Religion and the DSM: from pathology to possibilities

Thematic Content Analysis of Repugnant Intrusions in Highly Religious Canadian and Turkish Samples

The degree of religiosity, a culturally relevant concept, has been associated with obsessive phenomena such as obsessional symptoms, the nature of unwanted intrusive thoughts, and responses to intrusive thoughts. Although previous research reported that repugnant (i.e., sexual and religious) intrusions had the lowest endorsement rates, these were also the most difficult to control and more likely to turn into obsessions. Highly religious individuals are more likely to be distressed by repugnant intrusions as the repugnant nature of intrusive thoughts critically threatens the perceived self. Thus, individuals with high religiosity may be more likely to respond to repugnant intrusions with dysfunctional strategies and thus become more vulnerable to OCD. This study presents the endorsement rates and qualitative features of sexual and religious intrusions among highly religious Canadian and Turkish samples. Highly religious participants were interviewed using the International Intrusive Thoughts Interview Schedule (IITIS). Thematic content analysis of the IITIS data was conducted with MAXQDA. Sexual intrusion themes of Forceful Sex, Gay Sex, Immoral Sex, and Sex with Undesirable People were identified in both samples. Religious intrusion themes of Questioning, How They Are Perceived by God, Violating Religious Doctrines, Punishment by God, and Worship also emerged in both samples. The percentages of these themes suggested the presence of cross-cultural qualitative similarities and differences.

The association between fear of COVID-19 and depression, anxiety, and psychosis among Lebanese chronic patients with schizophrenia: any moderating effect of spirituality?

AIM

To assess whether fear of coronavirus disease 2019 (COVID-19) is associated with depression, anxiety, and psychosis and to evaluate if these variables are correlated with the interaction between spirituality and fear of COVID-19.

METHODS

Between September and November 2020, this cross-sectional study enrolled 118 chronic schizophrenia patients. The interview with patients included Fear of COVID-19 Scale, Lebanese Anxiety Scale-10, Montgomery-Asberg Depression Rating Scale, Positive and Negative Syndrome Scale (PANSS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-12. The results were analyzed by using linear regressions (Enter method), with anxiety, depression, total PANSS score, positive PANSS, negative PANSS, and general psychopathology PANSS subscales as dependent variables. Spirituality, fear of COVID-19, and the interaction of spirituality with fear of COVID-19 were independents variables.

RESULTS

Fear of COVID-19 was positively correlated with increased total PANSS scores (Beta=0.90, P=0.030). Higher spirituality was significantly associated with lower anxiety (Beta=-0.14, P=0.009), lower depression (Beta=-0.21, P=0.001), lower total PANSS score (Beta=-0.90, P=0.004), lower negative PANSS score (Beta=-0.23, P=0.009), and lower general psychopathology PANSS score (Beta=-0.61, P=0.001). In patients with high fear of COVID-19, having low spirituality was significantly associated with higher anxiety, depression, and psychotic symptoms.

CONCLUSION

This study suggests a positive correlation between fear of COVID-19 and higher psychosis among inpatients with schizophrenia. The interaction of spirituality with fear of COVID-19 was correlated with reduced anxiety, depression, and psychosis.

Guilt, Psychological Well-Being and Religiosity in Contemporary Cinema

This study explains the change in meaning that psychology has given to the relationship between religiosity and psychological well-being since the beginning of the 20th century, dating it back to the deep change introduced by post-modernity. Guilt is interpreted as a paradigm of this change in meaning, and the reflection that the different ways of understanding guilt have had on the screen is analyzed. The Content Analysis of a sample of 94 films showed 5 modes of expression of guilt that can be placed on a continuum from the traditional Judeo-Christian model that serves as a benchmark—harm-repentance-penitence-forgiveness—to the removal of guilt as a requirement for self-realization. The other three models emerge between these two poles: the absence of guilt as a psychiatric pathology; the resignification of the guilty act for the reduction in dissonance; and idealized regret at no cost. Studying guilt-coping models of the films allows us to infer the hypothesis that a large part of the current positive view of religiosity in psychological well-being is related to a culture that does not demand psychological suffering as a requirement for a full experience of spirituality.

Embodied Ethical Decision-Making: A Clinical Case Study of Respect for Culturally Based Meaning Making in Mental Healthcare

How does embodied ethical decision-making influence treatment in a clinical setting when cultural differences conflict? Ethical decision-making is usually a disembodied and rationalized procedure based on ethical codes (American Counseling Association, 2014; American Dance Therapy Association, 2015; American Mental Health Counseling Association, 2015) and a collective understanding of right and wrong. However, these codes and collective styles of meaning making were shaped mostly by White theorists and clinicians. These mono-cultural lenses lead to ineffective mental health treatment for persons of color. Hervey’s (2007) EEDM steps encourage therapists to return to their bodies when navigating ethical dilemmas as it is an impetus for bridging cultural differences in healthcare. Hervey’s (2007) nonverbal approach to Welfel’s (2001) ethical decision steps was explored in a unique case that involved the ethical decision-making process of an African-American dance/movement therapy intern, while providing treatment in a westernized hospital setting to a spiritual Mexican–American patient diagnosed with PTSD and generalized anxiety disorder. This patient had formed a relationship with a spirit attached to his body that he could see, feel, and talk to, but refused to share this experience with his White identifying psychiatric nurse due to different cultural beliefs. Information gathered throughout the clinical case study by way of chronological loose and semi-structured journaling, uncovered an ethical dilemma of respect for culturally based meanings in treatment and how we identify pathology in hospital settings. The application of the EEDM steps in this article is focused on race/ethnicity and spiritual associations during mental health treatment at an outpatient hospital setting. Readers are encouraged to explore ways in which this article can influence them to apply EEDM in other forms of cultural considerations (i.e. age) and mental health facilities. The discussion section of this thesis includes a proposed model for progressing towards active multicultural diversity in mental healthcare settings by way of the three M’s from the relational-cultural theory: movement towards mutuality, mutual empathy, and mutual empowerment (Hartling & Miller, 2004).

Self-Transformation at the Boundary of Religious Conversion and Psychosis

The relationship between religious conversion, as a form of spiritual emergency, and psychosis is one of the fundamental issues at the meeting point of theology and clinical psychology. In the present study, we assessed 53 individuals referred to a psychiatry center with the initial diagnosis of a psychotic episode by focusing on the clinical diagnosis (psychosis vs. spiritual emergency), subjective experiences (basic symptoms), and neuropsychological functions. Twenty-nine individuals meet the diagnosis of schizophrenia-spectrum disorders, but 24 persons experienced only religious and spiritual problems (religious conversion). Both groups reported similar levels of perplexity (e.g., ambivalence, inability to discriminate between own feelings, and hyperreflectivity) and self-disorder (e.g., depersonalization, impression of a change in one's mirror image, and experience of discontinuity in own action). Diminished affectivity, disturbed contact, and perceptual/cognitive disorders were pronounced in psychosis, whereas anxiety and depressive symptoms were more severe in people with spiritual and religious problems. These results indicate that perplexity, self-disorder, and emotional turmoil are common features of turbulent religious conversion and psychosis, but a broader emergence of anomalous subjective experiences and cognitive deficits are detectable only in psychosis.

A Dimensão Religiosidade/Espiritualidade na Prática Clínica: Revisão Integrativa da Literatura Científica

RESUMO Este estudo apresenta uma revisão integrativa sobre como a religiosidade/espiritualidade (R/E) está presente na literatura científica acerca da prática clínica em Psicologia. As buscas nas bases LILACS, SciELO, PePSIC, MEDLINE/PubMed e PsycINFO (janeiro 2010/março 2016) recuperaram 50 produções predominantemente qualitativas e publicadas em periódicos internacionais. Evidenciou-se que a R/E vem sendo incorporada nas noções de saúde, cuidado e integralidade, sendo reconhecida como dimensão que possui aspectos culturais que devem ser considerados na clínica. A literatura apresenta alguns protocolos e estratégias que podem ser empregados na prática clínica como forma de integrar a R/E ao cuidado oferecido. Sugere-se que os pesquisadores brasileiros continuem investigando o tema, visando a fornecer subsídios para práticas éticas e inovadoras quanto às dificuldades enfrentadas pelos psicoterapeutas e recém-formados.