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The ‘spiritually integrated’ approach to anxiety

Anxiety is the single largest public health problem in America.

Anxiety image
Pictured is Dr. David H. Rosmarin, a psychology who opened an anxiety clinic for the spiritual clients.

Of the many afflictions facing society today, a surprising one takes the lead: Anxiety is the single largest public health problem in America, with nearly 20 percent of the population meeting the criteria for a diagnosis every year.

While psychologists are well equipped to deal with the symptoms of anxiety, they are less so when it comes to treating patients who consider themselves to be spiritual. That is where Dr. David H. Rosmarin comes in.

Ten years ago, Dr. Rosmarin, who is an instructor in the Department of Psychiatry at Harvard Medical School and assistant in psychology at McLean Hospital, discovered a painful void.

"More than 50 percent of this country says that religion is 'very to moderately important'," he said, "however, most clinicians are not religious, and that creates a vibe in therapy that is poisonous for people who are religious and seeking treatment."

People think they will be shamed for their religious beliefs, that they will be unable to find common ground with their psychologist, and that is frequently true, says Rosmarin.

Rosmarin began to study different ways of incorporating spirituality into psychological treatment. He recently spent time in Israel, meeting with dozens of rabbis. The task he gave them was simple: "Teach me how to help people who have anxiety using the Torah."

His years of research have culminated in a different approach to psychological treatment, which he refers to as the "Spiritually Integrated Program." Rosmarin is quick to clarify that this is not a new brand of psychology, rather, integration into the standard method

Most psychologists, including Rosmarin, ascribe to evidence-based treatments such as Cognitive Behavior Therapy (CBT). CBT advocates engaging a patient in his life by encouraging him to follow his daily routine instead of succumbing to the symptoms of anxiety. This is referred to as "behavioral activation," the theory being that the more engaged one is with one's life, the less depressed or anxious that person feels.

Rosmarin follows the same model of "behavioral activation," but from the perspective of spirituality. For example, he practices what he calls "gratitude exercises," that are designed to take a person out of their narrow day-to-day focus. He will ask a patient to think about his left hand, and then picture his life without it. The left hand, then, becomes a gift. The goal, he said, is "positive spiritual engagement to produce a lift in mood."

"Religious traditions are full of it, blessings over [the little things]," he said. "The whole point is to live life through it and appreciate what we're given."

Rosmarin says that the difference between CBT and the spiritually integrated program is that the former is about scheduling your day, while the latter adds an element to your life.

And you won't find a couch in his office. Rosmarin's aim, he said, is to get patients back to their normal lives as quickly as possible. "I want people out of my office. I give them skills, I hike them a balland I say 'go.' My goal is to get them out of the nest."

Initially, Rosmarin was skeptical of the rabbis' findings and his own research. "I thought, this is cute, but is it really going to work?"

So he conducted a study with more than 500 patients, and the results were astounding. He divided the patients into three groups: One received no treatment, one received the standard evidence-based treatment, and one received the spiritual treatment.

After two weeks, where patients in the third group practiced the techniques Rosmarin had developed once a day for 30 minutes, patients who started at the 95th percentile for their level of anxiety were at the 50th percentile. Rosmarin also found that there was no significant difference between patients who received no treatment and those who received the standard treatment, and the improvement for both was slight in comparison.

In 2011, Rosmarin took his years of research to the next level and opened the Center for Anxiety in New York City. Through the use of the spiritually integrated program, the center treats afflictions related to anxiety, ranging from psychosis to phobia to obsessive-compulsive disorder and depression. Treatment is offered remotely (through the phone or Skype), or in intensive individual or group sessions.

While the center is still relatively new, Rosmarin said that most of his referrals come from rabbis. The treatment is not exclusive to Jewish patients; it is open to anyone who is seeking out a form of treatment that speaks to their spirituality.

"What I'm doing is not magic, and it's not mysticism," Rosmarin said. "We're talking about shifting the emotional state by integrating spirituality into ordinary psychological treatment."

Masha Rifkin is the managing editor of JointMedia News Service, an independent, non-profit, editorial content resource for Jewish media.

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