Recent research results show that a thorough S/R assessment is well tolerated by patients with psychosis.13 Following the assessment, a patient might want to discuss S/R issues with his or her psychiatrist. The major S/R themes elicited during the discussion can be integrated into treatment and used to support positive coping and address negative coping.
Religion and psychiatric disorders
The patient’s dependence on S/R is not directly related to his diagnosis; however, there are certain connections. In a patient with MDD, the effect of S/R ranges from increased vulnerability to better recovery. For example, people involved in religion may be more likely to report feelings of guilt, even though this may be more a reflection of their perceived moral standards and religious upbringing than about pathological guilt.
S/R activities have been shown to reduce the risk of suicide both in the general population and in depressed patients. Spirituality may foster the acquisition of a positive world view and provide meaning, hope, and acceptance.17 Furthermore, religious worship attendance has been found to be an independent protective factor against suicide attempts.18
Symptoms of obsessive-compulsive disorder (OCD) may involve a religious dimension. Research shows that religiosity is significantly correlated with the severity of OCD symptoms.8 Nevertheless, it is not possible to say whether religiosity aggravates OCD symptoms or whether OCD symptoms lead to greater religiosity.
Spirituality and religiosity are well-known protective factors that consistently predict lowered risk of alcohol and drug misuse. S/R acts through a reduction of behavioral risks brought about by the promotion of a healthier lifestyle and by expanding the social support network.
Regarding the relationship between S/R and bipolar disorder, the question remains as to what extent religious tradition influences the emergence of increased religious insights and emotions during the manic state. S/R preoccupations can be an early sign of relapse into a manic episode. During the depressive state and the symptom-free interval, the patient may experience disillusionment with S/R.
S/R coping appears to be important for a large majority of patients with psychosis. Religion provides these patients with a positive sense of self, guidelines for interpersonal behavior, and resources to cope with symptoms.7 At times, patients with psychosis may present with delusions consisting of S/R content. Those delusions may coexist with positive S/R coping. In treating patients with such symptoms, look beyond the label of religious delusion, which is likely to involve stigmatization. Recommended strategies are to treat religious delusions with standard care, assess the patient’s spiritual struggles and spiritual resources, and collaborate with a member of the clergy when appropriate.19
Interventions beyond the spiritual assessment
Spiritual assessment, which can reveal psychological and social issues that are relevant to treatment, should be part of the investigation of the cultural context of any patient who presents to a psychiatric facility.20 Any S/R issues that arise during the assessment should be addressed as part of supportive psychotherapy, which will foster positive coping and help the patient deal with any associated negativity (ie, spiritual struggle).
Depending on the cultural context, some cases may be more complex. In some areas where there are no psychiatrists, traditional healers will try to help patients with mental disorders in the context of “integrated care” that incorporates both spiritual healing and more secular techniques. Conversely, in most European countries, psychiatrists work from a layman’s position. Hence, issues that arise during the spiritual assessment may be considered as pertaining to clergy and/or religious representatives. The complexity of this field is also related to the existence of a gray zone, sometimes grounded in the domain of psychotherapy, in which some intrapsychic material may be considered either as theological or as a cognitive process that warrants psychological intervention, or as both.
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