INT’L. J. PSYCHIATRY IN MEDICINE, Vol. 43(1) 85-98, 2012
THE EFFECT OF PRAYER ON DEPRESSION AND
ANXIETY: MAINTENANCE OF POSITIVE INFLUENCE
ONE YEAR AFTER PRAYER INTERVENTION*†
PETER A. BOELENS, MD, MPH
University of Mississippi, Jackson; and
Executive Director of Shalom Prayer Ministry
ROY R. REEVES, DO, PHD
Jackson VA Medical Center; and University of Mississippi, Jackson
WILLIAM H. REPLOGLE, PHD
University of Mississippi Medical Center, Jackson
HAROLD G. KOENIG, MD
Duke University Medical Center, Durham, North Carolina; and
King Abdulaziz University, Jeddah, Saudi Arabia
Objective: To investigate whether the effect of direct contact person-to-
person prayer on depression, anxiety, and positive emotions is maintained
after 1 year. Design, Setting, and Participants: One-year follow-up of sub-
jects with depression and anxiety who had undergone prayer intervention
*The design and conduction of the study, collection, management, analysis, manuscript
preparation, and review were provided by the authors who received no financial or any other
support for their involvement in this study. The corresponding author, Peter A. Boelens, had
full access to all of the data in this study and takes responsibility for the integrity of the data
and the accuracy of the data analysis.
†This randomized cross-over trial was conducted between September 2005 and May 2010
in an outpatient setting in Vicksburg, Mississippi. The Institutional Review Board approval
was obtained through Copernicus Group IRB, Research Triangle Park, North Carolina.
Ó2012, Baywood Publishing Co., Inc.
consisting of six weekly 1-hour prayer sessions conducted in an office setting.
Subjects (44 women) completed Hamilton Rating Scales for Depression and
Anxiety, Life Orientation Test, and Daily Spiritual Experiences Scale after
finishing a series of six prayer sessions and then again a month later in an
initial study. The current study reassessed those subjects with the same
measures 1 year later. One-way repeated measures ANOVAs were used to
compare findings pre-prayer, immediately following the six prayer sessions,
and 1 month and again 1 year following prayer interventions. Results: Evalu-
ations post-prayer at 1 month and 1 year showed significantly less depression
and anxiety, more optimism, and greater levels of spiritual experience than
did the baseline (pre-prayer) measures (p< 0.01 in all cases). Conclusions:
Subjects maintained significant improvements for a duration of at least 1
year after the final prayer session. Direct person-to-person prayer may be
useful as an adjunct to standard medical care for patients with depression
and anxiety. Further research in this area is indicated.
(Int’l. J. Psychiatry in Medicine 2012;43:85-98)
Key Words: depression, anxiety, direct person-to-person prayer, emotions, neuroplasticity
Depression and anxiety are common disorders and are among the leading causes
of distress and impairment. At any given time, 10% of the UnitedStates population
has been affected by depression and 18% by an anxiety disorder in the previous
year [1, 2]. These disorders are associated with significant morbidity and are
often chronic and resistant to treatment, producing a significant burden of ill
health worldwide [3, 4].
Numerous studies have investigated the influence of religious practices serving
as a coping behavior in mental diseases such as depression and anxiety. In the
majority of these cases, the effect has been positive . A systematic review of
23 trials involving 2,774 participants evaluating the efficacy of any form of
“distant healing” as treatment for any medical condition showed that 13 trials
(57%) yielded statistically significant treatment effects, 9 trials showed no effect
over control interventions and 1 showed a negative effect . However, a meta-
analysis of 14 studies of distant prayer for healing suggested no discernable
effect  and a review of 10 studies (7,646 subjects) of intercessory prayer for a
variety of health conditions concluded that the results could not be interpreted
with any degree of confidence . Direct contact prayer on a person-to-person
basis with the “laying on of hands,” however, has been associated with enhanced
participant well-being  and clinical improvement of individuals with chronic
rheumatoid arthritis .
In a recent study , we investigated the effect of direct person-to-person
prayer on depression, anxiety, positive emotions, and salivary cortisol levels.
After six weekly 1-hour prayer sessions, individuals receiving prayer showed
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significant improvement of depression and anxiety as well as increases of daily
spiritual experiences and optimism compared to controls who did not receive
prayer (p< 0.01 in all cases). Cortisol levels did not differ significantly between
intervention and control groups, or between pre- and post-prayer conditions.
Subjects who received prayer maintained significant improvements (p< 0.01
in all cases) for at least 1 month after the final prayer session. Participants in the
control group did not show significant changes. The purpose of this study was
to investigate whether improvements were still maintained for a year following
these prayer interventions.
This investigation involved assessment of participants who received prayer
in the above study at least 1 year after completion of the prayer sessions. The
original study was conducted in an outpatient setting in Vicksburg, Mississippi.
Institutional Review Board approval was obtained through Copernicus Group
IRB, Research Triangle Park, North Carolina. Methods have been previously
described for prayer intervention and collection of data at baseline, at completion
of prayer interventions, and 1 month after prayer intervention . These methods
will be briefly reviewed here. In addition, described in this article will be an
extension of the original study involving completion of the same measures (except
cortisol measurement) 1 year after the prayer intervention.
Severity of depression in subjects was measured utilizing the Hamilton
Depression Rating Scale (HDRS); scores of 10 or more were indicative of
depression . Severity of anxiety was assessed using the Hamilton Anxiety
Rating Scales (HARS); scores of 17 or more were indicative of anxiety . The
Life Orientation Test (LOT), an eight question instrument with a maximum
possible score of 32 (most optimistic) measured the effects of dispositional
optimism on self-regulation in a variety of circumstances . The Daily Spiritual
Experiences Scale (DSES) used 16 questions with possible total scores ranging
from 16 to 94 to measure spiritual experiences such as joy, a sense of inner
peace, and closeness to God .
Participants were individuals 18 years or older who met DSM-IV-TR criteria
for depressive disorder . Most also had symptoms of anxiety. Individuals
were excluded if they had any chronic disease or evidence of cognitive impair-
ment, if they had received steroidal medication within the preceding 2 months,
or if they had been treated with psychotherapy during the preceding year. If
subjects were taking antidepressants or anti-anxiety medications, the dosages of
EFFECT OF PRAYER ON DEPRESSION AND ANXIETY / 87
these medications remained unchanged through the 1-month post-prayer assess-
ment. In the ensuing year, medication could be discontinued if desired, but no
other changes in medications occurred.
Participants were recruited from medical physician offices through posters
placed in the waiting area and examination rooms. Some individuals also pre-
sented from the community requesting enrollment. Sixty females and three
males completed the prayer sessions and evaluation 1 month later. Of these, 44
females (average age 48 years-old; 57% African American, 43% Caucasian)
underwent evaluation at least 1 year after the end of the prayer intervention.
In the initial study, after providing informed consent, participants were admin-
istered the HDRS, HARS, LOT, and DSES and samples for cortisol measure-
ments collected. Subjects were randomized into a prayer intervention group or
a control group (Figure 1). A series of six weekly prayer intervention sessions
were begun for the prayer intervention group. The control group received no
prayer or any other intervention during that time. After serving as controls for
the prayer intervention group, control subjects were eligible to cross over to
participate in prayer intervention and receive prayers following the same protocol
as the prayer intervention group.
After the six prayer sessions, there was no prayer intervention during the
following month or any other counseling, psychotherapy, or medication changes.
At the end of that month, subjects who received prayer and control subjects
were again administered the rating scales and salivary samples were collected
as before. In the current extension of that original study, four subjects moved
from the area and were lost to follow-up, and the remaining 44 subjects who had
received the six prayer sessions were reassessed after a year by the readminis-
tration of the HDRS, HARS, LOT, and DSES. There were no non-prayer
controls during this portion of the study; rather, prayer subjects were compared
at different points in time. Cortisols were not reassessed because no significant
changes were observed in the initial part of the study. During the year following
the prayer intervention, these subjects received no psychotherapy and no changes
in psychotropic medications except for decrease or discontinuance if desired.
At the conclusion of the prayer intervention, subjects had been encouraged to
participate in regular church attendance and Bible reading, but had no additional
prayer intervention by the investigators during that period of time.
All prayer interventions were conducted by a single lay prayer minister who
was a non-denominational Caucasian college graduate in her late sixties with
prayer training by Christian Healing Ministries (Jacksonville, FL). A distance
was maintained from the client so as to avoid touching through a hand shake or any
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EFFECT OF PRAYER ON DEPRESSION AND ANXIETY / 89
Figure 1. Prayer study profile.
other physical contact. A history was taken in order to delineate particular areas
for prayer. There was no psychotherapy, however, causing participants to gain
insights into their problems. Direct person-to-person prayer was the only inter-
vention. The prayers utilized were determined by the lay prayer minister and based
on the history of the participant. During the prayer sessions, the prayer minister
prayed and was often joined by the participant in praying various form prayers,
prayers releasing hurts, and prayers of blessings on those who had offended them.
The first prayer session was 90 minutes in duration and involved determina-
tion of the subject’s issues to be addressed by prayer. The remaining sessions
were 60 minutes each and were tailored to the individual participant’s needs.
Sessions included prayer about specific stressors and, when needed, for childhood
traumas and for repentance of behavior. In cases of emotional difficulty related
to traumatic memories, prayers asking that God come into the memories and
heal were provided.
In the original study, we performed separately for the prayer intervention
group, the crossover prayer intervention group, and the combined prayer and
crossover prayer group a one-way repeated measures ANOVA with the baseline,
post-prayer intervention, and 1-month follow-up measures as the three dependent
variables. For the current study, we used the same procedure and included the
1-year follow-up measure as the fourth dependent variable. As in the original
study, significant ANOVAs were followed by Bonferroni adjusted pair-wise
comparisons of the four assessments. An alpha level of 0.05 was used to determine
For the HDRS, HARS, LOT, and DSES, the repeated measures ANOVAs
indicated significant within-group differences, p< 0.01. Bonferroni adjusted
pair-wise comparisons of the four assessments revealed that post-treatment,
1-month follow-up, and the 1-year follow-up measures showed significantly
less depression and anxiety, more optimism, and greater levels of spiritual
experience than did the baseline (pre-prayer) measures. All other pair-wise com-
parisons, including the 1-year follow-up compared to the post-treatment and
1-month follow-up, were non-significant (Table 1, Figures 2-5).
The participants in this follow-up study maintained improvement of depres-
sion and anxiety 1 year following prayer intervention. They also maintained the
same level of optimism and spirituality. During this 1-year interim, there was no
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additional prayer intervention, psychotherapy, or medicinal therapy. How these
levels of mental and spiritual health were maintained is not fully understood.
It was previously postulated  that feelings of self-reproach and guilt and
rumination over past errors created a milieu of self-devaluative negativity and
hopelessness which had the potential to cause and perpetuate depression and
anxiety . We hypothesize that these thought patterns and their causes are
removed during prayers for specific stressors, childhood traumas, emotional
difficulty related to traumatic memories and, where applicable, repentance of
behavior. Following these prayers, when clients were asked to recall the hurtful
memories, the memories were now without emotional significance. This is
important in that the negative emotions linked to hurtful memories are per-
petuated throughout life. This persistent negative emotional presence adversely
affects the subconscious emotional appraisal system . It is this compromised
appraisal system that produces detrimental thought patterns with corresponding
With the root causes for negative thought patterns removed, it becomes
important to replace the harmful thought patterns with positive ways of thinking.
This may be accomplished through a “decentering” process . As old thoughts
are recognized by a client, they are immediately stopped. A prayer is breathed,
“God how do you want me to think and act.” If clients have been meditating on
Scriptures and praying them back to God, they are positioned to bring these new
Biblical thoughts to mind. This process not only produces new thought patterns
by removing the old, but new ways of thinking may begin to be established in the
EFFECT OF PRAYER ON DEPRESSION AND ANXIETY / 91
Table 1. Mean Response
Scale (n= 44)
Hamilton Anxiety Scale
Life Orientation Test
*Baseline vs. post-treatment, 1-month FU and 1 year FU, p< 0.01.
92 / BOELENS ET AL.
Figure 2. Hamilton Depression Scale values.
< 10-13 Mild; 14-17 Mild to moderate; > 17 Moderate to severe.
EFFECT OF PRAYER ON DEPRESSION AND ANXIETY / 93
Figure 3. Hamilton Anxiety Scale values.
< 17 Mild or None; 18-24 Mild to moderate; 25-30 Moderate to severe.
94 / BOELENS ET AL.
Figure 4. Daily Spiritual Experiences Scale.
An increased numerical score correlates with a decrease in spirituality and closeness to God.
The highest score (least spiritual) is 94 and lowest score (most spiritual) is 16.
EFFECT OF PRAYER ON DEPRESSION AND ANXIETY / 95
Figure 5. Life Orientation Test.
An increase in the numerical score correlates with an increase in optimism.
The highest score (most optimism) is 32 and lowest 0.
brain through a process known as self-induced neuroplasticity . The link
with the transcendent is reinforced through daily spiritual disciplines of Bible
reading, Scriptural meditation, and prayers. This discipline offers immediate
and positive reinforcement. It may enable clients to maintain their mental and
It is well known that the treatment of depression does not lie exclusively
within the realm of antidepressant drug or other biological therapies, but involves
other modalities such as interpersonal support and psychotherapy. These other
modalities may also come in the form of various religious practices, the majority
of which may have positive effects , but there have been no published studies
of these practices in a peer reviewed journal documenting their effect on
depression and anxiety. It is for this reason that direct person-to person prayer
may be one such modality worthy of further investigation. It is interesting to
note that 7 of the 15 clients who originally entered the study on medication
discontinued their medication in the ensuing follow-up year without any negative
effects. The majority had maintained a strong devotional life, had improved
personal relationships and had become proactive in managing their life. These
positive effects transpired without any further prayer therapy or personal contact.
Their activities during this 1-year period were not monitored.
This study is limited by the fact that it was not blinded and a sham control
group was not utilized. There was selection bias in the study in that individuals
desiring prayer were self referred through posters in physicians’ offices and by
word of mouth. Since this follow-up study involved only women, the findings
cannot be generalized to men. The study was conducted in the “Bible-belt” of
the United States and represented the demographics of the area (a denominational
mix of Christians) which may not allow the results of this study to be generalized
to other areas of the country or to other belief systems. The numbers of subjects
were insufficient for subgroup analysis of those receiving antidepressants. Data
on income and educational level was not collected. Other limitations include
difficulty comparing this study with other studies on interventions used to treat
depression or anxiety. Because of different methodologies among studies, it is not
possible to directly compare this study on the effectiveness of prayer with other
interventions such as recreational group therapy, psychotherapy, motivational
group therapy, art therapy, and other interventions that may have similar results.
This prayer intervention produced significant results in several domains of
mental health, and those benefits persisted for at least 1 year. Additional research
is needed to replicate these findings and, if replicated, to better understand how
96 / BOELENS ET AL.
person-to-person prayer has such effects. It is conceivable that clients activate
a form of prayerful self-directed neuroplasticity. With the effects of these
prayers maintained over time, it is possible that permanent structural changes in
the brain may have been induced. Direct person-to person prayer may provide
a modality of treatment, in addition to antidepressants for patients with mild to
moderate depression. The knowledge gained through this study may be a starting
point for a generation of future studies in this area.
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Direct reprint requests to:
Peter A. Boelens, MD, MPH
1121 Grove Street
Vicksburg, MS 39180
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