The evaluation of religious and spirituality-based therapy compared to standard treatment in mental health care: A multi-level meta-analysis of randomized controlled trials.

OBJECTIVE: Psychotherapies are increasingly incorporating spiritual and religious systems of belief and practice, which aligns with recent developments toward person-centered treatments. The main objective of this meta-analysis was to compare the efficacy of a religion and spiritually-based (R/S) therapy to non-R/S treatments. METHOD: A multi-level meta-analysis was conducted to compare randomized controlled studies of the efficacy between R/S-based and regular treatments in mental health care setting. Inclusion criteria were diagnosis, psychotherapeutic treatment, and explicitly religion/spirituality therapy. Outcome was assessed for symptoms and for functioning separately, and combined. We also examined several moderators, such as type of comparison, outcome domain, and diagnosis. RESULTS: Overall effect sizes obtained from 23 studies and 27 comparison groups indicated that a R/S treatment is moderately more efficacious compared to regular treatments at posttreatment (g = .52, p < .01) and at follow-up (g = .72, p < .01) (only available for symptoms). Results were similar for symptoms (g = .44, p < .01) and functioning (g = .62, p < .01). CONCLUSION: In patients with a strong religious and spiritual affiliation, treatments with a focus on religious and spiritual issues are more efficacious than non-R/S-based therapy. Limitations as well as future directions are discussed.

Accountability as a virtue in medicine: from theory to practice.

Accountability is a norm basic to several aspects of medical practice. We explore here the benefits of a more explicit focus on the virtue of accountability, which as distinct from the state of being held accountable, entails both welcoming responsibility to others and welcoming input from others. Practicing accountably can limit moral distress caused by institutional pressures on the doctor patient relationship. Fostering a mindset that is welcoming rather than resistant to feedback is critical to enhancing a culture of learning. Analysis of failures of accountable practice offers opportunities for improving the delivery of clinical care.

A Dutch Study of Remarkable Recoveries After Prayer: How to Deal with Uncertainties of Explanation.

This article addresses cases of remarkable recoveries related to healing after prayer. We sought to investigate how people who experienced remarkable recoveries re-construct and give meaning to these experiences, and examine the role that epistemic frameworks available to them, play in this process. Basing ourselves on horizontal epistemology and using grounded theory, we conducted this qualitative empirical research in the Netherlands in 2016-2021. It draws on 14 in-depth interviews. These 14 cases were selected from a group of 27 cases, which were evaluated by a medical assessment team at the Amsterdam University Medical Centre. Each of the participants had experienced a remarkable recovery during or after prayer. The analysis of the interviews, which is based on the grounded theory approach, resulted in three overarching themes, placing possible explanations of the recoveries within (1) the medical discourse, (2) biographical discourse, and (3) a discourse of spiritual and religious transformation. Juxtaposition of these explanatory frameworks provides a way to understand better the transformative experience that underlies remarkable recoveries. Uncertainty regarding an explanation is a component of knowing and can facilitate a dialogue between various domains of knowledge.

Can you be cured if the doctor disagrees? A case study of 27 prayer healing reports evaluated by a medical assessment team in the Netherlands.

THE SETTING: between 2015 and 2020 a medical assessment team evaluated 27 reports of prayer healing in the Netherlands. OBJECTIVES: Three research questions were formulated. What are the medical and experiential findings? Are there medically remarkable and/or unexplained healings? Which explanatory frameworks can help us understand the findings? METHODS: The reported healings were analyzed using both medical files and patient narratives, as part of a case study research design compiled by a multidisciplinary research team. An independent team of five medical consultants, representing different fields of expertise, evaluated the 27 case files. According to criteria these were selected from a larger group of 83 received reports. Experiential data was obtained by in-depth interviews and analyzed. Instances of healing could be classified as 'medically remarkable' or 'medically unexplained'. Subsequent analysis was transdisciplinary. RESULTS: Eleven of the 27 healings assessed were evaluated as 'medically remarkable', none were labelled as 'medically unexplained'. Recurring characteristics were common to some degree in all healings, whether 'medically remarkable' or not: a temporal connection with prayer, instantaneity and unexpectedness of healing, strong emotional and physical manifestations, and a sense of 'being overwhelmed' and transformed. The healings were invariably interpreted as acts of God. Positive effects have persisted for 5 to 33 years, with 2 relapses. CONCLUSIONS: Our findings on remarkable healings do not fit well in the traditional biomedical conceptual framework. All healings exhibited important non-medical aspects, whether or not they were assessed as medically remarkable. We need a broader multi-perspective approach in which all relevant data is considered to be valuable, both experiential and objective. This so-called horizontal epistemology may be helpful when trying to understand the findings, and it may bring about mutual understanding between patients, health practitioners and relevant disciplines.

Grievance-fueled violence can be better understood using an enactive approach.

Understanding lone actor grievance-fueled violence remains a challenge. We believe that the concept of grievance provides an opportunity to add an engaged, first-person perspective to the assessment of lone actor extreme violence. We propose an enactivist philosophical approach that can help to understand the why and how of the pathway from grievance to violent extremism. Enactivism sees grievance as a dynamic, interpersonal, and context-sensitive construct that indicates how (potential) offenders make sense of the world they live in and how under certain circumstances it fuels violent behavior. Hence, grievance should not be understood as a given thing, but as an unfolding experience that involves sense-making through (regulation of one's) interaction with the (social) environment. This (self-)relational and ecological understanding requires another approach than looking at demographic factors or life histories, only from an outsider's perspective. Enactivism invites us to look at such risk factors as external indices of an ongoing process of active self-regulation and sense-making, and in some cases spiraling toward extreme violence. To understand the mindset of the offender we need to look more in depth at the processes that shape this mindset: why does this person, with this history, in this context, and at this point in time, proceed to use violence? The enactivist approach to the mind offers a complementary framework that may help us to understand the dynamics of grievance as a possible precursor to violent extremism. It also helps to appreciate why the relative unpredictability of the pathway toward lone actor extreme violence is not necessarily a sign of empirical weakness but a matter of principle due to the non-linearity of the processes involved. We end by summarizing how enactivism could contribute to the prevention of extremist violence and research and how it can help to avoid reinforcing stigmas and re-establishing a confirmation bias.

Using network models in person-centered care in psychiatry: How perspectivism could help to draw boundaries.

In this paper, we explore the conceptual problems that arise when using network analysis in person-centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that perspectival reasoning can make more explicit what questions personalized network models can address in PCC, given their boundaries.

Three cases of hearing impairment with surprising subjective improvements after prayer. What can we say when analyzing them?

AIM: to enhance the understanding of documented mismatches between 'subjective' experiences and 'objective' data in three cases of self-reported instantaneous healing of hearing impairment upon prayer. METHOD: description of three cases taken out of a larger retrospective case-based study of prayer healing in the Netherlands. In this larger study multiple reported healings were investigated using both medical files and patients' narratives through in-depth interviews. A subset of three cases with dramatic subjective reduction of hearing impairment upon prayer was studied. These patients underwent extensive additional investigations at the audiology center of the Amsterdam University Medical Centre. All data was evaluated by an interdisciplinary medical assessment team, subsequent analysis was transdisciplinary. RESULTS: the three case histories with self-reported healing after prayer demonstrated a clear mismatch between subjective experiences and objective findings. No measurable improvements were found in four different audiological testing methods. However, in-depth interviews, hetero-anamnesis and a validated questionnaire all confirmed the healings. The medical assessment team could not label these healings as 'medically remarkable' because of absence of measurable 'objective' changes, but they did consider them as 'remarkable in a broader sense'. On expert consultation no equivalents of mismatches to this extent could be found. The healing experiences of our participants involved their entire being with profound positive effects in different domains of their lives, and a perception of a benevolent God who acted upon them. There was a distinctive pattern, labelled by the participants as a healing of mind, soul and body. CONCLUSIONS: The subjective-objective incongruities that were found were not well understood. We noticed a paradox: the 'objective' measurements did not reflect hearing abilities in daily life where-as 'subjective experiential' data did. The latter could be 'objectified' and validated in various ways. In fact, a rigid distinction between 'objective' and 'subjective' was not relevant here, nor a hierarchy among them. A model leaving room for different causations (horizontal epistemology) complied best with the multi dimensionality we came across.

The Network Theory of Psychiatric Disorders: A Critical Assessment of the Inclusion of Environmental Factors.

Borsboom and colleagues have recently proposed a "network theory" of psychiatric disorders that conceptualizes psychiatric disorders as relatively stable networks of causally interacting symptoms. They have also claimed that the network theory should include non-symptom variables such as environmental factors. How are environmental factors incorporated in the network theory, and what kind of explanations of psychiatric disorders can such an "extended" network theory provide? The aim of this article is to critically examine what explanatory strategies the network theory that includes both symptoms and environmental factors can accommodate. We first analyze how proponents of the network theory conceptualize the relations between symptoms and between symptoms and environmental factors. Their claims suggest that the network theory could provide insight into the causal mechanisms underlying psychiatric disorders. We assess these claims in light of network analysis, Woodward's interventionist theory, and mechanistic explanation, and show that they can only be satisfied with additional assumptions and requirements. Then, we examine their claim that network characteristics may explain the dynamics of psychiatric disorders by means of a topological explanatory strategy. We argue that the network theory could accommodate topological explanations of symptom networks, but we also point out that this poses some difficulties. Finally, we suggest that a multilayer network account of psychiatric disorders might allow for the integration of symptoms and non-symptom factors related to psychiatric disorders and could accommodate both causal/mechanistic and topological explanations.

"My Body Does Not Fit in Your Medical Textbooks": A Physically Turbulent Life With an Unexpected Recovery From Advanced Parkinson Disease After Prayer.

AIM: The purpose of this article is to enhance our understanding of prayer healing by studying a case which was described as a 'remarkable healing' by a medical assessment team at the Amsterdam University Medical Centre (UMC) in the Netherlands. METHOD: This retrospective, case-based study of prayer healing investigated numerous reported healings using both medical files and patient narratives. A medical assessment team evaluated the associated medical files, as well as any experiential data. The instances of healing could be classified as 'remarkable' or 'unexplained.' Experiential data were obtained by qualitative, in-depth interviews. The study was transdisciplinary in nature, involving medical, psychological, theological, and philosophical perspectives. The object was to understand such healings within the broader framework of the science-religion debate. RESULTS: We present the case of a female patient, born in 1959, with Parkinson disease who experienced instantaneous, nearly complete healing in 2012 after intercessory prayer. At that point the disease was at an advanced stage, rapidly progressive, with major debilitating symptoms. High doses of oral medication were required. Following this healing there was no recurrence of her former symptoms, while the remaining symptoms continued to improve. She regained all of her capacities at work, as well as in daily life. The medical assessment team described her recovery as 'remarkable.' The patient reported that she had always 'lived with God,' and that at a point when she had given up hope, 'life was given back to her.' This recovery did not make her immune to other illnesses and suffering, but it did strengthen her belief that God cares about human beings. CONCLUSION: This remarkable healing and its context astonished the patient, her family, and her doctors. The clinical course was extraordinary, contradicting data from imaging studies, as well as the common understanding of this disease. This case also raised questions about medical assumptions. Any attempt to investigate such healings requires the involvement of other disciplines. A transdisciplinary approach that includes experiential knowledge would be helpful. Against the background of the science-religion debate, we feel that the most helpful approach would be one of complementarity and dialogue, rather than stoking controversy.

The Multilayer Network Approach in the Study of Personality Neuroscience.

It has long been understood that a multitude of biological systems, from genetics, to brain networks, to psychological factors, all play a role in personality. Understanding how these systems interact with each other to form both relatively stable patterns of behaviour, cognition and emotion, but also vast individual differences and psychiatric disorders, however, requires new methodological insight. This article explores a way in which to integrate multiple levels of personality simultaneously, with particular focus on its neural and psychological constituents. It does so first by reviewing the current methodology of studies used to relate the two levels, where psychological traits, often defined with a latent variable model are used as higher-level concepts to identify the neural correlates of personality (NCPs). This is known as a top-down approach, which though useful in revealing correlations, is not able to include the fine-grained interactions that occur at both levels. As an alternative, we discuss the use of a novel complex system approach known as a multilayer network, a technique that has recently proved successful in revealing veracious interactions between networks at more than one level. The benefits of the multilayer approach to the study of personality neuroscience follow from its well-founded theoretical basis in network science. Its predictive and descriptive power may surpass that of statistical top-down and latent variable models alone, potentially allowing the discernment of more complete descriptions of individual differences, and psychiatric and neurological changes that accompany disease. Though in its infancy, and subject to a number of methodological unknowns, we argue that the multilayer network approach may contribute to an understanding of personality as a complex system comprised of interrelated psychological and neural features.

Reintroducing Consciousness in Psychopathology: Review of the Literature and Conceptual Framework.

Alterations in consciousness are among the most common transdiagnostic psychopathological symptoms. Therefore clinical practice would benefit from a clear conceptual framework that guides the recognition, comprehension, and treatment of consciousness disorders. However, contemporary psychopathology lacks such a framework. We describe how pathology of consciousness is currently being addressed in clinical psychology and psychiatry so far, and how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, Tenth Edition (ICD-10) refer to this subject. A brief review of the literature on consciousness is then given. After describing psychological perspectives on consciousness and discussing theoretical issues involved in exploring consciousness, we offer a practical clinical working definition of consciousness and we illustrate its connections with a variety of diagnoses. Making use of Jean-Paul Sartre's distinctions among: states, functions, qualities, and structure, provide a conceptual framework to understand consciousness, to refine diagnostics and to guide the development of therapeutic possibilities in clinical practice.

Conceptual issues in neuroscientific research on empathy.

This paper gives an analysis of some conceptual issues in the neuroscientific study of empathy. The focus will almost exclusively be on a seminal paper by Decety and Jackson (2004) on the functional architecture of empathy. The authors withstand reductionistic tendencies in the exposition of what their findings might mean for the psychology of social cognition. They are aware of the thorny conceptual issues that arise when attempting to bridge intuitive folk psychological conceptions of empathy with explanations offered by social psychology, developmental science, and, most of all, neuroscience. They defend a conception which puts emphasis on the developmental, interactional and human aspects of empathy. In the second part of the paper we will see that this overt contention is at some points at odds with the conceptual framework that underlies the presentation of scientific findings. It will appear that the method of decomposition, i.e., breaking empathy down into (mutually interacting) 'pieces', is difficult to reconcile with the idea that empathy should primarily be defined as an interactional phenomenon. The method of decomposition puts empathy back within the brain, whereas recent philosophical work argues that empathy needs a definition which includes both processes in the empathizing subject and in the person with whom the subject empathizes. In the final part of the paper it is asked whether, how and to what extent it does matter that professionals know about the social neuroscience of empathy and, especially, its underlying conceptual framework. It is argued that conceptual innovations that currently are emerging in social neuroscience do matter for clinical and legal practices. In spite of the limitations mentioned earlier, Decety & Jackson's developmental and interactional approach helps to overcome reductionistic and mentalistic interpretations of human empathy.

Examining the factor structure of the self-report Yale-Brown Obsessive Compulsive Scale Symptom Checklist.

Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version.

Structural Validity of the World Assumption Scale.

The World Assumption Scale (WAS) is a frequently used measure in trauma research. The 32 items of the WAS are intended to represent eight assumptions about the benevolence of the world, the meaningfulness of events, and the worthiness of the self. Debate about the validity of the WAS is ongoing, particularly in terms of its empirical factor structure; some studies have confirmed a model of eight correlated factors whereas several other studies have not. The WAS items were administered to a clinical sample of patients who sought professional help because of posttraumatic complaints (n = 1,791) as well as a sample of healthcare professionals (n = 236). We split the clinical sample into three subsamples, then performed exploratory factor analysis using data from one subsample and tested the factor structure with confirmatory factor analysis using the other two subsamples. A consistent model of eight correlated factors was demonstrated, with almost all factors showing acceptable reliability, Cronbach's αs = .68-.84. We tested this factor model against data from the sample of healthcare professionals with increasingly stringent levels of invariance and found it to be scalar invariant (same structure, loadings, and thresholds). In a regression analysis, five factors showed significant associations with posttraumatic stress disorder (PTSD) symptoms, and two factors had unique associations with PTSD symptoms after we controlled for traumatic events: Self-Worth, ß = -.31; and Luck, ß = -.15. Future research should aim to distinguish between different assumptions and their individual influences on posttraumatic complaints.

Thinking about the nerve impulse: A critical analysis of the electricity-centered conception of nerve excitability.

Nerve impulse generation and propagation are often thought of as solely electrical events. The prevalence of this view is the result of long and intense study of nerve impulses in electrophysiology culminating in the introduction of the Hodgkin-Huxley model of the action potential in the 1950s. To this day, this model forms the physiological foundation for a broad area of neuroscientific research. However, the Hodgkin-Huxley model cannot account for non-electrical phenomena that accompany nerve impulse propagation, for which there is nevertheless ample evidence. This raises the question whether the Hodgkin-Huxley model is a complete model of the nerve impulse. Several alternative models have been proposed that do take into account non-electrical aspects of the nerve impulse and emphasize their importance in gaining a more complete understanding of the nature of the nerve impulse. In our opinion, these models deserve more attention in neuroscientific research, since, together with the Hodgkin-Huxley model, they will help in addressing and solving a number of questions in basic and applied neuroscience which thus far have remained outside our grasp. Here we provide a historico-scientific overview of the developments that have led to the current conception of the action potential as an electrical phenomenon, discuss some major objections against this conception, and suggest a number of scientific factors which have likely contributed to the enduring success of the Hodgkin-Huxley model and should be taken into consideration whilst contemplating the formulation of a more extensive and complete conception of the nerve impulse.

Self-Knowledge in Personality Disorder: Self-Referentiality as a Stepping Stone for Psychotherapeutic Understanding.

This article provides a philosophical framework to help unpack varieties of self-knowledge in clinical practice. We start from a hermeneutical conception of "the self," according to which the self is not interpreted as some fixed entity, but as embedded in and emerging from our relating to and interacting with our own conditions and activities, others, and the world. The notion of "self-referentiality" is introduced to further unpack how this self-relational activity can become manifest in one's emotions, speech acts, gestures, and actions. Self-referentiality exemplifies what emotions themselves implicitly signify about the person having them. In the remainder of the article, we distinguish among three different ways in which the self-relational activity can become manifest in therapy. Our model is intended to facilitate therapists' understanding of their patients' self-relational activity in therapy, when jointly attending to the self-referential meaning of what their patients feel, say, and do.

Prayer Healing: A Case Study Research Protocol.

Context • Prayer healing is a common practice in many religious communities around the world. Even in the highly secularized Dutch society, cases of prayer healing are occasionally reported in the media, often generating public attention. There is an ongoing debate regarding whether such miraculous cures do actually occur and how to interpret them. Objective • The aim of the article was to present a research protocol for the investigation of reported cases of remarkable and/or unexplained healing after prayer. Design • The research team developed a method to perform a retrospective, case-based study of prayer healing. Reported prayer healings can be investigated systematically in accordance with a step-by-step methodology. The focus is on understanding the healing by studying it from multiple perspectives, using both medical judgment and patients' narratives collected by qualitative methods Setting • The study occurred at Vrije Universiteit (VU) and VU Medical Center (Amsterdam, Netherlands) as well as the general medical practice of the first author. Participants • Potential participants could be any individuals in the Netherlands or neighboring countries who claim to have been healed through prayer. The reports of healing came from multiple sources, including the research team's medical practices and their direct vicinities, newspaper articles, prayer healers, and medical colleagues. Outcome Measures • Medical data were obtained before and after prayer. Subsequently, a member of a research team and of a medical assessment committee made a standardized judgment that evaluated whether a cure was clinically remarkable or scientifically unexplained. The participants' experiences and insider perspectives were studied, using in-depth interviews in accordance with a qualitative research methodology, to gain insight into the perceptions and explanations of the cures that were offered by participants and by the members of the medical assessment committee. The medical findings and participants' experiences were weighed and interpreted based on a transdisciplinary framework, including biopsychosocial and theological perspectives, with reference to a conceptual framework derived from Ian Barbour's typology of positions in the science-religion debate. Conclusion • A case-based, research study protocol that compares medical and experiential findings and that interprets and structures those findings with reference to Ian Barbour's conceptual model is an innovative way of gaining deeper insight into the nature of remarkable and/or unexplained cures.

The Existential Concerns Questionnaire (ECQ)-Development and Initial Validation of a New Existential Anxiety Scale in a Nonclinical and Clinical Sample.

OBJECTIVE: Existential anxiety (EA) is a construct that refers to fears that are provoked by core threats of human existence, such as death, meaninglessness, and fundamental loneliness. The objective of this study was to develop an EA measure that can be used in research and clinical practice. METHOD: The Existential Concerns Questionnaire (ECQ) was completed by a nonclinical sample of 389 adults, together with questionnaires measuring death anxiety, intolerance of uncertainty, neuroticism, distress, meaning, and life events. Adaptations were made based on item analysis and factor analysis. A total of 99 adults who had an anxiety and/or depressive disorder completed the final version. RESULTS: The ECQ was demonstrated to be essentially unidimensional and showed good reliability and stability. Correlations with other measures were within the expected range of strength, except for a weak association with life events. CONCLUSION: Initial results regarding the psychometric properties of the ECQ are promising.