Religious or spiritual activities can be practiced to help treat or prevent illnesses. Richards and Bergin differentiate between religious and spiritual interventions on the basis of structure. Religious interventions are more structured, denominational, external, cognitive, ritualistic and public, whereas spiritual interventions are more crosscultural, affective, transcendent and experiential. Interventions should be agreed with the patient, and tailored to their worldly perspectives to help them during an illness or crisis. Spiritual interventions are contraindicated in cases of psychotic illnesses when dealing with poor 'ego boundaries', or when a patient does not want to participate. Not all of the cited studies that follow in this article were performed strictly in the elderly, but they may inform future research on spirituality and aging.
Prayer & Religious Rituals
Prayer is a powerful form of coping that helps people physically and mentally. Nearly 60% of Americans report praying daily. Prayer is a communication or conversation with divine powers or a 'higher self.' Prayer is practiced by all Western theistic religions and several of the Eastern traditions (e.g., Hinduism, Sikkhism, Buddhism and Taoism). Group prayer is associated with a greater wellbeing and happiness, while solitary prayer is associated with depression and loneliness. However, scientific validation of the efficacy of prayer, in terms of health outcomes, remains in its infancy when dealing with positive and negative biases. A number of studies report negative findings on the therapeutic effects of intercessory prayer, and illustrate the need for nonbiased experimental designs. Critics of prayer research have proposed that the benefits of prayer may be the results of a placebo effect. Open dialog and refining research methodology in studies of the health benefit of prayer can help discern potential health effects.
Worship and religious rituals are encouraged by most religions. Benson suggests that potentially therapeutic elements of worship include music, asthetic surroundings, rituals, prayer and contemplation and opportunities to socialize with others. Bibliotherapy involves the use of literature to help gain insight into feelings and behaviors, and to assist with positive coping. All major world religions have a text that their followers view as holy, and use as a source of comfort, wisdom and guidance. All major theistic world religions teach that people should accept and forgive those who have harmed them and seek forgiveness from those whom they have harmed. Spiritual reading and practicing forgiveness and repentance are significant parts of any 12-step program.[11,167–169] Steps 4 and 5 of Alcoholic Anonymous involve public 'confessions', and recounting of one's wrongdoing. In medical settings, forgiveness and repentance are within the purview of a pastoral counselor and clergyperson. Both prayer and bibliotherapy with sacred writings must be consistent with patients' needs and requests.
Meditation, essentially, is a physiological state of reduced metabolic activity that elicits physical and mental relaxation, and is reported to enhance psychological balance and emotional stability.[152–159] Meditation produces the sense of calm, limited thought and attention. Meditation is widely used as an alternative therapy for physical ailments. Meditation involves either the narrowing or focusing of the attention on internal events, such as breathing, an object, one point in space or a mantra (in Buddhist or yoga practices), or expanding the attention nonjudgmentally on moment-to-moment experiences, and observing thoughts and feelings from a meta-cognitive awareness state (Mindful Meditation, Vipassana and Zen Buddhist practices). Many physicians now routinely recommend meditation or yoga techniques to their patients, and include them as a part of integrated health programs, although some forms of Eastern mediation may be viewed in an unfavorable way by Christian patients. While evidence is not yet definitive, preliminary studies suggest health benefits of meditation for improved reaction time, creativity and comprehension.[174,175]
Ethical considerations should be taken into account when practicing or recommending spiritual interventions by healthcare professionals, to avoid promoting self-interest or imposing personal beliefs on patients via linking religious practices to better health outcomes; acknowledging limitations of current research into the effects of spirituality on health and, most importantly, respecting patients boundaries and beliefs by obtaining their informed consent to share their spiritual history and choosing spiritual interventions should be recognized.
The effort to develop a cohesive understanding of mindfulness is useful for both clinicians and researchers, but it has proven to be difficult to define.[176,177] Kabat-Zinn gave definitions of mindfulness as a conscious discipline of paying attention to the present moment in a particular way and in a nonjudgmental state.[178,179] Three key elements of the definition include intentionality, present-centeredness and absence of judgment; or, as Shapiro described, the processes of intention, attention and attitude engaged simultaneously in the process of mindfulness. The Mindfulness-based Stress Reduction Program (MBSR) has been used in people with physical or psychological symptoms to alleviate the 'stress' that tends to be inherently holistic and nonpathologizing. The structure of the MBSR program involves a limited number of sessions over the course of 8 weeks. Scheduled class time each week is divided between a formal meditation practice, a small- and large-group discussion, and inquiry with individuals into their present-moment experiences. Formal MBSR practices may include mindfulness body scans (a sitting meditation while focusing on controlled breathing), mindfulness Hatha yoga (a sitting meditation with expanded awareness of several objects of attention), a walking meditation and an eating meditation. The participant outcomes include discovering embodiment (interoception and proprioception), experiencing new possibilities or new ways of perceiving, observing experience, moving toward acceptance and a growing compassion for self and others. A number of studies and meta-analyses document the usefulness of the MBSR approach for mental health and psychosocial adjustment of cancer patients. The studies indicated that the MBSR approach resulted in decreasing anxiety and distress in cancer patients, and an overall improvement in immunity,[182,183] chronic pain, health-related quality of life in the community-dwelling and nursing-home populations of older adults.[185,186]
Practitioners of yoga, the ancient Indian healthcare practice, use breathing exercises, posture, stretch and meditation to balance the body's energy centers. Mindful physical exercise is a special kind of physical exercise with an additional element that focuses on one's state of mind. A physical exercise is considered mindful if it posses the following:
A meditative/contemplative component that is noncompetitive and nonjudgmental;
Proprioceptive awareness that involves low-to-moderate levels of muscular activity with mental focus on muscular movement;
Focus on anatomic alignment, such as spine, trunk, pelvis or proper physical form;
Concerns energy centric as an awareness of an individuals' flow of intrinsic energy or vital life force, for example.
With the aforementioned framework, yoga and qigong are two major streams of mindfulness physical exercise based on the literature. Yoga is used in combination with other treatments for depression, anxiety and stress-related disorders.
There are 22 types of yoga practices, and several modifications of yoga. The most popular in the USA is Hatha yoga, a branch of yoga that requires a vast repertoire of physical postures during sitting, standing or lying on the floor, along with specific breathing patterns. Similar to yoga, the breathing style of qigong is slow and deep in order to achieve body relaxation, clearing of the mind and maintenance of health. Combining all of the mentioned components, mindful physical exercise has been shown to provide an immediate source of relaxation and mental quiescence. Scientific evidence has shown that medical conditions, such as hypertension, cardiovascular disease, insulin resistance, depression and anxiety disorders respond favorably to mindful physical exercises.
Despite a growing body of evidence to show the effects of mindful physical exercises, such as qigong, tai chi and yoga, on depression,[189–197] there is a dearth of reviews that examined mindful physical exercise regarding its effects on alleviating depression,[198,199] and even fewer on memory enhancement. A recently released review on complementary and alternative treatments for older adults shows that mind–body interventions were effective on treating depression, anxiety and insomnia in ten out of 12 studies reviewed. In a recent review of Tai Chi and Qigong interventions, in 36 research reports with a total of 3799 participants, significant improvement in physical function and reduce blood pressure, fall risk, and depression and anxiety were reported. An integrated approach of yoga therapy in menopausal women improved cognitive functions, such as remote memory, mental balance, attention and concentration, delayed and immediate recall, and verbal retention and recognition tests. As the 'baby-boomers' grow older, mind–body practices will be more prevalent among older adults, and will require research validation in the elderly.
Aging Health. 2010;6(6):749-769. © 2010 Future Medicine Ltd.
Cite this: Spirituality and Aging - Medscape - Dec 01, 2010.