Effectiveness of Spiritual group Therapy with an Islamic approach on decreasing the anxiety and worry of the female students with generalized anxiety disorder

Introduction and Objectives: Generalized anxiety disorder is one of the most common anxiety disorders and its main processes reflect the fundamental processes of all anxiety disorders (Wells, 2013). Anxiety, worry, or physical symptoms cause impairment in social or occupational functioning, create inner suffering for the individual, and disrupt important areas of the individual's life. Research results indicate that among students, the prevalence of generalized anxiety disorder is higher than other anxiety disorders, and female students are more likely to exhibit this disorder than male students (Rashtbari et al., 2020). Among all anxiety disorders, generalized anxiety is the disorder that has less therapeutic effectiveness (Newman & Fisher, 2013). One of the most important reasons for the failure of therapeutic approaches is the lack of attention to cultural contexts, beliefs, and intracultural values. This is because psychotherapy and its effectiveness depend on the degree of harmony with the cultural and religious backgrounds of the individuals being treated (Loewenthal, 2006). Today, a new wave of studies has focused on examining the effect of spiritual therapies on reducing psychological stress (Koenig, 2012). A lot of research has been conducted on the effectiveness of spiritual therapies in the field of mental health and reducing psychological stress, However, little research has been conducted on the impact of spirituality-based interventions on generalized anxiety disorder. Considering the extensive role of spirituality and religion on mental health and anxiety reduction, as well as the prominent role of religion in our country, the present study aimed to investigate the effectiveness of spiritual group therapy with an Islamic approach on reducing symptoms of anxiety and worry in female students with generalized anxiety disorder.
Method: This study was an experimental design with pre-test-post-test and control group. The statistical population included all female students with generalized anxiety disorder at Lorestan University in the academic year 2015-2016. In this study, 712 students of Lorestan University completed the generalized anxiety disorder questionnaire using a one-stage cluster sampling method. Then, based on the cut-off point of the questionnaire and clinical interview, 34 students with generalized anxiety disorder were selected. The implementation method was as follows: after the identification and sampling stages, an introductory session was held for students with the necessary conditions and their consent to participate in the intervention sessions and cooperate in the research was obtained. Then, the selected members were randomly assigned to two experimental and control groups, and a pre-test was administered to them. In the next stage, the students in the experimental group participated in the spiritual group therapy program with the Islamic approach of Kopani (2014). This program was prepared in consultation with academic and religious scholars and reliable sources for use in anxiety disorders, and was held in eight two-hour sessions weekly for two months on designated days. In the training sessions, methods such as group discussion, providing a role model or example in the form of stories from the Quran, religious and literary texts, and homework were used. It is worth mentioning that after the post-test, an intensive course of spiritual group therapy with an Islamic approach was implemented in three sessions for the control group.
Results: Descriptive statistics (mean and standard deviation) and inferential statistics (univariate analysis of covariance) were examined using SPSS software version 23. The assumptions of normal distribution of scores and homogeneity of variances of dependent variables, which are statistical assumptions for using parametric tests, were confirmed by Kolmogorov-Smirnov, Levine, and M-box tests with values ​​of (p > 0.05), and the assumption of homogeneity of regression was examined by the test of homogeneity of slopes assumption, which showed that the interaction effect was not significant (p > 0.05); therefore, analysis of covariance can be used. The results of univariate covariance showed that there was a significant difference between the groups in anxiety scores in the post-test (F(1,31) = 31.27, P < 0.001); meaning that the anxiety scores in the post-test in the experimental group were significantly different from the control group. Looking at the means, it was determined that the anxiety scores in the post-test in the experimental group were significantly reduced, so spiritual group therapy with an Islamic approach significantly reduced anxiety in the experimental group (compared to the control group). The effectiveness of the treatment was 50 percent. Also, the results of the univariate covariance on the post-test scores of worry by controlling the pre-test showed that there is a significant difference between the groups in the scores of worry in the post-test (F(1,31) = 56.97, (P<0.001). Looking at the means, it was found that the post-test worry scores in the experimental group were significantly reduced; therefore, the spiritual group therapy with an Islamic approach significantly reduced worry in the experimental group (compared to the control group). The effectiveness of the treatment was 64 percent.
Discussion and Conclusions: The results showed that spiritual group therapy significantly reduced the average anxiety and worry scores of this group of students. In explaining the effectiveness of this treatment method, it can be said that the first and perhaps most important factor is related to the special effect of spiritual therapy in improving the individual's attitude and interpretation of life; in fact, spirituality, by targeting the individual's beliefs, influences important cognitive evaluations in the coping process and helps the individual evaluate negative events in a different way and create a stronger sense of control, which leads to his peace and confidence in life (Falah et al., 2011). On the other hand, faith in God creates a sense of security in an anxious person who has a negative perception of threat and risk assessment, especially in situations that are uncontrollable and unpredictable, because the person considers the events of the world to be in the hands of an active and wise resourceful being. Another factor that can facilitate the effectiveness of this research is related to some of the indigenous and cultural characteristics of our society. Iranian people are religious people based on cultural conditions and turn to religion more to adapt to critical and stressful situations (Rezaei et al. 2009). In our society, religion is considered one of the most effective psychological supports that can provide meaning to life throughout life and save the individual from meaninglessness; especially in difficult and critical times, it can be an important help for the individual. Accordingly, some experiences and evidence show that in our country, the treatment of many psycho-emotional disorders is in interaction with spiritual issues and without paying attention to them, diagnosis and treatment will not be successful (Gadampour et al. 2015).
Acknowledgement: We hereby express our gratitude to all the students who participated in this study and who helped us in the implementation of this research.
Conflict of Interests: The authors declare no conflict of interest for this study.