Spiritually-Modified Cognitive-Behavioral Therapy's Impact Upon Christians with Depression

"Despite the crucial role that religion plays in the lives of many people, religious beliefs are perhaps the least addressed in modern day psychology" (Haque, 2001, p. 241). Spirituality is viewed as the relationship between the individual and an "ultimate transcendent reality" (Hodge & Hodge, 2006, p. 158). Furthermore, religion is perceived as the manner in which spirituality is expressed through beliefs, behaviors, and practices consistent with others who believe in the same "transcendent reality" (Hodge & Hodge, 2006, p. 158). Most recently, due to the increased awareness that religion and spirituality have an impact on the mental health of individuals, certain therapeutic models are incorporating these dimensions into intervention techniques (Hawkins, Siang-Yang, & Turk, 1999).

CBT, one effective treatment procedure often used for clinical depression, may not be as beneficial when addressing religious populations (Propst, Ostrom, Watkins, Dean, & Mashburn, 1992). As a result, this literature review is an exploration of religion and spirituality combined with CBT and its impact upon Christians with depression.

Several studies have sought to integrate religious and spiritual values with CBT. This has been accomplished in a variety of ways which include the following. The identified techniques that are currently being integrated include the use of religious tenets to dispute irrational thought processes and religion-based imagery methods (Propst et al., 1992). Additional characteristics that are used in spiritually-modified CBT include biblical scripture to guide behaviors and thought processing, prayer, worship, seeking fulfillment through God versus personal autonomy, and the acknowledgement of important Christian factors (i.e. history, theology, family and society) (Hawkins et al., 1999). Recent studies focused on studying the addition of these techniques to traditional CBT have revealed significant improvement in religious persons with depression.

The usefulness of spiritually-modified CBT was observed in two research studies included in this literature review. Each study used a pretest-posttest design to assess client outcomes. The therapists chosen to conduct the research study counseling sessions yielded from varying backgrounds. A strong point of each study was the use of religious therapists to implement the spiritually-modified CBT, while nonreligious therapists or those who chose not to disclose their religious beliefs implemented the standard CBT (Propst et al., 1992; Hawkins et al., 1999). In spite of religious orientation differences, the therapists had similar professional backgrounds which included clinical psychology, Christian therapy and fulfilling the role of pastor. The level of therapist experience with CBT varied, ranging from having no training to four years of practically implementing the treatment method (Propst et al., 1992; Hawkins et al., 1999).

The first study by Probst, et al. (1992) explored the impact of nonreligious cognitive therapy (NRCT), religious cognitive therapy (RCT), pastoral counseling (PCT), and a waiting list with religious patients. The RCT incorporated "religious imagery treatment and religious placebo (group discussion of religious issues)" (p. 94). Both religious and nonreligious therapists were used to provide both forms of therapy due to a lack of religious therapists. The results presented no statistically significant difference upon the treatment effects of the patients. Patients who received RCT and PCT resulted in decreased symptoms of depression, "general improvement in social adjustment" versus those who received CBT (p. 101). In addition, the study revealed that nonreligious therapists performed "better in the RCT condition than in the NRCT condition" and no difference with religious therapists and the therapy performed (p. 102). The patients who yielded the best results were those who received RCT with nonreligious therapists while those who received NRCT with nonreligious therapists had the worst pattern of performance. The hypothesized causes of these results were unspecified within the literature.

The second study used individual and group therapy methods to measure the effectiveness of spiritually-modified CBT compared to traditional CBT and to explore the dynamics between depression and spiritual well-being (Hawkins et al., 1999). A significant result was the increased spiritual well-being of the individual as examined through the Spiritual Well-Being Scale. Spiritual well-being positively correlates to self-esteem and negatively correlates to issues such as depression and stress (Hawkins et al., 1999). Therefore, this study revealed that as spiritual well-being increased, there was an increased probability for a decrease in symptoms of depression. Next, in regards to spirituality, clients who used the spiritually-modified CBT displayed significant improvement in their relationships with God and experienced increased life satisfaction and purpose versus those who received standard CBT. This represents the prospect that an individual's spiritually can be enhanced (Hawkins et al., 1999). Although these studies provided significant evidence towards the effectiveness of spiritually-modified CBT with Christian persons, further exploration is necessary to support this treatment method.

The purpose of this literature review was to explore the effectiveness of spiritually-modified CBT versus standard CBT upon Christians with depression. The literature indicated a consistent decrease in symptoms of depression and dysfunctional behaviors, as well as an increase in spiritual well-being and social adjustment. A method to help improve the exploration of the effectiveness of spiritually-modified CBT is to increase the sample size of future studies in order to enhance the results. In addition, the use of a longitudinal study can be implemented to monitor the resilience of the effects over a longer duration (Hawkins et al., 1999). Finally, future studies could include more rigorous designs such as group designs and a series of case studies (Hodge & Hodge, 2006). The effectiveness of spiritually-modified CBT can be broadened through research of additional areas.

In conclusion, the implementation of spiritually-modified CBT could be benefited by future study topics. First, a focus on inpatient mental health treatment through religious-based hospitals and treatment centers to determine the effectiveness of the programs could be explored (Hawkins et al., 1999). Next, researchers should observe the therapist-treatment interaction, which includes the values and beliefs of the therapist and the effects upon the implementation of spiritually-modified CBT (Propst et al., 1992). Lastly, further research could also compare this method to that of a completely different therapeutic theory base with varying mental health disorders (Hodge & Hodge, 2006).

References

Haque, A. (2001). Interface of psychology and religion: Trends and developments. Counselling

Psychology Quarterly, 14(3), 241-253. Retrieved September 09, 2006, from Academic

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Hawkins, R.S., Tan, S., & Turk, A.A. (1999). Secular versus Christian inpatient cognitive-

behavioral therapy programs: Impact on depression and spiritual well-being. Journal of

Psychology and Theology, 27(4), 309-319. Retrieved September 09, 2006, from ProQuest

Religion database.

Hodge, D., & Hodge, D. (2006). Spiritually modified cognitive therapy: A review of the

literature. Social Work, 51(2), 157-166. Retrieved September 09, 2006 from Academic

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Propst, L., Ostrom, R., Watkins, P., Dean, T., & Mashburn, D. (1992). Comparative efficacy of

religious and nonreligious cognitive behavioral therapy for the treatment of clinical

depression in religious individuals. Journal of Consulting and Clinical Psychology,

60(1), 94-103. Retrieved September 09, 2006, from PsycARTICLES database.