Journal of Psychology and Christianity

Journal of Psychology and Christianity

Journal of Psychology and Christianity

2007, Vol. 26, No. 2, 101-111

Copyright 2007 Christian Association for Psychological Studies

ISSN 0733-4273

Use of Prayer and Scripture in Cognitive-Behavioral Therapy

Siang-Yang Tan Graduate School of Psychology Fuller Theological Seminary

This article covers the appropriate and ethical use of prayer including inner healing prayer, and Scripture in a Christian approach to cognitive-behavioral therapy (CBT), Expanded CBT now includes Mindfulness- Based Cognitive Therapy, Acceptance and Commitment Therapy, and Dialectical Behavior Therapy, Implicit and explicit integration in therapy are briefly described, A composite clinical case example is included to illustrate how prayer and Scripture can be explicitly used in Christian CBT, Results of outcome studies on the efficacy of religiously-oriented CBT are also briefly mentioned.

Cogntive-behavioral therapy (CBT) is one of the most empirically supported treatments (ESTs) available for a wide variety of psychological dis- orders (Chambless & Ollendick, 2001; see also Butler, Chapman, Forman, & Beck, 2006; Nathan & Gorman, in press; Roth & Fonagy, 2005; Tan, 2001a).

It should be noted however, that a more recent randomized placebo-controlled trial of behavioral activation, cognitive therapy and antidepressant medication (paroxetine) with 241 adult patients with major depressive disorder (MDD) found that for severely depressed adults, behavioral activation is as efficacious as antidepressant medication and more efficacious than cognitive therapy (Dimidjian, et al,, 2006),

Empirically supported therapy relationships (ESRs) and empirically supported principles of therapeutic change (ESPs) have also been more recently emphasized in addition to ESTs, In fact, evidence-based practice in psychology (EBPP) presently focuses not only on the best available research, but also on therapist clinical expertise, and client characteristics, culture, and preferences (see Tan, 2007).

Hayes, Luoma, Bond, Masuda and Lillis (2006) recently pointed out that a historical overview of behavior therapy can be divided into three major generations or waves: the first generation or wave consisted of traditional behavior therapy; the second generation or wave consisted of CBT (which is now more than 30 years old); the third generation or wave presently consists of relatively contextualistic approaches such as Acceptance and Commitment Therapy (ACT;

Please address all correspondence to: Siang-Yang Tan, Ph,D,, Professor of Psychology, Graduate School of Psychology, Fuller Theological Seminary, 180 N, Oak- land Avenue, Pasadena, CA 91101.

Hayes, Strosahl, & Wilson, 1999), Mindfulness- Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002), and Dialectical Behavior Therapy (DBT; Linehan, 1993), CBT today has therefore been expanded to include such mindfulness and acceptance-based thera- pies as ACT, MBCT, and DBT (Hayes, FoUete, & Linehan, 2004), Bishop et al, (2004) have recent- ly proposed the following operational definition of mindfulness:

We propose a two-component model of mindfulness. The first component involves the self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. The second component involves adopting a particular orientation that is characterized by curiosity, openness, and acceptance, (p, 232)

Mindfulness and acceptance-based CBT has some spiritual roots in Zen Buddhism and similar meditative and contemplative religious or spiritual traditions, including those that emphasize the sacrament of the present moment from a Christian perspective (see De Caussade, 1989). More explicit religiously-oriented or spiritually oriented CBT has also been developed in recent years, especially within Christian and Muslim traditions (Tan & Johnson, 2005).

In such explicitly religious or spiritual approaches to CBT, the use of prayer and sacred Scripture (e,g,, the Holy Quran for Muslims, the Bible for Christians) is a core component, especially with religious clients desiring a religiously-oriented CBT that is compatible with their religious faith. There are now at least 10 outcome studies (six Christian and

Journal of Psychology and Christianity

102 USE OF PRAYER AND SCRIPTURE IN COGNITIVE-BEHAVIORAL THERAPY

four Muslim) with varying levels of methodological rigor, that provide some empirical support for the efficacy of religiously-oriented or spiritually- oriented CBT with religious clients, particularly for those with clinical depression, and to a lesser extent, those with generalized anxiety disorder (see Tan & Johnson, 2005, pp, 85-86; Worthington & Sandage, 2001),

A Biblical, Christian Approach to CBT

In this article, I will describe the appropriate and ethical use of prayer, including inner heal- ing prayer, and Scripture or the Bible in a biblical, Christian approach to CBT that I have developed and practiced for over 25 years, I have used it in a hospital setting, a Bible college counseling service, and in private practice. It has also been applied in pastoral care and counseling contexts, including lay counseling (see Tan, 1991), The following are key features of such a biblical, Christian approach to CBT (see Tan, 1987, p,108-109):

1, Emphasize the primacy of agape love (1 Cor, 13) and the need to develop a warm, empathic, and genuine relationship with the client,

2, Deal more adequately with the past, especially unresolved developmental issues or childhood traumas and will use inner healing or healing of memories judiciously and appropriately,

3, Pay special attention to the meaning of spiritual, experiential, and even mystical aspects of life and faith, according to God’s wisdom as revealed in Scriptures and by the Holy Spirit’s teaching ministry (John 14:26), and will not overemphasize the rational, thinking dimension, although biblical, propositional truth will still be given its rightful place of importance. The possibility of demonic involvement in some cases will also be seriously considered and appropriately dealt with,

4,Focus on how problems in thought and behavior may often (not always, because of other factors, e,g,, organic, or biological) underlie problem feelings (Prov, 23:7; Rom, 12:1-2; Phil. 4:8; Eph, 4:22-24) and will use biblical truth Qohn 8:32), not relativistic values, to conduct cognitive restructuring and behavioral change interventions,

5, Emphasize the Holy Spirit’s ministry in bringing about inner healing as well as cognitive, behavioral, and emotional change. It will use prayer and affirmation of God’s Word in facilitating dependence on the Lord to produce deep and lasting personality change and will be cautious not to inadvertently encourage sinful self-sufficiency (cf, Phil, 4:13),

6, Pay more attention to larger contextual factors such as familial, societal, religious, and cultural influences and hence will utilize appropriate community resources in therapeutic interventions, including the church as a body of believers and fellow “priests” to one another (1 Cor, 12; 1 Pet, 2:5,9),

7, Use only those techniques that are consistent with biblical truth and will not simplistically use whatever techniques work. It will reaffirm scriptural perspectives on suffering, including the possibility of the “blessings of mental anguish,” with the ultimate goal of counseling being holiness or Christ-likeness (Rom, 8:29), not necessarily temporal happiness. However, such a goal will include being more open to receiving God’s love and grace and thereby growing to be more Christ-like, and overcoming mental anguish due to unbiblical erroneous beliefs (i,e,, misbeliefs).

Journal of Psychology and Christianity

8, Utilize rigorous outcome research methodology before making definitive statements about the superiority of CBT,

Implicit and Explicit Integration in Therapy

I have previously described two major models of professional integration in the actual practice of therapy, i,e,, implicit and explicit integration as two ends of a continuum (Tan, 1996):