Prayer and Social Support Key to Recovery from Depression and Bipolar Disorder
More religious involvement and prayer may be related to less depressions and less hopelessness in depression treatment, argues new book. The following is an excerpt from Chapter 10 of Depression and Bipolar Disorder: Your Guide to Recovery by William R. Marchand, MD.
Religion and spirituality
The aim of this section is not to advocate for any particular religious point of view or belief system. Religious belief and affiliation, or lack thereof, are obviously individual choices, and I am not arguing for or against religion and spirituality. However, a handful of scientific studies have looked for possible relationships between depression and religious involvement. Since the goal of this book is to provide evidence-based information to support your recovery, I will briefly discuss the possible role of religion.
Some of the research that has been done suggests that religious involvement may be inversely associated with depression. In other words, more religious involvement may be related to less depression. However, religious involvement can be difficult to study for a number of reasons. As one example, it could be the social support from belonging to a religious group that has an impact on depression rather than the actual religious practice. That said, a recent study found that frequency of prayer or meditation, not church attendance, predicted lower hopelessness and depression severity scores in older adults treated for depression. This investigation argues against the social support idea, but it is only one study. The conclusion is that we do not have enough research to understand the relationship between religious involvement and depression. Still, the few studies that have been done suggest that a religious or spiritual practice could be a recovery tool for those who are so inclined.
Social support refers to your network of relationships with other people. A number of psychosocial stressors have been shown to be related to depression. One of the most important factors may be level of social support. Inadequate social support is associated with depression, and higher levels of social support have been associated with better outcomes. Deficits in social support have also been associated with relapse and delayed recovery in bipolar depression. These studies suggest that one of the most important steps you can take to foster your recovery is to make sure that you have adequate social support in your life.
So, where do you start? My recommendation is to first evaluate your current level of support. One way to go about this is to take a look at both the quantity and quality of your current relationships. Quantity, of course, refers to the number of relationships; however, perhaps more important is the quality. Quality is more difficult to define because there are many facets to each of our relationships. For our purposes, let’s define quality as the amount of support that you feel you get from each relationship. Of course, this probably varies over time, but just try to think of an average level of support over the last few months. I think it can be helpful to use a numerical scale when doing ratings. I invite you to use that approach in this process. In the following exercise, please rate each of your important relationships on a scale from -5 to +5. A score of +5 means that you feel you are getting the maximum social support possible from a relationship. In contrast, a -5 means that the relationship feels like it is draining your emotional resources rather than adding to them. One important point: This scale is not intended to say anything at all about how much you care for others or how much they care about you. It is simply a rating of the level of support. For example, you may have a best friend whom you love very much; however, he may be going through a difficult time and you are providing support for him. Right now, your providing support may feel like an emotional drain, even though he is one of your dearest friends. Sometimes I find the analogy of a battery useful. Is the relationship charging or discharging your battery? One final point: Please do not limit your list of relationships to individuals. You may belong to groups or organizations that are either supporting or draining - for example, clubs, groups, or classes that you attend. Now please complete the following exercise.
Evaluation of your level of social support
List the ten relationships that you currently feel are most important in your life. These can be individuals or groups. Then rate the average amount of emotional and social support you feel you have received from that relationship during the past six months. Negative numbers mean that you are giving more support than you are receiving. Positive numbers reflect support you are getting. Zero means neutral - the relationship is neither charging nor discharging your emotional battery. The social support evaluation is included in this book as Form 10.1 and is also available as a PDF file that can be freely downloaded from our website (http://www.bullpub.com).
Now that you have completed your evaluation, let’s talk about the results. What is your total score? If it’s highly positive, with lots of +4s and +5s, then you are probably receiving adequate social and emotional support. That said, it still might be beneficial for you to increase your support further. You don’t have to worry about damaging your emotional batteries by overcharging them. If your scores are mainly +2 or lower, there may be opportunity for improvement.
What about negative numbers? If you have one or more relationships that seem to be discharging your emotional battery, you may be wondering what to do about those. Often there aren’t easy answers. Relationships are complex. However, just being aware is a good starting point. If you are working with a therapist, then perhaps you will want to explore in therapy why a certain relationship feels draining. If not, introspection may help you sort out what is going on. Maybe there are ways that you can continue to be supportive to the other person that do not feel so draining. Often, helping others can be very therapeutic for us if we are able to change our perspective so that it feels positive rather than draining. Mindfulness mediation (discussed above) may help in this regard.
Besides looking at any negative numbers, the other approach is to increase the score for relationships you already have or add new relationships with positive numbers. Let’s talk about increasing the positive score for existing relationships first.
Sometimes we don’t receive as much support as possible from our relationships simply because we don’t ask. Many of us think that we have to “be strong” or shouldn’t “burden” others with our problems. If that applies to you, then I invite you to reconsider. We all need emotional support and it is unrealistic to always be the “strong one.” Further, asking for help can make our relationships stronger. When we ask for support, we are being authentic and honest. This is much more intimate than keeping our feelings bottled up and not letting the other person know what is really going on with us. I invite you to consider assessing how well you are doing with asking for the support you need.
Another way to increase support might be to devote more time to the relationship. Some of us tend to isolate ourselves when we feel bad emotionally, and this is usually not helpful for recovery. Perhaps you could spend more time with individuals on your list. Or, for groups, maybe you could increase your participation or involvement.
Finally, consider adding some new relationships that could be supportive. Table 10.1 lists some ideas for you to consider. One option is to join a support group. It may be especially beneficial to become a member of a support group for individuals with mood disorders. An Internet search is a good way to find out what is available in your area. Also see the resources listed at the end of this book and in Chapter 5.
The preceding section focused on emotional support from humans. Companion animals also provide caring and comfort to many. In some ways, animals are more reliable than humans. Think about the dogs you have known. They love us no matter what. They don’t care if we have a bad hair day or aren’t in the best mood; our canine companions will always be there for us. Of course, other animals can also be great companions, but I think the love that dogs have for humans is a great example of what we can get from our furry friends. Still, it’s a two-way street: We give our companion animals a lot too. This can be especially true if we take in an animal from a shelter or rescue organization. This is just my opinion, but I think that adopting an animal that needs a home is an act of compassion that may help you recover. That said, adopting an animal and taking on the responsibility of caring for a pet are very personal decisions and are not feasible for everyone. Please think carefully about whether it is a good option for you. Talk with your loved ones and maybe your treatment team before making a decision.
There isn’t enough research, but there is some evidence that interacting with animals is beneficial for humans. Benefits may include enhanced socialization; reduced levels of stress, anxiety, and loneliness; improved mood; and development of recreation skills.396-399 Although this section mostly represents my opinion, there is some preliminary evidence that having an animal friend may support your recovery.
Self-help books and websites
Many excellent resources are available that complement this book, including other books and online sources of information. However, there is unfortunately a lot of information out there that may not be helpful and, even worse, may be inaccurate. I have listed recommended websites and books in Appendixes B and C, respectively. My lists are not meant to be exhaustive; there are many good resources available that I did not include. However, please use appropriate caution when considering sources of information other than those I have listed. One way to do this is evaluate the credentials of the author or owner of the site. Is she or he a trained professional and/or affiliated with an organization, such as a university or hospital? For a website, is it an official site of a professional organization or government entity? Another good approach is to ask a member of your treatment team about books or sites you find.
Along these lines, an important question is whether self-help books are effective. Of course, what “effectiveness” means may vary from one book to another. For books that provide information (like this one), effectiveness might be measured by how much one’s knowledge is increased after reading it. However, some books are directly aimed at decreasing mood symptoms. Is there any evidence that this approach, known as “bibliotherapy,” actually works? The answer is that, in fact, there is some evidence for its effectiveness for depressive symptoms.400-403 Still, there are many unanswered questions. For example, we don’t know whether bibliotherapy works equally well for everyone. Further, many of the available books have not been studied. I think the conclusion is that some books may be helpful for some people in terms of symptom reduction. As I’ve said throughout this book, I recommend doing everything possible to get well. Thus, I encourage you to consider adding some of the books listed in Appendix C to your recovery toolbox. Even if reading them does not directly contribute to symptom reduction, I believe the knowledge you gain can help guide your recovery. Some also have the potential to help you beyond recovery - by providing a pathway to a more satisfying and happier life. Before ending this chapter, I want to specifically mention some books in that category along with others that I think may be particularly worth reading (see Appendix C for complete citations).
The first recommendation is An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison. Dr. Jamison is Professor of Psychiatry at the Johns Hopkins University School of Medicine, and she also has bipolar disorder. Her book provides a compelling and intimate account of living with this illness from the unique perspective of a mental health professional. While this book is not aimed at helping you lead a happier life or reduce your symptoms, I think it can be particularly helpful in a couple of ways. It can help those with bipolar disorder avoid feeling like they are the only ones with this condition. It can seem that way if you don’t personally know anyone else with the illness. More important, Jamison’s story is a story of courage. I find it inspiring and hope that you will too.
Another recommendation is the classic Feeling Good: The New Mood Therapy by David Burns. This book was originally published in 1980 and has been a best seller. It is one book that has been studied, and there is evidence that reading it and completing the included exercises can help reduce depressive symptoms. There is a companion text, also by Dr. Burns, The Feeling Good Handbook. Both books explain cognitive behavior therapy (see Chapter 9 for more information) in a simple and easy-to-read fashion. Most important, both books provide a model of cognitive behavior therapy that it is easy to understand and incorporate into your life. These books contain many useful exercises to help you include cognitive therapy methods in your overall recovery plan. Either or both of these books can definitely provide information to help guide your recovery and may directly contribute to a reduction in depressive symptoms.
I highly recommend several books about mindfulness. Mindfulness refers to a practice that usually involves meditation and is aimed at developing the capacity to live in the present moment. Practicing mindfulness also facilitates the development of compassion for self and others. Finally, mindfulness practice can enable us to detach from many negative thoughts and emotions associated with mood disorders. I discuss mindfulness in much more detail in Chapters 4, 9, and 10. As I said in those chapters, there is compelling evidence that a mindfulness practice can help decrease symptoms of depression and anxiety as well as increase general feelings of psychological well-being, happiness, and life satisfaction. Therefore, I encourage you to consider adding a mindfulness practice to your recovery plan. The following recommendations can help to guide you in that process and may be beneficial for both reducing symptoms and increasing life satisfaction and happiness.
The first title is Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness by Jon Kabat-Zinn. Dr. Kabat-Zinn is Professor of Medicine Emeritus and founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. As described in Chapter 9, he developed the psychotherapy approach known as mindfulness-based stress reduction (MBSR). His book provides a description of the main components of MBSR, such as yoga and mindfulness meditation, along with instructions on how to do these techniques on your own. The book also provides statistical information on how well this program works and case studies. Two other books by Kabat-Zinn are Coming to Our Senses: Healing Ourselves and the World through Mindfulness and Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Both are worth reading to enhance your understanding of the relationship between mindfulness and emotional and spiritual well-being as well as the practice of meditation for its own sake. Finally, please consider reading The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness. Drs. Mark Williams, John Teasdale, and Zindel Segal along with Dr. Kabat-Zinn wrote this book. It is aimed specifically at implementing a mindfulness practice to reduce depressive symptoms.
Summary of alternative and adjunctive recovery strategies
This chapter has covered a lot of territory. Table 10.2 provides a summary of my recommendations. Please keep in mind that new research results are reported every day. Thus, new information might change my opinion of some of these recovery approaches. Please ask your mental health providers for the latest data. Finally, please consider implementing some of these recommended strategies as part of your comprehensive recovery plan.
Excerpt from Depression and Bipolar Disorder: Your Guide to Recovery
William R. Marchand, MD
Copyright - 2012 by Bull Publishing Company
Bull Publishing Company