Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2010 Integration of Spirituality and Cognitive-behavioral Therapy for the Treatment of Depression Jennifer J. Good Philadelphia College of Osteopathic Medicine, [email protected] Follow this and additional works at: http://digitalcommons.pcom.edu/psychology_dissertations Part of the Clinical Psychology Commons Recommended Citation Good, Jennifer J., "Integration of Spirituality and Cognitive-behavioral Therapy for the Treatment of Depression " (2010). PCOM Psychology Dissertations. Paper 55. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at DigitalCommons@PCOM. It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of DigitalCommons@PCOM. For more information, please contact [email protected]. Philadelphia College of Osteopathic Medicine Department of Psychology INTEGRATION OF SPIRITUALITY AND COGNITIVE-BEHAVIORAL THERAPY FOR THE TREATMENT OF DEPRESSION By Jennifer J. Good Submitted in Partial Fulfillment of the Requirements of the Degree of Doctor of Psychology July 2010 Committee Members' Signatures: Brad Rosenfield, Psy.D., Chairperson Robert A. DiTomasso, Ph.D., ABPP William J. Librizzi, Psy.D. Robert A. DiTomasso, Ph.D., ABPP, Chair, Department of Psychology Spiritually Informed CBT iii Acknowledgement I would like to thank all of those individuals who have encouraged, mentored, and supported me throughout the dissertation process. First, I would like to thank Brad Rosenfield, Committee Chairperson, for his support, guidance, and mentorship throughout the doctoral process. His drive, intellect, compassion, and diligence have helped me to develop more fully as a person, researcher, and clinician. I would also like to thank my committee members, Dr. DiTomasso for his commitment and dedication to the development of each doctoral student, and Dr. Librizzi for assisting in providing fuel for this project in the very beginning, his spiritual wisdom and knowledge in creating the integrative manual, and his kind words and praise throughout the entire process. A special thank you to my mother, Shirley Amass, for spending countless hours revising, editing, and reading through the various drafts that I created over the past year and her abundant and constant love. Thanks to my dad, Walter Amass, for a listening ear, word of encouragement, and endless amount of love whenever I needed it. I would like to thank my husband, Ben Good, for his abundant love, understanding, and support everyday that we have together. To my family, the Amass’ and the Goods, for their love and support when I felt exhausted and drained. Without the love, blessings, continuous praise, and encouragement from these individuals, the work that I have accomplished would not have been possible. Finally, I want to praise God for giving me strength, intellect, and the knowledge to persevere throughout the trials of this dissertation process. I know that all things are Spiritually Informed CBT iv possible with God, and He continues to direct my path in all areas of my life and in particular my development as a Christian Clinical Psychologist. Spiritually Informed CBT v Abstract Major depressive disorder (MDD) is a common mental health problem that is treated by many mental health practitioners. Cognitive-behavioral therapies have proven to be effective in helping restructure the cognitions of the client, which in turn reduces depressive symptom. Research has shown that individuals with MDD who value spirituality tend to view the world in a different way than those individuals that do not hold spirituality as an important value in their life. Spiritual individuals have religious schemas, and therefore, it would be important to incorporate spirituality into the treatment setting. This pilot study utilized a manualized treatment approach that focuses on spiritual growth and decreasing depression through a spiritually informed cognitive- behavioral approach (SICBT). Spiritually Informed CBT vi TABLE OF CONTENTS Chapter 1………………………………………………………………………………......1 Introduction……………………………………………………………………………...1 Statement of the Problem…………………………………….......................................1 Purpose of the Present Study………………………………………….........................2 Relevance to one or more of the goals of the Clinical PsyD program…………….......3 Chapter 2. ……………………………………………………………………..…………..5 Literature Review………………………………………………………………………..5 Definition……………………………………………………………………………...5 Important Elements of Spirituality…………………………………………………….6 Spirituality in Treatment………………………………………………………………7 Cultural differences/considerations…………………………………………………...8 Assessment of Spirituality……………………………………………………………9 Clinical Issues………………………………………………………………………..11 Spirituality and Benefits……………………………………………………………..12 Spiritual Interventions…………………………………………..……………………17 Major Depressive Disorder…………………………………………………………..32 Spirituality and Depression…………………………………………………………..51 Spirituality and Cognitive-Behavioral Treatment……………………………………52 Manualized Integrative Treatment…………………………………………………...57 Chapter 3 ………………………………………………………………………………...60 Hypotheses……………………………………………………………………………..60 Research Question…………………………………………………………………...60 Spiritually Informed CBT vii Statement of Hypotheses…………………………………………………………..…60 Chapter 4 ………………………………………………………...………………..……..70 Methods………………………………………………………………………………...70 Design and Justification……………………………………………………………...71 Requirements………………………………………………………………………...76 Analysis of Risks/Benefits Ratio…………………………………………………….78 Procedure…………………………………………………………………………….79 Initial Evaluation……………………………………………………………………..80 Diagnosis……………………………………………………………………………..81 Case Formulation and Clinical Impressions…………………………………………84 Chapter 5………………………………………………………………..………………..88 Results……..…………………………………………………………………………...88 Data Sources…………………………………………………………………………88 Data Sources…………………………………………………………………………94 Data Sources………………………………………………………………………..100 Data Sources………………………………………………………………………..104 Objective Data……………………………………………………………………...107 Chapter 6: Discussion…………………………………………………………………..110 Limitations……………………………………………………………………………116 Future Directions…………………………………………………………………..…121 References……………………………………………..………………………………..126 Appendices……………………………………………………………………………...143 Spiritually Informed CBT viii Appendix A: Ten-Week Integrative Manualized Treatment Approach Including Cognitive-Behavioral Therapy and Spirituality………………………...……..……143 Appendix B: Spiritual Assessment Tool………….……………………………..….297 Appendix C: Depression Information Sheet………….…………………………….299 Appendix D: Cognitive-Behavioral Therapy Sheet…………………………….......303 Appendix E: Elijah Story…………………………………….…………………......304 Appendix F: Weekly Activity Monitoring Schedule……….……………………....306 Appendix G: Weekly Check list….……………………………………………..….307 Appendix H: Cognition Log……………………………………….…………….....308 Appendix I: Spiritually-Informed Dysfunctional Thought Record…………...……309 Appendix J: Biblical Passages that are Related to Various Cognitive Distortions....310 Appendix K: Cognitive Quadrant…………….……………………………….........326 Appendix L: Passages of God’s Love…………………………………….……..….327 Appendix M: Scriptures for Meditation……………….…………………………....329 Appendix N: Calendar…………………….…………………………………..……335 Appendix O: Spiritual Issues for Treatment………………….……………….........336 Appendix P: Transcription of Treatment Sessions……….……………………...…350 Chapter 1 Introduction Statement of the problem. Spirituality is an integral and vital element in the lives of many individuals. There has been a recent explosion of studies and research in this area. Spirituality is regarded as one of the four components of overall well-being (Mohr, 2006). The four essential components of an individual, as noted by Mohr (2006), are the physical, emotional, social, and spiritual dimensions. Spirituality may also play an important part in the identity of an individual. People often make decisions based upon their religion and may even adhere to certain rules of living founded upon their spiritual beliefs. Research has shown that spirituality is associated with values of wholeness, hope, meaning, harmony, and transcending (O’ Reilly, 2004). These values help individuals cope with stressors in the world and strive toward reaching their natural potential. An important factor is ignored when the clinician fails to incorporate spirituality into the treatment of a spiritual individual. The research and development of several approaches related to integration have evolved over time (Richards, Rector, & Tjeltveit, 1999). These methods are relatively new, receiving mixed reviews from individuals in the field of psychology. In general, some clinicians are skeptical about the integration of spirituality and therapy, as there is a general fear that this new branch of psychology may be seen as unscientific or invalid (Lindridge, 2008). Other therapists, however, embrace this new domain and continue to work towards a healthy integration of spirituality into their practice (Shafranske & Sperry, 1990). Spiritually Informed CBT 2 The cognitive-behavioral approach has expanded to include spirituality. Within this approach, the therapist utilizes the basic tenets of cognitive-behavioral therapy (CBT) in combination with spiritual values and beliefs to treat the client (Beitel, Genova, Schuman-Olivier, Arnold, Avants, & Margolin, 2007). Incorporating a theory that is empirically validated