Trauma Survivors' Spiritual Struggles and the Anger of Hope: A Practice-Based Clinical Study Examining Links With Mental Health Symptoms and Well-Being

In addition to psychological distress, trauma survivors often grapple with religious/spiritual (R/S) struggles, which can compromise well-being and limit possibilities for flourishing. This practice-based clinical study of psychotherapy clients (N = 349) in a community mental health clinic compares clients reporting histories of trauma (n = 149) with a general clinical subsample (n = 200), exploring the interplay between R/S struggles and anger with symptom distress and well-being outcomes. Trauma survivors reported significantly higher levels of anger and both interpersonal and moral R/S struggles than other clients, reinforcing the need for careful attention to these domains in trauma-focused psychotherapy. Regression analyses revealed that anger accounted for unique variance in predicting R/S struggles with meaning, even after controlling for posttraumatic stress and depression, indicating the importance of understanding the complex functions of trauma-related affects (e.g., anger, shame) and formulating working through such emotion as closely linked with R/S struggles. Regressions also found evidence that-over and above mental health symptomology-R/S struggles accounted for unique variance in predicting survivors' sense of compromised well-being and limited flourishing, orienting therapists to the centrality of R/S struggles as a driving, but oft-neglected, force that may impede recovery. Limitations, future directions, and best practices for integrating R/S in trauma-focused psychotherapies are discussed.