The Qur’aanic Psychotherapy in OCD

1. The Qur’aanic Psychotherapy in OCD Dr Aziz Ahmed Quadri Professor of Psychiatry Director of Mental Health Center Padegaon, Aurangabad, M.S. India E-mail: merajquadri@hotmail.com www.mentalhealthcenterindia.com

3. MENTAL HEALTH CENTER Aurangabad, Maharashtra, INDIA.

4. Noble Qur’aan and Psychotherapy

5. The past decade has seen a growing demand for health professionals to take better account of patient’s religious belief and establish link with faith based organization as partners in health and welfare science. (Mental Health Foundation National Institute for mental health England, 2003). RELIGIOUS BELIEFSAND FAITH HEALING

6. RELIGION AND PSYCHIATRYSHARE SAME CONCERN • However although psychiatry and religion share similar concerns their relationship has seldom been harmonious with, perhaps just cause for suspicion on both side.

7. DIALOGUE • There is need for dialogue and mutual understanding.

8. U.S.A. NATIONALCOMORBIDITY SURVEY • In the U.S.A. analysis of the national co-morbidity surveys conducted in the 1990 revealed continuing use of the clergy alone and alongside professional and alternative practitioner for mental health problem (Wang et.al.2003).

9. PREFERENCE TO FAITH HEALERS • It is clear that faith based organizations and their clergy are contacted by people with mental health problems often in preference to consulting psychiatric professionals. • Broadly speaking healing has been observed as a central function of most religions and some people look to religion as a means of understanding suffering and as a beneficial way of coping with it.

10. BIOLOGICAL CAUSE NOT NEGLECTED • While giving psychotherapy we do not deny the biological causation of disease. Keeping in mind the biological causation, emphasis is laid on reducing severity of symptoms through psychotherapy while treating the biological cause of disease.

11. Islaamic Faith • A Muslim or Muslimah is supposed to believe in Allaah. He has to submit his will to the will of Allaah. • He is supposed to do all that Allaahdesires and refrain from all that Allaahforbids.

12. LIFE OF PROPHET [PBUH] • The personality of a Muslim is guided by the Holy Quran and, life history of Prophet Muhammad (Seerat) [salAllahualayhiwasallam]. • It is an ideal for every Muslim. A Muslim cannot take guidance in his personal matters from any other source which is not in light of Holy Quran and Hadith.

13. Masjid – E- Nabvi (Madina)

14. Knowledge is must for Muslim • It is obligatory for a Muslim to have knowledge of the Quran, which one acquires through behavior of elders in the family, religious scholars, reading and understanding the Holy Quran.

15. All Problems in Counseling are Guided in the Holy Qur’an. • In my 38 years of dealing with psychiatric patients I have found that in dealing with the psychological problems of a Muslim, be it counseling or any form of psychotherapy it has to be in the light of Holy Quran for it to be more effective and more acceptable. • I did not find any area which is covered in any standard text book of psychiatry that isn’t guided by Holy Quran and Sunnah of Prophet Mohammed [salAllahualayhiwasallam].

16. UNDERSTANDINGTHE NOBLE QURAN • اقْرَأْ بِاسْمِ رَبِّكَ الَّذِي خَلَقَ • Understanding of counseling and psychotherapy in the light of Holy Quran will encompass understanding of Holy Quran and Sunnah as applied to different life problems.

17. What is Psychotherapy? • Psychotherapy, or personal counseling with a psychotherapist, is an intentional interpersonal relationship used by trained psychotherapists to aid a client or patient in problems of living. • It is talking therapy and aims to increase the individual’s sense of their own well being. • Psychotherapists employ range of techniques based on experiential relationship building, dialogue, communication & behavior change that are designed to improve mental health of a client or patient, or to improve group relationships (such as in a family).

18. Different types of Psychotherapies • Individual psychotherapy, • Personal psychotherapy, • Dialectical psychotherapy, • Family therapy, • Couple therapy, • Marital therapy, • Cognitive therapy , • Supportive therapy, • Some aspects of analytical therapy, • Behavior therapy, etc. all should be guided by the Holy Quran.

19. Who can do Quraanic Psychotherapy? • One who has adequate knowledge of Islam, Quraan and Psychiatry. • Therapist should be psychological-minded. • He may or may not be a Muslim.

20. Different Psychiatric Disorders • Anxiety Disorders • PTSD ( Post Traumatic Stress Disorders) • Phobias • OCD (Obsessive Compulsive Disorders) • Conversion Disorders • Dissociative Disorders • Personality Disorders • Psychotic Disorders • Bipolar Mood Disorders • Addictions • Childhood problems • Dementia • Mental retardation and learning disability • Geriatric Problems

21. Brief case discussion Two cases of Quranic Psychotherapy will be discussed in brief.

22. CASE 1 A 45 year old Muslim lady came with complaint of recurrent thoughts and feeling of committing sins for last 6 yrs. She was apparently alright 6 yrs back when she developed an intense feeling that she had committed sins in her life. The same thought ruminated in her mind all day and she was not able to concentrate on anything; leading to a disturbed family, personal & social life. Though she was a religious scholar, she visited faith-healers for this problem. Disappointed, she later saw a psychiatrist who put her on antidepressant medication. She reported 40-50% relief from her symptoms, but never recovered completely. The psychiatrist re-assessed the patient and this time also she reported that she has committed a sin & she will go to hell. The psychiatrist started CBT & tried to correct her thought. Even with repeated sessions, patient remained distressed because of the same thought, On the contrary her distress increased during CBT sessions.

23. Cognitive Behavior Therapy The psychiatrist decided to give her CBT. The therapist tried to correct her thought in this way (as described by the patient): “Whenever you feel you have committed sin you will go to hell, tell yourself nothing will happen even if you go to hell”. Even with repeated sessions, patient remained distressed because of the same thought, On the contrary her distress increased as she used to say nothing will happen if I go to hell. Five years later, she saw me for the same complaint.

24. Psycho-education Obsessive-compulsive disorder (OCD) is represented by intrusive thoughts, rituals, preoccupations, or compulsions which cause severe distress to the person. They are time consuming and interfere significantly with the person's normal routine, occupational functioning, usual social activities, or relationships. A patient with OCD may have an obsession, a compulsion, or both. An obsession is a recurrent and intrusive thought, feeling, idea, or sensation. In contrast to an obsession, which is a mental event, a compulsion is a behavior. A patient with OCD realizes the irrationality of the obsession and experiences both the obsession and the compulsion as ego-dystonic (i.e., unwanted behavior). Although the compulsive act may be carried out in an attempt to reduce the anxiety associated with the obsession, it does not always succeed in doing so. The completion of the compulsive act may not affect the anxiety, and it may even increase the anxiety. Anxiety is also increased when a person resists carrying out a compulsion.

25. QURANIC EDUCATION In the light of religious knowledge, she was reminded that she was an Alima (an Islamic scholar) and the Holy Quran mentions that if you ask for forgiveness from the bottom of your heart, you will be granted forgiveness & sent to heaven (Insha Allah). Chapter 4(Al- Nisa) of the Holy Quran says (verse no.106) “And seek the Forgiveness of Allâh, certainly, Allâh is Ever Oft Forgiving, Most Merciful.” And verse no. 110 of Chapter 4 says, “And whoever does evil or wrongs himself but afterwards seeks Allâh's Forgiveness, he will find Allâh Oft Forgiving, Most Merciful.” Being a person with strong religious orientation, she was convinced with the idea.

26. Quranic Teaching: • Importance of seeking forgiveness from Allah. • Importance of reward in life here-after. • Importance of religious-mindedness. • Importance of Quran-mindedness.

27. Cognitive Model AUTOMATIC THOUGHT: I have committed sin. MEANING OF AUTOMATIC THOUGHT: I will go to hell. EMOTION: Sadness. BEHAVIOR: Isolation. Rational perspective ALTERNATIVE THOUGHT SUGGESTED BY THERAPIST: Nothing happens if one goes to hell. RESPONSE OF PATIENT: More anxiety, more sadness. BEHAVIOR: Rejected treatment.

28. Quranic Perspective Alternative thought Insha Allah, Allah (SWT) will forgive my sins. I will go to Paradise (Jannat).

29. Follow up • Medications were prescribed by me and she was asked to follow-up in a week’s time. On her next visit she reported 80% betterment with Quranic insight, a significant relief from her feeling of guilt. • For a Muslim, the thought of going to hell is distressing enough even for a normal person, and then justifying that nothing will happen even if one is sent to hell is not acceptable to a Muslim, rather more distressing. This is what exactly happened in this case when she was given CBT without considering religious background. • When her religious background was considered and her distressing thought was replaced by the hope of going to heaven, it was more acceptable to the patient’s psyche, thus relieving her of her long-standing distress. • The above case has been analyzed in a rational as well as Islamic perspective.

30. RESPONSE OF PATIENT Decrease in anxiety and sadness. BEHAVIOR: Started leading normal life. Even after five years of follow-up, she is enjoying a quality life without any distress.

31. CASE 2 • 23 years male presented with the following complaints of 8 months duration. • Recurring thought related to Kalma e Tayyaba, • When he wears cloths he get some thoughts that he should give his cloths in charity (Sadqa) • If he forgets reciting Bismillah before doing any act he thinks that he has committed sin and repeats the action again and again. • If he sees any person, animal, or temple he feels that he is prostrating (Sajda) before them. • If his foot touches somebody or even if it does not, he repeatedly asks for forgiveness. • When wearing slippers he puts his foot thrice in and takes out thrice. • While offering Salat (prayer) he gets recurring thoughts and for that he performs SajdaSahoo repeatedly. • Before interacting with anybody he waits for 5 minutes and then interacts. • He gets repeated thoughts that he is going astray without proper religious knowledge.

32. When offering wudhu he gets thoughts he has not recited prayer (Duaa) before that so he repeats wudhu again and again. • He does not wear new cloths because looking at new cloth he gets thought that it should be given in charity (Sadqa). • He had collected 8 thousand rupees for giving charity but he has not given a charity and gave that amount to his brother for his business. And he gets repeated thought that he has committed sin.

33. He was prescribed antidepressants by psychiatrist (Clofranil and Fluvaxamine) for 6 months without much relief. • He consulted many faith healers without any relief. • One of the faith healers told that while going to latrine Jinn has afflicted him. Other one told that Jinn of water had possessed him. Third one told that has been afflicted by “Fairy (pari), Joban, Chudail). • As he has not shown improvement to medications and T/t by faith healers, how would you go ahead with this case?

34. PSYCHOEDUCATION • Obsessive-compulsive disorder (OCD) is represented by intrusive thoughts, rituals, preoccupations, or compulsions which cause severe distress to the person. They are time consuming and interfere significantly with the person's normal routine, occupational functioning, usual social activities, or relationships. A patient with OCD may have an obsession, a compulsion, or both. • An obsession is a recurrent and intrusive thought, feeling, idea, or sensation. In contrast to an obsession, which is a mental event, a compulsion is a behavior. A patient with OCD realizes the irrationality of the obsession and experiences both the obsession and the compulsion as ego-dystonic (i.e., unwanted behavior). • Although the compulsive act may be carried out in an attempt to reduce the anxiety associated with the obsession, it does not always succeed in doing so. The completion of the compulsive act may not affect the anxiety, and it may even increase the anxiety. Anxiety is also increased when a person resists carrying out a compulsion.

35. QURANIC EDUCATION • He should have faith in Allah and always think that Allah is with him as it is mentioned in the Quran (Chapter no.50, Verse 16)- “I am nearer than the jugular vein”. • As he always remained in company of someone to avoid anxiety, this verse was told to remind him that he is not alone, Allah is with him at all times. For a believer this thought is easily acceptable and by this thought, his anxiety is reduced. • He should have belief that time of death is fixed (Chapter 7, verse 34) “And every nation has its appointed term; when their term is reached, neither can they delay it nor can they advance it an hour (or a moment).” When time of death comes it is not postponed or preponed even by a second. This thought helps in avoiding negative thoughts of death whenever he gets palpitations.

36. He was also told the incidence of Prophet Mohammad (PBUH) when he traveled from Makkah to Madina with HazratAbubaker (RA). Enemies of believers (unbelievers) could not harm them as the Prophet (PBUH) always used to recite “La Tahzen! InnallaheMaana!” • (‘Do not grieve, Allah is with us’: Chapter 9, verse no. 40). Thus they reached Madinah safely, remembering Allah on their way. This incident helps a believer to think that Allah is always with him so he should not depend on any person or thing to reduce anxiety. The verse from Holy Quran is added, “Do they not get tranquility by remembering Allah.” (Chapter 13, verse no.28)

37. QURANIC TEACHINGS • First thing done was removal of misconcepts about Jinn effect, in light of Holy Quraan and Sunnah which were acceptable to patient. • As his symptoms had religious coloring and had misconcepts about different aspects of religious teachings they were corrected in light of Holy Quraan and Sunnah in First session hence he got 50% relief in first session only. • In second session he was explained about exposure and response prevention and was given intensive exposure in that session he showed 70% improvement. • In third and fourth sessions his behavior and cognitive correction was reinforced and he showed further improvement up to 90%. This all was done (after hospitalization) in period of 6 days. • He was continued on same medications as before. • On follow up after one week he reported 95 % improvement.

38. Cognitive Model AUTOMATIC THOUGHT: I have committed sin MEANING OF AUTOMATIC THOUGHT: I will go to hell. EMOTION: Sadness. BEHAVIOR: Isolation. Rational perspective ALTERNATIVE THOUGHT SUGGESTED BY THERAPIST: Nothing happens if one goes to hell. RESPONSE OF PATIENT: More anxiety, more sadness. BEHAVIOR: Rejected treatment.

39. Quranic Perspective • In the light of religious knowledge, she was reminded that she was an Alima (an Islamic scholar) and the Holy Quran mentions that if you ask for forgiveness from the bottom of your heart, you will be granted forgiveness & sent to heaven (Insha Allah). Chapter 4(Al- Nisa) of the Holy Quran says (verse no.106) “And seek the Forgiveness of Allâh, certainly, • Allâh is Ever Oft Forgiving, Most Merciful.” • And verse no. 110 of Chapter 4 says, “And whoever does evil or wrongs himself but afterwards seeks Allâh's Forgiveness, he will find Allâh Oft Forgiving, Most Merciful.” • Being a person with strong religious orientation, she was convinced with the idea.

40. RESPONSE OF PATIENT As his symptoms had religious coloring and had misconcepts about different aspects of religious teachings they were corrected in light of Holy Quraan and Sunnah in First session hence he got 50% relief in first session only. In second session he was explained about exposure and response prevention and was given intensive exposure in that session he showed 70% improvement. In third and fourth sessions his behavior and cognitive correction was reinforced and he showed further improvement up to 90%. This all was done (after hospitalization) in period of 6 days.

41. Psychotherapy can be used .. 1. Before starting treatment 2. During the treatment 3. After treatment

42. Psychotherapy before Treatment • To remove misconcepts about illness. • Verily, he and Qabiluhu (his soldiers from the jinn or his tribe) see you from where you cannot see them. Verily, We made the Shayatin (devils) Auliya (protectors and helpers) for those whobelieve not .(QS7. Al A'raafayat 27) • 2. To motivate for treatment.

43. Psychotherapy during Treatment • To improve quality of life during treatment. • To increase sense of well being. • To increase acceptability of illness.

44. Psychotherapy after Treatment • To prevent relapse • To reduce stress Hadith, Best of act is moderation. (Bukhari) Stress management, in the light of Qur’an. • وَإِنَّكَ لَعَلَىٰ خُلُقٍ عَظِيمٍ Indeed, you are of great moral character. (68:4)

45. Common teachings fromThe Nobel Quran used in psychotherapy • Moderation • Suicide prevention • Addiction prevention • Violence prevention • STD prevention • Behavior with old parents • Anger management • Good deeds • Patience • Scientific attitude • Accountability as per ability

46. The Book “The Noble Qur’an and Psychotherapy” is available for FREE download on www.mentalhealthcenterindia.com

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