Religious Cognitive–Emotional Therapy: A New Form of Psychotherapy

Abstract

From the ancient times up to this date, it has been thought that religion and spirituality have important effects on human being's mental life. However, some psychologists and psychotherapists have ignored this role, and thus neglected to study the effects of applying religion and spirituality in psychotherapy. However, many psychologists and psychotherapists have recently studied the relationship between religion or spirituality and mental health; or used religious interventions in psychotherapies. Although different kinds of religious psychotherapies have been proposed, no comprehensive theory has been presented in this area. In this article a scientific, comprehensive and applied spiritual method of psychotherapy is suggested. Religious Cognitive- Emotional Therapy (RCET) is a new form of cognitive therapy that uses the basic religious beliefs and insights in psychotherapy. RCET is a new integration of cognitive, humanistic, and existential psychotherapies that takes into account religious beliefs and insights of the clients. RCET is an effective method of psychotherapy for the treatment of those who suffer from identity crisis, depression, and anxiety; and it can be developed to address other psychological disorders as well. Because RCET is a new approach, practically is needed to do further theoretical research in this area.

From the ancient times up to this date, religion and spirituality have been important topics in human being's life. Moral discipline derived from religion has important effects on behavior, feeling and experience of human beings. Even though most of early psychologists such as William James (1902), Carl G. Jung (1969), Gordan Allport (1950), and others studied religious experiences and their role in psychological well-being, religion and spirituality were neglected in psychology and psychotherapy for many years (1–3).

The first question is why such a separation occurs when human beings are the subject of both religion and psychology. Probably psychologists think that psychology is a science that must study human beings in a scientific manner, while religion and spirituality is a completely individual or subjective experience not subjected to scientific or objective methods. Therefore, psychology, as a rigorous discipline, must detach itself from its philosophical and religious roots. On the other hand, some of the religious topics were confused with spiritualism, mesmerism, superstitious beliefs and other pseudo –scientific endeavors. In addition, two major clinical paradigms, psychoanalysis and behaviorism, tended to ignore religion and spirituality in explaining human behaviors (4–6).

These are the reasons why many psychologists avoided studying religious concepts in psychology through scientific methods.

However, many psychologists and psychotherapists have recently studied the relationship between religion or spirituality and mental health or used religious interventions in psychotherapy (5, 7–13). In extensive literature, dealing with religious and spirituality topics is spurring now. The increasing rate of publications is 600% in a ten- year period (14). Towards the late 20th – century which is known as the post positivistic era, new approaches such as positive psychology and Eastern psychology were more open to religion and spirituality: (5).

Researches show that in many Western countries, the prevalence of religious beliefs and affiliation is high. For example, recent estimations indicate that over 80% of Americans consider themselves affiliated with one religion and over 75% confirm the absolute existence of God and pray at least once a week (15). Also in UK, over 75% of the population state that they hold religious and spiritual beliefs (16). In Eastern countries, these percentages are very high; for example, one study on the Iranian youth indicates that %92 of Iranian youth trust in God and %91 believe that God sees their actions (17). Therefore, the psychotherapists need to consider the religious beliefs of these individuals and come up with new theories to help them.

Many researches in this filed focused on the relationship between religion or spirituality and mental health. Although many of these researches showed a positive relationship between spirituality and mental well being (18–23), some studies identified particular spiritual risk factors for poorer mental well- being, such as feeling of anger towards God, conflicts with congregation and clergy and spiritual doubts and confusion (24).

In recent decades, many psychotherapists have tried to use religious and spiritual concepts in psychotherapy. These religious interventions are being used with different types of psychotherapy theories, including the Behavior Therapy (25), Psychoanalytic (26), existential –humanistic Therapy (27), Gestalt Therapy (28), Adlerian Therapy (29), Person-Centered Therapy (13), Rational –Emotive Therapy (30), and Cognitive Therapy (31, 32).

However, it was proved that psychotherapists need systematic, rigorous and practical theories of religious psychotherapy which can be used in therapeutic sessions. Religious Cognitive- Emotional Therapy (RCET) is a new theory which help therapists to find comprehensive and practical theories of psychotherapy.

Basic Concepts of Religious Cognitive-Emotional Therapy (RCET)

The Religious Cognitive – Emotional Therapy is essentially a new form of cognitive theory based on religious approaches. According to cognitive theories, what we think (cognition), what we feel (emotion and affect) and how we act (behavior) interact with each other. The basic aim of the cognitive therapy is to identify irrational or maladaptive thoughts, assumptions and beliefs which are related to debilitating negative emotions to identify what is dysfunctional or just not helpful about them. Therefore, the patients must give away irrational and distorted thoughts and replace them with more realistic and self - helping alternatives (33). Two major theories in the cognitive approach are the Cognitive Behavior Therapy (CBT) that was developed by Aaron T. Beck (34, 35) and Rational Emotive Behavior Therapy (REBT) that was proposed by Albert Ellis (36, 37).

Beck (38) described a number of thinking errors, maladaptive, unhelpful and unrealistic thoughts about oneself, others and the world that he believed contribute to emotional distress and inappropriate behaviors of human beings. Some of the thinking errors described are as follows: black and white thinking, arbitrary inference, selective abstraction, overgeneralization, magnification and minimization. The Cognitive Therapy seeks to identify and change “ distorted ” or “ unrealistic ” ways of thinking and to influence emotions and behaviors. In the REBT framework, our ways of thinking and irrational beliefs are the cause of much emotional disturbance. According to Ellis (39), the belief system of people, not external events, determine their feelings and behaviors.

He suggested some beliefs through which people disturb themselves. In REBT, a therapist may point out irrational beliefs, but he or she teaches the patients how to challenge these beliefs in their daily life outside the therapy and provide them with exercises. The result of challenging self- defeating beliefs and replacing them with rational ones yields an effective new philosophy.

The CBT and REBT are used widely, and the efficacy of these therapies in the treatment of psychological disorders has been shown in many researches (40–42). However, these Cognitive Therapies emphasize more on the way individuals interpret ideas and events they face within their every day lives; they put less stress on basic beliefs which deepen philosophical roots of the individual's life.

In Religious Cognitive- Emotional Therapy (RCET), psychotherapists must consider basic philosophical beliefs which relate to the meaning of human beings' lives. There are important questions about the self and existence in human's mind that must be answered; for example, what am I ? Where do I come from? What is the existence? Where does the existence come from? Who is the creator of the world and me? And many other questions that human beings seek answers for. On the other hand, the RCET framework assumes that people through their lives find that things and events disagree with their desires. They are confronted with difficulties and unbearable events. Furthermore, they are confronted with events that can not be controlled and interrupted. Their parents, intimate friends and dear ones die, and they may face disasters. Therefore, they ask themselves why they must tolerate these serious disasters and finally see the death of their dear ones? Why are they to live?, So they seek to find the meaning of life.

Existential philosophers have already emphasized the importance of human being's search for the meaning of life. Existential psychology is partly based on the existential belief which state man is alone in the world. This loneliness leads to the feeling of meaninglessness that can be overcome only by creating self values and meanings (43). Frankl (44) said that individual's search to find meaning or a purpose for his or her life is the most fundamental need which has to be met; it is said that the striving to search for and to possess a meaning or a purpose for one's life is said to be “ the primary motivational force in man ”. According to Frankl (44), when an individual can not form a meaning or purpose of life for oneself, he or she suffers from “an existential vacuum”. The existential vacuum can be described as a private and personal form of nihilism. These individuals experience despair and hopelessness, and do not know why they ought to live.

For many years, I have faced many individuals that suffered from psychological disorders. All of them have had symptoms of“ existential vacuum”, that was suggested by Frankl. They were aimless, affected by the feeling of absurdity, despair, and hopelessness in their lives. They have had no meaning in their lives. They have avoided purposeful efforts and did not have any plan in their lives. I think that these persons suffer from “identity crisis ”. According to RCET, these people could not find the meaning of life without basic religious beliefs. There are three basic religious beliefs: God, existence, and human being. These basic religious beliefs influence one's thinking about oneself, interpretation of life events, and determine the mental health (feeling and behavior) of people (45).

What are the basic religious beliefs?

Basic religious beliefs are psychological states in which individuals are convinced of truth in a proposition. These beliefs are rooted in religions. They are divided into three groups in RCET: God, existence and human beings. They can answer the essential questions about the self, others,world, God, and interactions between them. When people find answers to essential questions, they will achieve a good and stable sense of hopefulness towards the world, purpose and can distinguish the meaning of life, feel integrated with existence and accept realities. They understand why they live, how they should behave e and what they want in their lives. These people live peacefully without any anxiety or depression. Three groups of basic religious beliefs are:

1-God: (a) There is no God except the unique God that is the creator of the world and existence.(b) God is almighty and all-knowing.(c) God is merciful, very kind and compassionate.

These items are the most essential ones and believing in them can cause the most important effects on humans' mental life. The acceptance of the merciful, compassionate and almighty God gives the best direction to lives. The responsibilities, here are clear for all people. They are to be resistant in solving the problems of lives; furthermore, relaxation is another result of believing in God.

2-Human beings: (a) Human being is the highest creation in the great chain of beings and it is the God's representative on earth. (b) He has intellectual capacity and will. (c) He is supposed to achieve transcendence in life. (d) When he dies, his life is not finished but it is transformed. These basic beliefs help people to gain high self - esteem or confidence, and to plan in their life and consider their worth. With these beliefs, they are not obsessed with death but try to be ready for it.

3-Existence: (a) nothing is without any purpose or goal, and neither is the world. (b) The world and existence are created in a complex and wonderful way. (c) The world is characterized by order and discipline. These basic religious notions help people to understand the world events better. They develop creative thinking to resolve the complexity of the world and to find the meaning of it, self and life.

These beliefs are adapted from Islamic references, but many of them are shared with other religions. In fact, I mentioned a few of basic religious beliefs, and there are more of them that can be used in psychotherapy sessions.

Human Nature and Psychopathology in RCET

According to RCET, human being has two dimensions: body' and psyche. Body and psyche interact with one another. Thus, in human psychopathology, we must pay attention to both physiological and psychological levels.

Physiological or biological factors have an important role in many disorders in different ways. For example, in anxiety disorders, there are a number of physiological reactions that occur automatically, such as increasing heart rates, pain in heart and shoulders and unpleasant sensations. These automatic emotional reactions are produced by classical conditioning.

If a woman is faced with a snake, as a stimulus, the other neutral stimuli can be conditioned and produce a similar reaction in her at a future time. Therefore, according to the RCET theory, some individuals may suffer from anxiety or other psychological disorders, because they have suffered from physical injuries or physiological symptoms that are produced by classical conditioning. In addition, other psychotherapies, for example Cognitive Behavioral Therapy (CBT), pay attention to physiological organs in treating psychological disorders (34, 46).

Human being is an intelligent creature. He/she can think about events and interpret them. Sometimes thoughts, anticipations, and interpretations of life events can produce unpleasant emotions or maladaptive behaviors in humans; therefore, in the second level of human psychopathology, the ways of one's thinking about every day problems are considered. Irrational beliefs that were suggested by Albert Ellis (37, 39) and thinking errors proposed by Aaron Beck (34, 35) are mental processes which cause emotional disturbance and maladaptive behaviors.

Religious Cognitive Emotional Theory (RCET) points out that if human beings have not physical health but their thoughts and everyday beliefs are realistic, they do not know their purpose and the meaning of life and do not answer the essential questions about their lives; they can not have healthy emotions, behaviors and feeling of comfort and satisfaction in their lives. Thus, everybody seeks the meaning of life, existence and God. The questions such as:, where did we come from?Why did we come to this world? Where are we going? Who created the world and existence? Who is God? Who is the creator of existence? And many other questions occupy human beings' minds. Not being able to answer these questions and leading a meaningless life cause identity crisis and confusion. (47).

The RCET assumes that path of human beings development is toward the transcendence, and reaching to an acceptation and comfort feeling with self, world, and God. Figure 1 shows the general model of psychopathology and therapeutic method of RCET.

Figure 1.

General psychopathology and therapeutic model of RCET

The Therapeutic Process

In the RCET, the intervention can be directed at three levels: physiological, cognitive and spiritual levels. These three levels are related to one another. The RCET therapist can use and emphasize the therapeutic levels based on every client's problem. For example, the person who suffers from GAD, shares the physiological symptoms, thinking errors and feeling of worry, despair, worthlessness, nihilism, confusion, and loss of meaning of life. The therapist must use all levels for the treatment. However, in a depressed person who has not any physical symptoms, the therapist must use cognitive and spiritual levels.

The therapist, after initial clinical interviewing, explains the general model of the RCET, first, and delineates these three levels (physiological, cognitive, and spiritual) of psychopathology and treatment. The therapist describes the interaction between these three levels to determine the individual's health, emotions and behaviors (general mental health).

In the physiological level, the therapist identifies the physical and emotional reactions of the client (such as increased heart rates, perspiration, feelings of pain in some area of body and so on) that have unpleasant sensations and are produced by classical conditioning. In this level, the therapist describes the automatic connection between the stimulus and the situation with these physiological symptoms. The therapeutic method in the physiological level is to teach relaxation and breath control which help the client to control his physiological reactions and reduce his unpleasant emotions.

The RCET therapist, in the second level of treatment, considers the ways of thinking and interpreting events of the person's daily life. The therapist tries to identify and change distorted and unrealistic ways of thinking which cause emotional disturbance and maladaptive behavior in individuals. Ellis (39 suggested that people disturb themselves through irrational beliefs. These beliefs are rigid explicit/ implicit demand and command that cause some extreme conclusions such as awfulness, overgeneralizations, depravation, frustration and low tolerance.

The RCET also considers these irrational thoughts; and RCET therapist identifies and changes the client's self-defeating and irrational thoughts with more rational and self- constructive ones, which then are likely to cause healthier and more constructive emotions and behaviors. The thinking errors, such as black and white thinking, arbitrary inference, overgeneralization that were proposed by Beck, (34, 35) are addressed in this level of treatment.

One key tenet in the RCET framework is that although changing the irrational beliefs and negative thoughts into rational and positive ones is important, it is not enough and the process of treatment is not complete. Therefore, the third level of treatment is the spiritual level. At this level, the RCET therapist through purposeful questions examines the client's basic beliefs about the self, existence (world), God and the meaning of life. Most of those persons that suffer from depression, anxiety, and other emotional disturbances have nihilistic beliefs about the self, others and existence. They are uncertain about the existence of God. (45, 48).

At first, at the spiritual level of RCET, the therapist asks the clients to talk about themselves and others, and how they think about themselves as a human being. Most of clients have negative pictures about the self and human beings. They have feeling of worthlessness, despair, and do not know why they have to live. The RCET therapist should challenge the clients' beliefs through proposing the basic religious beliefs and clarifying how these basic religious beliefs can help one to decrease their anxiety, depression or other unpleasant emotions, and promote the individual development and mental health.

Human beings live in the world; so any beliefs and attitudes about the world and existence have important effects on one's mental health. In the second stage, the RCET therapist identifies the clients negative and nihilistic beliefs about the world and existence and helps them to change these beliefs into positive and purposeful one's, so that the clients acquire a new insight of existence.

In the third stage, the therapist makes clients aware of God's role. (God is the best patron with best characteristics that guides human beings). When people accept God as the unique creator, they will gain the safe and reliable force in the world and feel relief in their lives.

In summary, the therapist uses the basic religious beliefs about human beings, existence and God to help the client to gain a new insight and the meaning of life. The therapist should have a structured thinking and systematic planning in the process of treatment. The therapist must show the effects of the ten basic religious beliefs in the human life. These are very important and have deep effects. Thus, the RCET therapist needs special training to apply physiological, cognitive and spiritual levels of treatment.

In addition to the special method of the RCET, therapists must show sympathy and have a good rapport and positive attitude towards clients. The RCET therapist must avoid direct advice to patients for the accepting religious beliefs. He or she must bear in mind that human beings are privileged with free will. Therefore, the therapist must show positive functions of any basic religious beliefs to promote human's development and transcendence and help the patients to gain a good mental health without any insistence.

Conclusion

Religion and its principles have always been important factors which effect humans' psyche and mind. Nevertheless, some of psychologists and psychotherapists reject the application of religion and spirituality in psychology. However, because the subject of religion and psychology is human beings, both of them try to show the ways of human development and well being. Thus, there are some similarities between these two fields. However, many psychologists believe that religions study the mankind with nonscientific methods and psychology, as a science, must use a rigorous scientific method. In recent years, science has undergone important changes, ranging from modernity to post – modern paradigm, and scientific studies of spirituality and religion have increased.

The studies of spirituality and religion in psychology have been developed in many topics.For example, the relationship between spirituality and mental health (7, 19, 49); receiving social support (50, 51); copying styles (10, 47, 52, 53); and spiritual interventions in psychotherapy (5, 8, 9, 54).

Although many methods of religious psychotherapy have been proposed, there have not been any comprehensive theories in this field so far. This article suggests a scientific, comprehensive and applied spiritual psychotherapy method. Religious Cognitive Emotional Therapy (RCET) is a new form of cognitive therapy that uses basic religious beliefs and insights in psychotherapy. RCET is a new integration of cognitive, humanistic, and existential theories that is combined by religious beliefs and insights. RCET is a new approach that can lead to a new field of treatment, research, and education in psychology and psychotherapy; and we need more researches in this field. RCET is an effective method of psychotherapy for the treatment of persons that suffer from identity crisis, depression, anxiety and it can be developed to remove other psychological problems.