In 2016 and 2017 alone, there were 31 U.S. natural disasters (e.g., severe storms, floods, droughts, and wildfires) that each caused $1 billion or more in damages. Collectively, these 31 disasters resulted in 500 deaths and $354.4 billion in estimated damages, with an average event cost of $11.4 billion. By comparison, between 1980 and 2015, there were an average of 7.2 high-cost natural disasters in the U.S. per year, with an average event cost of $6.3 billion and an average annual cost of $45.5 billion (National Centers for Environmental Informatoin [NCEI], 2018). Given the increased prevalence and impact of natural disasters, it is crucial to understand how disasters affect survivors' mental health and what factors might protect against common negative mental health consequences of disasters.

One common type of mental health problem that can be caused by natural disasters is Post-Traumatic Stress Disorder (PTSD). When an experience is stressful enough to violate one's core beliefs about the world, it can initiate a process of meaning-making--attempting to reconcile the trauma with one's existing belief system (Park, Mills, & Edmondson, 2012; Park et al., 2016). In such times, many individuals turn to their religious/spiritual (R/S) beliefs to find answers and make sense of their experiences (Aldwin, 2007; Bussing, Ostermann, & Matthiessen, 2005). However, little is known about how individuals may engage their R/S belief systems to make sense of trauma and how doing so might impact their mental health (Hale-Smith, Park, & Edmondson, 2012). Scholars have suggested that when people are able to mitigate belief violations by incorporating the experience into their current belief systems, it can reduce the likelihood they will develop PTSD symptoms (George, Park, & Chaudoir, 2016).

Empirical work on this topic is scarce, in part due to lack of appropriate measures. Just recently, scholars have developed measures of belief violations (Park et al., 2016) and R/S views of suffering (i.e., theodicies; Hale-Smith et al., 2012). Initial studies utilizing these measures have demonstrated a link between belief violations and PTSD symptoms and between benevolent theodicies and positive mental health (e.g., George et al., 2016; Wilt, Exline, Grubbs, Park, & Pargament, 2016). However, most of these studies are limited in that they rely on undergraduate samples rather than recruiting trauma-exposed community samples. Accordingly, the purpose of the present study is to examine a community sample of disaster survivors and test whether the relationship between belief violations and PTSD symptoms is buffered by benevolent theodicies.

The Role of Belief Violations in the Development of PTSD

Traumatic experiences can violate individuals' core beliefs about the world (Horowitz 1986; Park et al., 2016). Such belief violations have been linked with increased psychological distress, including symptoms of PTSD (Chukwuorji, Ifeagwazi, & Eze, 2017; George et al., 2016; Park et al., 2012, 2016). Stress response theory provides a framework for understanding this link: when individuals experience an event that is incompatible with their existing belief structure, their attempts to reconcile this discrepancy can lead to symptoms of avoidance and intrusive memories, which are hallmarks of PTSD (Horowitz, 1986). Similarly, shattered assumptions theory (Janoff-Bulman, 1992) posits that individuals have an unarticulated assumption of a just and predictable world, and this assumption provides them with a sense of meaning and invulnerability. But traumatic events violate this assumption and therefore can lead to the development of PTSD symptoms.

Although these theories are generally accepted within the scientific literature, they have largely gone untested due to a lack of appropriate measures (Park et al., 2012). With recent advancements in measurement, however, scholars have begun to examine these theories empirically. For example, in a sample of 130 undergraduates who had experienced a traumatic event, Park et al. (2012) found evidence that belief violations were related to negative beliefs about oneself and the world, which were in turn related to PTSD symptoms.

Likewise, at least two studies have examined whether belief violations mediate the relationship between event centrality (i.e., how central a stressful event is to one's identity and life story) and PTSD symptoms. George et al. (2016) found evidence of this mediated relationship using a sample of 367 undergraduates who had experienced a traumatic event, and Chukwuorji et al. (2017) replicated these results in a sample of 279 older, internally displaced adults in Nigeria. Taken together, these studies offer preliminary support that traumatic events can cause belief violations, which in turn can lead to the development of PTSD symptoms. Two important next steps include continuing to replicate these findings in community samples and examining protective factors that might reduce the impact of belief violations on mental health.

Benevolent Theodicies as a Protective Factor

When individuals experience belief violations, they may engage in meaning-making processes that attempt to reconcile or integrate the violating experience with their existing worldview in order to reduce distress (Park et al., 2016). One way individuals may do this is through engaging their theodicies (i.e., R/S beliefs about suffering; Brown, 1999; Hale-Smith et al., 2012). Although there are a number of theodicies, in this study we are primarily focused on benevolent theodicies--that is, "beliefs that attribute a benevolent role to God in suffering" (Wilt, Exline, Lindberg, Park, & Pargament, 2017, p. 137). Beliefs about God's role in suffering may vary considerably, but we were interested in whether three benevolent theodicies might serve as protective factors for natural disaster survivors: (a) the belief that God has providential control over suffering and uses it for a higher purpose (i.e., providence theodicy), (b) the belief that God is present in the midst of suffering and suffers compassionately alongside people (i.e., suffering-God theodicy), and (c) the belief that God uses suffering to build virtues into people's character (i.e., soul-building theodicy; Hale-Smith et al., 2012; Wilt et al., 2016, 2017).

These benevolent theodicies might help individuals make sense of their suffering. For example, benevolent theodicies can help monotheistic religious believers reconcile traumatic life events with their beliefs in a good, loving, and all-powerful God (Wilt et al., 2016, 2017). Indeed, there is initial empirical support for this possibility. In two independent samples of U.S. undergraduates (N = 3,083) and adults (N = 1,047) who were facing nonspecific stressors, Wilt et al. (2016) found evidence that benevolent theodicies were linked to higher psychological well-being (rs = .21 to .29). Similarly, in an undergraduate sample (N = 454) who reported experiencing a specific individual R/S struggle in the past few months, Exline, Hall, Pargament, and Harriott (2017) found that benevolent theodicies predicted students' engagement in positive religious coping, which in turn predicted their perceived posttraumatic growth. Moreover, in a nationally representative sample of chaplains in the Veterans Healthcare Administration (N = 298), benevolent theodicies were linked with chaplains' professional quality of life (i.e., their sense of purpose and enjoyment in their work), leading currier, Drescher, Nieuwsma, and McCormick (2017) to conclude that benevolent theodicies "might serve as a pathway to resilience for individuals in spiritual communities and traditions in [the] USA" (p. 286).

Taken together, these studies offer preliminary evidence that benevolent theodicies might serve as a protective factor against the negative mental health impact of adverse life events. The existing evidence base has focused on samples dealing with a range of stressors, but it is important to see how well this theorizing holds up in the context of collectively experienced traumatic events such as natural disasters.

Overview and Hypotheses

Accordingly, the purpose of the present study of natural disaster survivors was to examine the link between belief violations and PTSD symptoms and then test whether benevolent theodicies buffered this relationship. We focused on survivors of the 2016 Louisiana flood. Because this flood was one of the costliest and most severe natural disasters to hit the U.S. in the past 5 years (Yan & Flores, 2016), and because Louisiana is one of the most religious states in the U.S. (Lipka & Wormald, 2016), survivors of this flood represent an optimal population for studying the role of religion in mitigating the negative mental health impact of disasters. The 2016 Louisiana flood began between August 12 and 15, 2016, as vast areas of southern Louisiana received 20 to 30 inches of rain, resulting in catastrophic flooding (NOAA, 2018). This flooding rendered 200 roadways impassable (including parts of two interstate highways) and damaged over 109,000 homes, 90,000 vehicles, and 6,000 businesses ("AIR Worldwide," 2016; Funes, 2016; Terrell, 2016). In all, the 2016 Louisiana flood caused over $10 billion in damage, ranking it among the 25 costliest natural disasters in U.S. history (NOAA, 2018; Yan & Flores, 2016). Thirteen people lost their lives (NOAA, 2018). Additionally, more than 30,000 people and 1,000 pets had to be rescued by emergency responders and civilian volunteers (Di Liberto, 2016; Visser et al., 2016). A large percentage of these survivors lived in areas that were also hit by Hurricane Katrina in 2005 (Lipinski, 2016).

In the current study, we predicted that higher levels of belief violations would be positively associated with PTSD symptoms (Hypothesis 1). Moreover, we predicted that benevolent theodicies would moderate the relationship between belief violations and PTSD symptoms, such that greater endorsement of benevolent theodicies would attenuate the relationship between belief violations and PTSD symptoms (Hypothesis 2). See Figure 1 for a conceptual diagram of the moderation effect we test in Hypothesis 2.

Method

Participants and Procedure

One month after the 2016 Louisiana flood, we recruited adults from Baton Rouge, Louisiana and its surrounding communities. Participants were recruited through local community agencies (e.g., faith communities and mental health clinics), and they completed study measures via an online survey platform. They were compensated with a $25 gift card either to Amazon.com or Walmart. Individuals were eligible to participate if they were at least 18 years old and had been living in one of the flood-affected Louisiana parishes at the time of the flood.

Initially, 935 participants either partially or fully completed the survey. Participants were excluded from analysis if they failed more than one of the attention checks (e.g., validity questions such as "Please respond to this question with 'moderately'"; n = 190) or completed the survey in an impossibly fast amount of time (n = 180). Additionally, participants were excluded from analysis if they did not meet inclusion criteria (i.e., did not reside in Louisiana at the time of the flood) or provided duplicate responses (determined by the same name/email combination entered more than once; n = 119). Some participants failed more than one of the attention checks or inclusion criteria; ultimately, 469 people were excluded from data analysis.

The final sample consisted of 466 participants (46.1% women) who ranged in age from 20 to 77 years old (M = 36.69, SD = 7.21). Participants were mostly White (75.5%), with smaller numbers of Latino/a (10.7%), Black/African-American (10.3%), and other races (< 2% each for Asian, Pacific Islander, American Indian, or multiracial). The most frequently endorsed household income category was $100,000 to $149,999 (28.5%), followed by $50,000 to $74,999 (23.8%) and $75,000 to $99,999 (21.9%). Additionally, most participants were currently married (85.4%) and had a bachelor's degree or higher (61.4%).

Most participants were religiously affiliated (89.3%). Specifically, participants identified as Christian Protestant (42.7%), Christian Catholic (34.3%), Mormon (1.9%), Orthodox Christian (0.4%), Jewish (2.8%), Muslim (5.4%), Buddhist (1.1%), Hindu (0.6%), atheist (1.7%), agnostic (0.4%), and nothing in particular (8.6%). This sample is religiously representative of Louisiana (www.pewforum.org). The sample was highly religious; on a scale from 1 (not at all important) to 4 (very important), the average religious importance rating was 3.34 (SD = 0.82).

When asked to use a 5-point Likert scale (1 = not stressful to 5 = extremely stressful) to indicate how stressful the flood was for them, the average level of disaster-related stress was 3.23 (SD = 0.98). Additionally, 29.0% of participants responded "yes" when asked if they were still dealing with some negative consequences from the flood, whereas 56.4% said "somewhat" and 14.6% said "no." Around half the participants (53 2%) did not have flood insurance. Finally, 64.6% of participants indicated that, in 2005, they lived in an area affected by Hurricane Katrina.

The materials and measures presented here are drawn from a larger set of measures administered to this sample. The measures that are not discussed here address other research questions, but the results presented in the current study have not been published elsewhere.

Measures

Belief violations. We assessed belief violations using the 5-item Belief Violations subscale from the Global Meaning Violation Scale (GMVS; Park et al., 2016). Respondents were asked to use the 5-point GMVS Likert scale (1 [not at all] to 5 [very much]) to rate each of the five items in response to the following prompt: "When you think about how you felt before and after experiencing the 2016 Louisiana flood ..." Two example items are "How much does this stressful experience violate your sense that God is in control?" and "How much does the occurrence of this stressful experience violate your sense of the world being fair or just?" Item scores are summed to yield a total score, with higher scores reflecting higher belief violations. The GMVS has demonstrated strong evidence of reliability and of concurrent, discriminant, and predictive validity (Park et al., 2016). For the present sample, Cronbach's alpha was .81.

PTSD symptoms. We assessed PTSD symptoms using the 20-item Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5; Blevins et al., 2015), which measures PTSD symptoms according to the PTSD symptom criteria indicated in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). The PCL-5 asks respondents to use a 5-point Likert scale (0 [not at all] to 4 [extremely]) to indicate "how much you have been bothered by that problem in the last month." Two example items are "Repeated, disturbing, and unwanted memories of the stressful experience" and "Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)." item scores are summed to yield a total score, with higher scores indicating higher levels of PTSD symptoms. The PCL-5 has demonstrated strong evidence of reliability and of convergent, discriminant, and predictive validity (Blevins et al., 2015; Bovin et al., 2016). For the present sample, Cronbach's alpha for the PCL-5 total score was .95.

Benevolent theodicies. We assessed benevolent theodicies using three subscales from the Views of Suffering Scale (VOSS; Hale-Smith et al., 2012): the Providence, Suffering God, and Soul Building subscales. Each of these subscales consists of three items and asks respondents to indicate the extent of their belief or disbelief, using a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Three sample items are: "Everything that we experience--including suffering--is planned in detail by God" (Providence subscale), "When we suffer, God is suffering along with us" (Suffering God subscale), and "Suffering is intended by God to be a source of personal growth" (Soul-Building subscale). Each subscale's responses are summed to create a subscale score, with higher scores reflecting higher levels of providence theodicy beliefs, suffering-God theodicy beliefs, and soul-building theodicy beliefs, respectively. The VoSS has demonstrated strong evidence of reliability and of concurrent, discriminant, and predictive validity (Hale-Smith et al., 2012; Wilt et al., 2017). For the present sample, Cronbach's alphas for the three VoSS subscales were .80, .83, and .75, respectively.

Results

Before imputing data, we examined patterns of missing data. Less than 2% of data were missing per item. Little's MCAR test was significant; however, because less than 1% of data was missing overall, we could move forward with imputation without introducing bias (Schlomer, Bauman, & Card, 2010). We used expectation maximization to impute missing data.

Next, we examined the data for outliers and normality. outliers (2% or less per variable) were adjusted to three standard deviations from the mean. Skewness and kurtosis values were all within an acceptable range (between -1 and +1). In Table 1, we report the psychometric properties and bivariate correlations of study variables.

Hypothesis 1: Are Belief Violations Related to PTSD Symptoms?

In support of Hypothesis 1, belief violations were strongly positively correlated with PTSD symptoms (r = .62, p < .001). Interestingly, belief violations were positively related to all three of the assessed benevolent theodicies (rs = .17 to .29, all ps < .001), and PTSD symptoms also were positively correlated with providence theodicy beliefs (r = .31, p < .001) and with suffering-God theodicy beliefs (r = .23, p < .001).

Hypothesis 2: Do Benevolent Theodicies Buffer the Negative Effects of Belief Violations?

To test Hypotheses 2, we used Model 1 of the PROCESS macro for SPSS (Hayes, 2013), which tests for a single moderator (M [benevolent theodicies]) of the relationship between a single antecedent variable (X [belief violations]) and a single outcome variable (Y [PTSD symptoms]). We ran three separate moderation analyses to test the moderation effect for each of the three benevolent theodicies we assessed: providence theodicy beliefs ([M.sub.1]), suffering-God theodicy beliefs ([M.sub.2]), and soul-building theodicy beliefs ([M.sub.3]). Belief violations and benevolent theodicies were mean-centered prior to analysis. See Table 2 for results of these three separate regression analyses, and see Table 3 for a summary of the conditional effect of belief violations on post-disaster PTSD symptoms at values of each distinct moderator.

Providence theodicies. As can be seen in the first moderation analysis, belief violations were positively related to PTSD symptoms (b = 2.16, p < .001), but providence theodicy beliefs were not (p = .420). supporting Hypothesis 2, the moderation effect was significant, indicating the interaction between belief violations and providence theodicy beliefs is predictive of PTSD symptoms, b = -.15, p < .001; [DELTA][R.sup.2] = .03, F(1, 462) = 11.87, p < .001. Specifically, the association between belief violations and PTSD symptoms was reduced at higher levels of providence theodicy beliefs.

Suffering-God theodicies. Similarly, in the second moderation analysis, belief violations were positively related to PTSD symptoms (b = 2.19, p < .001), but suffering-God theodicy beliefs were not (p = .649). Again, supporting Hypothesis 2, the moderation effect was significant, indicating the interaction between belief violations and suffering-God theodicy beliefs is predictive of PTSD symptoms, b = -.16, p < .001; [DELTA][R.sup.2] = .03, F(1, 462) = 21.30, p < .001. Specifically, the association between belief violations and PTSD symptoms was reduced at higher levels of suffering-God theodicy beliefs.

Soul-building theodicies. in the third and final moderation analysis, both belief violations (b = 2.36, p < .001) and soul-building theodicy beliefs (b = -0.50, p = .034) were related to PTSD symptoms. Supporting Hypothesis 2, the moderation effect was significant, indicating the interaction between belief violations and soul-building theodicy beliefs is predictive of PTSD symptoms, b = .12, p = .006; [DELTA][R.sup.2] = .01, F(1, 462) = 7.78, p = .006. Specifically, the association between belief violations and PTSD symptoms was reduced at higher levels of soul-building theodicy beliefs.

Discussion

The main purpose of this study was to use a community sample of natural disaster survivors to examine whether the relationship between belief violations and post-disaster PTSD symptoms is attenuated by benevolent theodicies. Prior work has shown a link between belief violations and PTSD (George et al., 2016; Park et al., 2012), as well as between benevolent theodicies and various indices of psychological well-being (Currier et al., 2017; Exline et al., 2017; Wilt et al., 2016). However, most of this work has been done with undergraduate samples dealing with nonspecific stressors (Wilt et al., 2016) or specific individual stressors (Exline et al., 2017), so it was important to replicate and extend this work to the role of benevolent theodicies in buffering the negative mental health consequences of collectively experienced traumatic events (e.g., natural disasters).

Consistent with our hypotheses and replicating and extending prior work (George et al., 2016; Park et al., 2012), we found belief violations had a strong positive relationship with PTSD symptoms. This finding supports the predictions of stress response theory (Horowitz, 1986) and shattered assumptions theory (Janoff-Bulman, 1992), suggesting that in the acute wake of disasters, the degree to which survivors experience PTSD symptoms is heavily tied to the degree to which their beliefs about God, the world, and themselves have been violated. Park (2016) has made similar theoretical predictions when discussing her meaning-making model in the context of disasters.

We also found that providence and suffering-God theodicies were weakly to moderately related to PTSD symptoms, which may seem counterintuitive. However, these associations correspond with findings in prior work. The bivariate correlations can be misleading and do not take into account the potential influence of stressor severity on engagement with God (or another deity) as a means of coping. For example, Wilt et al. (2016) found weak to moderate correlations between benevolent theodicies and both greater divine struggle and greater psychological distress, and Gerber, Boals, and Schuettler (2011) found a weak relationship between positive religious coping and higher PTSD symptoms. Taken together with our results, these findings suggest that, in the midst of suffering, people in distress may tend to engage with their theodicies about God (Wilt et al., 2016) and cope by cultivating their perceived relationship with God (Gerber et al., 2011), even if it means expressing some anger or disappointment toward God. This possibility is consistent with claims that a mature religious faith allows for some level of R/S struggle (Exline et al., 2017; Pargament, 2007; Wilt et al., 2016).

Our primary hypotheses regarding moderation were supported: the relationship between belief violations and PTSD symptoms was moderated by benevolent theodicies. Specifically, as belief violations increased, flood survivors who endorsed greater belief that God was in control of their suffering, was suffering compassionately alongside them, and was building their character through suffering tended to report fewer symptoms of PTSD than survivors who held less benevolent theodicies. As suggested by previous studies, following traumatic events, survivors who hold more benevolent theodicies may tend to engage in more positive religious coping, which often leads to better psychological outcomes (Park, Currier, Harris, & Slattery, 2017; cf. Exline et al., 2017; Pargament, 2007; Wilt et al., 2016, 2017).

These results have important implications for disaster preparedness and response. Specifically, our findings suggest there is value in helping people cultivate spiritual resources in addition to physical resources (e.g., shelter planning). Indeed, these findings suggest that benevolent theodicies may serve as a protective factor for disaster-affected people and communities. As such, benevolent theodicies could be a potential intervention target for disaster preparedness and response efforts. For example, preparedness efforts might involve helping theistic religious believers prepare for disasters by cultivating benevolent theodicies during times when life is going well. Then, in the aftermath of a disaster, people providing disaster spiritual and emotional care can help survivors remember and nurture those theodicies, thereby helping buffer against common post-disaster reactions such as PTSD, anxiety, or depression.

This possibility requires disaster care providers to be both competent and comfortable with addressing religious and spiritual concerns. However, commonly utilized disaster mental health interventions (e.g., Psychological First Aid [PFA]) do not explicitly target survivors' religion and spirituality. To fill this gap, Aten et al. (2018) have developed a spiritually integrated disaster mental health intervention called Spiritual First Aid (SFA). SFA addresses survivors' immediate practical needs as well as their spiritual distress. It assesses survivors' spiritual resources and connects survivors with additional spiritual coping resources if needed (e.g., a faith community; mental health care). Drawing from nearly 40 years of psychological research on religion and spirituality, SFA is an evidence-informed intervention designed to facilitate survivors' holistic wellness and improve their post-disaster trajectory of recovery. In line with results of the current study, SFA addresses spiritual distress by adopting a strengths-based approach that helps survivors draw upon their existing positive spiritual resources (e.g., benevolent theodicies) in order to prevent or mitigate post-disaster spiritual and psychological distress.

Strengths, Limitations, and Future Research

The current study replicates and extends previous work on belief violations, benevolent theodicies, and the role of R/S in mitigating negative post-disaster reactions. It has several strengths, including the use of a community sample of disaster survivors, comprised of roughly equal numbers of men and women and encompassing a wide range of ages. Moreover, this study exhibits high external validity in that data was collected from survivors of a natural disaster, within one month post-disaster, and using a highly religious (yet religiously representative) sample.

Even so, this study is not without limitations. First, our sample was roughly 75% White and 75% Christian, and it over-represented people who are currently married, are of middle or upper socioeconomic status, and/or have a bachelor's degree or higher. Therefore, it remains unclear whether these findings are generalizable to racial/ethnic minorities and religious minorities (e.g., people who are religiously unaffiliated or adhere to a non-Christian faith), as well as to individuals who are not currently married or have a lower socioeconomic status or education level. Second, we tested our moderation hypotheses using a cross-sectional design, but a longitudinal design would provide stronger evidence for how belief violations and benevolent theodicies influence the trajectory of PTSD over time. Third, we assessed PTsD symptoms broadly, using the standard instructions of the PCL-5 (which do not ask respondents whether their trauma symptoms are related specifically to the disaster). Future disaster researchers might adapt the PCL-5 instructions to ask specifically about disaster-related PTSD symptoms. Lastly, experimental research would help clarify the pattern of relationships we examined in this study (i.e., whether disasters cause belief violations, which in turn cause PTSD symptoms, and whether benevolent theodicies might attenuate this causal relationship), and intervention research (e.g., comparing SFA and PFA) could help explore whether interventions targeted at increasing benevolent theodicies might be effective in mitigating post-disaster PTSD symptoms as well. Lastly, more research is needed to replicate and extend this line of inquiry by comparing survivors' responses to different types of disasters (e.g., natural disasters versus human-caused disasters) in order to determine whether various disaster-related stressors elicit different R/S responses and/or different moderating effects of benevolent theodicies.

Indeed, we hope the next frontier in disaster research includes a focus on identifying factors (e.g., benevolent theodicies) that can help protect disaster-affected individuals and communities from negative post-disaster reactions. Similarly, researchers can work to develop and test spiritually integrated disaster mental health interventions (e.g., SFA) that focus on harnessing survivors' R/S in ways that can promote their health, well-being, and resilience. Ultimately, having a better understanding of the ways disaster survivors might adaptively engage their R/S can lead to interventions that are both evidence-informed and culturally responsive.

References

AIR Worldwide: Louisiana's record rainfall caused by low-pressure system. (2016, August 16). Insurance Journal. Retrieved from http://www.mynewmarkets.com

Aldwin, C. M. (2007). Stress, coping, and development: An integrative approach. New York, NY: Guildford.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, 5th ed., VA: American Psychiatric Association.

Aten, J. D., Shannonhouse, L., Davis, D. E., Davis, E. B., Hook, J. N., Van Tongeren, D. R., ... Leonard, L. (2018). Spiritual first aid. Manuscript in progress.

Belles, J., Dolce, C., & Erdman, J. (2016). 2016 hurricane season recap: 10 things we will remember. Retrieved from: https://weather.com/storms/hurricane/news/hurricane-season-2016-atlantic-recap.

Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489-498.

Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders--Fifth Edition (PCL-5) in veterans. Psychological Assessment, 28, 1379-1391.

Brown, R. F. (1999). Theodicy. In E. Fahlbusch & G. Bromiley (Eds.), The encyclopedia of Christianity (Vol. 5, pp. 353-356). Grand Rapids, MI: Eerdmans.

Bussing, A., Ostermann, T., & Matthiessen, P. F. (2005). The role of religion and spirituality in medical patients in Germany. Journal of Religion and Health, 44, 321-340.

Currier, J. M., Drescher, K. D., Nieuwsma, J. A., & McCormick, W. H. (2017). Theodicies and professional quality of life in a nationally representative sample of chaplains in the veterans' health administration. Journal of Prevention & Intervention in the Community, 45, 286-296.

Chukwuorji, J. B. C., Ifeagwazi, C. M., & Eze, J. E. (2017). Event centrality influences post-traumatic stress disorder symptoms via core beliefs in internally displaced older adults. Aging & Mental Health. Advance online publication. doi: 10.1080/13607863.2017.1396580

Di Liberto, T. (2016, August 19). August 2016 extreme rain and floods along the Gulf Coast. NOAA. Retrieved from http://www.climate.gov

Exline, J. J., Hall, T. W., Pargament, K. I., & Harriott, V. A. (2017). Predictors of growth from spiritual struggle among Christian undergraduates: Religious coping and perceptions of helpful action by God are both important. The Journal of Positive Psychology, 12, 501-508.

Funes, Y. (2016, August 30). Latest numbers show Louisiana flooding was worse than initially thought. Color Lines. Retrieved from http://www.colorlines.com

George, L. S., Park, C. L., & Chaudoir, S. R. (2016). Examining the relationship between trauma centrality and posttraumatic stress disorder symptoms: A moderated mediation approach. Traumatology, 22, 85-93.

Gerber, M. M., Boals, A., & Schuettler, D. (2011). The unique contributions of positive and negative religious coping to posttraumatic growth and PTSD. Psychology of Religion and Spirituality, 3, 298-307.

Hale-Smith, A., Park, C. L., & Edmondson, D. (2012). Measuring beliefs about suffering: Development of the Views of Suffering Scale. Psychological Assessment, 24, 855-866.

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Publications.

Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York, NY: The Free Press.

Lipinski, J. (2016, August 16). For many Katrina survivors, Louisiana Flood of 2016 revives trauma. The Time-Picayune. Retrieved from www.nola.com

Lipka, M., & Wormald, B. (2016). How religious is your state? Retrieved from http://www.pewresearch.org/fact-tank/2016/02/29/how-religious-is- your-state/

National Centers for Environmental Information (NCEI). (2018). U.S. billion-dollar weather and climate disasters. Retrieved from https://www.ncdc.noaa.gov/billions

Pargament, K. I. (2007). Spiritually integrated psychotherapy: Understanding and addressing the sacred. New York, NY: Guilford Press.

Park, C. L. (2016). Meaning making in the context of disasters. Journal of Clinical Psychology, 72, 1234-1246.

Park, C., Currier, J., Harris, I., & Slattery, J. (2017). Trauma, meaning, and spirituality: Translating research into clinical practice. Washington, DC: APA.

Park, C. L., Mills, M. A., & Edmondson, D. (2012). PTSD as meaning violation: Testing a cognitive worldview perspective. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 66-73.

Park, C. L., Riley, K. E., George, L. S., Gutierrez, I. A., Hale, A. E., Cho, D., & Braun, T. D. (2016). Assessing disruptions in meaning: Development of the Global Meaning Violation Scale. Cognitive Therapy and Research, 40, 831-846.

Schlomer, G. L., Bauman, S., & Card, N. A. (2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57, 1-10.

Terrell, D. (2016). The economic impact of the August 2016 floods on the State of Louisiana: Louisiana Economic Development. Lake Charles, LA: Lewis Terrell & Associates, LLC.

Visser, S., Jackson, A. Yan, H., & Flores, R. (2016, August 18). Louisiana flooding: Cajun Navy answers call for volunteers. CNN. Retrieved from http://www.cnn.com

Wilt, J. A., Exline, J. J., Grubbs, J. B., Park, C. L., & Pargament, K. I. (2016). God's role in suffering: Theodicies, divine struggle, and mental health. Psychology of Religion and Spirituality, 8, 352-362.

Wilt, J. A., Exline, J. J., Grubbs, J. B., Park, C. L., & Pargament, K. I. (2017). Theological beliefs about suffering and interactions with the divine. Psychology of Religion and Spirituality, 9, 137-147.

Yan, H., & Flores, R. (2016, August 19). Louisiana flood: Worst US disaster since Hurricane Sandy, Red Cross says. CNN. Retrieved from http://www.cnn.com

Stacey E. McElroy-Heltzel

Georgia State University

Edward B. Davis

Wheaton College

Don E. Davis

Georgia State University

Jamie D. Aten

Wheaton College

Daryl R. Van Tongeren

Hope College

Joshua N. Hook

University of North Texas

Jenny Hwang

Wheaton College

This publication was made possible through the support of a grant from the John Templeton Foundation (Grant #44040). The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the John Templeton Foundation. Correspondence concerning this article should be addressed to Stacey McElroy-Heltzel, Department of Counselling and Psychological Services, Georgia State University, 30 Pryor Street, Atlanta, GA 30303; smcelroy3@gsu.edu

Authors

Stacey E. McElroy-Heltzel (Ph.D. in Counseling Psychology, Georgia State University) is a Postdoctoral Research Associate at Georgia State University. Dr. McElroy-Heltzel's research interests include intercultural couples, humility, and religion/spirituality.

Edward B. Davis (Psy.D, Regent University) is an Associate Professor of Psychology at Wheaton College (IL). His research focuses on the psychology of religion and spirituality, especially relational spirituality, God representations, disasters, and positive psychology.

Don E. Davis (Ph.D. in Counseling Psychology) is an Associate Professor of Psychology at Georgia State University, Atlanta, GA. His research interests include positive psychology--especially relational virtues of humility, forgiveness, and gratitude--as well as integration of spirituality into counseling.

Jamie D. Aten (Ph.D. in Counseling Psychology, Indiana State University) is the Dr. Arthur P. Rech and Mrs. Jean May Rech Associate Professor of Psychology and the Founder and Executive Director of the Humanitarian Disaster Institute at Wheaton College. Dr. Aten's primary professional interests include the psychology of religion/spirituality and disasters, spiritually oriented disaster psychology, and psychology in disaster ministry.

Joshua N. Hook (Ph.D. in Counseling Psychology, Virginia Commonwealth University) is an Associate Professor of Psychology at the University of North Texas. Dr. Hook's research interests include humility, religion/spirituality, and multicultural counseling. He also blogs regularly at www.joshuanhook.com.

Daryl R. Van Tongeren (Ph.D. in Social Psychology, Virginia Commonwealth University) is an Associate Professor of Psychology at Hope College. He studies the psychology of meaning, religion, virtues, and suffering.

Jenny Hwang (M.A. International Disaster Psychology, University of Denver) is the Managing Director for the Humanitarian Disaster Institute at Wheaton College. Her research interests includes global mental health (in the context of disaster settings), human trafficking, cross cultural communication, and refugee and immigrant mental health.

Caption: Figure 1. Hypothesis 2: Conceptual diagram depicting the moderation of the effect of belief violations (X) on post-disaster PTSD symptoms (Y) by benevolent theodicies (e.g., beliefs that God has providential control over suffering [providence theodicy, [M.sub.1]], willfully shares in our suffering [suffering-God theodicy, [M.sub.2]], and uses suffering to build our character [soul-building theodicy, [M.sub.3]]). Stated differently, benevolent views of God's role in suffering are the boundary condition that influences how much of an effect belief violations have on post-disaster PTSD symptoms.

Table 1

Psychometric Properties and Intercorrelations of Study Variables

Variable                      M        SD     Possible   Actual
                                               Range     Range

1. Belief Violations        13.78     4.27      5-25      5-25
2. PTSD Symptoms            30.26    15.99      0-80      0-75
3. Providence Theodicy      10.64     3.60      3-18      3-18
4. Suffering-God Theodicy   11.56     3.76      3-18      3-18
5. Soul-building Theodicy   11.80     3.11      3-18      3-18

Variable                      1        2         3       4        5

1. Belief Violations        (.81)
2. PTSD Symptoms            .62 *    (.95)
3. Providence Theodicy      .29 *    .31 *     (.80)
4. Suffering-God Theodicy   .29 *    .23 *     .65 *    (.83)
5. Soul-building Theodicy   .17 *     .05      .51 *     .64 *   (.75)

Note. N = 466. PTSD = Post-traumatic Stress Disorder. Coefficient
alphas are presented along the diagonal.

* p < .001.

Table 2

Results from Regression Analyses Examining the Moderation of the
Effect of Belief Violations (X) on Post-disaster PTSD Symptoms
(Y) by Benevolent Theodicies (M)

                                       Coeff.    SE      t        P

Intercept                 [i.sub.1]    30.94    .60    51.72    .000
Belief violations (X)     [b.sub.1]     2.16    .16    13.26    .000
Providence theodicy       [b.sub.2]     0.21    .26     0.81    .420
  ([M.sub.1])
Moderation effect         [b.sub.3]    -0.15    .04    -3.45    .001
  (X [M.sub.1])

                                  [R.sup.2] = .43, MSE = 146.17
                                   F(3, 462) = 199.56, p < .001

Intercept                 [i.sub.1]    31.00    .61    50.51    .000
Belief violations (X)     [b.sub.1]     2.19    .16    13.36    .000
Suffering-God theodicy    [b.sub.2]    -0.09    .20    -0.45    .649
  ([M.sub.2])
Moderation effect         [b.sub.3]    -0.16    .03    -4.62    .000
  (X [M.sub.2])
                                  [R.sup.2] = .42, MSE = 148.29
                                   F(3, 462) = 167.83, p < .001

Intercept                 [i.sub.1]    30.52    .59    51.54    .000
Belief violations (X)     [b.sub.1]     2.36    .15    16.13    .000
Soul-building theodicy    [b.sub.2]    -0.50    .23    -2.13    .034
  ([M.sub.3])
Moderation effect         [b.sub.3]    -0.12    .04    -2.79    .006
  (X [M.sub.3])

                                  [R.sup.2] = .40, MSE = 153.90
                                   F(3, 462) = 111.80, p < .001

Note. N = 466. SE = standard error. Belief violations (X) and
benevolent theodicies (M) were mean-centered prior to analysis.

Table 3

Conditional Effects of Belief Violations (X) on Post-disaster PTSD
Symptoms (Y) at Values of the Moderator Benevolent Theodicies (M)

Moderator (M)                              Effect     SE        t

Providence theodicy (M1)
Low providence theodicy beliefs             2.71      .19     14.39
Average providence theodicy beliefs         2.16      .16     13.26
High providence theodicy beliefs            1.62      .26     6.21

Suffering-God theodicy (M2)
Low suffering-God theodicy beliefs          2.78      .18     15.71
Average suffering-God theodicy beliefs      2.18      .16     13.36
High suffering-God theodicy beliefs         1.59      .24     6.74

Soul-Building theodicy (M3)
Low soul-building theodicy beliefs          2.73      .18     15.11
Average soul-building theodicy beliefs      2.36      .15     16.13
High soul-building theodicy beliefs         2.00      .21     9.42

Moderator (M)                               p           CI

Providence theodicy (M1)
Low providence theodicy beliefs           .000     [2.34, 3.08]
Average providence theodicy beliefs       .000     [1.84, 2.48]
High providence theodicy beliefs          .000     [1.11, 2.13]

Suffering-God theodicy (M2)
Low suffering-God theodicy beliefs        .000     [2.43, 3.12]
Average suffering-God theodicy beliefs    .000     [1.86, 2.50]
High suffering-God theodicy beliefs       .000     [1.12, 2.05]

Soul-Building theodicy (M3)
Low soul-building theodicy beliefs        .000     [2.38, 3.09]
Average soul-building theodicy beliefs    .000     [2.08, 2.65]
High soul-building theodicy beliefs       .000     [1.58, 2.41]

Note. N= 466. SE= standard error; CI = confidence interval. Belief
violations (X) and benevolent theodicies (M) were mean-centered
prior to analysis. Values for each moderator are the mean and
plus/minus one standard deviation from the mean.