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THE IMPACT OF ORTHODOX CHRISTIAN NEPTIC-PSYCHOTHERAPEUTIC INTERVENTIONS ON SELF-REPORTED DEPRESSIVE SYMPTOMATOLOGY AND COMORBID ANXIETY by ZORAN VUJISIC submitted in accordance with requirements for the degree of DOCTOR OF THEOLOGY in the subject PRACTICAL THEOLOGY at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF A P PHILLIPS JOINT SUPERVISOR: DR P DI LEO NOVEMBER 2009 ABSTRACT Orthodox Christianity represents the oldest Christian tradition. However, the tragic schism between the Christian East and West has resulted in a lost cognizance of the East by the West (Chrysostomos, 2007). Ultimately, this loss, for the West, involves the loss of part of its own Christian heritage. As attempts at rapprochement are made, on the ecclesiastical, cultural, and international levels, it is important that the West begin to develop an understanding of human psychology from an Orthodox perspective, i.e., a psychology consistent with the cosmology and soteriology of Orthodoxy. Orthodox Christian Psychotherapy bridges the divide between mystical, neptic, and hesychastic teachings and the methods and goals of modern Western psychotherapy. It is the meeting of the transcendent and the secular, and of spirituality and psychotherapy, as they impact all those in need of inner healing from spiritual, behavioral, and / or psychological disorders and pathologies (St. John Climacus, 1979; Romanides, 2007). This study in practical theology concretizes the above by examining the intensity of depressive symptomatology and comorbid anxiety before and after a twelve-week treatment plan using Orthodox Christian neptic-psychotherapeutic interventions and techniques. The results represent yet another step in disentangling the mystery of the relationship between spirituality, psychological treatment, and mental health. The findings, which confirm the efficacy of Orthodox Christian Psychotherapy, offer insight into the ways in which neptic-psychotherapeutic interventions may be applied at the pastoral and clinical level and utilized to treat and / or prevent depressive symptomatology and comorbid anxiety, and possibly other spiritual, behavioral, developmental, and / or psychological disorders and pathologies, in both the Orthodox and general populations. ii Key Words: ascesis, dynamis, energeia, hesychia, metanoia, nepsis, noetic prayer, nous, psyche, theoria, and theosis. iii TABLE OF CONTENTS ABSTRACT………………………………………………………………………… ii TEN KEY WORDS…………………………………………………………………. iii CONTENTS………………………………………………………………………… iv LIST OF TABLES…………………………………………………………………... x LIST OF ACRONYMS……………………………………………………………… xii DEDICATION………………………………………………………………………. xiii ACKNOWLEDGMENTS…………………………………………………………… xiv CHAPTER I: INTRODUCTION……………………………………………………. 1 1.1 Orthodox Psychotherapy……………………………………………………... 2 1.2 Rationale……………………………………………………………………… 5 1.3 Framework and Literature Review…………………………………………… 6 1.4 Research Problem and Hypotheses..………………………………….……… 10 1.5 Thesis Statement……………………………………………………………... 11 1.6 Aims of Research…………………………………………………………….. 11 1.7 Delimitation of Study………………………………………………………… 12 1.8 Research Design and Methodology…………………………………………... 12 1.9 Definition of Terms and Concepts…………………………………………… 14 1.9.1 Definition of Terms……………………………………….………….… 15 1.9.2 Definition of Concepts…………………………………………………. 24 1.9.2.1 Dynamis and Energeia………………………………………….... 24 1.9.2.2 Human Nature…………………………………………………….. 27 iv 1.9.2.3 The Human Psyche………………………………………………. 27 1.9.2.4 The Human Spirit………………………………………………… 30 1.9.2.5 The Image and Likeness………………………………………….. 31 1.9.2.6 The Nature of Sin…………………………………………………. 33 1.9.2.7 The Passions……………………………………………………… 34 1.9.2.8 The Nature of Salvation………………………………………….. 35 1.9.2.9 Hesychasm………………………………………………………... 38 1.9.2.10 Neptic Psychology………………………………………………. 42 1.10 Researcher’s Background and Interests……………………………………… 43 1.11 Chapter Outline………………………………………………………………. 45 1.12 Dissemination of Research…………………………………………………… 45 CHAPTER II: LITERATURE REVIEW……………………………………………. 46 2.1 The Foundational Presuppositions of Orthodox Psychotherapy……………... 46 2.1.1 The Psyche and the Nous……………………………………….……… 47 2.1.2 Pathology……………………………………….………….…………... 56 2.1.3 Fantasy……………………………………….………….……………... 61 2.1.4 Emotions……………………………………….………….……………. 62 2.1.5 The Movement of the Nous……………………………………….…….. 63 2.2 Etiology of Disorders / Pathologies………………………………………….. 64 2.3 The Cycle of Temptation……………………………………………………... 70 2.4 Neptic Treatment……………………………………………………………... 74 2.4.1 Cognitive Interventions……………………………………….………... 74 2.4.2 Conative, Identity, and Self-Concept Interventions……………………. 81 v 2.4.3 Behavioral Interventions……………………………………….………. 83 2.4.4 Hesychia and the ‘Prayer of the Heart’………………………………... 91 2.4.5 Overview of Neptic Treatment………………………………………….. 98 2.5 Depression and Anxiety……………………………………………………… 99 2.5.1 Depressive Disorders in the DSM-IV …………………………………. 100 2.5.2 Anxiety Disorders in the DSM-IV ……………………………………… 103 2.5.3 Depression and the Holy Fathers………………………………………. 105 2.5.4 Anxiety and the Holy Fathers……………………………….………….. 112 2.6 Summary…..…………………………………………………………………. 116 CHAPTER III: METHODOLOGY…………………………………………………. 118 3.1 Paradigm and Methodology…………….……………………………………. 118 3.2 Research Validity / Reliability……………………………………………….. 121 3.3 Participants…………………………………………………………………… 123 3.4 Sample Size and Unobserved Heterogeneity in Causal Inference…………… 123 3.5 Research Instruments………………………………………………………… 125 3.6 Ethical Considerations………………………………………………………... 127 3.7 Summary……………………………………………………………………... 129 CHAPTER IV: DATA, FINDINGS, AND ANALYSIS……………………………. 130 4.1 Hypotheses………………...…………….…………………………………… 130 4.2 Findings………………………………………………………………………. 131 4.2.1 Pre-Treatment BDI………………………….………………………….. 131 4.2.2 Pre-Treatment BAI®………………………….………………………… 136 vi 4.2.3 Neptic-Psychotherapeutic Treatment Compliance………………...…… 140 4.2.4 Post-Treatment BDI……………………………………………………. 159 4.2.5 Post-Treatment 160 BAI®…………………………………………………… 4.2.6 Pre-Treatment / Post-Treatment BDI and BAI® 164 Scores………………... 4.3 Analyses and Evaluation of Findings………………………………………… 167 4.3.1 Pre-Treatment / Post-Treatment BDI……………….………………….. 167 4.3.2 Pre-Treatment / Post-Treatment BAI®……………….………………… 173 4.3.3 BDI and BAI® Scores vs. Treatment…………………………………… 175 4.3.4 Extraneous and Confounding Variables……………………………….. 180 4.4 Follow-up Interviews……………………………………………………….... 181 4.4.1 Analysis of Responses: Participant No. 1……………………………… 182 4.4.2 Analysis of Responses: Participant No. 2……………………………… 183 4.4.3 Analysis of Responses: Participant No. 3……………………………… 183 4.4.4 Analysis of Responses: Participant No. 4……………………………… 184 4.4.5 Analysis of Responses: Participant No. 5……………………………… 184 4.4.6 Analysis of Responses: Participant No. 6……………………………… 185 4.4.7 Analysis of Responses: Participant No. 7……………………………… 185 4.4.8 Analysis of Responses: Participant No. 8……………………………… 186 4.4.9 Analysis of Responses: Participant No. 9……………………………… 186 4.4.10 Analysis of Responses: Participant No. 10…………………………… 187 4.4.11 Analysis of Responses: Participant No. 11…………………………… 187 vii 4.4.12 Analysis of Responses: Participant No. 12…………………………… 188 4.4.13 Analysis of Responses: Participant No. 13…………………………… 188 4.4.14 Analysis of Responses: Participant No. 14…………………………… 189 4.4.15 Analysis of Responses: Participant No. 15…………………………… 189 4.4.16 Summary of Follow-up Interviews……………………………………. 190 4.5 Conclusion……………………………………………………………………. 190 CHAPTER V: SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS….. 208 5.1 Overview of Study………………...…………….…………………………… 208 5.1.1 BDI Findings………………………………………………….………... 209 5.1.2 BAI® Findings………………………………………………….………. 210 5.1.3 Compliance Rates……………………………………………………………... 211 5.1.4 Correlations………………………………………………….………… 211 5.1.5 Follow-up Interviews…………………………………………………………. 211 5.2 Conclusions…………………………………………………………………... 212 5.3 Implications…………………………………………………………………... 213 5.3.1 Implications for ‘Self Analysis’……………………………………………… 215 5.3.2 Implications for Dialogical Explication……………………………………. 216 5.3.3 Implications for Psychotherapy and Psycho-Education…………………. 217 5.3.4 Summary………………………………………………………………………... 218 5.4 Limitations…………………………………………………………………… 220 5.5 Recommendations……………………………………………………………. 221 REFERENCES………………………………………………………………………. 224 viii APPENDICES……………………………………………………………………….. 241 A. Part I: Informed Consent……………………………………………………... 242 B. Part II: Qualifying Information Questionnaire……………………………….. 244 C. Part III: Pre-Treatment Inventories…………………………………………... 246 D. Part IV: Treatment Program………………………………………………….. 251 E. Part V: Treatment Monitoring………………………………………………... 262 F. Part VI: Post-Treatment Inventories…………………………………………. 264 G. Part VII: Follow-up Interviews………………………………………………. 269 H. Vujisic Inventories………………………………………………………….... 271 ix LIST OF TABLES Table 1 Participants’ Demographic and Qualifying Information………………. 126 Table 2 Pre-Treatment BDI Scores……………………………………………... 134 Table 3 Pre-Treatment BDI Item Scores………………………………………... 135 Table 4 Pre-Treatment BAI® 138 Scores…………………………………………….. Table 5 Pre-Treatment BAI® Item 139 Scores……………………………………….. Table 6 Participants’ Treatment Compliance…………………………………... 143 Table 7 Participant No. 1 Treatment Compliance (Orthodox Female)………… 144 Table 8 Participant No. 2 Treatment Compliance (Orthodox Male)…………… 145 Table 9 Participant No. 3 Treatment Compliance (Orthodox Female)………… 146 Table 10 Participant No. 4 Treatment Compliance (Orthodox Female)………… 147 Table 11 Participant No. 5 Treatment Compliance (Orthodox Male)…………… 148 Table 12 Participant
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