Friday, March 12, 2021

Spiritual CBT Protocol May Help Patients Integrate Their Spirituality Into Treatment

Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) may be useful for patients in psychiatric hospitals who wish to integrate spirituality into their treatment, a study in Psychiatric Services in Advance suggests. SPIRIT is based on cognitive-behavioral therapy (CBT) and includes a psychoeducation component and specific tools or skills drawn from spiritual concepts or beliefs and activities that patients can use to shape their emotional experience.

David H. Rosmarin, Ph.D., of Harvard Medical School, and colleagues analyzed data from a one-year trial at McLean Hospital, an independent academic psychiatric hospital in Belmont, Mass. During the trial, 22 clinicians in 10 different clinical units provided SPIRIT to 1,443 adults. The patients had a range of psychiatric diagnoses such as bipolar disorder, depressive disorder, eating disorders, psychotic disorders, trauma- or stress-related disorders, substance use disorder, or other disorders. Clinicians identified with a range of religious or spiritual affiliations: Buddhist, Catholic, Jewish, Muslim, Protestant, spiritual but not religious, and no affiliation. Clinicians included mental health specialists, social workers, expressive art therapists, psychologists, and others.

All patients completed one SPIRIT group session, after which they completed the Clinically Adaptive Multidemensional Outcome Survey, which assesses the importance of spirituality and religion to the patient and whether the patient believes in God. The survey also assesses indicators of spiritual distress such as loss of spiritual inspiration or direction and spiritual guilt. Patients were also asked how much they agreed or disagreed with the following statements following their participation in the SPIRIT group: “This group helped identify spiritual/religious resources that I can utilize to reduce my distress” and “This group helped identify spiritual/religious struggles that are contributing to my distress.”

Sixty-nine percent of patients reported that SPIRIT helped them to identify spiritual and religious resources to aid their recovery to at least a “fair” extent and 47% reported such benefits to at least a “moderate” extent. Among those with significant spiritual distress, 76% reported that SPIRIT helped them to identify spiritual and religious struggles that were contributing to their distress to at least a “fair” extent and 51% reported that SPIRIT did so to at least a “moderate” extent. The patients’ diagnoses did not appear to affect how likely they were to respond to SPIRIT. However, greater religious affiliation in the clinicians who provided SPIRIT was associated with worse treatment outcomes, regardless of the patients’ spiritual or religious affiliation.

“Our results … suggest that religious therapists may be less apt in providing spiritual psychotherapy, compared with their secular colleagues. It is possible that religious therapists struggle to maintain objectivity about the subject matter when delivering clinical interventions that include spiritual content,” the researchers wrote. “Moreover, secular clinicians might be better positioned to validate and convey the importance of patients’ spiritual needs because they have no personal or religious incentive.”

For related information, see the American Journal of Psychotherapy article “Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment.”

(Image: iStock/Boonyachoat)

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