Religion and Spirituality in Psychiatry

138 Harold G. Koenigagainst religion, which may conflict with culturalnorms).6.2. SupportDuring initial inquiry and throughout most ofthe treatment (certainly treatment with medicationsand in situations where therapy is purelysupportive), the psychiatrist should support thepatient’s religious beliefs. Such support dependson whether the patient’s religious beliefs are generallyhealthy, appear to be anxiety relieving, andespecially if there is a situational stressor that isdriving anxiety. Support should be shown in theway that the therapist makes inquiries about thereligious beliefs of the patient. Facial expression,tone of voice, body posture, head nodding, andverbal expressions of support should all be used.Being sincere is crucial, because the patient willquickly sense if sincerity is absent. The psychiatrist’srealization that much objective researchand logical sense dictates that religion can bea tremendous resource should help him or herconvey that sincerity to the patient.6.3. Using Beliefs in TherapyIf the patient is religious, if religious beliefs aregenerally healthy and nonobstructive to therapy,if the therapist is well informed about thepatient’s religious belief system, and if the therapisthas had training on how to address religiousor spiritual issues (that is, some kind of clinicalpastoral education), then he or she may considerusing the patient’s religious beliefs in the therapyitself. This is particularly true when doing supportive,cognitive-behavioral, or interpersonalpsychotherapy with patients who have anxietydisorders. This will be discussed below withina Judeo-Christian framework, about which thepresent author is familiar.6.4. SupportiveTh e purpose of supportive therapy is to provideemotional and social support to persons who aredealing with overwhelming real-life stressors.Anxiety symptoms themselves can be stressors(as the old saying goes, “There is nothing to fearbut fear itself ”). Although there is much withinJudeo-Christian beliefs that appears nonsupportive,such as teachings about hell, damnation,and devils, there are also many teachings that arepositive, uplifting, confidence building, and hopeconveying. Take for example the book of Psalms,which contains many scriptures that emphasizeGod’s love and nearness (Ps. 139), protection(Ps. 91), power to make a difference (Ps. 68), andreliability (Ps. 31). These may be used to help theanxious patient to feel reassured and more confident.Many scriptures emphasize the peace thatreligious beliefs provide (Isa. 59:19; John 14:27;Col. 3:15; Rom. 5:1; 2 Thess. 3:16), and describeways to achieve that peace (2 Cor. 13:11; 1 John4:18). If the patient has strong religious beliefs,then he or she may believe that the words ofscripture are words directly from God and may,therefore, receive those words as the ultimateauthority. The therapist may provide the patientwith a list of scriptures to meditate on or torepeat when facing situations that might arouseanxiety or fear.6.5. Cognitive-BehavioralMaladaptive cognitions that involve catastrophizingare common among persons with anxietydisorders. These negative thoughts, and the behaviorsassociated with them, create fear and anxiety.Cognitive-behavioral therapy (CBT) seeks tochallenge these exaggerated negative cognitionsand behaviors and replace them with more positiveways of thinking and behaving that are optimisticand realistic. For that reason, CBT is one ofthe most common treatments for anxiety disorders.A form of religious CBT has been developedthat relies on Biblical scriptures to challenge negativeself-talk, (36, 37) and this therapy has beenshown in at least one randomized clinical trial toachieve benefits equal to or superior to traditionalCBT in religious patients.(38) Positive supportivescriptures are used to counter negative thoughtsabout the self and the situations or surroundingsthat generate anxiety. For example, if the patient