Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 199situation that seemed to be without escape,she developed suicidal thoughts and tookan overdose of pain medications. Luckily,she was found in time by a neighbor andrushed to the hospital, where she was successfullytreated for the overdose. ThereSherry was referred to a psychiatrist whobegan her on antidepressant medication.In four weeks, she was back to work andfeeling more like herself again. She foundanother church and became an activemember there.6. ANXIETY IN MEDICAL SETTINGSAlthough this topic is covered more fully inChapter 10, I address anxiety disorders here inthe context of medical illness, where CL psychiatristsare likely to be called on for assistance.Patients may have a variety of worries and fearswhen they are hospitalized with medical illness.Loss of control and feelings of helplessness driveanxiety in this setting. Patients are fearful of whattheir medical illness may mean for their ownfuture and the future of their families. They maybe worried about the results of lab tests or procedures.Some patients may become anxious afterbeing told about a disabling or terminal diagnosis.In some cases, the anxiety may become paralyzing,especially if patients have a history ofanxiety problems in the past.Religious beliefs may influence the type andthe severity of anxiety that patients experience.On the one hand, religious worries may centeron concerns about salvation, fear of hell, or guiltover becoming sick. Such patients may becomepreoccupied with religious worries or becomeinvolved in a frenzy of religious behaviors suchas compulsive prayer activity or repeated confessions.These behaviors may extend beyond “normal”kinds of religious involvement and becomepathological in nature.On the other hand, religious beliefs mayhelp medical patients cope with the anxietydue to medical illness, or if an anxiety disorderis present, help patients cope with the painand suffering that the anxiety causes. Religiousbeliefs and practices can give patients a sense ofcontrol over what is happening to them. Prayergives patients something they can do, which mayhelp to make a real difference in their situations.Patients may believe that prayer will physicallyheal their illness or give them the strength tocope with illness. The effectiveness of prayer inrelieving anxiety depends on the strength of thepatient’s religious belief, the specific kinds of religiousbeliefs as they relate to healing, and the useof prayer in the past as a coping behavior.Meditation may also help to relieve anxiety,although through a different mechanism thanthe kind of personal prayer described above.Personal prayer depends on the patient’s relationshipwith God and is heavily dependent oncognitive processes (for example, belief, commitment,and trust). Meditation in the Easternreligious traditions of Hinduism (transcendentalmeditation) or Buddhism (mindfulness meditation),however, involves more of a behavioralmechanism. The clearing of the mind and a repetitionof a sound, word, or phrase while sittingin a certain position, causes reflex relaxation –almost like biofeedback or progressive musclerelaxation – and if done consistently, can reduceanxiety or tension. This kind of meditation doesnot depend on a strong belief in, personal relationshipwith, or communication with God,but rather on a practice that involves a specificspiritual behavior that through physical proceduresresults in a deep, relaxed state. HerbertBenson has called this bio-behavioral reflex theRelaxation Response.(18)A number of randomized clinical trials haveshown that religious-based psychotherapy or psychotherapysupplemented by religious practices,may increase the speed of remission of anxiety,especially generalized anxiety disorder (GAD),which is common in medical settings. For example,Azhar and colleagues (19) randomizedsixty-two Muslim patients with GAD to eithertraditional treatment (supportive psychotherapyand anti-anxiety drugs) or traditional treatmentplus religious psychotherapy. Religious psychotherapyinvolved use of prayer and reading