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This entry is our analysis of a review or synthesis of research findings added to the Effectiveness Bank. The original review was not published by Findings; click Title to order a copy. Free reprints may be available from the authors – click prepared e-mail. Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text The Summary conveys the findings and views expressed in the review. Below is a commentary from Drug and Alcohol Findings.

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Adapting psychotherapy to the individual patient: Religion and spirituality.

Worthington E.L., Hook J.N., Davis D.E. et al.
Journal of Clinical Psychology: 2011, 67(2), p. 204–214.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Worthington at eworth@vcu.edu.

Meta-analytic review commissioned by a US task force concludes that psychotherapy patients who identify with the religious or spiritual orientation of a therapy improve more than if untreated or treated with exclusively secular therapies, but not more than if treated with otherwise equivalent established therapies.

Summary Many clients highly value religious Religion can be defined as adherence to a belief system and practices associated with a tradition in which there is agreement about what is believed and practiced. and spiritual Spirituality can be defined as a general feeling of closeness and connectedness to the sacred. What one views as sacred is often a socially influenced perception of either a divine being or object, or a sense of ultimate reality or truth. Many but not all people experience spirituality in the context of religion. commitments, and many psychotherapists have accommodated secular treatments to these perspectives. We meta-analysed 51 samples from 46 studies involving 3290 patients which examined the outcomes of non-religious spirituality therapies or therapies which have been adapted to religious perspectives. In the vast majority of studies, the patients in the samples identified with the particular religion or spirituality perspective on which the tested therapy was based. Outcomes were expressed as psychological or spiritual variables. Religious or spiritual therapies were compared to a no-treatment control condition or an alternative treatment. Some studies used a 'dismantling' design, testing the impact of adding religious content to therapies otherwise equivalent in theory, content and duration. Comparison conditions may differ in strength, so dismantling studies most rigorously test whether it is helpful to tailor psychotherapy to a client's religion or spirituality. We excluded studies of 12-step groups such as Alcoholics Anonymous and meditation or mindfulness interventions which were not explicitly religious or spiritual.

Patients allocated to religious or spiritual psychotherapies showed greater improvement than those allocated to alternative secular psychotherapies both on psychological (a small effect size A standard way of expressing the magnitude of a difference (eg, between outcomes in control and experimental groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of the variability in the outcome across both groups. The most common statistic used to quantify this difference is called Cohen's d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. of 0.26) and on spiritual (a medium effect size A standard way of expressing the magnitude of a difference (eg, between outcomes in control and experimental groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of the variability in the outcome across both groups. The most common statistic used to quantify this difference is called Cohen's d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. of 0.41) outcomes. In the dismantling studies, accommodating otherwise equivalent treatments to religious or spiritual perspectives improved spiritual (a small to medium effect size A standard way of expressing the magnitude of a difference (eg, between outcomes in control and experimental groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of the variability in the outcome across both groups. The most common statistic used to quantify this difference is called Cohen's d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. of 0.33) but not psychological outcomes. These findings may have been subject to bias due to the non-publication of negative studies or the religious commitments of the authors or publishers.

We conclude that religious/spiritually oriented psychotherapy works and can result in better psychological and spiritual outcomes than secular alternatives among patients who identify with those perspectives. However, adding religious/spiritual adaptations to an established secular psychotherapy does not reliably improve psychological outcomes for religious or spiritually inclined clients, so there is no empirical basis to recommend religious/spiritual psychotherapies over established secular psychotherapies when the primary or exclusive treatment outcome is psychological symptom remission. On the other hand, even in these studies, religious/spiritual psychotherapies do offer added spiritual benefits to clients. Religious/spiritual preferences may be among those which therapists can profitably adapt their approaches to.


Findings logo commentary This article was in a special issue of the Journal of Clinical Psychology devoted to adapting psychotherapy to the individual patient. For other Findings entries from this issue see:
What works for whom: tailoring psychotherapy to the person
Adapting psychotherapy to the individual patient: Stages of change
Adapting psychotherapy to the individual patient: Preferences
Adapting psychotherapy to the individual patient: Culture
Adapting psychotherapy to the individual patient: Coping style
Adapting psychotherapy to the individual patient: Resistance/reactance level
Adapting psychotherapy to the individual patient: Expectations
Adapting psychotherapy to the individual patient: Attachment style

Last revised 09 March 2011

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