Integration of Spirituality in Psychiatric Treatment May Boost Effectiveness

Spirituality and existential concerns that some patients may bring to treatment share with psychiatry some important goals and emphases—maintenance of hope, formation of identity, the importance of meaning and purpose, and questions about how to be moral. That’s what psychiatrist John Peteet, M.D., a professor of psychiatry at Harvard Medical School, and a panel of psychiatrists and mental health professionals representing various perspectives and faith traditions, said at APA’s 2014 annual meeting today in the symposium, “The Meaning of Despair: Existential and Spiritual Dimensions of Depression and Its Treatment.”

Presenting with Peteet at the symposium were David Rosmarin, Ph.D., of Harvard; Arjan Braam, M.D., of Altrecht Mental Health Care in the Netherlands; Gerit Glas, M.D., Ph.D., of University Medical Centre Utrecht and the University of Leiden; and Walid Sarhan, M.D., a consultant psychiatrist in Amman, Jordan, and chief editor of the Arab Journal of Psychiatry.

They emphasized that depression often has an existential and spiritual dimension, and many studies have found an inverse correlation between religious/spiritual involvement and depression. Yet the implications of these findings for clinicians have remained unclear. Presenters explored the evidence for belief in God as a factor in the recovery of depressed patients (Rosmarin), the relationship between God image and mood in late life (Braam), existential aspects of depression (Glas), a conceptual framework for spiritually integrated treatment of depression (Peteet), and depression and religious thinking from a Muslim perspective (Sarhan). Discussion focused on challenges and opportunities in treating patients suffering from emotional, spiritual, and/or existential distress.

In his talk, titled “Depression and the Soul,” Peteet said there were several bases for the integration of spirituality and psychiatric treatment of depression. They include the following: both depression and spirituality have been shown to have correlates in the limbic system; major depression has an important social and spiritual context; combined medication and talk treatment have the best outcomes; and both psychotherapy and spiritual practices produce brain changes.

Also, he presented results from the psychiatric literature showing spirituality to be protective, or important in the recovery from mental illness. A 2012 study by Miller and colleagues in the American Journal of Psychiatry looked at 114 adult offspring of depressed and nondepressed individuals followed longitudinally. At 10 years, offspring who reported that religion or spirituality was highly important to them had one-fourth the risk of major depression. The greatest protective effect was observed in offspring of depressed parents, who were found to have one-tenth the risk.

Peteet offered some questions for the future: What is the relationship between spiritual distress and depression? What evidence supports the use of which spiritual interventions in depression, and by what mechanisms? What models of integrated care have the most promise? What implications does the connection between spirituality and depression have for education and training? What is the relationship among emotional, existential, and spiritual distress?

“Spirituality can be a resource in dealing with problems related to identity, hope, meaning/purpose, guilt, or connection,” Peteet said. “But spiritual conflicts and loss can be risk factors and survivors may need support in their struggles with spiritual questions.”