In April of 2020, the University of Regina in Saskatchewan announced the development of its online therapy unit devoted to making treatment for anxiety and depression using Cognitive Behavioral Therapy (CBT) more accessible to the general public. This was an especially important move as experiences of these very challenges have become more prominent in peoples’ lives during the global COVID-19 pandemic.
The program offers 8-week courses covering topics of; Well-being for mental health, Well-being for Post-Secondary Students, Well-being for Chronic (physical) health conditions and pain, and an Alcohol Change course. Each course involves regular online modules as well as once-a-week therapist support. Additional information can be found at https://www.onlinetherapyuser.ca/.
CBT is a type of psychotherapy that usually takes place over a set period of time. It involves identifying unhelpful patterns of thinking that (for the individual) often results in subsequently unhelpful feelings and behaviors.
CBT has been shown to be effective in helping individuals cope with depression, anxiety, PTSD, substance use, and a host of other areas.
Recently I was engaged in a conversation with one individual who was in the early stages of the UofR online therapy program. As they described the core approach of CBT; becoming aware of the thoughts and emotions being experienced, understanding whether these are helpful or unhelpful in the current circumstance, and making choices based on that understanding, I couldn’t help but think of the Rules for the Discernment of Spirits as outline by St. Ignatius of Loyola.
The first set of fourteen ‘rules’ or guides that Ignatius provides in the context of the Spiritual Exercises identifies their purpose;
“…for becoming aware and understanding to some extent the different movements which are caused in the soul, the good, to receive them, and the bad to reject them.”
This simple formulation seemed to be closely related to the goals of CBT and provides an interesting spiritual connection to the work of growing coping skills both for those with mental health challenges and for those who serve as primary support persons.
It’s important to note that in using the term “rules,” Ignatius intends that we see these as helpful, experience-based measures or guides as opposed to set-in-stone laws or regulations. These guides seem very much related to our spiritual well-being in a way that is similar to what CBT provides for mental and emotional well-being.
More and more frequently, mental health professionals are noticing the benefits of combining religious practice with mental health therapies.
In fact, a 2015 study by Pearce, Koenig, Robins, Nelson, Shaw, Cohen, and King titled “Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness” found that “integrating clients’ spiritual and religious beliefs in therapy is as or more effective in reducing depression than secular treatments for religious clients” particularly when it comes to CBT.
This study did not just examine the results of incorporating religious practice into CBT programming but developed a 10-part method for integrating religious practice and CBT for five major world religions; Christianity, Judaism, Islam, Buddhism, and Hinduism. While they also do not explicitly name the Spiritual Exercises or their Rules for Discernment. Many aspects of both come out in their recommendations, including;
Renewing the mind
This is a recognition of the Christian call to conversion or ‘metanoia’ which is often translated as ‘changing the mind’ or ‘changing the heart’. As mentioned above, this is the heart of St. Ignatius’ purpose in his Rules for the Discernment of Spirits, that we might be aware of what is taking place within us, understand or assess whether the thinking, feeling, and proposed actions at this time are helpful in our relationships with ourselves, others, and God, and accept or reject these things. Accepting points to a more intentional integration of what is helpful, while rejection of that which is unhelpful indeed requires a changing of heart and mind and a turning away from that which hinders the aforementioned relationships. Key here, in both CBT and discernment, is becoming aware and understanding before renewing heart and mind. This awareness provides us with the necessary tools to make a decision that is not just based on emotion or reason. It recognizes that, in the midst of a spiritual or a mental health crisis, both emotion and reason may be hindered in ways we are not immediately aware. Taking time to foster awareness allows us to recognize our current emotional and/or spiritual state before taking action.
In their work on designing a religious CBT program, the study authors outline a method of contemplative prayer that is very similar to the Catholic practice of Lectio Divina or “sacred reading” of scripture. This kind of contemplative reading can help foster necessary connections between our lived experiences and basic foundations of faith. Engaging regularly in this kind of contemplative practice helps us to shape and re-shape the lenses through which we observe our actions, behaviors, and habits as well as ways that we conceive of our own selves in relation to God and others. This becomes another layer of understanding that can inform, challenge, and re-form unhelpful emotional responses and behaviors moving forward.
Religion-based CBT encourages individuals to engage in regular religious practices such as those mentioned above as well as memorization of scripture and prayer for others. All of which “have the potential to impact psychological skill agility and spiritual growth…that empowers the person to overcome depression.” Practices such as fostering and practicing forgiveness and reconciliation, expressions of gratitude, and acts of generosity are also marked by RCBT as helpful in combating depression.
In regards to the importance of religious practice in coping with and building resiliency around mental health challenges, I am reminded of Ignatius’ sixth rule regarding best practices for combatting spiritual desolation – the experience of feeling as though one is isolated or separated from God, which can be triggered by, and may exacerbate, experiences of emotional/psychological depression. After exhorting individuals experiencing spiritual desolation to make no drastic changes in choices and decisions made prior to the desolation, Ignatius suggests as well that an increase in prayer, in meditation, self-examination, and “extending ourselves, in some suitable way of doing penance” (which in the Catholic tradition may indeed include prayer for others, and as well as concrete acts of charity and generosity) can all be aids in combatting the spiritual effects of desolation.
Though Ignatius, writing in the 16th Century doesn’t have the same language for depression, anxiety, and other mental health challenges that we have today, his understanding of the relationship between spiritual and emotional well-being and religious practice would seem to be upheld by recent research into these relationships.
In its final therapeutic stages, RCBT places its focus on hope “as a positive state of being that results from using religious cognitive and behavioral strategies.” Hope also pervades St. Ignatus’ discernment of spirits. Fr. Timothy Gallagher of the Oblates the Virgin Mary (O.M.V.), an order dedicated to the spiritual teachings of St. Ignatius of Loyola, writes and speaks of how these Rules for Discernment are intended to be a light in the darkness. The Rules are steeped in the recognition that the human interior life is one of constant motion and activity. Though it may seem as though the powers and experiences of darkness have the upper hand, there is a constant, opposing, and active spiritual agent of God’s enduring love always acting for our good.
This is indeed the Advocate, the Holy Spirit of Jesus Christ supporting us in every challenge. Religious based cognitive behavioral therapy, much like (and perhaps even coupled with) the Rules for the Discernment of Spirits, provides vital insight into our own interior selves, as well as awareness of the often unseen, and unacknowledged influences we experience on a daily basis providing an avenue of awareness that can reveal our struggles, as well as the essential spiritually benevolent guidance and support provided by a life lived in faith and hope.
Peace and God Bless,
Deacon Eric Gurash