Medires Publishers - Article

Abstract

Introduction: Medicine maintains humans' health and restores health through science and practice. Health staffs are responsible for diagnosis, treatment of reactions to the life events in all aspects of health. Holistic treatment pays attention to physical-psychological-social and spiritual health disorders. Areas covered: Psycho-neuro-endocrine-immunology confirms effect of psychological conditions on the function of the nervous, endocrine and immune systems. Diathesis-stress model considers vulnerability and stress as the cause of disease. Expert opinion: The sound heart theory, considers the goal of spiritual interventions as maintaining and improving spiritual health. Spirituality as protective factor transforms traumatic experience of life events into spiritual experience with secure attachment to God. Based on the theory protocol, spiritual communication, spiritual knowledge enhancement, spiritual skills training and motivation are necessary to achieve spiritual health and gain the courage in facing life crisis. Feeling of refuge in God, secure attachment to God and positive image of God act as protective factors which cause a change in attitude towards stress. The implementation of spiritual health services is one of the important duties of trained therapeutic team with clinical competence and licensed. They can provide spiritual scaffolding and model-oriented education with spiritual self-care in the position of spiritual mentors.

Introduction

Abu Bakr Rabi Ibn Ahmad Akhwini, in his book "Hidayah al-Mu'taalmin" defined medicine: “Medicine is a profession that maintains the health of people and when it is lost, restores health through science and practice”) Naseri, et al. 2013). Health staffs are responsible for diagnosis, treatment and care of biological-psychological-social-spiritual reactions of people towards life events throughout life and in the spectrum of health and disease (Asadzandi, et al. 2021a). Holistic care and comprehensive medicine pay attention to all aspects of health (Ventegodt, et al. 2003). According to the psycho-neuro-endocrine immunology approach, psychological conditions affect the function of the nervous, endocrine and immune systems. And the tendency to vulnerability along with stress considered as the cause of the disease in diathesis-stress model (Sadock, & Sudoku, 2018). So, in health services, transformative methods for mind-body-spirit integration are important (Luskin, 2004). Spiritual health services considered as a protective factor (Asadzandi, et al. 2020a). Of course, because spirituality has a philosophical background, health and illness are social concepts, the definition of spiritual health and spiritual distress are different according to the culture of societies (Ghalyanee, et al. 2021). Semiology investigated the signs and symptoms of spiritual health disorders, spiritual pathology explains the causes of spiritual distress, so spiritual interventions (care/counseling) that used to treat spiritual distress must be community-oriented and harmonize with the culture and beliefs of health care recipients (Asadzandi &Seyed Kalal, 2023a).

The Sound Heart theory in spiritual health was designed and validated by Minoo Asadzandi in the paradigm of Abrahamic religions (Asadzandi, 2017). The theory has been judged in the fourth stage of exact and strict judgments by “Specialized Chair of Behavioral Sciences” ", the “Specialized Chair of transformative Science”, "Pre-Summit" and "Final Summit Sessions " in 2019 to 2023. Finally, model was confirmed in 2023 by the "Support Board of Chairs of Theorizing, Criticism and Scientific Debate " of the "Supreme Council of the Cultural Revolution of Iran" (Asadzandi, 2023a). The reviewers emphasized the explanation of the propositions of this theory to create a deeper understanding of spiritual health as a specific cultural phenomenon for the followers of Abrahamic religions (Asadzandi, 2023c). Because explanation as a set of statements can pass from the pure description of the phenomenon to discover its causes. 

Theory plays a central role in explaining a specific phenomenon (Asadzandi, 2023b). Explanation should express and clarify the communication pattern exists between the causes, structure and background, consequences and effects of a particular phenomenon by explaining what this phenomenon is, how it happens, and what are its cause-and-effect relationships (Hoban, 2015). Due to the lack of explanation of the effect of spiritual health interventions and the protective effect of spirituality on diathesis-stress, this study was conducted with the aim of explaining the effect of spiritual health interventions based on the Sound Heart Theory with the diathesis-stress model approach. 

Method

In combined study, based on the Creswell et al. model (2003) with discovery-explanatory approach (Tashakkori & Creswell, 2007; Creswell, 2003), qualitative data from: —non-systematic review and contractual content analysis of different types of religious spirituality, spiritual care, spiritual counselling, spiritual mentoring, the theory of personality and spiritual pathology theory of Sound Heart Model, —Quantitative data from the clinical applications of model were integrated. The validity of meta-inferences of research was measured: - in the quantitative data section through internal-external validity, -in the qualitative data section with “reliability” or “capability index” (Mohammadpour et al., 2012).

Result

Healthy spiritual personality which leads to spiritual health (sound heart) is the main protective factor against stress. Spiritual health caused by true worship. The truth of worship improves:

• -Social health by: kindness, forgiveness, charity, helping the needy,
• -Mental health by: trusting in God, delegating life's problems to God, adaptability,
• -Physical health by: carrying out the "orders and rules of religion" in daily living activity (avoidance of alcohol, drugs, risky sexual relations, inactivity, overeating, etc). (Figure1)

Fig 1: Spiritual factors for achieving healthy spiritual personality

Table 1: The propositions of the theory in explaining the effect of spirituality:

Based on the Sound Heart Model the implementation of spiritual health services is one of the important duties of a trained therapeutic team with clinical competence and licensed to provide spiritual scaffolding and model-oriented education with spiritual self-care in the position of spiritual mentors. In model- protocol, spiritual communication, spiritual knowledge enhancement, spiritual skills training and motivation are necessary for patients /clients to achieve spiritual health (Sound Heart) and gain the courage in facing life crisis. Considering the role of healthy spiritual personality as the main protective factor against stress in the diathesis-stress model, following actions are necessary for the health system staff (Figure2):

1. Try to acquire the competence to play a professional role as a mentor. Through spiritual self-care mentors can implement spiritual scaffolding and model-oriented training.
2. Try to create secure attachment with spiritual therapeutic communication based on compassion, empathy, respect, and unconditional acceptance.
3. Try to gain the trust of clients, 
4. Try to increase spiritual knowledge, explain the spiritual causes of life events through the expression of the prophets’ sufferings.
5. Try to teach the spiritual methods of developing the communication with self, people and nature.
6. Try to create a positive image of God by teaching "faith-therapy skills".
7. Try to spiritual motivation and strengthen secure attachment to God.

Try to introduce God as a safe haven, provide the possibility of take refuge in God in difficulties 

Fig2: Spiritual health interventions based on the Sound Heart Model

Discussion

The Sound Heart theory as a hermeneutic model based on the Abrahamic religious evidence, introduces spiritual health as having a sound heart(a confident and hopeful heart, with a sense of trust, security, cheerfulness, happiness, love and satisfaction with destiny) which is the result of a healthy spiritual personality as a relatively stable patterns of perception, feelings, behaviors that shape the communication with God, self, people and nature based on a positive perception of God and a secure attachment to God (Asadzandi, &Seyed Kalal, 2023b). Spiritual pathology is the study of socio-cultural factors that cause misunderstanding of religion, negative image of God and insecure attachment to God (Asadzandi, &Seyed Kalal, 2023a). This negative perception of God affects people's spiritual reactions to life events through changing their attitudes and their interpretation of the life events outside of the Lordship of God. So creates spiritual distress (feelings of loneliness and helplessness, hopelessness of God's mercy, dissatisfaction with destiny, insecurity, worry, fear and anxiety of death) (Zoheiri, et al.2022). Spiritual health interventions are measures that carried out throughout life, in the spectrum of health and illness, by the staffs of health care centers as mentors to deepen spirituality and treat spiritual distress (Asadzandi, Seyed Kalal, et al.2023). These services can be implemented in the form of spiritual care for patients (Asadzandi, 2020a), spiritual counseling for healthy clients (Ahmadi, et al. 2020), spiritual self-care empowerment for community members (Asadzandi, et al.2021a) as a protective factor that transforms the traumatic experience of life events into a spiritual experience which is consistent with the diathesis-stress model. According to the bio-psycho-social model that was developed by the American psychiatrist George Engel in 1977, biological factors (including genetic problems, low immunity, hormonal disorders, physical injuries) are effective in many disorders. The psychological factors (such as depression, addiction, low self-confidence, negative thoughts) and social factors (relations, cultural environment, peers, media) contribute to the manifestation of illness (Asadzandi, 2022b). According to the diathesis-stress model as a multi-cause developmental etiology model which was developed by Paul Mill in the 1960 for explaining schizophrenia and describing psychopathology, health disorders are the result of the interaction between a "talent for vulnerability" (diathesis /sensitivity) and stress caused by life experiences (Meehl, 1962). This model emphasizes on personal responses to stress. The stress-susceptibility model provides the possibility of discovering how biological or genetic traits (diatheses and sensitivities) interact with environmental influences (stressors) in the occurrence of health disorders. It shows that if the combination of vulnerability and stress exceeds a certain threshold, the person will have a health disorder (Ingram, & Luxton, 2005).

The diathesis or susceptibility/ vulnerability", makes a person susceptible to disease when exposed to certain stress. In fact, susceptibility means being vulnerable to a disorder or having the background to suffer from that disorder. It can be biological (for example having a genetic background, reducing or increasing a neurotransmitter) or psychological (for example, incompatible cognitive schemas, incompatible personality style) (Heidi, &Gary, 2003).              Susceptibility to illness is a necessary condition for creating a health disorder, not a sufficient condition for it. Along with susceptibility to disease, stress caused by life events is also necessary (Monroe, &Simons, 1991). According to the level of vulnerability of people, stresses cause health problems (Jeronimus, et   al. 2013). In the meantime, attention should be paid to the role of protective factors such as spiritual attitude towards life events that can neutralize the effects of stress and prevent or restrain the occurrence of spiritual distress (Asadzandi, et al. 2022). Jung (1875-1961) considered any religious belief necessary for the mental health of those who believe in it. William James (1842-1910) called some religious approaches healthy and others pathogenic and believed: “Faith is undoubtedly the most effective treatment for anxiety. A truly religious person does not succumb to anxiety and maintains the balance of his personality and is always ready to deal with unpleasant issues that the times may present to him." (Abolghasemi, & Asadzandi, 2019). Allport considered internal religious orientation or heart adherence to religion as a mature and healthy form, external religious orientation or instrumental use of religion as pathogenic (Allport, 1978). Asadzandi introduces the goal of spiritual health interventions as transforming the traumatic experience of life events into a spiritual experience, until difficulties as challenges can be managed with "the Lordship of God" (Asadzandi, et al. 2023). She considers the feeling of refuge to God, secure attachment to God (belief in the presence and the sufficiency of merciful God) and a positive image of God (belief in God's love and responsiveness) as the most important factor for change in the perception of life's stresses (Asadzandi, et al. 2022b). Theorist considers spiritual health services as a protective factor against stress. In this theory, the members of the treatment team are introduced as spiritual mentors who need spiritual self-care for "spiritual scaffolding" and model-oriented training (Lotfian, et al. 2022). Promotion of spiritual knowledge, training of spiritual skills and motivation are necessary for patients/clients to achieve spiritual health (Sound Heart) and gain the courage to face life's crises (Nasrollahi, et al. 2021). Therefore, it seems that the diathesis-stress model can explain the role of secure attachment to God. Also, paying attention to the sufferings of the prophets can be considered as a protective factor in reducing the spiritual distress of people in the society with wrong customs that consider human suffering as punishment for sins (Asadzandi, & Seyed Kalal, 2023c).

Conclusion

It seems that due to the influence of spirituality from cultural and religious contexts in every society, the Sound Heart Theory can be effective for relieving the spiritual distress of the followers of Abrahamic religions. Model based spiritual health services can treat insecure attachment to God and the negative image of God as the most important causes of spiritual distress.

Acknowledgement

The theorist appreciates the careful judgment of the judges, critics, and observers nominated by the “Support Committee of Theorizing Chairs, Criticism and Scientific Debate”. 

Conflict of interest

The authors declare that there is no conflict of interest in the present study.

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