Existential groups run by healthcare chaplains within mental healthcare have a long tradition in Norway. By using a national cross-sectional survey design, this study explored and described both quantitatively and qualitatively these groups' characteristics. Quantitative data were analysed by descriptive statistics and content analysis inspired by Graneheim and Lundman was used to analyse the qualitative data. The current existential group practice was present in 11 of 25 Norwegian health authorities and across service levels. Five different group approaches, all addressing patients' existential, spiritual and religious needs and issues, were identified and described. The existential groups were in general eclectic and applied a variety of therapeutic strategies representing group psychotherapy, existential therapy and clinical pastoral care. The findings suggest that this Norwegian existential group practice can be regarded as a wellestablished and integrated part of the Norwegian mental healthcare. Researchers are challenged to further qualitatively explore this Norwegian existential group practice.ARTICLE HISTORY

Research has shown that addressing and integrating the existential dimension in treatment settings reduce symptoms like anxiety, depression and substance abuse. Healthcare chaplains are key personnel in this practice. A nationwide, cross-sectional survey influenced by a mixed-methods approach was used to examine the attitudes, practices, understanding and perceptions of mental health professionals, including healthcare chaplains, regarding the value of addressing the existential dimension in treatment programmes. The existential group practice was led by the healthcare chaplains as an integrated part of specialist mental health services. A positive and open attitude towards addressing the existential dimension was identified among the informants. Despite this, a small gap between attitude and practice was reported. Existential, religious and spiritual concerns are reported as part of the existential dimension and as relevant topics to be discussed in specialist mental health services. The findings indicate that the existential group practice could have a positive influence on the co-leaders’ competence to address existential, religious and spiritual concerns; however, this should be further investigated.

Spirituality groups led by healthcare chaplains have been found to aid patients' recovery processes in US psychiatric units. In Norway, existential groups (EGs) led by healthcare chaplains and co-led by healthcare staff members are offered at psychiatric units; these groups share commonalities with spirituality groups, group psychotherapy, existential therapy and clinical pastoral care, facilitating patients' reflections regarding existential, spiritual and religious issues. The study aimed to examine associations between patients' participation and topics discussed in the EGs and their experiences of psychological distress, crisis of meaning and meaningfulness. A crosssectional design was applied among 157 patients attending EGs led by healthcare chaplains across Norway. Multivariate regression analyses assessed the strength of possible associations, adjusted for relevant demographical variables. Significant association was found between lengthier EG participation and lower levels of psychological distress, while discussion topics concerning religious and spiritual issues were significantly associated with the experience of meaningfulness.

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