Combining Spirituality with Other Forms of Treatment for Depression - Thesis Example

What are the benefits of combining spirituality with other forms of treatment for depression? 22 March Introduction The relationship between spirituality and psychology is “tumultuous” (Hook et al., 2009, p.46). Psychologists like Skinner and Freud questioned the role of religion in treating mental illnesses, while James and Jung provided positive views of religion in clinical work (Hook et al., 2009, p.46). Depression is believed as one of the most widespread psychiatric disorders in the world, with more than 300 million people suffering from it (Nelson et al., 2009, p.105). In the United States, the rates of depression among women range from 5% to 12%, while it has an incidence of 2% to 3% for men (Nelson et al., 2009, p.105). Spirituality, despite the negative perceptions of some psychologists and psychiatrists, has increasingly shown positive effects in reducing depression (Hopko & Colman, 2010; Gitlin et al., 2007; Wittink et al., 2009). This paper examines the benefits of combining spirituality with other modalities. Some of the popular modalities for depression are pharmacological and behavioral approaches, and integrated treatments (i.e. including medicine and psycho-education). The studies noted overwhelming support that spirituality can decrease depressive symptoms, especially when combined with pharmacological (Murphy & Fitchett, 2009; Rajagopal et al., 2002) and behavioral approaches (Hodge, 2006; Hopko & Colman, 2010; Phillips et al., 2009). Benefits of Spirituality When Integrated With Other Modalities This section discusses the particular benefits of spirituality when added to other modalities. Spirituality can enhance the efficacy of these modalities through increasing engagement (Diaz et al., 2011) and improving the clients’ sense of meaning and hope, which is beneficial to treating depression too (Sorajjakool et al., 2008). Acceptance of and Response to Pharmacological Treatment Spirituality can help enhance acceptance of pharmacological treatment to depression. Rajagopal et al. (2002) noted from other studies that for older adults with minor depression, spiritual aspects of therapy can help them accept a pharmacological approach in treating their depression. Past studies from Lundervold and Lewin (1990 cited in Rajagopal et al., 2002, p.154) and Oslin et al. (2001 cited in Rajagopal et al., 2002, p.154) provided evidence, where many senior citizens were particularly sensitive to being diagnosed of mental illness, and they preferred behavioral treatment over pharmacological treatment, particularly those concerning antidepressant medications, such as selective serotonin reuptake inhibitors, bupropion, serotonin-norepinephrine reuptake inhibitors, trazodone, and tricyclics. Rajagopal et al. (2002) suggested that adding a spirituality dimension to their treatment can help them accept pharmacological treatment (p.154). The main strategy is to use a collaborative approach in using spirituality as part of their general treatment (Phillips et al., 2009, p.19). Spirituality can also enhance the response to pharmacological treatment. Murphy and Fitchett (2009) examined if a belief in a concerned God can mediate hopelessness for depressed patients and decrease depression. Sampling included 136 adults with clinical depression, who completed the Beck Depression Inventory, the Beck Hopelessness Scale, and the Religious Well-Being Scale (RWB). Their treatment included antidepressant medication that was not specified by this study. Findings showed patients in “the upper third of RWB at admission were 75% more likely to have a response to treatment than persons in the lower third” (p.1000). Engagement in Pharmacological and Behavioral Treatments Spirituality can make patients more engaged with their treatment. Phillips et al. (2009) underlined in their review of spirituality, as a modality for treating depression, that spirituality can help patients remain engaged in their pharmacological treatment, where their doctors recommend antidepressants to help alleviate their depression (p.17). Engagement with the treatment happens when spirituality gives them hope and strength, specifically during challenging times, which will induce them to take and continue their medication. Diaz et al. (2011) highlighted from their study on people with substance abuse problems that hope is key to motivating them to change their outlook in life. Some examples they mentioned are alcoholics who are seeking help from Alcoholics Anonymous (AA) and other treatments that offer 12-steps of escaping substance addictions. These people use hope to cope with their depression and to continue their treatment. Spirituality can also improve positive thinking and behaviors and help patients accept and continue their treatment (Phillips et al., 2009, p.18). Phillips et al. (2009) stressed that the role that spirituality plays in treating depression depends on the coping styles and motivations of patients and whether there are conflicts between spiritual values and treatment (p.18). Activation of Social Support that Can Alleviate Depression Religious activities are often social in nature, and social support can help decrease depression. Phillips et al. (2009) emphasized that spirituality can improve the effects of behavioral therapies, if the former can also activate patients’ social support systems. Social support, in turn, can mediate the effects of different forms of behavioral therapies, especially for people who belong to collectivist cultures, or cultures where they value their social group as part of their recovery (Gitlin et al., 2007). Larson and Larson (2003) underscored that for older adults, they have formed close relationships with people of similar spiritual or religious beliefs. These social groups help give them hope and motivate them to continue treatment. Enhancement of Effects of Control Strategies Spirituality can improve the effects of control strategies for depression. Gitlin et al. (2007) explored if control-oriented strategies eventually cushion the effects of functional difficulties on depressive symptoms in older African-American and white adults with disability. They used the Life Span Theory of Control, which believes that threats to or real losses to the capacity to control crucial results, such as doing self-care, may induce people to use strategies that reduce these threats and losses (Gitlin et al., 2007, p.1024). Gitlin et al. (2007) employed control strategies that enhanced the range to which respondents supported cognitive and behavioral strategies that can improve and preserve functional independence. Functional independence means that they can perform basic tasks, such as self-care. Their research design is a community-based, perspective, randomized trial study with baseline data and 12-month data. Participants included 129 African Americans and 151 white adults. The measures for spirituality were included in the Valuation of Life scale instrument that this study used, such as believing in spiritual or religious beliefs. Findings showed that poor spirituality and low social support among African Americans predicted elevated 12-month depressive symptom scores. Spirituality helped patients take control of their lives, since they felt more hope in their treatments. Improved Efficacy of Behavioral Treatments Numerous older adults frequently partake in religious/spiritual activities and integrating spirituality into psychosocial treatments can enhance mental health (Phillips et al., 2009, p.17). One of the most successful treatments for depression is cognitive-behavioral therapy (CBT). CBT employs behavioral activation and coping styles that can boost mental health (Phillips et al., 2009, p.17). Behavioral activation uses pleasurable activities to motivate people to attain their goals in life, where they can change negative behaviors into something positive through reinforcement strategies (Phillips et al., 2009, p.17). Phillips et al. (2009) noted that cognitive-behavioral treatment is effective for treating depression and anxiety, especially when its spiritual component is maximized. For instance, health care providers can add spirituality to their patients’ treatment, if the latter agree to pursue spiritual activities. Spiritual activities that follow therapy can improve the motivation of patients to follow through with their CBT. Health care professionals, however, should weigh the pros and cons of discussing spiritual values and practices with patients and they should be aware of how certain forms of spiritual can be particularly effective in decreasing depressive symptoms (Phillips et al., 2009, p.17). Studies showed the efficacy of spiritual dimensions in behavioral approaches to depression. Hodge (2006) evaluated the literature of spiritually modified cognitive therapy, where he used articles from SocialWork Abstracts, Medline, PsycINFO, and Dissertation Abstracts. He showed that in general, for studies where depression served as the dependent variable, they exhibited a higher degree of methodological rigor than studies on anxiety, stress, and other mental illnesses. These studies referred to Azhar and Varma (2000), Johnson and colleagues (1994), Hawkins and colleagues (1999), Propst (1980), Johnson and Ridley (1992), Peccheur and Edwards (1984), and Peccheur and Edwards (1984). These mentioned studies in Hodge (2006) used either a pretest-posttest control group design or a comparative research design. Majority of them also employed treatment manuals, a process that improves the replicability of the study. These studies agreed that spirituality decreased depressive symptoms among affected individuals. Hopko and Colman (2010) studied the effect of cognitive treatment for depressed breast cancer patients. Their sampling was composed of two women with breast cancer. Assessment measures included the Hamilton Rating Scale for Depression, Quality of Life Inventory, Medical Outcomes Study Short Form, Multidimensional Scale of Perceived Social Support, Client Satisfaction Questionnaire, and Beck Depression Inventory-II. Spirituality included praying and being more active in church activities, such as bible reading and attending church regularly. Findings showed that when spirituality was included in the cognitive treatment intervention, depression was considerably reduced and the quality of life and medical outcomes were also enhanced. Better Physical and Emotional Health Spirituality can improve physical and emotional health, which are critical to reducing depression, where better emotional health means changing from having negative perceptions of life to having positive feelings, such as hope and peace of mind (Phillips et al., 2009, p.17). Phillips et al. (2009) stressed that many patients used spirituality as a coping mechanism for depression and anxiety. They highlighted the importance of using spirituality for people who value religious or spiritual beliefs and practices. Praying and spiritual activities, such as reading and reflecting on favorite Bible verses, for instance, can lift the patients’ mood and provide them hope or strength (Phillips et al., 2009, p.17). Larson and Larson (2003) noted from their study that older adults indicated that their spiritual beliefs helped them cope with the stress of their physical illnesses. Bosworth, Park, and McQuoid (2003) confirmed these findings for their study in geriatric patients. Their findings showed that religiousness helped patients cope with depression. Better emotional health can be attained through finding faith as a cause of and resolution to depression. Wittink et al. (2009) examined the role of spirituality in how African Americans conceptualize depression, which also affected how they deal with it. Sampling included 47 older African American patients. Findings showed that loss of faith was a primary cause of depression and that renewing faith through greater spiritual activities could alleviate depression. Wittink et al. (2009) added that spirituality may also help discuss and detect depression in the first place, especially for African Americans who do not see depression as a clinical illness, but rather, as a form of spiritual relapse. Hook et al. (2010) evaluated the efficacy of religious and spiritual (R/S) therapies for mental health problems, such as depression, anxiety, unforgiveness, and others. Religions included Christianity, Islam, Taoism, and Buddhism. Findings showed that Muslim psychotherapy for depression and Christian accommodative cognitive therapy (CT) for depression have high efficacy in treating depression. Meaning of Life Spirituality helps people find “meaning” in their lives, thereby making it easier for them to handle and manage their depression. The definition of “meaning” differs for individuals and scholars who study it. Personal/existential meaning is occasionally used to also refer to life meaning. Mascaro and Rosen (2006) defined spiritual meaning as “Having a sense of purpose or calling derived from beliefs about spiritual forces underlining or arching over life” (p. 184), while personal meaning means “Having a sense of purpose about one’s individual life irrespective of the status of life itself or other metaphysical and/or spiritual consideration” (p. 184 cited in Sorajjakool et al., 2008, p.523). People tend to seek for meaning in their lives and to deal with their pain in a spiritual manner (Sorajjakool et al., 2008, p.521). Nelson et al. (2009) stressed that spirituality can reduce depression, if it can improve the sense of meaning and hope among patients. Spirituality helps patients improve their perspective in life, which helps them deal with their pain. Simonelli et al. (2008) studied the role of meaning in life as a mediator between physical sequelae and depressive symptoms. Findings showed that patients with more physical concerns make them feel that life was meaningless, which induced depression. Sorajjakool et al. (2008) conducted semi-structured interviews to discover the role of spirituality and meaning among depressed individuals. Findings showed that aside from behavioral treatment, spirituality helped patients understand their conditions and depression, an understanding that helped them heal to some extent. Some Concerns with Spirituality Spirituality is not a flawless modality. It may present several conflicts with treatments, or introduce barriers to treatment. Spirituality as Barrier to Treatment Phillips et al. (2009) explained that spirituality can also deter treatment for depression. For instance, some religious people may think that they are depressed, because they are “bad.” This makes depression as something they deserve, a punishment for their evil thoughts and/or actions (Phillips et al., 2009, p.18). Nelson et al. (2009) stressed the inverse relationship between spirituality and depression, when belief in a punitive God increases depressive symptoms (p.111). Being spiritual may also make them feel more lost, or feel the loss of meaning in their lives (Simonelli et al., 2008). These patients may also say that their religion is against treatment, which can persuade them to resist pharmacological treatment, for instance (Phillips et al., 2009, p.17). Conflicts between Spirituality and Treatment Spirituality may lead people to perceive depression in a different framework. Wittink et al. (2009) and Cooper et al. (2001) noted the concerns of African Americans about depression when they use a spiritual framework. African Americans might be suspicious of the biological causes and pharmacological treatment of depression and may prefer counseling and praying as more suitable interventions (Wittink et al., 2009, p.402). Prayer, for instance, is central to the coping mechanisms of African Americans (Taylor, Chatters, & Levin, 2004). It is important for health care professionals to understand these conflicts and properly address them to help patients accept these treatments and improve their self-efficacy. Conclusion These studies generally agreed that spirituality can reduce depressive symptoms. It can be added to modalities that use medicine and behavioral therapies. Spirituality’s benefits are wide-ranging, including improving responses to and engagement in treatments, enhancing physical and emotional welfare, activating support systems, and helping patients feel better, because they find more meaning in life through their spiritual beliefs and practices. Clinical practitioners should not devalue the role of spirituality in managing depression. They should find ways to determine if spirituality can be used to alleviate depression among their patients. Clinical practitioners should be open to integrating spirituality into their treatment programs, especially for people who have spiritual or religious beliefs. For these patients, finding and using God in medicine may be the best way to deal with depression. References Bosworth, H.B., Park, K., & McQuoid, D.R. (2003). The impact of religious practice and religious coping on geriatric depression. International Journal of Geriatric Psychiatry, 18 (10), 905-914. Cooper, L.A., Brown, C., Thi Vu, H., Ford, D.E., & Powe, N.R. (2001). How important is intrinsic spirituality in depression care? JGIM: Journal of General Internal Medicine, 16 (9), 634-638. Diaz, N., Horton, E.G., Green, D., McIlveen, J., Weiner, M., & Mullaney, D. (2011). Relationship between spirituality and depressive symptoms among inpatient individuals who abuse substances. Counseling & Values, 56 (1/2), 43-56. Gitlin, L.N., Hauck, W., Dennis, M.P., & Schulz, R. (2007). Depressive symptoms in older African-American and white adults with functional difficulties: The role of control strategies. Journal of the American Geriatrics Society, 55 (7), 1023-1030. Hodge, D.R. (2006). Spiritually modified cognitive therapy: A review of the literature. Social Work, 51 (2), 157-166. Hook, J.N., Worthington Jr., E.L., Davis, D.E., Jennings II, D.J., Gartner, A.L., & Hook, J.P. (2010). Empirically supported religious and spiritual therapies. Journal of Clinical Psychology, 66 (1), 46-72. Hopko, D.R. & Colman, L.K. (2010). The impact of cognitive interventions in treating depressed breast cancer patients. Journal of Cognitive Psychotherapy, 24 (4), 314-328. Larson, D.B. & Larson, S.S. (2003). Spiritualitys potential relevance to physical and emotional health: A brief review of quantitative. Journal of Psychology & Theology, 31 (1), 37-51. Murphy, P.E. & Fitchett, G. (2009). Belief in a concerned god predicts response to treatment for adults with clinical depression. Journal of Clinical Psychology, 65 (9), 1000-1008. Nelson, C., Jacobson, C., Weinberger, M., Bhaskaran, V., Rosenfeld, B., Breitbart, W., & Roth, A. (2009). The role of spirituality in the relationship between religiosity and depression in prostate cancer patients. Annals of Behavioral Medicine, 38 (2), 105-114. Phillips, L.L., Paukert, A.L., Stanley, M.A., & Kunik, M.E. (2009). Incorporating religion and spirituality to improve care for anxiety and depression in older adults. Geriatrics, 64 (8), 15-18. Rajagopal, D., Mackenzie, E., Bailey, C., & Lavizzo-Mourey, R. (2002). The effectiveness of a spiritually-based intervention to alleviate subsyndromal anxiety and minor depression among older adults. Journal of Religion & Health, 41 (2), 153-166. Simonelli, L.E., Fowler, J., Maxwell, G.L., & Andersen, B.L. (2008). Physical sequelae and depressive symptoms in gynecologic cancer survivors: Meaning in life as a mediator. Annals of Behavioral Medicine, 35 (3), 275-284. Sorajjakool, S., Aja, V., Chilson, B., Ramirez-Johnson, J., & Earll, A (2008). Disconnection, depression, and spirituality: A study of the role of spirituality and meaning in the lives of individuals with severe depression. Pastoral Psychology, 56 (5), 521-532. Taylor, R.J., Chatters, L.M., & Levin, J. (2004). Religion in the lives of African Americans: Social, psychological, and health perspectives. Thousand Oaks: Sage Publications, Inc. Wittink, M.N., Joo, J.H., Lewis, L.M., & Barg, F.K. (2009). Losing faith and using faith: Older African Americans discuss spirituality, religious activities, and depression. JGIM: Journal of General Internal Medicine, 24 (3), 402-407. Read More