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A Systematic Review of the Empirical Literature on Intercessory Prayer

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A Systematic Review of the Empirical Literature on Intercessory Prayer A Systematic Review of the Empirical Literature on Intercessory Prayer David R. Hodge Arizona State University, West Campus Perhaps surprisingly, many social workers appear to use intercessory prayer in direct practice settings. To help inform practitioners’ use of this intervention, this article evaluates the empirical literature on the topic using the following three methods: (a) an individual assessment of each study, (b) an evaluation of intercessory prayer as an empirically supported intervention using criteria developed by Division 12 of the American Psychological Association (APA), and (c) a meta-analysis. Based on the Division 12 criteria, intercessory prayer was classified as an experimental intervention. Meta-analysis indicated small, but significant, effect sizes for the use of interces- sory prayer (g = –.171, p = .015). The implications are discussed in light of the APA’s Presidential Task Force on Evidence-based Practice. Keywords: intercessory prayer; evidence-based practice; spirituality; religion; direct practice Intercessory prayer is commonly defined as prayer offered among a national sample of NASW affiliated gerontolog- for the benefit of another person (Tloczynski & Fritzsch, ical workers (N = 299), 43% reported praying verbally 2002). Typically, either a silent or verbal request is made to with their clients either “sometimes” or “often.” In terms God, or some other type of transcendent entity, which the of their private prayer interventions, two thirds of respon- petitioner believes is able to effect change in another per- dents indicated they prayed either sometimes (43%) or son’s life (Halperin, 2001; Roberts, Ahmed, & Hall, 2003; often (24%) for their clients (Murdock, 2004). In short, Targ, 2002). Accordingly, intercessory prayer differs from although the use of prayer as a therapeutic intervention other types of prayer, such as personal prayer, in which an remains controversial (Canda, Nakashima, & Furman, individual prays for himself or herself. Although a consid- 2004; Praglin, 2004), the extant data suggest that most erable amount of research has explored the effects of per- social workers use intercessory prayer as a professional sonal prayer (Koenig, McCullough, & Larson, 2001), this intervention. article focuses on intercessory prayer because of its appar- The widespread use of intercessory prayer in clinical set- ent widespread usage as a therapeutic intervention. tings implicitly raises questions about the effectiveness of A surprisingly high percentage of social workers prayer as an intervention strategy. Even in newly emergent appear to use intercessory prayer in their work with areas such as spirituality, the NASW Code of Ethics (1999, clients (Heyman, Buchanan, Musgrave, & Menz, 2006; sec. 1.04 [c]) stipulates that social workers should employ Stewart, Koeske, & Koeske, 2006). One national survey interventions only after conducting the necessary research of direct practitioners affiliated with the National to ensure the competence of their work. Qualitative Association of Social Workers (NASW; N = 2,069) research, however, suggests that many social workers hold found that 28% of respondents had engaged in verbal strong beliefs, both in favor and against, on using prayer in prayer with their clients, whereas 57% prayed privately therapeutic settings (Canda et al., 2004). Consequently, it is for their clients (Canda & Furman, 1999). Similarly, unsurprising that concerns have been expressed in the social work literature that practitioners’ personal metaphysical beliefs rather than established professional protocols may Author’s Note: David R. Hodge, PhD, is an assistant professor at Arizona State be guiding therapeutic decisions (Sahlein, 2002). University-West campus and a senior nonresident fellow at University of In keeping with the premise that professional practice Pennsylvania's Program for Research on Religion and Urban Civil Society. should be based on empirical knowledge rather than a pri- Correspondence concerning this article should be addressed to the author at: Dept of Social Work, P. O. Box 37100, Phoenix, AZ 85069-7100. ori, personally held beliefs (Rosen, Proctor, & Staudt, 1999), this study explores the effectiveness of intercessory Research on Social Work Practice, Vol. 17 No. 2, March 2007 174-187 DOI: 10.1177/1049731506296170 prayer as an intervention strategy. It is important to note at © 2007 Sage Publications the onset that the purpose of this article is not to suggest 174 Downloaded from http://rsw.sagepub.com at ARIZONA STATE UNIV on February 12, 2007 © 2007 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. Hodge / INTERCESSORY PRAYER 175 that God, or some other transcendent entity, does or does decisions, studies had to meet the following criteria to not exist. Although it is theoretically possible that a tran- be included in the review: (a) use intercessory prayer as scendent being exists and responds to prayer, it is also pos- an intervention, (b) implement the intervention with a sible that prayer taps into presently undiscovered natural population of clients or patients, and (c) test the efficacy mechanisms that produce change (Hodge, 2000; Leder, of the intervention, preferably using standardized mea- 2005). In other words, intercessory prayer may effect sures and a double-blind randomized control trial (RCT) change supernaturally, naturally, or not at all. The discus- methodology. sion of various mechanisms lies beyond the purview of RCTs are widely considered to represent the “gold stan- this article. Rather, the purpose of this article is to exam- dard” for empirically validating interventions; although, ine the empirical literature that is capable of informing and concurrently, it is important to note that this method guiding practice decisions regarding the use of interces- involves a number of debatable epistemic assumptions sory prayer. (Slife & Gantt, 1999). In a double-blind RCT design, par- ticipants are randomly assigned to either a control group or an experimental group, which is sometimes referred to METHOD as a treatment or intervention group. Both the participants and the experimenter are kept uninformed regarding Search Protocol who is receiving the experimental intervention. Some observers have argued that RCTs are particularly impor- Toward this end, a key word search of Social Work tant in studies of intercessory prayer because they help Abstracts, PsycInfo, and Medline (latest years) was con- control for important confounders such as hope and ducted in July 2006 using the term prayer. Titles and expectation effects (Chambless & Ollendick, 2001; abstracts were reviewed and pertinent articles obtained. Targ, 2002). In other words, RCTs help minimize vari- Major reviews of the spirituality and religion literature were ous extraneous effects that might foster false positives also examined (Astin, Harkness, & Ernst, 2000; Halperin, or negatives, clarifying whether the experimental treat- 2001; Harris, Thoresen, McCullough, & Larson, 1999; ment, in this case intercessory prayer, is responsible for Johnson, 2002; Koenig et al., 2001; Masters, Spielmans, & the observed outcome. Goodson, 2006; McCullough & Larson, 1999; Ramondetta Studies were included regardless of whether partici- & Sills, 2004; Tolson & Koenig, 2003; Townsend, Kladder, pants knew they might be receiving prayer. Some institu- Ayele, & Mulligan, 2002). Potentially relevant articles were tional review boards (IRBs) have waived informed read and the reference sections examined for other studies consent procedures on the grounds that no known risks that might be pertinent to the present review. exist for receiving intercessory prayer, whereas others As might be expected given the subject matter, have required them. In the latter case, it is possible to studies on intercessory prayer have been controversial, argue that the administration of informed consent creates especially if positive outcomes are reported (Halperin, expectancy effects, although as discussed directly above, 2001; Sicher, Targ, Moore, & Smith, 1998; Targ, 2002). the RCT design helps mitigate any effects created. Perhaps the most controversial study has been con- Studies were held to be outside the parameters of the ducted by Cha and Wirth (2001), and the interchange review if they employed nonclinical/patient samples between Cha (2004) and Flamm (2005) illustrates some (O’Laoire, 1997; Tloczynski & Fritzsch, 2002) or featured of the issues in play. No attempt was made to assess the less rigorous designs, such as single case studies (Kowey, validity of the various arguments in deciding which Friehling, & Marinchak, 1986; Sajwaj & Hedges, 1973) or studies to include in this review. In at least some cases, nonrandom, voluntary assignment to control and treat- the central issues seem to be rooted in differing meta- ment groups (Carson & Huss, 1979). As implied in the physical assumptions about the nature of reality, a introduction, the relatively extensive research on the subject that is beyond the scope of the present article. effects of personal prayer fell outside the study’s scope Thus, all studies featured in academic journals that meet (Bernardi et al., 2001; Fabbro, Muzur, Bellen, Calacione, the search criteria were included in this study. & Bava, 1999; Sistler & Washington, 1999). Similarly, cross-sectional research on prayer was deemed beyond the Inclusion and Exclusion Criteria purview of the study (Ellison, 1993). In addition to intercessory prayer, other methods
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