Religious Coping Strategies in Healthy Elderly and in Those at Risk for Dementia

Evidence suggests that participation in religious activity among the elderly is associated with slower progression of Alzheimer’ s disease (Kaufman et al. 2007), lower morbidity and mortality (Holt and Dellmann-Jenkins 1992; Levin and Schiller 1987; McCullough et al. 2000), reduced cognitive aging (Corsentino et al. 2009), lower levels of depression and psycholog­ical stress (Ironson et al. 2002' Koenig et al. 1992), and enhanced qual­ity of life and well-being (Ellison and Levin 1998' Koenig 1994' Koenig 2000; Koenig, Hays, et al. 1999; Koenig, Idler, et al. 1999; Larson et al. 1992; Levin 1994). Religiosity, however, can also sometimes have a deleterious impact on some measures of mental health in some elderly individuals (Krause 2004' Krause et al. 1998). For better or worse, religious practices become increasingly important to many people as they age (Dillon and Wink 2007), yet very little is known about religious cognition in the aging brain/mind.

To our knowledge, no neurocognitive model of religious cognition in aging has yet been developed or rigorously tested—this despite the well-attested impact of religiosity on mind, brain, and overall health and well-being in the elderly. There is, therefore, an urgent need to develop explicit models of religious cognition that can focus research efforts on identification of potential mechanisms that mediate the impact of religious cognitions and practices on cognitive aging and on both posi­tive and negative health outcomes. The model I have proposed and will describe here is known as the “decoupling” model (described below and in McNamara 2009). It is focused on the impact of religious cognition on self-control and self-regulation, processes known to be crucial for health and well-being (Baumeister and Vohs 2004). It is, therefore, an ideal model to assess potential mediating cognitive pathways of religion’s effects on self-regulation, cognitive aging, and health outcomes.

Adults over age 65 are at increased risk for mood disorder, mild cogni­tive impairment, and higher rates of chronic disease (Anstey et al. 2009; Centers for Disease Control and Prevention 2008; Conwell and Duberstein 2001; Hybels and Blazer 2003; Lebowitz et al. 1997; Zihl et al. 2010). Those elderly who engage in regular religious practices are protected to some sig­nificant extent against these adverse outcomes (Krause 2004; Krause et al. 1998; Koenig et al. 1992; Corsentino et al. 2009). Elderly people more often rely on religious coping practices than do younger controls (Koenig et al. 1990; Van Ness and Larson 2002; McFarland 2010) and more often engage in religious cognition (Koenig et al. 1990; Van Ness and Larson 2002; McFar­land 2010) for problem solving. Negative forms of religious coping, delete­rious to health and well being (e.g., obsessing about punitive supernatural agents, etc.), are also all too common among the elderly.

Measures of religiosity such as frequent prayer or meditation, frequent attendance at religious services, and “intrinsic” forms of religiosity appear to have beneficial effects on some aspects of physical and mental health in the elderly (Koenig, Hays, et al. 1999; Koenig, Idler, et al. 1999; Musick et al. 2000; Koenig, McCullough, and Larson 2001; Powell, Shahabi, and Thoresen 2003). Other forms of religiosity can negatively impact mental health (Magyar-Russell and Pargament 2006). There have been forceful criticisms of many religion and health studies (see Lawrence 2002; Sloan and Bagiella 2002; Sloan, Bagiella, and Powell 1999; Sloan et al. 2000; Sloan and Ramakrishnan 2006). And there have also been more positive over­all assessments (see Koenig 2000; Koenig 2001, “Religion and Medicine II”; Koenig 2001, “Religion and Medicine III”; Koenig 2001, “Religion and Medicine IV”; Koenig, The healing 2001; Miller and Thoresen 2003; Thore­sen and Harris 2002; Williams and Sternthal 2007). Yet, while many early studies failed to account for key confounding variables and other covari- ates, more recent research efforts are less vulnerable to such criticisms. Recent meta-analytic reviews of well-controlled studies and randomized clinical trials of religious practices and health outcomes (Townsend et al. 2002; Powell, Shahabi, and Thoresen 2003; Coruh et al. 2005) all concluded that religious practices of various kinds such as private meditation and prayer and frequent attendance at religious services enhance a variety of health outcomes. Despite the apparent protective effects of religiosity on health outcomes in the aged, there are still no neurocognitive models that can address how religious cognition might influence health in aging.

We (McNamara 2001, 2002, 2006, 2009; McNamara, Andresen, and Gellard 2003; McNamara, Durso, and Brown 2006; McNamara, Durso, Brown, and Harris 2006; McNamara, Durso, and Harris 2006; Butler, McNamara, and Durso 2009) have been developing a research program that addresses the need for a neurocognitive model of religiosity that can help to account for religion’s effects on the aging brain/mind. We suggest that a distinguishing mark of religious cognition in aging is that religious cognitions involve privileged access to the self and can help promote development of generative aspects of the self in aging. Religious cognition can therefore become a powerful tool in processes of self-regulation and elderly people avail themselves of this tool. This impact of religiousness on self-regulation can also help to explain negative effects of religiosity when they occur. Since we are interested in understanding religion’s effects on cognition and health, we have built upon previous models of various aspects of the religious mind (reviews in Andresen 2001) as well as more general models of self-regulation (Baumeister and Vohs 2004).

Consistent with the work of many other investigators (see reviews in McCullough and Willoughby 2009 and McNamara 2009) in these and related fields, we argue that one major pathway by which religion influences health out­comes (particularly in the elderly) is via its effects on self-regulation. At the cognitive level, we argue that religious cognition (e.g., triggered in prayer, meditation, or ritual contexts, etc.) is characterized by a transient “decou­pling” of the present self-concept from control over attentional resources of the individual and then a linking up or integration of the current self with some version of an ideal future self or god-concept. When operating normally, this linking of present with ideal selves and/or with supernatu­ral agents promotes positive self-development and enhances control over attentional resources and behavior of the individual. Strengthening self­control, in turn, promotes improved self-regulation and improved health outcomes in the long run (McNamara 2009; McCullough and Willoughby 2009)   . The transient decoupling of self and attentional mechanisms, how­ever, can also lead to liminal states of consciousness that open the individ­ual to negative outcomes if integration of old self into an ideal generative self is not accomplished. The generative self builds on Erickson’s idea of generativity versus despair as an emotional and spiritual challenge in old age. The generative self delivers wisdom and the blessings and gifts of experience to others.

We situate our theory of religion’s effect on self-regulation within the tradition of work on so-called possible selves. According to Markus and Nurius (1986), possible selves are images of what people hope to become, expect to become, or fear becoming in the future. Possible selves appear to be elaborated out of imaginary narratives involving the self both in childhood and in adulthood (e.g., Erikson 2001; Markus and Ruvolo 1989; Whitty 2002). Possible selves consist of a description of a set of behavioral actions aimed at some goal designed to overcome some conflict, along with causes and consequences of those imaginary actions, with an end state that is described as an event. According to narrative theorists (Bruner 1995; Ricoeur 1984; Oatley 2007), narratives about future selves provide interpretations about what we see as possible. As stories they help to inte­grate material about conflict involving the present self into a resolution of that conflict—a resolution involving a higher, more complete, and more complex self.

Empirical work has supported this narrative-related integrative func­tion of possible selves. We evaluate our current and past selves with refer­ence to possible selves. Possible selves become relevant for self-regulation when they are recruited into the subset of self-knowledge that is active in working memory (Markus and Kunda 1986; Markus and Nurius 1986). Obviously when a possible self is periodically or chronically activated it becomes particularly important for evaluation of current representa­tions of the self as well as discrepancy reduction behaviors or engage­ment of approach and/or avoidance behaviors (Norman and Aron 2003). For example, frequent attendance at religious services or performance of religious rituals will periodically activate a number of possible selves, including an ideal self. The chronically activated ideal self is then in a position to contribute to self-regulation by providing a standard by which to evaluate progress toward a goal and resolution of internal and social conflicts (Oyserman et al. 2004). People use possible selves as behavioral standards to guide conflict resolution and self-regulation more generally (e.g., Hoyle and Sowards 1993; Hoyle and Sherrill 2006; Kerpelman and Lamke 1997; Oyserman et al. 2004). Hoyle and Sherrill (2006) have pointed out that possible selves map particularly well into hierarchically orga­nized control-process models of self-regulation (e.g., Carver and Scheier 1981; Hoyle and Sowards 1993). Behavioral reference points or standards are organized in these models of self-regulation in a hierarchical fashion from abstract and general to concrete and specific. A particular behavioral standard derives from the level above it. The highest levels of standards are global ideals. In the context of religious ritual, these global standards are the ideal selves that the current self is urged to become or desires to become. The highest global standard is the god-concept toward which the entire religious service is oriented.

In our decoupling model of religious cognition, religious practices are thought to create a subtle and brief decentering (of the self) effect that leads ultimately to greater self-control. We postulate four basic cognitive processes that occur in religious cognition (situated within the cognitive architecture proposed by Nichols and Stich [2000] to account for pretend play): (1) A transient and subtle reduction in agency such that the self relaxes control over attentional and behavioral responses. (2) The self-concept is then placed into a suppositional or liminal state (a pos­sible worlds box); that liminal state is filled with potentially positive and negative consequences. On the positive side, decoupling of the self from cognitive control mechanisms puts the individual into a receptive and integrative mode, thereby allowing the individual to perform a lot of off­line maintenance and integrative information-processing tasks. On the negative side, the decoupling process can, if prolonged and depending on context, lead to dangerous disintegrative psychic states including fanati­cism and psychotic and delusionary states, particularly if step 4 fails or is delayed. (3) A search is activated in semantic memory for an ideal self that can link up with and integrate the old self. (4) Integration of old and ideal self is accomplished with the help of normal inferential machinery and an “updater” that deletes nonuseful material and adds as much of the ideal self (in the form of new beliefs, and so on) as possible to the old self construct. The updater also establishes control of the new Self (via belief-desire systems) over behavioral output systems.