Religion and Spirituality in Psychiatry

Integrating Spiritual Issues into Therapy 245one’s problems in religious or spiritual terms canbe a powerful alternative to a biological or psychologicalframework. Although reframing the issuein this manner may not change the reality of thesituation, but having a higher purpose may makea big difference in an individual’s willingness tobear pain, work hard, and make sacrifices. Giventhe fact that people with serious mental illnessesalready struggle against widespread prejudice anddiscrimination, it would seem important to maintainor strengthen people’s existing religious affiliationsand support systems as part of their treatmentor rehabilitation plan. (2)Furthermore, mental health practitioners willincreasingly be seeing clients who choose to viewtheir mental health problems through a traditional,non-Western lens. Although a significantmajority of Americans define themselves asChristians (76.5 percent), the percentage of theU.S. population that identifies itself with otherreligious and spiritual traditions is increasing. (6)Substantial increases are seen in the percentageof people identifying themselves as New Age(240 percent), Hindu (237 percent), Buddhist(170 percent), and Muslim (109 percent). TheChristian population showed only a smallincrease (5 percent), and the Jewish populationeven declined slightly (-10 percent). As a consequenceof this shift, many culturally based“alternative” treatments are widely accepted asbeneficial, including prayer and faith healing.1.3. The Voice of Persons Sufferingfrom Mental IllnessMany individuals with psychiatric disabilitiesview spiritual activities as an integral part of theirrecovery process. They have consistently indicatedthat religion and spirituality can serve asa major resource in recovery. (5, 7–14) Lindgrenand Coursey (15) interviewed participants in apsychosocial rehabilitation program: 80 percentsaid that religion and spirituality had been helpfulto them. Trepper et al. (11) found that participantsexperiencing greater symptom severityand lower overall functioning are more likely touse religious activities as part of their coping.Symptom-related stress leads to greater use ofreligious coping, a phenomenon that has beenshown in other studies too.( 16 , 17 ) Baetz et al.(18) demonstrated among psychiatric inpatientsthat both public religion (for example, worshipattendance) and private spirituality were associatedwith less severe depressive symptoms.Religious patients also had shorter lengths ofstay in the hospital and higher life satisfaction.Koenig, George, and Peterson (19) followedmedically ill older persons who were diagnosedwith a depressive disorder and found that intrinsicreligiosity (following religion as an “end initself,” rather than as a means to other end) waspredictive of shorter time to remission of depressivedisorder, after controlling for multiple otherpredictors of remission. Pargament ( 20 , 21 ) hasstudied extensively the role of religious copingmethods in dealing with stress. He found consistentconnections between positive styles of religiouscoping and better mental health outcomes.Religious coping styles such as perceived collaborationwith God, seeking spiritual support fromGod or religious communities, and benevolentreligious appraisal of negative situations havebeen related to less depression,( 19) less anxiety,( 22) and more positive affect. (23)1.4. Religious and Nonreligious TherapistsCan nonreligious therapists deliver religious therapyfor religious patients, and if yes, how effectiveare they? Is religious therapy per se more effectivefor religious patients than nonreligious therapy?To answer these questions, Rebecca Probstfrom the Department of Counseling Psychology,Portland, Oregon, conducted a comparative studyof the efficacy of religious and non-religiouscognitive-behavioral therapy with religious andnonreligious therapists on religious patients withclinical depression. (24) She hypothesized that religiouscognitive-behavioral therapy (RCT) mightbe more effective for religious patients than standardcognitive-behavioral therapy (CBT) becauseof higher consistency of values and frameworks.