James W. Lomax

Older Adults’ Preferences For Religion/Spirituality In Treatment For Anxiety And Depression

Objectives: To examine patient preferences for incorporating religion and/or spirituality into therapy for anxiety or depression and examine the relations between patient preferences and religious and spiritual coping styles, beliefs and behaviors. Method: Participants (66 adults, 55 years or older, from earlier studies of cognitive-behavioral therapy for late-life anxiety and/or depression in primary care) completed these measures by telephone or in-person: Geriatric Anxiety Inventory, Client Attitudes Toward Spirituality in Therapy, Patient Interview, Brief Religious Coping, Religious Problem Solving Scale, Santa Clara Strength of Religious Faith, and Brief Multidimensional Measure of Religiousness and Spirituality. Spearmans rank-order correlations and ordinal logistic regression examined religious/spiritual variables as predictors of preferences for inclusion of religion or spirituality into counseling. Results: Most participants (77–83%) preferred including religion and/or spirituality in therapy for anxiety and depression. Participants who thought it was important to include religion or spirituality in therapy reported more positive religious-based coping, greater strength of religious faith, and greater collaborative and less self-directed problem-solving styles than participants who did not think it was important. Conclusion: For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.

Understanding and addressing religion among people with mental illness

This article reviews recent advances in the domain of psychiatry and religion that highlight the double‐edged capacity of religion to enhance or damage health and well‐being, particularly among psychiatric patients. A large body of research challenges stereotyped views of religion as merely a defense or passive way of coping, and indicates that many people look to religion as a vital resource which serves a variety of adaptive functions, such as self‐regulation, attachment, emotional comfort, meaning, and spirituality. There is, however, a darker side to religious life. Researchers and theorists have identified and begun to study problematic aspects of religiousness, including religiously‐based violence and religious struggles within oneself, with others, and with the divine. Religious problems can be understood as a by‐product of psychiatric illness (secondary), a source of psychiatric illness (primary), or both (complex). This growing body of knowledge underscores the need to attend more fully to the potentially constructive and destructive roles of religion in psychiatric diagnosis, assessment, and treatment. In fact, initial evaluative studies of the impact of spiritually integrated treatments among a range of psychiatric populations have shown promising results. The article concludes with a set of recommendations to advance future research and practice, including the need for additional psychiatric studies of people from diverse cultures and religious traditions.

Integration of religion into cognitive-behavioral therapy for geriatric anxiety and depression.

Religion is important to most older adults, and research generally finds a positive relationship between religion and mental health. Among psychotherapies used in the treatment of anxiety and depression in older adults, cognitive-behavioral therapy (CBT) has the strongest evidence base. Incorporation of religion into CBT may increase its acceptability and effectiveness in this population. This article reviews studies that have examined the effects of integrating religion into CBT for depression and anxiety. These studies indicate that improvement in depressive and anxiety symptoms occurs earlier in treatment when CBT incorporates religion, although effects are equivalent at follow-up. The authors present recommendations for integrating religious beliefs and behaviors into CBT based on empirical literature concerning which aspects of religion affect mental health. A case example is also included that describes the integration of religion into CBT for an older man with cognitive impairment experiencing comorbid generalized anxiety disorder and major depressive disorder. It is recommended that clinicians consider the integration of religion into psychotherapy for older adults with depression or anxiety and that studies be conducted to examine the added benefit of incorporating religion into CBT for the treatment of depression and anxiety in older adults. (Journal of Psychiatric Practice 2009;15:103–112).

Psychological Distress Among Religious Nonbelievers: A Systematic Review

Studies of religious belief and psychological health are on the rise, but most overlook atheists and agnostics. We review 14 articles that examine differences between nonbelievers and believers in levels of psychological distress, and potential sources of distress among nonbelievers. Various forms of psychological distress are experienced by nonbelievers, and greater certainty in one’s belief system is associated with greater psychological health. We found one well-documented source of distress for nonbelievers: negative perceptions by others. We provide recommendations for improving research on nonbelievers and suggest a model analogous to Pargament’s tripartite spiritual struggle to understand the stresses of nonbelief.

Spouses of Patients with Dementia

Abstract Caregiver spouses struggle to cope with the multiple demands of caregiving and complexities of medical care. In this article, the emotional, marital, attachment, and spiritual aspects of spousal caregiving for patients with dementia are addressed. This paper explores what keeps spouses together during this devastating illness. The literature has been reviewed to identify value systems that enable spouses to continue caregiving in these challenging circumstances. Articles were targeted that focus on the psychological and spiritual meaning of the marital bond, and its disruption when a spouse develops dementia. Recommendations for the clinical management of caregiver burden emerge from a pluralistic understanding that encompasses such constructs as “quid pro quo”; commitment and family solidarity; holding on to the familiar versus “letting go”; rupture and repair of the marital bond; mastery of separation-individuation; spirituality; changes in the sexual relationship; and reaching out for emotional support. Techniques are highlighted to help couples deal with loss, and changes in communication and intimacy. A multidimensional approach by the geriatric mental health team is emphasized in order to provide optimal care to caregiver spouses.

The Aging Physician With Cognitive Impairment: Approaches to Oversight, Prevention, and Remediation

There are many important unanswered issues regarding the occurrence of cognitive impairment in physicians, such as detection of deficits, remediation efforts, policy implications for safe medical practice, and the need to safeguard quality patient care. The authors review existing literature on these complex issues and derive heuristic formulations regarding how to help manage the professional needs of the aging physician with dementia. To ensure safe standards of medical care while also protecting the needs of physicians and their families, state regulatory or licensing agencies in collaboration with state medical associations and academic medical centers should generate evaluation guidelines to assure continued high levels of functioning. The authors also raise the question of whether age should be considered as a risk factor that merits special screening for adequate functioning. Either age-related screening for cognitive impairment should be initiated or rigorous evaluation after lapses in standard of care should be the norm regardless of age. Ultimately, competence rather than mandatory retirement due to age per se should be the deciding factor regarding whether physicians should be able to continue their practice. Finally, the authors issue a call for an expert consensus panel to convene to make recommendations concerning aging physicians with cognitive impairment who are at risk for medical errors.

Perspectives on “Sacred Moments” in Psychotherapy

In this article, we describe a clinical experience and offer comments on it from the perspectives of a psychoanalyst, a psychotherapy researcher, and a historian of religions. The clinical context is a psychodynamic psychotherapy with a patient who is describing what she has tentatively thought about intellectually as a “paranormal experience,” but she is concerned that it might be further evidence to support labeling her as an odd, weird, and “severely pathologic” individual. Our purpose is to encourage clinicians to be open to our patients’ descriptions of anomalous experiences and to work with patients to construct meanings of these experiences that will promote health, positive coping, and growth. A midcareer intensive care unit cardiologist had been in treatment for over a year when the following session occurred. Her DSM-IV diagnosis had been major depression. She was distressed by a series of disappointments in her personal and professional life. A simplifi ed version of her developmental history is that she had a long series of severe, but not technically “traumatic,” developmental interferences, beginning with rather extreme and odd failures of “self-object function” by both parents. Repeatedly, she would come to them with an idea, thought, or feeling to which they would respond dismissively, accusingly, or in other ways that made her feel foolish and “inappropriate.” She had attempted treatment with several psychiatrists and other professionals before referral for a more intensive psychotherapy. We were meeting twice a week at the time of the following session. She was a faculty member of a department that included a well-known chairman, “Dr. Brown.” In addition to his great scientifi c and clinical productivity, Dr. Brown possessed a legendary ability to make faculty, residents, staff, and students feel important and feel that they were valued members of “the Team.”

Role of the family in suicide prevention: An attachment and family systems perspective

Suicide can be an act of despair, anger, or escape from intolerable pain associated with prior bonding disturbances within the family system, interpersonal loss, and current perceived lack of social support. Using a variety of online databases, the authors examined the research on the familys role in preventing suicide from an attachment and family systems perspective. They found relevant articles describing how to make use of family support in suicide prevention. From a study of the literature, the authors outline three new family concepts in suicide prevention: family cohesion, family adhesion, and formation of a new family. Therapists should use every familial resource to avoid premature closure and to expand perception of support options. The authors suggest specific practice recommendations to successfully involve families in suicide prevention based on the outlined family conceptual framework, and they recommend research investigation to determine empirical validation of these tentative formulations.

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

These Practice Guidelines for the Psychiatric Evaluation of Adults mark a transition in the American Psychiatric Association’s Practice Guidelines. Since the publication of the 2011 Institute of Medicine report Clinical Practice Guidelines We Can Trust, there has been an increasing focus on using clearly defined, transparent processes for rating the quality of evidence and the strength of the overall body of evidence in systematic reviews of the scientific literature. These guidelines were developed using a process intended to be consistent with the recommendations of the Institute of Medicine (2011), the Principles for theDevelopment of Specialty Society Clinical Guidelines of the Council of Medical Specialty Societies (2012), and the requirements of the Agency for Healthcare Research andQuality (AHRQ) for inclusion of a guideline in the National Guideline Clearinghouse. Parameters used for the guidelines’ systematic review are included with the full text of the guidelines; the development process is fully described in a document available on the APA website: http:// www.psychiatry.org/File%20Library/Practice/APA-GuidelineDevelopment-Process–updated-2011-.pdf. To supplement the expertise of members of the guideline work group, we used a “snowball” survey methodology to identify experts on psychiatric evaluation and solicit their input on aspects of the psychiatric evaluation that they saw as likely to improve specific patient outcomes (Yager 2014). Results of this expert survey are included with the full text of the practice guideline.

Cultural Psychiatry Education during Psychiatric Residency

At a time when more important information is known about cultural influences in psychiatry, a survey indicates that markedly less is being taught residents on this subject. Problems in defining what needs to be taught and how to do it are discussed. It seems than an emphasis during PGY1 and 2 on the cultural identity on the residents themselves will stimulate them to become more interested in the theoretical and practical issues which can be presented in the PGY 3 and/or 4 years.