According to the Gallup Poll and Pew Forum, more than 90% of Americans believe in G-d, and religion is “very important” to more than 50% of the population. In fact, even in the least religious enclaves of the country (e.g., New Hampshire), nearly a quarter of residents attend religious services weekly and more than two-fifths pray on a daily basis. Furthermore, even in this increasingly secular period of history, spirituality continues to shape political, economic, and familial trends on a global scale. And let’s not forget that every bill printed by the United States Mint boldly displays the phrase: “In G-d We Trust.”

Given the centrality of spirituality in the general public, it is no surprise that more than 50% of psychotherapy patients in national surveys wish to discuss this subject matter in the context of their care. Indeed, a study I recently conducted at Harvard’s McLean Hospital in Eastern Massachusetts – not exactly a hotbed of religious fundamentalism – found that 56% of patients had such a desire. It is therefore not surprising that clergy are far more likely to be approached for help with emotional difficulties than mental health professionals. Furthermore, the most widely practiced modality of psychosocial treatment in the world is Alcoholics Anonymous – a spiritually-based treatment program for addictions that has over 2,000,000 members!

Despite these facts, however, G-d has virtually no place in psychotherapy for anxiety disorders. Most of the mental health clinicians I have encountered barely inquire about their patients’ spirituality, let alone address it. Utilization of spiritual beliefs or practices – e.g., by framing psychotherapy concepts with a religious lens, or identifying religious observances to focus on in treatment – is almost anathema. Even more unfortunate, many close colleagues from our communities, who are deeply religious and highly observant themselves, remain reticent to approach the subject matter of religion in the therapy room. Some have even criticized me for being a proponent of spiritually-based treatments, despite growing evidence that such approaches are effective, as well as preferred by many patients.

Why is this the case? Why is a field dedicated to the alleviation of emotional suffering so hesitant to include G-d in the process of treatment? Why does the inclusion of G-d into treatment seem so foreign, even to mental health professionals who themselves profess faith in G-d?

I don’t know the answer for sure, but it certainly didn’t help when Sigmund Freud came out in spades against G-d by openly calling religion a “neurosis”. Today, anti-religious sentiments in the mental health disciplines are less common (though not entirely uncommon). However, what does remain is widespread apathy for spirituality and religion. To put it simply, many mental health practitioners simply don’t care enough about this domain and therefore they fail to envision how helpful it can be to patients. The irreligious culture of mental health, especially against the backdrop of previous antipathy towards religion, creates widespread reluctance to address the subject matter – even among religious practitioners. The result is many patients who lose out.

Fortunately, the tide is beginning to shift – albeit slowly. The past decade has seen a sharp rise in research on Spiritually-Integrated Psychotherapy, and results are most promising. However, the availability of Spiritually-Integrated Psychotherapy remains limited. Further, most people – mental health professionals and laypersons alike – remain ignorant about how G-d can be brought into the treatment process. To this end, here is one example of how spirituality can be successfully integrated into treatment. It involves emunah.

In his famed Da’as Torah, the Mir Mashgiach, HaRav Yerucham Levovitz zt”l, defined emunah as faithfulness – remaining steadfast in one’s actions despite inner struggle. Commenting on the lives of the Avos, he points out that emunah involves moving forward in the direction of one's goals and dreams despite a lack of certainty that things will work out in a manner that one expects or desires. L’havdil, as Martin Luther King Jr. is reputed to have said: "Faith is taking the first step, even when you don't see the whole staircase."

This being the case, emunah is actually the bedrock of one of the best-established cognitive behavioral therapy (CBT) techniques for the treatment of anxiety disorders: exposure therapy. Specifically, exposure therapy involves encouraging patients to approach their anxieties head-on, step-by-step, until their distress comes down. The process isn't pretty. Imagine being afraid of snakes and being encouraged to step closer and closer towards a real, live (non-poisonous) snake until its cold, scaly and slimy skin is placed on your forearm. Frightening? Perhaps. But the miracle of treatment, if you will, is that people can overcome life-long fears in a matter of a few days, and sometimes in just a few hours. More centrally, the message of exposure therapy is clear: At each point in the treatment process, patients are encouraged to take small steps towards their goals despite the fact that they are experiencing inner struggle in the form of high levels of anxiety. In other words, patients are encouraged to practice emunah.

Of course, exposure therapy – like other CBT approaches – are not explicitly spiritual, and most CBT practitioners do not speak about their practices in spiritual terms. However, framing the process of exposure therapy for patients as an exercise in building emunah can do two things. First, it can help patients to get through treatment. Needless to say, exposure therapy is difficult work. It takes immense inner strength and persistence to overcome one’s fears. Viewing treatment as an exercise in building emunah can help increase motivation when things get tough. Many patients, whom I’ve treated using an emunah-based explanation of exposure therapy, remarked to me that they would have given up midway had they not held this message in mind.

Second, and perhaps more important, framing exposure treatment in terms of emunah can turn treatment into an exercise in spiritual growth. Numerous patients I’ve seen for treatment of specific phobias have been highly successful individuals whom are happily married, but they remain burdened by one or more specific fears. What motivation could such people have to overcome a phobia, you might ask? Several have entered and completed treatment simply because they saw it as a spiritual quest. As one patient recently remarked to me: “G-d doesn’t want me to live in fear, so it’s time that I learn to get over this.”

Needless to say, not all individuals wish to involve G-d, faith, spirituality or religion in treatment. But many do, far more than we might think. And for those individuals – many of whom reside in our communities – it’s time to take a step forward and offer spiritually-based treatments en masse. In other words, it’s time to have a little faith!

David H. Rosmarin, Ph.D., is an Instructor in the Department of Psychiatry at Harvard Medical School, and Director of the Center for Anxiety in New York City, a clinical-research facility with a focus on the Jewish community. He can be reached at 646.837.5557 or [email protected]