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Islamic Integrated Cognitive Behavior Therapy: a Shari’Ah- Compliant Intervention for Muslims with Depression

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Islamic Integrated Cognitive Behavior Therapy: a Shari’Ah- Compliant Intervention for Muslims with Depression MJP Online Early 02-01-19 ORIGINAL PAPER Islamic Integrated Cognitive Behavior Therapy: A Shari’ah- Compliant Intervention for Muslims with Depression Zuraida Ahmad Sabki1, Che Zarrina Sa’ari2, Sharifah Basirah Syed Muhsin2, Goh Lei Kheng3, Ahmad Hatim Sulaiman1, Harold G Koenig4,5 1Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 2Department of Aqidah and Islamic Thought, Academy of Islamic Studies, University of Malaya, Kuala Lumpur, Malaysia 3Department of Psychological Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia 4Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States 5Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia Abstract Objective: Depression is one of the most common mental disorders that is encountered in the health care setting. Empirically-based psychotherapy for depressed patients that explicitly incorporates client’s religious beliefs and practices has been shown to predict faster resolution and may be as efficacious as antidepressant medication. There is a demand for high-quality research to evaluate the effectiveness of modified therapies that meet the needs of depressed Muslim patients, as research has shown that most of the existing interventions are methodologically weak. A Shari’ah-compliant Islamic psychotherapy intervention is a requirement in Muslim countries that practice Sunni such as in Malaysia. Method: To address these gaps in research; we adapted a Religiously Integrated Cognitive Behavior Therapy (RICBT) that intergrates Muslim patients’ faith and practices based on the Quran and Hadith. We call this intervention Islamic Integrated Cognitive Behavior Therapy (IICBT). Results: This article describes the steps taken to identify practices, approaches and the selection of verses from the Quran and Hadith that conform to Sunni Muslim scholars. The authors provide ethical considerations and a brief description of the 10 sessions. Conclusion: Islamic Integrated Cognitive Behavioral Therapy is a manualized therapeutic approach may help to assist depressed Muslim clients to develop thoughts and behaviors to reduce depression, informed by their own Islamic beliefs, practices, and resources. Further research is recommended to demonstrate the efficacy and improve the content and application of this manual. Keywords: Islam, Religion, Depression, Psychotherapy, Muslim MJP Online Early 02-01-19 Introduction religious/spiritual matters gradually in therapy and this helps in initiaitng Depression is one of the most common therapeutic alliance with the therapist. The mental disorders in the general population effectiveness of such interventions depend and is frequently encountered in health care more on the patients’ religious commitment settings. A review of 25 epidemiological than on the beliefs of the therapist as long as studies suggested that 17% of Asians are the therapist is able to integrate the religious currently depressed [1]. The 1-month perspective (mindfulness, prayer, religious prevalence of major depressive disorder may concepts) in keeping with the patient’s be as high as 5.5% [2]. Due to its chronic or belief. recurring nature with significant morbidity and mortality rates, a biopsycho-social and In a meta-analysis, religiously integrated spiritual approach has been recommended CBT based on patients’ religious beliefs and by many experts. practices was shown to be as effective as the conventional CBT in the treatment of Many types of psychotherapies are known to depression and anxiety [6]. When patients be efficacious in treating depression. The incorporate healthy religious beliefs and most common evidence-based treatment is values into their thoughts, actions, and Cognitive Behavioral Therapy (CBT). CBT emotions, these clients show faster helps the patient to learn adaptive behavioral improvement of depressive symptoms [7]. strategies and develop more accurate and Despite the many studies finding a positive helpful beliefs to reduce depressive association between religiosity and mental symptoms and improve functional outcomes health, religious/spiritual issues are usually [3]. Based on the CBT model, patients’ brought up by patients not therapists [8]. depressive symptoms worsen as they are Psychiatrists and psychotherapists have been locked in a vicious cycle of maladaptive reluctant to address these issues in therapy thought patterns, behaviors and emotional citing time constraint and their ethical responses. Teaching patients how to identify obligation to maintain neutrality [9]. and modify maladaptive cognitive processes and behaviors, empowers them to become Psycho-spiritual concepts in Islam as the their own therapist, actively trying to adopt basis for IICBT adaptive behavioral and cognitive strategies that can reduce depressive symptoms and According to Malik Badri, in his book improve quality of life. In fact, behavioral “Contemplation: An Islamic Psycho- activation alone, a component of CBT, has spiritual study” [10]; early Muslim scholars been found to be effective in alleviating had already focused on internal cognitions depressive symptoms and is recommended through contemplation of God and His as a first-line treatment for mild or moderate Creations, along with self-examination and depression [4]. reflection based on the Quran and Hadith, indicating that this was a powerful force A review of spiritually-integrated towards transformation in mind and psychotherapy by Post and Wade [5]; found behavior. For Muslim patients, then, by that psychotherapists generally identify instilling these faith-centered thoughts and more with spirituality than religion as behavior, turning to God during tribulations compared to the patients. Many may assist them find meaning and purpose religious/spiritual patients prefers to initiate in adversity as a sign of God’s love for MJP Online Early 02-01-19 them. The Qur’an mentions trials and Research shows that, religiousness and tribulations repeatedly and encourages spirituality develop across the life span, believers to persevere, promisng them that related to cognitive, affective and God would grant believers spiritual psychosocial factors, and have a significant guidance. The Qur’an also describes how relationship with quality of life and mental Islamic based therapy should be approached, health [15]. Religion enhances the ability to that is with wisdom and grace: cope effectively through prayer with negative life events, illness and disability “Invite (all) to the Way of your Lord with [16], is negatively related to drugs and wisdom and beautiful preaching; and argue alcohol abuse [17], and improves quality of with them in ways that are best and most life [18]. A systematic review on religion gracious: for your Lord knows best, who and suicide risk, found that religious have strayed from His Path, and who affiliation protects against suicide attempts receive guidance” (Al-Nahl 16:125) [11]. although not necessarily against suicidal ideation [19]. It is also important to note that Islamic based psychotherapy has been found despite these positive correlations, a higher to be effective for Muslim patients suffering prevalence of depression, anxiety and from anxiety, depression, and bereavement mortality have been found among those who [7,12-14], increasing response to therapy view adversities as punishments or significantly faster. Patients are encouraged abandonment by God [20,21]. More than to identify negative thoughts and, discuss two thirds of quantitative research on issues related to their culture and illness. religion/spirituality and mental health are They are guided to the teachings of the conducted in majority Christian populations Quran and Hadith as well as to living a and very little research has been reported on lifestyle that is consistent with Islamic Islamic based therapy among Muslim teachings as revealed to the Prophet patients. As noted earlier, the results of Muhammad (pbuh). Azhar et al. encouraged those studies show improvement in well- patients to recognize religious values based being, hope and optimism, meaning and on Islamic teachings that they would adopt purpose, self-esteem, internal locus of and cultivate these in their thoughts, actions, control, depression, suicide, anxiety, and and emotions [12]. The concept of alcohol/drug use/abuse similar to Christian- repentance and forgiveness is often based CBT. However, research has also introduced to depressed patients to shown that many of the interventions overcome the effects of guilt and regret [7], conducted using religious based therapy for but needs to be done cautiously otherwise it treating depressed Muslim patients has been may trigger patient’s underlying dynamics methodologically weak. Walpole et. al. with regard to perceptions of their illness as indicated the need for high-quality research punishment from God. A proper to determine how existing therapies can be understanding of one’s spiritual relationship modified to meet the needs of Muslim with God allows the patient to rely on God clients, and stresssed the need to evaluate at all times through daily prayers and, the effectiveness of such modified therapies supplication (Duā), as these promote [22]. relaxation and enhance a sense of well-being [12-14]. MJP Online Early 02-01-19 Ethical issues related to integrating Religiously Integrated CBT and Islamic religiosity into psychotherapy Integrated CBT The Ethics Code of the American In recent
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