Fold Faith into the Treatment Mix for Depression
According to the Disease Control and Prevention Morbidity and Mortality Weekly Report from June 16, 2023, 18.5% of adults over 18 self-reported a lifetime diagnosis of depression. Per the National Health Interview Survey (NHIS), 40% of US high school students in 2023, reported persistent feelings of sadness and hopelessness in the past year, 20% seriously considered suicide, 16% made a suicide plan and 9% reported a suicide attempt.
According to the National Institutes of Health (NIH), an estimated 21 million adults in the United States had at least one major depressive episode in 2021. This number represented 8.3% of all U.S. adults. The Center for Disease Control reported that 12.5% of emergency department visits were related to depression (National Center for Health Statistics 2023).
Suicide ranks as the second leading cause of death in the US for ages 5-24 and 10-34 and the fourth leading cause for ages 35-54. Approximately 40% of the increase in the US suicide rate between 1999 and 2014 could be attributed to the decline in weekly religious attendance during that period (Thygesen, Dalton and Johansen, 2017).
Studies have shown that approximately 60% - 70% of depressed patients improve when combining counseling and psychotropic medication. (Psychology Today, 2018). Given the tremendous emotional and physical pain that patients with depression experience, falling far short of complete treatment coverage ought not be acceptable.
There is a practice that goes a long way in filling the healing gap, religion or faith in a God. Unfortunately, many health organizations and providers shy away from, ignore or lack faith in religion as a mitigating factor against depression because of an attachment to science and/or a negative attitude toward religion.
Over the past several decades a substantial body of research with origins in very different disciplines, ranging from the social sciences to psychiatry to clinical epidemiology, has emerged pertaining to the association between religion and the course of depression. Several aspects of religion such as church-attendance, community involvement and pertinence to living well, have now been shown to have a consistent ability to predict lower levels of depression over time.
Religiously-integrated cognitive behavioral therapy (RCBT) for depression was developed in 1992 by Rebecca Propst, Ph.D. from Duke University and colleagues (Journal of Consulting and Clinical Psychology, 1992). RCBT is the reframing of negative or distorted thoughts using Biblical scripture or the word of God. Dr. Propst and her colleagues compared religious vs. conventional Cognitive Behavioral Therapy (CBT) for depressed religious adults and found that 18 weekly sessions of RCBT resulted in faster improvement in depressive symptoms than conventional CBT.
In an analysis of 46 studies (3,290 participants) examining outcomes from religious therapies and non-religious spiritual therapies, Worthington and colleagues found that clients receiving religious therapies showed greater improvement on psychological outcomes than those receiving secular psychotherapies (Worthington Jr, 2011).
256 studies reported greater life satisfaction, happiness or other indicators of well-being among the more religious. Seven of these studies reported a significant positive relationship between positivity and religiosity (Koenig, Kleiman and Liu, 2012).
Another large body of research has demonstrated that religiosity increased Serotonin levels, led to a thickening of the cortex of the brain or provided protection against cortical thinning (Weissman, 2019) and provided mood resilience for adults who experienced childhood abuse.
Additionally, religiosity closed the gap in the mood of adults with a high risk of depression due a family history of depression and those without a family history of depression or at low risk (Miller, Wickramaratne, Gameroff, Sage, Tenke and Weissman, 2012). Lastly, religiosity enables better blood flow to brain areas associated with positivity and low levels of depression (Newberg, 2011).
Religion not only serves as an antidote for depression, but also provides prophylactic against this disease. By relying on faith from an early age, one develops a spirit of joy, peace, love, kindness and “an anchor for the soul” in a soulless world.
Given the cited research, psychologists, clinical social workers and licensed mental health clinicians ought to be as ethically obligated to identify and utilize the practice of religion, e.g., RCBT as any of the other treatments of choice for depression, e.g., Cognitive Behavioral Therapy, Psychodynamic Therapy, Positive Psychology, Mindfulness-Based Therapy and physical exercise.
Behavioral health clinicians may or may not be familiar with any particular religion but certainly can reference the relevant research and emphasize the importance of learning recommended habits or practices of a patient’s chosen religion. Moreover, clinicians ought to familiarize themselves with these practices and follow-up with patients regarding these habits to learn how often each are employed and what the impact is on mood.
Reading religious text is an obvious habit for any religious practice whether it be the Bible for Christians, Qur’an for Muslims, Torah for Jews or the sacred texts of Hinduism or Buddhism. For this paper, the Bible will be the focus. The Bible is an instruction manual for all of life’s problems. In fact, scripture or the word of God has answers to the classic symptoms of depression. The following verses address these symptoms and feelings of depression that appear in the diagnostic reference manuals of psychiatry, the DSM-5-TR and ICD-10-CM.
Pervasive Sadness/Low Mood
The LORD is close to the brokenhearted and saves those who are crushed in spirit (Psalms 34-18).
Feelings of Hopelessness
May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope (Romans 15:13).
Feelings of Helplessness
Ask and it will be given to you; seek and you will find; knock and the door will be opened to you. For everyone who asks receives; the one who seeks finds; and to the one who knocks, the door will be opened (Matthew 7:7-8).
Feelings of Worthlessness
Others were given in exchange for you. I traded their lives for you because you are precious to me. You are honored and I love you. (Isaiah 43:4).
Negative Thoughts
Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things (Philippians 4:8).
Crying Spells
In my distress I called upon the LORD; to my God I cried out for help. From his temple he heard my voice, and my cry to him reached his ears (Psalm 18:6)
Excessive Guilt
God is faithful and reliable. If we confess our sins, he forgives them and cleanses us from everything we’ve done wrong (1 John 1:9).
Shame
For the Scripture says, “Everyone who believes in him will not be put to shame (Romans 10:11).
Joylessness
These things I have spoken to you, that my joy may be in you, and that your joy may be full
(John 15:11).
Low Energy
But they who wait for the Lord shall renew their strength; they shall mount up with wings like eagles; they shall run and not be weary; they shall walk and not faint (Isaiah 40:31).
Lack of Motivation
I can do all things through him who strengthens me (Philippians 4:13).
Loneliness/Isolation
Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand (Isaiah 41:10).
Darkness
Again Jesus spoke to them, saying, “I am the light of the world. Whoever follows me will not walk in darkness but will have the light of life (John 8:12).
Ruminations
Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus (Philippians 4:6-7).
Sleeplessness
Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light (Matthew 11:28-30).
Poor Appetite
Blessed are those who hunger and thirst for righteousness, for they shall be satisfied (Matthew 5:6).
Difficulty Making Decisions
I will instruct you and teach you in the way you should go; I will counsel you with my eye upon you (Psalm 32:8).
Purposeless
I cry out to God Most High, to God who fulfills his purpose for me (Psalm 57:2).
Restlessness
Be still, and know that I am God. I will be exalted among the nations, I will be exalted in the earth (Psalm 46:10).
Suicidal Thoughts
For I am sure that neither death nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord (Romans 8:38-39).
There are several figures in the Bible who appeared to suffer from depression. Hannah felt worthless and despaired because she was unable to conceive a baby. The prophet Elijah was physically and emotionally depleted and suicidal after battling the people of Baal and fasting for 40 days in the wilderness. Job wished he was never born after losing everything he had including his wife and children. King David experienced anguish, loneliness, guilt and grief due to his failures and losses including the death of his 2 sons. Jonah was swallowed by a whale and wanted to die because he ran away from God’s purpose for him. Jeremiah, known as the weeping prophet, experienced profound sadness and loneliness because he was not able to marry or have children, felt rejected by the people to whom he ministered and lamented that he wished he was never born. Moses was so depressed, and grief stricken by the sins of his followers, he asked God to deny him a place in eternity. Finally, even Jesus himself felt deep sorrow and fear as he anticipated the inevitable suffering he would experience on the cross. The Lord’s anguish was so great that he sweat “drops of blood.”
These seven biblical figures experienced depressive symptoms due to immense trials but remained faithful until God intervened and provided each mercy, transformation and in Jesus’ case resurrection. For example, Hannah which means “Grace of God” miraculously got pregnant for the first time at age 130, had 6 children in all and her first child, Samuel, meaning “God Heard”, became a prophet of God, a judge and an anointer of Kings.
In the final analysis, Jehovah Raffa, God the healer, and the restorative nature of his word in the Bible is far too potent of a weapon against depression to be kept a secret weapon. Likewise, it is the case for the Qur’an, Torah and the sacred texts of Hinduism and Buddhism. The word of God not only presents the way to ameliorate depressive symptoms but also the opportunity to transform from a self-involved, scarcity mindset to a heart of abundance, dedicated to serving others. By receiving God’s omniscient instruction, one develops hope, purpose and not just a reason for living but a reason for living well. And finally, by accepting the love of God, we are called to share this love with our neighbors, and nothing is more healing for one’s spirit.