David Hillel Rosmarin

A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community, delivered via the Internet

OBJECTIVE This study evaluated the efficacy of a spiritually integrated treatment (SIT) for subclinical anxiety in the Jewish community. METHOD One hundred and twenty-five self-reported religious Jewish individuals with elevated levels of stress and worry received SIT (n=36), progressive muscle relaxation (PMR, n=42), or a waitlist control condition (WLC, n=47). SIT and PMR participants accessed Internet-based treatment on a daily basis for a period of 2 weeks. All participants completed self-report assessments at pre-treatment (T1), post-treatment (T2), and 6-8-week follow-up (T3). RESULTS SIT participants reported large improvements in primary (stress and worry) and secondary (depression and intolerance of uncertainty) outcomes, and moderate improvements in spiritual outcomes (positive/negative religious coping; trust/mistrust in God). SIT participants reported greater belief in treatment credibility, greater expectancies from treatment and greater treatment satisfaction than PMR participants. SIT participants also reported better improvements in both primary outcomes (stress and worry), one of two secondary outcomes (intolerance of uncertainty), and two of four spiritual outcomes (positive religious coping and mistrust in God) compared to the WLC group, whereas PMR and WLC participants did not differ on most outcomes. CONCLUSIONS Results of this investigation offer initial support for the efficacy of SIT for the treatment of subclinical anxiety symptoms among religious Jews. Results further suggest that it is important to incorporate spiritual content into treatment to help facilitate the delivery of psychotherapy to religious individuals.

The role of religiousness in anxiety, depression, and happiness in a Jewish community sample: A preliminary investigation

Although social scientists have convincingly demonstrated relationships between religious beliefs/practices and mental health, almost none of the empirical findings or related theory apply specifically to Jews. To address this limitation, we investigated the role of Jewish religiousness in anxiety, depression, and happiness, in a large Jewish community sample (n = 565). Several facets of global Jewish religiousness were examined, as well as a theoretically based Jewish religious variable, trust in God. A self-report measure of trust in God was created, and factor analyses yielded two reliable and valid subscales: trust in God and mistrust in God. Contrary to our hypotheses, global Jewish religiousness was on the whole unrelated to mental-health functioning. As expected, higher levels of trust in God were associated with less anxiety and depression, and greater personal happiness, whereas inverse associations emerged for the unanticipated but robust mistrust subscale.

The importance of worry across diagnostic presentations: prevalence, severity and associated symptoms in a partial hospital setting.

Although excessive worry has been linked primarily with Generalized Anxiety Disorder (GAD), recent work suggests worry is dimensional, with potential relevance to a range of psychiatric disorders. The current study examined associations between worry and psychological symptoms across several primary diagnoses and tested worrys hypothesized unique relation to GAD in an acute psychiatric setting. Participants were 568 patients with primary diagnoses of Major Depression, Bipolar Disorder-Depressed, Bipolar Disorder-Manic, and Psychosis. Participants completed a structured diagnostic interview and questionnaires at admission. Partial correlations controlling for GAD diagnosis indicated that worry correlated with higher depression and poorer overall well-being in the Depressed, Bipolar-Depressed, and Psychosis groups and decreased functioning in the Depressed, Bipolar-Manic, and Psychosis groups. Depressed and Bipolar-Depressed groups endorsed the highest level of worry. A comorbid anxiety disorder was associated with higher worry across primary diagnoses, even after controlling for GAD. Of the anxiety disorders, GAD and Panic Disorder diagnoses predicted higher worry scores. Results discussed in terms of conceptual implications for worry as a transdiagnostic concept and clinical interventions.

Religious coping among psychotic patients: Relevance to suicidality and treatment outcomes

Religious coping is very common among individuals with psychosis, however its relevance to symptoms and treatment outcomes remains unclear. We conducted a prospective study in a clinical sample of n=47 psychiatric patients with current/past psychosis receiving partial (day) treatment at McLean Hospital. Subjects completed measures of religious involvement, religious coping and suicidality prior to treatment, and we assessed for psychosis, depression, anxiety and psychological well-being over the course of treatment. Negative religious coping (spiritual struggle) was associated with substantially greater frequency and intensity of suicidal ideation, as well as greater depression, anxiety, and less well-being prior to treatment (accounting for 9.0-46.2% of the variance in these variables). Positive religious coping was associated with significantly greater reductions in depression and anxiety, and increases in well-being over the course of treatment (accounting for 13.7-36.0% of the variance in change scores). Effects remained significant after controlling for significant covariates. Negative religious coping appears to be a risk factor for suicidality and affective symptoms among psychotic patients. Positive religious coping is an important resource to this population, and its utilization appears to be associated with better treatment outcomes.

Religion as a Predictor of Psychological Distress in Two Religious Communities

Although spirituality and religion play a role in the lives of many North Americans, the relationship of these variables to symptoms of affective disorders has not been rigorously studied. The authors, therefore, evaluated the extent to which religious factors predicted symptoms of distress in a large community sample of 354 individuals (120 Christian and 234 Jewish). Results indicated that religious denomination was a poor predictor of distress. However, general religiousness (e.g. importance of religion), religious practices (e.g. frequency of prayer), and positive religious core beliefs predicted lower levels of worry, trait anxiety, and depressive symptoms, whereas negative religious core beliefs predicted increased symptoms. These variables accounted for a small but significant portion of the variance in reported symptoms after controlling for covariates. These findings are taken to indicate that religion is an important factor to consider when evaluating and treating distress in religious individuals. Implications for clinical practice of empirically supported treatments with religious individuals are explored.

Religious Coping Among Jews: Development and Initial Validation of the JCOPE

Numerous studies have underscored the importance of religious coping in psychological health and illness; however, the majority of research in this area has been conducted with Christian samples and knowledge about other religious groups is lacking. Although recent investigations have developed scales to measure religious coping among Hindus and Muslims, the potential for future research in Jewish populations remains limited as no measures of religious coping have been validated in the general Jewish community. This two-part study reports on the development and validation of the 16-item Jewish Religious Coping Scale (JCOPE). In Study 1, an exploratory factor analysis identified two factors reflecting positive and negative religious coping strategies, and the concurrent validity for the measure was evaluated by examining correlations with indices of Jewish beliefs and practices. In Study 2, a confirmatory factor analysis (CFA) verified the JCOPEs 2-factor structure, and the scales incremental validity was evaluated by examining Jewish religious coping as a predictor of psychological distress over and above significant covariates. Results suggest that the JCOPE has good psychometric properties, and that religious coping is a significant predictor of psychological distress among Jews.

Grateful to God or just plain grateful? A comparison of religious and general gratitude

Psychological science has consistently highlighted links between gratitude and religion, however mediating pathways by which religion relates to gratitude remain ambiguous. Further, it is unclear whether religious gratitude (e.g., gratitude to God) is more related to well-being than general gratitude. To address these gaps, we assessed for both religious and general dimensions of gratitude alongside measures of religious commitment and mental/physical well-being in a diverse sample of n = 405 adult individuals. Consistent with previous research, gratitude was positively correlated with religious commitment (r = 0.45, p < 0.001). This relationship, however, was fully mediated by gratitude towards God. Using hierarchical linear regression, results further found that the interaction of religious commitment and religious gratitude added unique variance in predicting mental well-being, over and above general gratitude. This suggests that being grateful to God enhances the psychological benefits of gratitude in accordance with ones level of religious commitment.

Religious and spiritual factors in depression: review and integration of the research.

Depressive symptoms and religious/spiritual (R/S) practices are widespread around the world, but their intersection has received relatively little attention from mainstream mental health professionals. This paper reviews and synthesizes quantitative research examining relationships between R/S involvement and depressive symptoms or disorders during the last 50 years (1962 to 2011). At least 444 studies have now quantitatively examined these relationships. Of those, over 60% report less depression and faster remission from depression in those more R/S or a reduction in depression severity in response to an R/S intervention. In contrast, only 6% report greater depression. Of the 178 most methodologically rigorous studies, 119 (67%) find inverse relationships between R/S and depression. Religious beliefs and practices may help people to cope better with stressful life circumstances, give meaning and hope, and surround depressed persons with a supportive community. In some populations or individuals, however, religious beliefs may increase guilt and lead to discouragement as people fail to live up to the high standards of their religious tradition. Understanding the role that R/S factors play in preventing depression, facilitating its resolution, or leading to greater depression will help clinicians determine whether this is a resource or a liability for individual patients.

Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: A pilot randomized trial.

Abstract We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = −0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression in persons with chronic medical illness. Efficacy, as well as adherence, may be affected by client religiosity.

Do medical models of mental illness relate to increased or decreased stigmatization of mental illness among orthodox Jews

Research suggests that attributing mental illness to moral causes and perceiving it as dangerous relates to greater stigma, whereas belief in biomedical factors is associated with less. Within the family-centric Orthodox Jewish community, mental illness is perceived as a risk to family functioning and future generations, and is therefore stigmatizing of the individual and their family. Since biomedical models may exacerbate these concerns, we hypothesized that unlike within the general population, biological causal attributions would relate to increased stigma among Orthodox Jews. Consequently, we also examined the attitudinal correlates of stigmatization of obsessive-compulsive disorder within the Orthodox community, as measured by both social distance and family/marriage concerns. Results indicated that, unlike previous research, biological models were associated with greater marriage/family stigma, and did not predict less social distance. This suggests that biomedical approaches may increase salient aspects of stigma within the Orthodox community, and clinical practice should be sensitive to these concerns.