Spirituality in Clinical Practice: An Islamic Perspective

1. Spirituality in Clinical Practice: An Islamic Perspective Shehzi Yusaf Clinical Psychologist

2. Bringing back the soul in psyche – ology • Science and religion or spirituality do not mix • Psychology’s endeavour to become a science • Experimental psychology, behaviourism, cognitive theories, attachment theory • Neuroscience, reduction theory, brain-behaviour

3. Evidence based Treatments • Behaviour Therapy • Cognitive Therapy • Cognitive Behaviour Therapy (CBT) • Dialectical Behaviour Therapy (DBT) • Interpersonal Psychotherapy (IPT) But something is missing!

4. New third wave therapies • Mindfulness Based CBT: non judgmental attention and acceptance of the here and now. Metacognitive awareness. Thoughts/feelings as passing events rather than inherent aspects of the self or reality • Acceptance and Commitment Therapy(ACT):acceptance of internal experiences instead of avoidance or control. Cognitive defusion.Learning to live a valued life. Use of mindfulness, goal setting, behaviour change.

5. What works for Muslim clients? Cognitive Behaviour Therapy!(Badri.M,2000) ‘ Early Muslim scholars described and taught cognitive behavioural models and methods: SD, exposure, cognitive restructuring, behaviour change Cognitions underlie feelings and behaviour which are under our voluntary control and can be changed (Ibn al Qayyim) Graded exposure to the threat will lead to habituation of negative feelings (Al Ghazali) Contemplation and the rememberance of Allah (Zikr) is the key to inner peace and well being • CBT

6. Highly detailed Islamic belief / schematic system • Islamic teachings / practices embody potent cognitive & behavioural prescriptions: decreases physiological arousal (anxiety) and enhanced emotional functioning (mood management). • Cognitive restructuring is fundamentally characteristic of Islamic thinking style prescribed by early Muslim scholars eg Ibn al-Qayyim

7. Muslims prescribe to religious schema above all other competing schema (eg. Familial, traditional, cultural) • Islam is a powerful instrument for cognitive realignment • Islamic psychology uses CBT, offering key to unlock / access / modify schema for enhanced pt wellbeing / outcomes.

8. Mindfulness and Acceptance Based Therapies • Concept of Mindfulness identical to Islamic contemplation and Sufism (eg Rumi) • Methods similar: focus on breathing, Zikr and “Allah Hu” • Notion of unconditional acceptance of the here and now akin to concept of total submission and trust in Allah

9. Spiritual Assessment General • Are you spiritual? • What is your religion? • What do you think drives our mind and our body? • Where do you believe we came from? • What are your beliefs about the nature of Man? • What happens when we die? • What do you see as the purpose of life? • Why does adversity happen to us? • What does your faith say about acceptance? Note: assess suitability and willingness of client to answer

10. Muslim • You said that you are a Muslim, tell me about some of your beliefs? • How do you make sense of what is happening to you? • What does Islam say about this event? • Why do you think it happened? • As a Muslim how do you cope with this? Identifies Muslim clients with various degrees of faith, eg was born a Muslim but do not follow any of its tenets to, Islam is an integral part of my life, I live and breathe it.

11. Further explore the level of knowledge about Islam, their practice of Islam, their cognitive evaluation of what it means for them eg say prayers five times a day because it is compulsory vs indepth knowledge of why it is prescribed, what are the benefits and how it is meant to be said. • Explore what spiritual practices they have, eg fasting outside of Ramadhan, doing Zikr, reading the Quran, contemplation,

12. Treatment • CBT based as most suited to religious clients including Muslims. • Now ACT and MBCBT most effective

13. Components of Treatment • Psychoeducation: nature, cause and maintenance of the disorder. • Cognitive restructuring/acceptance model • Emotional distress management • Exposure • Problem solving • Assertion training • Activity scheduling • Goal setting

14. Islamic Methods Education from the Quran and Hadith. • Human Nature. Concept of Fitra. every soul is born pure. • Individual differences recognised in Islam (single ummah but made you different so you may know each other, Allah gives some more others, less) • Concept of Rizq or what is due to us: sustenance • Role of parents in Islam: Unconditional love and acceptance of children. Parenting rules specified • Homework to research topic, eg why does adversity happen to us?

15. Contemplation of the relevant text from the Quran eg. ‘On no soul do We place a burden greater than it can bear’ (23:62) • Aim; re-alignment of competing beliefs. “I could have died. I didn’t, because my time had not come”

16. Concept of the Self • Aql (intellect, rational/reasoning mind) • Qalb (spiritual heart, seat of knowledge, intention, belief, justice) • Nafs (ego, feelings, desires, -ve thoughts) • Ruh (the spirit, the true human, the one in charge, live on after physical death)

17. Aim • To use the rational, reasoning mind (Aql) to problem solve, understand ourselves and the world • To develop the Heart (Qalb), make it pure, eg through Sadaqa (charity), patience, compassion, kindness, honesty. • To tame the Nafs Ammara (lower negative self) via self discipline • To develop the Nafs Lawwama (self reproaching self) via self analysis, remorse and repentence • To continuously strive to achieve Nafs Mutmainnah (peaceful self) via following the righteous path, overcoming negative thoughts, feelings, behaviour. Use of Zikr, prayers, contemplation, mindfulness.

18. Teaching Mindfulness Meditation: Focus on breathing and “Allah Hu” • Application of Mindfulness to: • Zikr (recitation of the 99 attributes of Allah, Ya Sabir, Ya Qavi, Ya Salamu). • Salat (prescribed prayers 5 times a day) • Recitation of the Quran as a meditative spiritual exercise.

19. Case Study • 35 yr old Salman, married to a Christian. No children. Involved in an MVA. Minor physical injuries. Developed PTSD. Stopped driving for 4mnths. Sx of reliving (thgts, images, emot arousal, hallucinations, nightmares, flashbacks) avoidance (of thgts feelings situations, amnesia, dissociation, detachment) hyperarousal (irritability, insomnia, poor memory, startle, hypervigilance at home and outside). • IES: v. high. Impact: moderate on interpersonal/marital, high on occupational and severe on social.

20. Spiritual Ax: “Good” Muslim family background but limited knowledge of the essence, spiritual basis . • Treatment: CBT plus the Islamic methods and Mindfulness meditation. Exposure imaginal and in-vivo. Cognitive re-alignment re fear of death, chronic pain, ‘why me?’ • Outcome: V. effective. Reduction in all Sx, increase in quality of life, in spirituality, sense of self ‘peaceful’