As a leading researcher in this field, Pargament (1997) makes reference to the transactional model of stress and coping (Lazarus & [Folkman], 1984) as a potential point of departure for understanding and organizing research on religiosity and spirituality. Notably, he has focused on the process of religious coping behaviour with some additional emphasis on religious appraisals or attributions in response to various life stressors (e.g., Pargament & Hahn, 1986; [Mahoney, Pargament], Koenig, & Perez, 2000). Pargament continues to expand the application of these religious and spiritual domains in the coping process, most recently addressing the importance of spiritual attachment (connection) to God as a key factor in driving the religious coping process (Belavich & Pargament, 2002). Following Pargament's lead, a handful of researchers have started to apply the transactional model to their investigation of spirituality, coping, and health (e.g., [Stolley] et al., 1999). And yet, these applications remain limited in their focus on one or two aspects of the coping process (e.g., role of person factors). Research in the area of psychosomatic medicine has long demonstrated that hope has an ameliorative effect on healing (

This longitudinal study addressed the role of spirituality in women's response to breast cancer. Ninety-three women diagnosed with breast cancer were assessed on various measures of image of God, positive attitude, social well-being and emotional distress at pre-diagnosis, 6 months post-surgery and 1 year post-surgery. As compared to women who dropped out of the study, this sample reported religion to be less important in their daily lives. Path analyses showed evidence of direct and indirect effects of positive and negative images of God on emotional distress in cross-sectional but not longitudinal data. A positive image of God was related to greater concurrent distress while a negative image of God was indirectly related to greater distress through the pathways of social well-being and positive attitude. In the longitudinal path model, a pre-diagnosis measure of religious salience was the only aspect of spirituality that predicted an increase in distress at 1 year post-surgery. The cross-sectional analyses provided limited support for the "religious/spiritual mobilization" hypothesis as put forth by Pargament (The psychology of religion and coping. New York: Guilford Press, 1997). There was also limited support for the mediator variables of positive attitude and social well-being as mechanisms through which spirituality influences adjustment. Finally, there was no support that spirituality acted in a protective manner rather the negative elements of spirituality were more prominent in relation to various aspects of women's adjustment to breast cancer. Such results suggest that women who were less spiritually/religiously involved prior to the onset of breast cancer and who attempt to mobilize these resources under the stress of diagnosis may experience a negative process of spiritual struggle and doubt that, in turn, has implications for their long-term adjustment.

Notably the nature of the relationship between religious coping and emotional adjustment depended on the type of religious coping strategy as well as the specific time of assessment. Specificity of information in the use of religious coping can allow health-care professionals to better identify resources and address potential points of difficulty during the process of women's adjustment to breast cancer.

This study investigates the role of religious salience, God image and religious coping in relation to perceived growth following a diagnosis of breast cancer. Eighty-seven breast cancer patients were followed from pre-diagnosis up to 24 months post-surgery. The findings of this study provided limited support for the role of positive aspects of spirituality in relation to perceived growth. Religious involvement at pre-diagnosis was predictive of less growth at 24 months post-surgery while a positive image of God had no association with growth. While some forms of positive religious coping demonstrated positive associations, others evidenced no relationship or negative relationships with growth. Negative aspects of spirituality were more consistently related to growth with the nature of the association again depending on the type of negative spirituality being assessed. For example, passive deferral coping was related to less growth while spiritual discontent coping was related to greater growth across time. Such findings underscore the need to attend to negative aspects of spirituality from early on in the process of cancer adjustment as such expressions may have implications for women's ability to develop and maintain a positive perspective in their coping over the long-term.

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