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christian counseling today
Vol. 21 no. 2
sessions of RCBT resulted in faster improvement in depressive symptoms
than conventional CBT, although the difference faded to non-significance
by three months post-intervention (when depressive symptoms were low
level for all participants). In a 2011 meta-analysis of 46 studies (3,290
participants) examining outcomes from religious accommodative therapies
and non-religious spiritual therapies, Worthington and colleagues found
that clients receiving religious accommodative therapies showed slightly
greater improvement on psychological outcomes than those receiving
secular psychotherapies.
7
Are there certain parameters or constructs pertaining to a patient’s faith
orientation or specific practices that are particularly effective? Regardless
of technique, the therapeutic alliance that develops between therapist
and client seems to be a dominant factor (as it is in secular therapies). We
recently developed a version of religiously-integrated CBT
8
and compared
it to conventional CBT in 132 clients (88% Christian) with major depres-
sion and chronic medical illness. Five, manual-based, religiously-integrated
therapies were developed, starting first with a Christian prototype
9
and then
developing Jewish, Muslim, Buddhist, and Hindu versions.
10
The results
of this randomized clinical trial indicated equal efficacy for both RCBT
and CBT in reducing depressive symptoms, and RCBT was more effective
than CBT in highly religious clients (who were also more adherent with
RCBT).
11
In that study, the therapeutic alliance developed more rapidly
in those receiving RCBT, although conventional CBT soon caught up.
12
Religiously-integrated forms of psychotherapy for anxiety in patients from
non-Christian faith backgrounds have been developed… and found to be
more effective than conventional treatments, but again only in those who
are religious.
13, 14
Thus, it appears that religiously-integrated psychothera-
pies are most effective in religious clients and may not be as useful in those
who are less religious. We are now developing a religiously-integrated form
of psychotherapy for “moral injury” in active duty U.S. soldiers and veterans
with post-traumatic stress disorder (PTSD), many of whom are religious and
having inner conflicts over what they experienced while serving in the mili-
tary (which could be driving PTSD symptoms years later).
15
With regard to suicide, there is now a vast amount of research
published in peer-reviewed academic journals documenting that religious
faith makes a difference in terms of suicidal thoughts, plans, attempts, and
completed suicide. In our systematic review of the peer-reviewed litera-
ture published prior to 2010, we identified 141 quantitative studies that
had examined relationships between religious involvement and suicidal
thoughts, attempts, or completed suicide. Of those, 106 (75%) reported
significantly fewer suicidal tendencies in those
who were more religious.
16
Multiple studies
published within the past 18 months confirm
these findings across different populations and
geographical areas.
17, 18, 19, 20
Not all research, however, finds that religious
belief has a protective effect on suicidal tenden-
cies. This is particularly true for studies coming
out of mainland China. In a psychological
autopsy study of 392 suicides in people aged
15–34 compared to matched living controls from
rural counties in China in 2008, religious involve-
ment was significantly
more common
among
young people who committed suicide compared
to controls (28.8% vs. 16.8%), especially among
men (24.8% vs. 9.9%).
21
When other predictors
of suicide were controlled, though, the differences
lost statistical significance.
In a more recent study, we examined suicidal
thoughts, plans, and attempts in a population-
based sample of 2,769 community-dwelling
adults in far Western China (50% without any
religious affiliation), a region where more than
one-third of the population is Muslim.
22
We
also found that higher personal religiosity scores
and total religiosity were correlated with more
suicidal tendencies, but again this relationship
disappeared after controlling for demographic
characteristics. In secular countries like China
(2.8% Christian), many turn to religion for
comfort only after their lives become desperate.
As a result, religiosity often becomes a marker
for emotional distress. Also, historically, those
needing mental health care in China typically
sought help from the Church, which was their
only option. Thus, the relationship between faith
and suicide is not always simple.
My own beliefs were recently challenged in a case
that made me realize how complex the situa-
tion may become when faith and yearnings to
die occur in the setting of severe and protracted
physical illness. Mr. Q was an elderly gentleman
is his mid-80s who had a very successful and
active career in business, many friends, a devoted
wife, and several children who were incredibly
involved in his life.
23
Mr. Q’s latter years had
not been kind to him. Very independent and
physically vigorous throughout most of his life,
things changed after he reached the age of 80. At
that time, he developed chronic pain syndrome,
problems with his bladder causing incontinence,
With regard to suicide, there is now
a vast amount of research published
in peer-reviewed academic journals
documenting that religious faith makes a
difference in terms of suicidal thoughts,
plans, attempts, and completed suicide.