3-How can achieving mindfulness achieve the same results as the common prescribed drugs?
Mindfulness is commonly described as a type of mental state achieved by focusing one's awareness on the present moment and living in the “now”, while calmly accepting one's feelings, thoughts, and bodily senses, and if mastered is something that allows us to choose whether to follow or not follow our thoughts as we choose. “According to the APA, studies show that mindfulness practices (such as relaxation or meditation) help to reduce stress, boost memory, enhance focus & concentration, decrease emotional reactivity & improve personal relationships.” Mindfulness practices can be spiritual or non-spiritual and is classed as a type of religious reflection, where working towards it improves mental wellbeing, which in turn helps in developing healthy coping methods to live with personal autonomy with mental and physical disorders.
4-How do religious practices offer any benefit?
Religious reflection is not something that is advertised as a lifesaving drug, nor does it claim to chemically alter the brain at all. However stark contrasts are visible in many medical procedures especially pertaining to recovery rates. One study (Mayo Clinic, 2019) states “belief in a transcendent being is associated with reduced depressive symptoms. Quantitative research demonstrates reduced levels of anxiety in several populations, including medical patients in later life, women with breast cancer, middle aged with cardiac problems and those recovering from spinal surgery. Qualitative research demonstrates that yoga and meditation are also associated with improvements in mental health and reductions in anxiety. “
First, these studies show that religion and spirituality are usually, beneficial to people in dealing with trauma aftermath. Second, they show that traumatic experiences can lead to a deepening of religion or spirituality. Third, that positive religious coping, religious openness, readiness to face existential questions, religious participation, and intrinsic religiousness are typically associated with improved post-traumatic recovery. The strong belief in something higher than us removes an element of control, which is a sigh of relief for many people as having one less thing to worry about makes it seem the weight of the world is not constantly on their shoulders. Religious rituals that manifest into daily affirmations and reflective practices may allow to reframe episodes that may have changed lives (often uncontrollable) in a way that makes them less stressful or more meaningful.
Religious beliefs are expressed daily, but how do different religions interpret having a relationship with their Lord?
5-forms of prayer that are regarded as religious reflection
Prayer is identified as an active form of communication with a higher power and building a loving and responsive relationship with this higher power. It can take several forms, and each religion places more emphasis on different types. For example, ritual prayer is often congregational and follows set recitations and movements, such as Friday Jumma prayer for Muslims and Sunday mass and the Lord’s prayer for those who follow any of the many branches of Christianity. Jews observe Shabbat and find it a time of renewal and peace. It reminds them to take time to live, and they often avoid seemingly mundane worldly errands such as cooking and shopping.
Meditational prayer is where a person reflects on themes of a spiritual theme and the relationship of the divine to mankind, and their purpose. Buddhists idolise and respect the Buddha, but do not see him as a deity, instead spending time meditating to find purpose.
Conversational prayer is seen as something less rigid, where conversations occur with God with no certain day, time frame or restriction. Hindus will often worship in the times they see fit, e.g., early morning or during a commute, or at places they feel the most spiritual such as a temple.
Prayer is a common coping method for most of the world and takes many different forms. However can its effects(and thus its suitability as treatment) be altered by pre-existing frameworks already built up in a person’s mind?
6-how do schemas of the mind play into success rates after treatment?
How does the concept of locus of control affect recovery or response to treatment following an unfortunate event? Locus of control is defined as an individual's perception about the underlying main causes of situations and events in their life. The term locus of control is defined as a spectrum with 2 sides that vary greatly. One side suggests belief that your destiny is controlled by yourself ( internal locus of controls are less likely to be affected by peer and social pressures as they take higher accountability of their actions, and realise that actions have consequences and that they are fully in control of their life and the decisions they make)or by external forces (such as fate, God, or simply others; known as having a high external locus of control, linked to victim complexes and belief in tragic predestination)
Abrahamic religions believe in both, to a certain degree and in a positive aspect. Ultimately, all power and decision making are attributed to a higher power, and He is in full control. However, destiny is not something permanent or set in stone as humans are given free will and have full control over their actions. Living life with a purpose and an aim greatly increases motivation to positively contribute to society, and to grow as a person for the hope of eternal bliss, reducing any chance for existential anxiety to develop. A verse in the Quran narrates – “And He will not change a condition of a people until they first change themselves” meaning if a believer wishes to change his destiny or his situation, he must take the first step and the divine power he puts his trust in will also help him along.
“When the locus of control shifts from the external to the internal frame, clients find more energy, motivation, and greater confidence to change” according to Moore and Tschannen Moran, (Cornah, 2006) when people shift to a more internal locus of control, they seem to have regained control of their life as they feel in charge again. They feel accountable and whether their accountability is held against themselves, or is driven by someone else, religion provides a higher accountability that the drugs do not offer.
Many of the world’s most popular religions such as Islam, Christianity, Judaism etc all promote life as being a test, with each action and deed being held accountable and weighted and judged in an afterlife. In the Islamic faith, the day after resurrection is when deeds are weighed on scales, and it is the factor that determines the eternal resting place of bliss in gardens of heaven, or pain through the gates of hell fire. With this day often referred to as the judgement day, those who believe in it work towards a positive outcome and as, throughout their life their actions were regarded to with a high internal locus of control, the standard they hold themselves to will be higher than someone who doesn’t believe in a higher being considering their every action, so may see no need to take full accountability. Conducted by Colquitt et al a meta-analysis of 222 research studies showed that “people with an internal locus of control enjoyed better health, including higher self-reported mental well-being, fewer self-reported physical symptoms”. With, it can be concluded that spirituality does affect a person’s coping mechanisms and their locus of control perceptions. Some expressions of religion affect its followers lifestyle and may encourage individuals to limit illness-related behaviors, such as smoking, drinking alcohol and overeating( as they are told not to by either God himself or His messengers, or are advised against certain behaviors as they take higher accountability for their actions and do not want to displease the Creator or His creation.) or to increase health-related behaviors such as meditation, exercise and helping others, which not only positively impacts the individual but also others that may be in need of help also.
7-How does the wellness of atheists compare to those who place their belief in something?
Interestingly, the way a person views the deity they pray to has an impact on their mental health. Those who view God as loving gain benefit from prayer, but those who view God as distant or unresponsive are more likely to experience anxiety. In an article by Independent, (Matthews-King, 2018) it claims religious people live 4 years (on average) longer than an atheist.” The difference between practising worshippers and those who were not part of a religious group could be down to a mix of social support, stress-relieving practices and abstaining from unhealthy habits, the authors suggest. For the study, a team of Ohio University academics, analysed more than 1,500 obituaries from across the US to piece together how the defining features of our lives affect our longevity. Published in Social Psychological and Personality Science today, (Andrade and Radhakrishnan, 2009) found that on average people whose obituary mentioned they were religious lived an extra 5.64 years. Religious participation often goes together with increased participation in activities and social groups, which might help to tackle loneliness and sedentary lifestyles that could also shorten life expectancy.” If not only effective in treating disease, but religion is also seen to play into effects of modern-day sedentary lifestyles, and tackles a post covid loneliness, of which its effects are widespread and well known especially after the isolated bursts of lockdowns that appeared to negatively impact the mental wellbeing of all the population, young and old.
8-Are there any perceived negatives to engaging in religious reflection?
Can prayer really be the answer to these issues we face in society today, or would anything similar in its place produce the same effect? Are the results simply a placebo effect that millions around the world partake in, and even dedicate their lives to? In an article (Psych Central, 2010), it suggests “Clinically significant treatment gains have been observed with placebo in numerous disorders, including anxiety, depression, schizophrenia, obsessive-compulsive disorder, tardive dyskinesia, ischemic heart disease, cardiac failure, Parkinson's disease and even cancer, among a host of other conditions”
Is this a placebo that is harmful? In most cases the answer is no, so the addition of some dedicated meditative or religious reflective time may still be beneficial even if partially nothing but a holistic sugar-pill. “The handful of reasonably well-designed studies on the placebo effects of prayer cautiously conclude it could mediate analgesia (pain relief), working its way perhaps partly through a stronger social support network among the religious or maybe even through the direct influence of specific religious prayers and symbols.” Exactly how remains an open question. It sounds reasonable to conclude that patients would engage in prayer with the expectation of health benefit. Thus, rather than placebo versus prayer, prayer itself could be expected to and indeed appears able to mediate the placebo effect in some disease symptoms in some people in some circumstances. Some symptoms, some people, some circumstances, and therein lies the proverbial elephant-sized problem because we currently lack a thorough biological understanding of how prayer or anything else for that matter mediates placebo effects. “This Forbes website (Broseley, 2018) suggests that if there was more scientific evidence for the correlation between the religious practices and the positive recovery time, it would be a more popular treatment option, however it lacks evidence and validity as it is so hard to test.
9-Is religious reflection used as a coping method rather than corrective treatment, and is that the correct place for it in traditional treatment plans?
Dr Lee writing in psych central comments “They’re better able to cope with stress, they heal faster from illness, and they experience increased benefits to their health and well-being. On an intellectual level, spirituality connects you to the world, which in turn enables you to stop trying to control things all by yourself. When you feel part of a greater whole, it’s easy to understand that you aren’t responsible for everything that happens in life.” This goes hand in hand with what the SSRI’s try to chemically do- by making more serotonin available, it makes these experiences more likely to occur and the person is better equipped mentally and physically to cope with the anxious and depressive situations life may throw at them early on, and if the drugs would potentially harm their development, religion and its practices seem to offer a good alternative which is safer with the same perceived benefits.
In an article by the guardian (Kam, 2010) New treatments are badly needed, the experts say.“We don’t have any very precise treatments for depression at this point in time,” said Geddes. “Another thing that is questioned is just how effective the drugs currently are, and whether a treatment plan that isn’t supplemented with anything else is still effective. "It’s that the antidepressants work better when compared to placebo, which is a little tricky," he says. "It means that, with the less severely depressed, placebos work pretty darn well." Another way to look at it is: If you have mild symptoms, you’re likely to get better with other options. "It could be well worth trying a nondrug treatment first, such as cognitive behavior therapy [CBT] or another psychotherapy," Sanora says. “According to WebMD, other therapies are encouraged first before introducing the drugs and it could be argued that religious reflection may be considered a type of home remedy psychotherapy, which unravels in people in their moments of existential crisis or later as mid-life crisis’s. Religious reflection could fill the gap by being a self-soothing form of therapy and may be labelled as when people “find themselves”, not only as an attempt to correct common disorders.
10-The drugs that are commonly prescribed are popular for a reason
Alternative therapies would be the norm if the drugs prescribed weren’t doing their job properly- so the common treatment plan includes similar drugs as there is proven evidence that they are effective. However, do the possible harms outweigh the benefits? The research published (Informed Health, 2020) suggests that caution is advisory and that other avenues should be explored first before drugs are prescribed. “Antidepressants can cause dizziness and unsteadiness, increasing the risk of falls and bone fractures. Interactions with other medications can increase this risk. A very small number of people have had heart problems, epileptic fits or liver damage while taking antidepressants. “It is believed that these were rare side effects of antidepressants
Various studies suggest that teenagers are more likely to think about killing themselves (committing suicide) when taking SSRIs or SNRIs, and attempt to take their own lives more often. Because of this, teenagers should see their doctor or therapist more regularly at the beginning of treatment so that any risk of suicide can be identified early on. It makes the most sense to prescribe drugs in severe cases where the benefits starkly outweigh the potential side effects; and while prayer may not be something that can be written down alongside a Prozac administration, with the research ongoing it may be useful to advertise its mindfulness benefits more, and how to begin treatment at home and while not a complete alternative it proves to be a harmless yet useful additive to a typical treatment plan, that may improve the quality of life of patients and further reduce other disorders down the line such as existential anxiety etc.
11-Other factors mediating the relationship between spirituality and mental health
Social support is something that directly impacts an individual’s mental health, reportedly more so than having a romantic partner does. The sense of community and support that is derived from members and leaders of religious congregations is widely considered as a key mediator between any links drawn between spirituality and mental health. Religious support provides a stable community that supports companionships and friendships that otherwise would not have been formed; and can be a valuable source of self-esteem and practical help that equips its members with the skills and help they need to cope with stress and negative episodes in their life much better than someone who feels alone or isolated. Some researchers have argued that certain elements of spirituality may positively affect many physiological mechanisms involved in health. Emotions encouraged in many spiritual traditions and religious reflections including hope, contentment, love, and forgiveness, may positively serve the individual, and thereafter the wider community by affecting the neural pathways that connect to the endocrine and immune system.
However, there are limitations to this research. It relies almost entirely on quantitative research methods which may not fully document the meaning spiritual activity has for the individual. The research methods used tend to try and isolate the impact of one activity (e.g., church attendance) upon another (e.g., level of depression), which may not always accurately represent the complicated interactions of other factors that are present on any association found. Yet another methodological limitation of the research is that it focuses on the effects of spirituality on mental health problems, with no mention of any pre-existing mental or physical factors that may affect it and therefore affect the results that are concluded. There are not many currently that address the mechanisms through which spirituality may promote good mental health and wellbeing in populations without those problems highlighted that the individuals may face. Is the research scientific enough to be applicable?
12-How can this research be implemented into treatment plans?
At the beginning of appointments or when symptoms are first noticed and addressed, the service providers should enquire about patients religious or spiritual obligations and needs prior to recognising objectives. All patients should also receive the option to speak to any recognised spiritual leader such as a chaplain or imam if desired. Spaces should also be made available to meditate or practise their faith in times of diagnosis and healthcare providers should avoid pathologizing or dismissing spiritual experiences of those who may experience them.
13-Can certain religious practices possibly interfere with the way the medicine works?
Certain religions reject certain medical practices that could be the difference between life and death due to their scripture- this could negatively impact the effectiveness of a formulated treatment plan. Muslims are generally not allowed to donate their organs after death; Jehovah’s witnesses cannot accept blood transfusions; the Amish refuse heart transplants and many Sikhs refuse treatment if any element contains animal products. This in turn could affect treatment if any of the capsules or tablets contained ingredients such as gelatine- where a more holistic approach such as meditation and reflection could be just as beneficial while respecting their beliefs.
14-Does being spiritual/religious affect depression?
Depressive episodes lead to excessive and usually unnecessary questioning; where doubt arises about the things that have previously given an individual motivation, meaning and hope that enables them to carry on and live their lives fully. These are key elements of life that tend to disappear partially or entirely from their lives during and after these episodes. Many religious and spiritual traditions are often followed as they offer those individuals who follow it a sense of meaning and purpose amidst an otherwise confusing and depressing existence; and aims to offer some sense of structure and security especially in current times of the world post pandemic where mental health is a growing issue.
Although more people are aware of the problems around mental health, the existential anxiety and uncertainty contributed to the number of young people also newly afflicted with these conditions. One of the key contributions of spirituality and religious reflection in the lives of these individuals, may be the power it offers to restore meaning, purpose and hope to their lives (Austin, Harkness and Ernst, 2000). It also provides a sense of order, where their days may revolve around things such as the 5 times daily prayers for Muslims instead of revolving around a job. One way in which meaning can be recovered through spirituality in the lives of people with depression is through mutual love, understanding of their issues, empathy and a sense of validation and adequacy.
It seems that when depression leads people to struggle with functioning with normal life after a testing life event or keeping up with their faith; the structures of religious reflection are able to calm people even during their worst moments.
Surprisingly even when in situations of life and death or high stress, even atheists admit to turning to a higher power for perceived comfort, even if it isn’t something they entirely believe in. In a pdf where meaningfulness through spirituality is explored, “Hodges describes four dimensions of spirituality – meaning of life, intrinsic values, belief in transcendence and spiritual community – and argues that each of these dimensions has an inverse linear relationship with depression. One study (Leibrich, 2002) found that for every 10-point increase in a person’s intrinsic religiosity, there was a 70% increase in recovery from depressive symptoms after physical illness. Similar findings have been found amongst those who believe in a transcendent being or higher power and amongst those who belong to a community with others who share their values and offer support.” So, it remains unknown if religious reflection is the sole cause of better recovery and quality of life in practising theists or whether it is the positive baggage that religion brings with it such as the supportive community or structure it provides.
15- Why focus on the treatment for young adults?
The heightened levels of anxiety recorded in young adults is at a record high due to a multitude of reasons, that previous generations didn’t have to juggle all at the same time or didn’t face at all. There are confusions around gender and race, and the rising of technology which brings along harm as well as benefit. Young adults are constantly being bombarded with news of the whole world in the space of seconds, and they are also constantly comparing their own lives to that of others carefully curated social media presences. In this time and place where so many things are questioned, a belief in a faith can center someone, and can be critical to the understanding they have of themselves. The extent of benefit reflection may have can have a projected outlook like that of the medication prescribed and should be considered a valuable asset in the alleviation of symptoms experienced especially in the early developmental years where medication may produce side effects in a time period where decisions are constantly made that will affect the future of the individual such as friend groups and careers. – (Anagha, K, 2021)
16-Can there be a negative relationship with prayer and healing?
The results are often down to personal differences between the relationship they have with their higher divine being that they spend time with or ask from. If they perceive their God as something or someone who is vengeful, spiteful, or angry, religion and times of spirituality could add to the stress they are already experiencing. However, if they view God in a positive light, and enjoy time and rituals spent with their deity they could find religion as an escape from a hectic life and busy day.
“Prayer may be associated with improvements that result from spontaneous remission, regression to the mean, nonspecific psychosocial support, the Hawthorne effect and the Rosenthal effect”- (Supplemental Material for A Matter of Faith: The Role of Religion, Doubt, and Personality in Emerging Adult Mental Health, 2018) prayer is often seen as a placebo, and any positive correlation between healing and time spent in religious reflection was as a result of random fluctuation in the severity of illness, or having a comforting environment rather than the actual effects of the act or intention of prayer. “Austin et al. (Sykes, 2000) defined distant healing to include spiritual healing, prayer, and any form of healing from a distance, effected as a conscious act that seeks to benefit another person. Therapeutic touch and Reiki were both included in the definition; as both may elicit an expectancy response, it becomes even harder to draw definitive conclusions about the literature that Austin et al. examined.” While hard to derive any positive outcomes to a single source, even a mix of many holistic and non-invasive therapies are seen to be helpful, and effective in a wide range of disorders, however the details are less researched- such as possible difference in recovery based on who does the praying/religious reflection.
17-Does the person praying make a difference- are results the same if you are the one praying versus the one prayed upon?
Cha et al. conducted a study with over 200 consecutive infertile women with ages ranging from 20 to 40, who were treated with IVF embryo transfer in Seoul, South Korea. These women were then randomly put into groups of distant prayer and control groups. Prayer was conducted by religious prayer groups in USA, Canada and Australia who would pray according to their rituals and beliefs for the group they were assigned. The patients and their providers were not informed about this, and they were unaware about whether they were being prayed for or not. The investigators, and even the statisticians who were dealing with all the numbers and producing graphs, did not know the group allocations until all the data had been collected, double checked, and measured against the control groups to remove bias and make sure all the research was accurate.
Thus, the study was randomized, triple-blind and strictly controlled. He concluded that the women who had been prayed for had nearly twice as high a pregnancy rate as those who had not been prayed for; the women who had been prayed for showed a higher implantation rate than those who had not been prayed for, even though they were unaware that they were being prayed for and the results can’t be extrapolated to another cause of the results found (Faulkner, 1998). Finally, the benefits of prayer were independent of clinical or laboratory providers and clinical variables. Thus, this study showed that distant prayer facilitates implantation and pregnancy and produces a higher chance of reaching interpersonal and societal goals.
18-So to what extent is religious reflection useful or helpful in the treatment of anxiety and depression in young adults?
Following the studies and the research carried out, religious reflection is a consequential addition to the treatment of not only anxiety and depression, but other societally imposed behaviours too such as the increased loneliness reported by all ages post pandemic. While we won’t be seeing 5 minutes of bible reading every morning prescribed by GP’s any time soon, it would prove to be a relatively easy and beneficial addition to many treatment plans. For the NHS, in their perspective it would be at no cost to them, and it may take more time to implement and educate the staff and healthcare providers, but the investment would later prove useful as the research backed evidence shows positive impact that the person can achieve relatively self-sufficiently, without relying on chemical drugs that may have adverse effects and cost a fair amount.
Even before a treatment plan, implementing routines of religious reflection may help to minimise symptoms before they are big enough to make an impact in the individuals’ personal life and daily functioning. Increased awareness and advertising of benefits may positively impact the mental health of not only individuals but communities as a whole and may be considered as more of a treatment especially after Covid.
Words- 5600
References
1)nhs.uk. (2021). Overview - SSRI antidepressants. [online] Available at: .
2)Mayo Clinic. (n.d.). The most commonly prescribed type of antidepressant. [online] Available at: .
3)Cornah, D. (2006). Impact spirituality. [online] Available at: https://www.mentalhealth.org.uk/sites/default/files/impact-spirituality.pdf.
4)The Independent. (2018b). Religious people live four years longer than atheists, study finds. [online] Available at: https://www.independent.co.uk/news/health/religion-live-longer-muslim-jewish-christian-hindu-buddhist-life-expectancy-age-a8396866.html..
5) Andrade, C. and Radhakrishnan, R. (2009). Prayer and healing: A medical and scientific perspective on randomized controlled trials. Indian Journal of Psychiatry, [online] 51(4), p.247. doi:10.4103/0019-5545.58288.
6)Quora (n.d.). The Science Behind Prayer And The Placebo Effect. [online] Forbes. Available at: https://www.forbes.com/sites/quora/2018/12/04/the-science-behind-prayer-and-the-placebo-effect/?sh=d7d783d639cd [Accessed 13 May 2022].
7) Psych Central. (2010). Spirituality and Prayer Relieve Stress. [online] Available at: https://psychcentral.com/blog/spirituality-and-prayer-relieve-stress#1.
8) Boseley, S. (2018). The drugs do work: antidepressants are effective, study shows. [online] the Guardian. Available at: https://www.theguardian.com/science/2018/feb/21/the-drugs-do-work-antidepressants-are-effective-study-shows.
9) WebMD (2014). WebMD - Better information. Better health. [online] WebMD. Available at: https://www.webmd.com/depression/features/are-antidepressants-effective. [Accessed 20 Jun. 2022].
10) Informed Health (2020). Depression: How Effective Are Antidepressants? [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK361016/.
11) Leibrich, J. (2002). Making space: Spirituality and mental health. Mental Health, Religion & Culture, 5(2), pp.143–162. doi:10.1080/13674670210144095.
12) Supplemental Material for A Matter of Faith: The Role of Religion, Doubt, and Personality in Emerging Adult Mental Health. (2018). Psychology of Religion and Spirituality. doi:10.1037/rel0000231.supp.
13) Sykes, S. (2000). A Matter of Faith: Religion and Mental Health. Journal of Public Mental Health, 2(2), pp.17–19. doi:10.1108/17465729200000012.
14) Faulkner, A. (1998b). Strategies for living. Mental Health Practice, 1(6), pp.7–7. doi:10.7748/mhp.1.6.7.s13.
15) Astin, J.A., Harkness, E. and Ernst, E. (2000). The Efficacy of ‘Distant Healing’. Annals of Internal Medicine, 132(11), p.903. doi:10.7326/0003-4819-132-11-200006060-00009.
16) Cognitive Behavioral Therapy Los Angeles (n.d.). How Effective Is Cognitive Behavioral Therapy. [online] Cognitive Behavioral Therapy Los Angeles. Available at: https://cogbtherapy.com/how-effective-is-cbt-compared-to-other-treatments.
17) Atheist, F. (n.d.). Jehovah’s Witnesses Reject Blood Transfusions, but Doctors Are Finding New Ways to Save Their Lives. [online] Friendly Atheist. Available at: https://friendlyatheist.patheos.com/2015/08/12/jehovahs-witnesses-reject-blood-transfusions-but-doctors-are-finding-new-ways-to-save-their-lives/ [Accessed 20 Jun. 2022].
18) iStockphoto, 2014 (2013). What If My Child Is Prescribed an SSRI? [online] MGH Clay Center for Young Healthy Minds. Available at: https://www.mghclaycenter.org/parenting-concerns/grade-school/child-prescribed-ssri/ [Accessed 20 Jun. 2022].
19) Rinna Sari (2013). Social Psychology:Schemas. [online] Available at: https://www.slideshare.net/rinazamri/social-psychologyschemas [Accessed 20 Jun. 2022].
20) Panchal, N., Kamal, R., Cox, C. and Garfield, R. (2021). The implications of COVID-19 for mental health and substance use. [online] The Henry J. Kaiser Family Foundation. Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/.
by
mahekhxgmailcom (student)
