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Published in final edited form as: J Relig Health. 2021 Nov 6;61(6):4923–4933. doi: 10.1007/s10943-021-01450-z

Spirituality Influences Emotion Regulation During Grief Talk: The Moderating Role of Prolonged Grief Symptomatology

Sherman A Lee 1, Jeffrey A Gibbons 1, Jamison S Bottomley 2
PMCID: PMC11270485  NIHMSID: NIHMS2005547  PMID: 34741228

Abstract

A growing body of research demonstrates that religion greatly affects people’s adjustment to loss. However, little is known about the influence of religiosity on emotion regulation during grief. The present study attempts to fill this void in the literature by examining the predictive relationship between variables assessing facets of religiosity and emotion regulation during an interview about loss in a sample of bereaved adults. The results demonstrated that religiousness, spirituality, and negative religious coping were correlated with emotion reactivity following an interview. Spirituality’s influence was also found to be moderated by prolonged grief symptoms, as spirituality predicted more adaptive emotion regulation among those with low-to-mild levels of prolonged grief symptomatology, but not among participants with elevated prolonged grief disorder (PGD) symptoms. These findings support the beneficial effects of religion in bereavement adjustment as well as its limits.

Keywords: Religion, Spirituality, Grief, Emotion regulation

Introduction

The death of a loved is regarded as one of the most emotionally painful events in life. This is particularly the case among those who experience prolonged grief disorder (PGD), which is chiefly characterized as the distressing and disabling experience of yearning for the decedent that extends beyond the first year of the loss (Prigerson et al., 2021). As such, many mourners turn to their respective religious practices for answers, community, and emotional comfort (Pargament, 1997). Despite the growing recognition that religion plays a significant role in responding to adverse life events (e.g., Carey et al., 2016), and bereavement adjustment (Wortmann & Park, 2008) specifically, little is known about the way religious factors influence emotion regulation during grief.

Emotion Regulation in the Context of Grief

It is widely accepted that emotion regulation, the process by which an individual intentionally or unconsciously influences the time and way that particular emotions are experienced (Gross, 1998), plays a major role in promoting resilience and reducing the risk for psychopathology in individuals experiencing stressful life events (Aldwin et al., 2014; Werner & Gross, 2010). In the context of loss, one’s inability to regulate emotion (i.e., emotion dysregulation) appears to be strongly associated with grief complications, including PGD symptomatology. For example, a recent systematic review identified many emotion regulation studies in the context of loss and found consensus in the literature that maladaptive emotion regulation strategies increased grief difficulties, while adaptive emotion regulation strategies reduced them (Eisma & Stroebe, 2021). In addition, researchers have observed that emotion dysregulation evidenced during interviews about loss are associated with PGD symptoms (Bonanno et al., 2007; Parkes, 1986), including the prospective prediction of grief difficulties a year into the future (Bonanno & Keltner, 1997).

Importantly, unlike static factors that may increase risk for grief complications, such as the traumatic nature of the loss or one’s relationship to the decedent, emotion regulation processes are highly amenable to change. Identifying factors that may be associated with emotion regulation in the context of bereavement is, thus, an important avenue of inquiry. Religious practices inherently include elements of emotion regulation strategies, such as cognitive reappraisal, positive thinking, and mindfulness, and as such, may affect emotion regulation processes more broadly in the context of the loss of a significant other.

Religion, Emotion Regulation, and Loss

Researchers have also discovered that mourners who employ negative forms of religious coping with their loss (e.g., anger toward God, reappraisals of God as being punishing, perceived abandonment by God) tend to also experience emotion dysregulation in the form of intense and prolonged feelings of grief during such interviews as well (Lee et al., 2013). These same outcomes occur among individuals who experience non-death losses. For example, in a narrative inquiry of divorced or separated individuals, the cumulative ostracism of the dissolution of the marriage and loss of faith produced substantial psychological suffering for some of those individuals (Zamperini et al., 2020). Despite these findings, the role of other religious factors in emotion regulation during grief interviews remains unclear. Therefore, the purpose of the current study was to fill this void in the literature by examining different facets of religion (i.e., religiousness, spirituality, positive religious coping, and negative religious coping) and their predictive relationship to emotion dysregulation (i.e., intense and prolonged feelings of grief) in a sample of young adult mourners interviewed about their loss.

Based on the literature, we proposed a number of hypotheses. First, we expected both religiousness (i.e., tendency to identify with and practice traditional religious beliefs) and spirituality (i.e., tendency to engage in spiritual awareness, peace, and communion with God) to be associated with low emotion dysregulation (e.g., McCullough et al., 2000). For example, meta-analytic studies have shown that religious individuals tend to live longer (McCullough et al., 2000) and are generally more psychologically healthy (Smith et al., 2003; Witter et al., 985) than their less-religious peers. Second, we expected emotion dysregulation to be inversely associated with positive religious coping (e.g., forgiveness, support from clergy members, spiritual connection), but positively associated with negative religious coping (e.g., appraising one’s difficulties as a punishment from God). A meta-analysis of 49 studies showed that positive religious coping is linked to healthy emotional outcomes, such as satisfaction and happiness, whereas negative religious coping is tied to psychopathology (Ano & Vasconcelles, 2005). Furthermore, because mourners suffering from intense grief are often inconsolable and difficult to comfort (Parkes, 1986), these individuals may experience diminished emotion regulation capacities regardless of the degree of religiosity. Therefore, we also explored the possibility that prolonged grief symptoms could moderate the relationship between religion and emotion dysregulation in our analyses.

Method

Participants

Data from 100 bereaved American college students were used in this study. The study was approved by the Institutional Review Board (IRB) of a small public university in the eastern part of the USA. All participants consented to the study and were debriefed following all study procedures. The sample consisted of 73 women and 27 men reporting a mean age of 19.62 years (SD = 1.75). The participants were predominately White (n = 82) and of Christian faith (n = 87). Participants reported a moderately high level of closeness to the deceased (M = 3.02; SD = 0.84) and most experienced the death of a family member (n = 63). The mean time since the loss was 14.25 months (SD 9.84), with one unreported time. Of these losses, illness was the most commonly reported cause of death (n = 42).

Procedure

All procedures performed in this study were in accordance with the ethical standards of an institutional research committee and the American Psychological Association. Informed consent was obtained from all individual participants prior to the commencement of the study. Each participant was greeted and then instructed to sit in a seat adjacent to the experimenter. A chest-high barrier was positioned between the experimenter and the participant to provide the participant with a sense of privacy when completing questionnaires. The first assessment, which followed a brief orientation and informed consent period, was a baseline measure of the participant’s current emotional state (T1). Specifically, the participant completed a Feeling Card, which asked the participant to rate current feeling states associated with grief (Lee et al., 2013). Upon completion, the participant filled out a packet of questionnaires, which assessed demographic characteristics, information regarding a significant loss, and measures of religiousness, spirituality, religious coping, and grief symptoms.

After the questionnaires were completed, the experimenter proceeded with a brief (Mean = 3.81; SD = 1.70 min) semi-structured interview about the participant’s loss. During this interview, the participant was asked to describe details about the deceased and his/her personal experiences with the loss. This interview format has been shown to reliably elicit grief-related emotions (Lee et al., 2013). Furthermore, the brevity and homogeneous content of the interview is also consistent with recommendations for emotion-induction research (Rottenberg et al., 2007). Immediately following the interview, a second Feeling Card was administered (T2) to assess one’s emotional reaction to the grief-related interview (i.e., emotional reactivity). Once the second Feeling Card was complete, the experimenter exited the room for 1 min, and then distributed a third Feeling Card (T3) to record any change in one’s emotional state in this immediate period (i.e., recovery). Once again, when the participant completed a Feeling Card, the experimenter exited the room for a 5-min period and, upon return, gave the participant the final Feeling Card (T4) to assess intermediate emotional change (i.e., prolonged recovery). This method of empirically assessing emotion regulation has been used in prior research (e.g., Lee et al., 2013) and is based on the notion that individuals with emotion regulation difficulties experience protracted emotional reactivity following provocative stimuli given that emotions are understood to be transient states (e.g., Ekman, 1992).

Measures

All items within a measure were averaged together to form composite scores. Measures of religiousness were z-score converted before forming composite scores because the items used different response formats.

Basic information.

Participants were asked to report their age and gender (0 = Male; 1 = Female). Participants were also asked to report their ethnicity (0 = non-White; 1 = White) and religious affiliation (0 = non-Christian; 1 = Christian).

Deceased information.

Participants were asked to report their relation to the deceased (0 = other; 1 = family member) and the time since loss in months. Participants were also asked to rate their closeness to the deceased (1 = not at all to 4 = extremely) and the cause of death (0 = other; 1 = illness).

Religiousness.

The General Religiousness measure (Rowatt et al., 2009) was used to assess religiousness. This 4-item long scale exhibited a solid level of internal consistency (α = 0.83).

Spirituality.

The Spiritual Transcendence Index (Seidlitz et al., 2002) was used to measure spiritual tendencies (1 = strongly disagree; 5 = strongly agree). This 8-item scale displayed excellent internal consistency (α = 0.95).

Religious coping.

The Brief-Religious Coping Scale (Pargament et al., 1998) was used to measure positive and negative forms of religious coping with loss (1 = not at all; 5 = a great deal). This 14-item measure showed solid internal consistency in both positive (α = 0.86) and negative (α = 0.79) scales.

Prolonged grief disorder symptoms.

The PG-13 (Prigerson & Maciejewski, 2008) was used to measure prolonged grief disorder symptoms (1 = not at all; 5 = several times a day / overwhelming). The 11-item scale exhibited strong internal consistency (α = 0.89).

Emotion Dysregulation.

The Feeling Card (Lee et al., 2013) was used to assess present feeling states (i.e., upset, depressed, and sad) associated with grief (0 = not at all; 4 = extremely). This 3-item scale exhibited solid internal consistency across four periods: T1 (before the Loss Interview; α = 0.80), T2 (immediately following the Loss Interview; α = 0.84), T3 (1 min following the Loss Interview; α = 0.81), and T4 (5 mins following the Loss Interview; α = 0.80). To calculate emotion dysregulation (i.e., reactivity, recovery, and prolonged recovery), composite scores were converted into simple change scores based on Lee et al. (2013). Reactivity, which refers to the increase in grief intensity from pre to post interview, was calculated as the difference between T1 and T2 scores. Recovery, which refers to the decrease in grief intensity from immediately after the interview to 1-min post-interview, was calculated as the difference between T2 and T3 scores. Prolonged recovery, which refers to the decrease in grief intensity from immediately after the interview to 5-min post-interview, was calculated as the difference between T2 and T4 scores.

Results

Preliminary Analyses

Preliminary inspections of the variables revealed that the assumptions of linearity, singularity, multicollinearity, heteroscedasticity of residuals, and the absence of univariate outliers were met. However, two violations of assumptions were addressed following the recommendations of Tabachnick and Fidell (2013). First, a logarithmic transformation was applied (skewness = 1.70; kurtosis = 2.79) to the negative religious coping variable because it exhibited moderate positive skewness (2.26) and kurtosis (8.15). This transformation brought this variable within reasonable limits of normality. Second, two multivariate outliers were identified and consequently excluded from the analyses to avoid biased results.

Hierarchical Multiple Regression

Zero-order correlations were performed to identify predictor and criterion variables for the regression analyses (see Table 1). The correlations indicated that emotion reactivity was the only parameter of emotion dysregulation that was associated with the variables of interest. The correlations also indicated that religiousness, spirituality, negative religious coping, and prolonged grief were associated with emotion reactivity. Therefore, emotion reactivity was designated as the criterion variable, while religiousness, spirituality, negative religious coping, and prolonged grief were examined as predictor variables. All the variable scores were converted into standardized values prior to running the regression analyses. This process improves the interpretability of the coefficients and avoids problems with multicollinearity when testing the effects of moderation (Friedrich, 1982).

Table 1.

Correlation of variables

Variable 1 2 3 4 5 6 7 8
1. Emotion Reactivity – .50*** .61*** −.30** −.24* −.04 27** .37***
2. 1-Minute Emotion Recovery – .78*** −.09 −.13 .01 .10 .04
3. 5-Minute Emotion Recovery – −.13 −.13 −.05 .15 .21*
4. Religiousness – .81*** .60*** −.15 −.05
5. Spirituality – .64*** −.24* −.11
6. Positive Religious Coping – .10 .10
7. Negative Religious Coping – .53***
8. Prolonged Grief Symptoms –
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N = 100. Emotion Reactivity (T2 – T1); 1-Minute Emotion Recovery (T3 – T2); 5-Minute Emotion Recovery (T4 – T2). Negative Religious Coping (Log 10 Transformed Scores)

*

p < .05

**

p < .01

***

p < .001 (two-tailed)

A preliminary test of a regression model indicated a problem of net suppression. Because religiousness exhibited a suppressor effect on spirituality, these variables were modeled separately. In the first hierarchical multiple regression model, religiousness was examined without spirituality. In Step 1, prolonged grief (β = 0.32, p < 0.01) and religiousness (β = − 0.27, p < 0.01) were significant predictors, whereas negative religious coping (β = 0.06, p = 0.57, ns) was not a significant predictor, adjusted R2 = 0.19, F(3, 96) = 8.75, p < 0.001. In Step 2, prolonged grief (β = 0.33, p < 0.01) and religiousness (β = − 0.27, p < 0.01) continued to be significant predictors, whereas negative religious coping (β = 0.09, p = 0.43, ns), the interaction between negative religious coping and prolonged grief symptoms (β = − 0.06, p = 0.52, ns) and the interaction between religiousness and prolonged grief symptoms (β = 0.06, p = 0.56, ns) were not significant predictors, adjusted R2 = 0.18, F(5, 94) = 5.33, p < 0.001. Therefore, religiousness and prolonged grief symptoms uniquely predicted emotion reactivity scores.

In the second hierarchical multiple regression model, spirituality was examined without religiousness. In Step 1, prolonged grief (β = 0.31, p < 0.01) and spirituality (β = − 0.19, p < 0.05) were significant predictors, whereas negative religious coping (β = 0.06, p = 0.61, ns) was not a significant predictor, adjusted R2 = 0.15, F(3, 96) = 6.89, p < 0.001. In Step 2, prolonged grief (β = 0.31, p < 0.01) and spirituality (β = − 0.20, p < 0.05) continued to be significant predictors, whereas negative religious coping (β = 0.13, p = 0.30, ns) and the interaction between negative religious coping and prolonged grief symptoms (β = − 0.06, p = 0.46, ns) were not significant predictors. However, the interaction between spirituality and prolonged grief symptoms was also a significant predictor (β = 0.22, p < 0.05), adjusted R2 = 0.18, F(5, 94) = 5.40, p < 0.001.

A formal simple slopes analysis was run to determine where along the slopes the effects were most pronounced (O’Conner, 1998). The analysis demonstrated that emotion reactivity was the lowest among participants who were highly spiritual and experiencing low (β = − 0.43, p < 0.01)-to-moderate (β = −0.22, p < 0.05) levels of prolonged grief symptoms (see Fig. 1). In other words, highly spiritual individuals with low-to-moderate grief exhibited the greatest emotion regulation following the grief interview.

Fig. 1.

Fig. 1

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Moderating effect of prolonged grief symptoms on spirituality in predicting emotion reactivity. Only the slopes for the low (p = .003) and medium (p = .019) levels of prolonged grief symptoms are significant

Discussion

The purpose of this study was to examine the association between religion and emotion regulation during grief interviews. The results suggested that specific religious factors play a beneficial role in the management of grief emotions when mourners talk about loss. Specifically, the results showed that mourners who are religious or spiritually inclined tend to stay more emotionally calm after talking about their loss than their counterparts. These findings are consistent with our hypotheses, and they follow the trends found in meta-analyses showing that religion is associated with psychological well-being (Smith et al., 2003; Witter et al., 1985). According to Aldwin et al. (2014), religion’s positive effects on health are due, in part, to the positive physiological changes that are brought about through emotion regulation. Because spiritual individuals focus on personal transcendence, they reduce arousal and inflammatory processes that lead to illness during emotional and stressful encounters (Aldwin et al., 2014). Our results are in accordance with this model of self-regulation.

The findings of the study also revealed the limits of religion’s effect on emotion regulation during grief talk. Specifically, the results of the moderation analysis showed that the calmness exhibited by highly spiritual mourners was present only for those individuals who reported mild-to-moderate prolonged grief symptoms. In other words, spirituality did not show emotion regulation benefits for mourners experiencing high levels of prolonged grief symptoms. One explanation for this finding could be that high levels of negative religious coping (i.e., spiritual discontent or reappraisals of God as punishing), which are linked to highly emotional experiences, are generated by pathological grief symptoms. For example, in a longitudinal study of homicidally bereaved individuals, severity of prolonged grief symptoms was prospectively associated with negative religious coping at numerous timepoints in the grief trajectory (Burke et al., 2011). Furthermore, this study found that individuals who met criteria for prolonged grief disorder experienced significantly greater levels of negative religious coping than those individuals who did not meet criteria, with no differences in positive religious coping levels. Taken together, the Burke et al. (2011) study and the findings highlighted here illustrate the often-impairing nature of elevated prolonged grief symptoms and the way they affect one’s ability to lean on religious practices, which, in turn, affects emotion regulation practices. In fact, the current study found significant correlations between negative religious coping and emotional reactivity, but not positive religious coping, further supporting this possibility. This explanation is also consistent with meta-analyses showing that religion’s protective effects are more robust for healthy populations than for populations reporting compromised general health (Chida et al., 2009). As bereavement is considered one of the most emotionally challenging events in life and may generate spiritual crisis, the finding that spirituality yields no emotion regulation benefits for mourners suffering from high levels of prolonged grief symptoms should not be surprising.

The associations found between religious coping and emotion regulation were consistent with our expectations based on previous research. Specifically, the current study found small and non-significant relations between positive religious coping and emotion regulation, which replicated the findings for Lee et al. (2013). Despite these non-significant relations, the literature is mixed on the insulating effects of positive religious coping on emotions in the wake of a loss (e.g., Lee et al., 2013). In fact, Meert et al. (2001) found that positive religious coping was inversely related to grief difficulties in a study using grief severity as a proxy for emotional reactivity among parents who experienced the death of a child in a pediatric intensive care unit. However, in their study of 252 mourners of an HIV-related death, Tarakeshwar et al. (2005) found that positive religious coping was related to high levels of grief-related challenges, with other studies finding no relation between positive religious coping and difficulties that occurred following the loss of a loved one (Anderson et al., 2005). Clearly, findings regarding the buffering role of positive religious coping are mixed, and largely do not assess emotion regulation specifically. As such, future research would benefit from probing this relationship in greater detail with diverse groups of mourners.

The association between negative religious coping and emotion reactivity was expected and found in the current study, which is consistent with extant literature. For example, in a similar study conducted by Lee et al. (2013), negative religious coping was found to be associated with heightened reactivity to grief-related stimuli and lengthy time intervals before individuals recovered from emotional reactivity. Specifically, perceived punishment and abandonment from God were most strongly linked to grief-related emotional reactivity. Likewise, research in the general mental health literature among individuals facing numerous stressors and life transitions highlights similar relationships. For example, Pargament et al. (1998) evaluated religious coping for college students who experienced major life stressors (e.g., significant death in the family) around the time of the Oklahoma City Bombing as well as elderly patients hospitalized with serious medical conditions. The researchers found that negative religious coping was associated with a high degree of emotional distress. Although the correlations between negative religious coping and the other parameters of emotion dysregulation followed the expected patterns in the current study, the associations were not strong enough to be statistically significant.

Study Limitations

A couple of important limitations should be considered in this study. First, the sample studied was composed of American college students, most of whom lost an immediate family member and exhibited mild symptoms of grief. Although grief follows the same structure for clinical and non-clinical populations (Holland et al., 2009), the developmental stage of the participants could have impacted the results evidenced here. As such, the study sample may not be an accurate representation of individuals confronted with the death of a close other, and, hence, generalizations should be made cautiously. Relatedly, the study did not include a detailed assessment of kinship of the decedent even though a majority of the sample experienced the death of a family member. This fact further limits the ability to generalize the results of the current study across specific relationship types. Future research should aim to replicate this study using more diverse samples in terms of age, decedent relationship, loss type, and ethnic and sociocultural backgrounds. Additionally, this study was based on participants’ self-reported feelings. Because grief can be expressed and measured across many domains, such as physiological and behavioral indicators, future research would benefit from a multifaceted approach.

Conclusion

Overall, this study demonstrates the link between religion and emotion regulation during grief talk. The results demonstrated that religiousness, spirituality, and negative religious coping were correlated with emotion reactivity among study participants. Specifically, spirituality’s influence was found to be moderated by prolonged grief symptoms, such that spirituality predicted strong adaptive emotion regulation among individuals reporting low-to-mild levels of prolonged grief symptomatology, but not among individuals reporting elevated prolonged grief symptoms. These findings support the idea that religion can be a beneficial and limited bereavement tool, which should be examined in much greater detail in future research.

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