Transcending Trauma: Exploring the Role of Spirituality in Psychiatry

Journal of Psychiatry Reform vol. 11 #6, June 10, 2024

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Caroline Giroux, MD, FRCPC¹

Ivy Song, MD²

David Patron, MD³

Author information:

1.Professor of Psychiatry, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

2. 3nd-year resident, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA.

3. 3nd-year resident, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA.

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Introduction

An holistic model of care, or a treatment approach that aims to address all dimensions of a person (emotional, psychological, social etc.) is the best practice. Viktor Frankl, a psychiatrist who survived Nazi camps and developed logotherapy, proposed a vision of  human beings, recognizing them as a unit in the totality that includes body, psyche and spirit (noos) [1].  Because spirituality is an inherent part of our human nature, it should also be a core component of medical care.

Spirituality involves the recognition of a feeling or sense or belief that there is something greater than oneself. It pertains to the divine, or experience of transcendence, as opposed to material realm. It is part of a human being’s essence, or ”soul”, as opposed to external attributes, such as roles, titles, possessions or accomplishments in the tangible world. It is a portal to our Higher Self, made of love, enlightenment, and inner knowing. Everyone has some potential for deep wisdom, yet not everyone chooses to connect with it or express it. Spirituality is a dimension of spacious awareness that is a common denominator of human beings and is cultivated through values such as kindness, compassion, gratitude, transcendence.

Frankl states that spiritual dimension does not fall ill, and, unlike the body and mind, it has resources to face adverse situations, such as self-transcendence and self-distancing [1].

Spirituality is therefore an integral aspect of human experience, often encompassing practices aimed at enhancing well-being and connection. These practices, which include yoga, deep breathing, meditation, and engaging with nature, can be pursued individually or in group settings, with or without religious affiliations [2]Despite the proven benefits of cultivating spiritual values and mindfulness qualities, such as gratitude and joy, within mental health care, the integration of spirituality into psychiatric practice has historically been limited[3] Spiritual beliefs and practices have been primarily associated with conditions such as hysteria, neurosis, psychotic delusions, and hallucinations [4] However, there is a growing recognition within the medical community, including organizations like the AMA (American Medical Association), of the importance of spirituality in clinical care [2] The authors have witnessed various benefits in their patients within a trauma recovery program and group therapy they have been co-facilitating.

Background

Research indicates that spirituality is associated with reduced rates of depression, suicidality, and substance use, while also promoting a sense of connection, particularly among trauma survivors. Spiritual practices, including those based on the 12-step model, have shown effectiveness in preventing and coping with relapse in addiction recovery.

At UC Davis Department of Psychiatry, the RESTART (Resilience, Education and Supportive Tools for Adults Recovering from Trauma) program has been incorporating spirituality as part of its trauma recovery approach since 2018. Group interventions, using components of Dialectical Behavioral Therapy (DBT) model with a holistic and spiritual approach offer additional benefits by fostering a sense of community, integration of polarities, and support. The group consisted of 12 sessions with focus on topics pertaining to trauma, such as adverse childhood events, attachment, boundaries, shame and guilt, self and sense of identity, trauma schemas, re-enactments, loss and grief, and transgenerational trauma, to name a few.

Each week, the structure of the 90-min group session is as follows:

– Intro: Check-ins (how has the week been, and gratitude practice, agenda, announcements (5 min)

– Mindfulness exercise guided by one of the co-facilitators (3-5 min)

– Topic of the day: video, mini didactic presented by one of the co-facilitators (10-15 min)

– Discussion/reflections in group during which participants share insights, ask questions and support each other (35-40 min)

– Closing mindfulness practice (2-3 min)

Methods

• Participants (n=5) of the Spring 2024 RESTART group took part in this pilot study. A survey was emailed to the participants during the final session of the group, and they were given time to complete it during the session.
• Qualitatively, participants were asked to share their spiritual practices, how participating in this group had helped with their spiritual practice, their biggest takeaway, and any additional comments.
• Quantitatively, participants were asked to self-report on a Likert scale (1-5) for the following statements, both before and after participating in the RESTART group:

1. Understanding of spiritual practice in trauma recovery
2. Daily practice of spirituality (such as meditation, gratitude, and compassion)
3. Effectiveness of spirituality in coping with trauma
4. Level of connection with self (self-awareness, emotional attunement)
5. Level of connection with others (social connections, sense of community)

Results

The parameters measured were self-rated within a range that fell between 2 and 2.5 before, and 3.75 and 4.5 after, indicating an overall improvement in all the five dimensions explored.

Narrative comments from group participants included: “I no longer feel alone in my journey. I am accepting change more easily.” “It also allows me to do guided meditation whenever I feel necessary.” “More connected with nature. More aware of self and others.” “The meditation/mindfulness sessions made me feel so relaxed”.

Their most significant takeaways were: “Being a part of supportive group, learning tools to deal with trauma.” “The education, tools, and love for humanity at their worst.” “I also wish Dr. Song would record her mindfulness reading sessions so I can just play them as needed. They are so relaxing.” “The wise mind and mindfulness guided meditation are really helpful.”

The co-facilitators also emphasize the importance of the group interaction during recovery, as a form of social skills training. As such, interesting dynamics were observed as participant grew more comfortable with the co-facilitators, the format of the group, and with other participants. Either consciously or unconsciously, at times participants took on various roles or archetypes during discussion/reflection, reminiscent of Jungian archetypes, e.g. the innocent, the orphan, and most often, the caregiver. The ability to take on and take off these roles appropriately in a group, while still allowing for one’s own vulnerability, requires much cognitive flexibility, emotional attunement, and likely reflects the participants’ trust in the group and readiness for deeper trauma work.

 

Discussion and Conclusion

Spiritual practices such as mindfulness practices, connecting with nature and expressing gratitude and compassion, are effective methods for healing. Additionally, spiritual practices can be enhanced by using objects as conduits to connect with our inner wellbeing. Different cultures and traditions have included objects such as drums, dreamcatcher, crystals and candles in spiritual practices. These practices contribute to a sense of purpose and facilitate personal growth and can be tailored to make them patient-centered. Using a bell to signal the beginning and the end of a meditation practice can also be grounding and a practice to awareness of sound.

In summary, spiritual-based interventions can serve as adjunctive treatments for various mental health conditions, offering advantages such as affordability, accessibility, and social connectedness. Recognizing spirituality as a fundamental dimension of health underscores the importance of adopting more holistic approaches in mental health care.

 

Future directions

Based on the positive outcomes observed in the RESTART program, further clinical studies with larger sample sizes are recommended. Additionally, efforts should be made to disseminate information and make spiritual services more accessible to individuals seeking mental health support.

References

1. Medeiros AY, Pereira ER, Silva RM. The Medical Healing of Souls: a strategy for welcoming post-pandemic mental health. Revista Brasileira de Enfermagem. 2023 Dec 4;76:e20220331.
2. Lucchetti, G., Koenig, H. G., & Lucchetti, A. L. G. (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

3. Spittles, B. (2023). Better understanding psychosis: Psychospiritual considerations in clinical settings. Journal of Humanistic Psychology, 63(2), 246–254. https://doi.org/10.1177/0022167820904622
4. Rosmarin, D. H., Pargament, K. I., & Koenig, H. G. (2021). Spirituality and mental health: challenges and opportunities. The Lancet. Psychiatry, 8(2), 92–93. https://doi.org/10.1016/S2215-0366(20)30048-1