Religion and Spirituality in Psychiatry

Integrating Spiritual Issues into Therapy 247EXTENDED BIO PSYCHO SOCIAL MODELReligion SpiritualityPsychology of ReligionSociology of ReligionPsycho-SocialBio-“Biology of Religion”Figure 17.2. Extended bio-psycho-social model integrating religion/spirituality as a fourthdimension (published by Hefti R, 2003).enhanced by integrating religious elements intothe therapy protocol and that this can be successfullydone by religious and nonreligious therapistsalike.2. A HOLISTIC AND INTERDISCIPLINARYMODEL FOR THERAPY2.1. The Extended Bio-Psycho-SocialModelIn psychiatry and psychosomatic medicine, thebio-psycho-social model, introduced by George L.Engel (27) is the predominant concept in clinicalpractice and research. It shows that biological,psychological, and social factors interact in a complexway in health and disease. Our book illustratesthat there is a fourth dimension involved.Religion and spirituality constitute an additional,distinct, and independent dimension, interactingwith biological, psychological, and social factors.I have called this model the extended bio-psychosocialmodel (Figure 17.2 ).(28)Th e extended bio-psycho-social model is auseful framework to understand the religiousand spiritual dimension in clinical practiceas well as in religion, spirituality, and healthresearch. It shows that religion and spiritualitycan be causing, mediating, or moderating factorson mental health and disease in the sameway as biological, psychological, and social factors,constituting biology of religion, psychologyof religion, and sociology of religion. Themodel illustrates that pharmacotherapeutic,psychotherapeutic, sociotherapeutic, and spiritualelements must be integrated in a holisticperspective, thus establishing a whole-personapproach to mental health.2.2. Religion and Spirituality as a MainResourceIn general, people who are more religiously orspiritually devout report better physical health,psychological adjustment, and lower rates ofproblematic social behavior. (29–32) Spiritualitystrengthens a sense of self and self-esteem,( 5 , 10 , 33) of feeling more like a “whole person,”and of being valued by the divine (as part of creation,as a “child of God”), countering stigma andshame by positive self-attributions and, throughall of this, reinforcing “personhood.”( 34)Spirituality is associated with decreased levelsof depression,( 35) especially among people with