Religion and Spirituality in Psychiatry

Religion, Spirituality, and Anxiety Disorders 139routinely thinks that he or she is in danger, out ofcontrol, or dwells on disasters that might happen,then this patient would be instructed to modifyhis or her thinking so it will be more consistentwith what Biblical scriptures are saying.In fact, scriptures instruct people to dwell onthe positive, not the negative: “Finally, brethren,whatsoever things are true, whatsoever thingsare honorable, whatsoever things are just, whatsoeverthings are pure, whatsoever things arelovely, whatsoever things are of good report; ifthere be any virtue, and if there be any praise,think on these things [emphasis added]” (Phil.4:8). * For religious patients with anxiety disorders,then, the following scriptures may be usedto alter negative thinking. These represent promisesby God to his people:■■■■■■“Do not be anxious about anything, but ineverything, by prayer and petition, withthanksgiving, present your requests to God”(Phil. 4:6).“Do not be afraid; you will not suffer shame.Do not fear disgrace; you will not be humiliated.You will forget the shame of your youthand remember no more the reproach of yourwidowhood” (Isa. 54:4).“You will not fear the terror of night, nor thearrow that flies by day, nor the pestilence thatstalks in the darkness, nor the plague thatdestroys at midday. A thousand may fall atyour side, ten thousand at your right hand,but it will not come near you” (Ps. 91:6–7).“I will not fear the tens of thousands drawn upagainst me on every side” (Ps. 3:6).“God is our refuge and strength, an everpresenthelp in trouble. Therefore we will notfear, though the earth give way and the mountainsfall into the heart of the sea, thoughits waters roar and foam and the mountainsquake with their surging” (Ps. 46:1–3).“Do not fear, O Jacob my servant; do not bedismayed, O Israel. I will surely save you out* Scripture verses taken from the Holy Bible, NewInternational Version. Copyright © 1973, 1978, 1984,International Bible Society.■■of a distant place, your descendants from theland of their exile. Jacob will again have peaceand security, and no one will make him afraid”(Jer. 46:27).“So do not fear, for I am with you; do not bedismayed, for I am your God. I will strengthenyou and help you; I will uphold you with myrighteous right hand” (Isa. 41:10).“For I am the Lord, your God, who takes holdof your right hand and says to you, Do notfear; I will help you” (Isa. 41:13).Although the scriptures above are from theJudeo-Christian Bible, other world religionshave similar teachings that build confidence andmay calm the anxious person. Recall that bothMuslim and Buddhist (Tao) forms of CBT foranxiety disorders exist and have been studied inclinical trials.(21, 22) The type of religious CBTchosen, of course, should match the religion ofthe patient.Furthermore, the particular cultural environmentmay influence whether or not thepsychiatrist uses religious scriptures to combatdysfunctional cognitions. For example, whilereligious CBT may be perfectly acceptable in theUnited States, South America, the Middle East,Africa, and other religious areas of the world, inmore secular areas (such as found in some countriesof Europe), it may meet with resistance frompatients and peers. Regardless of cultural context,as mentioned earlier, a spiritual history is alwaysrequired to determine whether patients might bereceptive to such an approach.6.6. InterpersonalSome experts view the experience of interpersonalloss and disordered attachment as theunderlying causes for much of human psychopathology.Interpersonal psychotherapy (IPT)is a method of addressing these issues within atherapeutic framework.(39) Patients with anxietydisorders often have problems with attachmentrooted in their early developmental experiencesand relationships with parents. Religious IPTmay facilitate healing of these early relationships