Religious belief–does it make a person more or less anxious? Is God a friend or foe? Can spirituality be part of the cure for anxiety? The Center for Anxiety in New York specializes in these kinds of questions, incorporating assessments of a person’s spiritual beliefs into treatments for anxiety. Moment spoke with David Rosmarin, instructor in department of psychiatry at Harvard Medical School and the Center’s founder and director, about the intersection of anxiety treatment and religious belief.
Can you tell me about the Center for Anxiety and your work?
The Center for Anxiety is a clinical treatment facility in New York providing cognitive behavioral therapy scientifically evidence based treatment for an array of anxiety problems. One of the unique pieces that we do that’s different from other cognitive behavioral therapy centers is attending to patients’ spirituality within the CBT framework. We’ll talk to patients about their spirituality, assess for its relevance and how their beliefs, cognitions and behaviors might be related to their anxiety.
What does that mean, exactly?
Sometimes people have faith and could use it to help make themselves less anxious. We’re health-care practitioners, not clergy—we don’t encourage people to change their faith, but to strengthen their faith. If people utilize their faith in treatment, they often like it, and that’s in their interest. Sometimes people need new practices, and in certain cases, for patients who want it, that’s helpful as well. On the negative side, sometimes people might come in with a spiritual struggle—they might feel that God hates them, that nothing goes right, that they’ve been dealt a lousy hand of cards. In psychotherapy, classically speaking, you don’t really speak about spirituality—it’s almost anathema. So if someone comes in and it’s part of their life, we’re sort of there to help them work through it.
Can you give me an example?
Recently, a 19-year-old boy from a Hasidic family came in. He had chronic social anxiety that had never been treated. What’s common when that occurs is people get depressed, so he was very sad and shying away from social situations. He was even starting to feel disconnected from his spirituality. We used exposure therapy; you build a list of situations that make a person anxious and you march them though it. He’d start by saying hello to people in the street or wearing a flashy jacket, and then it would move up. We literally went with him to a synagogue and had him lead services during session. He realized, “I’m not going to let anxiety take control of my life.”
What is the attitude in the Orthodox community to psychological disorders and their treatment?
There’s a widespread perception in the Orthodox community that psychological disorders are caused by a person’s biology. It’s a widespread belief en masse, but in the Orthodox community, specifically. Most people today recognize that there are multiple factors involved in how psychological disorders develop, but in the Orthodox community people have more of a biological impression. Why is that significant? The stigma in the community is unique. People are thinking about marriage and families; that’s very core in the values system. If someone has a biological mental illness, do you want them marrying into your family? If you’re genetically predisposed to have depression, then you don’t want those genes coming into your gene pool.
There’s been a lot of talk about psychological disorders within the Orthodox community–particularly eating disorders. Is there something about Orthodox Judaism that breeds this?
To my knowledge, it’s very hard to find levels of psychopathology within any religious group. Eating disorders, obsessive-compulsive disorder, they’re not going to be higher in the religious community than in the general population. I don’t know of any data suggesting that prevalence of eating disorders is higher. There are unique social pressures in the Orthodox community, but also unique benefits. People have more emotional and financial family support—sometimes too much. That’s a double-edged sword. It’s an overgeneralization, but it’s less materialistic in general. Socioeconomic status seems to be lower in the Orthodox community, which actually decreases stress to outdo your neighbors. It’s not that you have to have a Mercedes—there’s no pressure.
Right, but low socioeconomic status brings other stressors.
The happiness-finance connection is really tenuous. It’s not a linear relation. More wealth does not equal more happiness.
Are there other treatment facilities that are doing something similar to your work?
Not in an evidence-based treatment–that’s what makes us unique. We are committed to the current evidence-based practices, but also in taking patients’ spirituality seriously when it’s relevant. I don’t know of any other place doing it within a CBT framework. We’re on the speed dial of a number of rabbis.
Moment‘s 2012 Elephant in the Room Contest asks readers to share their experiences with anxiety. Three winners will each receive an iPad and have their essays published in Moment. Read more about the contest–and submit an essay–here. This year’s contest is a partnership between Moment and the Andrew Kukes Foundation for Social Anxiety.
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