The temporal association between religious/spiritual struggles and anxiety symptoms: A longitudinal study of psychiatric outpatients

Curtis Beeman, Edward B. Davis, Vitaliy L. Voytenko, John M. McConnell, Austin W. Lemke, Thomas Douce, Tessa Walk, Nathan D. Mills, Kenneth P. Phillips, Robert Marseilles, Richard P. Wolff, Kenneth I. Pargament

Research output: Contribution to journalArticlepeer-review


Background: Anxiety disorders like Generalized Anxiety Disorder (GAD) often cooccur with religious/spiritual (R/S) struggles, but the temporal association between anxiety symptoms and R/S struggles has not been studied in many clinical samples. The current longitudinal study examines this association in a sample at high risk for elevated anxiety and R/S struggles—adult psychiatric outpatients. Methods: After their initial psychiatrist evaluation at a U.S. group practice, 163 outpatients completed measures of R/S struggles, anxiety symptoms, depressive symptoms, and religiousness. The analytic sample (N = 120; 77.9% T1 retention) completed these measures 6-months and 12-months later (T2 and T3). Results: Patients exhibited high baseline rates of anxiety symptoms (72.5% met likely criteria for GAD) and R/S struggles (59.2% reported high levels of at least one R/S struggle subtype), yet they demonstrated small-to-moderate decreases in anxiety, depression, and R/S struggles over time. Controlling for sociodemographics and baseline struggles, anxiety, and depression, there was a bidirectional association between T2/T3 overall R/S struggles and T3/T2 anxiety symptoms. T2 moral and ultimate-meaning struggles were related to higher T3 anxiety symptoms, and T2 anxiety symptoms were related to higher T3 demonic struggles. Limitations: Results may have been impacted by attrition, selection bias, maturation, and statistical regression. Findings need replication in larger, more diverse samples and in other countries, treatment settings, and clinical populations. Conclusions: Adult psychiatric outpatients are at high risk for R/S struggles, and these struggles are important to assess and address in their mental health treatment. Moral, ultimate-meaning, and demonic struggles may be most anxiety-relevant.

Original languageEnglish (US)
Article number100709
JournalJournal of Affective Disorders Reports
StatePublished - Apr 2024
Externally publishedYes


  • Anxiety
  • Outpatient treatment
  • Religious coping
  • Religious/spiritual struggles
  • Spirituality

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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