Efficacy of Spiritual Integration

Home , Abu Yusuf, Ahmad Sirhindi, Rumi, Shah Waliullah Dehlawi

10/29/2020

Traditional Islamically Integrated Psychotherapy (TIIP) Hooman Keshavarzi, Psy.D Khalil Center

• Past research has demonstrated that religiously congruent therapists have a significant positive impact on the client who is religiously observant (Anderson, Heywood-Everett, Siddiqi, Wright, Meredith, & McMillan, 2015). • Spirituality isolated in a study from physical function, social support and personal meaning controlled and showed significant contributor to positive mental health (Aflakseir & Colemane, 2009) • Worthington & Sandage (2001) found spiritually oriented cognitive and rational-emotive psychotherapies were equally effective as secular ones for Christian and Muslim clients with depression and anxiety (and in several studies SOPs were more effective) • Smith, Bartz, & Richards (2007) found that overall random-effects weighted average effect size for SOPs was d = .56, which provides moderately strong empirical support for their general effectiveness; specifically, Christian and Muslim forms of cognitive and rational-emotive psychotherapy for religious clients • Hook, Worthington, Davis, Jennings, Gartner, & Hook (2010) state that, there is evidence that SOPs are efficacious (i.e., outperform a control group and/or are equivalent to an alternative treatment) and that gains are maintained at follow-up; however, the data base is small and some SOPs have no evidence supporting their efficacy; no SOPs meet strict criteria for specificity (i.e., work better than an alternative treatment), SOPs with some evidence supporting their efficacy are: Muslim forms of CBT for depression and anxiety.

1 10/29/2020

Islamic Intellectual Heritage The development of Islamic Religious Discourse saw the explosion of literature on human behavior (tahdheeb al-nafs) and character reformation (tahdheeb al-akhlaq) and ontology.

Era of Muhaditheen & Early Sufism Golden Era Physicians/Philosophers Ottoman Era . Ibn Sireen (32 H/654 AD)  Abu Ali ibn Miskawayh (310 H/932 AD)  Ibn Khaldun (710 H/1332 AD) . Hasan Al-Basri (106 H/728 AD)  ibn Sina/Avicenna (358 H/980 AD)  Sultan Bayezid II (825 H/1447 . Harith al-Muhasibi (159 H/781 AD) AD) . Ibrahim ibn Adham (158 H/782 AD)  ibn Rushd/Averroes (576 H/1198 AD)  Taqi uddin ’Imam’ al-Birgivi (900 . Ahmad bin Hanbal (160H/780 AD) Later Mutakalimeen & Formalized Sufism H/1522 AD) . Imam al-Bukhari (188 H/810 AD)  Abu al-Hafs Al-Nasfai (445 H/1067 AD) . Imam Tirmidhi (202 H/824 AD)  Ahmad Sirhindi – Imam al-  Abu Hamid al-Ghazali (489 H/1111 AD) Rabbani (942 H/1564 AD) Early Physicians/Polymaths . Abu Zayd al-Balkhi (228 H/850 AD)  Yahya ibn Habash Suhrawardi (532 H/1154 AD)  Ibrahim al-Laqani (918 H/1540 AD) . Abu Yusuf al-Kindi (251 H/873 AD)  Muhyiddin ibn Arabi (543 H/1165 AD) . Abu Bakr al-Razi (232 H/854 AD)  Shah Waliullah Dehlawi (1081  Jalaluddin al-Rumi (585H/1207 AD) Eary Mutakallimeen H/1703 AD)  Ibn al-Qayyim al-Jawziyya (670 H/1292 AD) . Abu Mansur al-Maturidi (232 H/853 AD)  Ibrahim al-Bajuri (1161 H/1783 . Abu al-Hasan al-Ashari (252 H/874 AD)  Baha-uddin Naqshaband (696 H/1318 AD) AD) . Abu Ja’far al-Tahawi (309 H/933 AD)

Pre-Ghazalī –Disciplines in Islamic Heritage

Disciplines

CORE Islamic Sciences Auxiliary Sciences Theory/Methodology “Islamisized” Pure Kalam Greek (‘itqadi) Philosophy

Fiqh al- Fiqh al-Zahir Hikmah/Tibb Application (‘Amal) Batin/Sufism

2 10/29/2020

Post-Ghazalī – Kalamasized Philosophy

Islamic Disciplines

CORE Islamic Sciences Auxiliary Sciences

Theory/Methodology Fiqh al-Akbar Kalamasized (‘itqadi) (Kalam) Philosophy

Fiqh al-Batin Fiqh al-Zahir Hikmah/Tibb Application (‘Amal) (Sufism)

Islamically Integrated Mental Healthcare

Islamic Disciplines

CORE Islamic Sciences Auxiliary Sciences Kalamasized Theory/Methodology Fiqh al-Akbar ‘Western (Kalam) (‘itqadi) Sciences’

Tibb/ Fiqh al-Batin Fiqh al-Zahir Mental Application (‘Amal) (Sufism) Healthcare

3 10/29/2020

Islamically Integrated Holistic Mental Healthcare within the context of the Islamic Sciences

Taking a TIIP approach

An integrative approach allows you to draw two types of interventions: 1. Empirically validated interventions that are culturally and religiously adapted. 2. Exploratory Islamic interventions that may have promising value

4 10/29/2020

• A structured articulation of an emerging Islamic Hence: orientation to psychotherapy • TIIP is an integrative model of mental health care Creation of that is grounded in the core principles of Islam TIIP while drawing upon empirical truths in psychology • TIIP is situated within an Islamic epistemological and ontological framework, providing a discussion of the nature and composition of the human psyche, its drives, health, pathology, mechanisms of psychological change, and principles of healing.

DOES TIIP WORK?

• Conducted a Paired Value T- Test to compare pre and post intervention scores. • Differences were statistically significant at p=0.011

5 10/29/2020

1 year Process Outcome Study on TIIP (107 patients – over 400 sessions)

Epistemology

6 10/29/2020

A Sunni Conceptual Framework for Islamic Psychology

• Maturidi/Ashari Sunni theology as a classical Sunni approach toward the investigation of human cognition, behavior, emotion and spirituality. • Integrative by filtering and incorporating modern behavioral science, through a classical sunni tradition, while re-presenting the sunni classical intellectual tradition for modern scientific consumption and application.

Sources of Knowledge (Asbaab al-ilm)

1. Sensory (Hissi) 2. Khabr (wahi & Takweeni) 3. Rationality/reason (aqli)

• Equality among all three sources of knowledge

7 10/29/2020

Empirical Knowledge

Epistemology Revelational Mental Rational Knowledge Health Knowledge

Doctrine of Occasionalism

8 10/29/2020

Qatii (mansus alayhi)

• Thubut Classification • dalalah with regard to certainty Dhani (ijtihad) or its strength • Thubut • Dalalah

Examples

• All the previous sources of knowledge fit into this. • Hissi/Empirical – • Qati – Brain stores memory. • Dhani – correlational data • Khabar – • Tawheed, sifat of Allah (wahi); China exists (takweeni) • Dhani – wiping over non-leather socks • Rational • Qatii – the whole of something is greater than the sum of its parts. Existence of opposites. • Dhani – contingent worlds, life on other planets, speculative philosophy

9 10/29/2020

Apparent Contradictions Between Sources

• Any contradictions (taʿāruḍ) between conclusions originating in these sources are understood to be only apparent and demand resolution through either: i. reconciliation (tatbiq), ii. abrogation (naskh), iii. interpretation (taʾwīl) (Farfur, Abdul Latif, 2002, pg. 155).

• For example, Qurʾānic verses mention Allah’s creation of the universe in six “ayyām” (lit. days) • denote in their use of the term ayyām Example of not the customary 24-hour cycle of day Creation of and night or simply daytime (as opposed to night) but broad and Earth Question ambiguous “periods” of time due to the rational unlikelihood that ayyām be restricted to earthly, normative time.

10 10/29/2020

• For example, some Muslim scholastic suggested that the metaphysical aql is physically located in the brain on account of cognitive faculties being impaired through brain damage despite the Qur’an’s apparent attribution of cognitive faculties to the heart in surah al-Hajj, verse 22. • Exegetes have offered several potential Example of meanings to this verse that consider empirical information and reason. Localization of • Meanwhile, the majority (jumhur) of discursive theologians have maintained that the Aql Question metaphysical aql is a property of the metaphysical heart but its metaphysical light stimulates the cognitive faculties in the brain, thereby reconciling the between empirical information, rationality and revelation (Bajuri, pg 273).

Objective Knowledge vs Subjective Religious Experience

11 10/29/2020

Role of modern behavioral science w/in this Framework

• Filtering modern behavioral science through an Islamic epistemological and ontological framework. • Ghazali (Horse Example) • Mantiq • Muslims generally used Medical examples in their works, including sufi works. • Adopting research that provides insights into the application of Islamic interventions with human beings, ie tajrabah. • Inherently Islamic & Islamic adaptations of mainstream interventions

Ontological Framework of Human Psyche, Health & Pathology

12 10/29/2020

Defining our Schema of Health: Islamic Primordial Purpose

• God based salvation theory • Salvation from fire of Hell • Gnosis/Ihsan – God consciousness • Aspirations towards spiritual nourishment and perfection. • Proximity to God and His messenger (Haque, 2004) • Leading a meaningful life (tied to original purpose) • All on this pathway with different ranges of functioning: • Melting the Barriers for us to get to that goal: • Bio-Psycho-Social-Spiritual (Be they clinical or not) 25

Balkhian Division: Clinical Pathology

Exogenous Pathology Endogenous

13 10/29/2020

Pathology - Exogenous

• Seen as impacting: • Prenatal - Primordially • Post-Natal Lifespan (Worldly) • Post-Mortum • A fundamental difference between an exclusively clinical conception of dysfunction and Islamic holistic health is that Islam does not restrict dysfunction solely to the temporal world or to clinical impairment. • Character flaws that adversely impact a patient’s afterlife are also taken into consideration as well as such character traits that lead to poor functioning even before they may become significantly impairing. • Narcissism

Beyond the DSM

• In fact, Cloninger (2004) makes the argument that people who are naturally inclined to desire deeper meaning in their lives as they face the inevitable reality of sickness, suffering, and mortality can only find lasting satisfaction and health in spiritual approaches to well-being. • Through spirituality, he asserts, one can find hope and meaning in life that helps reduce vulnerability and increases resiliency to clinical pathologies (Cloninger, 2004).

14 10/29/2020

Ontology of Human Psyche

• Imam Shahab ad-Din Yahya Suhrawardi (d. 632 H/1244 AD), an ascetic scholar in his Awarif al-Ma’arif, offers that it is permissible to discuss the nature of the ruh or metaphysical essence of the human being, however it must be considered as a possible meaning (ta’wil), not an interpretation (tafsir) of the Qur’anic term asserted with certainty (qaṭʿī) (pg. 243). • The existence of an inner metaphysical self is a matter of certainty in Islam, while the specifics of its nature is probabilistic (Zanni). • Potentially falsifiable and probabilistic models as incontrovertible, or to consider any contention with such models as un-Islamic. • Example: Is aql part of ruh?

Human is Dualism

1. outer (ẓāhir) and inner (bāṭin) self, or the physical self on one hand 2. the metaphysical or subtly physical self on the other

15 10/29/2020

• Heart – in the vicinity of physical heart lies a subtle metaphysical essence (al-latifa al-rabaniyyah/Qalb) • Said differently, it is the metaphysical heart, with a light that illuminates or enlivens the body. Ex. lamp that illuminates a room. • Subtle essence, With respect to (I’tibar) • cognition (tafakur) it is the aql. • the life force (hayat al-jasad/haywani) & divine celestial spirit (ruh samawi) • its carnal/predatory desires or behavioral inclinations it is known as the nafs (Bajuri) • All three are interacting, interchangeable and interconnected. They are just different qualities of the same al-latifah al-rabaniyyah manifested in different forms.

al-Latifah al-Rabanniyah (Ghazali)

روح

روح سماوي روح حيواني قلب

عقل

نفس

al-Latifah al-Rabanniyah (Bajuri/Ghazali/Suhrawardi)

16 10/29/2020

Intrapsychic Tension

Drive Theory – Competing Drives

• Fitra - Human beings are all born with a primordial, inherently good nature. • Comprehend universal truth, know both good and evil • Recognition and inclination for the Divine • Amongst such competing drives are what Shāh Walī Allāh called the dichotomy of man’s angelic (malakūtī) and the animalistic (bahīmī) natural drives. • These animalistic drives arise out of the pleasure seeking (quwat shahwi) and destructive instinct (quwat ghadabi).

17 10/29/2020

• Suhrawardi, - competing drives between the ruh haywani bashari and ruh samawi uluwi. • They become entrenched in the untrained nafs ammarah (behavioral inclinations), but through • inkishāf (introspective awareness) and • tarbiya (spiritual training) • it is possible to reorient the fiṭra towards its angelic tendencies (malakuti) and spiritual elevation (taraqi). • This embrace of the ruh samawi and its nurturance leads to tranquility whereby the tension between the competing drives is released. However, left unchecked, lower carnal desires drive the person towards his bestial nature and render them vulnerable to the inculcation of evil traits and a satanic orientation (Ghazali p 137). Optimal Health

Qalb

• Qalb – By qalb we refer to the spiritual heart, which is the receptacle of all health and pathology. Input from any of the other components results in either the illumination or darkening of the heart:

18 10/29/2020

Nafs – behavioral inclinations.

Nafs

Ghadab/Survival/Aggressive Shahwah/Appetitive Drives drives

Nafs mutmainnah Nafs lawwamah

Nafs Ammarah

تفكير/تفكر تمييز بين الحق و الباطل و Aql الحسن و القبح (غريزة) معرفة عواقب اﻷمور من المضار و ادراك المنافع

19 10/29/2020

Restraint Reflection/cogn ition/Memory

Distinguish between truth & falsehood; Aql (Inherent Good/Evil Metaphysical Disposition)

Appreciation for the consequences Conception of actions

Rūḥ

1. the human being’s spirit and life force (ruh haywani) • The origin of putting the drives of the nafs ammarah into motion 2. the spirit’s inclination (ruh samawi uluwi) toward the sacred and longs for reconnection and remembrance of the divine. • Inner self that thirst’s for deeper meaning, purpose and transcendence to its primordial state of aspiring for divine presence that corresponds to the nafs mutma’innah.

20 10/29/2020

Ihsās

• Loosely to as an individual’s basic emotions. • This is a secondary aspect of the human experience and may not warrant admissibility as a separate and distinct aspect of the human psyche. • It can be seen as a byproduct of the interaction between nafs, ruh and ‘aql. • Emotions can have adaptive or healthy manifestations or become dysregulated and unhealthy, such as man’s innate anger, which is positive when it produces assertiveness and dysfunctional if it produces aggression.

21 10/29/2020

Process of Change

Excess I’tidal Insufficient

ʿAql

Nafs

Ittiḥād

Rūh

Iḥsās

22 10/29/2020

Case Simulations

• Abdullah comes in and discloses to you that he feels dissatisfied with life. He does not feel like he is living for any particular reason and finds Case himself feeling sadness all the time. To overcompensate for this sadness he notices Simulations that his appetite has gone up and he eats to cope. He is having a difficult time controlling his eating. Additionally he reports that he is having trouble with prayer and feels a void in his spirit.

23 10/29/2020

• Sister Aminah reports that she is always irritable at home. She is irritable at home with her children and husband and finds herself becoming enraged. She states that she often finds herself crying at night and cannot really understand why she cries so much. She is a housewife that longed to go to college but she has been raising her 4 children since graduating from high school.

• Abu Bakr states that he is angry that God did not allow him to marry a woman that he had hoped for. He feels that God has not answered his prayers and states that he is angry with God. He believes that he has been living a good life and doesn’t understand why God would not answer his prayers. This is causing him to question his faith.

24 10/29/2020

• Sarah is not sure why she has been inflicted with a life-threatening disease. She finds herself thinking that she is being punished by Allah and has intense fear of dying. This fear is causing her intense anxiety that is exacerbating her physical condition.

• Abdullah is struggling with pornography addiction, this is accompanied by self-gratification (climax). He has been trying to control these impulses for years. He finds himself consistently relapsing. He has gone for some weeks at a time without using pornography but cannot seem to conquer this, consistent relapses cause him to feel depressed and suffers from poor self-esteem.

25 10/29/2020

Background: 33-year-old working professional, married with 2 kids (Mixed Anxiety Depressive Disorder) Situation: Mom wants her to come over everyday.

Personalization ʿAql: • Judging me: thinks I am bad Mind-Reading Personalization • ”I am hurting her” Self-Conscious Villainization vs Villainization • “I am sinning”

Anger Ihsās: • Anger Guilt/Shame Dysregulation • Shame/Guilt

• Doesn’t answer phone Avoidance Nafs: • Won’t visit Irritability • Irritability/disrespect with Enmeshment Avoidance vs mom • Visit excessively Enmeshment (overcompensatory behaviors)

•Religion is too hard, I Rūḥ: am going to hell Connection Obedience to anyway w/mom  Disconnect w/mom •no point in praying Connect w/Allah  Disconnect person vs w/Allah •disconnect from Obedience to Allah faith

26 10/29/2020

Background: 35-year-old working professional male, married with 3 kids (GAD) Situation: Family complains that he is inflexible and refuses to go on trips.

Catastrophizing ʿAql: • If I do not get enough sleep, I will be Minimizing Catastrophizing dysfunctional

Anxiety Ihsās: • Hyperarousal, Too Relaxed Hyperviligence • Anxiety/fear/worry

Nafs: Avoidance • Avoidance behaviors (no Restrictive Avoidance & vacations, agoraphobia), Behaviors Too Flexible • does not wake up for fajr Restrictive since it will disturb sleep. • Rigid routine behavs

Rūḥ: •Missing prayer Overreliance on means Absence of •Overreliance on Neglect means tawakul means

Example Intervention: As anxiety goes up, energy goes down. Therapist: How much energy do you have when you 10 10 get 8 hours of sleep: Client: 10 energy level and 0 anxiety level. Therapist: How much energy do you have when you get 5 hours of sleep: Client: 2 energy level and 5 anxiety level. Therapist: Your theoretical score should be 7 energy 5 5 level, 0 anxiety level. But when you add 5 anxiety level, it decreased your ACTUAL energy level to 2 (7 – 5). Energy Anxiety If we decrease anxiety, then it will increase your energy level Client: How? Therapist: Through changing your perspective (ʿaql), 1 1 changing your behaviors (nafs) and increasing tawakul (rūh), which will lower your anxiety (ihsās).