A Call for the Inclusion of Spirituality in Yoga Research

ISSN:2157-7595 Journal of Yoga & Physical Therapy The International Open Access Journal of Yoga & Physical Therapy Editor-in-Chief H Clare Lewis California State University, USA Executive Editors Xiaofen D Keating The University of Texas at Austin, USA Elaine Louise Bukowski The Richard Stockton College of New Jersey, USA Andreas Michalsen Charité - Universitätsmedizin Berlin, Berlin Kuei-Min Chen Kaohsiung Medical University, Taiwan Available online at: OMICS Publishing Group (www.omicsonline.org) T his article was originally published in a journal published by OMICS Publishing Group, and the attached copy is provided by OMICS Publishing Group for the author’s beneit and for the beneit of the author’s institution, for commercial/research/ educational use including without limitation use in instruction at your institution, sending it to speciic colleagues that you know, and providing a copy to your institution’s administrator. All other uses, reproduction and distribution, including without limitation commercial reprints, selling or licensing copies or access, or posting on open internet sites, your personal or institution’s website or repository, are requested to cite properly. Digital Object Identiier: http://dx.doi.org/10.4172/2157-7595.1000138 MacDonald, J Yoga Phys Ther 2013, 3:3 http://dx.doi.org/10.4172/2157-7595.1000138 Yoga & Physical Therapy Research Article Review Article Open OpenAccess Access A Call for the Inclusion of Spirituality in Yoga Research Douglas A MacDonald* Department of Psychology, University of Detroit Mercy, Michigan, USA Abstract In this brief article, the author draws attention to the fact that much of the current scientiic research on yoga has tended to exclude spirituality as a focus of study. In response, he presents arguments and information regarding the value of incorporating spiritual constructs in yoga investigations and makes suggestions for future studies. A call for the inclusion of spirituality in yoga research With its origins tracing back more than two millennia to ancient India, yoga is a popular practice throughout the world in our time. Accompanying this rise in popularity in the past few decades has been a growing interest on the part of scientists and health professionals alike to empirically explore the salubrious efects of yoga on health and to apply it to the amelioration of physical and mental illness. In this vein, available meta-analyses of the investigations done to date suggest that yoga holds excellent potential for the treatment of pain [1,2] and contributes to improved psychological health in a variety of clinical populations including cancer patients [3-5], menopausal women [6], and persons sufering from a range of neuropsychiatric conditions [7,8]. Notwithstanding its promise as a complementary health intervention, one notable trend seen in the literature has been the tendency for practitioners and researchers to deine and study yoga without overt consideration and inclusion of its foundational spiritual nature and goals [9-11]. he deinition of yoga ofered by this journal is a salient example- as stated on the journal webpage, yoga is “the practice of attaining physical and mental health through meditation and physical exercise” (http://www.omicsonline.org/jypthome.php; retrieved July 25, 2013). he same trend has been observed in how meditation in general is deined in the current research [12]. hough the exclusion of spirituality is somewhat understandable since it is a construct that historically has been associated with religion which itself has been viewed as falling outside the purview of scientiic inquiry [13], such a trend in how yoga is operationalized and investigated may be seen as unfortunate as a burgeoning body of theory and research indicates that spirituality is not only an important component of human functioning that has a substantive impact on health [14] but also that its incorporation into meditative interventions results in improved outcomes above and beyond what is seen with more secularized meditation [15,16] . Given these indings, it would seem important and even prudent for research on yoga to incorporate spirituality so as to best ascertain how it may incrementally contribute to health and wellbeing. With this in mind, I would like to dedicate the remainder of this short article to an overview of the status of spirituality as a scientiic construct with emphasis given to my own research done over the past two decades. What is Spirituality? As already noted, spirituality and related concepts such as religion/ religiousness have come to be the focus of increasing amounts of research within the health and social sciences (e.g. medicine, nursing, psychology, social work, counseling). As an ostensible manifestation of the empirical work, signiicant eforts have been put forth to devise scientiically useful deinitions and at present there are a wide array of standardized assessment instruments available. For instance, in J Yoga Phys Ther ISSN: 2157-7595 JYPT, an open access journal literature surveys I completed in the mid-to-late 1990s, my colleagues and I uncovered over 100 measures of spirituality and related concepts [17,18] and several more have appeared since then. However, despite the ready availability of measurement tools, there exists considerable controversy surrounding how to best conceptualize and measure spirituality with the main issues revolving around (a) its relation to religion (e.g., are spirituality and religion the same or diferent?), (b) the utilization of metaphysical concepts and terms in its deinition which cannot be rendered open to conventional modes of inquiry and investigation (e.g., do we need such notions as divine, sacred, and God in order to deine spirituality?), (c) its contamination with other health constructs, particularly well-being, (d) whether it is best measured quantitatively or qualitatively, and (e) its universality across cultures [19-25]. Some scholars have been so frustrated with the persistence and seeming intractability of these issues that they have suggested the abandonment of spirituality as a topic of study [26]. I myself have spent the better part of the past 20 years working in the area of spirituality with most of my eforts directed at measurement. While I am very aware of the aforementioned issues (and have been among the more vocal members of the scientiic community in highlighting them), this has not discouraged me from advocating for spirituality studies. Rather, these problems have served to motivate me to adopt a thoughtful and methodical stance toward the science and to profer approaches to research which show sensitivity to the complexities of studying spirituality. Considering the vast number of available instruments and the lack of apparent consensus regarding how to best conceptualize the construct, my eforts have been most centrally directed identifying and operationalizing robust core features of spirituality as they are embodied in existing tests so as to bring some degree of order to what the empirical literature is actually telling us about spirituality. hese eforts resulted in the development of a multidimensional measurement model based upon the conjoint statistical analysis of a wide sampling of extant measures [21]. he dimensions themselves appear to embody broad domains of spirituality which have found expression in the scientiic, philosophical, and spiritual literature. Succinctly stated, the dimensions are Cognitive Orientation toward Spirituality (i.e., beliefs about the existence and importance *Corresponding author: Douglas A MacDonald, Department of Psychology, University of Detroit Mercy, 4001 West Mc Nichols Road, Detroit, Michigan, USA, 48221-3038; Tel: (313) 578-0388; E-mail: [email protected] Received July 30, 2013; Accepted August 26, 2013; Published August 29, 2013 Citation: MacDonald DA (2013) A Call for the Inclusion of Spirituality in Yoga Research. J Yoga Phys Ther 3: 138. doi:10.4172/2157-7595.1000138 Copyright: © 2013 MacDonald DA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Volume 3 • Issue 3 • 1000138 Citation: MacDonald DA (2013) A Call for the Inclusion of Spirituality in Yoga Research. J Yoga Phys Ther 3: 138. doi:10.4172/2157-7595.1000138 Page 2 of 3 of spirituality to one’s daily living), Experiential/Phenomenological Dimension (i.e., non-ordinary experiences and states of consciousness of a spiritual nature which involve some alteration to one’s sense of self), Existential Well-Being (i.e., a perception of self as having meaning and purpose and the capacity to deal with the existential adversities of life), Paranormal Beliefs (i.e., beliefs in the validity of parapsychological phenomena), and Religiousness (i.e., beliefs in the existence of a higher power and involvement in practices and activities typically associated with devout religious life such as meditation and prayer). To make these dimensions accessible for investigation, I concurrently created a paper-and-pencil self-report measure called the Expressions of Spirituality Inventory (ESI) [21,27] which demonstrates good psychometric properties. To date, the ESI has proven valuable in not only bringing order to the empirical literature [24], but also for validation of other instruments [28,29], empirical examination of the relation of spirituality to personality and psychosocial functioning [21,30-35] and for theory development [36] (also see end note 1). In general, the work done with the ESI strongly suggests that spirituality (a) is a unique domain of human functioning and individual diference that is not reducible to other recognized aspects of functioning (e.g., health, personality) though is related to them, and (b) demonstrates complex and multidirectional relationships to health and pathology across the dimensions with Existential Well-Being, Religiousness, and Cognitive Orientation toward Spirituality showing the most consistently positive associations, the Experiential/Phenomenological Dimension showing mixed relations, and Paranormal Beliefs the most consistent linkages to psychopathology. What does this mean for yoga research? Some recommendations In a paper I co-authored for the International Journal of Yoga [37], I presented information on a variety of instruments which appear to hold promise for yoga research. he ESI is included among these tests and would be good to use if one wants to measure general dimensions of spirituality. However, in many instances, an investigator is in need of tools that assess more specialized and theory-driven spiritual concepts. In the case of yoga with its grounding in Hindu philosophy, research employing measures of explicitly Hindu concepts would seem to be prime candidates for consideration. As such, tests such as the Hindu Religious Coping Scale [38], Measures of Hindu Pathways [39] and the Vedic Personality Inventory [40,41] may prove valuable. Regardless of the type of measure used, the incorporation of spiritual variables in yoga research would help to broaden the informativeness of such investigations by fostering greater understanding of the reciprocal inluence they have on each other. hat is, whether studying yoga practice as part of lifestyle or as a treatment, such studies would permit for greater insight as to how spirituality may contribute to selection (e.g., do people’s spirituality inluence whether or not they choose to practice yoga and/or show receptiveness to engaging in yoga-based interventions?), outcomes (e.g., does involvement in yoga enhance spirituality in practitioners and vice versa?), and change mechanisms (e.g., does spirituality serve as a mechanism to facilitate therapeutic and/or personological change?). Based upon my own past and ongoing research, some of which is cited earlier, here are three concrete examples of the kind of empirical studies that I am encouraging-(a) explore whether one or more major aspects of spirituality mediate the relation between yogic practice and physical and health outcomes in samples of people participating in yoga-based interventions. Particularly promising dimensions of my ESI for use in such investigations include J Yoga Phys Ther ISSN: 2157-7595 JYPT, an open access journal Cognitive Orientation toward Spirituality, Religiousness, and the Experiential/Phenomenological Dimension; (b) examine the extent to which spiritual variables moderate the relation of yoga to treatment outcomes through the examination of the interaction efects of one or more ESI dimensions with yoga practice, and; (c) compare preversus post-treatment levels of spirituality in both clinical and nonclinical samples of yoga practitioners to ascertain if there are changes in spirituality as a function of yoga practice. A more speciic study idea along these lines would be to compare secular versus spirituallycontextualized yoga practice on both health and spiritual outcomes. It is my hope that such research will be energetically pursued by those in the yoga community Endnote At the time of writing this article, I am involved with additional investigations examining the generalizability of the ESI across cultures and languages. Preliminary analyses indicate that the instrument shows good structural invariance but that culture needs to be taken into account when studying spirituality. I am also in the early stages of exploring the relation of spirituality assessed via the ESI to resting brain states measured using quantitative EEG. I am expecting to have manuscripts reporting the results of these studies completed in the near future and am hopeful that they ind publication. Author Biographical Statement Douglas A. MacDonald, Ph.D. is an Associate Professor of Psychology at the University of Detroit Mercy. He has been actively involved in research on spirituality for several years with primary emphasis given to its measurement and explorations of its relations and implications for psychological and social functioning. He is Editor Emeritus of the International Journal of Transpersonal Studies, Associate Editor of the Journal of Transpersonal Psychology, and Research Editor of the Journal of Humanistic Psychology. As well, he is on the editorial board for the Journal of Management, Religion, and Spirituality, and the Australian Gestalt Journal and serves as an ad hoc reviewer for a variety of other journals specializing in research on religion, spirituality, humanistic and existential psychology, personality psychology, and psychometrics. References 1. Büssing A, Ostermann T, Lüdtke R, Michalsen A (2012) Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain 13: 1-9. 2. Cramer H, Lauche R, Haller H, Dobos G (2013) A systematic review and metaanalysis of yoga for low back pain. Clin J Pain 29: 450-460. 3. Buffart LM, van Uffelen JG, Riphagen II, Brug J, van Mechelen W, et al. (2012) Physical and psychosocial beneits of yoga in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. BMC Cancer 12: 599. 4. Cramer H, Lange S, Klose P, Paul A, Dobos G (2012) Yoga for breast cancer patients and survivors: A systematic review and meta-analysis. BMC Cancer 12: 412. 5. Lin KY, Hu YT, Chang KJ, Lin HF, Tsauo JY (2011) Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: A meta-analysis. Evidence-based Complementary and Alternative Medicine659876. 6. Cramer H, Lauche R, Langhorst J, Dobos G (2012) Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine 863905. 7. Balasubramaniam M, Telles S, Doraiswamy PM (2013) Yoga on our minds: Volume 3 • Issue 3 • 1000138 Citation: MacDonald DA (2013) A Call for the Inclusion of Spirituality in Yoga Research. J Yoga Phys Ther 3: 138. doi:10.4172/2157-7595.1000138 Page 3 of 3 a systematic review of yoga for neuropsychiatric disorders. Frontiers in Psychiatry3:117. 8. Cramer H, Lauche R, Klose P, Langhorst J, Dobos G (2013) Yoga forschizophrenia: A systematic review and meta-analysis. BMC Psychiatry 13: 32. 9. Feuerstein G (1989) Yoga: The technology of ecstasy. Los Angeles, CA: Jeremy Tarcher, USA. 10. Taimni IK (1961) The science of yoga. The yoga-sutras of Patanjali in Sanskrit with transliteration in Roman, translation in English and commentary. Wheaton, IL, USA: Theosophical Publishing House. 11. Vishnudevananda S (1960) The complete illustrated book of yoga. New York: Julian Press, USA. 12. MacDonald DA, Walsh R, Shapiro SL (2013) Meditation: Empirical research and future directions. In: Friedman HL, Hartelius G (Eds). Wiley-Blackwell Handbook of Transpersonal Psychology. New York: Wiley-Blackwell, USA, 433-458. 13. Jones SL (1994) A constructive relationship for religion with the science and profession of psychology: Perhaps the boldest model yet.American Psychologist 49:184-199. 14. Lucchetti G, Lucchetti AL, Koenig HG (2011) Impact of spirituality/religiosity on mortality: Comparison with other health interventions. Explore (NY) 7: 234-238. 15. Cole BS, HopkinsCM, Spiegel J, Tisak J, Agarwala S, et al. (2012) A randomised clinical trial of the effects of spiritually focused meditation for people with metastatic melanoma. Mental Health, Religion & Culture 15: 161-174. 16. Wachholtz AB,Pargament KI (2008) Migraines and meditation: Does spirituality matter? Journal of Behavioral Medicine 31: 351-366. 17. MacDonald DA, LeClair L, Holland CJ, Alter A, Friedman HL (1995) A survey of measures of transpersonal constructs. Journal of Transpersonal Psychology 27: 171-235. 18. MacDonald DA, Kuentzel JG, Friedman HL (1999) A survey of measures of spiritual and transpersonal constructs: Part two- Additional instruments. Journal of Transpersonal Psychology 31: 155-177. 19. Helminiak DA (2008) Confounding the divine and the spiritual: Challenges to a psychology of spirituality. Pastoral Psychology 57: 161-182. 20. Helminiak DA, Hoffman L,Dodson E (2012) A Critique of the “Theistic Psychology” Movement as Exempliied in Bartz’s (2009) “Theistic Existential Psychotherapy”. The Humanistic Psychologist 40: 179-196. 24. MacDonald DA, Friedman HL (2002) Assessment of humanistic, transpersonal, and spiritual constructs: State of the Science. Journal of Humanistic Psychology 42: 102-125. 25. Migdal L, MacDonald DA (2013) Clarifying the relation between spirituality and well-being. Journal of Nervous and Mental Disease201: 274-280. 26. Koenig HG (2008) Concerns about measuring “spirituality” in research. Journal of Nervous and Mental Disease 196: 349-355. 27. MacDonald DA (2000)The Expressions of Spirituality Inventory: Test development, validation, and scoring information. Unpublished test manual. 28. Kassab V, MacDonald DA (2011) Examination of the psychometric properties of the Spiritual Fitness Assessment. Journal of Religion and Health 50: 975-985. 29. MacDonald DA, Holland D (2002) Examination of the psychometric properties of the Temperament and Character Inventory Self-Transcendence dimension. Personality and Individual Differences 32: 1013-1027. 30. Affeldt DL, MacDonald DA (2010) The relationship of spirituality to work and organizational attitudes and behaviors in a sample of employees from a health care system. Journal of Transpersonal Psychology 42: 192-208. 31. Huber JT, MacDonaldDA (2012) An investigation of the relation between altruism, empathy, and spirituality. Journal of Humanistic Psychology52: 206221. 32. MacDonald DA, Holland D (2002) Spirituality and boredom proneness. Personality and Individual Differences 32: 1113-1119. 33. MacDonald DA, Holland D (2002) Spirituality and self-reported complex-partial epileptic-like signs. Psychological Reports 91: 785-792. 34. MacDonald DA, Holland D(2003) Spirituality and the MMPI-2. Journal of Clinical Psychology 59: 399-410. 35. Mendez DM, MacDonald DA (2012) Spirituality and the MMPI-2 Restructured Clinical Scales. International Journal of Transpersonal Studies 31: 1-10. 36. MacDonald DA (2009) Identity and Spirituality: Conventional and transpersonal perspectives. International Journal of Transpersonal Studies 28: 86-106. 37. MacDonald DA, Friedman HL (2009) Measures of spiritual and transpersonal constructs for use in yoga research. International Journal of Yoga2: 2-12. 38. Tarakeshwar N, Pargament KI, Mahoney A (2003) Initial development of a measure of religious coping among Hindus. Journal of Community Psychology31: 607-628. 21. MacDonald DA (2000) Spirituality: Description, measurement and relation to the Five Factor Model of personality. Journal of Personality 68: 153-197. 39. Tarakeshwar N, Pargament KI, Mahoney A (2003) Measures of Hindu pathways: Development and preliminary evidence of reliability and validity. Cultural Diversity and Ethnic Minority Psychology 9: 316-332. 22. MacDonald DA (2011) Studying spirituality scientiically: Relections, considerations, and recommendations. Journal of Management, Spirituality and Religion 8: 195-210. 40. Wolf DB (1998) The Vedic Personality Inventory: A study of the Gunas. Journal of Indian Psychology 16: 26-43. 23. MacDonald DA, FriedmanHL (2001) The scientiic study of spirituality: Philosophical and methodological considerations. Biofeedback Newsmagazine 29: 19-21. 41. Wolf DB (1999) A psychometric analysis of the three gunas. Psychological Reports, 84: 1379-1390. Submit your next manuscript and get advantages of OMICS Group submissions Unique features: • • • User friendly/feasible website-translation of your paper to 50 world’s leading languages Audio Version of published paper Digital articles to share and explore Special features: Citation: MacDonald DA (2013) A Call for the Inclusion of Spirituality in Yoga Research. J Yoga Phys Ther 3: 138. doi:10.4172/2157-7595.1000138 J Yoga Phys Ther ISSN: 2157-7595 JYPT, an open access journal • • • • • • • • 250 Open Access Journals 20,000 editorial team 21 days rapid review process Quality and quick editorial, review and publication processing Indexing at PubMed (partial), Scopus, EBSCO, Index Copernicus and Google Scholar etc Sharing Option: Social Networking Enabled Authors, Reviewers and Editors rewarded with online Scientiic Credits Better discount for your subsequent articles Submit your manuscript at: http://www.omicsonline.org/submission Volume 3 • Issue 3 • 1000138