Journal of Religion and Health

, Volume 55, Issue 5, pp 1763–1777 | Cite as

Effects on Daily Spiritual Experiences of Religious Versus Conventional Cognitive Behavioral Therapy for Depression

  • Harold G. KoenigEmail author
  • Michelle J. Pearce
  • Bruce Nelson
  • Alaattin Erkanli
Original Paper


We compared religiously integrated cognitive behavioral therapy (RCBT) versus conventional CBT (CCBT) on increasing daily spiritual experiences (DSE) in major depressive disorder and chronic medical illness. A total of 132 participants aged 18–85 were randomized to either RCBT (n = 65) or CCBT (n = 67). Participants received ten 50-min sessions (primarily by telephone) over 12 weeks. DSE was assessed using the Daily Spiritual Experiences Scale (DSES). Mixed-effects growth curve models compared the effects of treatment group on trajectory of change in DSE. Baseline DSE and changes in DSE were examined as predictors of change in depressive symptoms. DSE increased significantly in both groups. RCBT tended to be more effective than CCBT with regard to increasing DSE (group by time interaction B = −1.80, SE = 1.32, t = −1.36, p = 0.18), especially in those with low religiosity (B = −4.26, SE = 2.27, t = −1.88, p = 0.07). Higher baseline DSE predicted a decrease in depressive symptoms (B = −0.09, SE = 0.04, t = −2.25, p = 0.025), independent of treatment group, and an increase in DSE with treatment correlated with a decrease in depressive symptoms (r = 0.29, p = 0.004). RCBT tends to be more effective than CCBT in increasing DSE, especially in persons with low religiosity. Higher baseline DSE and increases in DSE over time predict a faster resolution of depressive symptoms. Efforts to increase DSE, assessed by a measure such as the DSES, may help with the treatment of depression in the medically ill.


Daily spiritual experiences Clinical trial Cognitive behavioral therapy Religious Religion Depression 



This study was funded by the John Templeton Foundation (Grant Number 21399).

Compliance with Ethical Standards

Conflict of Interest

Dr. Koenig, Dr. Pearce, Mr. Nelson, and Dr. Erkanli declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Beck, A. T., Rush, J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford Press.Google Scholar
  2. Beck, A. T., Ward, C. H., Mendelson, M., & Al, E. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefPubMedGoogle Scholar
  3. Boelens, P. A., Reeves, R. R., Replogle, W. H., & Koenig, H. G. (2009). A randomized trial of the effect of prayer on depression and anxiety. International Journal of Psychiatry in Medicine, 39(4), 377–392.CrossRefPubMedGoogle Scholar
  4. Campbell, J. D., Yoon, D. P., & Johnstone, B. (2010). Determining relationships between physical health and spiritual experience, religious practices, and congregational support in a heterogeneous medical sample. Journal of Religion and Health, 49, 3–17.CrossRefPubMedGoogle Scholar
  5. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.CrossRefPubMedGoogle Scholar
  6. Djuric, Z., Mirasolo, J., Kimbrough, L. V., Brown, D. R., Heilbrun, L. K., Canar, L., & Simon, M. S. (2009). A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. Journal of the National Medical Association, 101(6), 552–564.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Einolf, C. J. (2013). Daily spiritual experiences and prosocial behavior. Social Indicators Research, 110(1), 71–87.CrossRefGoogle Scholar
  8. Ellison, C. G., & Fan, D. (2008). Daily spiritual experiences and psychological well-being among US adults. Social Indicators Research, 88(2), 247–271.CrossRefGoogle Scholar
  9. Futterman, A., & Koenig, H. G. (1995). Measuring religiosity in later life: What can gerontology learn from the sociology and psychology of religion? Background paper. In Conference on Methodological Approaches to the Study of Religion, Aging, and Health, co-sponsored by National Institute on Aging and Fetzer Institute (Bethesda, MD, March 16–17).Google Scholar
  10. Hlatky, M. A., Boineau, R. E., & Higginbotham, M. B. (1989). A brief self-administered questionnaire to determine functional capacity (The Duke Activity Status Index). American Journal of Cardiology, 64, 651–654.CrossRefPubMedGoogle Scholar
  11. Hoge, R. (1972). A validated intrinsic religious motivation Scale. Journal for the Scientific Study of Religion, 11(4), 369–376.CrossRefGoogle Scholar
  12. Kalkstein, S., & Tower, R. B. (2009). The Daily Spiritual Experience Scale and well-being: Demographic comparisons and scale validation with older Jewish adults and a diverse internet sample. Journal of Religion and Health, 48, 401–417.CrossRefGoogle Scholar
  13. Keefe, F. J., Affleck, G., Lefebvre, J., Underwood, L., Caldwell, D. S., Drew, J., & Pargament, K. (2001). Living with rheumatoid arthritis: The role of daily spirituality and daily religious and spiritual coping. Journal of Pain, 2, 101–110.CrossRefPubMedGoogle Scholar
  14. Koenig, H. G. (1996). An abbreviated mini-mental state exam for medically ill older adults. Journal of the American Geriatrics Society, 44(2), 215–216.CrossRefPubMedGoogle Scholar
  15. Koenig, H. G., Al-Zaben, F., Khalifa, D. A., & Al Shohaib, S. (2014). Measures of religiosity. In G. J. Boyle, D. H. Saklofske, & G. Mathews (Eds.), Measures of personality and social psychological constructs (pp. 533–564). San Diego, CA: Academic Press (Elsevier).Google Scholar
  16. Koenig, H. G., George, L. K., Titus, P., & Meador, K. G. (2004). Religion, spirituality, and acute care hospitalization and long-term care by older patients. Archives of Internal Medicine, 164, 1579–1585.CrossRefPubMedGoogle Scholar
  17. Koenig, H., Parkerson, G. R., & Meador, K. G. (1997). Religion index for psychiatric research. American Journal of Psychiatry, 154(6), 885–886.PubMedGoogle Scholar
  18. Koenig, H. G., Pearce, M. J., Nelson, B., Shaw, S. F., Robins, C. J., Daher, N. S., & King, M. B. (2015). Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness. The Journal of Nervous and Mental Disease, 203(4), 243–251.CrossRefPubMedGoogle Scholar
  19. Koenig, H. G., Westlund, R. E., George, L. K., Hughes, D. C., Blazer, D. G., & Hybels, C. (1993). Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics, 34(1), 61–69.CrossRefPubMedGoogle Scholar
  20. Landerman, R., George, L. K., Campbell, R. T., & Blazer, D. G. (1989). Alternative models of the stress buffering hypothesis. American Journal of Community Psychology, 17, 625–642.CrossRefPubMedGoogle Scholar
  21. Lee, M. T., Veta, P. S., Johnson, B. R., & Pagano, M. E. (2014). Daily spiritual experiences and adolescent treatment response. Alcoholism Treatment Quarterly, 32(2–3), 271–298.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Linn, B., Linn, M., & Gurel, L. (1968). Cumulative Illness Rating Scale. Journal of the American Geriatrics Society, 16, 622–626.CrossRefPubMedGoogle Scholar
  23. Manuals and Workbooks. (2014). Retrieved from Duke University Center for Spirituality, Theology and Health: Durham, NC.
  24. Margolin, A., Schuman-Olivier, Z., Beitel, M., Arnold, R. M., Fulwiler, C. E., & Avants, S. K. (2007). A preliminary study of spiritual self-schema (3-S+) therapy for reducing impulsivity in HIV-positive drug users. Journal of Clinical Psychology, 63, 979–999.CrossRefPubMedGoogle Scholar
  25. McCauley, J., Tarpley, M. J., Haaz, S., & Bartlett, S. J. (2008). Daily spiritual experiences of older adults with and without arthritis and the relationship to health outcomes. Arthritis and Rheumatism, 59(1), 122–128.CrossRefPubMedGoogle Scholar
  26. Miller, W. R., Forcehimes, A., O’Leary, M. J., & LaNoue, M. D. (2008). Spiritual direction in addiction treatment: Two clinical trials. Journal of Substance Abuse Treatment, 35(4), 434–442.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Mofidi, M., Devellis, R. F., Blazer, D. G., Devellis, B. M., Panter, A. T., & Jordan, J. M. (2006). Spirituality and depressive symptoms in a racially diverse US sample of community-dwelling adults. The Journal of Nervous and Mental Disease, 194(12), 975–977.CrossRefPubMedGoogle Scholar
  28. Park, C. L., Brooks, M., & Sussman, J. (2009a). Dimensiions of religion and spirituality in psychological adjustment in older adults living with congestive heart failure. In A. Ai & M. Ardelt (Eds.), Faith and well-being in later life: Linking theory with evidence in an interdisciplinary inquiry (pp. 41–58). Hauppauge, NY: Nova Science Publishers.Google Scholar
  29. Park, C. L., Edmondson, D., Hale-Smith, A., & Blank, T. O. (2009b). Religiousness/spirituality and health behaviors in younger adult cancer survivors: Does faith promote a healthier lifestyle? Journal of Behavioral Medicine, 32(6), 582–591.CrossRefPubMedGoogle Scholar
  30. Park, J., & Roh, S. (2013). Daily spiritual experiences, social support, and depression among elderly Korean immigrants. Aging and Mental Health, 17(1), 102–108.CrossRefPubMedGoogle Scholar
  31. Pearce, M. J., Koenig, H. G., Robins, C. J., Nelson, B., Shaw, S. F., Cohen, H. J., & King, M. B. (2015). Religiously integrated cognitive behavioral therapy: A new method of treatment for major depression in patients with chronic medical illness. Psychotherapy, 52(1), 56–66.CrossRefPubMedGoogle Scholar
  32. Pew Foundation. (2007). U.S. religious landscape survey: Beliefs and practices: Importance of religion.
  33. Robinson, E. A., Cranford, J. A., Webb, J. R., & Brower, K. J. (2007). Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample. Journal of Studies on Alcohol and Drugs, 68(2), 282–290.CrossRefPubMedGoogle Scholar
  34. Sheehan, B. V., Lecrubier, Y., Sheehan, K. H., & Al, E. (1998). Mini International Neuropsychiatric Interview (MINI): The development and validation of structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl), 22–33.PubMedGoogle Scholar
  35. Skarupski, K. A., Fitchett, G., Evans, D. A., & Mendes de Leon, C. F. (2013). Race differences in the association of spiritual experiences and life satisfaction in older age. Aging and Mental Health, 17(7), 888–895.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Underwood, L. G. (2011). The Daily Spiritual Experiences Scale: Overview and results. Religions, 2, 29–50.CrossRefGoogle Scholar
  37. Underwood, L. G., & Teresi, J. A. (2002). The daily spiritual experience scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 24(1), 22–33.CrossRefGoogle Scholar
  38. Vallis, T. M., Shaw, B. F., & Dobson, K. S. (1986). The Cognitive Therapy Scale: Psychometric properties. Journal of Consulting and Clinical Psychology, 54(3), 381–385.CrossRefPubMedGoogle Scholar
  39. Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28(4), 369–384.CrossRefPubMedGoogle Scholar
  40. Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620–630.CrossRefPubMedGoogle Scholar
  41. Watlington, C. G., & Murphy, C. M. (2006). The roles of religion and spirituality among African American survivors of domestic violence. Journal of Clinical Psychology, 62(7), 837–857.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Harold G. Koenig
    • 1
    • 2
    • 3
    Email author
  • Michelle J. Pearce
    • 4
  • Bruce Nelson
    • 5
  • Alaattin Erkanli
    • 6
  1. 1.Duke University Medical CenterDurhamUSA
  2. 2.King Abdulaziz UniversityJeddahSaudi Arabia
  3. 3.School of Public HealthNingxia Medical UniversityYinchuanPeople’s Republic of China
  4. 4.Department of Family and Community Medicine, Center for Integrative MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  5. 5.Department of ResearchGlendale Adventist Medical CenterGlendaleUSA
  6. 6.Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamUSA

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