The Relationship Between Religiosity, Mindful Acceptance of LGBT Identity, and Anxiety
Overview of Topic & Significance
In recent years, there has been a remarkable shift in cultural attitudes in the United States regarding the lesbian, gay, bisexual, and transgender (LGBT) community (Witeck, 2014). According to Witeck (2014), roughly 60% of Americans support gay marriage compared to 60% of Americans opposing gay marriage just 10 years prior. Witeck (2014) reported that more and more states have begun to recognize same-sex marriages and civil unions, ultimately culminating in the landmark supreme court case of Obergefell v. Hodges (2015) when bans on same-sex marriages were lifted across all 50 states. That said, Steele et al. (2017) reported that when compared to heterosexuals, members of the LGBT community – specifically lesbians, bisexual women, and transgender people, report generally poorer mental health outcomes. Fuist (2016) reported on the role religion and spirituality has played in how sexuality has been understood over the years. Runkel (1998) described how Christianity’s punitive measures when sexual norms are violated become a source of deeply rooted anxiety in the most religiously identified individuals. To continue the national trend of increasing LGBT acceptance and to establish appropriate mental health care for the LGBT community, it is vitally important to continue researching the intersection of religion and mental health disorders within this population.
Numerous studies have been done on the role of religion and spirituality in mental healthcare among LGBT populations (Fuist, 2016; Halkitis et al., 2009; Kanamori, Pegors, Hall, & Guerra, 2019; Ogland & Verona, 2014; Runkel, 1998; Wood, 2012). Moreover, one need not search too deeply to find research regarding mindfulness and mindfulness-based interventions (Kabat-Zinn, 2009; Shapiro, Astin, Bishop, & Cordova, 2005; Vosvick & Stem, 2019). And clearly, countless research studies have been performed over the last several decades addressing the many facets of psychological distress and mental health diagnoses such as depression and anxiety. However, only recently have these constructs begun to be formally researched specifically with the LGBT population in mind. The limited research among this population has certainly established a connection between sexual minority status and religion, stress, depression, suicidal ideation, and suicide completion (See: Mustanski, Garofalo, & Emerson, 2010; Ogland & Verona, 2014; Steele et al., 2017; Vosvick & Stem, 2019). However, other mood disorders (e.g., anxiety) are not well studied within the LGBT population.
Religiosity and spirituality. Though the terms religion and spirituality are often used interchangeably in research, there is evidence that shows they refer to different, yet related, concepts (Wood & Conley, 20140). Research done by Halkitis et al. (2009) found little consensus among researchers regarding the specific definitions of religiosity and spirituality. Regardless, there are several themes common to the many different definitions explored – among them: transcendence, divinity, the sacredness of life, and awareness of a higher power (Halkitis et al., 2009). How members of the LGBT community conceptualize religion and spirituality is largely speculative and is further complicated since many of these individuals construct their spirituality in hostile religious environments (Halkitis et al., 2009).
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Mindfulness and mindful acceptance. Mindfulness is a challenging construct to define. Some researchers conceptualize it to be relatively simple and straightforward (Vosvick & Stem, 2019). Jon Kabat-Zinn, professor, and creator of the mindfulness-based stress reduction (MBSR) program, defines mindfulness as paying purposeful and nonjudgmental attention to the present moment (Kabat-Zinn, 2009; Shapiro, Astin, Bishop, & Cordova, 2005). In a recent study by Vosvick and Stem (2019), Mindful Acceptance is identified as the purposeful and nonjudgmental recognition of a situation or condition without attempting to change it and is just one of a series of processes one must use to define the construct. A study by Fritz and Vosvick (2011) found mindfulness to be negatively correlated with stress and depression among sexual minorities, however, there appears to be little research available that study mindful acceptance in LGBT samples.
Due to the paucity of research related to this population, this study will be an attempt to add to the ongoing efforts to fill the myriad of research gaps. This between subjects, non-experimental study will use a two by two factorial design with non-equivalent groups to examine the relationship between personal religiosity, mindful acceptance of LGBT identity, and anxiety-related symptoms among LGBT adults.
The target population for this study will be self-identified LGBT adults, ages 21 to 30 years who have some degree of religious affiliation. To have a minimum of 25 to 30 participants for each of the four conditions provided by this two-by-two factorial design, there must be 100 to 120 total participants involved in the study. A simple internet survey will be created that will ask participants: 1. How they identify – lesbian, gay, bisexual, and/or transgender; and 2. If they currently identify or have ever identified with any religion and which religion. Additionally, demographic information will be gathered, including geographic location, ethnicity, income, highest level of education received, and marital status. To attempt inclusion of often under-studied segments of the LGBT population (i.e., transgender, people of color, low-income, and rural communities), paper surveys will be made available for those with no internet access along with special outreach conducted through LGBT centers across the country.
The Religious Commitment Inventory (RCI-10). The Religious Commitment Inventory-10 is a brief 10-item screening tool that measures how committed the test-taker is to their every-day religious beliefs, values, and practices (Kanamori, Pegors, Hall, & Guerra, 2019). The RCI-10 uses very straight forward scoring and can be either summed in total or divided into its two subcategories – Intrapersonal Religious Commitment and Interpersonal Religious Commitment (Worthington et al., 2012). The RCI-10 uses a Likert scale that ranges from 1 (not at all true of me) to 5 (totally true of me); there are no reversed scores and higher total scores indicate a higher level of religious commitment. A sample item from the Intrapersonal Religious Commitment subscale is, “Religion is especially important to me because it answers many questions about the meaning of life.” A sample item from the Interpersonal Religious Commitment subscale is, “I keep well informed about my local religious group and have some influence in is decisions” (Worthington et al., 2012). The original validation study for the RCI-10 reported high convergent and discriminant validity and subsequent studies demonstrated high reliability with Cronbach’s αs ranging from .92 to .98 (Kanamori, Pegors, Hall, & Guerra, 2019; Worthington et al., 2003).
Kentucky Inventory of Mindful Acceptance Skills (KIMS). This measurement uses 39 items across 4 separate subscales – Observe, Describe, Act with Awareness, and Accept without Judgment (Baer, Smith, & Allen, 2004). The 9-item Accept without Judgment subscale will be used due to the high levels of discrimination and homophobia to which the LGBT community is exposed. Baer, Smith, and Allen (2004) identify this to be a valuable skill for those who experience distress related to exposure to such judgment. The KIMS uses a Likert scale that ranges from 1 (never or very rarely true) to 5 (very often or always true). There are reverse-scored items along with standard-scored items; higher total scores on the inventory indicate higher levels of mindful acceptance. A sample item from the Accept without Judgment subscale is, “I think some of my emotions are bad or inappropriate and I shouldn’t feel them.” Baer et al. (2004) report high convergent validity when compared to other mindful acceptance measures. The entire inventory demonstrates a Cronbach’s α of .86 and the Accept without Judgment subscale demonstrates a Cronbach’s α of .87 (Baer et al., 2004).
Beck Anxiety Inventory (BAI). The Beck Anxiety Inventory is a 21-item inventory that will be used to measure the severity of participant’s subjective, somatic, or panic-related anxiety symptoms (Beck, Epstein, Brown, & Steer, 1988). The BAI uses a Likert scale that ranges from 0 (least severe) to 3 (most severe). A few examples of symptoms the BAI measure are: numbness or tingling, feeling hot, and wobbliness in legs. Each item is totaled for a raw score ranging from 0 to 63. The participant’s anxiety severity is categorized as low (0-21), moderate (22-35), or high (36 and above). The BAI demonstrates strong 1-week test-retest reliability (0.75) and high internal consistency (Cronbach’s α=0.92) (Beck, Epstein, Brown, & Steer, 1988).
Following approval by the Institutional Review Board (IRB), surveys establishing a sample group of 21 to 30-year-old LGBT adults with a connection to religion will be collected over 10 to 12 months, or until enough participants (25 to 30) have been chosen for each subject group. Once an appropriate sample size has been established, informed consent will be obtained and each participant will be administered the Religious Commitment Inventory-10, the Kentucky Inventory of Mindful acceptance Scale, and the Beck Anxiety Inventory by qualified personnel. Completion of the three assessments should take each participant roughly an hour, however, no time limit will be given. The participants will be instructed to answer honestly and reminded that participation in the study is voluntary and that confidentiality will be strictly enforced throughout the research process. Assessment results will be collected for analysis by our research team. Upon completion of the study, participants will be debriefed regarding the general idea behind the study, what we were investigating, and will be allowed to discuss any questions or concerns they have as a result of their participation in this research.
Figure 1. Predicted anxiety level associated with low and high degrees of religiosity in LGBT adults with high and low levels of mindful acceptance (MA) of their sexual minority status.
The data will be analyzed using a factorial analysis of variance (ANOVA). We expect that participants who report a low degree of religiosity will demonstrate lower levels of anxiety than those who report a high degree of religiosity. Additionally, we expect that participants who report a high level of mindful acceptance will demonstrate lower levels of anxiety than those who report low levels of mindful acceptance. We anticipate that the combination of high religiosity and low mindful acceptance will result in higher levels of anxiety than can be explained by the main effects of either factor individually (see figure 1).
According to Mustanski, Garofalo, and Emerson (2010), lesbian, gay, and bisexual adults tend to experience internalizing and externalizing mental health disorders at higher rates than heterosexuals. The limited available research tends to focus more on depression and suicide and less on other mental health disorders such as anxiety. Furthermore, sexual and gender minorities experience alienation and marginalization at alarming rates; as such, the interventions demonstrated to be effective for treating depression and anxiety in heterosexual, cisgender people may not be generalizable to the LGBT population (Vosvick & Stem, 2019). By examining another, non-depression-related mental health disorder, we hope to add to a growing list of effective interventions for anxiety and stress that the counseling field can draw upon to treat their sexual and gender minority clients.
We chose a two by two factorial design primarily for its relative simplicity. The relationship between the LGBT individual and depression and suicide is fairly well understood (Steele et al., 2017). Sexual minorities encounter stressors such as homophobia, discrimination, and prejudice that heterosexuals often do not. (Baer, Smith, & Allen, 2004). One gap in the research is that other mood disorders (e.g., anxiety) experienced by the LGBT population are often overlooked in favor of addressing the safety concerns associated with depression and suicidality. This study, therefore, is designed to be a starting point on the road to better understanding the relationship between religion, acceptance of identity, and anxiety in LGBT adults.
Other Possible Study Designs
While the two by two factorial design offers a simple, straightforward look, it is likely too simplistic to offer a full understanding of how religion and anxiety relate to one another when experienced by the LGBT community. Constructs like religiosity and mindful acceptance do not exist as a dichotomy, they exist on a spectrum with varying degrees of measurement beyond the simple “low” and “high” offered by this factorial design. Future research should consider expanding on this study by conducting a correlational study. Moreover, conducting a quasi-experimental study wherein interventions aimed at increasing mindful awareness are introduced may prove to be valuable in treating the psychological disturbances experienced by members of the LGBT population.
Potential Ethical Concerns
A potential concern is that investigation into a person’s state of mental health may lead to discoveries of which they were previously unaware and the inferences drawn from this study may pose a detriment to their greater well-being. For example, the realization that their involvement in a religious community may be associated with higher levels of anxiety could destabilize their sense of identity. This potential ethical issue will be addressed by its inclusion in the informed consent and by ensuring the participants have the opportunity to discuss with the researchers any questions or concerns that arose during the research process with the intention of helping the participant leave the study in the same frame of mind as when they entered it (Mcleod, 2015).
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