Spiritual interventions in Iran : A review article

Nadereh Memaryan1, Zeinab Ghaempanah2* and Ruohollah Seddigh3 1School of Behavioral Sciences and Mental Health (Excellence Center of Psychiatry and Clinical Psychology), Iran University of Medical Sciences, Tehran, Iran 2The office of Islamic studies in Mental Health, School of behavioral sciences and mental health. Iran University of Medical Science, Tehran, Iran 3Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran SOJ Psychology Open Access Review Article

• In recent decades, spiritual care has been added to the collection of patients care • There is no clear definition of spiritual care and it often overlap with religious concepts • There is too much diversity in spiritual clinical trial interventions What this paper adds?
• Even though Iran is among the six countries with the most studies in this area, it appears design of spiritual interventions in Iranian clinical trials are not based on a specific study to find the best spiritual/religious interventions for their study group (Allah).Accordingly, the concepts of spirituality and religion are thus inseparable, although not in the sense that they are one and the same, but in the sense that religion is necessary for spiritual improvement [1].
Spiritual care as patient needs is a dynamic and subjective concept and refers to healing presence, therapeutic use of self, intuitive sense, exploration of the spiritual perspective, patientand meaning-centered interventions, and creation of a spiritual environment [2].Spiritual care can be integrated into other aspects of care and influence treatment decisions and with facilitation of coping and healing can influence prognosis and quality of life [2][3][4][5][6][7][8].On the other hand, a wrong approach to spiritual intervention is not only unethical, but it can also increase the burden of disease instead of reducing it [9,10].Among patients, there is also a tendency to incorporate spiritual/religious interventions in normal care services [11,12].Therefore, in recent decades, "spiritual care" has been added to the collection of patients care and has accompanied the development of research in this area [13,14].
However, there is no single definition of spiritual care.Various concepts and definitions have been given, from religious care that refers to performing some religious rituals to secular care that refers to the individual level experience of care [15,16].In addition, these concepts often overlap with each other.Patient definition of spiritual care is also different from the definition of providers of this kind of services [17].Cultural, social, and religious variables also have an effect on it [18,19].Additionally, it can cause a feeling of helplessness and confusion in this type of service providers, too much diversity in clinical trial interventions, and finally bias in researches [18,[20][21][22].Even though Iran is among the six countries with the most studies in this area, it appears such conditions do also exist in Iran [23].Therefore, this study was designed to answer the following question: what are the spiritual interventions that have been designed for Iranian context in clinical trials.The answer to this question can create

Discussion
The results of the present study show the range of spiritual interventions in patients and healthy subjects, which can be an inspiration to researchers in this field.However, due to the diversity of methods in these studies, a single method for spiritual interventions that suits the cultural and religious context of Iran cannot be achieved, and regarding research, a systematic review or meta-analysis cannot be done.In such circumstances in which few therapeutic models exist and it is expected that researchers in this field create standards by developing clearly identified research boundaries, a number of these studies have used the models of spiritual interventions of other cultures and religions, and some of them have even combined various components and have evaluated their effect as a whole; however, an explanation Limitations of our study are the exclusion of studies that did not have English abstracts and not searching for studies that were performed as theses and therefore not published.

Spiritual interventions in Iran: A review article
Copyright: © 2017 Ghaempanah, et al.
as to how and why the different sectors of interventions were combined was not provided.In fact, we found just 1 article in clinical trial until May 2016 that implemented interventions based on a specific study to develop culturally appropriate interventions.So a local version of spiritual therapy backed by solid research cannot be achieved.The absence of comparison with other methods of treatment (which in our study, only 5 involved these comparisons), lack of a control group in some studies, and no clear boundary between spiritual and religious interventions are also some cases which contribute to the above problem[24,27,28,32,34,39,40,42].Increased research in this area, strengthening the link between health care researchers and scholars of Islam, focused research on previous research studies in order to improve their generalizability, encouraging the publication of study results in English, and carrying out joint research with other Muslim countries are strategies to promote research in this area.
In most Iranian spiritual clinical trials, interventions are not evidence-base.Interventions are either a mixture or arbitrary selection of some spiritual/religious concepts.So, no clear model for spiritual interventions can be extracted from Iranian studies.

Table 1 :
Summary of spiritual interventions in clinical trials in Iran Communication with inner self and God, Altruism, relationships with holy sites, forgiveness, fear of death and thanksgiving Hosseini L, et al. 2016 (54) Some spiritual/religious concepts training based on some Quran verses and Islamic supplications