ORIGINAL RESEARCH published: 27 March 2019 doi: 10.3389/fpsyg.2019.00630 Religiosity and Meditation Practice: Exploring Their Explanatory Power on Psychological Adjustment Jesus Montero-Marin 1 , Maria C. Perez-Yus 1,2* , Ausias Cebolla 3,4 , Joaquim Soler 5,6 , Marcelo Demarzo 7 and Javier Garcia-Campayo 1,8,9 1 Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain, 2 Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain, 3 Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain, 4 CIBERObn Ciber Physiopathology of Obesity and Nutrition, Madrid, Spain, 5 Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau–IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain, 6 Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain, 7 Mente Aberta – Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil, 8 Miguel Servet Hospital and University of Zaragoza, Zaragoza, Spain, 9 Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain There has been increased interest in the relationships between religiosity, meditation practice and well-being, but there is lack of understanding as to how specific religious components and distinct meditation practices could influence different positive and negative psychological adjustment outcomes. The aim of this study was to assess the explanatory power of religious beliefs and the practice of prayer, focused attention (FA), open monitoring (OM), and compassion meditation (CM) on psychological adjustment, Edited by: taking into consideration a number of practice-related variables such as session length, Helena Moreira, frequency of practice and lifetime practice. Psychological adjustment was assessed University of Coimbra, Portugal by means of happiness, positive affect, depression, negative affect, and emotional Reviewed by: Anne Berthold, overproduction. A cross-sectional design was used, with a final sample comprising University of Zurich, Switzerland 210 Spanish participants who completed an online assessment protocol. Hierarchical Cassandra Vieten, Institute of Noetic Sciences, regressions were performed, including age, sex and psychotropic medication use in United States the first step as possible confounders, with the addition of religious beliefs and the *Correspondence: practice of prayer, FA, OM, and CM in the second step. FA session length was related Maria C. Perez-Yus to all psychological adjustment outcomes: happiness (1R2 = 0.09, p = 0.002; β = 0.25, mcperezy@unizar.es p = 0.001), positive affect (1R2 = 0.09, p = 0.002; β = 0.18, p = 0.014), depression Specialty section: (1R2 = 0.07, p = 0.004; β = −0.27, p < 0.001), negative affect (1R2 = 0.08, p = 0.007; This article was submitted to Clinical and Health Psychology, β = −0.27, p < 0.001) and emotional overproduction (1R2 = 0.07, p = 0.013; β = −0.23, a section of the journal p = 0.001). CM session length was related to positive affect (β = 0.18, p = 0.011). CM Frontiers in Psychology practice frequency was associated with happiness (1R2 = 0.06, p = 0.038; β = 0.16, Received: 15 September 2018 p = 0.041). Lifetime practice of FA was related to happiness (1R2 = 0.08, p = 0.007; Accepted: 06 March 2019 Published: 27 March 2019 β = 0.21, p = 0.030) and OM to emotional overproduction (1R2 = 0.08, p = 0.037; Citation: β = −0.19, p = 0.047). Religious beliefs and prayer seemed to be less relevant than Montero-Marin J, Perez-Yus MC, meditation practices such as FA, OM, and CM in explaining psychological adjustment. Cebolla A, Soler J, Demarzo M and Garcia-Campayo J (2019) Religiosity The distinct meditation practices might be differentially related to distinct psychological and Meditation Practice: Exploring adjustment outcomes through different practice-related variables. However, research Their Explanatory Power on into other forms of institutional religiosity integrating social aspects of religion is required. Psychological Adjustment. Front. Psychol. 10:630. Keywords: religious beliefs, prayer, focused attention, open monitoring, compassion meditation, psychological doi: 10.3389/fpsyg.2019.00630 adjustment, practice variables Frontiers in Psychology | www.frontiersin.org 1 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice INTRODUCTION the two concepts (Zimbauer and Pargament, 2005), forming a multifactorial construct (Koenig, 2008). Thus, religiosity is Religiosity has been associated with a variety of psychological made up of domains that are institutional, i.e., integrating social well-being outcomes and seems to provide a protective function aspects; ideological, i.e., focused on beliefs; and devotional, against mental illness (Koenig and Larson, 2001; Hebert et al., i.e., with reference to individual practices such as prayer. 2007; Candy et al., 2012; Balbuena et al., 2013; Bonelli and Koenig, Hackney and Sanders (2003) suggested that institutional forms 2013; Barton et al., 2013; Macilvaine et al., 2013; Pargament and of religiosity provide the least relevant aspects of religion in Lomax, 2013; Gonçalves et al., 2015). It has also been associated existential terms, and therefore would produce few effects on with longevity, better indicators of quality of life, more effective psychological adjustment, compared with ideology and, more coping strategies, greater optimism and self-esteem, and less particularly, devotion. Religious beliefs could benefit mental anxiety, depression and autolytic or alcoholic behaviors (Cotton health by providing a sense of meaning and purpose (Koenig, et al., 2006; Pikó and Kovács, 2009; Taheri Kharame et al., 2014; 2009; Weber and Pargament, 2014). On the other hand, religious Unterrainer et al., 2014). However, there is some controversy practices, such as prayer, are common coping behaviors among regarding the relationship between religiosity and psychological patients suffering from mental illness (Koenig, 2009), and they well-being, with some studies pointing out that it would depend could play a role in the recovery process (Tepper et al., on how they are defined (Lindeman et al., 2012), and whether 2001; Unterrainer et al., 2014; Johnson, 2018). As can be groups of non-believers are also considered (Zuckerman et al., seen, psychological adjustment can be defined in several ways: 2016). In addition, there is little understanding of the precise as an absence of negative outcomes (e.g., depression, etc.), mechanisms by which religiosity might influence mental health as a matter of happiness (e.g., well-being, etc.), or as a self- (Peres et al., 2017). actualization process (e.g., identity integration, etc.). Based on Religiosity has been implicated in predicting treatment the self-determination theory (Deci and Ryan, 1985), Hackney response among patients with mental disorders (Kim et al., and Sanders (2003) proposed that religious beliefs and practices, 2015), but it may have both costs and benefits (Rippentrop when they are driven by an internal motivation, and thus et al., 2005; Weber and Pargament, 2014). It has been established based on ideology and more especially devotion, would be that not only positive health consequences flow from religious associated with positive well-being outcomes such as happiness engagement, and thus the identification of distinct dimensions or self-actualization. of religiosity would enable the search for both positive and Psychological adjustment could be developed through negative health-related outcomes (Seeman et al., 2003). In fact, religious contemplative practices such as meditation (Gelderloos whether religiosity is beneficial, detrimental or neutral with et al., 1990). Meditation is “a family of attentional and emotional regard to psychological adjustment is a question that has been regulatory training regimes developed for various ends, including examined repeatedly (Koenig and Larson, 2001; Lewis et al., the cultivation of well-being and emotional balance” (Lutz et al., 1997; Schaefer, 1997). One concern is that whenever religiosity 2008). Benefits of meditation for mental health have been and psychological adjustment have been analyzed to assess documented in clinical and non-clinical populations (Khoury their common variation, little attention has been given to et al., 2013; Demarzo et al., 2015). Although meditation the nature of religion itself, which is multidimensional and encompasses a group of practices that share distinctive features, might incorporate different aspects. For instance, Wood (2016) it is not easy to reduce meditation to a single procedure (Ospina proposed that religious communities that impose great efforts et al., 2007; Sedlmeier et al., 2012). Currently, the most studied and obligations offer more opportunities for the development forms of meditation are focused attention (FA), open monitoring of self-regulation abilities, favoring well-being as a longitudinal (OM), and compassion meditation (CM) (Lippelt et al., 2014; product. It has also been suggested that people might only Cebolla et al., 2017). FA includes practices that aim to narrow benefit from a religious affiliation if they actively practice their attentional scope by the cultivation of concentration on a religion, and that people with religious beliefs but who do not single event/object, such as breathing or a candle flame. OM practice would not gain substantial benefits (Berthold and Ruch, permits attentional scope to be expanded by focusing attentive 2014). Furthermore, it has been proposed that different forms contemplation onto any experience that may arise (thoughts, of religiosity might be differentially related to distinct forms of emotions or perceptions), with no selecting, over-identifying or psychological adjustment (Hackney and Sanders (2003). judging of any particular experience. CM focuses on cultivating Religiosity implies affiliation with a specific religion and its pro-social and empathic behaviors by the recognition of and dogmas – i.e., beliefs, practices and rituals associated with the desire to relieve pain and suffering for oneself and others. FA and sacred – and usually includes rules governing behavior (Koenig, OM are attentional types of meditation – i.e., they train processes 2009). However, there are people who consider themselves associated with the regulation of attention – whereas CM is a to be spiritual but not religious, understanding spirituality in form of constructive meditation – i.e., it replaces maladaptive individualistic and secular terms (Koenig, 2009). Spirituality is self-schema with more adaptive conceptions of the self (Lippelt a personal and informal adherence to transcendent meanings et al., 2014; Dahl et al., 2015). and beliefs that is relatively free of the rules associated with The potential regulatory function of FA, OM, and CM on religion (Huguelet and Koenig, 2007). Although there is no attentional and emotional processes may have an impact on agreement on a single definition of spirituality, it is considered the brain and behavior, affecting psychological adjustment (Lutz in terms of religion, because there are many similarities between et al., 2008). The type of effect produced by meditation would Frontiers in Psychology | www.frontiersin.org 2 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice likely vary according to the type of meditation that is practiced, control for sex, age and use of psychotropic medication, to because different types of meditation practices display distinct subtract their possible influence from the above-mentioned psychological processes, which could differentially impact relationships that are the main intention of the present study emotional experiences (Lutz et al., 2008; Goyal et al., 2014). (Seeman et al., 2003). Previous research has shown that FA, OM, and CM might have Owing to the incipient state of the literature, we did distinct effects on attention, conflict monitoring and creativity, not establish strong hypotheses beyond the idea that the with different neural structures and electroencephalographic previously described forms of religiosity would contribute patterns being activated (Lee et al., 2012; Tang and Posner, 2013; positively to psychological adjustment – and that they would Lippelt et al., 2014). Another study found that both attentional therefore be positively related to positive outcomes and and CM practices reduced self-reported stress reactivity in negatively associated with negative outcomes. However, healthy participants, but only compassion routes lowered the we proposed the heuristic that different forms of religiosity physiological response of the HPA axis and cortisol (Engert and meditation practice would have different impacts on et al., 2017). Data regarding how different meditation practices the distinct types of psychological adjustment, and that this are associated with distinct psychological adjustment domains would depend on session length, frequency of practice and are scarce, but attentional meditation procedures, such as lifetime experience, after controlling for the possible effects those included in meditative therapy programs, are generally of sex, age and psychotropic medication use. In summary, thought to target the alleviation of negative emotions (Khoury we expected that: (1) the devotional aspects of religiosity et al., 2013; Gotink et al., 2015), while CM techniques, such (i.e., prayer and meditation) would be more important than the as loving-kindness, seem to improve positive emotions (Zeng ideological components (i.e., belief status) in terms of explaining et al., 2015). Likewise, not only would the kind of religiosity psychological adjustment (Hackney and Sanders, 2003); (2) the component and meditation technique have relevance, but also attentional procedures of meditation (i.e., FA and OM) would the inclusion of certain practice-related variables such as session reduce negative outcomes, while CM would improve positive length, frequency of practice and lifetime practice, whose entire outcomes (Khoury et al., 2013; Gotink et al., 2015; Zeng et al., absence constitute a widespread methodological shortcoming 2015); and (3) length of practice would have greater impact of many studies (Lykins and Baer, 2009; Soler et al., 2014). on psychological adjustment than the other practice-related One exception is the study by Fredrickson et al. (2017) in variables (Cebolla et al., 2017). which length and frequency of meditative practice in general were related to positive well-being outcomes but were not associated with negative ones. Although Cebolla et al. (2017) did MATERIALS AND METHODS not consider psychological adjustment outcomes, they observed that length of FA practice was particularly associated with Design, Procedure, and Participants dispositional mindfulness. A cross-sectional study design was used in order to evaluate There has been increased interest in the relationships the explanatory power of religious beliefs and the practice of between religiosity, meditation and well-being in recent years, prayer and meditation over positive and negative psychological but there is a lack of understanding as to how specific adjustment outcomes, through the practice-related variables of religious components and meditation practices could influence session length, frequency of practice and lifetime experience, different psychological adjustment outcomes. In this context, after controlling for sex and age. Participants completed an the aim of this study was to assess the explanatory power assessment protocol in the Spanish language via a commercial of ideological (e.g., religious beliefs) and devotional (e.g., online survey system1 . A link to this protocol was posted practice of prayer, FA, OM, and CM) forms of religiosity on on several Spanish websites related to religion, meditation psychological adjustment, measured through positive outcomes and psychology (monasteries, meditation associations, scientific (e.g., happiness and positive affect) and negative outcomes associations, etc.), as well as on non-professional social media (e.g., depression, negative affect, and emotional overproduction), (e.g., Facebook). A total of 599 subjects accessed the website, of giving consideration to the practice-related variables of session whom 487 voluntarily agreed to participate and 365 completed length, frequency of practice and lifetime practice. Sex and the survey. The only inclusion criterion established was to answer age were also considered as possible confounders because both all the practice-related variables of the survey in full. Given have been associated with mood disorders, such as depression. this condition, the final sample comprised 210 participants, of In general, women are diagnosed with depression about twice whom 62.9% were female, with a mean age of 43.11 years (11.04) as often as men (Salk et al., 2017), and depressive symptoms and a range of 18–74 years. As regards education, 20.0% held show increased values for older people (Hinz et al., 2014), a Ph.D. degree, 70.5% were university graduates, and 9.5% had although the relationships between depression and sex seems to only secondary studies; and therefore, the sample was composed be weaker with age (Patten et al., 2016). The reasons for this mainly of participants with a high cultural level. With regard to are not clear. Biological, psychological and sociological factors health status, 87.1% did not suffer from any chronic disease, and have been proposed to explain it, although strong empirical 87.6% were not taking any psychotropic medication. In terms of studies are still lacking. The use of psychotropic agents has religious adscription, 30.0% were affiliated as Christians, 13.3% also been associated with emotional and mental problems (Estancial Fernandes et al., 2018). Therefore, we decided to 1 www.surveymonkey.com Frontiers in Psychology | www.frontiersin.org 3 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice as Buddhists, and 56.7% were non-believers. In summary, happened the day before), with dichotomous response options the participants were Spanish adults – mostly women, with (yes vs. no). The remembered well-being score is calculated a university degree, without chronic diseases and not taking with the mean score of the first 11 items, which may vary any psychotropic medication – of whom a little under half between 0 and 10. The 10 items for experienced well-being are had Christian or Buddhist religious beliefs, with the others converted into a single score between 0 (zero positive experiences being non-believers. and 5 negative experiences) and 10 (5 positive experiences and no negative experiences). The mean of the remembered and Compliance With Ethical Standars experienced scores produces a combined well-being index (total Ethics Statement PHI) ranging between 0 and 10 and can be used to monitor All procedures performed in studies involving human changes in well-being, with adequate psychometric properties participants were in accordance with the ethical standards (Hervas and Vázquez, 2013). The internal consistency of the PHI of the institutional and/or national research committee and total scale in the present study as measured by Cronbach’s alpha with the 1964 Helsinki declaration and its later amendments was α = 0.88. or comparable ethical standards. The study protocol was -Remission from Depression Questionnaire (RDQ): the RDQ approved by the local ethics committee - Ethics Committee of has 41 items with 7 subscales that capture a broad array of Aragon (PI12/00083) - and all participants had signed a written depression-related domains, and offers a negative psychological (online) consent form indicating their willingness to participate. adjustment outcome total score by including symptoms of They were informed about the purpose of the study, and it depression, other symptoms, positive mental health, coping was made clear to them that their answers would be treated ability, functioning, life satisfaction and a general sense of well- confidentially. In order to allow for replication studies, the data, being. The items refer to the previous week and are rated on a and procedures of the present study are available in an open 3-point Likert scale (scored between 0, “not at all or rarely true.” repository after anonymization. and 2, “often or almost always true”). The RDQ has demonstrated excellent psychometric properties (Zimmerman et al., 2013), Measurements allowing a broad point of view of depressed patients’ status to Sociodemographic Information be gained that is consistent with a bio-psycho-social approach We collected information on sex and age, not only to describe the (Zimmerman et al., 2014). The internal consistence reliability sample but also to control for these possible confounding factors value of the RDQ total scale, which ranges between 0 and 82, was when analyzing the main relationships of interest, as mentioned α = 0.95 in the present study. previously. Other descriptive variables of the sample were -The Positive and Negative Affect Schedule (PANAS): the education (primary, secondary, graduate, and postgraduate PANAS (Watson et al., 1988) is a self-report questionnaire studies), presence of chronic disease (yes vs. no) and whether they that measures positive and negative affectivity, and thus offers were taking psychotropic medication (yes vs. no). We also asked both positive and negative psychological adjustment outcomes. about religious affiliation (Christian, Buddhist, others, none). This instrument consists of a list of 20 adjectives, 10 per subscale (e.g., positive: “interested”; negative: “guilty”), which Religious Belief Status and are rated on a 5-point Likert-type scale (between 1, “nothing,” Practice-Related Variables and 5, “very much”), using the time instructions desired by -Religious belief status was assessed by only one item, the researcher. Present-moment instructions were used in this as religiosity measures have consistently been estimated study. Each subscale ranges between 10 and 50. The PANAS has (Norenzayan and Hansen, 2006; Gebauer et al., 2016), with two been validated in the Spanish language with good psychometric possible options: “believer” vs. “non-believer.” Measures for the properties (Sandín et al., 1999). The internal consistency of amount of prayer and meditation practice were also included the positive and negative affect scales in the present study was to assess the specific practice-related variables (i.e., length of α = 0.90 and α = 0.88, respectively. sessions in minutes; practice frequency: “daily,” “3–4 times/week,” -Emotional Overproduction Scale (EOPS): this scale consists “once a week or less,” “never”; and lifetime experience in months) of 13 items that explore the role of emotional overproduction, for each type of practice independently (i.e., prayer, FA, OM, conceptualized as the tendency to simultaneously experience CM). We included a short description of each technique in order negative emotions and feelings during sad episodes (Hervas to ensure standardization among participants. and Vazquez, 2011), and thus can be considered as a negative psychological adjustment outcome. Emotional overproduction Psychological Adjustment Outcomes has been found to be associated with ruminative responses, -Pemberton Happiness Index (PHI): this scale measures which have a relevant role in the onset, duration and severity happiness in the general population, and thus can be considered of depressive episodes. Participants are asked to rate how often a positive psychological adjustment outcome. The PHI includes they typically experience different negative emotions during sad eleven items related to different domains of remembered well- episodes according to a 5-point Likert-type scale (between 1, being (general, hedonic, eudaimonic, and social well-being), each “never,” and 5, “always”). The Spanish EOPS has proved to with an 11-point Likert scale from 0 (“totally disagree”) to have good psychometric properties (Hervas and Vazquez, 2011). 10 (“totally agree”), and 10 items related to experienced well- The internal consistence of the EOPS total scale, which ranges being (i.e., positive and negative emotional events that possibly between 13 and 65, was α = 0.90 in the present study. Frontiers in Psychology | www.frontiersin.org 4 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice Data Analysis All tests were bilateral, with a significance level of p < 0.05. A descriptive analysis was first performed of religious belief There were no corrections for multiple comparisons given status, prayer and meditation session length, frequency of the highly exploratory nature of this study (Feise, 2002). The practice and lifetime practice, as well as the psychological SPSS v19.0 statistical software package was used to perform adjustment outcomes of PHI, RDQ, PANAS-Positive, PANAS- the data analysis. Negative and EOPS by using means and standard deviations (SD), or frequencies and percentages (%), according to the specific nature of each variable. RESULTS We subsequently compared the positive and negative psychological adjustment outcomes of PHI, RDQ, PANAS- Characteristics of Study Participants Positive, PANAS-Negative and EOPS according to the belief Table 1 shows the general characteristics of study participants status using t-tests and Cohen’s d effect size measures, and we in terms of religious belief status, prayer and meditation also used Pearson’s r coefficients in order to bivariately evaluate practice-related variables, and psychological adjustment the correlations of session length, frequency of practice and outcomes. As can be observed, 43.3% of participants assigned lifetime practice of prayer, FA, OM, and CM over the positive and themselves as believers, and 56.7% as non-believers. The longest negative psychological adjustment outcomes, without subtracting session length of practice was found in FA (Mn = 15.95 min; the possible influence of sex, age and the other variables of SD = 12.97), while the shortest session length of practice was interest in order to give a general non-adjusted overview of the observed in prayer (Mn = 8.57 min; SD = 17.52). Daily practice relationships proposed. showed 34.3% of participants practicing FA; 27.1%, OM; 16.2%, Finally, hierarchical multivariate linear regression models prayer; and 8.6%, CM. The largest lifetime practice experience were built to assess the explanatory power of religious belief was found in FA (Mn = 82.75 months; SD = 102.69), while status, and session length, frequency of practice and lifetime the shortest lifetime practice experience was observed in CM practice of prayer, FA, OM and CM on the psychological (Mn = 37.85 months; SD = 80.02). In general terms, and judging adjustment outcomes of PHI, RDQ, PANAS-Positive, PANAS- from the values obtained in each variable, the participants of the Negative and EOPS. We used these analyses to estimate present study showed good psychological adjustment (Table 1). the impact of religious belief status and the practice of prayer and meditation techniques, considered in their entirety, Religious Beliefs, Prayer, Meditation on psychological adjustment, in addition to identifying the most important predictors. For this purpose, we built three Practice, and Psychological Adjustment There were no significant differences between believers and non- regression models, one for each practice-related variable (session believers in the positive and negative psychological adjustment length, frequency of practice and lifetime practice) on each outcomes, although a certain trend was observed in the positive dependent variable (PHI, RDQ, PANAS-Positive, PANAS- outcomes, favouring believers [(PHI: believers Mn = 8.18; Negative and EOPS), considering religious belief status and the SD = 1.01; non-believers Mn = 7.88; SD = 1.16; d = 0.28; corresponding prayer, FA, OM, and CM practice-related variables t = 1.91; p = 0.058); (PANAS-Positive: believers Mn = 38.76; as independent factors. Specifically, the following predictors were SD = 5.66; non-believers Mn = 37.17; SD = 6.61; d = 0.26; included: age, sex and psychotropic medication use in the first t = 1.83; p = 0.069); (RDQ: believers Mn = 10.80; SD = 11.47; step in order to control for possible variation patterns (Seeman non-believers Mn = 11.71; SD = 12.99; d = 0.07; t = 0.53; et al., 2003; Estancial Fernandes et al., 2018), and religious belief p = 0.600); (PANAS-Negative: believers Mn = 14.69; SD = 5.31; status, and prayer, FA, OM, and CM, according to the different non-believers Mn = 15.73; SD = 6.06; d = 0.18; t = 1.30; practice-related variables, in the second step. Standardized p = 0.196); (EOPS: believers Mn = 30.68; SD = 10.29; non- coefficients (β) were used to assess the individual contribution believers Mn = 31.81; SD = 8.04; d = 0.12; t = 0.86; p = 0.392)]. of the independent variables to explaining the psychological Table 2 presents the raw correlations between the practice-related adjustment outcomes, and their statistical significance was variables and the psychological outcomes. As can be seen, length established by the Wald test. Multiple determination coefficients of FA sessions was related to all the psychological outcomes (PHI: (R2 ) were calculated to observe their grouped explanatory power r = 0.20, p = 0.003; PANAS-Positive: r = 0.15, p = 0.026; RDQ: in each regression model, and the statistical significance of the r = −0.21, p = 0.002; PANAS-Negative: r = −0.22, p = 0.002; increment (1R2 ), obtained when going from the first hierarchical EOPS: r = −0.18, p = 0.008). Length of CM sessions was related model to the next, was tested using ANOVA. to PANAS-Positive (r = 0.21, p = 0.003). Practice frequency of The Kolmogorov–Smirnov test was used to determine prayer and CM was related to PHI (r = 0.16, p = 0.023; r = 0.16, whether the conditional distribution of the residuals met the p = 0.022; respectively). Lifetime practice of FA was related to all assumption of normality. It was confirmed that the Durbin– the outcomes (PHI: r = 0.23, p = 0.001; PANAS-Positive: r = 0.23, Watson (DW) values approached a value ≈2.00 to rule out p = 0.001; RDQ: r = −0.18, p = 0.009; PANAS-Negative: r = −0.18, autocorrelation problems in the errors, and that the variance p = 0.011; EOPS: r = −0.19, p = 0.007). Lifetime practice of OM inflation factor (VIF) and tolerance parameters (T) did not exceed was related to all the outcomes (PHI: r = 0.23, p = 0.001; PANAS- critical values, in order to prevent multicollinearity problems in Positive: r = 0.22, p = 0.001; RDQ: r = −0.17, p = 0.017; PANAS- the regression models (Martínez-González, 2006). Negative: r = −0.15, p = 0.029; EOPS: r = −0.24, p = 0.001). Frontiers in Psychology | www.frontiersin.org 5 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice TABLE 1 | Descriptive data for religious belief status, practice-related variables, TABLE 2 | Raw relationships between the practice-related variables of prayer and and psychological adjustment outcomes. meditation techniques and the different psychological adjustment outcomes. Variables Total (n = 210) Prayer FA OM CM Religious belief status, Yes 91 (43.3) Length of Prayer sessions r p r p r p r p -Session length (minutes) PHI 0.05 0.468 0.20 0.003 −0.05 0.503 0.13 0.054 Mn (SD) 8.57 (17.52) PANAS-Positive 0.06 0.406 0.15 0.026 −0.04 0.607 0.21 0.003 -Frequency of practice RDQ −0.07 0.350 −0.21 0.002 −0.03 0.612 −0.04 0.526 Daily 34 (16.2) PANAS-Negative −0.06 0.372 −0.22 0.002 −0.05 0.437 0.05 0.481 3–4 times/week 16 (7.6) EOPS 0.01 0.881 −0.18 0.008 −0.04 0.578 −0.08 0.232 Once a week or less 19 (9.0) Practice frequency Never 141 (67.1) PHI 0.16 0.023 0.09 0.211 0.06 0.415 0.16 0.022 -Lifetime practice (months) PANAS-Positive 0.10 0.176 −0.03 0.656 0.04 0.616 0.08 0.260 Mn (SD) 81.02 (161.78) RDQ −0.12 0.084 −0.13 0.055 −0.11 0.129 −0.09 0.203 Focused attention PANAS-Negative −0.13 0.052 −0.13 0.058 −0.08 0.270 −0.02 0.801 -Session length (minutes) EOPS −0.08 0.224 −0.03 0.665 −0.07 0.337 0.01 0.882 Mn (SD) 15.95 (12.97) Lifetime practice -Frequency of practice PHI 0.10 0.159 0.23 0.001 0.23 0.001 0.14 0.047 Daily 72 (34.3) PANAS-Positive 0.01 0.903 0.23 0.001 0.22 0.001 0.14 0.046 3–4 times/week 62 (29.5) RDQ −0.06 0.418 −0.18 0.009 −0.17 0.017 −0.09 0.180 Once a week or less 50 (23.8) PANAS-Negative −0.06 0.389 −0.18 0.011 −0.15 0.029 −0.07 0.326 Never 26 (12.4) EOPS −0.03 0.627 −0.19 0.007 −0.24 0.001 −0.08 0.251 -Lifetime practice (months) Prayer, practice of prayer. FA, focused attention. OM, open monitoring. CM, Mn (SD) 82.75 (102.69) compassion meditation. PHI, Pemberton Happiness Index. PANAS-Positive, Open monitoring positive affect. RDQ, Remission from Depression Questionnaire. PANAS-Negative, -Session length (minutes) negative affect. EOPS, Emotional Overproduction Scale. r, Pearson’s r coefficient. Mn (SD) 14.93 (15.81) p, p-value. -Frequency of practice Daily 57 (27.1) 3–4 times/week 57 (27.1) Lifetime practice of CM was related to PHI (r = 0.14; p = 0.047) Once a week or less 58 (27.6) and PANAS-Positive (r = 0.14; p = 0.046). Never 38 (18.1) When carrying out the hierarchical regression analyses, -Lifetime practice (months) separating out the practice-related variables, we observed that Mn (SD) 72.28 (93.89) religious beliefs and length of sessions of prayer and meditation Compassion meditation (Table 3) produced significant 1R2 values from step 1 to step 2 -Session length (minutes) in all the psychological adjustment outcomes: PHI (1R2 = 0.09; Mn (SD) 12.91 (21.65) p = 0.002), PANAS-Positive (1R2 = 0.09; p = 0.002), RDQ -Frequency of practice (1R2 = 0.07; p = 0.004), PANAS-Negative (1R2 = 0.08; p = 0.007) Daily 18 (8.6) and EOPS (1R2 = 0.07; p = 0.013). Specifically, FA session 3–4 times/week 36 (17.1) length contributed significantly to explaining PHI (β = 0.25; Once a week or less 63 (30.0) p = 0.001), PANAS-Positive (β = 0.18; p = 0.014), RDQ (β = −0.27; Never 93 (44.3) p < 0.001), PANAS-Negative (β = −0.27; p < 0.001) and EOPS -Lifetime practice (months) (β = −0.23; p = 0.001). In addition, CM session length also Mn (SD) 37.85 (80.02) contributed significantly to PANAS-Positive (β = 0.18; p = 0.011). PHI, Mn (SD) 8.01 (1.11) On the other hand, religious beliefs and frequency of prayer PANAS-Positive, Mn (SD) 37.86 (6.26) and meditation practice (Table 3) produced significant 1R2 RDQ, Mn (SD) 11.31 (12.33) values from step 1 to step 2 in PHI (1R2 = 0.06; p = 0.038), PANAS-Negative, Mn (SD) 15.28 (5.76) while only frequency of CM practice contributed to explaining EOPS, Mn (SD) 31.32 (9.09) PHI (β = 0.16; p = 0.041). Finally, religious beliefs and lifetime practice of prayer and meditation (Table 3) produced significant PHI, Pemberton Happiness Index. PANAS-Positive, positive affect. RDQ, Remission from Depression Questionnaire. PANAS-Negative, negative affect. 1R2 values from step 1 to step 2 in PHI (1R2 = 0.08; EOPS, Emotional Overproduction Scale Values are frequencies and percentages p = 0.007), PANAS-Positive (1R2 = 0.08; p = 0.007) and EOPS (%) except for age (in years), length of sessions (in minutes), experience of practice (1R2 = 0.08; p = 0.037). However, of these, only lifetime practice (in months), happiness (from 0 to 10), positive affect (from 10 to 50), depression of FA contributed to explaining PHI (β = 0.21; p = 0.030), (from 0 to 82), negative affect (from 10 to 50), and emotional overproduction (from 13 to 65), which are means (Mn) and standard deviations (SD). while lifetime practice of OM contributed to explaining EOPS Frontiers in Psychology | www.frontiersin.org 6 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice (β = −0.19; p = 0.047). Age significantly and consistently benefits of religiosity could be contingent on socio-cultural explained (inversely) RDQ, PANAS-Negative and EOPS in steps values, so that the benefits of religious adjustment would only be 1 and 2. Sex was not consistently related to any of them. really achieved in scenarios of high country-level religiosity – i.e., Psychotropic medication use was consistently related to RDQ and societies with a high social value of religion, which is not the case EOPS in steps 1 and 2. of the modern Spanish society on which the present study was The statistics related to the adequacy of residuals and factors carried out (Gebauer et al., 2016). were appropriate in all the models and allowed interpretation of There is insufficient knowledge regarding the mechanisms the regression analyses with guarantees. that mediate the effect of religion on mental health and well- being, although it has been proposed that some spiritual practices could facilitate awareness states that help to identify values such DISCUSSION as patience, perseverance, kindness, compassion, forgiveness, gratitude, altruism, equanimity and wisdom, which could play an To the best of our knowledge, this is the first study to assess important role in this regard (Chaudhry, 2008; Baetz and Toews, the explanatory power of religiosity by means of religious belief 2009; Sharma and Singh, 2018). In the present study, the practice status, and session length, frequency of practice and lifetime of meditation was related to psychological adjustment. It has been practice of prayer and different meditation techniques such said that the relationship between meditation practice and values as FA, OM, and CM on a number of positive and negative seems to be mediated by decentering (Franquesa et al., 2017), one psychological adjustment outcomes. In our sample, we observed of the main mechanisms of action in meditation, which allows that almost half of the participants had a believer status, and one to become separated from one’s thoughts, enabling the person the most practiced meditation technique was FA, while CM to observe experiences with greater clarity, and thus to choose was the least used. more wisely in line with personal values (Shapiro et al., 2006; The main result of the present study suggests that greater Kocovski et al., 2009; Garland et al., 2015). Decentering is to a psychological adjustment can be associated in general, regardless great extent developed with mindful breathing, which is a type of sex, age, psychotropic medication use, religious belief status of FA technique, but it is not developed in the same way by other and practice of prayer with training in meditation techniques, in techniques such as loving-kindness meditation, which is designed line with previous prospective research, showing that meditation to increase feelings of compassion (Feldman et al., 2010). This leads to greater well-being. This finding is in agreement with is in line with our results, because the length of FA sessions was a growing body of evidence supporting the general hypothesis consistently associated with positive and negative psychological that meditation practice may be linked to psychological and adjustment variables, and this is interesting because only FA physiological health-related processes, and that commitment to session length, but not OM or CM session length, has been related religiosity – in a broad sense – might also include negative to observing, awareness, non-judging and non-reacting to inner experiences (e.g., feelings of being punished by God, anger experiences, which are the most important facets of mindfulness at God, religious doubts, religious passivity, conflicts with (Cebolla et al., 2017). other members, etc.), as well as negative beliefs and forms Mindfulness refers to an awareness that emerges by inten- of coping, misunderstandings and miscommunication, which tionally focusing attention on the present moment experience in could counterbalance other possible positive effects (Seeman a non-judgemental or non-evaluative way (Kabat-Zinn, 2005). et al., 2003; Weber and Pargament, 2014). A recent study The relationship between meditation practice and mindfulness found that certain religiosity dimensions, such as spiritual has been clearly established (de Castro, 2015), as it has also experiences, values, forgiveness and organizational religiousness, been established between mindfulness and psychological health were associated with higher mental health status, while the (Carmody et al., 2008; Khoury et al., 2013; Demarzo et al., religiosity dimension of meaning was related to somatic 2015). Greeson et al. (2011) suggest that mindfulness partly symptoms (Kioulos et al., 2015). We have observed in the mediates the association between increased spiritual experiences present study that “believers” showed higher values in the positive and improved mental health related to quality of life. In general, psychological adjustment outcomes, although with a non- mindfulness has been associated with a number of cognitive significant trend and moderately low effects, which remained functions (Lippelt et al., 2014), but there are few studies that non-significant in the subsequent multivariate analyses. This deal with the effect of the different meditation techniques on trend might achieve levels of significance in a larger sample, psychological adjustment. In a study where three techniques but it would need to be tested. Our results suggest that (FA, body scan and yoga) were compared (Sauer-Zavala et al., any interactions, if they exist, are relatively weak. In this 2012), the body scan technique was shown to be associated sense, the most parsimonious explanation is that there was with reductions in rumination and describing, whereas FA not a strong relationship. It has been said that while active was associated with an increase in non-judging of the inner participation in religious communities could have salutary effects, experience. In another study (Carmody and Baer, 2008), FA was liminal positions such as “believing but not belonging” may be associated with improvements in most facets of mindfulness and accompanied by a higher risk of mental health problems, even several measures of symptoms and well-being, suggesting that greater than for atheists, showing that the relationships between the practice of FA meditation increases mindfulness abilities, religiosity, secularity and mental health could be complex (Baker which in turn lead to symptom reduction and improved well- et al., 2018). One possible explanation for the results obtained in being. Thus, the length of FA sessions – and perhaps also lifetime the present study in this regard might be that the psychological practice – could be related to psychological adjustment through Frontiers in Psychology | www.frontiersin.org 7 March 2019 | Volume 10 | Article 630 TABLE 3 | Hierarchical regression of (age, sex, medication) religious beliefs and practice-related variables of prayer and meditation on psychological adjustment. Age Sex Medication Beliefs Prayer FA OM CM Montero-Marin et al. Length of sessions R2 1R2 β t β t β t β t β t β t β t β t PHI Step 1 0.05∗ 0.11 1.55 0.13 1.76 −0.14 −1.97 Step 2 0.14∗∗∗ 0.09∗∗ 0.13 1.90 0.12 1.70 −0.14 −2.00∗ 0.08 1.09 0.03 0.47 0.25 3.53∗∗ −0.12 −1.77 0.09 1.22 PANAS-Positive Step 1 0.05∗ 0.16 2.30∗ 0.08 1.08 −0.12 −1.72 Step 2 0.14∗∗∗ 0.09∗∗ 0.19 2.74∗∗ 0.07 1.00 −0.11 −1.66 0.10 1.44 0.02 0.30 0.18 2.48∗ −0.10 −1.42 0.18 2.58∗ RDQ Step 1 0.18∗∗∗ −0.36 −5.36∗∗∗ −0.06 −0.91 0.20 3.07∗∗ Frontiers in Psychology | www.frontiersin.org Step 2 0.25∗∗∗ 0.07∗∗ −0.37 −5.66∗∗∗ −0.06 −0.90 0.21 3.23∗∗ 0.01 0.06 −0.03 −0.46 −0.27 −4.07∗∗∗ 0.02 0.34 −0.01 −0.16 PANAS-Negative Step 1 0.06∗∗ −0.19 −2.71∗∗ −0.02 −0.29 0.14 1.92 Step 2 0.14∗∗ 0.08∗∗ −0.19 −2.76∗∗ −0.01 −0.14 0.15 2.19∗ −0.06 −0.88 −0.03 −0.38 −0.27 −3.74∗∗∗ 0.01 0.12 0.10 1.44 EOPS Step 1 0.09∗∗ −0.21 −3.01∗∗ −0.04 −0.60 0.20 2.85∗∗ Step 2 0.16∗∗ 0.07∗ −0.24 −3.42∗∗ −0.04 −0.53 0.20 2.92∗∗ −0.08 −1.08 0.07 0.91 −0.23 −3.24∗∗ −0.01 −0.12 −0.04 −0.56 Practice frequency PHI Step 1 0.05∗ 0.12 1.72 0.14 2.05∗ −0.14 −2.09∗ Step 2 0.11∗∗ 0.06∗ 0.10 1.44 0.12 1.72 −0.15 −2.20∗ 0.10 1.33 0.09 1.25 0.06 0.71 −0.02 −0.24 0.16 2.06∗ PANAS-Positive Step 1 0.04∗ 0.15 2.13∗ 0.07 1.05 −0.12 −1.75 Step 2 0.07 0.03 0.13 1.89 0.06 0.82 −0.13 −1.84 0.12 1.65 0.04 0.48 −0.07 −0.84 0.03 0.39 0.09 1.22 −0.35 −5.28∗∗∗ −0.06 −0.92 8 RDQ Step 1 0.17∗∗∗ 0.20 3.12∗∗ Step 2 0.21∗∗∗ 0.04 −0.35 −5.23∗∗∗ −0.06 −0.84 0.20 3.00∗∗ <0.01 0.02 −0.09 −1.23 −0.14 −1.87 −0.04 −0.47 −0.01 −0.07 PANAS-Negative Step 1 0.06∗ −0.20 −2.91∗∗ −0.03 −0.49 0.14 2.03∗ Step 2 0.10∗ 0.04 −0.20 −2.86∗∗ −0.02 −0.35 0.14 1.96 −0.05 −0.71 −0.10 −1.31 −0.14 −1.83 −0.03 −0.31 0.06 0.79 EOPS Step 1 0.09∗∗ −0.21 −3.07∗∗ −0.03 −0.43 0.19 2.74∗∗ Step 2 0.10∗∗ 0.02 −0.21 −2.96∗∗ −0.03 −0.39 0.18 2.67∗∗ −0.04 −0.52 −0.07 −1.00 −0.02 −0.19 −0.07 −0.89 0.04 0.57 Lifetime practice PHI Step 1 0.05∗ 0.11 1.52 0.14 1.90 −0.14 −1.98 Step 2 0.13∗∗ 0.08∗∗ 0.07 1.01 0.14 1.95 −0.16 −2.26∗ 0.08 1.05 −0.01 −0.07 0.21 2.19∗ 0.11 1.10 −0.05 −0.53 PANAS-Positive Step 1 0.03 0.14 1.95 0.06 0.81 −0.10 −1.37 Step 2 0.11∗∗ 0.08∗∗ 0.14 1.88 0.08 1.05 −0.11 −1.62 0.12 1.67 −0.13 −1.67 0.18 1.88 0.10 1.03 −0.01 −0.15 RDQ Step 1 0.16∗∗∗ −0.34 −5.10∗∗∗ −0.05 −0.73 0.19 2.86∗∗ Step 2 0.20∗∗∗ 0.04 −0.34 −4.90∗∗∗ −0.06 −0.85 0.21 3.11∗∗ −0.03 −0.40 0.08 1.06 −0.19 −2.12∗ −0.03 −0.34 0.07 0.79 PANAS-Negative Step 1 0.06∗ −0.20 −2.78∗∗ −0.02 −0.29 0.12 1.77 Step 2 0.10∗ 0.04 −0.19 −2.54∗ −0.02 −0.25 0.15 2.06∗ −0.09 −1.17 0.04 0.54 −0.20 −2.06∗ −0.03 −0.35 0.08 0.93 EOPS Step 1 0.07∗∗ −0.20 −2.85∗∗ −0.01 −0.19 0.17 2.46∗ Step 2 0.13∗∗ 0.06∗ −0.19 −2.66∗∗ −0.03 −0.46 0.18 2.61∗ −0.05 −0.67 0.07 0.87 −0.13 −1.37 −0.19 −2.00∗ 0.12 1.41 Medication, psychotropic medication use (no vs. yes); Beliefs, belief status (believer vs. non-believer); Prayer, practice of prayer. FA, practice of focused attention. OM, practice of open monitoring. CM, practice of compassion meditation. Step 1: age and sex as independent variables. Step 2: age, sex, beliefs, and length of sessions (minutes) or practice frequency (times per week) or lifetime practice (hours) of prayer, FA, OM, and CO., as independent variables. PHI, Pemberton Happiness Index. PANAS-Positive, positive affect. RDQ, Remission from Depression Questionnaire. PANAS-Negative, negative affect. EOPS, Emotional Overproduction Scale. R2 , determination coefficient. 1R2 , increment of R2 . β, standardized slope. t, t-test. ∗ p < 0.05. ∗∗ p < 0.01. ∗∗∗ p < 0.001. March 2019 | Volume 10 | Article 630 Religiosity and Meditation Practice Montero-Marin et al. Religiosity and Meditation Practice the development of decentering and mindfulness skills, allowing human ability to experience pleasant emotions was selectively reduced reactivity to repetitive thoughts and release from mental advantageous, and positive emotion experiences hold a value as fixations by means of acceptance, which is an adaptive and resources in the face of life’s demands, extending momentary fundamental component of third-generation psychotherapies awareness in ways that build personal resources such as resilience, (Öst, 2008; Feldman et al., 2010; Kliem et al., 2010; Athay, mental health and social integration (Fredrickson et al., 2017). 2012; A-Tjak et al., 2015). Given that a high tendency for Whether the practice of CM meditation genuinely contributes the mind to wander has been associated with lower levels to pro-sociality beyond a simple desire to appear pro-social, of psychological well-being (Killingsworth and Gilbert, 2010), considering that religiosity is strongly influenced by reputational length of FA practice might be allowing the tendency for this concerns and stereotypes, is a question for future research wandering to be reduced, since attention is focused on activity (Galen, 2012). in the present moment. However, owing to the limitations of the On the other hand, lifetime practice of OM was negatively present study, we cannot rule out the assumption that people with associated with emotional overproduction in the present study a lower tendency for mind-wandering are able to practice FA for (lifetime practice of OM and also lifetime practice of FA were a longer period of time, and that, finally, these practitioners are related to all the psychological outcomes through bivariate the ones who acquire more experience in FA over time. analysis, but their explanatory power disappeared when using Nevertheless, it has also been suggested that type of meditation multivariate models). Emotional overproduction, as the tendency does not seem to be associated with level of mindfulness skills to simultaneously experience an elevated number of negative (Soler et al., 2014), and it is true that findings of specific emotions and feelings during sad episodes (Hervas and Vazquez, effects of different meditation techniques are still inconsistent 2011), has been associated with rumination and difficulties (Vettese et al., 2009). One study (O’Connor et al., 2015) in emotion regulation. OM is one of the main techniques found that religion-based practitioners had lower levels of of meditation and it is usually practiced by experienced guilt, empathic distress, depression and neuroticism, and higher meditators who have developed mindfulness mechanisms, such levels of conscientiousness, resilience and altruism toward as emotion regulation, as a consequence of the practice (Hölzel others, compared with secular meditators. When comparisons et al., 2011), which is aligned with our results. OM could be were made between techniques, findings suggested that those expected to affect this tendency, perhaps by improving perceptual practicing contemplative prayer, a type of prayer that in fact could processes, and especially by decreasing psychological reactivity be considered in the attentional group of meditation practices (Tang and Posner, 2013). (Dahl et al., 2015), showed higher levels of altruism toward The main limitations of the present study were the cross- strangers, and lower levels of neuroticism (O’Connor et al., 2015), sectional design used, which did not allow us to establish causal with length of practice predicting positive outcomes, as we have relationships, and the non-random sampling procedure, which found in FA meditation. We also found that the practice of may have resulted in a selection bias (e.g., the high proportion prayer, in general terms, was associated with happiness in our of participants with university-level education), thus reducing study through bivariate analysis, but its individual contribution the representativeness of our results. These have been two of disappeared when using multivariate models. Previous pilot the main limitations of research in the field of religiosity and studies indicated that prayer, as well as meditative practice spirituality to date (Seeman et al., 2003). It is important to in general, might be related to a decreased sense of the self highlight the great effort required in order to recruit regular and could be an important factor in the relationship between meditators, and that the sample size we obtained allowed us religiosity and psychological well-being (Maltby et al., 1999; to develop a statistical analysis with a relatively high power, Johnstone, 2009). Therefore, we suggest that future research enabling control for possible socio-demographic confounders should study distinct techniques of prayer, and whether they are such as age, sex, and psychotropic medication use. In this performed individually or in community, to elucidate possible sense, we observed that sex was not a determinant in explaining factors of influence. psychological adjustment, and this is not the first time this kind Within this prevailing discrepancy, we also found that CM of result has been obtained, probably due to the influence of session length contributed to explaining positive affect, and that other factors such as work-family trajectories (Stordal et al., 2001; frequency of CM practice was specifically related to happiness Engels et al., 2019). However, age was directly related to positive (lifetime practice of CM was also related to happiness and positive affect, and inversely related to depression, negative affect and affect through bivariate analysis, but its explanatory power was emotional overproduction, which is contrary to the findings of null when using multivariate models). Interestingly, both positive other studies (Hinz et al., 2014). Nevertheless, age has also shown affectivity and happiness are positive psychological adjustment inconsistent results as a potential risk factor, for instance, for outcomes, which suggest this type of meditation practice could depression (Blazer, 2000; Djernes, 2006), and we believe one specifically enhance this side of psychological adjustment, as we determining factor for obtaining our results was the fact that hypothesized. This could be possible through the processing of our sample did not include very elderly participants, who usually positive memories in an imagery-based way, which is a procedure form a part when studying age as a risk factor for depression habitually used in CM meditation (Nelis et al., 2015), and a (Glaesmer et al., 2011). Psychotropic medication use was found central aspect of happiness when considering it as remembered to be associated with depression and emotional overproduction, well-being (Hervas and Vázquez, 2013). The “broaden-and-build which is consistent with previous research (Estancial Fernandes theory of positive emotions” (Fredrickson, 2013) sustains that the et al., 2018). Although our design did not allow us to establish Frontiers in Psychology | www.frontiersin.org 9 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice directional relationships between them in this specific population prayer was only significantly related to happiness in the of religious and meditator practitioners, those participants with raw analysis. However, we found preliminary evidence that emotional difficulties could be presumed to be taking medication distinct meditation practices might be differentially related to to relieve their symptoms. distinct psychological adjustment outcomes, through different Thus, future research should also consider the impact of practice-related variables. older age groups and other possible factors that moderate these We observed that devotional aspects of religiosity were relationships, but also the possible biases and socially desirable more important in order to explain psychological adjustment responding of participants when using self-report measures. (hypothesis 1). Our study has pointed out that some meditation Religious subjects may be influenced when reporting data of practices could fit better with some psychological adjustment religious practice, and they could under-report symptoms in variables, answering the question of which indicators of order to project a socially desirable image of themselves, due to practice would predict them. This is in line with previous illusory mental health states as a denial mechanism of suffering studies that demonstrated the differential efficacy of meditation (Gillings and Joseph, 1996; de Oliveira Maraldi, 2018). Another practices in promoting mindfulness skills (Lykins and Baer, limitation was the method used to measure the practice-related 2009; Soler et al., 2014; Cebolla et al., 2017), or even the variables of prayer and meditation techniques – by means distinct relationships between specific facets of mindfulness and of one single item for each, which were reported through psychological symptoms (Cash and Whittingham, 2010; Colgan a recall method – and whose test-retest reliability was not et al., 2015). All of this is important in order to understand assessed. This issue is particularly complex when measuring the relationships between meditation practice and psychological the specific effects of distinct spiritual techniques, because most adjustment, and has relevant implications. For instance, we can practitioners usually combine different types in their routines, make use of specific forms of practice, depending on the aspects and which is why the measure of distinct practice-related of psychological adjustment we are interested in enhancing, variables makes real sense. In addition, we assessed religiosity through meditation practice. We have seen that FA session and spirituality by means of the presence of religious beliefs and length might be related to the entire range of psychological prayer and meditation practices, but other forms of institutional adjustment outcomes, that length and frequency of CM practice religiosity integrating social aspects such as church attendance, could be related to positive psychological adjustment outcomes, reading of religious texts and other aspects of religious services and that lifetime practice of OM techniques may be potentially seems mandatory because congregational support might also be related to self-regulation processes of negative emotions. Thus, related to health outcomes (Johnstone, 2009). In this sense, the CM would contribute to explaining the positive aspects of context of practice could play a differential role, e.g., retreats psychological adjustment, and the attentional procedures of at monasteries seems to be a good source of improvements meditation (e.g., FA and OM) would reduce the negative (Shaku et al., 2013; Montero-Marin et al., 2016). It would outcomes, as we proposed (hypothesis 2). However, we have be also necessary to consider that religious communities may also seen that the attentional practice of FA might improve differentially affect well-being depending on identity values, positive outcomes. This could especially be manifested by the such as sexual orientation (Hamblin and Gross, 2013), and length of sessions in that longer practice sessions would provide to differentiate “intrinsic” vs. “extrinsic” forms of religiosity greater benefits, which is aligned with our initial assumption – religion as an end in itself or as a means of obtaining that length of practice would have higher impact than the personal/social benefits, or to distinguish between atheists and other practice-related variables (hypothesis 3). However, the agnostics in the group of non-believers (Zuckerman et al., 2016). explanatory power of all these relationships, although significant, Finally, follow-ups would be interesting because the effects of was not very large, meaning that these results are a starting religiosity and meditation on psychological adjustment variables point. More research is needed to investigate possible benefits may vary over time. Despite all of these limitations, this study of other specific forms of religiosity, such as institutionalized has a number of strengths. For instance, the classification of ones, in addition to other types of meditation practices and meditation techniques was based on the most widely used other possible interactions with the practice-related variables. methods, while also being based on traditional sources. The Thus, new studies confirming these effects and their stability over variables used to estimate psychological adjustment covered a time are required. wide range of outcomes. Moreover, to our knowledge, this is It has been suggested that religiosity can be approached the first study to explore the relationships between religiosity for health providers inside healthcare systems in several and psychological adjustment, integrating the presence/absence ways, for instance, under a body-mind-spirit model based of religious beliefs – from both Christian and Buddhist traditions on an Eastern approach, with possible improvements in – and prayer and meditation practice-related variables as possible physical and mental health (Chan et al., 2001, 2006). A new sources of variation. proposal has currently been developed for going “back to the future” in Western medicine by means of religiosity (Cayley, 2015). Research and training in religiosity/spirituality practices CONCLUSION directed toward psychologists and mental health providers, should address and include the findings of these kinds of Religious belief status was not significantly related to studies in order to refine prescription through an evidence- psychological adjustment in the context of our study, and based approach. Frontiers in Psychology | www.frontiersin.org 10 March 2019 | Volume 10 | Article 630 Montero-Marin et al. Religiosity and Meditation Practice DATA AVAILABILITY in Primary Care (REDIAPP) grant from the Instituto de Salud Carlos III of the Spanish Ministry of Economy and In order to permit replication studies, data are available at Competitiveness, co-financed with European Union ERDF funds the following open access repository: http://doi.org/10.3886/ (RD16/0007/0005). The source of funding had no influence on E108603V1. the design of the study, data collection and analysis, or the writing of the manuscript. AUTHOR CONTRIBUTIONS JG-C, AC, MD, and JS contributed to the conception and ACKNOWLEDGMENTS design of the study. MP-Y organized the database. JM-M CIBERObn is an initiative of ISCIII. CIBERsam is an initiative performed the statistical analysis, wrote the first draft of ISCIII. We would like to thank Red de Investigación en of the manuscript and subsequent versions. All authors Actividades de Prevención y Promoción de la Salud (Research contributed to manuscript revision, and read and approved the Network on Preventative Activities and Health Promotion) submitted version. (REDIAPP-G06-170 and RD06/0018/0017), Red de Excelencia (Excellence Network) PROMOSAM (PSI2014-56303-REDT), FUNDING Dharamsala Institute of Mindfulness Psychotherapy of Zaragoza, Spain, and Mente Aberta Brazilian Center for Mindfulness and The project has received funding from DGA group (B17- Health Promotion of São Paulo, Brazil, for their support in the 17R) and the Network for Prevention and Health Promotion realization of this study. REFERENCES Cash, M., and Whittingham, K. (2010). What facets of mindfulness contribute to psychological well-being and depressive, anxious, and stress-related Athay, M. (2012). Satisfaction with life scale (SWLS) in caregivers of clinically- symptomatology? Mindfulness 1, 177–182. doi: 10.1007/s12671-010-0023-4 referred youth: psychometric properties and mediation analysis. Adm. Policy. Cayley, W. J. (2015). A proposal for getting "back to the future" of spirituality in Ment. Health 39, 41–50. doi: 10.1007/s10488-011-0390-8 medicine. Acad. 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Religiosity/spirituality and health. are credited and that the original publication in this journal is cited, in accordance A critical review of the evidence for biological pathways. Am. Psychol. 58, 53–63. with accepted academic practice. No use, distribution or reproduction is permitted doi: 10.1037/0003-066X.58.1.53 which does not comply with these terms. Frontiers in Psychology | www.frontiersin.org 13 March 2019 | Volume 10 | Article 630