Religion and Spirituality in Psychiatry

130 Harold G. Koenigwhich helped to explain the relationship betweenreligiosity and trait anxiety, this could not accountfor the relationship with state anxiety. In a secondcross-sectional study, Wollin and colleagues examinedchildren just prior undergoing general anesthesia.They found that children with the greatestanxiety were those whose mothers did not practicea religion. (16) At least two prospective studies havefound that anxiety symptoms decreased in personsfollowing religious conversion or rededication toreligion, (17, 18) and one recent study found thatpatients with panic disorder who reported religionas very important to them recovered more quicklyin response to traditional cognitive-behavioraltherapy.(19) Finally, two randomized clinical trialsin patients with generalized anxiety disorder(GAD) reported that religious interventions addedto secular treatments resulted in faster improvementof symptoms compared to secular interventionsalone.(20, 21)3. RELIGION AND SPECIFIC ANXIETYDISORDERSI now review these studies in greater detail sothat psychiatrists can have a better sense of whatexactly was examined and what was found.3.1. Generalized Anxiety DisorderPatients are diagnosed with a generalized anxietydisorder (GAD) when they have a long historyof worrying about many things, both minor andmajor, and these worries cause dysfunction intheir daily lives. Religious interventions appearto be effective in this type of anxiety disorderbased on the following three randomized controlledtrials.First, Azhar and colleagues randomized sixtytwoMuslim subjects to traditional treatment(supportive psychotherapy plus anti-anxietydrugs) or traditional treatment plus religiouspractices, such as prayer and reading verses fromthe Holy Koran.(20) Those who received therapysupplemented with religious practices improvedsignificantly faster than those receiving traditionaltherapy.Second, Razali and colleagues examined theeffects of Muslim-based cognitive-behavioraltherapy (CBT) on anxiety symptoms in a study inwhich they randomized eighty-five religious andeighty nonreligious Muslims with GAD to eitherstandard treatment (benzodiazepines, supportivepsychotherapy, and simple relaxation exercises)or standard treatment plus use of the Koran andHadith (sayings of Mohammed) to alter negativethoughts and behaviors and increase religiousness.(21)Religious subjects receiving thereligious CBT recovered significantly faster thanreligious subjects receiving standard treatmentalone; however, religious CBT had no impact innonreligious subjects.Finally, Zhang and colleagues examinedthe effects of Chinese Taoist cognitive therapy(CT) in 143 Chinese patients with GAD whowere randomized to Taoist CT, benzodiazepines(BDZ) only, or combined Taoist CT and BDZtreatment.(22) Subjects receiving BDZ treatmentalone experienced a rapid reduction in GADsymptoms by one month, but these benefits weregone by six months of follow-up. Those receivingTaoist CT alone had little improvement insymptoms at one-month follow-up, but showedsignificant symptom reduction by six months.Those in the group receiving both Taoist CT andBDZ experienced significant symptom reductionat both one- and six-month follow-ups. However,there was no way to determine whether there wasanything therapeutic about the religious aspects(Taoist) of CT or whether improvements weresimply due to the nonreligious aspects of CT.3.2. Panic DisorderPanic disorder (PD) involves brief but recurrentfeelings of extreme fear associated with physicalsymptoms such as rapid heart rate, difficultybreathing, and fear of dying. In some cases, panicdisorder may be associated with agoraphobiaor fear of the “market place” (open spaces orcrowds). Such patients may be literally imprisonedin their homes, fearful that if they go outinto the open where others congregate, they willexperience panic and not be able to escape. This