The definition of religion I am referring to is as defined by Webster: service and worship of God or the supernatural, commitment or devotion to religious faith or observance, personal set or institutionalized system of religious attitudes, beliefs and practices. This differs from "spirituality," which has come to encapsulate every known human and mystical experience. Spirituality has become a term with a much broader concept encompassing the transcendental and focusing more on the individual and his search for answers. I’m looking at the traditional religious beliefs of the world and their practices.

It is interesting to note here that 90% of all people in the U.S. claim to believe in God, but only 63% say that religion is very important in their lives. These figures came from a millennium poll by the London-based Taylor-Nelson Sofres and the Gallup International Assn. for atheists.org, so there’s certainly no bias there, right? Compared with the rest of the world, here’s how the numbers add up: 87% of World Population claims to believe in God; South America, 88%, Hong Kong, 36%; Czech Republic, 36%, Africa, 99%, South Korea, 54%, Sweden, 45%, Norway, 48%, Denmark, 51%, Canada, 82%. Interestingly too, only 40% of psychologists and psychiatrists profess to believe.

Wendell Waters is a respected physician and professor of psychiatry at McMaster University in Ontario, Canada. In 1992 he published the book “Deadly Doctrine,” in which he states that Christian doctrines and teachings are harmful to human beings and spends 5 pages describing the allegedly negative affects of Christianity.

But one prominent researcher, Harold G. Koenig, MD, whom I have had the pleasure of conversing with via e-mail, has completed countless studies on the topic of religion and health. You may have heard of him. He is one of the world’s foremost researchers on religion and health with 150 scientific articles, 35 book chapters, and 13 books. He is editor of the International Journal of Psychiatry in Medicine, has been on countless news broadcasts and has been published in journals and newspapers such as the Daily Telegraph and the Guardian.

Perhaps in part due to Dr. Koenig’s research, the DSM-IV is now more sensitive to religion, where it used to refer very negatively to the subject. What I found amusing was that all early civilizations dealt with physical illness in spiritual terms. So why have we been so reluctant to include it in our treatment? Studies have shown the relevance of religion to health, and here are a few that pertain to general medical treatment:

A study of 811 hospitalized patients reported in the Archives of International Medicine, July 26, 2004, showed that patients who most often engaged in prayer and Bible reading, spent fewer than 12 days in long-term care. That compared to nearly 27 days among patients who reported the fewest private religious practices.

A 2001 study at Duke Clinical Research Institute studied 150 heart patients randomized into 5 groups. One group received standard cardiac care while others received each of four noetic therapies, one of which was intercessory prayer. Patients receiving the prayer showed more than a 50% overall reduction in complications than those who received standard care alone.

Finally, religious activities were also found to predict rates of hypertension. A study by Staig and colleagues of 1,757 Californians showed that religious affiliation predicted lower rates of hypertension. Those with high attendance at church services and high incidence of personal prayer and Bible study had the lowest average diastolic blood pressure. Those with no affiliation had rates almost double that of subjects with religious affiliation (29.3% and 15%, respectively).

Recently, the JAMA indicated that during the last decade there have been more visits to complementary and alternative medicine practitioners than to primary care physicians. This trend is most likely the reason for much of the change we’ve seen as far as treatment philosophies go. Duke University has been a leader in this area and now has a Center for Integrative Medicine. Twenty two medical schools are now members of a consortium for Integrative Medicine, the NIH created a center for Complementary and Integrative Medicine, and 60 medical schools now offer courses on religion and medicine. There has even been a mind-body-spirit conference in the field of psychneuroimmunology, which looks at the mind, the immune system, and health. So in this respect, we are seeing the gradual shift toward the necessity of treating the whole person ­ mind, body, and spirit ­ not just their disease.

To this point we’ve looked at how religion has affected general health. But how does it affect mental health, and specifically anxiety and panic attacks?

In the American Journal of Psychiatry, March 2003, Kendler et al, did a study of 2,616 people and found that an attitude of thankfulness, social religiosity, and unvengefulness were three factors that reduced the risk for developing panic disorder, GAD, and bulimia. In other words, maintaining a grateful heart, operating in forgiveness, and participating in Bible study, prayer meetings or church worship services indicated a reduced lifetime risk of panic disorder, GAD and bulimia.

Another study that produced results specifically for panic disorder was published in the Journal of Clinical Psychology, Jan. 1998. Trenhold, P. et al studied 60 women who were classified into three groups ­ a group with panic disorder, a group with other issues, and a third asymptomatic group. The panic disorder group had higher scores on negative religious conflict. This indicates that the person may be in conflict with what she believes, thus placing her in a state of emotional unrest. It is important to behave in synchrony with one’s values in order to have positive health consequences.

Negative religious conflict could also be when extremes are involved; for instance legalism or "rituals" that had to be completed prior to having play time during childhood, or not being allowed to celebrate birthdays or holidays when growing up. Either of these two examples of negative religious conflict appears to be a predictor of developing panic disorder.

There were not an abundance of studies done on panic disorder specifically, but several studies in 1997 and 1998 addressed the benefits of religious activity on depression. Religious activity and church attendance was associated with the remission of depression of Protestants and Catholics in the Netherlands, remission of depression in older U.S. adults, and protection against depression in a ten-year follow-up study in the U.S. on Protestants and Catholics. It also found religious activity led to less depression in Spanish care-givers, and was found to yield an absence of depression in older adults. In the same review, we found activities such as church attendance correlated with decreased mortality and a lower suicide rate.

Koenig and colleagues in 1993 also examined the relationship between religious involvement and anxiety disorders among nearly 3,000 young, middle-aged, and elderly adults in North Carolina. Among adults aged 18-39, rates of anxiety were lower among frequent church attendees, mainline protestants and those who considered themselves born again. This was lower than those in the group of infrequent attendees and those with no affiliation. Failure to attend church service weekly was also associated with a 40% increase in depression!

Williams and colleagues followed 720 randomly selected adults to examine the effects of religious attendance on psychological distress. They found that frequency of attendance was significantly and inversely related to psychological distress two years later. And when examining the interactions among religious attendance, stressful events, and psychological distress, they found that frequent religious activity buffered against the negative mental health consequences of negative life stress occurring during the two-year follow-up period.

Another study concluded that meditation can significantly reduce anxiety for individuals with mild or severe anxiety. Carlson et al evaluated devotional meditation which consists of prayer, quiet reading, and biblical reflection. They compared this to progressive relaxation and found that anger and anxiety scores were significantly lower in the meditation group vs. the relaxation or control group.

The studies looked at so far have been Christian in nature. But I wanted to be sure to bring other faiths into focus as well and came across randomized controlled trials (RCT) by two different authors that evaluated the effect of Islam-based psychotherapy in Muslims suffering from anxiety and depression. In ________, patients received psychotherapy based on the Muslim Koran and Hadith in addition to secular psychotherapy. The study did not control for use of medication, but it did indicate that Islam-based psychotherapy may speed recovery from anxiety and depression in Muslims with a strong religious background. There was no difference in the study and control group for non-religious patients, and the improvement seen became non-existent at the end of 6 months.

Similarly, a study was done in 1992 by Kabat-Zinn and colleagues. There were 22 individuals diagnosed with GAD or panic disorder. These individuals received a Buddhist meditation-based treatment plan, and the results showed a reduction of anxiety and in frequency of panic attacks in 20 of 22 patients. A 3-year follow-up showed 18 of 22 maintained this reduction in symptoms.

As the above studies suggest, the results may apply to other religions as well. But it is thought that because the content of belief differs between religions, effects on mental health may also vary.

To this point we’ve talked primarily about the positive effects of religion; are there any negative? Well, as with everything, there needs to be balance. If you become too extreme with your faith and lose sight of the needs around you and neglect family or others, that is not healthy. People have also been known to stop life-saving medications, fail to seek proper medical attention, refuse transfusions or immunizations, or even replace mental health care with religion. Proper medical care can, and should be in conjunction with faith. Like Albert Einstein said, "Science without religion is lame. Religion without science is blind."

And in the 2002 book, The Link between Religion and Health, Dr. Koenig concludes that "because religion and science both search for truth, neither should fear the other."

Something else I came across in my research was the terms extrinsic and intrinsic religiosity. This refers to the element of "true belief." In other words, "do you really believe what you say you believe?" Research on western religions has demonstrated that extrinsic religiousness (using one’s religion for one’s own needs, such as gaining social status) may be related to poorer outcomes and higher anxiety while intrinsic religiousness (using religion as a guide for everyday decisions) may be related to better health outcomes and lower anxiety. (Genea, 1996; Tarpanya, 1997)

I believe extrinsic and intrinsic religiosity can be seen across all faiths. In other words, you can have someone who professes to be a Jew, but doesn’t live it, or professes to be a Muslim, but doesn’t practice the five pillars of Islam, or says he’s a Christian, but doesn’t walk out his faith in love. Yet he wants the "benefits" of being a person of faith. I equate that to someone who is seeking the presents of God, not His presence; seeking His hand for what He can give you and not His face to want to know Him more.

One final group of studies I want to look at pertains to death anxiety. In a study of Muslims at Hamad Medical Corp., after-death fears dominated panic attacks. The predominant distress associated with death anxiety is the fear of the unknown. In this study, women, older participants, and those less religious were more afraid of their impending death.

In comparison, the more intrinsically religious one is, at least for the Christian faith, the less death anxiety is seen. This is believed to be because of faith in eternal life. Death anxiety is also present in Hindu and Buddhist faiths due to the meaninglessness of life and the fear of not being; or possibly of samsara, the cycle of passing from death to life over and over.

Now that we’ve reviewed the positive affects of religion on general and mental health, and seen that our medical schools and even an entire branch of study are embracing it, I ask, why is this so? What is the cause of the relationship? Perhaps it is because of the sense of hope and control over one’s destiny, or the common interests of those involved and the unity of following the commandment to love God, self, and others, which, by the way, is so opposite of popular psychology and the fascination with self. In any event, the following areas need further study:

- We need to conduct observational studies to see if people with different religious practices or degree of practice differ in severity of panic and frequency.

- In extrinsic/intrinsic subjects…we need to isolate a specific aspect, i.e. Prayer, and measure anxiety or panic levels afterward

- Which belief structures/content of belief are associated with which effects?

- Can we use religious approaches to treat anxiety even among moderately or non-religious?

Jesus is the only One who gives me peace and assurance of knowing that I was, that you are, worth so much that He would rather die than ever live without us! That we can be free from anxiety knowing that we don’t have to earn or perform our way into heaven; that it is a free gift of grace. That He took what I deserved and redeemed me and purchased what I could never earn. That, my friend, is true love. That is the absence of fear and panic. That is true peace. That is Him, Jesus. He’s the only truth I can live with and the only truth I can’t live without. And the good news is that He did this for you too!