Religiously-Integrated Cognitive Behavioural Therapy for Major Depression in Chronic Medical Illness

Review of Results from a Randomized Clinical Trial

Authors

  • Harold G. Koenig Duke University Medical Center
  • Nathan A. Boucher Duke University Medical Center
  • Keisha-Gaye N. O’Garo Duke University Medical Center
  • Michelle Pearce University of Maryland School of Medicine

DOI:

https://doi.org/10.1558/hscc.v4i2.31655

Keywords:

Chaplains, chronic medical illness, major depression, cognitive behavioural therapy, randomized clinical trial, religious, spiritual

Abstract

A randomized clinical trial was conducted over a three year period to compare the effectiveness of religiously-integrated cognitive behavioural therapy (RCBT) with conventional CBT (CCBT) for the treatment of a major depressive disorder (MDD). A total of 132 participants with chronic medical illness and MDD were enrolled in the trial (CCBT=67, RCBT=65). Ten 50-minute treatment sessions were delivered by master’s level certified counsellors over 12 weeks. All sessions were delivered remotely, largely over the telephone. In this review, we describe the findings from this trial, including the effects on depressive symptoms, positive emotions, and immune and endocrine markers in blood and urine. We also examine the effects of treatment based on genotype, in particular polymorphisms of the serotonin transporter, serotonin receptor, and monoamine oxidase genes. Lessons learned from conducting this trial are also discussed. Although not designed as a non-inferiority trial, the results suggest that RCBT is as effective as standard CBT in the treatment of major depression in this setting, especially among highly religious clients, and can be delivered by appropriately trained chaplains.

Author Biographies

Harold G. Koenig, Duke University Medical Center

Harold G. Koenig is Professor of Psychiatry & Behavioural Sciences and Associate Professor of Medicine, Duke University Medical Center, Durham, North Carolina. He is also an Adjunct Professor of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia.

Nathan A. Boucher, Duke University Medical Center

Nathan A. Boucher is a Post-Doctoral Fellow, GRECC Durham Veterans Administration Medical Center, Center for Aging, Duke University Medical Center, Durham, NC, USA, and Adjunct Associate Professor in Disability Studies at City University of New York.

Keisha-Gaye N. O’Garo, Duke University Medical Center

Keisha-Gaye N. O’Garo is a Clinical Associate, Department of Psychiatry, Duke University Medical Center, Durham, NC, USA.

Michelle Pearce, University of Maryland School of Medicine

Michelle Pearce is Assistant Professor, Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

References

Azhar, M. Z., S. L. Varma and A. S. Dharap (1994) “Religious Psychotherapy in Anxiety Disorder Patients”. Acta Psychiatrica Scandinavica 90(1): 1–3. https://doi.org/10.1111/j.1600-0447.1994.tb01545.x

Azhar, M. Z., and S. L. Varma (1995a) “Religious Psychotherapy in Depressive Patients”. Psychotherapy & Psychosomatics 63(3–4): 165–73. https://doi.org/10.1159/000288954

—(1995b) “Religious Psychotherapy as Management of Bereavement”. Acta Psychiatrica Scandinavica 91(4): 233–35. ttps://doi.org/10.1111/j.1600-0447.1995.tb09774.x

Beck, A. T., C. H. Ward, M. Mendelson, J. Mock and J. Erbaugh (1961) “An Inventory for Measuring Depression”. Archives of General Psychiatry 4(6): 561–71. https://doi.org/10.1001/archpsyc.1961.01710120031004

Beck, A. T., J. Rush, B. F. Shaw and G. Emery (1979) Cognitive Therapy of Depression. New York: Guilford Press.

Berk, L. S., D. L. Bellinger, H. G. Koenig, N. Daher, M. J. Pearce, C. J. Robins, B. Nelson, S. F. Shaw, H. J. Cohen and M. B. King (2015) “Effects of Religious vs. Conventional Cognitive-Behavioural Therapy on Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial”. Open Journal of Psychiatry 5(3): 238–59. https://doi.org/10.4236/ojpsych.2015.53028

Bower, P., S. Byford, B. Sibbald, E. Ward, M. King, M. Lloyd and M. Gabbay (2000) “Randomised Controlled Trial of Non-directive Counselling, Cognitive-Behaviour Therapy and Usual General Practitioner Care for Patients with Depression. II Cost Effectiveness”. British Medical Journal 321(7273): 1389–392. https://doi.org/10.1136/bmj.321.7273.1389

Daher, N., H. G. Koenig, M. J. Pearce, B. Nelson, S. F. Shaw, L. S. Berk, D. Bellinger, C. J. Robins, H. J. Cohen, M. B. King (2016) “Effects of Religious vs. Conventional Cognitive-Behavioural Therapy on Purpose in Life in the Setting of Major Depression and Chronic Illness”. International Journal of Existential Positive Psychology and Psychotherapy 6(1): 16–31.

Healthy People 2020 (2010) Washington, DC: U.S. Office of Disease Prevention and Health Promotion. Available at: http: //www.healthypeople.gov/2020/About-Healthy-People (accessed 14 January 2016).

Kelly, E. W. Jr. (1995) “Spirituality and Religion in Counselor Education: A National Survey”. Counselor Education and Supervision 33(4): 227–37. https://doi.org/10.1002/j.1556-6978.1994.tb00290.x

Kessler, R. C., P. Berglund, O. Demler, R. Jim, D. Kortez, K. R. Merikangas, A. J. Rush, E. E. Walters and P. S. Wang (2003) “The Epidemiology of Major Depressive Disorder: Results from the National Comorbidity Survey Replication (NCS-R)”. Journal of the American Medical Association 289(23): 3096–105. https://doi.org/10.1001/jama.289.23.3095

King, M., B. Sibbald, E. Ward, P. Bower, M. Lloyd, M. Gabbay and S. Byford (2000) “Randomised Controlled Trial of Non-Directive Counselling, Cognitive-Behaviour Therapy and Usual General Practitioner Care in the Management of Depression as Well as Mixed Anxiety and Depression in Primary Care”. Health Technology Assessment 4(19): 1–83.

Kitchell, M. A., R. F. Barnes, R. C. Veith, J. T. Okimoto and M. A. Raskind (1982) “Screening for Depression in Hospitalized Geriatric Medical Patients”. Journal of the American Geriatrics Society 30(3): 174–77. https://doi.org/10.1111/j.1532-5415.1982.tb01300.x

Koenig, H. G., K. Meador, H. J. Cohen and D. Blazer (1988): “Depression in Elderly Men Hospitalized with Medical Illness”. Archives of Internal Medicine 148(9): 1929–936. https://doi.org/10.1001/archinte.1988.00380090031009

Koenig, H. G., H. J. Cohen, D. G. Blazer, C. Pieper, K. G. Meador, F. Shelp, V. Goli and R. DiPasquale (1992) “Religious Coping and Depression in Elderly Hospitalized Medically Ill Men”. American Journal of Psychiatry 149(12): 1693–1700. https://doi.org/10.1176/ajp.149.12.1693

Koenig, H. G., L. K. George, B. L. Peterson and C. F. Pieper (1997) “Depression in Medically Ill Hospitalized Older Adults: Prevalence, Correlates, and Course of Symptoms based on Six Diagnostic Schemes”. American Journal of Psychiatry 154(10): 1376–383. https://doi.org/10.1176/ajp.154.10.1376

Koenig, H. G., L. K. George and B. L. Peterson (1998) “Religiosity and Remission of Depression in Medically Ill Older Patients”. American Journal of Psychiatry 155(4): 536–42. https://doi.org/10.1176/ajp.155.4.536

Koenig, H. G., D. B. Larson and S. S. Larson (2001) “Religion and Coping with Serious Medical Illness”. Annals of Pharmacotherapy 35(3): 352–59. https://doi.org/10.1345/aph.10215

Koenig, H. G. (2007) “Religion and Remission of Depression in Medical Inpatients with Heart Failure/Pulmonary Disease”. Journal of Nervous and Mental Disease 195(5): 389–95.

Koenig, H. G., M. J. Pearce, B. Nelson, S. F. Shaw, C. J. Robins, N. Daher, H. J. Cohen, L. S. Berk, D. Bellinger, K. I. Pargament, D. H. Rosmarin, S. Vasegh, J. Kristeller, N. Juthani, D. Nies and M. B. King (2015a) “Religious vs. Conventional Cognitive-Behavioural Therapy for Major Depression in Persons with Chronic Medical Illness”. Journal of Nervous and Mental Disease 203(4): 243–51. https://doi.org/10.1097/NMD.0000000000000273

—(2015b) “Effects of Religious vs. Standard Cognitive-Behavioural Therapy on Optimism in Persons with Major Depression and Chronic Medical Illness”. Depression and Anxiety 32(11): 835–42. https://doi.org/10.1002/da.22398

—(2015c) “Genes, Religion, and Response to Religious vs. Conventional Psychotherapy: A Randomized Clinical Trial in Medically Ill Patients with Major Depression”. Austin Journal of Psychiatry & Behavioural Sciences 2(1): 1036.

Koenig, H.G., Pearce MJ, Nelson B, Shaw SF, Robins CJ, Daher N, Cohen HJ, King MB (2016a) “Effects of Religious vs. Standard Cognitive Behavioural Therapy on Therapeutic Alliance: A Randomized Clinical Trial”. Psychotherapy Research, 26(3): 365–76. https://doi.org/10.1080/10503307.2015.1006156

Koenig, H. G., M. P. Pearce and B. Nelson (2016b) “Effects on Daily Spiritual Experiences of Religious vs. Conventional Cognitive Behavioural Therapy for Depression”. Journal of Religion and Health 55(5): 1763–77. https://doi.org/10.1007/s10943-016-0270-3

Lopez, A. D. and C. C. Murray (1998) “The Global Burden of Disease, 1990–2020”. Nature Medicine 4(11): 1241–243. https://doi.org/10.1038/3218

Luborsky, L., J. P. Barber, L. Siqueland, S. Johnson, L. M. Najavits, A. Frank and D. Daley (1996) “The Revised Helping Alliance Questionnaire (Haq-II): Psychometric Properties”. Journal of Psychotherapy Practice and Research 5(3): 260–71.

McCullough, M. G., R. A. Emmons and J. Tsang (2002) “The Grateful Disposition: A Conceptual and Empirical Topography”. Journal of Personality and Social Psychology 82(1): 112–27. https://doi.org/10.1037/0022-3514.82.1.112

McLaughlin, K. A. (2011) “The Public Health Impact of Major Depression: a Call for Interdisciplinary Prevention Efforts”. Prevention Science 12(4): 361–71. https://doi.org/10.1007/s11121-011-0231-8

Murray, C., and A. Lopez (1996) The Global Burden of Disease. Cambridge, MA: Harvard University Press.

Pargament, K. I., B. W. Smith, H. G. Koenig and L. Perez (1998) “Patterns of Positive and Negative Religious Coping with Major Life Stressors”. Journal for the Scientific Study of Religion 37(4): 710–24. https://doi.org/10.2307/1388152

Pearce, M. J., H. G. Koenig, C. J. Robins, B. Nelson, S. F. Shaw, H. J. Cohen and M. B. King (2015a) “Religiously-Integrated Cognitive Behavioural Therapy: A New Method of Treatment for Major Depression in Patients with Chronic Medical Illness”. Psychotherapy 52(1): 56–66. https://doi.org/10.1037/a0036448

—(2015b) “Effects of Religious vs. Conventional Cognitive-Behavioural Therapy on Generosity in Major Depression Chronic Medical Illness: A Randomized Clinical Trial”. Spirituality in Clinical Practice 2(3): 202–15. https://doi.org/10.1037/scp0000076

Pearce MJ, Koenig HG, Robins CJ, Daher N, Shaw SF, Nelson B, Berk LS, Bellinger D, Cohen HJ, King MB (2016) “Effects of Religious vs. Conventional Cognitive-Behavioural Therapy on Gratitude in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial”. Journal of Spirituality in Mental Health 18(2):124–44. https://doi.org/10.1080/19349637.2015.1100971

Pearce, M. J., and H. G. Koenig (2016) “Effects of Religious vs. Conventional Cognitive-Behavioural Therapy on Spiritual Struggles in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial”. Journal of Psychology and Theology, 44:3-15

Propst, L. R. (1980) “The Comparative Efficacy of Religious and Nonreligious Imagery for the Treatment of Mild Depression in Religious Individuals”. Cognitive Therapy and Research 4(2): 167–78. https://doi.org/10.1007/BF01173648

Propst, L. R., R. Ostrom, P. Watkins, T. Dean and D. Mashburn (1992) “Comparative Efficacy of Religious and Nonreligious Cognitive-Behavior Therapy for the Treatment of Clinical Depression in Religious Individuals”. Journal of Consulting and Clinical Psychology 60(1): 94–103. https://doi.org/10.1037/0022-006X.60.1.94

Ramos, K., A. Erkanli, and H. G. Koenig (2016) “Effects of Religious vs. Conventional Cognitive-Behavioural Therapy on Suicidal Thoughts in Major Depression and Chronic Medical Illness”. In: Psychology of Religion and Spirituality (forthcoming).

Razali, S. M., C. I. Hasanah, K. Aminah and M. Subramaniam (1998) “Religious–Sociocultural Psychotherapy in Patients with Anxiety and Depression”. Australian & New Zealand Journal of Psychiatry 32(6): 867–72. https://doi.org/10.3109/00048679809073877

Rose, E. M., J. S. Westefeld and T. N. Ansley (2001) “Spiritual Issues in Counseling: Clients Beliefs and Preferences”. Journal of Counseling Psychology 48(1): 61–71. https://doi.org/10.1037/0022-0167.48.1.61

Rosemann, T., M. Backenstrass, K. Joest, A. Rosemann, J. Szecsenyi and G. Laux (2007) “Predictors of Depression in a Sample of 1,021 Primary Care Patients with Osteoarthritis”. Arthritis & Rheumatism 57(3): 415–22. https://doi.org/10.1002/art.22624

Rosmarin, D. H., K. I. Pargament, S. Pirutinsky and A. Mahoney (2010) “A Randomized Controlled Evaluation of a Spiritually Integrated Treatment for Subclinical Anxiety in the Jewish Community, Delivered Via the Internet”. Journal of Anxiety Disorders 24(7): 799–808. https://doi.org/10.1016/j.janxdis.2010.05.014

Ryff, C. D. (1989) “Beyond Ponce de Leon and Life Satisfaction: New Directions in Quest of Successful Aging”. International Journal of Behavioural Development 12(1): 35–55. https://doi.org/10.1177/016502548901200102

Scheier, M. F., and C. S. Carver (1985) “Optimism, Coping, and Health: Assessment and Implications for Generalized Outcome Expectancies”. Health Psychology 4(3): 219–47. https://doi.org/10.1037/0278-6133.4.3.219

Sheehan, B. V., Y. Lecrubier, K. H. Sheehan et al. (1998) “The Mini International Neuropsychiatric Interview (MINI): The Development and Validation of Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10”. Journal of Clinical Psychiatry 59 (Suppl 20): 22–33.

Spina, E., V. Santoro and C. D’Arrigo (2008) “Clinically Relevant Pharmacokinetic Drug Interactions with Second-Generation Antidepressants: an Update”. Clinical Therapeutics 30(7): 1206–227. https://doi.org/10.1016/S0149-2918(08)80047-1

Stanley, M. A., A. L. Bush, M. E. Camp, J. P. Jameson, L. L. Phillips, C. R. Barber, D. Zeno, J. W. Lomax, J. A. Cully (2011) “Older Adults’ Preferences for Religion/Spirituality in Treatment of Anxiety and Depression”. Aging and Mental Health 15(3): 334–43. https://doi.org/10.1080/13607863.2010.519326

Ward, E., M. King, M. Lloyd, P. Bower, B. Sibbald, S. Farrelly, M. Gabbay, N. Tarrier and J. Addington-Hall (2000) “Randomised Controlled Trial of Non-Directive Counselling, Cognitive-Behaviour Therapy and Usual General Practitioner Care for Patients with Depression. I Clinical Effectiveness”. British Medical Journal 321(7273): 1383–388. https://doi.org/10.1136/bmj.321.7273.1383

Xiao, S., D. Young and H. Zhang (1998) “Taoistic Cognitive Psychotherapy for Neurotic Patients: a Preliminary Clinical Trial”. Psychiatry & Clinical Neurosciences 52 (S6): S238–241. https://doi.org/10.1111/j.1440-1819.1998.tb03232.x

Published

2016-12-15

How to Cite

Koenig, H., Boucher, N., O’Garo, K.-G., & Pearce, M. (2016). Religiously-Integrated Cognitive Behavioural Therapy for Major Depression in Chronic Medical Illness: Review of Results from a Randomized Clinical Trial. Health and Social Care Chaplaincy, 4(2), 237-253. https://doi.org/10.1558/hscc.v4i2.31655

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Section

Research Article

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