The Epidemic of Depression in the Post-Modern Age
Depression is one of the most common mental illnesses in the US. Among the 21 million adults that are affected by at least one major depressive episode, it is majorly prevalent in individuals aged 18-25, and higher among adult females.[1] Depression is still rising at an alarming rate despite the existence of multi-billion-dollar pharmaceutical companies and growing healthcare industry, as not everyone has access to care nor can afford it. Some of the signs and symptoms of depression include, but are not limited to:[2]
Persistent sad, anxious, or “empty” mood
Feelings of hopelessness, or pessimism
Feelings of irritability, frustration, or restlessness
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities
Decreased energy, fatigue, or feeling "slowed down"
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping, early morning awakening, or oversleeping
Changes in appetite or unplanned weight changes
Hidaka (2012) notes that, using a retrospective methodology, modernity is a cause of the current predicament [2]. That is to say, the equivalent progress of physical well-being in mental health is lacking. For example, significant lifestyle changes have occurred over the past century due to technological advancements and urbanization, resulting in a decrease in individuals' physical activity.[3] Similarly, technological facilities like social media can become problematic wherein they contribute to psychological distress – manifesting as depression and anxiety – of adolescents and young adults by impairing their personal and social development.[4]
Daniel Goleman, who has written extensively on mindfulness, emotional intelligence, and depression, identified the consequences of modernity in 1992 as a cause for rising depression. He reported that the rise in divorce rates, loss of nuclear families, and increasing industrialization (which often results in parents spending less time with their children) prepared a breeding ground for a lack of self-identification, hopelessness, and social support for young adolescents as well as elderly people.[5]
Spiritually Integrated Psychotherapy
Treating depression with modern therapeutic measures (such as Cognitive Behavioral Therapy (CBT) and SSRIs) has been largely successful; one way to improve outcome efficacy may be to include Spiritually Integrated Psychotherapy (SIP). One difficulty with this implementation, however, is noted by Harris & Goldberg: modernity is, unfortunately, characterized by a conflict between religion and the secular world.[6,7]
Despite this characterization, a study by Pew Research in 2010 found that nearly 84% of the world’s 6.9 billion people still identified as religious.[8] As Rosmarin et al. noted, individuals facing mental health distress are showing a growing interest in practices that involve spirituality/religion.[9] As the religious needs of the population increase, the 21st century is seeing a rise in the integration of the mind, body, and spirit in the psychological field. Luchetti et al. (2021) identified a new interest rising among clinical mental health practices: integrating spirituality/religion into therapeutic measures;[10] as a result, SIP has become one of the major fields in psychology.[11]
To shed light on SIP, an understanding of ‘spirituality’ is in order. Defined by author Kenneth Pargament, as “the search for the sacred,”[12] it is not a concrete set of beliefs that are rooted in one religion - rather it is fluid and constantly changing. The word ‘sacred’ might prompt a notion of the individual’s relationship with God or a higher power; however, secular, psychological, physical, and social aspects can also be imbued with the sacred. As defined by Pargament, the ‘sacred’ is a significant object that is responsible for order and coherence in an individual’s life. Additionally, stages in an individual’s life that include discovery, struggle, and transformational coping can all be part of one’s spirituality.[13]
Psychotherapy (i.e., talk therapy) emphasizes building a relationship with the patient to relieve them of their mental strain. Even though this does not guarantee the complete eradication of a mental illness, it is especially helpful for patients to develop better strategies of their own, alleviate stress, and establish a better understanding of their obstacles. SIP builds upon traditional psychotherapy, enhancing it with the added component of spirituality.
Through SIP people can draw from psychological, religious, and spiritual perspectives to create and sustain a meaningful purpose in life. A client may choose to use music, art, poetry, church, ritual, prayer, meditation, and mindfulness to express their spiritual emotions. These methods can be used to examine if a client feels they have a spiritual emptiness and help them discover meaning in difficult life events, catering to any emotional/spiritual struggles.
SIP & Depression
Spirituality can be a coping mechanism when facing physical or psychological adversity, which has made spiritual intervention an important aspect of health care. In the event of physical adversity and in regards to mental health, spirituality-based interventions have shown promising results in the recovery from, and the prevention of, depression.[14] For example, In 2011, Delaney et al. examined patients suffering from cardiovascular diseases who took part in a 1-month intervention program focusing on spirituality. Participants demonstrated an increase in the overall quality of life as well as lower depression scores.[15] Similarly, Saisunantararom et al. (2015) found that patients with chronic kidney disease were better able to manage their depression with an understanding of spirituality.[16] A study by Bamonti et al. (2016) showed depressive older adults with high levels of spirituality reported levels of meaning in life equal to those who did not have depressive symptoms. This suggests that incorporating spirituality fosters a meaning of life, showing a link between the preservation of the meaning of life and spirituality.[17]
In light of these studies, patients who indicate higher spirituality also indicate higher meaning in life and peace. As a result, most (if not all) types of spiritualities show common themes of a quest for deeper meaning and a kind of transcendence from the material aspect of life, resulting in a deeper sense of meaning. Considering the broad nature of spirituality, it encompasses many elements which can be used independently in psychotherapy based on the needs of the client. These elements help tackle the significant symptoms of depression such as hopelessness, loss of interest, or feelings of worthlessness. Such elements include:[18]
Self-acceptance - Uncovering and accepting the real you; breaking through barriers
Forgiveness - Dealing with past trauma and moving forward
Self-Transcendence - Connecting with nature, others, and the divine
Gratefulness - Counting your blessings; includes forgiveness of others
Prayer - Counseling sessions, active listening, or asking for divine help
Spiritually integrated psychotherapy that is well-developed and fluid caters to the varying worldviews of individuals and often helps them gain a comprehensive methodology to overcome the challenges life throws at them. If you are interested in exploring SIP, reach out to a licensed mental health care provider who is versed in this methodology to discuss your options.
Contributed by: Musa Zafar
Editor: Jennifer (Ghahari) Smith, Ph.D.
references
1 U.S. Department of Health and Human Services. (2022, January). Major depression. National Institute of Mental Health. Retrieved December 6, 2022, from https://www.nimh.nih.gov/health/statistics/major-depression
2 Hidaka, B. H. (2012). Depression as a disease of modernity: explanations for increasing prevalence. Journal of affective disorders, 140(3), 205-214.
3 Lambert, K. G. (2006). Rising rates of depression in today's society: consideration of the roles of effort-based rewards and enhanced resilience in day-to-day functioning. Neuroscience & Biobehavioral Reviews, 30(4), 497-510.
4 Greenfield, S. (2015). Mind change: How digital technologies are leaving their mark on our brains. Random House.
5 Goleman, D. (1992, December 8). A rising cost of modernity: Depression. The New York Times. Retrieved December 6, 2022, from https://www.nytimes.com/1992/12/08/science/a-rising-cost-of-modernity-depression.html
6 Harris, S. (2005). The end of faith: Religion, terror, and the future of reason. WW Norton & Company.
7 Goldberg, M. (2006). Kingdom coming: The rise of Christian nationalism. WW Norton.
8 Author. (2022, April 14). The global religious landscape. Pew Research Center's Religion & Public Life Project. Retrieved December 6, 2022, from https://www.pewresearch.org/religion/2012/12/18/global-religious-landscape-exec/
9 Rosmarin, D. H., Forester, B. P., Shassian, D. M., Webb, C. A., & Björgvinsson, T. (2015). Interest in spiritually integrated psychotherapy among acute psychiatric patients. Journal of consulting and clinical psychology, 83(6), 1149–1153. https://doi.org/10.1037/ccp0000046
10 Lucchetti, G., Koenig, H. G., & Lucchetti, A. (2021). Spirituality, religiousness, and mental health: A review of the current scientific evidence. World journal of clinical cases, 9(26), 7620–7631. https://doi.org/10.12998/wjcc.v9.i26.7620
11 Smith, L. C. (2007). Conceptualizing Spirituality And Religion: Where We'Ve Come From, Where We Are, And Where We Are Going. Journal of Pastoral Counseling, 42.
12 Derezotes, D. S. (2009). Kenneth I. Pargament: Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred.
13 Ibid.
14 Baetz, M., & Toews, J. (2009). Clinical implications of research on religion, spirituality, and mental health. The Canadian Journal of Psychiatry, 54(5), 292-301.
15 Delaney, C., Barrere, C., & Helming, M. (2011). The influence of a spirituality-based intervention on quality of life, depression, and anxiety in community-dwelling adults with cardiovascular disease: a pilot study. Journal of Holistic Nursing, 29(1), 21-32.
16 Saisunantararom, W., Cheawchanwattana, A., Kanjanabuch, T., Buranapatana, M., & Chanthapasa, K. (2015). Associations among spirituality, health-related quality of life, and depression in pre-dialysis chronic kidney disease patients: An exploratory analysis in thai buddhist patients. Religions, 6(4), 1249-1262.
17 Bamonti, P., Lombardi, S., Duberstein, P. R., King, D. A., & Van Orden, K. A. (2016). Spirituality attenuates the association between depression symptom severity and meaning in life. Aging & mental health, 20(5), 494-499.
18 Pečečnik, T. M., & Gostečnik, C. (2022). Use of Spirituality in the Treatment of Depression: Systematic Literature Review. Psychiatric Quarterly, 1-15.