Religion and Anxiety

Anxiety is an unpleasant emotional (and physiological) state that occurs when a person anticipates a potentially threatening event, or even when there is no threatening event but the temperament of the person is worry-prone (due to heredity or early life experiences). Anxiety is actually quite useful when it is not pathological.  Normal day-to-day anxiety prepares the body and mind for daily stressful situation that must deal with (called the “flight or fight” response).

Nevertheless, for many people, anxiety can become prolonged and/or excessive beyond that associated with normal functioning.

A sign that anxiety is abnormal and requires treatment is when the feeling persists even when no immediate physical or emotional threat exists, causing the person to worry most of the time without apparent reason.  The worry may become so intense that it begins to interfere with the person’s ability to performing their everyday activities – work, social, and recreational.  Anxiety disorders include the following: generalized anxiety disorder (worrying all the time over just about everything), (2) panic disorder (episodes of intense anxiety lasting 5-10 minutes and accompanied by rapid breathing, increased heart rate, and sometimes sweating and tingling), (3) social phobia (difficulty talking in public or intense discomfort in social situations), (4) obsessive-compulsive disorder (recurrent thoughts and compulsions involving rituals and checking), (5) post-traumatic stress disorder (following a severe stressful event involving threat to life, avoidance of similar situations, nightmares, and often intense depression and anxiety), and (6) phobias (unrealistic fear of heights, animals, insects, closed spaces, etc.).

Anxiety disorders like the above are actually very common.  Over 30 million Americans will develop an anxiety disorder at some point in their lifetimes and nearly 15 million will have an anxiety disorder during any given 12-month period.  These disorders are often associated with adverse health consequences, including suicide attempts and alcohol and drug abuse.

Anxiety symptoms and disorders are thought to be due to multiple genetic and environmental factors, which means that heredity has an influence as well as early life experiences and adult situations and circumstances.  Religious factors may also play a role.   Sigmund Freud argued that because religion focuses on punishment for wrong or sinful thoughts or deeds, leading to excessive guilt and thus increased anxiety (see Obsessive Acts and Religious Practices, 1907, and Future of an Illusion, 1927).   Other mental health professionals in the latter half of the twentieth century believed that religious beliefs and practices could help relieve stress and anxiety by enabling people to cope better with life’s stressors.

In our systematic review of the research conducted over the past 130 years in the Handbook of Religion and Health, Second Edition (2012, forthcoming), we identified 299 quantitative studies that had examined the relationship between religious beliefs and behaviors and anxiety.  Of those research reports, 147 (49%) found inverse relationships between religiosity and anxiety or a decrease in anxiety in response to religious/spiritual interventions.

However, 33 studies (one out of 10 reported that religious involvement was related to greater anxiety; all but two of those studies, however, were cross-sectional, meaning that the study design prevented any determinations of whether religious involvement caused greater anxiety or whether greater anxiety caused more religious involvement (“there are no atheists in foxholes”).  Furthermore, as the quality of the study design increased, the likelihood of finding less anxiety in those who were more religious increased (i.e., 57% found inverse relationships with anxiety).  Finally, of the 41 experimental studies or randomized clinical trials, 71% reported that R/S interventions lowered anxiety.

With regard to intervention studies, one was particularly interesting and deserves summarizing here. Researchers in this study examined whether including a religious/spiritual approach to meditating might reduce anxiety more effectively than secular meditation. In the first part of their study, 68 college students were taught either a spiritual meditation or a non-spiritual relaxation technique to practice for 20 minutes a day for two weeks. After that time, participants returned to the lab, practiced their technique for 20 minutes, and placed their hand in a cold-water bath of 2 degrees C for as long as they could endure it. The length of time that individuals kept their hand in the water bath was measured. Pain, anxiety, mood, and the spiritual health were assessed following the two-week intervention. Results indicated that the spiritual meditation group had greater decreases in anxiety and more positive mood, spiritual health, and spiritual experiences than the other two groups. The same protocol was used in the second part of the study to evaluate the effectiveness of spiritual versus secular meditation in 83 migraine-sufferers.  The findings were again that spiritual meditation was more effective than secular meditation in reducing the frequency of headaches, reducing anxiety and lowering other negative emotions.  They concluded that it was the spiritual aspects of meditation that were particularly effective in conveying benefits.

Much remains unknown about the relationship between religion and anxiety.  Religion may either increase anxiety (as Sigmund Freud claimed) or anxiety may cause people to turn to religion as a way of coping with the anxiety (i.e., through prayer, meditation, or other religious practices).  Both may be going on to some extent.  There is an old saying that religion afflicts the comforted and comforts the afflicted.  The answer may depend on the particular person and the particular situation that person is in.  For example, psychiatric patients who may have a fragile sense of self, low self-esteem, and are vulnerable to feelings of anxiety, guilt, or obsessive thoughts, may find that religious beliefs make them feel more anxious or guilty.  On the other hand, people who are more stable mentally but are dealing with real life circumstances, such as chronic pain, severe disability, or life-threatening and terminal illnesses may find great comfort, peace and hope in their religious faith.

We also don’t know much about the effectiveness of religious interventions in anxiety disorders in persons from different faith traditions.  For example, are Hindu or Buddhist-based forms of meditation (transcendental meditation or mindfulness medication) as effective as Christian-based forms of meditation (contemplative prayer or centering prayer) in relieving anxiety symptoms in largely Christian Western populations?  Furthermore, if religious interventions are based on a person’s faith traditions, does that person persist in the intervention longer than if the religious intervention is from a foreign belief system or completely disengaged from any beliefs system (as some forms of mindfulness meditation have become).  These are questions that researchers must answer, but that we must also think about if considering taking up meditation to relieve anxiety.


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Harold G. Koenig, MD, MHSc., completed his undergraduate education at Stanford University, his medical school training at the University of California at San Francisco, and his geriatric medicine, psychiatry, and biostatistics training at Duke University Medical Center. He is board certified in general psychiatry, geriatric psychiatry and geriatric medicine, and is on the faculty at Duke as Professor of Psychiatry and Behavioral Sciences, and Associate Professor of Medicine, and is on the faculty at King Abdulaziz University, Jeddah, Saudi Arabia, as a Distinguished Adjunct Professor. He is also a registered nurse. Dr. Koenig is Director of the Center for Spirituality, Theology and Health at Duke University Medical Center, and is considered by biomedical scientists as one of the world's top experts on religion and health.

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