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A New Perspective on Therapeutic Itineraries for Anxiety Management
"A Single Case Formulation of the Effectiveness of Islamic Ruqyah in
Reducing Panic Attacks"
ﻮﻈﻨﻣ ﻖﻠﻘﻟا ةرادﻹ ﺔﻴﺟﻼﻌﻟا تارﺎﺴﳌا ﺪﻳﺪﺟ ر"ةدﺮﻔﻣ ﺔﻟﺎﺣ ﺔﻏﺎﻴﺻ ﺔﻴﻋﺮﺸﻟا ﺔﻴﻗﺮﻟا ﺔﻴﻠﻋﺎﻔﻟ
ﻊﻠﻟا تﺎﻮﻧ ﺾﻔﺧ "
- 131 -
* Corresponding author:
Received: 21/07/2024 Accepted: 28/11/2024 Published: 31/12/2024
Farid Nafir *1
University August 20, 1955- Skikda– (Algeria)
Email : f.nafir@univ-skikda.dz
Slimane Boumediene 2
University August 20, 1955- Skikda– (Algeria)
Email : boumedieneslimane@yahoo.fr
Abstract
:
This study explored the efficacy of Ruqyah Shariah (Islamic spiritual healing) in reducing
panic disorder symptoms. Using a single-case A-B-A' design, the study examined one
participant (age 24) experiencing exam-related panic attacks. Assessment tools included the
Bandelow Panic and Agoraphobia Scale and Chambless Agoraphobic Cognitions
Questionnaire, administered before and after a 7-week Ruqyah intervention (5 sessions) that
combined religious recitations with imaginal exposure.
Results demonstrated significant improvements: panic symptoms decreased from 66.66%
to 16.66%, agoraphobic avoidance from 75% to 37.5%, anticipatory anxiety from 62.5% to
12.5%, work/family problems from 62.5% to 25%, health anxiety from 50% to 12.5%, and
overall agoraphobic cognitions from 60% to 24.28%.
The study recommends further research with larger samples and suggests developing
integrated protocols combining Ruqyah Shariah with evidence-based treatments like CBT,
emphasizing collaboration between mental health and religious practitioners.
Keywords: Panic Disorder, Religious Therapy, Therapeutic Itinerary, Ruqyah
.
ﺺﻣ
ﺔﻴﻗﺮﻟا تﺎﻧﺎﻣإ فﺎﺸﻜﺘﺳا إ ﺔﺳارﺪﻟا ﺖﻓﺪﺔﻴﻋﺮﺸﻟا )ﺔﺳرﺎﻤﻣ ﺔﻴﻣﻼﺳإ ﺔﻴﺣور ﺔﻴﺟﻼﻋ ( باﺮﻄﺿا ﺾﻔ ﻴﻤﻜﺗ ﻼﻋ ﻨﻛ
ﻊﻠﻟا .ةﺪﺣاﻮﻟا ﺔﻟﺎا ﻢﻴﻤﺼﺗ ﺔﺳارﺪﻟا ﺖﻣﺪﺨﺘﺳا A-B-A ' ةﺪﺣاو ﺔﻟﺎﺣ ﻊﻣ) ﺎﺮﻤﻋ24 ﺎ ًﻣﺎﻋ (تﺎﻧﺎﺤﺘﻣ ءﺎﻨﺛأ ﻊﻠ تﺎﻮﻧ ﻦﻣ ﻲﺎﻌ . ﻢﺗ
ﻞﺧﺪﺘﻟا ﺪﻌو ﻞﺒﻗ ﺔﻴﻓاﻮا رﺎﻓﻸﻟ ﺲﻠﺒﻣﺎﺷ نﺎﻴﺘﺳاو ﺔﺣﻮﺘﻔﳌا ﻦﻛﺎﻣ فاﻮﺧو ﻊﻠﻠﻟ ﻮﻟﺪﻧﺎﺑ سﺎﻴﻘﻣ ماﺪﺨﺘﺳﺎﺑ تﺎﻤﻴﻴﻘﺘﻟا ءاﺮﺟإ
ﺔﻴﻗﺮﻟﺎﺑﻚﻟذو ،ﺔﻴﻋﺮﺸﻟا ةﺪﳌ7 ﻊﻴﺑﺎﺳأ)5 تﺎﺴﻠﺟ .(ﻴﻗﺮﻟا نﺑ ﻞﺧﺪﺘﻟا ﻊﻤﺟ ضﺮﻌﺘﻟا تﺎﻴﻨﻘﺗو ﺔﻴﻋﺮﺸﻟا ﺔﻴﺨﺘﻟا . ﺮﻇأت ﺪﻌ ﺞﺋﺎﺘﻨﻟا
ﻞﺧﺪﺘﻟا:
- ﻦﻣ ﻊﻠﻟا ضاﺮﻋأ ضﺎﻔﺨﻧا66.66 إ ٪16.66٪
- ﻦﻣ اﻮا ﺐﻨﺠﺘﻟا ضﺎﻔﺨﻧا75 إ ٪37.5٪
- ﻦﻣ ﻊﻗﻮﺘﳌا ﻖﻠﻘﻟا ﻦﺴﺤﺗ62.5 إ ٪12.5٪
- ﻞﻤﻌﻟﺎﺑ ﺔﻘﻠﻌﺘﳌا ﻞﺎﺸﳌا ضﺎﻔﺨﻧا/ ﻦﻣ ﺔﻠﺋﺎﻌﻟا62.5 إ ٪25٪
- ضﺎﻔﺨﻧا ﻦﻣ ﺼﻟا ﻖﻠﻘﻟا50 إ ٪12.5٪
- ﻦﻣ ﺔﻴﻓاﻮا رﺎﻓ مﺎﻋ ضﺎﻔﺨﻧا60 إ ٪24.28٪
ﻮﻳءاﺮﺟﺈﺑ نﺎﺜﺣﺎﺒﻟا تﺎﻨﻴﻋ ﻊﻣ تﺎﺳارﺪﻟا ﻦﻣ ﺪﺰﳌا،ﻛأ ﺔﻤﺋﺎﻘﻟا تﺎﺟﻼﻌﻟا ﻊﻣ ﺔﻴﻋﺮﺸﻟا ﺔﻴﻗﺮﻟا ﺞﻣﺪﺗ ﺔﻴﻠﻣﺎﺗ ﺔﻴﺟﻼﻋ جذﺎﻤﻧ ﺮﻮﻄﺗو
ا ﻋ ﺪﻴﻛﺄﺘﻟا ﻊﻣ ،ﻲﻮﻠﺴﻟا ﺮﻌﳌا جﻼﻌﻟا ﻞﺜﻣ ﺔﻟد ﻋنﻴﻳﺪﻟا نﺎﻌﳌاو ﺔﻴﺴﻔﻨﻟا ﺔﻟا ﺼﺨﺘﻣ نﺑ نوﺎﻌﺘﻟ.
ﺔﻴﺣﺎﺘﻔﳌا تﺎﻤﻠﻟا :ﺔﻴﻋﺮﺸﻟا ﺔﻴﻗﺮﻟا ،ﻼﻌﻟا رﺎﺴﳌا ،ﻳﺪﻟا جﻼﻌﻟا ،ﻊﻠﻟا ﺔﻮﻧ باﺮﻄﺿا.
Journal of research and human studies
Issue 18 N°02 year 2024 p p. 131-155
ISSN : 1112-8151 EISSN : 2588-2317
A New Perspective on Therapeutic Itineraries for Anxiety Management
"A Single Case Formulation of the Effectiveness of Islamic Ruqyah in
Reducing Panic Attacks"
- 132 -
1. Introduction
Panic Disorder is a common mental illness that significantly affects an
individual’s life and ability to perform daily tasks. The Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5), characterizes this disorder
by recurrent and unexpected episodes of intense fear and distress, accompanied
by severe physical and psychological symptoms (American Psychiatric
Association, 2013). With increasing interest in integrative approaches to mental
health, and consideration of the central role of Islam in Muslim society
worldwide, alternative therapeutic approaches that acknowledge and provide for
patients’ spiritual and cultural contexts are being sought an approach that makes
it so spiritually sensitive to psychotherapy that these demographic issues have
become important. In this context, Ruqyah, a form of religious healing derived
from Islamic heritage, is gaining popularity in some communities as a potential
way to reduce anxiety symptoms and fear.
A review of the scientific literature reveals a notable knowledge gap in three key
aspects of this technique. These aspects encompass its therapeutic efficacy, the
underlying psychophysiological mechanisms through which it operates, and the
feasibility of its integration into contemporary therapeutic approaches.
Despite these research gaps, preliminary findings from recent studies offer
promising prospects. The available research indicates significant potential for
this therapeutic modality, opening new horizons in the treatment field.
Razali et al. (2002), found in a study on a sample of Muslim patients with
Generalized Anxiety Disorder, that religious and culturally sensitive
psychotherapy led to rapid improvements in anxiety symptoms among Muslim
patients, with strong religious beliefs.
Furthermore, existing research highlights the potential psychological and
physiological benefits of Quranic recitation and Islamic spiritual practices. For
instance, Nazir (2023) indicates that Quran recitation can alter physiological
parameters within the cardiovascular and respiratory systems ,and the
psychological function is enhanced by reducing stress levels,anxiety, depression,
or other emotional disorders..
Araqsousi (1992) emphasizes the effect of relaxation and religious Ruqyah in
treating hypertension, with a 60% improvement rate among individuals in the
sample, reaching 87.11% when Ruqyah is combined with relaxation techniques.
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Farid Nafir / Slimane Boumediene
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Similarly, Hilsa's (2008) study, "The effect of psychotherapy by the Quran on
reducing the level of depression among depressed patients," utilized the Beck
Depression Inventory translated by Dr. Abdulkhaleq (1996). The researcher
conducted pre and post-tests for each case, then applied six therapeutic sessions
lasting one hour each, incorporating Quranic verses reading and Ruqyah. The
study demonstrated a significant decrease in the arithmetic mean in the post-test
compared to the pre-test. The difference between the arithmetic means of the pre
and post-tests was statistically significant. The efficacy of this approach was
also supported by the study of Noureddine Za'tar (2016), who developed a
multidimensional behavioral therapy program with religious content to reduce
depression.
Further supporting a potential link between Islamic practices and stress
reduction, Aziz et al. (2019) suggest that listening to the Quran can be a
complementary method for reducing stress responses in intensive care patients.
Therefore, based on these aforementioned studies, this research aims to analyze
the efficacy of Ruqyah and its impact on panic attacks, focusing on the
theoretical underpinnings and available empirical evidence. We also aspire to
explore how to integrate this approach into modern therapeutic pathways
scientifically, methodically, and evidence-based.
2. Conceptual Framework :
2.1. Theoretical Framework of Panic Disorder: A Multidimensional Model
2.1.1 Concept and Diagnosis:
Panic disorder is defined according to globally recognized classifications
through two main sources:
1) DSM-5-TR Criteria:
A panic attack is an abrupt surge of intense fear or intense discomfort that
reaches a peak within minutes, and during which time four (or more) of the
following symptoms occur;
Note: The abrupt surge can occur from a calm state or an anxious state.
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensations of shortness of breath or smothering.
5. Feelings of choking.
6. Chest pain or discomfort.
A New Perspective on Therapeutic Itineraries for Anxiety Management
"A Single Case Formulation of the Effectiveness of Islamic Ruqyah in
Reducing Panic Attacks"
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7. Nausea or abdominal distress.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Chills or heat sensations.
10. Paresthesias (numbness or tingling sensations).
11. Derealization (feelings of unreality) or depersonalization (being detached
from oneself).
12. Fear of losing control or “going crazy.”
13. Fear of dying.
Diagnosis of Panic Disorder necessitates the presence of recurrent and
unexpected panic attacks, along with at least one month of persistent worry or
concern about having more panic attacks or their consequences, or a significant
maladaptive change in behavior related to the attacks (American Psychiatric
Association, 2013).
* Symptoms not attributable to physiological effects of substances or other
medical conditions.
2) ICD-11 Criteria (WHO, 2022):
- Recurrent episodes of intense anxiety (panic)
- Occur in predictable or unpredictable situations
- Include four or more specified symptoms
2.1.2 Theoretical Explanatory Models:
a) Neurobiological Model:
Recent research by Liberzon and Abelson (2016), published in Nature Reviews
Neuroscience, revealed that anxiety disorders stem from disruptions in neural
networks that modulate fear and anxiety responses. These findings, supported by
neuroimaging evidence from Shin and Liberzon's (2010) research, highlight the
neurobiological basis of anxiety disorders.
1) Neurotransmitter Dysregulation: (Graeff & Del-Ben, 2023)
1. Serotonergic Mechanism:
5-HT enhances inhibitory avoidance in the forebrain
5-HT inhibits one-way escape in the midbrain PAG
2. Behavioral Correlations:
- Inhibitory avoidance and anticipatory anxiety are associated with GAD
- Escape behavior is associated with Panic Disorder (PD)
3. Endocrinological Findings:
- HPA axis is activated during anticipatory anxiety
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Farid Nafir / Slimane Boumediene
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- HPA axis is not activated during panic attacks
4. Functional Neuroimaging Results:
- During panic attacks:
* Activation of the insula
* Activation of upper brain stem (including PAG)
* Deactivation of the anterior cingulate cortex (ACC)
5. Morphometric Analysis Results:
- Panic patients compared to healthy controls show:
* Increased grey matter volume in the insula
* Increased grey matter volume in upper brain stem
* Decreased grey matter volume in ACC
6. Neural Substrates of Interoception:
- Insula and ACC translate interoceptive stimulation into feeling
- Panic patients demonstrate interoceptive supersensitivity
- These regions are potential sites of action for:
* Drug therapy
* Cognitive Behavioral Therapy (CBT)
7. Pharmacological Mechanism:
- Antidepressants prevent panic attacks by enhancing 5-HT inhibition in the
PAG.
b) Cognitive-Behavioral Model:
Main components according to Clark & Beck's (2023) updated model:
1) Core Cognitive Beliefs:
- Danger beliefs (87% of patients)
- Catastrophic expectations (92% of patients)
2) Disorder Maintenance Cycle:
- Misinterpretation of bodily signals
- Avoidance behaviors
- Self-reinforcing anxiety
2.1.3.Recovery and Healing Criteria:
a) Quantitative Recovery Indicators:
According to Barlow et al.'s (2000) longitudinal study, core criteria include:
1. Reduction in Attack Frequency:
- Less than two attacks per month
- Attack duration less than 10 minutes
A New Perspective on Therapeutic Itineraries for Anxiety Management
"A Single Case Formulation of the Effectiveness of Islamic Ruqyah in
Reducing Panic Attacks"
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2. Functional Improvement:
- 70% improvement on PDSS scale
- 85% return to functional performance
b) Qualitative Recovery Indicators:
According to a qualitative study by Hofmann & Smits (2022):
1.Improvement Indicators:
- Ability to manage anxiety
- Restoration of self-confidence
- Improved quality of life
2.Stability Criteria:
- Sustained improvement for 6 months
- Ability to face anxiety-provoking situations
- Reduction in avoidance behaviors
2.1.4.Diagnostic and Assessment Criteria:
According to the American Psychiatric Association (2023):
- Use of objective assessment measures
- Documentation of physical and psychological symptoms
- Tracking improvement using standardized measurement tools.
2.2. Islamic Ruqyah:
2.2.1 Religious Concept:
Ruqyah is defined as the recitation of Quranic verses and prophetic
supplications with the intention of healing and treatment. It is a form of Islamic
religious therapy involving specific Quranic recitations and prayers aimed at
healing physical and psychological ailments (Eneborg, 2013). The practice of
Ruqyah is based on religious texts indicating the Quran's healing power, such as
the verse: "And We send down of the Quran that which is healing and mercy for
the believers" (Quran 17:82).
Al-Qarafi stated in Al-Furuq: "(The Ninth Truth) Ruqyah consists of specific
phrases that result in healing from illnesses, diseases, and fatal causes" (Al-
Qarafi, n.d.). Al-Bayhaqi reported from Talha bin Musarrif that it was said:
when the Quran is recited near a sick person, they find relief (Al-Bayhaqi,
2003).
According to Keshavarzi & Haque (2013), Islamic Ruqyah relies on the concept
of spiritual healing and aims to strengthen the connection between the individual
and God, potentially contributing to improved mental and physical health.
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Farid Nafir / Slimane Boumediene
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2.2.2.Psychological and Physiological Effects of recitation of Quranic
verses(Murottal): Peer-Reviewed Clinical Studies(Experimental Results):
Murottal represents a systematic methodology of Quranic recitation that
adheres to precise phonological and prosodic principles. This form of sacred
textual delivery incorporates meticulous attention to pronunciation (tajwid),
rhythmic patterns, and melodic elements while maintaining the integrity of the
Quranic text. Research indicates that engagement with such precisely rendered
Quranic verses can facilitate psychological tranquility and emotional
equilibrium in listeners. The therapeutic potential of murottal lies in its unique
combination of linguistic precision, rhythmic consistency, and spiritual
significance, which collectively contribute to its capacity to induce states of
calmness and mental composure
A systematic literature review revealed statistically significant disparities in
anxiety and depression levels among coronary heart disease patients, comparing
baseline and post-intervention measurements utilizing Murottal therapy. The
analysis encompassed the intervention's effects on clinical outcomes and
mortality rates, demonstrating meaningful statistical differences across multiple
parameters.
As Wisuda et al. (2024) eloquently establish in their groundbreaking systematic
review, "Islamic spiritual care with Murottal represents a significant
advancement in holistic patient care approaches for cardiovascular conditions".
This comprehensive analysis delves into the intersection of traditional Islamic
practices and modern healthcare interventions, with particular emphasis on
clinical settings where spiritual care integration has gained increasing attention
in recent years. As noted by Wisuda et al. (2024), "The application of Murottal,
the melodic recitation of Quranic verses, presents a unique therapeutic approach
that bridges religious practice with clinical care". This innovative intervention
addresses both the psychological and physiological dimensions of patient care,
marking a significant development in holistic healthcare approaches.
The research demonstrates significant improvements in patient outcomes across
multiple dimensions:
a) Anxiety Reduction
As Wisuda et al. (2024) report, "The implementation of Murottal therapy
showed statistically significant reductions in anxiety levels among coronary
heart disease patients" (p. 3). This finding supports the integration of spiritual
care in cardiovascular treatment protocols.
b) Depression Management
"The systematic application of Islamic spiritual care demonstrated
measurable improvements in depression scores" (Wisuda et al., 2024, p. 4),
indicating the therapeutic value of this intervention in managing
psychological comorbidities.
A New Perspective on Therapeutic Itineraries for Anxiety Management
"A Single Case Formulation of the Effectiveness of Islamic Ruqyah in
Reducing Panic Attacks"
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c) Physiological Response
The authors note that "patients receiving Murottal therapy showed improved
vital signs and reduced stress markers" (Wisuda et al., 2024, p. 5), suggesting
a direct physiological benefit from the intervention.
d) Discussion and Implications
This research contributes significantly to our understanding of integrative
healthcare approaches. As highlighted by Wisuda et al. (2024), "The
intersection of spiritual care and conventional medical treatment offers a
promising pathway for enhanced patient outcomes" (p. 6).
e) Clinical Practice Recommendations
The study suggests several key implementation strategies:
Structured integration of Murottal sessions
Standardized delivery protocols
Cultural competency training for healthcare providers
Regular assessment of patient response
This comprehensive review establishes a strong foundation for the continued
development and implementation of spiritually-informed healthcare
interventions.
3. Integration of Traditional and Modern Therapeutic Models: Theoretical and
Empirical Evidence
3.1. Theoretical Basis for Therapeutic Integration
Koenig (2009) presented an integrated theoretical framework explaining the
relationship between religious practices and mental health, indicating:
- Psychological impact mechanisms of religious practices
- Role of beliefs in shaping therapeutic responses
- Importance of integrating psychological and religious therapy
3.2. Cultural and Social Foundation
Lewis-Fernández & Kleinman (1994) emphasized:
- Importance of understanding the cultural context of psychological disorders
- Role of beliefs in shaping illness experience
- Importance of adapting treatment to cultural context
Nortje et al. (2016) presented a systematic analysis showing the role of
traditional therapy:
- Effectiveness of traditional and religious healers
- Importance of integrating traditional practices into healthcare systems
- Community role in supporting treatment
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3.3. Clinical Empirical Evidence on Integration Effectiveness
a) Razali et al. (2002) found that culturally and religiously compatible
psychotherapy led to:
- Rapid improvement in anxiety symptoms
- Increased treatment compliance rates
- Improved long-term therapeutic outcomes
b) Faridah (2015) found that :
By listening to the noble verses of the Koran, the vibrations of the neurons
will return to stability and even perform their principal functions well
c) Based on Weber & Pargament's (2014) study, mechanisms were identified
as:
1. Integration of Religion/Spirituality in Psychiatric Treatment:
- Must align with patients' values
- Should enhance treatment outcomes
- Already implemented in various programs
2. Benefits Reported from Spiritual Programs:
- Increased practice of:
* Forgiveness
* Gratitude
* Compassion
* Acceptance
- Reduced:
* Negative thinking
* Ego-centricity
* Judgmental attitudes
- Improved:
* Self-esteem
* Mood
* Mental clarity
* Relationships
* Anxiety and depression symptoms
3. Evidence-Based Results:
- Nondenominational spiritual interventions showed higher efficacy for GAD
- Spiritual group treatment reduced PTSD symptoms in military trauma
survivors
A New Perspective on Therapeutic Itineraries for Anxiety Management
"A Single Case Formulation of the Effectiveness of Islamic Ruqyah in
Reducing Panic Attacks"
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- Los Angeles County implementation (2012):
* 98% of wellness centers offered spiritual activities
* One-third provided spirituality focus groups
4. Religion-Specific Therapeutic Approaches:
- Christian CBT proved superior to conventional CBT
- Muslim-based psychotherapy showed better results when combined with:
* Prayer
* Quran reading
- Bible use helpful for addressing religious doubts
5. Enhanced Therapeutic Methods:
- Mindfulness interventions improved with spiritual components
- Religious incorporation in treatment led to:
* Better stress and worry management
* Higher patient satisfaction rates
d) Za'tar (2016) proposed implementation mechanisms through:
- Integration of behavioral and cognitive elements
- Integration of religious content
- Application of multidimensional therapeutic techniques
So murattal Al-Quran therapy is more effective in reducing anxiety compared to
other therapies so that it can be applied as a complementary therapy to reduce
anxiety (Atmaja & Saputra, 2020)
4. Methodology:
4.1. Study Design:
This study employed a single-case design, known as A-B-A' design where;
• A: Baseline Phase (Pre-Intervention): Consistently measuring the target
behavior (severity of panic attacks and related symptoms) without intervention.
• B: Intervention Phase: The Ruqyah intervention was introduced and
implemented.
• A': Follow-Up Phase (Post-Intervention): Measuring the same behavior after
the intervention to examine changes and treatment effects.
This method is one of single-subject research designs that offer a chance for
establishing the consequences of an intervention on an individual. Through
evaluating their behavior before, during and after intervention, individuals
become their own control. A-B-A' designs are commonly used in clinical
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practice, special education, and behavioral research to evaluate the effectiveness
of interventions and treatments.
4.2. Study Limitations :
• Spatial and Temporal Boundaries: The study was done at the researcher’s
private center which is specialized in Ruqyah practice, it took place within a
duration of seven weeks starting from March 31, 2022 to May 12, 2022 then
followed by another session three weeks later.
• Single-Case Design: However useful for exploratory purposes these designs
may not be applicable to larger populations without further research.
4.3. Study Instruments :
a) Bandelow's Panic and Agoraphobia Scale (1995): This test was
invented by B. Bandelow and it examines the severity of panic disorder
and Agoraphobia through the use of 14 questions that each have a scale
ranging from zero to four. The test measures five core domains relating
to these disorders:
- Panic attack symptoms (12 symptoms)
- Phobic avoidance behavior (items 6, 7, and 8)
- Anticipatory anxiety (items 9 and 10)
- Work and family-related problems (items 11 and 12)
- Health anxiety (items13and14)
1. Translation & Validation: Belghalem Mohamed translated this scale from
French into Arabic during the period of 2016-2017 adjusting it for
Algerian population with strong psychometric properties presenting
high validity rate =0.78 ,test-retest reliability=0.73,Cronbach’s alpha
=0.89,content validity=94%.
2. Scoring: Each item is rated on a scale of 0-4, reflecting the extent,
severity, duration, frequency, anticipation, importance and difficulty of
symptoms. The test continues with items 1 (panic symptoms) and 7
(agoraphobic situations), but they are not considered for the total score.
The highest score attainable is 48 while the lowest possible score is
zero.
b) Chambless Phobic Thoughts Questionnaire (1984): This questionnaire
was created by D.L. Chambless in order to evaluate the intensity of
irrational negative thoughts associated with fear and anxiety. It consists
A New Perspective on Therapeutic Itineraries for Anxiety Management
"A Single Case Formulation of the Effectiveness of Islamic Ruqyah in
Reducing Panic Attacks"
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of fourteen items that are rated on a five-point scale ranging from one to
five and measures two primary dimensions:
- Behavioral/social fears related phobic thoughts (items 6,8,9,11,12,13&14)
- Physical sensations related phobic thoughts (items 1,2,3,,5,,7 &10)
1. Translation and Validation: The questionnaire was translated from Canadian
French into Arabic by Belghalem Mohamed (2016-2017) and it has shown
high levels of psychometrics measurements such as – high content validity,
test-retest reliability = 0.86 after six days and 0.75 after 30 days, Cronbach’s
alpha = 0.80 and a strong correlation with panic/agoraphobia scales.
2. Scoring: Each item uses a five-point rating scale ranging from “Never,”
“Rarely,” “Sometimes,” “Frequently,” and “Always” to indicate the
frequency of thoughts. Total scores for the scale range between 14 and 70,
while behavioral/social fears score between 6 and 30, physical sensations
fear between 8-40.
4.4. Study Procedures:
The intervention program included seven sessions held at an interval of five
days each session took about forty-five to sixty minutes.
A. Baseline Phase (A) :
a) Initial Interview: Information gathering and getting to know each other.
b) Bandelow (1995) and Chambless (1984) questionnaires were administered
at the close of the first interview.
c) Second Interview: Information about Panic Disorder, Agoraphobia and
Ruqyah
B. Intervention Phase (B) :
1. Ruqyah program was implemented for five sessions, at an interval of 5 days
between each session and lasted for 45-60 minutes per session.
2. Imaginal Exposure: During every session, the patient is directed to imagine
entering into an examination room while recording anxiety levels on a scale
of one to ten. Imaginal exposure is combined with a recitation of “soothing
verses” by the ruqyah practitioner as well as invocations.
3. Homework: Assigned activities included recording level of anxiety-
provoking situations in a dedicated notebook and listening repeatedly to
soothing verses recorded earlier during session six.
C. Follow-Up Phase (A'):
1. Post-Test Questionnaires: Administration of post-test questionnaires.
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2. Follow-up Session : Conducted three weeks after the intervention
phase.
3. Regular follow-up by a general practitioner, psychiatrist, and
neurologist to verify the results
4.5.Case Presentation: Ms. R.
Age : 24 years old
Education Level: A student at a university
Sibling Rank: Third born and last child
Presenting Problem: Fearful feelings, Panic attacks during exams,
characterized by abdominal pain, heart palpitations, trembling, sweating,
intense fear of failure, feelings of emptiness, inability to recall
information and nausea leading to exam avoidance.
Interview Summary:
Ms. R. was accompanied by her mother who said that she had been experiencing
panic attack since she was in middle school during examinations period. Ms.R
appeared neat and composed though with an introverted personality. She
narrated how she feels bodily sensations so strong as to make her leave
examination room without completing it on several occasions despite being
good academically.She also indicated having excellent academic performance
apart from this situation.She mentioned good relations with family as well as a
small circle of close friends.There is no family history of mental
illness.Otherwise medical history is noncontributory
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4.6. Pre-Test and Post-Test Results for Ms. R.:
4.6.1..Pre-Test Measures:
After the initial assessment through the first interview, Ms. R.'s responses to the
Bandelow Panic and Agoraphobia Scale were as follows in Table 1.:
Table 1.
Dimension Symptoms (Score)
Panic Attack Symptoms Axis 8/12 (66.66%)
Phobic Avoidance Behavior Axis 6/8 (75%)
Anticipatory Anxiety Axis 5/8 (62.5%)
Work and Family-Related Problems Axis
5/8 (62.5%)
Health Anxiety Axis 4/8 (50%)
Total Score 29/48 (60.41%)
Notes: 14 out of 14 panic attack symptoms were reported. Avoidance of
phobic situations: 6 out of 24 situations. Panic attack severity: 9/16
(56.25%).
Her scores on the Chambless Phobic Thoughts Questionnaire were as follows in
Table 2.
Dimension Score
Behavioral and Social Fears 24/30 (80%)
Fears Related to Physical State
18/40 (45%)
Global Score 42/70 (60%)
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4.6.2. Post-Test Measures:
After the Ruqyah intervention and at the end of the seventh session, Ms. R.'s
responses on the Bandelow Panic and Agoraphobia Scale were as follows in
Table3:
Table 3.
Dimension Symptoms (Score)
Panic Attack Symptoms Axis 2/12 (16.66%)
Phobic Avoidance Behavior Axis 3/8 (37.5%)
Anticipatory Anxiety Axis 1/8 (12.5%)
Work and Family-Related Problems Axis
2/8 (25%)
Health Anxiety Axis 1/8 (12.5%)
Total Score 12/48 (25%)
Notes: 10 out of 14 panic attack symptoms were reported. Avoidance of
phobic situations: 2 out of 24 situations. Panic attack severity: 5/16
(31.25%).
Her scores on the Chambless Phobic Thoughts Questionnaire were as follows in
Table4:
Table 4
Dimension Score
Behavioral and Social Fears 9/30 (30%)
Fears Related to Physical State
8/40 (20%)
Global Score 17/70 (24.28%)
4.6.3.Results:
a) Bandelow Panic and Agoraphobia Scale: The number of symptoms reported
reduced from 14 to 10. The number of avoided phobic situations decreased
from 6 to 2. This is clear improvement across all dimensions upon the scale
which comprises:
-Symptoms of panic attack Axis decreased from 66.66% to 16.66%.
-Phobic avoidance behavior Axis decreased from 75% to 37.5%.
-Anticipatory anxiety Axis fell down from 62.5%to12.5%.
-Family and work problem axis went down by more than half from 62.5% to
25%
-Fears about health axis dropped by half, decreasing from 50% to12.5%.
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b) Chambless Phobic Thoughts Questionnaire: There was a significant
reduction in phobic thoughts indicated by a decrease in the total score from
42 to 17.
Fig.1: A graph showing the comparison between the results of pre-test and post-
test measurements on the Panic and Agoraphobia Scale by B. Bandelow 1995
Fig.2: A graph showing the comparison between the results of pre-test and post-
test measurements on the Agoraphobic Cognitions Questionnaire by Chambless,
D.L. 1984
2
3
4
3 3
5
1
4
2
3
1
3
4
5
1111111
2
1
2
1
2
1 1
1
2
3
4
5
6
Chambless scale
5.Initial Interview Analysis and Pre-Test Results:
The initial interview and pre-test results revealed that Ms. R. presented
with severe panic disorder, demonstrating symptoms that align with current
diagnostic criteria (American Psychiatric Association, 2022). Her score on the
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Bandelow Panic and Agoraphobia Scale measured 29/48 (60.41%), with all
characteristic symptoms present. This elevated score is particularly significant
given the established reliability of standardized assessment tools in anxiety
disorder diagnosis (Bandelow et al., 2017).
The Panic Attack Symptoms Axis score of 6/12 confirmed the presence
of multiple panic symptoms necessary for diagnosis according to current clinical
standards (World Health Organization, 2022). The interview findings
demonstrated significant functional impairment across academic and social
domains, with Ms. R. exhibiting marked difficulty in academic engagement due
to anticipatory anxiety about potential panic episodes. This presentation aligns
with the fear-conditioning model proposed by Bouton et al. (2001), wherein
initial panic experiences establish robust associations between fear responses
and internal sensations or environmental triggers.
The documented avoidance patterns (scoring 6 out of 24 on the avoidance
subscale) represent a classic defensive mechanism in panic disorder. While this
avoidance temporarily reduces anxiety, it ultimately reinforces the cycle of fear
and avoidance behaviors. This phenomenon is well-explained by Clark's
cognitive model (1986), which posits that panic attacks result from catastrophic
misinterpretation of bodily sensations. The maintenance of these patterns
through avoidance behavior has been thoroughly documented by Clark and
Ehlers (1993), who demonstrated how avoidance prevents the disconfirmation
of catastrophic beliefs.
Ms. R.'s pre-existing personality characteristics, notably shyness and
introversion with limited social connections, suggest potential predisposition to
anxiety disorders. The high anticipatory anxiety score (62.5% on the Bandelow
scale) corroborates recent findings by Kim et al. (2021) regarding the significant
impact of panic symptoms on daily functioning and quality of life. This is
further evidenced by her elevated score (62.5%) on Work and Family-Related
Problems, consistent with epidemiological studies showing widespread
functional impairment in panic disorder patients (Kessler et al., 2006).
The assessment revealed substantial impact on both physical and mental
health domains, aligning with current understanding of panic disorder's
pervasive effects on overall functioning (Craske & Barlow, 2014). Moreover, the
findings support the growing recognition of panic disorder as a condition with
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significant implications for occupational and social functioning, extending
beyond mere symptom presentation to affect multiple life domains (Clark &
Beck, 2023).
The comprehensive nature of Ms. R.'s symptoms and their impact on
daily functioning underscores the importance of considering both psychological
and physiological aspects in assessment and treatment planning. This holistic
approach is supported by current neurobiological research (Graeff & Del-Ben,
2008) and contemporary cognitive-behavioral conceptualizations of panic
disorder (Hofmann & Smits, 2008).
6.Study Results Analysis and Connections to Prior Research and Theoretical
Approaches:
Comparing the pre- and post-intervention surveys, along with the interview data,
significant improvements were observed in Ms. R's condition following the
Ruqyah intervention program. The analysis can be structured as follows:
a) Reduction in Panic Symptom Severity:
1. Measurement results:
- Decrease in Bandelow Panic and Agoraphobia Scale scores from 60.41%
to 25%
- Reduction in reported symptoms from 14 to 10
- Panic symptoms decreased by 66.66% to 16.66%.
2. Interview Results Interpretation: Ms. R initially experienced severe
physiological symptoms including abdominal pain, palpitations, and
tremors. Post-Ruqyah intervention, a significant reduction in these
physical manifestations was observed, indicating Ruqyah's positive impact
on physiological anxiety responses. This aligns with recent findings by
Nazir (2023) regarding the physiological benefits of Quranic recitation
therapy..
3. Theoretical Framework and Research Connections:
- Cognitive interpretation: The symptom reduction aligns with Clark's
cognitive model (1986), which emphasizes the role of cognitive
reinterpretation of bodily sensations. Ms. R's shift in perceiving
examinations as challenges rather than threats corresponds with the
decrease in anticipatory anxiety from 62.5% to 12.5%.
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- Physiological Basis: Recent research by Aziz et al. (2019) demonstrates
that Quranic listening can positively influence physiological stress
responses. This is supported by traditional findings on religious Ruqyah's
effectiveness (Eneborg, 2013).
b) Reduction in Avoidance Behavior:
1. Measurement results: Agoraphobic avoidance behavior decreased from 75%
to 37.5%.
2. Interview Analysis: Ms. R reported significant reduction in situation
avoidance, showing increased willingness to engage in previously anxiety-
provoking scenarios. This improvement aligns with findings from Razali et
al. (2002) on religious-cultural psychotherapy's effectiveness.
3. Theoretical and Research Integration:
- Cognitive-Behavioral Framework: The results support Clark and Ehlers'
(1993) model suggesting that reducing avoidance breaks the maintenance
cycle of panic disorder.
- Treatment Effectiveness: These outcomes align with Hofmann and Smits'
(2008) meta-analysis on cognitive-behavioral interventions' efficacy in
treating anxiety disorders..
c) Quality of Life Enhancement:
1. Measurement Results:
- Work/family-related problems reduced from 62.5% to 25%
- Health anxiety decreased from 50% to 12.5%
2. Interview-Based Analysis: Ms. R demonstrated marked improvement in
academic performance and social relationships, consistent with findings by
Kim et al. (2021) on functional improvement in panic disorder patients..
3. Theoretical Framework Integration:
- The improvements align with current understanding of panic disorder's
impact on daily functioning (Craske & Barlow, 2014)
- These outcomes support research by Telch et al. (1995) on treatment
impact on quality of life in panic disorder patients
- The results validate the effectiveness of culturally integrated approaches
(Keshavarzi & Haque, 2013).
The overall improvement pattern demonstrates the effectiveness of integrating
traditional Islamic healing practices with contemporary psychological
approaches. This integration is supported by recent research on the benefits of
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incorporating spiritual and religious elements in mental health treatment
(Koenig, 2009). The significant reduction in both physiological and
psychological symptoms suggests that Ruqyah intervention, when properly
implemented, can contribute to comprehensive therapeutic outcomes in treating
panic disorder. These findings are particularly relevant in cultural contexts
where traditional healing practices are valued alongside modern psychological
interventions (Lewis-Fernández & Kleinman, 1994).
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Conclusion and Recommendations:
The results of this single-case study indicate promising potential for Islamic
Ruqyah as a complementary approach in reducing panic attack symptoms,
particularly for patients who place significant importance on spiritual and
religious aspects in their lives. However, further experimental research is still
needed to confirm the effectiveness of this approach and better understand its
mechanisms.
Based on these findings, we present the following recommendations:
a) In-Depth Research
Future studies should focus on identifying specific factors determining the
psychological and physiological effects of Ruqyah through:
- Ensuring standardized implementation of Ruqyah procedures
- Utilizing more precise measurement tools for objective assessment of changes
in symptoms, thoughts, and behavior
- Conducting similar studies with larger case numbers to enhance result validity
and generalizability
- Implementing Multiple Baseline Design to evaluate Ruqyah's effectiveness
across diverse individuals with panic disorder
b) Medical Collaboration
It is essential to form therapeutic teams incorporating psychiatrists and qualified
Ruqyah practitioners to:
- Conduct more complex studies
- Provide integrated treatment for patients who prefer religious therapeutic
approaches
c) Intervention Diversity
Future studies should evaluate Ruqyah's effectiveness when integrated with
other techniques such as:
- Meditation
- Relaxation techniques
- Cognitive Behavioral Therapy
This integration would help determine whether combined approaches contribute
to enhanced outcomes.
in Summary This quasi-experimental study provides preliminary evidence for
the effectiveness of Islamic Ruqyah in reducing panic attacks. Through the
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single-case formulation design, we were able to document positive changes in
panic symptoms and phobic cognitions in the case study.
Ultimately, this study emphasizes the importance of viewing mental health from
a comprehensive perspective that considers the individual's biological,
psychological, social, and spiritual aspects. It also opens the door for further
research in the field of therapeutic interventions inspired by different cultures
and traditions, potentially leading to the development of more effective and
culturally appropriate therapeutic approaches for diverse cultural and social
groups.
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