Author(s)

Lee S. Berk^1,2,3, Denise L. Bellinger², Harold G. Koenig^3,4,5,6*, Noha Daher^1,7, Michelle J. Pearce^3,4,8, Clive J. Robins^4,9, Bruce Nelson¹⁰, Sally F. Shaw¹⁰, Harvey Jay Cohen^3,5, Michael B. King¹¹

¹Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, USA.
²Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, USA.
³Center for Spirituality, Theology and Health, Duke University, Durham, USA.
⁴Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, USA.
⁵Department of Medicine, Duke University Medical Center, Durham, USA.
⁶Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
⁷Epidemiology, Biostatistics, and Population Medicine, School of Public Health, Loma Linda University, Loma Linda, USA.
⁸School of Medicine, University of Maryland, Baltimore, USA.
⁹Department of Psychology and Neuroscience, Duke University Medical Center, Durham, USA.
¹⁰Department of Research, Glendale Adventist Medical Center, Glendale, USA.
¹¹Division of Psychiatry, Faculty of Brain Sciences, University College, London, UK.

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.

Cognitive Behavioral Therapy, Religion, Depression, Inflammation, Immune Function, Stress Hormones

Berk, L. , Bellinger, D. , Koenig, H. , Daher, N. , Pearce, M. , Robins, C. , Nelson, B. , Shaw, S. , Cohen, H. and King, M. (2015) 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. Open Journal of Psychiatry, 5, 238-259. doi: 10.4236/ojpsych.2015.53028.