Spirituality and Healing

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HomeCare Physicians 1800 N. Main Street Wheaton,
IL 60187 Phone [phone] Fax (630)
682-3727 www.homecarephysicians.org
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Evidence Based Healing Effects of Spirituality
Thomas Cornwell, MD
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Medicine
and
Spirituality
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Sir William Osler - 1910

• Nothing in life is more wonderful than
  faith--the one great moving force which we can
  neither weigh in the balance nor test in the
  crucible...mysterious, indefinable, known only by
  its effects, faith pours out an unfailing stream
  of energy while abating neither jot nor tittle of
  its potency.

(Sir William Osler British Medical Journal 1910)
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Medicine
Spirituality
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Medicine
Research
Spirituality
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Definition of Terms

• Religion Adherence to an organized set of
  beliefs and practices endorsed by a community of
  fellow believers.
• Spirituality An individuals private search for
  meaning and connection, particularly his or her
  relationship with God.

(Matthews DA The Faith Factor 1998)
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Definition of Terms

• Extrinsic Religiosity The extrinsically
  religious person uses religion as a means of
  obtaining status or personal security, for self
  justification and for sociability, thus making
  religion more utilitarian and self-oriented.

(Alport J J Person Soc Psych 1967)
Ask not what I can do for my religion, but what
my religion can do for me.
(Matthews DA The Faith Factor 1998)
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Definition of Terms

• Intrinsic Religiosity The intrinsically
  religious person internalizes beliefs and lives
  by them regardless of outside or extrinsic social
  pressure or other possible personal
  consequences.

(Alport J J Person Soc Psych 1967)
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Americans are Highly Religious

• 96 believe in God
• 75 pray at least once a day
• 61 say religion is very important in my life
• 43 have attended worship services within the
  past week
• (CNN/USA Today/Gallup Poll 1997)

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American Religious Healing Activities

• 14 of 586 adults in Richmond, Virginia reported
  having experienced physical healing (most
  commonly of viral infections, cancer, back
  problems, emotional problems, and fractures) from
  prayer or divine intervention.
• (Johnson DM Sociological Analysis 1986)
• 94 of 203 hospitalized patients in North
  Carolina and Pennsylvania believed that spiritual
  health is as important as physical health 73
  reported praying daily, 58 having strong
  religious beliefs, and 42 having attended faith
  healing services.
• (King DE Journal of Family Practice 1994)

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Health Professionals Less Religious

• 33 of psychologists, 39 of psychiatrists, 46
  social workers, and 62 of marriage and family
  therapists report that my whole approach to life
  is based on my religion versus 72 of the
  American Public.
• (Bergin AE Psychotherapy 1990)
• Among 146 family physicians and 135 family
  practice patients in Vermont, patients were more
  likely than physicians to believe in God (91 vs.
  64, plt0.01), and feel close to God (74 vs. 43,
  plt0.01).
• (Maugans TA Journal of Family Practice 1991)
• Exception A national survey of 438 family
  physicians found that 95.5 believe in God, 79
  reported a strong religious or spiritual
  orientation, and 74 reported weekly or monthly
  service attendance. These numbers were
  significantly higher than those found in previous
  studies.
• (Daaleman TP Journal of Family Practice 2/1999)

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Religious Variables Neglected in Research

• Among 603 articles in the Journal of Family
  Practice over a 10 year period, only 4 used
  religious measures and only one used a validated,
  multidimensional measure of religious commitment
  88 showed a positive effect for religious
  commitment.
• (Craigie FC Journal of Family Practice 1988)
• Among 2,348 psychiatric studies over a five year
  period, only 3 used a religious measure, 0.1
  examined religion as a central variable and only
  1 used a validated, multidimensional measure of
  religious commitment 72 of these studies showed
  a positive effect for religious commitment.
• (Larson DB American Journal of Psychiatry 1986)
• Among 2,766 quantitative studies in leading
  psychiatric journals from 1991-1995, 32 (1.2)
  included a religious or spiritual variable.
• (Weaver AJ J Nerv Ment Dis 1998)

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DSM-III-R Misrepresentations

• Of the 45 case examples used to illustrate
• psychopathology in the glossary of technical
  terms
• 10 (22.2) had religious content
• 2 (4.4) had occupational content
• 1 (2.2) had family content
• 0 had sexual, ethnic, racial, age, gender,
  educational or cultural content

(Larson DB Am J of Psychiatry 1993)
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Religion/Spirituality Neglected in Medicine

• 11 of 146 family physicians in Vermont reported
  they frequently or always addressed religious
  issues with patients most of the 135 patients in
  the study did not recall physicians addressing
  these issues, although 40 thought they should.
• (Maugans TA Journal of Family Practice 1991)
• 80 of 203 hospitalized patients in North
  Carolina reported that physicians rarely or never
  addressed spiritual issues 77 believed they
  should 48 desired the physician to pray with
  them, and 42 believed that physicians should ask
  them about their faith healing experiences.
• (King DE Journal of Family Practice 1994)

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Religion/Spirituality Neglected in Medicine

• In a national poll of 1,000 adults, 63 believed
  that physicians should talk to them about
  spiritual health, but only 10 indicated that
  their physician had done so.
• (McNichol T, USA Weekend 1996)
• In a national poll of 1,004 adults, 82 believe
  in the healing power of prayer and 64 said that
  physicians should pray with the patient if
  requested.
• (Wallis C Time 1996)

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Benefits of Religion/Spirituality

• Mental Health
• Adjusting and Coping
• Physical Health
• Recovery From Illness
• Greater Life Satisfaction
• Increased Life Expectancy

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Depression and Anxiety

• 720 individuals, psychological distress was
  inversely correlated with religious attendance,
  after controlling for age, education, marital
  status, and race.
• (Williams DR Social Science and Medicine 1991)
• Among 850 hospitalized veterans in North
  Carolina, use of religious faith in coping was
  inversely related to self-reported (RR0.16,
  plt0.001) and observer-rated (RR0.14, plt0.01)
  depression at baseline and the risk for
  depression at the time of subsequent
  hospitalization.
• (Koenig HG American Journal of Psychiatry 1992)

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Depression and Anxiety

• A study of 2,679 baby boom generation
  participants found the rates of psychopathology,
  including depression and other mental illnesses
  in frequent church attendees was half that among
  infrequent attendees (18 vs. 34).
• (Koenig HG Hospital and Community Psychiatry
  1994)
• A prospective study of 94 depressed patients age
  gt60 found greater intrinsic religiosity
  independently predicted shorter time to
  remission.
• (Koenig HG Am J Psychiatry 1998)
• Decreased suicidal ideation and attempts.
• (Gartner et al J Pscyhol Theo 1991)
• (Stack S J Sci Study Religion 1983)
• (Comstock GW Journal of Chronic Diseases 1972)

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Illness Prevention Twin Study

• Study sample 1,900 female-female twin pairs
  raised apart, average age 30.1 years. The study
  found, significantly lower rates of depressive
  symptoms, smoking and alcohol abuse among those
  who were more religious.
•   (Kendler KS Am J Psychiatry 1997)

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Addictions - Alcohol

• 13 of 1014 males entering John Hopkins Medical
  School between 1948 and 1964 met criteria for
  alcohol abuse. The strongest predictor during
  medical school of subsequent alcoholism was a
  lack of religious affiliation (RR4.1).
• (Moore RD American Journal of Medicine 1990)
• Of 2,969 participants in the National Institute
  of Mental Health Epidemiologic Catchment area
  study North Carolina, those who attended church
  weekly had 29 of the risk of alcoholism.
• (Koenig HG Hospital and Community Psychiatry 1994)

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Addictions - Alcohol

• Alcoholics Anonymous Twelve Step
• programs are based on spiritual principles
• Step 1 We admitted we were powerless over
  alcohol--that our lives had become unmanageable.
• Step 2 We came to believe that a Power greater
  than ourselves could restore us to sanity

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Addiction Prevention - Teenagers

• In a survey of 16,130 high school seniors in the
  U.S., more religious students had lower rates of
  alcohol use (RR0.19) and marijuana use
  (RR0.19).
• (Amoateng AY Sociological Perspectives 1986)
• In a survey of 2066 high school students in
  Ontario, more religious students had lower rates
  of marijuana, hallucinogen, stimulant,
  barbiturate, and tranquilizer use.
• (Adlaf EM British Journal of Addiction 1985)

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Addictions - Opiates

• Of 248 men (87 Mexican-American) with opiate
  addiction treated at a Public Health Service
  hospital from 1964-67, 11 subsequently enrolled
  in a long-term religiously-based program. These
  patients were significantly more likely (45 vs.
  5) to remain abstinent from opiates for one year
  after the program.
• (Desmond DP American Journal of Drug and Alcohol
  Abuse 1981)

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Addictions - Smoking

• A faith healing practitioner laid hands on 532
  smokers. 40 abstained from smoking for at least
  4 months 33 stayed smoke free for 1 year 20
  stayed smoke free for five years.
• (Gmur M International Journal of Addictions 1987)
• A study of 400 Lumbee Indians in tobacco-laden
  North Carolina found smokers who had not attended
  church in the past year smoked significantly more
  cigarettes per day and were 79 less likely to
  quit.
• (Spangler et al Ethnicity Disease 1998)

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Benefits of Religion/Spirituality

• Mental Health
• Adjusting and Coping
• Physical Health
• Recovery From Illness
• Greater Life Satisfaction
• Increased Life Expectancy

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Death of a Child

• 80 of 145 parents of children who had died of
  cancer reported receiving comfort from religion
  after the childs death 40 of the parents
  reported a strengthening of their religious
  commitment over the course of the year. These
  patients had better physiologic (RR0.18) and
  emotional adjustment (RR0.10) than others.
• (Cook JA Journal for the Scientific Study of
  Religion 1983)

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Coping with Gynecological Cancer

• 91 religion helped them sustain their hopes
• 76 religion had a serious place in their lives
• 49 patients became more religious since their
  diagnosis
• 41 religion supported their sense of worth
•  
• None had become less religious since their cancer
  diagnoses
•  
• (Roberts JA Am J Obstetrics and Gynecology
  1997)

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Coping with Medical Illness

• 200 elderly women, the most frequent coping
  responses chosen for handling medical illness
  were prayer (91) and thinking of God or
  religious beliefs (86).
• (Conway K International Journal of Aging and
  Human Development 1985-86)

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Coping with Moving

• In a prospective cohort of 225 elderly persons
  followed for two years after being forced to move
  from their homes, the more religiously-committed
  were twice as likely to survive the study period,
  after controlling for gender and health status.
  The most influential religious variable was the
  strength and comfort derived from religion.
• (Zuckerman DM American Journal of Epidemiology
  1984)

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Benefits of Religion/Spirituality

• Mental Health
• Adjusting and Coping
• Physical Health
• Recovery From Illness
• Greater Life Satisfaction
• Increased Life Expectancy

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Physical Health

• Among 1,344 outpatients in Glasgow, Scotland,
  those who participated in a religious activity at
  least monthly were less likely to report physical
  (RR0.14), mental (RR0.14), and social symptoms
  (RR0.11) after controlling for age and gender.
• (Hannay DR, Social Science and Medicine 1980)
• In a prospective study of 2,812 elderly persons
  in New Haven, Connecticut, religiosity was
  inversely related to subsequent disability
  (plt0.003) and directly related to improved
  functional ability (plt0.0014).
• (Idler EL American Journal of Sociology 1992)

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Physical Health

• Lower Blood Pressure
• (Graham TW Journal of Behavioral Medicine 1978)
• (Koenig HG Intl J. of Psychology in Medicine
  1998)
• Better compliance and coping with hemodialysis.
• (OBrien ME Journal of Religion and Health 1982)
• The highly religious (1/6 of total) of 1,077
  Northern Illinois University students had better
  health, less sickness, fewer doctor visits, fewer
  injuries, lower rates of alcohol, tobacco and
  drug use, and increased rates of exercise and
  seat belt use.
• (Oleckno WA Psychological Reports 1991)
• In study of 542 hospitalized elderly patients in
  North Carolina, participation in and affiliation
  with a religious community was associated with
  lower use of hospital services.
• (Koenig HG Southern Medical Journal 1998)

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Benefits of Religion/Spirituality

• Mental Health
• Adjusting and Coping
• Physical Health
• Recovery From Illness
• Greater Life Satisfaction
• Increased Life Expectancy

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Critical Care Unit Patients

• In a study of 393 patients in a San Francisco CCU
  who were randomized to receive intercessory
  prayer from a prayer group (n192) or to be in a
  control group (N201), patients receiving prayer
  support had a more favorable overall outcome and
  less
• Congestive Heart Failure (8 vs. 20, plt0.03)
• Pneumonia (3 vs. 13, plt0.03)
• Antibiotics (3 vs. 17, plt0.005)
• Intubation (0 vs. 12, plt0.002)
• Cardiac arrest (3 vs. 14, plt0.02)
• (Byrd RB Southern Medical Journal 1988)

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Recovery from Open Heart Surgery

• 232 patients undergoing elective heart surgery
  were studied to investigate survival and recovery
  rates. Six months after surgery 21 (9) had
  died.
• 12 of those who rarely or never attended church
  died
• 5 of those who attended church at least every
  few months died.
• None of the 37 patients who had described
  themselves as deeply religious died
• (Oxman TE Psychosomatic Medicine 1995)

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Participation in Groups and Strength and comfort
from Religion are different and risk is additive
Oxman TE Spirituality Healing in Medicine - V,
1998
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Benefits of Religion/Spirituality

• Mental Health
• Adjusting and Coping
• Physical Health
• Recovery From Illness
• Greater Life Satisfaction
• Increased Life Expectancy

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Marriage

• A study of 2,278 Americans of all faiths showed
  that frequency of attendance at religious
  services was the strongest predictor of marital
  happiness for both men and women--stronger than
  education, age, family income, occupational
  level, and number of children at home.
• (Glenn ND Journal of Marriage and the Family
  1978)
• Decreased Divorce
• (Shrum W Review of Religious Research 1980)

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Decrease Prison Recidivism

• Inmates who attended Bible studies at least
  monthly by Prison Fellowship, a Christian
  ministry, were much less likely to be re-arrested
  than those who did not attend--14 vs. 41.
• (Johnson BR Justice Quarterly 1997)

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Greater Life Satisfaction

• Spinal cord injuries more religious individuals
  reported a significant better quality of life.
• (Decker SD American Journal of Occupational
  Therapy 1985)
• Religious elderly report greater life
  satisfaction.
• (Guy RF International Journal of Aging and Human
  Development 1982)
• Decreased fear of death.
• (Gibbs HW Journal of Counseling Psychology 1978)
• (Smith DK International Journal of Psychology in
  Medicine 1983-84)

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Benefits of Religion/Spirituality

• Mental Health
• Adjusting and Coping
• Physical Health
• Recovery From Illness
• Greater Life Satisfaction
• Increased Life Expectancy

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Increased Life Expectancy

• In a survey of 91,909 individuals in Washington
  County, Maryland, those who attended church once
  or more per week had
• 50 fewer deaths from coronary artery disease
• 56 fewer deaths from emphysema
• 74 fewer deaths from cirrhosis
• 53 fewer deaths from suicides
• (Comstock GW Journal of Chronic Diseases 1972)
• In a 16 year follow-up study, members of Orthodox
  kibbutzim had 50 lower mortality rates than
  non-Orthodox kibbutzim members.
• (Kark JD American Journal of Public Health 1996)

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Increased Life Expectancy

• In a Netherlands study, Seventh-Day Adventists
  were found to have an additional life expectancy
  of nine years for men and four for women when
  compared with the general population. Adventists
  had 50 fewer neoplasms and 41 fewer cases of
  cardiovascular diseases compared with others.
• (Berel J International Journal of Epidemiology
  1983)
• Six year follow-up study of 3,968 older adults
  found weekly church attendance reduced the risk
  of dying by 28 after controlling for demographic
  factors, physical and mental health conditions,
  social connections and health practices (and was
  equivalent in magnitude to cigarette smoking).
• (Koenig HG Journal of Gerontology 1999)

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Increased Life Expectancy

• 6,928 persons in Alameda County, California were
  followed over the course of 28 years tracking
  their mortality rates and frequency of attendance
  at religious services. Carefully designed
  regular physical exams compared large number of
  factors that could affect longevity such as
  demographic factors (age, gender, education),
  health status and social supports. The study
  found that people who attend religious services
  frequently (once a week or more) had mortality
  rates 36 lower than those subjects who attended
  less frequently.
• (Strawbridge WJ American Journal of Public Health
  1997)

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Summary of Research

• Review of 2 leading psychiatric journals from
  1978 to 1989
• found the relationship between religion and
  mental health to be
• 84 beneficial
• 13.5 neutral
• 2.7 harmful
• (Larson et al Am J Psychiatry 1992)
• Review of the Journal of Family Practice over a
  ten year period
• found the relationship between religious
  commitment and
• physical health to be
• 81 beneficial
• 15 neutral
• 4 harmful
• (Cragie et al J Fam Practice 1990)

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Wheres the Biology?

• A study of 1,718 older adults in North Carolina
  found that those that attended church at least
  once a week were half as likely as non-attendees
  to have elevated levels of interleukin 6
  (inflammatory cytokine). (Koenig HG
  Int J Psychiatry Med 1997)
• Dr. Ignaz Semmelweis 19th century obstetrician
  who noted patients of midwives had significantly
  lower rates of puerperal fever than those of
  medical students. Medical students started
  washing their hands and the rate dropped from 18
  to 1.5.
• Dr. Edward Jenner Noted milkmaids who were
  exposed to cowpox rarely contracted smallpox.
  1796 he injected a boy, James Phipps, with cowpox
  which caused a slight fever. Two months later,
  Jenner gave James a potentially lethal dose of
  smallpox and he did not contract the
  disease. (Matthews DA The Faith Factor 1998)

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Physician Perceived Barriers to Addressing
Spiritual Issues

• Survey of 170 Missouri family physicians found
• 96 agreed spiritual well-being is an important
  component of good health
• 86 agreed inpatients with spiritual questions
  should be referred to a chaplain
• 58 agreed physicians should address spiritual
  concerns with patients
• However, the majority did not address spiritual
  issues.

(Ellis MR Journal of Family Practice 1999)
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Physician Perceived Barriers to Addressing
Spiritual Issues

• 71 lack of time
• 59 lack of experience or training in taking a
  spiritual history
• 56 uncertainty about how to identify patients
  who desire a discussion of spiritual issues
• 53 concern of projecting beliefs onto patients
• 49 uncertainty about how to manage spiritual
  issues raised by patients
• 45 lower priority than acute medical issues
• 42 discomfort with the subject matter
• 31 not appropriate to the physicians role

(Ellis MR Journal of Family Practice 1999)
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ApplicationTaking a Spiritual History

• 1) Is religion or spirituality important to you?
• 2) Do your religious or spiritual beliefs
  influence the way you look at your medical
  problems and the way you think about your health?
• 3) Would you like me to address your religious or
  spiritual beliefs and practices?
• (Matthews DA The Faith Factor 1998)

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Spiritual History FICA

• Faith or beliefs What is your faith or belief?
  Do you consider yourself spiritual or religious?
  What things do you believe in that give meaning
  to your life?
•  
• Importance or influence Is it important in your
  life? What influence does it have on how you
  take care of yourself? How have your beliefs
  influenced your behavior during illness? What
  role do your beliefs play in regaining your
  health?
• Community Are you part of a spiritual or
  religious community? Is this of support to you?
  If so, how? Is there a person or group of people
  you really love and who are really important to
  you?
•  
• Address How would you like me, your healthcare
  provider, to address these issues in your
  healthcare?
•  www.nihr.org/education/fica.html
• FP Report July 1999

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American Family Physician, January 2001
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ABCs of Praying with Patients - and Sometimes D

• Adoration Praise God for His power, love and
  caring.
• Blessings Thank God for how He has blessed the
  patient. No matter how difficult the situation,
  there are always blessings present.
• Care and Compassion Ask God to give wisdom and
  guidance to everyone involved in the patients
  care-including the patient.
• Death When facing end-of-life issues, ask God
  to keep the patient surrounded by loved ones and
  free of suffering.

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Application

• Determine your comfort level. I have found
  praying with patients to be tremendously
  rewarding and would encourage physicians
  comfortable with praying to try.
• Learn of resources in your community-this could
  include people in your office.
• We should promote, not preach, endorsing the
  health value of authentic religiosity but
  respecting patients choices about denomination
  and doctrine.
• (Matthews DA The Faith Factor 1998)