TITLE:
Effects of Religious vs. Conventional Cognitive-Behavioral Therapy on Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial
AUTHORS:
Lee S. Berk, Denise L. Bellinger, Harold G. Koenig, Noha Daher, Michelle J. Pearce, Clive J. Robins, Bruce Nelson, Sally F. Shaw, Harvey Jay Cohen, Michael B. King
KEYWORDS:
Cognitive Behavioral Therapy, Religion, Depression, Inflammation, Immune Function, Stress Hormones
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.5 No.3,
June
1,
2015
ABSTRACT: Background: Depressive
disorder is often accompanied by physiological changes that may adversely
affect the course of medical illness, including an increase in pro-inflammatory
cytokines. Methods: We examine
the effects of religious cognitive behavioral therapy (RCBT) vs. conventional
CBT (CCBT) on pro-/anti-inflammatory indicators and stress hormones in 132 individuals with major
depressive disorder (MDD) and chronic medical illness who were recruited into a multi-site
randomized clinical trial. Biomarkers (C-reactive protein and pro-inflammatory
cytokines TNF-α, IL-1β, IFN-γ, IL-6, IL-12-p70),
anti-inflammatory cytokines (IL1ra, IL-4, IL-10), and stress hormones (urinary
cortisol, epinephrine, norepinephrine) were assessed at baseline, 12 weeks, and
24 weeks. Differential effects of baseline religiosity on treatment response
were also examined, along with effects of religiosity on changes in biomarkers
over time independent of treatment group. Biomarker levels were log transformed
where possible to normalize distributions. Mixed models were used to examine
trajectories of change. Results: CRP increased and IL-4, IL-10, and epinephrine
decreased over time, mostly in the opposite direction expected (except
epinephrine). No significant difference between RCBT and CCBT was found on
average trajectory of change in any biomarkers. Religiosity interacted with
treatment group in effects on IL-6, such that CCBT was more effective than RCBT
in lowering lL-6 in those with low religiosity whereas RCBT appeared to be more
effective than CCBT in those with high religiosity. Higher baseline religiosity
also tended to predict an increase in pro-inflammatory cytokines INF-γ and IL-12 (p70) and urinary cortisol
over time. Conclusions: RCBT and CCBT had similar effects on stress biomarkers.
CCBT was more effective in reducing IL-6 levels in those with low religiosity,
whereas RCBT tended to be more effective in those with high religiosity.
Unexpectedly, higher baseline religiosity was associated with an increase in
several stress biomarkers.