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Research study offers free on-line treatment to Jews suffering from anxiety and stress

By David Hillel Rosmarin (www.jpsych.com)

With the world's financial markets in crisis and security concerns in Israel and around the world, one thing that the Jewish people seem to have no shortage of these days is worry and stress! Fortunately, resources are available to help the reduction of anxiety, and they're much more accessible than you may think. As a doctoral student of clinical psychology, I am currently conducting a randomized-controlled study to determine the effectiveness of two internet-based treatment programs in the Jewish community.

The first of these programs is a spiritually-based one – it seeks to link stressed-out Jewish individuals with religious/spiritual strategies to reducing anxiety. The second is an established treatment program involving relaxation. So far, more than 200 people have signed up for my study, and many have them have shared with me that the treatment they received was very helpful in reducing the amount of anxiety they experience in day to day life.

My hope is that the project will enable a better understanding of the needs of Jewish individuals suffering from anxiety, and whether spirituality and religiousness can be helpful to them. To see if you're eligible for the study please visit www.jpsych.com. For more information about this project, continue reading below.

Chronic stress and worry have been identified as risk factors for a number of major health problems including asthma (Sandberg et al., 2000), hypertension, (McEwen, 1998), diabetes (Wales, 1995), cardiovascular disease (Brosschot, Van Dijk & Thayer, 2007), and cancer (Eysenck, 1988). Fortunately, there is strong empirical support that relaxation techniques such as Progressive Muscle Relaxation (PMR) are clinically efficacious in reducing both stress and worry (Borkovec, Newman, Pincus & Lytle, 2002; Carlson & Hoyle, 1993; Smith, 1999; Rausch, Gramling & Auerbach, 2006). However, while PMR is used widely in clinical and health psychology settings (Matsumoto & Smith, 2001), conventional psychological services are generally underutilized by religious populations as religious individuals tend to prefer spiritually-integrated care (Lindgren & Coursey, 1995; Puchalski, Larson & Lu 2001).

In recognition of the need to provide religious communities with culturally appropriate services, as well as considerable evidence suggesting that religion can be a resource for people in times of stress (Pargament, 1997), numerous spiritually-integrated interventions have been created in recent years. These interventions draw on religious resources in the process of treatment (Pargament, 2007). Much like conventional therapies, spiritually-integrated interventions target various problems including addictions (Avants, Beitel & Margolin, 2005), sexual abuse (Murray-Swank & Pargament, 2005), social anxiety (McCorkle, Bohn, Hughes & Kim, 2005) and physical and psychological wellbeing among cancer patients (Cole, 2005).

In addition, several randomized and controlled evaluations have been conducted (e.g. Propst, Ostrom, Watkins, Dean & Mashburn, 1992; Wachholtz & Pargament, 2005; Rye et al., 2005; Wachholtz & Pargament, Submitted Manuscript; Oman, Hedberg & Thoresen, 2006), and a meta-analysis of 5 studies comparing the efficacy of spiritually-integrated psychotherapy to conventional treatments found religion-based approaches to be equally effective as cognitive therapies in reducing depressive symptomatology (McCullough, 1999). However, one major limitation in this burgeoning area of research is that no spiritually-integrated interventions for the Jewish population have been developed or evaluated to date. Additionally, only a single spiritually-integrated treatment has targeted an anxiety-spectrum problem (McCorkle et al, 2005) and no treatments have yet focused specifically on stress and worry.

Though perhaps not the most intuitive of platforms for the provision of spiritually-integrated treatment, electronic therapy (e-therapy) may be quite suitable for religious communities. It would be a seemingly simple task to collaborate with spiritual/religious leaders and incorporate spiritual content into e-therapy protocols at the design level. This would, in turn, circumvent many of the cumbersome ethical and practical issues that may arise when secular psychotherapists provide services to spiritual/religious individuals.

Additionally, spiritually-integrated e-therapies may help reduce stigma by enabling religious individuals to participate in treatment in a private setting. Finally, e-therapies may increase the accessibility of spiritually-integrated services to religious communities in a cost-effective manner. In recent years, internet-based interventions have been developed to treat a variety of difficulties including social phobia (Andersson et al., 2006), insomnia (Strom, Pettersson & Andersson, 2004), childhood encopresis (Ritterband et al., 2003), and eating disorders (Winzelberg et al., 2000). Several randomized controlled trials have been conducted, suggesting that e-therapies can be effective (Carlbring & Andersson, 2006). However, no e-therapies have addressed religious resources or focused on Jews in particular.

One religious construct that could be integrated into a treatment program for Jews is trust/mistrust in God. Trust in God is a cognitive and affective state in which one feels that God is taking care of his/her best interests (Rosmarin, Pargament & Mahoney, Submitted Manuscript). It involves several core beliefs about the nature of the Divine, including: (a) God has constant regard for all worldly affairs; (b) No power is greater than God; and (c) God is merciful and generous.

Conversely, mistrust in God is a state in which one feels that God is ignorant, impotent and malevolent. In a recent investigation with a large community sample of Jewish believers, higher levels of trust in God were linked to less anxiety and depression and greater personal happiness, whereas mistrust in God was associated with higher levels of anxiety and depression and lower levels of happiness (Rosmarin, Pargament & Mahoney, in press). It should be noted that although trust in God is theoretically compatible with all monotheistic religions (e.g. Judaism, Christianity, Islam), the theoretical and empirical links between trust/mistrust in God and psychological health do not apply to atheists because a basic belief in God's existence is a precondition for trust or mistrust in God.

Several psychological processes may tie trust/mistrust in God to stress and worry for individuals who believe in God. First, perceptions of adversity may be shaped by the beliefs associated with trust in God. A worldview in which God is wholly knowledgeable, powerful and good may generate positive appraisals and reduce negative appraisals of stressful situations.

Second, the core beliefs of trust in God may mitigate intolerance to uncontrollability and unpredictability, two cognitive factors that have been identified as important in maintaining worry (Barlow, 2002).

Third, trust in God may contribute to positive religious coping (Pargament, 1997) and act as a psychological resource in times of stress by promoting a sense of spiritual support, connectedness with a transcendent force, or inspiration, meaning, and hope.

Fourth, in light of current research linking religious beliefs to attachment theory (see Kirkpatrick, 2005 for a review), trust in God may facilitate secure attachment to a benevolent parent-like figure. Fifth, trust in God may further reduce stress and worry by increasing positive spiritual emotions, such as appreciation and gratitude, which have been linked to psychological well-being (Emmons & McCullough, 2003). In contrast, mistrust in God may exacerbate stress and worry by promoting fundamental questions, doubts, conflicts, and struggles with the Divine (Pargament, Murray-Swank, Magyar, & Ano, 2005). Furthermore, belief in a malevolent God may promote negative perceptions of threat and increase appraisals of danger, especially in situations that are uncontrollable or unpredictable.

This study will therefore be the first to evaluate the efficacy of a short-term spiritually-integrated e-therapy program for stress and worry among Jews. Furthermore, to our knowledge, it will be the first study to examine an electronic spiritually-based treatment program in a randomized controlled study. Please visit www.jpsych.com to see if you're eligible to participate in this study and, in the process, receive free on-line stress/worry reduction treatment.

For References, go to Page Two

David Hillel Rosmarin completed undergraduate studies in psychology and philosophy at York University (Toronto), and an M.A. in Counseling Psychology at the University of Toronto. He is currently a Ph.D. student in Clinical Psychology at Bowling Green State University where has been an instructor for Introduction to Psychology. He completed clinical training at the Center for Anxiety and Related Disorders at Boston University, the Anxiety Treatment and Research Centre of St. Joseph's Hospital (Hamilton, Ontario), and Toronto’s Centre for Addiction and Mental Health. Under the supervision of Kenneth I. Pargament, his graduate studies have focused on the relationship of religion/spirituality to symptoms of affective disorders. Next year, David will be completing a clinical fellowship at the Harvard Medical School in the Department of Psychiatry. He currently lives in Toronto, Canada with his wife Miri, and children Yehuda, Bina & Shlomo.

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