Anxiety, religion, and spirituality
Given the ubiquity of anxiety and religion, it is surprising how little research has been done with respect to the relationship between the two. The investigation of religious and spiritual issues in anxiety lags behind research on mental disorders such as depression and psychosis. Religious beliefs, practices, and coping may increase the prevalence of anxiety through the induction of guilt and fear. On the other hand, religious beliefs may provide solace to those who are fearful and anxious. Studies on anxiety and religion have yielded mixed and often contradictory results that may be attributed to a lack of standardized measures, poor sampling procedures, failure to control for threats to validity, limited assessment of anxiety, experimenter bias, and poor operationalization of religious constructs.27
Some studies have examined the relationships between religiosity and specific anxiety disorders such as obsessive-compulsive disorder and posttraumatic stress disorder (PTSD). Contrary to the views of Freud,28 who saw religion as a form of universal obsessional neurosis, the empirical evidence suggests that religion is associated with higher levels of obsessional personality traits but not with higher levels of obsessional symptoms. Religion may encourage people to be scrupulous, but not to an obsessional extent.29,30 Although religion has been found to positively affect the ability to cope with trauma and may deepen one’s religious experience, others have found that religion has little or negative effect on symptoms of PTSD.31
The relationships between generalized anxiety and religious involvement appear to be complex. In a comprehensive review of the relationship between religion and generalized anxiety in 7 clinical trials and 69 observational studies, Koenig and colleagues8 found that half of these studies demonstrated lower levels of anxiety among more religious people, 17 studies reported no association, 7 reported mixed results, and 10 suggested increased anxiety among the more religious.
A person’s strong religious beliefs may facilitate coping with existential issues whereas those who hold weaker beliefs or question their beliefs may demonstrate heightened anxiety.32 These contradictory findings may be accounted for by the fact that researchers have used diverse measures of religiosity. Other studies have focused on death anxiety. Research conducted in the United States and abroad points to denominational differences as well as to differential effects of religion and spirituality and emphasizes the complex relationships between religious and cultural factors.33 Studies on anxiety and religion to date have emphasized cognitive aspects of anxiety as opposed to the physiological aspects. Future studies should include physiological parameters.
A number of pathways have been discussed in the literature through which religion/spirituality influence depression/anxiety: increased social support; less drug abuse; and the importance of positive emotions, such as altruism, gratitude, and forgiveness in the lives of those who are religious. In addition, religion promotes a positive worldview, answers some of the why questions, promotes meaning, can discourage maladaptive coping, and promotes other-directedness.
Religion and coping in schizophrenia
Research in schizophrenia and religion has predominantly examined religious delusions and hallucinations with religious content. Recently, however, religion as a coping strategy and factor in recovery has been the subject of growing interest.34 Religious delusions have been associated with poorer outcomes, poorer adherence to treatment, and a more severe course of illness.35
A number of studies suggest that religious beliefs and practices can be a central feature in the recovery process and reconstruction of a functional sense of self in psychosis.36 On the other hand, Mohr and colleagues37 found that although religion instilled hope, purpose, and meaning in the lives of some persons with psychosis, for others, it induced spiritual despair. Patients also reported that religion lessened psychotic symptoms and the risk of suicide attempts, substance use, nonadherence to treatment, and social isolation.
Given that most religions actively discourage the use of substances that adversely affect the body and mind, it is unsurprising that studies generally indicate strongly negative associations between substance abuse and religious involvement. In a review of 134 studies that examined the relationships between religious involvement and substance abuse, 90% found less substance abuse among the more religious.8 These findings are corroborated by more recent national surveys and studies in alcohol(Drug information on alcohol) and drug use in African Americans, Hispanic Americans, and Native Americans that similarly indicate negative associations between religious involvement and substance abuse.38-41