Between September 2005 and May 2008 in Vicksburg, Mississippi, retired pediatrician Peter Boelens helped people with depression. But he didn't use medicine; he claimed that his cure was prayer. For one hour a week for six weeks, 27 men and women engaged in person-to-person prayer sessions during which they prayed with a Christian minister without making any physical contact. They prayed for forgiveness, and they prayed for god to heal their stresses.
Everyone in the study met the DSM criteria for depressive disorder, and many of them had anxiety too. At the end of six weeks, their self-reported scores on the Hamilton Rating Scales for Depression and Anxiety had all gone down. They also showed increases on a "Life Orientation Test" that tests for optimism and a "Daily Spiritual Experiences Scale," compared to a control group who received no intervention at all.
One year later, when Boelens followed up, the prayer group had maintained their mental health. "You release all the feelings and the emotions," he says. "You dump them out at the foot of the cross and dust them off, and the blood of Jesus washes them away." Last year, Boelens repeated his experiment, wanting to know more. He teamed up with a Baylor College of Medicine neuroscientist Ramiro Salas to see what the brains of the people who prayed were doing.
"I study the brain, not religion," Salas says, when I ask him about the possibility of prayer as a treatment for depression. Salas's work focuses on the mentally ill brain, trying to find ways to predict through imaging what treatments could be most effective. To do that, he designed an experiment for 14 new prayer subjects with depression, all recruited from Houston churches, and asked them to remember their biggest trauma. He scanned them before and after six weeks of prayer with Boelens. Along with their self-reported improvements, Salas found compelling neurological changes: He saw more activity in the prefrontal areas of the brain when he asked them to think about their trauma. This area of the brain is thought to regulate cognitive control, suggesting that "whatever happened during prayer allowed the patient to actually have better cognitive control over their emotions," Salas says.
The precuneus, a region which has been associated with introspection, was less activated when the group was asked to think about their trauma. "What that might mean is that, after prayer, they're feeling that these feelings are not really who they are, they don't define them anymore," Salas says. There are a lot of caveats to their study, Salas says. They only looked at 14 people. The sample group was biased, because they were all recruited from churches, so they were likely to be Christian already. Boelens, Salas says, is a very likeable and charismatic person. "One of my questions is: Is this a Peter-specific effect?' Salas says. "If Peter says after six weeks, 'Do you feel better?' and you really like Peter, you're going to tell him, 'Yes Peter, I feel better.'"
Salas says they need to repeat the study, and have people pray with someone else, test other religions, and a variety of degree of beliefs. "There's so many things we should do," he says. "Basically, the experiment we did shows that if you're a Christian, and you're depressed, and you pray with Peter for six weeks, your brain changes, and you claim that you're a lot better. But that's still something that should be studied."
In 2006, British neuroscientists studied the effects on the hippocampus in London bus and taxi drivers as they learned their routes. Bus driving in a major city is a complicated task, and the brain reflected that. They found that there were serial changes in the hippocampus as a result of their growing expertise in negotiating the city.
Richard Sloan, a professor of behavioral medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine, is telling me this story as an example of how anything and everything—driving a bus, learning an instrument, and even prayer or meditation—changes your brain.
"The idea that there's something specific about religious practices that changes your brain is just ridiculous," he says. "Everything changes your brain. Your brain is changing now, as is mine, as we're having this conversation. There's nothing special or magical about engaging in religious practices and showing certain changes in brain structure or function." Almost twenty years ago, Sloan became alarmed at what he thought were overstated claims about the benefits of religious devotion, and began to write papers in The Lancet and the New England Journal of Medicine that examined the empirical evidence and ethics of such studies.
He says that many of the studies—like Boelens'—didn't randomize their subjects or offer proper control groups. (Was prayer effective at treating their depression or could any therapy have helped just as well?) Or, as Salas mentioned, they recruited people from churches, who were likely already prone to prayer and religious belief. Would prayer have worked on a depressed atheist? On a Buddhist? Sloan is wary about the integration of prayer and medicine because he doesn't think that inquiring about religious practices should eat up the limited time patients have with doctors. He thinks it could be a privacy concern if your doctor starts to question your beliefs.
Prayer is such a broad category, that determining its potential health benefits is impossible if researchers don't decide on and study a uniform definition. For example, Boelens's prayers asked for god for relief from trauma and for forgiveness. But for the Jesuits, prayer means something different entirely—they don't believe in prayers of petition, only prayers of praise. How could a study claim that "healing prayer" could heal depression, when prayer means such different things to different people?
To find out more, I spoke with Andrew Newberg, the central figure in a field dedicated to asking just that question: neurotheology. Newberg is the director of research at the Marcus Institute of Integrative Health and a physician at Thomas Jefferson University. His early work looked at the brains of Buddhist monks and since then, he's dedicated his research to the neurophysiology of religion and spiritual practices, like prayer and meditation.
Despite a dose of healthy skepticism, it's hard to ignore the growing body of research dedicated to the neural correlates and potential benefits of these practices, including non-Christian ones, like mindfulness and meditation. Dozens of studies have found changes before and after prayer or meditative activities in the autonomic nervous system, which controls relaxation and arousal, in parasympathetic activity, which can decrease heart rate and blood pressure, metabolism, or respiration. Measurements of hormones and immune function have seen changes in cortisol, noradrenaline, endorphins, sex hormones, and growth hormones. Brain studies have implicated activity changes in the frontal and parietal lobes, the thalamus, limbic system, and brain stem, and show increases in grey and white matter in certain areas of the brain.
Could prayer be somehow changing the brain for the better? Or was Boelens just recording normal brain activity, in the same way that introducing any new practice for six weeks would change your brain in some way? The answer, like most in neuroscience, is not so simple.
It may seem obvious, but it's worth repeating: Brain activity reflects whatever action a person is doing. Newberg says what they see in the brain when people pray is less about the religion associated with the prayer they're doing, and more about what exactly it is they're doing. For example, if a person is repeating the rosary, or meditating on a chant, both involve focus and language centers of the brain, and we can expect those parts to be in use.
There are some generalizations he can make. The frontal lobe and particularly the prefrontal cortex, which help us to concentrate, are very frequently activated in different meditation and prayer practices, where there's a focus of attention, he says. The parietal lobes tend to quiet down, which is the region of the brain that involves our sense of self, and sense of space and time.
Practices that evoke emotions, like the feeling the love of god, or loving-kindness meditation, will activate parts of the reward system in the brain, which has to do with dopamine and serotonin, and can affect the limbic system, the emotional centers of the brain. The other piece of the puzzle is the autonomic nervous system, which regulates our heart rate and blood pressure, and helps us to feel that sense of relaxation, not only in the brain, but in the body. Doing a meditation practice that involves calming ourselves down causes the heart rate to go down, blood pressure to go down, and stress hormones go down.
Even with all that knowledge, he says we don't yet know enough about each kind of practice to start using them therapeutically. "I can't say, oh, you're a 55-year-old who is dealing with cancer, you should do transcendental meditation," he says. "The bottom line is we don't know how to tailor these practices to a given individual yet. We know that many of these practices work. We know that many of these practices affect the brain. They all affect the brain a little bit differently. But we don't know if some work better or worse."
This is where Sloan's argument could rebut: that everything changes the brain, not just spiritual practices. While Newberg agrees that these practices utilize the same basic brain areas that we use to read, talk, and think—he argues that they do so in more complex ways. "It's most likely activating these basic brain areas far more intense ways than what we would see in our normal everyday activities," he says. "It's based on the overall concept that the more you use your brain, the better it functions and the more you stave off aging and dementia. Our brain and our body are meant to be used, and the more we use them, typically, the better off we are."
The reasons why these practices can show benefits has little to do with god, then, and more to do with the fact that you're simply using your brain. Think of it like exercise, Newberg says. It's an overall strengthening of important brain regions, like attention and emotional regulation, that can help other cognitive processes, since they all share the same brain networks. But because it's the logistics of the practice that lead to its benefits, and not necessarily an intrinsic spirituality, Newberg says that also includes meditation and mindfulness—even though meditation practices are secular, the effects on the brain can be quite similar.
"If you're an atheist and you love to do mindfulness meditation, I see no reason why that isn't going to provide the same kinds of health benefits as a Catholic doing the rosary," he says. "In that way, there is a bit of a way of leveling that field."
In 1994, Sara Lazar, a neuroscientist at Massachusetts General Hospital and Harvard Medical School, was training for the Boston Marathon when she injured her knee and back. She tried yoga for physical therapy, and when she began the practice—which included meditation—she started to feel its effects. "I knew it wasn't just exercise, I knew it wasn't just stretching, there was something different about it," she says. "And that got me interested in trying to study it, and I've now been doing that for the past 18 years."
Like Newberg, Lazar's first studies were in long-term meditators. When compared to non-meditators, she found they had distinct differences in the insula, an area involved in integrating sensory and cognitive information and areas in the front of the brain that's involved in cognition, and is the number one region associated with fluid intelligence, or IQ.
The front of the brain result interested her, because of its relationship with aging. "The whole front of the brain shrinks with age, this is well known," she says. "It appeared in this one region that the 50-year-old meditators had the same amount of gray matter as the 25-year-olds." Her further studies have investigated meditation and the treatment of anxiety or depression in people with chronic pain, all finding that mindfulness could alleviate symptoms.
You may not have to be a long-time meditator to reap its rewards. Yi-Yuan Tang, a professor of psychological sciences and presidential endowed chair in neuroscience at Texas Tech University, has put people through five-week meditation training courses, and found improvements in participants' attention and self-regulation, along with changes in white matter in related brain areas. He looked into changes in the body as well, and found that even after only five days of integrative body-mind training, people showed better physiological reactions in heart rate, respiratory amplitude, and skin conductance response (SCR) than a control group. He also found significant decreases in stress hormones measured from blood or saliva samples after the five sessions.
He's previously shown that two weeks of meditation training—just five hours total—could help reduce smoking. (His smokers also showed increased activity for the brain areas related to self-control.) To Lazar, these kinds of results make sense. "What exactly is meditation? People think you're just sitting there spacing out. That's not it at all. It's actually quite the opposite." While there is some variation, most meditation involves focusing on the present moment, focusing on the body, noticing when the mind begins to wander and returning the attention to the breath, a candle, or some other focus point.
Like Newberg, she thinks of it as exercise. Training specific centers of your brain makes them stronger, and can have overall benefits to the body, like stress reduction. "Stress, we know has a huge negative impact on the body," she says. "By reducing stress, reducing cortisol, reducing inflammation, reducing these other negative things that happen from our chronic high stress, there's that benefit." Whether prayer is as effective, she's not sure. Prayer and meditation overlap in many ways, and within those similarities, she says they probably help just the same. For their subtle differences, we don't yet know for sure.
Sloan is cautiously more accepting of the literature on meditation, because the practice is more streamlined. Mindfulness and meditation offer less variability, and so the studies on it are more credible, he says. With meditation, which connects the use of specific parts of the brain to specific benefits, it's easier to return to the oft-used exercise metaphor: "If you exercise something you will increase proficiency at it," Sloan says. "So that makes sense to me."
There is a larger point Sloan has, besides questioning the methodology behind prayer and meditation studies. He's not doing so out of spite or atheism, nor is he denying that religion can serve a beneficial role in many people's lives. Prayer and meditation could be extremely helpful, both to the body and mind. He just thinks it's one of many things that can influence our health and bodies in a positive way, and studying it like it's unique is bad science. If prayer or meditation works for you, great. If there's another way you find to exercise your mind, that's ok too.
From a theological standpoint, Sloan doesn't think religious practices should need science to prove that they "work." "The message that I have always wanted to give, is that people shouldn't be looking to science to validate their religious beliefs," he says. "They should practice religion not because they think that somebody in a laboratory has shown that it benefits some portion of the brain, but rather they should engage in religious practices and beliefs that resonate with them. That's the only reason they need. They don't need to show that it activates the prefrontal cortex."
Salas thinks that his prayer study with Boelens can't and doesn't address any greater religious questions, just human ones. "This has absolutely nothing to do with studying god," he says. "That's something that is super clear to me, but I need to say it all the time. Maybe science will one day be in the position to ask the question whether god exists or not. Right now, we only know that religion exists. That is something I can study."
Another thing the field of neurotheology can offer is the ability to unite those with different beliefs, and the understanding that our brain is dealing with these beliefs in very similar ways. What's most important, Newberg says, is not if you pray, meditate, chant, or go into a trance, but that you do something that has meaning to you.
"One of the things that I have learned through all of this is a very healthy sense of respect and sense of compassion for everybody's belief system," Newberg says. "We all have a very finite, very flawed brain looking out on a virtually infinite universe, and are just hanging on as best as possible to make some sense out of all of this. The fact that we can get out bed in the morning and go to work is remarkable. The fact that somebody's Christian, somebody's Jewish, somebody's Muslim, and somebody's atheist; that we come to these different conclusions is just based on how our brain is swimming in the world."
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