Integrating Spirituality into Cognitive Behavioral Therapy in an Acute Psychiatric Setting: A Pilot Study
Rosmarin, David H., Auerbach, Randy P., Bigda-Peyton, Joseph S., Björgvinsson, Thröstur, Levendusky, Philip G., Journal of Cognitive Psychotherapy
Results from national studies in the United States suggest that spiritually integrated psychotherapy may be desired by and beneficial for a specific subset of patients. However, protocols to facilitate these aims within the context of evidence-based psychosocial treatments are few, and, consequently, the availability of spiritually integrated cognitive behavioral therapy (CBT) is limited. This article describes the development and implementation of a brief (50-minute), stand-alone Spirituality & CBT group piloted in an acute psychiatric setting. This novel treatment includes (a) psychoeducation about the relevance of spirituality to psychiatric symptoms, (b) the integration of spiritual beliefs into cognitive restructuring, and (c) the use of spiritual exercises in behavioral activation and self-care. We further report results from a brief survey of 45 patients regarding the perceived relevance of spirituality to symptoms and treatment and their subjective experiences in the group.
Keywords: spirituality; religion; culturally-sensitive treatment; diversity
National studies in the United States consistently highlight that spiritual beliefs and practices are part of daily life for most Americans (e.g., Gallup Poll, 2011; The Pew Forum on Religion & Public Life, 2008). Further, a rich body of empirical literature now ties spirituality and religion to psychological health in the general population. In one large-scale meta-analysis, 80% of 850 studies demonstrated a positive relationship between religious beliefs and practices and greater life satisfaction, and nearly two thirds of studies reported lower rates of anxiety and depression among more spiritual individuals (Koenig, McCullough, & Larson, 2001). Consistent evidence also indicates that spirituality and religion are vital resources for many individuals in times of psychological distress (Pargament, 1997). Consequently, it is not surprising that many medical and psychiatric patients report a desire for spiritually integrated care (Knox, Caitlin, Casper, & Schlosser, 2005; Lindgren & Coursey, 1995; Puchalski, Larson, & Lu, 2001).
In light of these findings, numerous spiritually integrated psychosocial treatments have been developed in recent years (Pargament, 2007). Spiritually integrated treatments are similar to conventional psychotherapy except the rationale for treatment can be presented in a spiritual framework, and patients are encouraged to harness spiritual resources and address spiritual concerns with the hope of ameliorating symptoms and enhancing motivation and treatment compliance. Numerous attempts to integrate spirituality into cognitive behavioral therapy (CBT) and rational emotive behavioral therapy have been met with success (see Rosmarin, Pargament, & Robb, 2010 for a discussion). In terms of treatment efficacy, although research on spiritually integrated treatments is still emerging, nearly 40 clinical trials have now been conducted and initial findings seem promising. Several prominent, randomized controlled studies have now demonstrated that spiritually based treatments can be effective for various symptoms, particularly for religious patients (e.g., Oman, Hedberg, & Thoresen, 2006; Propst, Ostrom, Watkins, Dean, & Mashburn, 1992; Rosmarin, Pargament, Pirutinsky, & Mahoney, 2010; Wachholtz & Pargament, 2009). Moreover, some research has indicated that spiritually integrated treatments might be marginally more effective than established secular therapies (Hook et al., 2009). For example, one recent meta-analysis (Smith, Bartz, & Richards, 2007) found that interventions with spiritual components produced a .51 greater reduction in symptoms than those without, across 16 experimental and quasi-experimental studies. Although the early state of literature and major methodological limitations in many previous studies make it difficult to speak conclusively about the comparative efficacy of spiritually integrated to secular treatments, more research and development in this area seems warranted. …