CHAPTER 5 - SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
In this chapter, an overview of the key components of the study, including the research problem, thesis statement, hypotheses, goals, literature review, methodology, and specifically, the findings are discussed. After summarizing the study and findings, (a) conclusions, (b) implications, (c) limitations, and (d) the researcher's recommendations are presented.
5.1 Overview of the Study
This study examined the intensity of depressive symptomatology and comorbid anxiety before and after a twelve-week treatment plan using Orthodox neptic-psychotherapeutic interventions and techniques. It was theorized that the techniques used in the neptic-psychotherapeutic method of the Holy Fathers of the Orthodox Church reduce the intensity of self-reported depressive symptomatology and comorbid anxiety in participants regardless of their religious affiliation. The hypotheses were formulated and tested using an integrated quantitative and qualitative paradigm. The quantitative component measured the levels of depressive symptomatology and comorbid anxiety through pre-treatment and post-treatment testing with the BDI and BAIŽ. The qualitative component gathered information regarding participant perceptions regarding the impact of treatment and other related matters through Follow-up Interviews. The literature review included contextual and background information concerning (a) the foundational presuppositions of Orthodox Psychotherapeutic theory and practice, (b) the etiology of spiritual / psychological disorders and pathologies as identified in the neptic tradition of the Holy Fathers, (c) the 'cycle of temptation', (d) neptic treatment, and (e) depressive symptomatology and comorbid anxiety from the perspectives of the DSM-IV and the Holy Fathers.
The investigation was guided by the following research question: Does Orthodox neptic-psychotherapeutic treatment have an effect on the intensity of depressive symptomatology and comorbid anxiety? The findings are presented under five subsections (a) BDI Findings, (b) BAIŽ Findings, (c) Compliance Rates, (d) Correlations, and (e) Follow-up Interviews.
5.1.1 BDI Findings
The three groups tested, i.e., Orthodox, other Christian, and agnostics presented the following pre-treatment / post-treatment BDI score ranges. The average pre-treatment BDI score for Orthodox participants was 25, representing 'Moderate Levels of Depression', vs. a post-treatment score of 7, representing 'Normalcy', with an 18-point differential. The average pre-treatment BDI score for other Christians was 25, representing 'Moderate Levels of Depression', vs. a post-treatment score of 17, representing 'Mild Levels of Depression', with an 8-point differential. The average pre-treatment BDI score for agnostic participants was 24, representing 'Moderate Levels of Depression', vs. a post-treatment score of 15, representing 'Mild Levels of Depression', with a 9-point differential. All groups presented improvement. However, the average BDI score of Orthodox participants improved by 18 points, the average score of agnostic participants improved by 9 points, and the average score of other Christian participants improved by 8 points. Only the Orthodox participants had post-treatment BDI scores ranging from 0 to 13, representing 'Normalcy'. All other participants had post-treatment BDI scores ranging from 14 to 19, representing 'Mild Levels of Depression'.
5.1.2 BAIŽ Findings
The three groups tested, i.e., Orthodox, other Christian, and agnostics presented the following pre-treatment / post-treatment BAIŽ score ranges. The average pre-treatment BAIŽ score for Orthodox participants was 32, representing 'Moderate Anxiety', vs. a post-treatment score of 8, representing 'Low Anxiety', with a 24-point differential. The average pre-treatment BAIŽ score for other Christians was 32, representing 'Moderate Anxiety', vs. a post-treatment score of 26, representing 'Moderate Anxiety', with a 6-point differential. The average pre-treatment BAIŽ score for agnostic participants was 35, representing 'Moderate Anxiety', vs. a post-treatment score of 21, representing 'Low Anxiety', with a 14-point differential. All groups presented improvement, the average BAIŽ score of Orthodox participants improved by 24 points, the average score of agnostic participants improved by 14 points, and the average score of other Christian participants improved by 6 points. The Orthodox participants had post-treatment BAIŽ scores ranging from 0 to 21, representing 'Low Anxiety'. The other Christian participants had post-treatment BAIŽ scores ranging from 22 to 35, representing 'Moderate Anxiety'. Three agnostic participants had BAIŽ scores ranging from 0 to 21, representing 'Low Anxiety', and 2 had scores ranging from 22 to 35, representing 'Moderate Anxiety'.
5.1.3 Compliance Rates
For the three groups tested, i.e., Orthodox, other Christian, and agnostics, the average CRs were analogous. The average CR for Orthodox participants was 100%. The average CR for other Christians was 92%. The average CR for agnostics was 94%. The variance between groups was 8%.
The correlation between the pre-treatment / post-treatment BDI and BAIŽ scores were examined in relation to the twelve-week treatment program. The correlations were measured using the Pearson's 'r' and the Chi-square, which is a non-parametric test of statistical significance for bivariate tabular analysis. The results indicated that the H0 can be rejected and that it can be concluded that a statistically significant relationship exists between the variables, i.e., between neptic-psychotherapeutic treatment and the intensity of depressive symptomatology and comorbid anxiety.
5.1.5 Follow-up Interviews
In the Follow-up Interviews, participants (a) identified factors related to the etiology and maintenance of depressive symptomatology and comorbid anxiety, (b) unanimously attributed recovery to treatment, and (c) discussed other factors that may have contributed to, or enhanced, the healing process. The Follow-up Interviews indicated that the etiological factors described by participants were not momentary or transient, i.e., the etiological factors were not limited to specific responses to isolated life experiences but were related to persistent and ongoing stressors, and therefore it can be reasonably concluded that the depressive symptomatology and comorbid anxiety experienced by the participants would not have subsided without treatment.
The following hypotheses were formulated and tested in this study based upon the definition of the conditions of the experiment described above:
1. The null hypothesis, i.e., that there is no statistically significant relationship between neptic-psychotherapeutic treatment and the intensity of self-reported depressive symptomatology and comorbid anxiety.
2. The non-directional hypothesis, i.e., that there is a statistically significant relationship between neptic-psychotherapeutic treatment and the intensity of self-reported depressive symptomatology and comorbid anxiety.
In order to test these hypotheses, it was necessary to measure the levels of depressive symptomatology and comorbid anxiety in the study's participants before neptic-psychotherapeutic treatment, and to compare those findings with the levels of depressive symptomatology and comorbid anxiety after treatment.
It had been theorized that neptic-psychotherapeutic techniques, i.e., fasting, prayer, physical postures, etc., would reduce the intensity of self-reported depressive symptomatology and comorbid anxiety among participants regardless of religious affiliation or orientation, thereby signifying the universal and inherent efficacy of those techniques. It was also theorized that optimal benefit from the treatment could only be obtained in conjunction with general Orthodox Christian praxis, and therefore it was expected, that the findings would show that, while all who participated in the nepticpsychotherapeutic treatment plan would benefit to some degree, only practicing Orthodox Christians, would obtain more favorable end results.
Therefore, from the findings of this research and from the analysis of the data presented in Chapter IV, it is concluded that:
Regardless of religious affiliation and / or orientation, there is a strong positive relationship between the intensity of self-reported depressive symptomatology and comorbid anxiety and neptic-psychotherapeutic treatment, i.e., even outward / superficial compliance with neptic-psychotherapeutic treatment is correlated to descending levels of depressive symptomatology and comorbid anxiety.
Having stated the above, Orthodox Christian praxis appears to be correlated with the efficacy of the treatment.
The neptic-psychotherapeutic method of the Holy Fathers can be practically applied and utilized with success in treating depressive symptomatology and comorbid anxiety, even in a non-Orthodox setting, and perhaps, in the treatment of other spiritual and mental health disorders.
Orthodox Psychotherapy makes an unprecedented contribution to human science because it offers a viable scientific alternative to the contemporary Western reason-based method and worldview by providing evidence that validates the hesychastic method as contained in the apophthegmatic writings of the Holy Fathers of the Orthodox Church.
This method proves itself to be invaluable for research, education, and personal development, and can serve as a basis for modifying behavior / conduct and for increasing spiritual, emotional, psychological, and physical health. This study has provided evidence that by means of neptic-psychotherapeutic treatment, which promotes a phenomenological approach to full personhood and true 'self-consciousness', (through the purification of the nous and the pursuit of theosis, by means of nepsis, or mindfulness / watchfulness, ascesis, or self-discipline and fasting, and hesychia, especially through the practice of the 'Prayer of the Heart'), existential problems can be resolved and mental health can be restored.
The early phenomenology of 'self-consciousness' in the writings of the Holy Fathers can be viewed as a predecessor of the Cognitive-Behavioral method. It is interesting to note that analogous archetypal religious approaches to 'knowledge by presence' can be found, e.g., Advaita Vedanta (Shankaracharya, 1947) and Sufism (Suhrawardi, 1999; Yazdi, 1992). The epistemic explication of 'logos' and 'self-consciousness', discovered through the 'Prayer of the Heart', points to the unity of existence in the ontopoesis, i.e., being-seeking, the interplay of thetic and operational / act intentionalities, and indispensable architecture of true self-consciousness, and ultimately of the rediscovery of the nous.
The reconstruction of the practice of the 'Prayer of the Heart' leads to psychogenesis, i.e., development within the psyche of the dialogical method of explication of the architecture of the psychological system commonly called 'self, but which is in reality the nous. The in-depth knowledge of the structure of the 'self serves to develop the techniques for both learning and psychotherapy, based on the enhancement of the critical elements of self-structure. This culminates in the discovery by the 'self of a new research methodology that includes implications regarding (a) the investigation of 'self-explication' or 'self-analysis' (St. Simeon the New Theologian, 1995); (b) the application of the dialogical 'self-explication' in personal development; and (c) using the neptic method in therapy and as an educational mnemonic technique.
5.3.1 Implications for 'Self-Analysis'
The results of self-analysis through nepsis, ascesis, and hesychia, and moreover, by means of the practice of the 'Prayer of the Heart' consists of the systematic re-focusing and focusing of attention on the pre-reflective components of the lived and embodied experience of the nous, i.e., the transcendent apperceptional power of the psyche, which is ontologically and anatomically associated within the human heart. Through the series of spontaneous phenomenological, eidetic and transcendental reductions of, and by, the nous, wo/man acquires the direct perception of the archetype or architecture of true 'self-awareness' and gestalt of meaning-structures, i.e., the energies of all that which is created, and ultimately, through the development of an Orthodox phronema, praxis, and through the purification of the nous, the Uncreated Light. Orthodox eidetic reduction is a technique used in the study of energies. Its goal is to identify the basic components of beings, objects, or phenomena, and requires that energies be examined. The intention is to extract the absolutely necessary and invariable components. This reduction is done with the intention of removing what is perceived, and leaving only that which is required and real.
5.3.2 Implications for Dialogical Explication
The 'Prayer of the Heart' includes the ongoing repetition of the Divine name in the dialogical interiority between the nous and Divine Energy, spatially identified in the interior the heart. The name has to be objectively 'located' inside the inward flow towards the nous, gradually absorbing towards its origins in pure subjectivity. Over the years, this process causes deep characterological, perceptual, cognitive, conative, behavioral, and epistemological transformation, culminating in what is known as the 'Purity of the Heart', and the direct apperception of the transcendent.
The systematic longitudinal explication of the interior meaning-structures of consciousness in this process can be viewed as a particular form of autopoiesis, or psychogenesis. This is the architecture of the self-awareness or rediscovery of the nous. The nous itself was once marginalized in West due to the emergence of limited and restricted pseudo-empiricism, engendered by Scholasticism. However, the nous can now ontically re-enter the center of psychological discourse in the West through neptic-psychotherapeutic practice (Benson, 2001; Misra, 2001; Schweder, 1991).
The method of the dialogical explication of the deep cognitive structures of 'self-awareness', and the development of a worldview, based on the compilation of the writings of the Holy Fathers (St. Nikodemos & St. Makarios, 1983) shows that spatiality is the primary organizational principle of the self, and moreover, that this is pervasive to the whole internal organization. The components of true 'self-consciousness' are organized in the 'internal space' of introspection as layers around the central experience of the nous in the process of purification. The darkened nous, through enslavement to the passions, in association with sensations, emotions and feelings, images, verbal thoughts, deeper non-verbal understandings, mental states, results in depression or torpor, anxiety or confusion, and / or 'nothing', also forms easily identifiable clusters.
Deeper analysis uncovers the inner, vital structural groupings, such as self-concept / self-sense, interiority / exteriority, constancy / changeability (subjectivity / objectivity), selfhood / transcendentality, and body-schema relatedness / unrelatedness. The self-concept / self-sense axis includes the polarity of self-related concepts vs. the body-based, spatial sense of one's own self. Interiority / exteriority includes the polarity of meaning and verbal-expression, constancy-changeability relates to the subject (constancy)-object (changeability) relationship within the introspective field. Transcendentality accommodates transpersonal psychological dimensions of experience such as 'larger-than-self or 'no self, and body schema relatedness refers to the psychological phenomena, which emerge in connection with particular locations within the body schema.
5.3.3 Implications for Psychotherapy and Psycho-Education
The nous as a persistent / constant component of 'self-consciousness' can be easily differentiated from changing components by clients in guided and attentive introspection. After initial training, 'awareness' of the nous can become available for the continuous and uninterrupted fixing of conative attention. This promotes well-being and increases higher-order thoughts about the self and the world. The increase of these secondary reflective thoughts corresponds to the human experience of becoming more conscious. Since the knowledge about the 'self is typically remembered better than other types of semantic information, the focusing on the sense of the nous can be used as a therapeutic, psycho-educational, and educational mnemonic technique. The voluntary focus of attention on the constant aspect of the nous in the process of therapy, learning, and other activities decreases anxiety and enhances learning.
Focusing on the awareness of the nous in therapy can assist in neutralizing depersonalization and disassociation. This, in turn, supports the re-establishment of the normal structure of self-experience. The phenomenological map of the spatial components of the self resonates with the in-situ distribution of neuromediators and neuropeptides, challenging the belief in the exclusive neuro-centricity of consciousness (Louchakova & Warner, 2003). The positive effects of focusing on the nous may also therefore affect biological processes, and may be connected with changes in the chemistry of the body, and ultimately in the decrease of both psychosomatic and physical illnesses.
This study proposed to present a concrete treatment methodology for spiritual / psychological disorders and pathologies, especially depressive symptomatology and comorbid anxiety using neptic-psychotherapeutic interventions at the clinical and pastoral level. The implications for treatment and, moreover, for integration modalities are multiple.
The therapeutic techniques used in Orthodox Psychotherapy are inherently efficacious in dealing with spiritual / psychological disorders and pathologies and their symptomatologies. Neptic-psychotherapeutic techniques orbit the triad of nepsis, ascesis, and hesychia, and result non-linearly in: (a) the development of awareness of deep cognitive structures, dialogical awareness, eidetic reduction, pre-reflection, secondary reflective thoughts, and conative attention; (b) increased self-analysis, self-discipline, self-capacities, and affect and tolerance regulation skills, (c) decreased characterologic difficulties associated with identity, emotional, and attachment / relational schemata and differentiation; and (d) the development of mnemonic devices, focus and re-focus, habituation, deeper self-consciousness, and higher order thinking. These emerge through the employment of neptic-psychotherapeutic techniques such as challenging self-talk, therapeutic fasting, contemplative prayer, and to a lesser extent, body postures, etc. These are all discussed at length in Chapter II. They can be used in therapy either explicitly or implicitly. Explicitly, they can include (a) methods of developing / maintaining Christ-centered thinking, (b) implementing an Orthodox fasting module, (c) practicing the 'Jesus Prayer' curriculum (including bodily postures), and (d) submission to spiritual direction through consistent and supportive weekly follow-up by the gerontas / therapist to monitor and encourage compliance. Implicitly, the method can be implemented by encouraging the development of generalized spiritual activities, e.g., (a) exercises of abstinence, including solitude, silence, meditation, fasting, frugality, chastity, and sacrifice; and (b) exercises of engagement, including study, service, prayer, fellowship, repentance and confession, and obedience. Additionally, in implicitly applying the cognitive, conative, and behavioral interventions proffered by the Holy Fathers in Chapter II, such tools as the Vujisic False Belief Inventory (FBI) might be utilized as a starting point for the cognitive interventions described in section 2.4.1, the Vujisic Self-Capacities Inventory (SCI) might be used as precursor for the conative interventions described in 2.4.2, and the Vujisic Self-Defeating Behavior Inventory (SDBI) and Vujisic Addictive Behavior Inventory (ABI) might be employed for the behavioral interventions in 2.4.3.
Having stated the above, this research does not suggest that Orthodox Psychotherapy supplant existing psychotherapeutic protocols and / or psychopharmacological treatment for all mental disorders. However, it does suggest that neptic treatment can be integrated into psychotherapeutic practice, both during treatment and at the post-clinical level. After clients have received psychotherapeutic treatment for acute symptomatology, and experience some relief, it may be possible to prepare them to enter a more expansive treatment of the psyche through Orthodox Psychotherapy.
There are several limitations to this study. An obvious limitation is related to the participant sample. The non-Orthodox participants belonged to one specific racial, ethnic, and cultural group and therefore the findings may differ if the study were to be undertaken with another population. Additionally, it should be noted that the participants lived and worked in a confined geographical area on the island of Puerto Rico, and it is possible that the results would vary if participants were selected from another geographical region. The participants' personal faith in the treatment program, i.e., in fasting and prayer, may also have had an affect upon the findings.
Another limitation is the question of the sample size. The determination of sample is an important and difficult step in planning an empirical study. From a statistical perspective, sample size depends on the following (a) the type of analyses to be performed, (b) the projected precision of estimates, (c) the type and number of comparisons, (d) the number of variables, and (e) the heterogeneity of the population. Other important considerations include (a) feasibility, (b) ethical limitations and (c) practicality. The available approaches for estimating sample size in social science research all have strengths and weaknesses. These approaches include (a) power analysis, (b) heuristics; (c) confidence intervals, (d) computer-intensive strategies, and (e) ethical and cost considerations. Additionally, strategies for mitigating pressures to increase sample size must be discussed, e.g., (a) emphasis on model parsimony, i.e., fewer dependent and independent variables, (b) simpler study designs, (c) an emphasis on replication, and (d) careful planning of analyses.
Notwithstanding, in this study, it has been shown that there is a strong positive relationship between the levels of depressive symptomatology and comorbid anxiety and neptic-psychotherapeutic treatment, i.e., compliance with neptic-psychotherapeutic treatment is correlated to descending levels of depressive symptomatology and comorbid anxiety. These findings, based upon the statistically valid sample of the target population, are transferable to the extent to which they can be generalized to other settings, which appears quite feasible.
In terms of future study, the effectiveness of Orthodox Psychotherapy for the prevention and / or treatment of other spiritual / psychological disorders and pathologies warrants further characterization. Studies, and in particular, qualitative studies with larger samples might be conducted to determine if participants' personal faith in the efficacy of fasting and the 'Jesus Prayer' curriculum has any effect on the treatment process. This might lead to the identification of specific methods to activate or reactivate this faith. Qualitative and quantitative studies might also be conducted with other populations. Such studies could shed additional light on the nature of the objective efficacy of Orthodox Psychotherapy. Similarly, investigation is needed regarding other factors and / or extraneous variables that may contribute to understanding the positive results obtained in this study.
To recap, this study has established that there is a strong positive relationship between the levels of depressive symptomatology and comorbid anxiety and neptic-psychotherapeutic treatment, i.e., compliance with neptic-psychotherapeutic treatment is correlated to descending levels of depressive symptomatology and comorbid anxiety. It should be mentioned that one of the strengths of this study, in fact, were its participants, whose personal insight assisted in the provision of rich and significant feedback related to the different stages of the study. The number of participants in this study (15), although small, has been robust enough to establish statistically valid trends. Ultimately, the conclusions were confirmed quantitatively through the results of the BDI and BAIŽ, and qualitatively affirmed through participant responses in the Follow-up Interviews.
In addition to the necessity of further studies related to the Orthodox Psychotherapy and spiritual / psychological disorders and pathologies, this research accentuates the fact that the theories reviewed and discussed in Chapter II regarding the neptic-psychology of the Holy Fathers and the power of fasting and the 'Prayer of the Heart' need to be revisited and re-examined, in order to establish a new preeminence in the learning and practice of these ancient methods. Additionally, the relationship between spiritual and mental health needs to be seriously considered and investigated, together with the cycle and acquiescence to temptations and sin, which can lead to a multitude of emotional / psychological disorders. Finally, it must be understood that spirituality and psychological disorders and pathologies are interrelated and that this relationship is much broader than generally considered.
Page created: 11-2-2011.
Last update: 11-2-2011.