Higher Prayer Frequency Higher Transformational Higher Suffering Positive Spiritual Higher Coping Negative Spiritual Lower Coping Spiritual Openness Higher Spiritual Perspective Higher Higher Spiritual Meaning Higher Higher Service Outside Local Church Service to Local Church Evangelism Note: "Higher" indicates STI scales on which the spiritually healthy are hypothesized to obtain higher SNA scores than the spiritually unhealthy; "Lower" indicates STI scales on which the spiritually healthy are hypothesized to obtain lower SNA scores than the spiritually unhealthy. Table 2 Inter-Rater Reliability: Pearson's Product Moment Correlation and Percent Agreement on each of the 22 SNA items Description of Item SNA 1.1 Priority of Ownership SNA 2.1 Commitment to and engagement with spiritual community SNA 2.2 Perceived safety of spiritual community SNA 2.3 Intentionality in building spiritual community SNA 2.4 Overall affect tone regarding spiritual community SNA 3.1 Openness to thinking about and describing struggle SNA 3.2 Connection to God's comforting presence SNA 3.3 Outcome of the struggle SNA 3.4 Commitment to biblical principles in struggle SNA 3.5 Process of coping SNA 3.6 Perception of God's involvement in resolution SNA 4.1 Adjectives are balanced SNA 4.2a Memories make sense in light of adjectives SNA 4.2b Memories are contradictory or lack detail SNA 4.2c Memories are difficult to understand SNA 5.1 Predominant affect tone is positive SNA 5.2 God is depicted as benevolent and is a source of gratification SNA 5.3 God is portrayed as abandoning or under-protective SNA 6.1 Ability to coherently articulate a process of discernment of God's communication SNA 7.1 Integration of faith into all aspects of life SNA 7.2 Ability to hold positive and negative aspects of faith at the same time SNA 7.3 Responses as a whole demonstrate a consistently open posture with complete answers Pearson's Percent Correlation Agreement SNA 1.1 .575 87.5% SNA 2.1 .577 100% SNA 2.2 .602 75% SNA 2.3 .500 62.5% SNA 2.4 1 75% SNA 3.1 .603 75% SNA 3.2 .731 57% SNA 3.3 1 87.5% SNA 3.4 .722 85.7% SNA 3.5 .789 62.5% SNA 3.6 .640 100% SNA 4.1 1 100% SNA 4.2a .713 62.5% SNA 4.2b 1 85.7% SNA 4.2c .935 100% SNA 5.1 * 100% SNA 5.2 * 100% SNA 5.3 * 100% SNA 6.1 .818 62.5% SNA 7.1 .844 75% SNA 7.2 1 100% SNA 7.3 .935 100% * Correlations were not calculated for items 5.1, 5.2, and 5.3. Table 3 Pearson's Product Moment Correlations for Items Hypothesized to Comprise the "Spiritual Community" Subscale SNA 2.1 SNA 2.2 SNA 2.3 SNA 2.4 SNA 7.3 SNA 2.1 1 .705 ** .782 ** .836 ** .552 ** SNA 2.2 .705 ** 1 .701 ** .812 ** .323 ** SNA 2.3 .782 ** .701 ** 1 .729 ** .506 ** SNA 2.4 .836 ** .812 ** .729 ** 1 .422 ** SNA 7.3 .552 ** .323 ** .506 ** .422 ** 1 Note. * = p < .05, ** = p < .01 Table 4 Pearson 's Product Moment Correlations for Items Hypothesized to Comprise the "Struggles" Sub-scale SNA 3.1 SNA 3.2 SNA 3.3 SNA 3.4 SNA 3.5 SNA 3.6 SNA 3.1 1 .551 ** .434 ** .407 ** .698 ** .290 * SNA 3.2 .551 ** 1 .667 ** .672 ** .660 ** .681 ** SNA 3.3 .434 ** .667 ** 1 .389 ** .552 ** .880 ** SNA 3.4 .407 ** .672 ** .389 ** 1 .431 ** .486 ** SNA 3.5 .698 ** .660 ** .552 ** .431 ** 1 .496 ** SNA 3.6 .290 * .681 ** .880 ** .486 ** .496 ** 1 SNA 6.1 .562 ** .593 ** .685 ** .456 ** .693 ** .641 ** SNA 6.1 SNA 3.1 .562 ** SNA 3.2 .593 ** SNA 3.3 .685 ** SNA 3.4 .456 ** SNA 3.5 .693 ** SNA 3.6 .641 ** SNA 6.1 1 Note. * = p < .05, ** = p < .01 Table 5 Pearson's Product Moment Correlations for Items Hypothesized to Comprise the "Secure Attachment to God" Subscale SNA 4.1 SNA 4.2a SNA 4.2b SNA 4.2c SNA 3.1 SNA 7.3 SNA 4.1 1 .302 ** .260 * .105 .282 * .318 ** SNA 4.2a .302 ** 1 .840 ** .145 .710 ** .767 ** SNA 4.2b .260 * .840 ** 1 -.165 .623 ** .745 ** SNA 4.2c .105 .145 -.165 1 .229 * -.140 SNA 3.1 .282 * .710 ** .623 ** .229 * 1 .610 ** SNA 7.3 .318 ** .767 ** .745 ** -.140 .610 ** 1 Note. * = p < .05, ** = p < .01 Table 6 Pearson's Product Moment Correlations for Items Hypothesized to Comprise the "God Image" Subscale SNA 5.1 SNA 5.2 SNA 5.3 SNA 5.1 1 .841 ** .746 ** SNA 5.2 .841 ** 1 .676 ** SNA 5.3 .746 ** .676 ** 1 Note. * = p < .05, ** = p < .01 Table 7 Internal Consistency of Five Subscales on Final SNQ Model Using Cronbach's Alpha Description of Subscale Cronbach's Alpha Subscale 1 Integrated Faith Ownership .651 Subscale 2 Spiritual Community .830 Subscale 3 Spiritual Struggles .818 Subscale 4 Secure Attachment .656 Subscale 5 Gut-Level Emotional Response to God .899 Table 8 One-Way Analysis of Variance of STI Subscales SNQ Scores SS df MS F SNQ Ownership Domain: Awareness 12.355 1 12.355 14.640 Intimacy 11.330 1 11.330 11.740 Spiritual Friendship 5.966 1 5.966 8.297 Christ Centeredness 7.295 1 7.295 13.371 SNQ Community Domain: Spiritual Community 12.699 1 12.699 14.140 Secure Connection to Others 13.186 1 13.186 23.355 Anxious Connection to Others 8.919 1 8.919 9.163 Distant Connection to Others 11.076 1 11.076 9.802 Spiritual Meaning 7.069 1 7.069 10.210 SNQ Struggles Domain: Secure Connection to Others 6.600 1 6.600 9.051 Distant Connection to Others 10.951 1 10.951 13.700 Secure Connection to Community 9.672 1 9.672 16.032 Distant Connection to Community 9.456 1 9.456 7.800 Christ Centeredness 7.347 1 7.347 13.887 SNQ God Image Domain: Awareness of God 16.641 1 16.641 17.234 Experiencing God in 5.429 1 5.429 15.857 Spiritual Practices Experiencing God in Prayer 4.559 1 4.559 9.477 Intimacy 20.867 1 20.867 21.39 Distant Connection to God 8.236 1 8.236 8.123 Christ Centeredness 7.631 1 7.631 14.507 Spiritual Perspective 6.872 1 6.872 8.851 p SNQ Ownership Domain: Awareness .001 ** Intimacy .002 ** Spiritual Friendship .007 Christ Centeredness .001 ** SNQ Community Domain: Spiritual Community .001 * Secure Connection to Others .000 * Anxious Connection to Others .004 * Distant Connection to Others .003 * Spiritual Meaning .003 * SNQ Struggles Domain: Secure Connection to Others .005 * Distant Connection to Others .001 * Secure Connection to Community .000 * Distant Connection to Community .009 Christ Centeredness .001 * SNQ God Image Domain: Awareness of God .000 * Experiencing God in .000 * Spiritual Practices Experiencing God in Prayer .004 * Intimacy .000 * Distant Connection to God .007 Christ Centeredness .001 * Spiritual Perspective .005 * Note. Bonferroni corrected significance values set at * p<.005 and ** p<.003. Items without an asterisk approached but did not reach significance.