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Religious vs. Conventional Cognitive Behavioral Therapy for Major Depression in Persons With Chronic Medical Illness

A Pilot Randomized Trial

Koenig, Harold G. MD*†‡§∥; Pearce, Michelle J. PhD*§¶; Nelson, Bruce MA#; Shaw, Sally F. PhD#; Robins, Clive J. PhD**; Daher, Noha S. DrPH††‡‡; Cohen, Harvey Jay MD†§; Berk, Lee S. DrPH§‡‡∥∥; Bellinger, Denise L. PhD∥∥; Pargament, Kenneth I. PhD¶¶; Rosmarin, David H. PhD##; Vasegh, Sasan MD***; Kristeller, Jean PhD†††; Juthani, Nalini MD‡‡‡; Nies, Douglas PhD#; King, Michael B. MD, PhD§§§

The Journal of Nervous and Mental Disease: April 2015 - Volume 203 - Issue 4 - p 243–251
doi: 10.1097/NMD.0000000000000273
Original Articles

We examine the efficacy of conventional cognitive behavioral therapy (CCBT) versus religiously integrated CBT (RCBT) in persons with major depression and chronic medical illness. Participants were randomized to either CCBT (n = 67) or RCBT (n = 65). The intervention in both groups consisted of ten 50-minute sessions delivered remotely during 12 weeks (94% by telephone). Adherence to treatment was similar, except in more religious participants in whom adherence to RCBT was slightly greater (85.7% vs. 65.9%, p = 0.10). The intention-to-treat analysis at 12 weeks indicated no significant difference in outcome between the two groups (B = 0.33; SE, 1.80; p = 0.86). Response rates and remission rates were also similar. Overall religiosity interacted with treatment group (B = −0.10; SE, 0.05; p = 0.048), suggesting that RCBT was slightly more efficacious in the more religious participants. These preliminary findings suggest that CCBT and RCBT are equivalent treatments of major depression in persons with chronic medical illness. Efficacy, as well as adherence, may be affected by client religiosity.

*Department of Psychiatry and Behavioral Sciences, and †Department of Medicine, Duke University Medical Center, Durham, NC; ‡Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; §Center for Spirituality, Theology and Health, Duke University, Durham, NC; ∥School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China; ¶School of Medicine, University of Maryland, Baltimore; #Department of Research, Glendale Adventist Medical Center, CA; **Department of Psychology and Neuroscience, Duke University Medical Center, Durham, NC; ††Epidemiology, Biostatistics, and Population Medicine, School of Public Health, and ‡‡Allied Health Studies, School of Allied Health Professions, Loma Linda University, CA; §§Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC; ∥∥Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, CA; ¶¶Department of Psychology, Bowling Green State University, OH; ##Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA; ***Department of Psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran; †††Department of Psychology, Indiana State University, Terre Haute; ‡‡‡Department of Psychiatry, Albert Einstein College of Medicine, New York, NY; and §§§Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.

Dr Juthani is a retired professor of psychiatry at the Albert Einstein College of Medicine in New York.

Send reprint requests to Harold G. Koenig, MD, Box 3400, Duke University Medical Center, Durham, NC 27710. E-mail:

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