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Existential thinking and religious/spiritual struggles in patients with major depressive disorder receiving cognitive-behavioral therapy

Year: 2025
Type: article
Abstract: Existential and spiritual issues may influence the symptoms and outcome of major depressive disorder (MDD). This study examined the interplay between existential thinking (fundamentals of meaning, purpose, and mortality), religious/spiritual (R/S) struggles (distress related to loss or questioning of faith, conversion to a new faith, or questioning of spiritual values), and mood/anxiety symptoms in individuals with MDD undergoing a 16-week course of cognitive-behavioral therapy (CBT). Participants were MDD patients with and without R/S struggles, as well as healthy controls. Before and after CBT, we assessed depressive and anxiety symptoms, existential thinking, and R/S struggles by using standard scales and interviews. Results revealed that MDD patients with R/S struggles exhibited significantly higher levels of existential thinking than non-clinical control participants and MDD patients without R/S struggles both before and after CBT. While existential thinking did not change during CBT, depressive and anxiety symptoms decreased in all MDD patients. Critically, patients with DSM-5 R/S problems showed substantial reductions in R/S struggle scores during CBT. However, these values remained elevated compared to non-clinical controls and MDD patients without R/S struggles, even when the therapy was completed. Correlation analyses indicated positive associations between existential thinking, R/S struggles, and depression in MDD. These findings highlight that existential and spiritual dimensions are integral to a subtype of MDD and may require a tailored clinical approach in addition to conventional symptom-focused treatments.
DOI: 10.1038/s41598-025-26014-z
Language: English
Subfield: Health
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W4416695251
FWCI: 2.143
Cites: 61
Cited by: 2
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