Religious change and posttraumatic growth

This systematic review examined the question whether positive religious/spiritual (R/S) change is facilitated by EMDR trauma therapy. The question is asked whether any such R/S change is simply a feature of overall post traumatic growth (PTG), or is it a form of change specific to EMDR? This systematic review found a number of articles showing that R/S change could follow EMDR, and also could be a feature of overall PTG. Further quantitative studies are needed to discover whether and how R/S change following EMDR is independent of PTG, or related to other aspects of PTG.

Introduction

I was carrying out EMDR trauma therapy with women from the orthodox Jewish community. They were happy with the way in which their PTSD symptoms had been eliminated, and distress levels had been reduced. Then one of my clients offered some thanks on a different topic. “It’s wonderful”, she said, “that my bitochon (Hebrew for religious and trust) has come back since this therapy.” Other clients offered similar reports (Loewenthal, 2019), and I went on to look at the effects of EMDR trauma therapy on religious and spiritual feelings in clients from the wider (non-Jewish) community (Loewenthal 2021).

EMDR is a form of therapy shown to be effective with PTSD, and probably other disorders (see Logie, 2014; Shapiro, 2018). EMDR reduces or eliminates the negative affect associated with traumatic memory, enabling reprocessing of the memory – termed Adaptive Information Processing (AIP) by Shapiro. EMDR enables the “frozen” traumatic memory to be adaptively processed and integrated with the individual’s other life memories, when it has been desensitised in EMDR. A central ingredient is BLS (bilateral stimulation). The right and left brains are stimulated alternately, either by moving the eyes from side to side, or by stimulating the right and left sides of the body alternately. EMDR is now recognised by the National Institute for Health and Clinical Excellence (NICE) and the World Health Organization as a treatment of choice for post-traumatic stress disorder. It appears that eye movement desensitisation and reprocessing (EMDR) has ‘come of age’ as a psychological therapy on a par with cognitive behavioural therapy or psychodynamic psychotherapy.

The finding that traumatised adults who had undergone trauma therapy using EMDR were likely to report an improvement in religious faith (Loewenthal, 2019) gave rise to the question whether this change in religiosity was an aspect of general post-traumatic growth (PTG), or whether other processes are involved, specific to religion and spirituality (R/S). The question could be addressed by studying post-traumatic growth and religious/spiritual change among traumatised individuals who have undergone trauma therapy. A related question is whether effects on religious change occur following other trauma therapy.

There have been a number of studies of PTG following trauma and trauma therapy. Shaw et al (2005) reported this in a significant systematic review, and since 2005, further studies have been published e.g. Jeon et al, (2017); Nijdam et al (2018). The most widely used measure of PTG has been the posttraumatic growth inventory (PTGI) (Tedeschi & Calhoun, 1996). Individual religiosity has proved to be a predictor of PTG. However it is important to bear in mind that religious/spiritual change is one of the features assessed in PTG. In other words, measurements of PTG and religious/spiritual change are confounded, and without assessing the non-religious aspects of PTG separately from the religious/spiritual, we cannot learn know whether and how non-religious PTG may relate to religious change. At this point it is worth noting that the PGTI assesses five factors, including R/S: Relating to others, New possibilities, Personal strength, Spiritual change, Appreciation of life.

The research questions are

• Is positive R/S change induced by EMDR?
• Is this simply a feature of overall PTG?
• How does it relate to other features of PTG?

Method

Studies of specifically religious/spiritual change following EMDR are the focus of interest and the remainder of this article reviews such studies. A systematic search of Scholar Google, (Medline) and EBSCO (APA PSYCHARTICLES) used the following search terms: EMDR and post traumatic growth, EMDR and religious change, EMDR and religion, EMDR and spirituality and EMDR and spiritual change.

Although there has been some controversy over the definition of the term “religious”, many/most studies include an assessment of religious practice such as prayer, attendance at religious gatherings, an/or simply agreement with items of religious belief. Agreement over definition of the term “spiritual” has been less definite, with some focus on the non-material and/or the soul. Pargament’s definitions of spirituality (e.g. Pargament & Exline, 2022) as search for the sacred, and search for meaning is considered useful.

Searches using Scholar Google and Psycharticles produced over 1,000 hits per search (8090 was the highest number), with later hits unlikely to contain fresh material on the topic of focus (which was the improvement/increase in spiritual/religious feelings and experiences following EMDR). Hence, searches were terminated after 30 hits, giving a total of 150 hits from each of Scholar Google and Psycharticles. /Medline produced very few results, 1-8 per search but these were scrutinised along with the 150 results from each of Scholar Google and Psycharticles (EBSCO).

Results

Table 1

The primary research question is whether religion/spirituality has been specifically affected by EMDR. The studies identified proved to be mainly qualitative, offering reports by therapists and clients; there appear to be no studies involving quantitative measurement of before and after religiosity Although the final three studies focused on PTG as an outcome, the authors and participants gave some note to the religious/spiritual feelings experienced post-traumatically. Two of these three studies were the only quantitative studies that came up in this review. Note the first eight studies, all report and emphasise religious/spiritual posttraumatic change following EMDR, but none of these studies are quantitative.

We can draw several conclusions from Table 1:

• Positive R/S change can certainly result from EMDR.
• PTG is also a result, and the current state of information does not permit us to analyse whether positive R/S change is part of a general PTG, or whether the different features of PTG may influence each other – for example might an improvement in affectional bonds help to improve R/S feelings, and/or vice versa.
• It would be helpful if the different components of PTG were analysed separately and their inter-relationships examined.
• Pre- and post-therapy measures of R/S are needed. Although the PTGI gives a measure of R/S, this is based on only two items, and more subtle and discriminating measures would be worthwhile.
• Only one study comparing EMDR to other trauma therapy was reported (Nijdam et al). This showed comparable effects of the two forms of therapy studied on PTG. R/S effects were not examined separately. Insofar as it goes this suggests that compared to other trauma therapy, there may be no unique effects of EMDR on PTG and its components, but a great deal more data are required.

Additionally, it can be noted that Loewenthal (2021) reported that R/S change following EMDR was reported only by those with a prior R/S identity/history. Participants without prior R/S beliefs reported no R/S changes at all. The numbers in this study were small but the effects were statistically significant. If this finding remains consistent, it may indicate an important factor explaining the widespread report that prior religiosity is a predictor of PTG. The effect would be at least partly because R/S is included in the measurement of PTG. But it is consistent with the view that a religious/spiritual belief framework will be important in shaping reactions to trauma (Loewenthal et al, 2000).

Further investigation could include the question whether R/S changes relate to specific features of PTG.

More rigour in the definition and assessment of R/S would be helpful.

Conclusions

Positive R/S change as a result of EMDR has been reported a number of times, but reports are usually solely observational and require greater rigour and structure in the assessment of R/S and its changes.

Measures of PTG include some assessment of R/S and it is possible that existing data may lend itself to examination of changes in the separate features of PTG and their inter-relations, including the relations of R/S to other features of PTG.

Comparison could be made of the effects of EMDR with the effects of other forms of therapy on PTG and R/S.

Acknowledgements

Grateful acknowledgements to New York University in London for the award of a Distinguished Research Fellowship facilitating the preparation of this paper.

Very many thanks to the EMDR users whose experiences and reflections led to this paper, and which have been have been so interesting and important to me.