U.S. Government Funds Spirituality Research

In one of his letters, the Apostle Paul exhorts: "If there are any that are sick among you, lift them up in prayer." Can this scriptural claim be validated scientifically? A new research project joins Johns Hopkins University's Center for Health Promotion and Duke University's Center for the Study of Religion/Spirituality and Health as they seek to answer this fascinating question.

This five-year joint project, the first study of prayer intervention ever funded by the National Institutes of Health, begins in October. The National Institutes of Health (NIH), is one of eight health agencies of the Public Health Services which, in turn, is part of the U.S. Department of Health and Human Services. The mission of the NIH is to uncover knowledge that will lead to better health for everyone. Part of the way it accomplishes this mission is by supporting the research of non-federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad.

The study will be centered on prayer intervention for African American women with early stage breast cancer. The basis for the study comes from the scientific evidence that stress alters the natural neuroendo-crine-mediated immunoprotective mechanisms and increases the likelihood of tumor recurrence or spread.

The reasons for choosing African American women as opposed to white women, who have a 12% higher incidence of breast cancer, include disease course, demographics, and religion. African American woman have a poorer prognosis at most stages, and they have been found to be more vulnerable to stress associated with post-operative social functioning. African American women also have a higher propensity to use spiritual healing than white women.

Dr. Harold G. Koenig, associate professor of medicine and Associate Professor of Psychiatry at Duke University, heads Duke's portion of the project. Dr. Koenig, who has been studying the effects of religion on health for 15 years, acts as a consultant for the study. He helped Dr. Diane Becker of Johns Hopkins University design the project, and will work with Dr. Becker in interpreting the results and writing any resulting journal articles or papers. The actual recruitment, lab work, and testing will be carried out at the Johns Hopkins Center for Health Promotion.

"We will be communicating monthly on study design and operation," explains Koenig. "I will probably fly up there a couple times a year."

The actual study will involve several aspects. Women will be recruited from Johns Hopkins by a trained research nurse. The eligible women will be those with early breast cancer that is neither metastatic nor invasive. Metastatic or invasive cancer involves the spread of the disease to different organs (metastatic) or infiltration into the fatty tissue, muscle, or bone around the breast (invasive). Either of these forms of cancer would require more rigorous treatment involving chemotherapy. If the patient passes these qualifications, the nurse will interview the patient, explaining the research and giving her a chance to enroll. Once the woman enrolls, she must wait 132 months after treatment with surgery and radiation before she actually begins the study.

Forty women will randomize to a control group that gets normal treatment after radiation. They will be given only written educational materials on what to expect after lumpectomy and radiation, which is typically given to breast cancer patients; no religious materials will be offered.

The forty women randomly assigned to the test group, however, will meet with a "comfort leader." The "comfort leader" will be a woman who has survived cancer, has a strong self-identified prayer and religious background, and has been specially trained to be a witness to the woman recovering from breast cancer surgery. The comfort leader will help the patient organize and run a prayer group for six months. The patient is allowed to choose whoever she wishes to participate in the prayer group. The patient May choose close friends or members of her church. Each prayer group will receive a book of 24 weeks of spiritual messages based on Biblical scripture that guide the prayer for any given week. The women will be offered instruction as to how to gather for prayer and personal witnessing, which is common among African-American women who participate in spiritual groups.

The group will be asked to focus on prayer for healing and comfort for the woman and for her family. The concept of centering prayer (see below) will be used both in the group and by the individual. Using this method, the group and the patient will select a symbolic scriptural word that to them will signify their recognition of a "divine presence." Twice each day, the patient is to use the centering prayer word to focus on a feeling of peace and inner spirituality, sitting quietly with eyes closed and disallowing intrusive thoughts. As a form of meditation, centering prayer uses the concept of the presence of a spiritual communication with a divine power during the quiet time the word is evoked. By choosing the word together, the group forms a unified spiritual bond. Thus, the intervention contains both a personal and a group component. At the end of six months, both groups will be tested and compared.

"The three important components of the test group are (1) spiritual witnessing from an African American breast cancer survivor (greater than 5 years) with the same stage and treatment, (2) personal spirituality using the concept of centered prayer, and (3) weekly prayer group meetings involving 538 women from the patient's group or social network," explains Dr. Koenig. "Getting their [the patients'] minds off their cancer, makes a big difference. However, counteracting the negative effects of stress induced by cancer with a sense of hope, social and psychological support, a positive belief system, and a sense of personal control through prayer are even more important," says Dr. Koenig.

What do they hope to accomplish in this study? "[To] determine whether religious involvement and belief affect immune functioning and cancer prognosis," replies Dr. Koenig. The effects of the prayer group on immune function will be determined using both lab tests and subject interviews.

Three lab-oriented measurements will involve testing neuroendocrine markers of stress in the patient's saliva and urine, testing the blood for CD4/CD8 T cell and NK cell activity, and measuring peripheral blood lymphocyte proliferation and cytokine release in response to cancer specific antigens. Number of T cells, natural killer cells and lymphocyte activity all reflect the strength of the immune response.

Finally, questionnaires will be administered to assess the effect of the prayer intervention on perceived stress, psychosocial functioning, and quality of life.

Long term, Dr. Koenig hopes that the findings from this research will give women and their religious communities a powerful tool for combating breast cancer. He also hopes that research such as this will help open the door to more studies on the effects that prayer May have on other diseases influenced by immune system activity, including other kinds of cancer and infectious diseases like AIDS.

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