One of the strongest tropical cyclones to hit land in recorded history, Typhoon Haiyan (Yolanda) tore through the central Philippines on November 8, 2013 (USAID, 2013). Over a 16-hour time period, with sustained winds up to 196 mph and gusts up to 235 mph, this Category 5 super typhoon produced tsunami-like waves, flooding, landslides, and catastrophic damage, resulting in a large-scale humanitarian crisis (USAID, 2013). To put this natural disaster into perspective, in 2005 Hurricane Katrina hit the southern United States with wind speeds averaging 140 mph at landfall (Lum & Margesson, 2014).

Typhoon Haiyan is the deadliest recorded weather event in the Philippines--an estimated 6,300 people were killed, 28,688 were injured, and 1,062 were missing (National Disaster Risk Reduction Management Council [NDR-RMC], 2013). The effects of this natural disaster were widespread, with 16 million people affected across 46 provinces and 4.1 million people displaced (World Health Organization, 2015). At least 70% of the area in the storm's path was destroyed, and an estimated 1.1 million homes were damaged or destroyed (USAID, 2013). Survivors faced a number of overwhelming challenges, including lack of shelter, food, drinkable water, and sanitation (World Health Organization, 2015). Widespread injuries, psychological distress, and lack of communication with the outside world only heightened the level of panic and chaos (Doyle, 2013; Yap, Guinto, & Bennett, 2013).

Response Efforts

In the wake of the typhoon, the president of the Philippines declared a national state of calamity, citing "mass casualty and major damages to property, disruption of means of livelihoods, roads and normal way of life for people in the affected areas" (Republic Act 10121, Section 3, 2010). Both the Inter-Agency Standing Committee and the World Health Organization categorized the situation as a Level 3 (L3) emergency, the highest designation possible, calling for immediate mobilization of international relief operations (World Health Organization, 2015). While the Philippine government oversaw humanitarian efforts, the United Nations, nongovernmental organizations (NGOs), private volunteer organizations (PVOs), and many other international agencies were involved in the on-the-ground crisis response, in addition to local churches and faith-based organizations. The United States and 20 other nations provided military support as well (Lum & Margesson, 2014).

Despite this international response, relief efforts were fraught with difficulty due to damaged infrastructure and limited communication ability. The majority of roads, bridges, and airports were destroyed or buried in debris, slowing deployment of relief supplies and humanitarian teams (Alcantara, 2014). Transportation to some areas took over 24 hours of travel by road and ferry, and inability to make contact with local authorities made it exceedingly difficult to identify where survivors were and what assistance was needed (Doyle, 2013). In some regions, aid personnel and supplies arrived within days, but in more remote locations, it took up to two weeks (Lum & Margesson, 2014). Widespread loss of power and water only exacerbated the fallout of the disaster, leading to violence, crime, and rioting (Yap, Guinto, & Bennett, 2013). Many survivors, exhausted and traumatized, fled the ruins of their communities on foot, in search of safety, food, and shelter (Doyle, 2013).

The Role of National Humanitarian Aid Workers

To fill the gap of government-coordinated relief operations, clergy, church staff, and volunteers from religious communities mobilized from nearby cities to provide assistance and support, while others sought to provide solace and assistance to survivors who fled on foot (Quezon, Ong, Valido, & Yazar, 2013). National humanitarian aid workers arrived to find that Tacloban and nearby communities in the Leyte, Samar, and Cebu provinces had been reduced to rubble. Dead bodies were scattered about and floating in the ocean, streets were blocked by debris, and there was an overwhelming stench of decay (Destura & Salvana, 2013).

High demand and shortage of help resulted in humanitarian aid workers serving extremely long shifts, sometimes with little food, water, or rest (Quezon, Ong, Valido, & Yazar, 2013). Many of these individuals were also personally affected by the disaster, often having had family members or friends who were injured or killed. Upon arrival, international support teams played a key role in medical care, debris cleanup, distributing supplies, and building shelter (Lum & Margesson, 2014). However, in the months following the disaster, national humanitarian aid workers were faced with the longer-term challenges of restoring a sense of normalcy and providing emotional, psychological, and spiritual care (Geroy, 2013).

Considering the complex nature of disaster response, Lum and Margesson (2014) have identified distinct phases of disaster relief efforts, including search and rescue, treatment and survival, relocation and rehabilitation, early recovery, and long-term reconstruction. Whereas internationally deployed humanitarian personnel may be on site for only a few weeks or months, national humanitarian aid workers, including clergy, church staff, and community members, are more likely to play a role in multiple phases of relief, including long-term reconstruction (Ager et al., 2012; Cardozo et al., 2012, 2013; Eriksson et al., 2013). As such, this subgroup of humanitarian workers may be uniquely impacted.

Psychological Effects of Relief Work

Despite benefiting survivors and society, humanitarian aid workers are at increased risk for psychological distress, including anxiety, depression, posttraumatic stress, and burnout (Connorton, Perry, Hemenway, & Miller, 2012; Fullerton, Ursano, & Wang, 2004). Such reactions have been noted in relief workers responding to earthquakes (Chang et al., 2003), tsunamis (Thoresen, Tonnessen, Lindgaard, Andreassen, & Weisaeth, 2009), armed conflict (Cardozo et al., 2005), genocide (McCormack & Joseph, 2013), and terrorist attacks (Razik, Ehring, & Emmelkamp, 2013). However, much remains unknown about the exact processes and pathways that lead to negative psychological outcomes.

In responding to disaster, humanitarian aid workers often are faced with emotionally distressing and gruesome realities, such as viewing or coming into contact with dead bodies, separated body parts, dying or severely wounded individuals, distressed or disoriented survivors, and people desperately looking for missing friends or family members (Thoresen et al., 2009). For humanitarian aid workers, such disaster exposure can lead to vicarious trauma and correspondent emotional distress (shah, Garland, & Katz, 2007). In disaster situations involving rioting, violence, or unrest, humanitarian aid workers may also experience personal threat (McCormack & Joseph, 2013).

Working long hours in adverse conditions, having low levels of organizational support, facing ethical and moral dilemmas, and being separated from home and loved ones can further exacerbate emotional reactions for humanitarian aid workers (Benedek, Fullerton, & Ursano, 2007). Considering the many potential influences on humanitarian aid workers' psychological health, Blanchetiere (2006) categorizes sources of stress into four main areas: (a) situational factors (health and safety risks, survivor demands, culture shock); (b) job-related factors (workload, living conditions, relationships with fellow workers); (c) organizational factors (program protocols, expectations and support, management style); and (d) personal factors (psychological vulnerabilities, unrealistic self-expectations, lack of experience and self-care). National humanitarian aid workers may be especially psychologically vulnerable, as they are embedded within the community and culture, rather than arriving on the scene after the event. These individuals are likely to have experienced the disaster firsthand or witnessed its destructive impact on loved ones. Additionally, they may not have the same training and preparation as career humanitarian aid staff (Cardozo et al., 2013; Eriksson et al., 2013).

Religious Coping and Burnout

Burnout is a complex phenomenon that has been defined as "a prolonged response to chronic emotional and interpersonal stressors on the job" (Maslach, Schauefeli, & Leiter, 2001, p. 397). It includes three core dimensions--emotional exhaustion, depersonalization, and reduced personal accomplishment (Maslach, Schauefeli, & Leiter, 2001). Burnout has been extensively studied in various professions, including social workers (Travis, Lizano, & Mor Barak, 2015), nurses (Kim, Kim, Kim, Yu, & Lee, 2014), teachers (Nazeer & Zubair, 2015), clergy (Doolittle, 2007), and rescue workers (Prati, Pietrantoni, & Cicognani, 2011). More recently, it also has been studied among humanitarian workers responding to natural disasters (Cardozo et al., 2012; Eriksson et al., 2009).

Many individuals pursue humanitarian work because they find it meaningful and fulfilling, perhaps due to having a generally altruistic identity (McCormack, Joseph, & Hagger, 2009). However, the chronic, overwhelming demands of such work can take a significant toll on their physical and psychological functioning. Humanitarian aid workers--particularly those who live and work long-term in a disaster-affected region--are at increased risk for burnout (Eriksson et al., 2009; Musa & Hamid, 2008). Indeed, elevated psychological distress and burnout have been found in humanitarian aid workers who respond to natural disasters, including tsunamis (Carballo, Heal, & Horbaty, 2006) and earthquakes (Ehring, Razik, & Emmelkamp, 2011).

The first visible sign of burnout is often emotional exhaustion, which has been operationally defined as "feelings of being emotionally overextended and exhausted by one's work" (Maslach & Jackson, 1981, p. 101). This exhaustion may lead aid workers to distance themselves cognitively, emotionally, and perhaps physically from the survivors they are trying to help, sometimes resulting in depersonalization (Maslach, Schauefeli, & Leiter, 2001). Depersonalization is "an unfeeling and impersonal response towards recipients of one's care or service" (Maslach & Jackson, 1981, p. 101), and it can lead to a greater likelihood of accidents, poorer quality of services provided, and inability to gain support from team members. Lack of personal accomplishment, the third facet of burnout, is described as a reduction in "feelings of competence and successful achievement in one's work with people" (Maslach & Jackson, 1981, p. 101). Feelings of reduced personal accomplishment may develop in tandem or as a result of the first two factors (Maslach, Schauefeli, & Leiter, 2001). In some situations, humanitarian aid workers may become so emotionally overwhelmed that they need psychological assistance and are unable to continue their responsibilities. Alternatively, their reduced level of functioning can place an extra burden on colleagues, thereby reducing team cohesion and effectiveness.

Religion as a Coping Resource

These potentially negative effects on humanitarian aid workers are likely to elicit feelings of stress, prompting some type of coping or meaning-making response. Noting the likelihood of disaster exposure in humanitarian work and the relationship between such contact and burnout, it is important to identify factors that may buffer against or exacerbate this risk. Cardozo et al. (2005) reported a lack of social support and separation from family as predictive of burnout among humanitarian aid workers, whereas Ager et al. (2012) identified higher levels of social support and team cohesion as associated with lower levels of burnout. De Paul and Bikos (2015) similarly found that in humanitarian personnel, organizational support was associated with higher psychological well-being. These converging findings substantiate the importance of both social and organizational support in protecting against burnout among this population; however, it is also important to consider intrapersonal factors that may influence humanitarian aid workers' susceptibility to burnout.

For instance, in a meta-analysis of 61 studies exploring risk and resilience among humanitarian aid workers, Brooks et al. (2015) identified coping strategies as a key predictive factor. For humanitarian aid workers who hold to religious beliefs, personal faith and the experience of a loving and intimate relationship with God may serve as an important source of transcendent social support. Religious belief has been connected with lower levels of burnout (Kova & Kezdy, 2008; Shin et al., 2014) and greater psychological health (Fiala, Bjork, & Gorsuch, 2002; Lazar & Bjorck, 2008), potentially through its provision of a cognitive framework that helps individuals cope with and make meaning of distressing experiences. For example, Haynes et al. (2017) found that among survivors of Hurricane Katrina, spiritual meaning making buffered against PTSD symptoms.

However, not all forms of religious meaning-making appear to be equally health-promoting. indeed, research suggests there are two main types of religious coping: positive and negative (Pargament, Smith, Koenig, & Perez, 1998). Positive religious coping refers to coping methods that reflect "a secure relationship with a transcendent force [e.g., God], a sense of spiritual connectedness with others, and a benevolent world view" (Pargament et al., 2011, p. 51). In contrast, negative religious coping refers to coping methods that reflect "underlying spiritual tensions and struggles within oneself, with others, and with the divine" (Pargament et al., 2011, p. 51). In their seminal meta-analysis, Ano and Vasconcelles (2005) found positive religious coping to be positively correlated with positive psychological adjustment and inversely correlated with negative psychological adjustment (cumulative effect sizes = .33 and -.12, respectively). In contrast, negative religious coping was positively correlated with psychological distress (cumulative effect size = .22).

Religious coping has been explored among adults affected by Hurricane Katrina (Chan & Rhodes, 2013; Henslee et al., 2015; Newton & McIntosh, 2009), students impacted by the September 11th terrorist attacks (Heyman, Brennan, & Colarossi, 2010), families affected by wildfires and tornadoes (Miller et al., 2012), and church members who experienced major flooding in their community (Smith, Pargament, Brant, & Oliver, 2000). Taken together, the findings from these studies suggest that positive religious coping is positively related to adaptive psychological outcomes and inversely related to maladaptive psychological outcomes, whereas negative religious coping is positively related to maladaptive psychological outcomes and unrelated to adaptive psychological outcomes. These findings corroborate Ano and Vasconcelles' (2005) meta-analytic findings within a disaster context.

Some initial work has examined religious coping among disaster responders as well. For instance, longitudinal research has identified distinct trajectories of spiritual change among humanitarian aid workers and faith-based relief providers (Eriksson et al., 2015). Also, among missionaries returning from short-term international trips (Bjorck & Kim, 2009), positive religious coping has been associated with better psychological adjustment. Examining burnout among expatriate humanitarian aid workers, Eriksson et al. (2009) found an interaction between age and felt support from God when it comes to predicting the depersonalization dimension of burnout. These findings suggest a complex relationship between religion and burnout, pointing to the need for further empirical exploration.

Although to date the majority of studies have examined religious coping in Western settings or among expatriate humanitarian aid workers, recent research has expanded to examining religious coping in cross-cultural contexts. For example, O'Grady et al. (2012) investigated transcendent beliefs among earthquake survivors in Haiti, and Dawson et al. (2014) explored religious appraisals among indonesian children following a tsunami. Moreover, spirituality and religious practice were found to be a key factors in coping among iranians impacted by civil war (Ebadi, Ahmadi, Ghanei, & Kazemnejad, 2009) and among sri Lankans re-building after a tsunami (Hollifield et al., 2008). Furthermore, among survivors of an earthquake in pakistan, Feder et al. (2013) found that negative religious coping was associated with higher levels of psychological distress. putman, Lea, and Eriksson (2011) explored religious coping in humanitarian workers following political violence in Kenya and Guatemala, using focus groups to identify culturally specific nuances of religious coping. Putman et al. (2011) particularly called for further exploration of religious coping among national humanitarian aid workers.

The Present Study

The purpose of the present study was to examine the associations between positive and negative religious coping and burnout among national humanitarian aid workers involved in disaster relief efforts following Typhoon Haiyan. In the Philippines, religion is an important aspect of cultural identity, making it a salient variable for investigation. Approximately 90-93% of Filipinos identify as Christian (the vast majority identify as Roman Catholic). islam is the largest minority religion, constituting between 5 and 11% of the Filipino population (U.S. Department of State, 2014).

Relative to other types of natural disasters, research investigating disaster response to typhoons is lacking, particularly within Southeast Asian contexts. The majority of research on humanitarian aid workers responding to natural disasters has taken place in scenarios that did not involve near the same level of catastrophic loss (e.g., economic losses, socioemotional impact, death and injuries, homes destroyed) as that caused by Typhoon Haiyan.

Research on the intersection between disaster exposure, religious coping, and mental health outcomes is scarce, and investigation of the intersections among disaster exposure, religious coping, and burnout is even rarer. Furthermore, although the role of religious coping in predicting negative mental health outcomes for disaster survivors has received some scholarly attention and empirical support (Aten et al., 2017), few studies to date have explored religious coping and burnout among national humanitarian aid workers.

With this in mind, we investigated the experiences of Filipino humanitarian aid workers, noting that this group may have been uniquely affected by their longer-term involvement and personal connection with the disaster. Furthermore, our sample mainly consisted of clergy, church staff, and volunteers from religious communities involved in disaster relief activities, and this subgroup of humanitarian aid workers has rarely been investigated in a disaster context. Ultimately, in this study, we hypothesized that, controlling for disaster exposure, negative religious coping would be associated with increased burnout symptoms, whereas positive religious coping would be associated with reduced burnout symptoms.

Method

Participants and Procedure

Participants were 61 adults (35 males [57%], 25 females [41%], 1 did not report sex [2%]) who were involved in long-term relief efforts following Typhoon Haiyan. All participants were relief workers who were attending a one-day workshop on disaster spiritual and emotional care and on burnout risk reduction. Workshop attendees were recruited through email announcements sent out through a national Filipino Christian church association and through advertisements on local faith-based radio stations. Thus, participants were either religiously/spiritually oriented themselves (e.g., involved in a faith community) or interested in learning about faith-based disaster relief work.

The workshop was offered 8 months postdisaster in two of the largest cities in the Philippines--Manila and Cebu City. The workshop was offered free of charge, and participants in this study's survey did not receive any form of compensation. Before completing the survey, participants were provided with an informed consent form and given the opportunity to pose questions to a native Filipino speaker who was familiar with the details and purpose of this study. Participants were informed that completion of the survey was entirely voluntary and was not a condition of their workshop attendance. Following their completion of the survey, participants were debriefed orally. All study materials and procedures received prior institutional approval. Participants ranged in age from 18 to 68 years old (M = 42.63, SD = 11.39). Their education level ranged considerably, with 22% having less than a bachelor's degree, 53% having a bachelor's degree, 20% having a master's degree, and 6% having a doctoral degree. When asked their primary role in the disaster relief efforts, participants were involved in providing spiritual and emotional care (42%), offering supplies (20%), aiding with health care (9%), assisting with debris cleanup (9%), building shelter (5%), acting as a first responder (3%), or some other role (12%). Notably, in the Philippines, there is an unclear distinction between church-sponsored relief work and NGO-sponsored relief work, with many faith communities functioning as both a faith community and an NGO. Likewise, humanitarian aid workers' roles are often unclear, and their training level varies widely. Our sample reflected this wide variation in training and experience. A few participants were professional humanitarian aid workers (i.e., it was their career), but most participants were church-sponsored volunteer humanitarian aid workers who had minimal training or experience in disaster relief work.

Measures

All utilized instruments were initially developed and validated in the English language but were translated into Filipino by a native Filipino speaker and then were back-translated independently by a non-native expert in English-Filipino translation. The surveys were administered in a paper-copy format, preceded by the study's informed consent form.

Direct and indirect disaster exposure. Direct and indirect disaster exposure were assessed using a 12-item measure developed by Thoresen et al. (2009), designed specifically to study the potentially stressful experiences of disaster relief workers. All items were adapted slightly in order to enhance linguistic clarity and readability. For instance, on the Witnessing Experiences subscale (8 items; assessing direct exposure to the disaster), the original item "Strong smells or other sensory perceptions" was adapted slightly to "I experienced strong smells or other sensory perceptions related to the disaster." Similarly, on the Personal Contact with Disaster Victims subscale (4 items; assessing indirect exposure to the disaster), the original item "Personal contact with disaster victims who had suffered loss of next of kin" was adapted slightly to "I had personal contact with disaster victims who had lost next of kin." We also adapted the scaling from the original dichotomous (yes-no scaling) by instead asking respondents to rate each item on a 5-point Likert scale ranging from 0 (never) 4 (very often). The original version of this scale was used to study the potentially stressful experiences of disaster relief workers serving after the 2004 Indian Ocean tsunami, and in that disaster research, the scale demonstrated good evidence of construct, content-related, and predictive validity. In the current study, we calculated mean item scores for each subscale (possible range: 1 to 4), with higher scores indicating higher levels of witnessing experiences (direct exposure) and personal contact with disaster victims (indirect exposure). For the current sample, the Cronbach's alphas were .85 for the Witnessing Experiences subscale and .71 for the Personal Contact With Disaster Victims subscale.

Positive and negative religious coping. Positive and negative religious coping were measured with the Brief RCOPE (Pargament, Feuille, & Burdzy, 2011). The Brief RCOPE consists of 14 items that assess religious coping in response to major life stressors. It has two 7-item subscales, respectively measuring positive and negative religious coping. A sample item on the Positive Religious Coping subscale is "Sought God's love and care," and a sample item on the Negative Religious Coping subscale is "Wondered whether God had abandoned me." Respondents rate each item on a 4-point Likert scale ranging from 1 (not at all) to 4 (a great deal), based on how they coped with a specific negative event in their life. For the purposes of this study, participants were instructed to rate how they coped with stressful experiences associated with providing disaster relief services to survivors of Typhoon Haiyan. Across widely differing samples, the Brief RCOPE has demonstrated evidence of good internal consistency and construct, content-related, convergent, discriminant, predictive, and incremental validity (Pargament et al., 2011), and it has been used in prior research in both Western and non-Western disaster contexts (e.g., Chan & Rhodes, 2013; Feder et al., 2013; Henslee et al., 2015). For each subscale, mean item scores were calculated (possible range: 1 to 4), with higher scores indicating higher levels of positive and negative religious coping. For the current sample, Cronbach's alphas were .78 and .86 for the Positive and Negative Religious Coping subscales, respectively.

Burnout. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS; Maslach & Jackson, 1981). The MBI-HSS consists of 22 items that assess burnout. It has three subscales: the Emotional Exhaustion subscale (9 items; e.g., "I feel burned out from my work"), the Depersonalization subscale (5 items; e.g., "I don't really care what happens to some recipients"), and the Personal Accomplishment subscale (8 items; e.g., "I feel I'm positively influencing other people's lives through my work"). Respondents rate each item on a 7-point Likert scale ranging from 0 (never) to 6 (every day). For each subscale, mean item scores are calculated (possible range: 0 to 6). On the Emotional Exhaustion and Depersonalization subscales, higher scores indicate higher levels of burnout, whereas on the Personal Accomplishment subscale, lower scores indicate higher levels of burnout. Across widely differing samples, the MBI-HSS has demonstrated evidence of good internal consistency and construct, content-related, convergent, and discriminant validity (Kleijweg et al., 2013; Maslach & Jackson, 1981; Wheeler, Vassar, Worley, & Barnes, 2011), and it has been used in previous research with humanitarian aid workers serving both in Western and non-Western humanitarian aid contexts (e.g., Ager et al., 2012; Cardozo et al., 2012; Eriksson et al., 2009). For the current sample, the Cronbach's alphas were .80, .55, and .79 for the Emotional Exhaustion, Depersonalization, and Personal Accomplishment subscales, respectively.

Results

To begin, we checked the data for outliers and normality, neither of which was a problem. Then we calculated descriptive statistics and intercorrelations for all the study variables (see Table 1). There were strong positive correlations between direct and indirect disaster exposure (r = .70, p < .001) and between emotional exhaustion and depersonalization (r = .55, p < .001). In addition, negative religious coping (R/S struggle) was moderately positively correlated with both emotional exhaustion (r = .39, p = .002) and depersonalization (r = .46, p < .001).

Our main hypothesis was that, after controlling for direct and indirect disaster exposure, positive and negative religious coping would predict each of the three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. We tested this hypothesis by conducting three hierarchical regression analyses, respectively using emotional exhaustion, depersonalization, and personal accomplishment as the dependent variables. For each analysis, in Step 1 we entered the two disaster exposure variables (witnessing experiences and personal contact with disaster victims) and in Step 2 we added the two religious coping variables (positive and negative religious coping).

First, we examined the model with emotional exhaustion as the dependent variable (see Table 2). In Step 1, disaster exposure did not predict emotional exhaustion, [R.sup.2] = .03, p = 428. However, in Step 2, controlling for disaster exposure, positive and negative religious coping significantly predicted emotional exhaustion, [DELTA][R.sup.2] = .16, p = .006, indicating a medium-sized effect. The final model (with all four predictors) predicted 18.9% of the variance in emotional exhaustion, but the only significant individual predictor of emotional exhaustion was negative religious coping ([beta] = .41, [sr.sup.2] = .16, p = .002). Thus, taken together, disaster exposure and religious coping explain a moderate amount of variability in emotional exhaustion, with negative religious coping contributing the most.

Second, we examined the model with depersonalization as the dependent variable (see Table 3). In Step 1, disaster exposure approached significance for predicting depersonalization, [R.sup.2] = .09, p = .064; personal contact with disaster victims was a significant positive predictor of depersonalization ([beta] = .42, p = .020). In Step 2, controlling for disaster exposure, positive and negative religious coping significantly predicted depersonalization, [DELTA][R.sup.2] = .20, p = .001, indicating a medium-sized effect. The final model (with all four predictors) predicted 28.6% of the variance in depersonalization, with two significant positive predictors: negative religious coping ([beta] = .45, [sr.sup.2] = .19, p = .002) and personal contact with disaster victims ([beta] = .38, [sr.sup.2] = .07, p = .025). Thus, taken together, disaster exposure and religious coping explain a moderate amount of variability in depersonalization, with negative religious coping contributing the most.

Third, we examined the model with personal accomplishment as the dependent variable (see Table 4). In Step 1, disaster exposure did not significantly predict personal accomplishment, [R.sup.2] = .01, p = .718. Likewise, in Step 2, when controlling for disaster exposure, positive and negative religious coping did not significantly predict personal accomplishment, [DELTA][R.sup.2] = .04, p = .340.

Discussion

Prior research suggests that witnessing disaster experiences and personal contact with disaster survivors can take a toll on humanitarian workers' psychological health and result in increased risk for burnout (Carballo, Heal, & Horbaty, 2006; Ehring, Razik, & Emmelkamp, 2011). Whereas religious belief has been associated with lower levels of burnout (Kovacs & Kezdy, 2008; Shin et al., 2014), not all forms of religiosity (e.g., positive and negative religious coping strategies) appear to be equally health-promoting (Pargament, Smith, Koenig, & Perez, 1998). Prior research among missionaries and Western humanitarian workers has found positive religious coping to be related with emotional well-being and negative religious coping to be correlated with psychological distress. The present study examined positive and negative religious coping among national humanitarian aid workers rather than international workers who had been deployed to the region for a short time. We explored religious coping among this population for two reasons. First, there is a clear gap in the literature concerning culturally specific nuances of religious coping (Putman, Lea, & Eriksson, 2011). Second, national humanitarian aid workers may be uniquely affected by their longer-term involvement and personal connection with the natural disaster, putting them at greater risk for burnout; moreover, they may lack formal training in disaster response (Cardozo et al., 2013; Eriksson et al., 2013).

Overall, our hypothesis for negative religious coping was mostly supported. Controlling for disaster exposure, negative religious coping was associated with increased burnout in the dimensions of emotional exhaustion and depersonalization, although it was not significantly associated with decreased personal accomplishment. Emotional exhaustion, often seen as the first sign of burnout, was not predicted by disaster exposure but instead was predicted by the use of negative religious coping strategies to manage distress. Depersonalization was predicted by both humanitarian aid workers' personal contact with disaster victims as well as their use of negative religious coping strategies. These findings provide evidence that, among humanitarian aid workers, specific types of religiosity--namely negative religious coping--may predict unique variance in burnout symptoms. The more national humanitarian aid workers endorsed negative religious coping strategies, the more they reported emotional exhaustion and depersonalization. That is, the more they questioned God's presence, love, and care, the more likely they were to endorse symptoms of burnout. This finding was true even after controlling for the effects of disaster exposure.

Considering previous studies that have found positive religious coping to be related with emotional well-being (Ano & Vasconcelles, 2005), we also hypothesized that positive religious coping would be associated with reduced burnout symptoms. However, this hypothesis was not supported in the current sample, as positive religious coping did not significantly predict burnout. This conflicting finding may be due to sample characteristics, such as culturally specific nuances of positive religious coping not captured by the Brief RCOPE, or it may be that the positive aspects of religious coping are not very helpful in reducing symptoms of burnout. Notably, Maslach, Schaufeli, and Leiter's (2001) expansion of the construct of burnout to include job engagement as its antithesis may offer clarity into the role of positive religious coping, especially when it comes to humanitarian aid workers.

The present study lends insight into the intrapersonal factors (e.g., cognitive and emotional processes) that may influence burnout symptoms. These findings support prior theorizing by Pargament and colleagues (1998; see also Exline, Pargament, Grubbs, & Yali, 2014), which suggests that negative religious coping includes cognitive reappraisals about God's power, goodness, sovereignty, and presence, and these reappraisals contribute to psychological distress. The present study adds to the growing body of evidence that negative religious coping may have a deleterious impact on psychological health (Ano & Vasconcelles, 2005; Feder et al., 2013). The current study expands on this literature by measuring religious coping and burnout among national humanitarian aid workers from religious communities--specifically humanitarian aid workers responding to a large-scale natural disaster in a non-Western context.

Limitations and Suggestions for Future Research

The present study used a cross-sectional, correlational design, and as such, causal conclusions should not be made. Most notably, negative religious coping cannot be assumed to produce emotional exhaustion and depersonalization. Gathering data at one time point (eight months after the disaster) provides only a snapshot of the experience of national humanitarian aid workers. Longitudinal research is needed to explore the inter-relationships among disaster exposure, religious coping, and burnout symptoms over time. Furthermore, although our results are partially consistent with Pargament et al.'s (1998) prominent theoretical model, there may be other conceptual frameworks that help explain our findings, such as Hobfoll's (2001) conservation of resources theory.

Due to the relatively small sample size of our study, lack of statistical power may have hampered our ability to detect meaningful relationships among some variables. Additionally, the use of a convenience sample limits generalizability, as this group of national humanitarian aid workers may have unique characteristics due to their religious beliefs and organizational culture. Furthermore, these findings should not be assumed to represent the experiences of humanitarian aid workers in other non-Western settings, and results should only be generalized with caution beyond a Filipino context. Future research should examine religious coping and burnout among humanitarian aid workers in diverse cultural settings in order to explore similarities and differences in their experiences, relative to this sample.

Any research involving self-report measures introduces inherent limitations, including possible social desirability of responses. Furthermore, although the self-report measures used in this study have exhibited generally strong psychometric properties, the low internal consistency of the depersonalization dimension of the MBI-HSS may have negatively affected power. Future research should empirically validate self-report measures of religious coping and burnout for use with Filipino and other cross-cultural samples, as well as include other types of measures (e.g., behavioral measures; cf. Dorn, Hook, Davis, Van Tongeren, & Worthington, 2014).

Although the present study offered evidence for the unique association between negative religious coping and burnout (while controlling for disaster exposure), other variables may also play an influential role. Future studies may seek to tease out individual traits and experiences that predispose someone toward positive or negative religious coping strategies. Personality factors, mental health, social support, organizational environment, past disaster exposure, level of training, posttraumatic stress symptoms, and alternate coping strategies are all important variables for consideration. Subsequent research could explore the relationship between religious coping and burnout, controlling for some of these additional factors. Exploration of the processes and pathways leading to burnout among national humanitarian aid workers may be further clarified through exploring possible mediators or moderators.

Considering that all our participants self-identified as Christian, this study could be replicated in samples of humanitarian aid workers who are affiliated with other religions (e.g., Muslim, Jewish, Buddhist, or Hindu workers) in order to explore similarities and differences across workers from various religious traditions. Future studies may also explore whether religious coping is truly a unique form of coping or simply the benefit of an adaptive worldview expressed in religious language. According to some theorists, all people engage in meaning making and employ sense-making strategies, which vary in their adaptive value (Park, 2016; Park, Currier, Harris, & Slattery, 2016). Potentially traumatic events disrupt these strategies and test their resilience. It is possible that there are universal characteristics of more adaptive strategies that are tied to a person's sense of the world and which could be examined using more culture-free measures.

Practical Implications

The findings of this study are particularly applicable to national humanitarian aid workers and volunteers who are high in religious commitment. These individuals may have been motivated to engage in helping behavior because of their spiritual values, such as compassion, service, and hope, and they may be likely to rely on their personal faith and connection with God as a source of meaning for their work. As such, when faced with emotionally distressing experiences, such as unjust suffering, gruesome realities, or the inability to help all victims, this subset of humanitarian aid workers may be particularly likely to engage in negative religious coping, doubting their previously held beliefs about God's character and involvement, and the meaningfulness of their role in disaster relief.

With this in mind, humanitarian and faith-based organizations may provide additional support to workers by facilitating safe environments to reflect on their spiritual beliefs in light of the distressing experiences inherent to relief work. Such interventions might occur in the form of counseling, debriefing, or process-oriented groups, and these interventions have the potential to help buffer against the impact of negative religious coping. Normalizing existential struggle and spiritual questioning as a result of disaster relief work (and correspondingly facilitating support from colleagues) may help psychologically protect national humanitarian aid workers from emotional exhaustion and depersonalization. Proactive interventions, such as those mentioned here, may have the potential to promote sustained job engagement, team cohesion, and increased effectiveness in relief efforts. These findings have additional implications for psychologists and mental health professionals who provide after-care to individuals engaged in humanitarian work.

Likewise, people who volunteer through their local faith community are at risk when sent to the field without proper screening, preparation, and support. This is less common in the developed world where there is an infrastructure that places some controls over who has access to a disaster. In many countries whose populace tends to be highly religious (e.g., the Philippines), volunteers from faith communities are typically the first on the scene and the longest to stay engaged, whether they are adequately prepared or not. NGOs partnering with local faith communities should consider the risk faced by such groups. Disaster training resources could be increased for faith communities in countries that recurrently are hit heavily by natural disasters (e.g., the Philippines gets an average of 25 typhoons per year).

Conclusion

Our findings suggest that, among humanitarian aid workers, burnout is not predicted so much by what workers are exposed to but rather by how they appraise and make meaning of their disaster experiences, using religious coping strategies. We encourage researchers to continue to explore the role of religious coping in protecting against or exacerbating symptoms of burnout among humanitarian aid workers. We call for special attention to be given to humanitarian aid workers in diverse cultural settings, particularly those who live and work in areas most prone to disasters (e.g., countries at high risk for typhoons, floods, hurricanes, earthquakes, etc.). Although our focus has been the experiences of national humanitarian workers responding to natural disaster, similar studies could be conducted among individuals engaged in relief work with refugees and those affected by political unrest, armed conflict, or human trafficking. Finally, in light of increasing attention to positive psychology, job engagement (which has been conceptualized as the antithesis of burnout) may be an important focus of future investigation.

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Laura E. Captari

Joshua N. Hook

David K Mosher

University of North Texas

David Boan

Jamie D. Aten

Edward B. Davis

Wheaton College

Don E. Davis

Georgia State University

Daryl R. Van Tongeren

Hope 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 Laura Captari, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203; Laura- Captari@my.unt.edu

Author

Laura E. Captari (M.S. in Counseling Psychology, University of North Texas) is a doctoral candidate at the University of North Texas. Laura's research and clinical interests include developmental trauma, attachment, religion/spirituality, and posttraumatic growth.

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

David K. Mosher (M.S. in Counseling Psychology, University of North Texas) is a doctoral candidate at the University of North Texas.

David's research interests include religion/spirituality, humility, forgiveness, and other aspects of positive psychology.

David Boan (Ph.D. in Clinical Psychology, Biola University) is the Director for Humanitarian Advocacy for the World Evangelical Alliance. He is a graduate of the Rosemead Graduate School at Biola University and an adjunct faculty member at Wheaton College (IL) and Northwest Nazarene University (ID).

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.

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.

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.

Table 1

Means, Standard Deviations, and Intercorrelations for the Study
Variables

Variable                      M      SD        1         2        3

1. Witnessing               1.42    0.75     (.85)
experiences
(direct disaster
exposure)
2. Personal contact         1.17    0.66    .70 ***    (.71)
with disaster victims
(indirect disaster expo-
sure)
3. Positive                 3.46    0.48      .19       .01     (.78)
religious coping
4. Negative                 1.45    0.59      -.11      -.03     .17
religious coping
5. Emotional                1.63    0.91      .09       .17      .00
exhaustion
6. Depersonalization        1.11    0.96      -.03      .19      .01
7. Personal                 4.21    0.96      .11       .07      .12
accomplishment

Variable                       4          5         6        7

1. Witnessing
experiences
(direct disaster
exposure)
2. Personal contact
with disaster victims
(indirect disaster expo-
sure)
3. Positive
religious coping
4. Negative                  (.86)
religious coping
5. Emotional                 .39 **     (.80)
exhaustion
6. Depersonalization        .46 ***    .55 ***    (.55)
7. Personal                   -.15       .03       .10     (.79)
accomplishment

Note. N = 61. Coefficient alphas are presented in parentheses along
the diagonal.

** p < .01. *** p < .001.

Table 2

Hierarchical Regression Analysis Predicting Emotional Exhaustion

Step and predictor variable       [R.sup.2]    [DELTA][R.sup.2]

Step 1                               .03              .03
Witnessing experiences
(direct exposure)
Personal contact with disaster
victims (indirect exposure)
Step 2                              .19 **          .16 **
Witnessing experiences
(direct exposure)
Personal contact with disaster
victims (indirect exposure)
Positive religious coping
Negative religious coping

Step and predictor variable       [sr.sup.2]    [beta]

Step 1
Witnessing experiences                .00        -.06
(direct exposure)
Personal contact with disaster        .02         .20
victims (indirect exposure)
Step 2
Witnessing experiences                .00         .05
(direct exposure)
Personal contact with disaster        .01         .15
victims (indirect exposure)
Positive religious coping             .01        -.08
Negative religious coping           .16 **      .41 **

Note. N = 61.

** p < .01.

Table 3

Hierarchical Regression Analysis Predicting Depersonalization

Step and predictor variable       [R.sup.2]    [DELTA][R.sup.2]

Step 1                               .09              .09
Witnessing experiences
(direct exposure)
Personal contact with disaster
victims (indirect exposure)
Step 2                              .29 **            .20 **
Witnessing experiences
(direct exposure)
Personal contact with disaster
victims (indirect exposure)
Positive religious coping
Negative religious coping

Step and predictor variable       [sr.sup.2]    [beta]

Step 1
Witnessing experiences                .05        -.33
(direct exposure)
Personal contact with disaster       .09 *       .42 *
victims (indirect exposure)
Step 2
Witnessing experiences                .03        -.24
(direct exposure)
Personal contact with disaster       .07 *       .38 *
victims (indirect exposure)
Positive religious coping             .00        -.03
Negative religious coping           .19 **      .45 **

Note. N = 61.

* p < .05. ** p < .01

Table 4

Hierarchical Regression Analysis Predicting Personal Accomplishment

Step and predictor variable         [R.sup.2]    [DELTA][R.sup.2]

Step 1                                 .01              .01
Witnessing experiences
(direct exposure)
Personal contact with disaster
victims (indirect exposure)
Step 2                                 .05              .04
Witnessing experiences
(direct exposure)
Personal contact with disaster
victims (indirect exposure)
Positive religious coping
Negative religious coping (reli-
gious/spiritual struggle)

Step and predictor variable         [sr.sup.2]    [beta]

Step 1
Witnessing experiences                  .01         .11
(direct exposure)
Personal contact with disaster          .00        -.01
victims (indirect exposure)
Step 2
Witnessing experiences                  .00         .03
(direct exposure)
Personal contact with disaster          .00         .04
victims (indirect exposure)
Positive religious coping               .02         .14
Negative religious coping (reli-        .03        -.17
gious/spiritual struggle)

Note. N = 61.