Religion and Spirituality in Psychiatry

Religion, Spirituality, and Anxiety Disorders 131disorder is very disabling both because of thepsychological anguish that it causes during anattack and because people restrict their lives toavoid recurrence of symptoms.Religious involvement may help to relievepanic symptoms, particularly when accompaniedby traditional psychotherapy. For example,Bowen and colleagues in Saskatchewan, Canada,explored coping and motivation factors relatedto treatment response in fifty-six patients withPD participating in a psychotherapy clinicaltrial.(19) Subjects were treated with group CBT,and then were followed for up to twelve monthsafter the baseline evaluation. Self-rated importanceof religion was a significant predictor ofimprovement in panic symptoms and reducedperceived stress at the twelve-month follow-up.Investigators concluded that high importanceof religion reduced PD symptoms by decreasinglevels of perceived stress.3.3. Post-Traumatic Stress DisorderReligion is a source of coping for many personssuffering from severe trauma. Post-traumaticstress disorder (PTSD) results when people cannotpsychologically integrate a traumatic experience,allowing it to continue to overwhelm them.These persons’ worldviews have been so shakenby the traumatic event that the world no longerappears predictable or controllable. This resultsin a paralyzing type of anxiety whenever anythingreminds them of the traumatic event. When religiousworldview is affected and faith is weakenedor lost (that is, spiritual injury), PTSD symptomsmay be particularly persistent and unresponsiveto therapy. For example, consider a studyof 1,385 veterans from Vietnam (95 percent),World War II and/or Korea (5 percent) involvedin outpatient or inpatient PTSD programs.(23) In this study, conducted by the VeteransAdministration (VA) National Center for PTSDand Yale University School of Medicine, investigatorsfound that a weakened religious faith wasan independent predictor of use of VA mentalhealth services. This effect was independent of(and stronger than) severity of PTSD symptomsor level of social functioning. Investigators concludedthat the use of mental health services wasdriven more by a weakened religious faith thanby clinical symptoms or by social factors.3.4. Obsessive-Compulsive DisorderSteketee and colleagues examined the relationshipbetween religiosity and obsessive- compulsive disorder(OCD) symptoms in thirty-three patientswith OCD and twenty-four patients with otheranxiety disorders.(24) Although they reportedthat religiosity was significantly correlated withseverity of OCD symptoms, they found no relationshipbetween religiosity and general anxiety,social anxiety, or depressive symptoms, suggestingspecificity for the relationship betweenreligion and severity of OCD symptoms withinpatients with OCD. They did not, however, finda difference in degree of religiosity between thepatients with OCD and the patients with otheranxiety disorders. All associations were crosssectional, so it is not possible to say whetherreligiosity led to greater OCD symptoms inOCD patients or whether OCD symptoms ledto greater religiosity. Furthermore, again no relationshipwas found between OCD (as a disorder)and religiosity.More recent research has also failed to findevidence to link religiousness to OCD as a disorder.For example, investigators in Tel Aviv, Israel,compared religiosity between twenty-two OCDpatients, twenty-two panic disorder patients, andtwenty-two normal controls undergoing surgery,matching these groups by age and gender.(25)No difference in religiosity was found betweenthese groups on any of the five measures used toassess religiosity, except that patients with panicdisorder scored significantly lower on religiositythan did surgery controls. Other studies of OCDpatients from a variety of religious backgroundshave likewise found no relationship between religiousnessand OCD as a disorder.(26–28)In fact, there may be a bias that favorsthe detection of OCD symptoms in religiouspersons. (29) OCD symptoms scales appear to becontaminated with questions that traditionally