Wellness Check: Spirituality

Christian Orthodox Church fasting may improve metabolic syndrome risk factors

1. In this scoping review, Christian Orthodox Church (COC) fasters had healthier blood lipid profiles during and after COC fasting periods.

2. Additionally, COC fasters had no nutritional deficiencies despite their restricted food intake during the fasting periods.

Evidence Rating Level: 2 (Good)

Christian Orthodox Church (COC) fasting periods resemble the traditional Greek diet which consists of a vegetarian diet that includes fish and seafood. Though there is good evidence for the Mediterranean diet on preventing and improving the symptoms of metabolic syndrome (MetS), there is limited evidence on how COC fasting affects MetS. As a result, the present scoping review aimed to explore the association between COC on various aspects of human health and MetS risk factors.

Of 1204 identified articles, 20 (n=1226) publications between January 1990 and March 2020 were included. Studies originated mainly from different areas within Greece. Studies were included if they were published in English or in Greek, and if they included anthropometric measurements and metabolic markers. Studies were excluded if the religion investigated was not COC and if reported measurements were not health related. PRISMA guidelines were followed. Fasting periods varied between 1 and 103 total days of fasting. Various dietary assessment methods were used in each publication (e.g., 24hr dietary recall, weighed food records, and food frequency questionnaires). The primary outcome of the study was the impact of COC fasting on MetS risk factors.

Results demonstrated that fasters’ diets were comprised of low-fat, high-complex carbohydrate, and high-fiber foods. Despite restricted food intake, fasters did not exhibit deficiencies in essential amino acids. Furthermore, fasters exhibited improvement in MetS risk factors, evidenced by healthier blood profiles, systolic blood pressure, body weight, and body mass index during and following fasting periods. However, the study was limited by the low number of included studies, and the quality of the studies included, with over half lacking a control group. Nonetheless, the results of this study provide initial evidence that the COC fasting dietary pattern may be beneficial in decreasing the MetS score.

Religious-based interventions improve illness perception in breast cancer patients

1. In this randomized controlled trial, religious psychotherapy was associated with significant improvements in disease perception in Iranian breast cancer patients.

2. Furthermore, patients who received religious psychotherapy also showed lasting improvements in inner strength.

Evidence Rating Level: 1 (Excellent)

Breast cancer is a leading cause of morbidity and mortality in Iran and negatively impacts quality of life for patients. Prior studies have shown that psycho-oncological and psychotherapeutic interventions are effective in improving the psychosocial aspects of the disease for breast cancer patients. Currently, there is limited research about the effect of group religious-spiritual psychotherapy on breast cancer in Iran. As a result, the objective of the present randomized controlled trial was to evaluate the effect of religious psychotherapy on breast cancer perception and inner strength.

The present trial included 45 hospitalized female breast cancer patients (ages 31-58). Patients were selected through convenience sampling at the chemotherapy and radiotherapy center and cancer specialist clinics in Bandar Abbas from October 2016-July 2017. Patients were excluded if they had comorbidity with other chronic or serious diseases or if they had metastasis of their cancer. Patients were randomized to either treatment (n=15), attention control (n=15), or untreated control (n=15) groups. The treatment group received 10, 90-minute sessions of religious-spiritual psychotherapy based on the Twelver Shia Sects of Islam (RSP-TSS), the attention control group received 10, 90-minute null matter sessions, and the control group received usual care. The Revised Illness Perception Questionnaire (IPQ-R) was used to determine the disease perception, while the Inner Strength Questionnaire (ISQ) was used to determine inner strength. All participants completed these instruments immediately after the intervention and at 4 months after the post-test. Statistical analyses were performed using MANOVA. The primary outcomes were patient illness perception and inner strength.

Patients that received RSP-TSS showed significant improvements in both disease perception and inner strength compared with patients in the attention control and untreated control groups. These findings were maintained at the 4-month follow-up, indicating a sustained improvement in these coping measures. However, the use of convenience sampling was a limitation which may affect the generalizability of the study findings. Nonetheless, these results suggest that religious-spiritual interventions may have a role in improving quality of life and coping in breast cancer patients.

Religiosity may be protective against internet addiction

1. In this systematic review, 6 of the 11 reviewed studies found that religiosity was associated with lower levels of internet addiction (IA).

2. Additionally, 2 of 3 studies examining internet gaming addiction found that religiosity was a protective factor.

Evidence Rating Level: 1 (Excellent)

Internet addiction (IA) is a growing concern that has been associated with several consequences such as mood disorders, personality changes, and decreased social interactions. There has been research into the association between religiosity and vulnerability to addiction. However, there is a lack of understanding of how religiosity/spirituality might affect IA specifically. As a result, the objective of the present systematic review was to evaluate the association between internet addiction and religiosity or spirituality.

Of 854 identified records, 13 (range n=97 to 11,956) observational studies that were conducted on adolescents and adults in various countries between 2012 and 2021 were included. Studies were included if there were measures to assess religiosity or spirituality, different types of IA, and the association between the two. Studies were excluded if they did not distinguish between online and offline gambling and if they only included individuals who reportedly belonged to a religion. The quality of the studies was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) and the systematic review was conducted according to PRISMA guidelines. The primary outcome was the association between religiosity and IA.

There were 11 studies that specifically looked at the association between religiosity and IA. Of these, 6 studies described an inverse association between religiosity and IA. However, 3 studies found no association, and 1 study described a positive correlation between religiosity and IA. Additionally, 2 of the 3 studies that looked at internet gaming addiction found an inverse relationship between religiosity and internet gaming rates. However, the study was limited by the different tools used to measure religiosity and IA among the included studies, which prevented the use of a quantitative meta-analysis. Nonetheless, this study provides evidence to suggest that religiosity may be a protective factor against IA.

Spiritual care reduces fatigue and pain among patients receiving chemotherapy

1. In this randomized controlled trial, the post-test fatigue score was significantly lower in those who received spiritual care, compared to the control group.

2. Furthermore, the post-test score for pain was significantly lower in the spiritual care group compared to the control group.

Evidence Rating Level: 1 (Excellent)

Cancer-related pain (CRP) and cancer-related fatigue (CRF) are common complications of chemotherapy which significantly reduce quality of life for patients. Spirituality is known to demonstrate positive health effects and has shown to be beneficial in coping with cancer diagnoses. However, previous studies looking at the effects of spiritual care on CRF and CRP have demonstrated conflicting results. As a result, the objective of the present randomized controlled trial was to explore the effects of spiritual care on CRF and CRP in patients receiving chemotherapy.

The study was conducted in 2018 and included 162 patients with gastrointestinal cancer undergoing chemotherapy at a single center in Iran. Patients were included if they were Muslim, had basic literacy skills, received only chemotherapy, used no analgesics during the 3-day intervention, and had no significant psychiatric history. Patients were excluded if there were any modifications in the treatment of cancer during the study period. Patients were randomized to either the intervention or control group through block randomization. Patients in the intervention group received of two 30-45-minute spiritual care sessions per day for 3 days, while the control group received routine care services. Fatigue and pain were measured using the Fatigue Severity Scale and the visual analog scale respectively. Data was analyzed using Chi-square tests and independent-sample t-tests. The primary outcomes were post-intervention fatigue and pain scores.

Results demonstrated that compared to the pre-test mean scores for both fatigue and pain, the post-test mean score was significantly lower in the intervention group compared to the control group. However, the study was limited by the lack of consideration for cancer stage, metastasis and prognosis which may impact its generalizability. Nonetheless, these results demonstrate the role of spiritual care in addressing CRP and CRF in cancer patients receiving chemotherapy.

Image: PD

©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.