The role of religion and spirituality in emotional well-being and treating mental illness dedicated to memory of Elizabe

1. The role of religion and spiritualityin emotional well-being and treating mental illnessdedicated to memory of Elizabeth Targ M.D. Colorado Integrative Medicine Conference July, 2009 James Lake M.D. www.IntegrativeMentalHealth.net

5. Religion, spirituality and mental health • The “gap” between physicians and patients • Religion and mental health—overview • The role of religious or spiritual beliefs in maintaining good mental health • The role of religious beliefs in “treating” specific psychiatric disorders • Prayer, directed intention and mental health • Taking a religious and spiritual history

6. Definitions • Religious involvement: shared experiences of religious affiliation and practice • Spirituality: individual experiences or beliefs outside organized social settings

7. Existential “gap” between clinicians and patients • ¾ of patients believe religious or spiritual beliefs directly related to health problems • 15% of M.D.s and R.N.s ask about beliefs (King 1994) • 92% of family M.D.s comfortable asking patients about beliefs • 37% of family M.D.s pray with patients; 90% believe praying with patients has beneficial effects on specific medical problem

8. Religious and spiritual beliefs What M.D.s believe

9. Patients want M.D.s to ask about beliefs • 2/3 patients in large multi-center study wanted M.D.s to ask about beliefs • 10% willing to give up time discussing medical issues to discuss spiritual beliefs (MacLean 2003) • Patients want to share spiritual beliefs only if they think M.D.s respect their values (Hebert 2001)

10. Physicians’ beliefs • Vary by geographic region and specialty • 80% family M.D.s disclose religious beliefs to patients (Daaleman 1999) • Only 25% of psychiatrists believe in God—92% of these inquire about patients’ beliefs (Neeleman 1993)

11. Slowly changing attitudes and practices • Only 2% of studies published in peer-reviewed psychiatric literature include religious variable (Larson 1986) • Discussions of religious and spiritual beliefs seldom included in training (Puchalski 1998)

13. Religion, spirituality and mental health Historical context

14. Religion and mental health—hx context • Roles of healers and priests have overlapped since beginning of recorded history • 4 centuries ago major World systems of medicine attributed mental illness to supernatural forces or humoralimbalances and treatments included magical incantations and prayers • Priests and other spiritual adepts were healers; gifted healers became priests or shamans

15. Evolution of mental health care • Mid-16th century De PraestigiisDaemonum…(“On the Illusions of the Demons and on Spells and Poisons” first scholarly work distinguishing madness from demon possession • Early 17th century Robert Burton’s The Anatomy of Melancholy, described natural and supernatural causes of serious mental illnesses • Early 18th through 19th century Quakers spear-headed humanitarian reforms in care for incurably insane

16. Changing attitudes • 19th century reforms of Benjamin Rush motivated by strong Christian beliefs • Early 20th century, Freud dismissed religious beliefs as pathology or shared delusions—dominant framework until mid-20th century • Biological models widely accepted as sufficient explanations of mental illness • Early beliefs and practices as relevant data

17. Religion, spirituality and mental health Defining the context

19. Role of religious or spiritual beliefs in mental health • Most studies examine general relationships between group religious practices and mental health • Relationships between mental health and spirituality have eluded analysis because intrinsically subjective (Thoresen 2002)

20. Protective effects of religious beliefs • Various social, behavioral and psychological models • Religious involvement promotes optimism, increases resilience (Taylor 1989) • Religious or spiritual values correlated with good physical and mental health, beneficial life style choices, including exercise, diet and moderate alcohol use (Baetz and Toews 2009)

21. Improved “well being” • Regular involvement in religious activities improves general emotional well-being (Mohr 2006) by • providing supportive network during stressful periods • offering coherence or meaning to enhance coping • improving self-confidence • Benefits of religious involvement achieved through regular contact with supportive group in safe encouraging environment

22. Causal relationships difficult to establish • Poorly defined relationships between religious experience and • Personality • Intelligence • social and economic variables • Preclude inferences of causal relationships between specific mental health problems and religiosity

23. Research on religion, spirituality and mental health Promising preliminary findings

24. Renewed research interest in prayer • Recent studies support legitimacy of prayer in: • maintaining good mental health • treating certain mental illnesses • Preliminary findings invite novel theories of prayer and distant human intention in health and healing

25. Influences of religious or spiritual beliefs on specific psychiatric disorders • Difficult to make strong arguments for direct beneficial effects of a religious or spiritual practice on particular psychiatric disorders (Blazer 2009): • Most data from epidemiologic surveys or retrospective analyses • Different prevalence rates of specific D.O.s in disparate religious

26. Religious beliefs and mental health • Most studies examine relationships between general beliefs (i.e. “religiosity”) and broad measures of emotional well-being • Meta-analysis of 89 studies found regular involvement in organized religious activity associated with reduced risk of depressed mood (Koenig 2009)

27. More sophisticated studies • Recent studies use factor analysis to deconstruct religiosity into discrete dimensions • A survey of 3000 adolescent girls identified two dimensions of religiosity—personal devotion and participation–correlated with moderately reduced risk of depression (Miller 2002)

28. Deconstructing “religiosity” into factors • Survey used in-person interviews with over 1000 pairs of adult twins to clarify associations between specific factors of religiosity and specific psychiatric disorders (Kendler 2003)

29. Deconstructing religiosity • 7 important factors identified: • general religiosity • social religiosity • involved God • Forgiveness • God as judge • Un-vengefulness • Thankfulness

30. Certain factors reduce risk • Social religiosity and thankfulness reduce risk for substance abuse, anti-social behavior, major depressive disorder, generalized anxiety disorder, panic disorder and bulimia • Findings limited by study design; cannot infer causal roles of discrete factors in specific psychiatric disorders

32. Religiosity and depressed mood Review of research evidence

33. Religious affiliation and risk of depressed mood • Review of 80 published and unpublished studies found organized religious affiliation decreased risk of depressed mood (McCullough 1999) • Survey of elderly men (N=832) with medical problems found cognitive but not somatic sx of depression less severe in pts who use religious coping (Koenig 2009)

34. Religious affiliation or beliefs reduce sx severity • Elderly depressed engaged in organized religious activity have fewer and less severe sx and lower suicide risk (Koenig 1997) • Depressed medically hospitalized elderly with strong religious beliefs significantly more likely to have complete remission (unrelated to participation in religious practices) (Koenig 1998)

35. Religiosity and other psychiatric disorders Review of research evidence

36. Religious beliefs in bipolar disorder and anxiety disorders • Large survey found religious beliefs associated with improved self-management of bipolar disorder (Mitchell 2003) • NIMH ECA survey (N=2,969) found weekly religious services significantly lowers sxseverity in agoraphobia, GAD, social phobia and OCD in younger individuals with strong religious beliefs (Koenig 1993; 2009)

37. Religion and schizophrenia • Religious beliefs and practices important source of encouragement, social support and insight in schizophrenia (Sullivan 1993) • Support groups built around shared spiritual themes improve self-esteem, quality of life and community involvement (Sageman 2004)

38. Religion and substance abuse • Alcohol and drug abuse rates lower with organized religious practices (Koenig 2009) • Feelings of deep personal devotion correlate with reduced risk of substance abuse and dependence (Miller 2000) • 12-Step programs based on religious and spiritual values have a strong record of success in prolonging abstinence (Carroll 1993)

39. The role of prayer in mental health Beliefs and theories

41. Prayer in health—attitudes and practices • Large population survey: over 80% believe prayer helps recovery from all forms of illness (Sloan 1999) • Large national survey: ½ pts want to share in prayer with their physicians (Yankelovich 1996) • But…only 11% of individuals who pray to improve health disclose to M.D.s • M.D.s with strong religious beliefs often pray alone for patients (Olive 1995)

42. Office of Prayer Research • Growing scientific interest in prayer led to Office of Prayer Research at 2004 Parliament of World Religions—a think-tank on prayer • Mission includes: • “give men and women of science and spirituality a place to go to pursue possibilities together” • advance scientific research on effects of prayer; provide conduit for exchange of information

43. Prayer in mental health • Over 60 % of severely depressed or anxious individuals pray for improved mental health; 1/3 believe prayer very helpful • 10% self-Rx mental health problem using prayer saw psychiatrist or family M.D. previous year

44. The neurophysiology of prayer • Serotonin hypothesis proposed to explain differences in capacity for transcendent spiritual experiences (Borg 2003) • PET and SPECT studies show high serotonin receptor binding correlates with greater capacity for “self-transcendence” (D’Aquili 1993; 2003)

45. Spiritual continuum model • Spiritual continuum model proposed to explain mystical and religious experiences (D’Aquili and Newberg 1993; 2000) • Capacity for spiritual experiences embedded in neural connections between limbic system and neocortex that confer evolutionary advantages on humans

46. Spiritual continuum model • Individual or group prayer, meditation, and other forms contemplation are unitive experiences with common experiential and neurophysiological features • Kind and intensity of spiritual experience determined by brain regions involved and degree of shared activity between them

48. Research on prayer and other forms of non-local healing intention Inconsistent findings and methodological limitations

49. Two forms of prayer • “Prayer:” patient requests loved one or traditional healer for healing intention to improve health problem • “Intercessory prayer:” patient asks loved one or traditional healer to pray for God to intercedeto improve health problem

50. Research on non-local healing intention • Non-local healing approaches: intercessory prayer, QiGongand Reiki • Findings on prayer and other distant healing intention highly inconsistent • Systematic review of 21 studies on distant healing identified 12 studies with adequate designs showing consistent significant beneficial effects on humans, animals and microorganisms (Benor2001)