Religion and Spirituality in Psychiatry

200 Harold G. Koenigverses of the Holy Koran specific to the person’ssituation. Patients receiving the religious psychotherapyimproved significantly faster than thosereceiving traditional therapy.Likewise, Razali and colleagues (20) testedthe effects of a Muslim-based religious cognitivepsychotherapy (RCP) as a treatment forGAD in eighty-five religious and eighty nonreligiousMuslims. Religious and nonreligious subjectswere randomized to either the interventiongroup or to a control group. All subjects receivedstandard treatment for GAD including benzodiazepines(BZD), supportive psychotherapy, and/or simple relaxation exercises. Patients in theintervention group received cognitive therapythat included use of the Koran and Hadith (sayingsof Mohammed) to alter negative thoughtsand behaviors and to increase religiousness. Eachof the four groups (religious subjects receivingRCP, religious controls, nonreligious subjectsreceiving RCP, and nonreligious controls) wasassessed at four, twelve, and twenty-six weeksafter the start of the intervention. Results indicatedthat religious subjects who received RCPimproved significantly faster than religious controls.However, no difference was found betweennonreligious patients receiving RCP and nonreligiouscontrols. This study suggests that religioustherapies work best in religious patients.Finally, Zhang and colleagues examined theeffects of Chinese Taoist-based cognitive psychotherapy(CTCP) in 143 Chinese patientswith GAD.(21) Subjects were randomized toCTCP only (n = 46), benzodiazepines only (BDZ)(n = 48), or combined CTCP and BDZ treatment(n = 49). CTCP combined cognitive therapy andTaoist philosophy (using the thirty-two characterTaoist formula). Those in the CTCP and combinedgroups received one hour of CTCP weeklyfor four weeks and then twice monthly one–hoursessions for the remaining five months. Subjectsreceiving BDZ remained on the same dose ofmedication for the final five months of the study.Results indicated that patients receiving BDZtreatment alone experienced the most rapidreduction in GAD symptoms, but that these beneficialeffects were gone by six months. CTCPalone had little effect on symptoms in the shortterm(at one month) when compared to BDZtherapy, but showed significant symptom reductionby six months. Combined treatment withboth CTCP and medication showed symptomreduction at both one and six months. The majorproblem with this study was that the design madeit impossible to determine whether the religiousaspect of the cognitive therapy had anything todo with the benefits observed (because a secularcognitive therapy group was not included in thestudy to compare with the CTCP group).Finally, there is some evidence that cognitivetherapy in patients with panic disorderworks better if the patient is more religious (seeChapter 10). Patients with strong religious beliefsdepend on religious scriptures for comfort, particularlythose scriptures promising that they areloved and never alone, and that there is nothingto fear, even death itself. These are powerful cognitionsthat can counteract anxious thoughts thatmay contribute to panic or other severe anxietysymptoms.I’m AfraidJanet is a 27-year-old unm arried schoolteacherwho lives with her parents. She hasrecently been diagnosed with a rare formof breast cancer and is undergoing chemotherapy.Janet was in the hospital gettingher weekly chemotherapy when she wokeup suddenly in a panic. Her sister Sally, whowas sitting across the room reading, immediatelycame to her bedside and asked whatwas wrong. Janet frantically told her, “I’mafraid I’m going to die. I can’t get my breathand my heart is jumping out of my chest.Am I dying? Please help me!” The patient’ssister rang the patient’s call bell to alert thenurse on duty and then reached over andgently took Janet’s hand. Sally said, “Janet,let’s pray.” When Janet nodded consent,Sally said a short comforting prayer askingGod to calm her sister’s nerves, giveher a deep sense of peace, and let her knowthat God loved her, was with her now, andwould never leave her. Gradually, Janet