Fasting and Research




Research Design

The tentative title for my research is "An Exploratory Study of the Effects of Therapeutic Fasting for Depression in the Short Term." The following is the introduction chapter for my dissertation/research proposal. The proposal is in the process of being approved by the Ethics Committee at the Institue of Transpersonal Psychology.

Introduction

This paper is a proposal for an exploratory study examining the relationship between the ancient practice of fasting and feelings of depression. Fasting is defined as abstinence from all food and drink (except water) for a specific length of time, typically for a therapeutic or religious purpose (Urdang, 1983, p. 417).

As a psychotherapist, I often talk with people who present with symptoms of depression. Most of them have sacrificed self-care in lieu of other activities, usually work related. They either abandoned a self-care routine or never had one. In these instances, part of my work is encouraging the development of such a practice. It seems now—more than ever—people struggle to find meaning and significance in their lives. Buddhist teacher and psychotherapist Jack Kornfield (2001) said, “We live in disordered times, complicated, distracted, and demanding . . . Whether in prayer or meditation, in visualization, fasting, or song, we need to step out of our usual roles, out of the busy days on automatic pilot” (p. 26).

After engaging in a number of spiritual practices, I found fasting to be the most beneficial, partially because it can reduce thoughts associated with depression and increase the feeling of well-being. It does this through several mechanisms. First, fasting changes brain chemistry, producing an antidepressant effect (Michalsen et al., 2003). Additionally, fasting can relieve the symptoms of a wide variety of medical problems, thus enhancing a feeling of wellness (Beleslin et al., 2007; Fuhrman, 2002; Horne et al., 2008; Kanazawa & Fukudo, 2006). Furthermore, fasting initiates a change in consciousness, providing exceptional human experiences (Cortright, 1997; Epstein, 1995; Frager & Fadiman, 2005; Peters, 1975; Vaughan, 1993). Through these various means, fasting has the potential to alter the perception of the participant.

Frances Vaughan (1993) suggested that fasting is a useful clinical intervention in transpersonal psychotherapy. According to Vaughan, methods like fasting, drumming, and chanting produce an altered state of consciousness that can have “powerful therapeutic effects” (p. 164). Brant Cortright (1997) echoed this belief, and called fasting "an effective non-drug technique useful for inducing an altered state of multidimensional consciousness" (p. 16).

Fasting is a versatile clinical intervention because it can be used briefly or for longer periods in a supervised setting. Additionally, it can be used therapeutically in conjunction with other therapies. Stanislav Grof (1998) recommended fasting before engaging in LSD psychotherapy, also known as psychedelic treatment.

Therapeutic Fasting

In therapeutic fasting, fasting is defined as “the complete abstinence from all substances except pure water in an environment of complete rest” (Goldhamer, 2009, 3). This definition is within the protocol of the standards set forth by the International Association of Hygienic Physicians (IAHP), a professional association for licensed, primary care physicians who specialize in the supervision of therapeutic fasting. The IAHP’s standards of practice for supervision of therapeutic fasting are as follows:

  • Prior to undertaking the supervision of a fast, the physician shall collect an appropriate case history and perform a physical examination.
  • Appropriate medical consultation shall be made for patients on prescribed medication when any modifications of the same are intended or anticipated.
  • Absent exceptional circumstances, appropriate laboratory monitoring is advisable for all fasting patients prior to initiating the fast. For all fasts beyond seven (7) days, ongoing continuous physiological monitoring shall be undertaken as deemed appropriate within the view of the attending physician.
  • Informed consent will be secured from all patients and the same will be documented in the patient’s file.
  • Vital signs of all fasting patients will be monitored daily and more often if necessary in view of the attending physician. Such monitoring will consist of at least the taking of blood pressure and pulse.
  • A written daily record of progress will be made, which shall include appropriate vital signs.
  • Water shall be available to patients at all times.
  • Care shall be exercised in terminating the fast and supervised post-fasting recuperation consistent with hygienic principles. Patients shall be encouraged to remain under supervision until sufficient recovery has been attained. (International Association of Hygienic Physicians, 1995)
Clinical Example of Therapeutic Fasting

Before therapeutic fasting is undertaken, a pre-fasting evaluation is conducted, including a complete health history with evaluation of previous illnesses, injury, and treatment. Family history is examined along with an assessment of current symptoms and treatment. A comprehensive physical exam is completed with laboratory procedures such as urinalysis and blood work. These tests give the practitioner a baseline to refer to during the fast as well as the information needed to determine if therapeutic fasting is appropriate. According to Alan Goldhamer (2009), a member of the board of governors of the IAHP:

Without a good base line, it can be very difficult to differentiate a positive healing crisis from a physiological compromise. For example, a person who develops an arrhythmia on the fourteenth day of a fast might be treated very differently from an individual who starts the fast with the same condition. (p. 6)

Once the initial evaluation is complete, the practitioner determines the length of the fast. The duration may change, however, depending on circumstances that arise during the fast. Although initial testing can help determine what additional evaluations may be needed during the fast, participant’s vitals are always monitored daily.

The lengths of fasting vary widely, although in therapeutic fasting, the course is generally between 4 and 40 days. The practitioner’s decision to terminate the fast is highly individualized and is based on the patient’s history, symptomatic presentation, examination results, laboratory results, psychological state, and personal circumstances. Therapeutic fasting is usually terminated with fresh fruit or vegetable juice.

Purpose of the Study

The purpose of this study is to investigate whether therapeutic fasting is a viable means of treating depression. Upon reviewing the scholarly literature in the field of clinical psychology, the researcher found little concerning fasting as a therapeutic treatment for depression. The purpose of this study is to narrow the gap between research in Transpersonal Psychology and the clinical application of therapeutic interventions utilized in Transpersonal Psychology. This study is designed with the intent of gaining a better understanding of the psychological response that occurs during therapeutic fasting.

Overview of the Method

This will be a quasi-experimental repeated measures design with a control group matched for BDI-II categories and gender at baseline. One hundred and ten participants will be given the Beck Depression Inventory (BDI-II) and Multidimensional Health Locus of Control (MHLC) scale (Appendix G; Appendix H). At testing time one, participants in both groups will be asked their age and gender. In addition, a short survey will be included at testing time two for the intervention group to gather additional information, including the participant’s perception of their experience and length of stay. Because current DSM–IV guidelines call for assessing depression symptoms over a two-week period and the BDI-II recommends this, participants will be assessed twice over a two-week period. Furthermore, the inventory will be administered twice to examine changes in level of depression in both treatment and control groups. The intervention group will be 42 attendees selected from True North Health, a medical fasting facility in Santa Rosa, California. The control group will consist of 68 people selected from the general population. At testing time one, the control group will be matched to the intervention group by gender and the BDI-II four category scores (minimal, mild, moderate, and severe levels of depression). The resulting data will be analyzed using a repeated measures analysis of variance (ANOVA) and presented in my final findings.

Significance of the Study

A study examining the effects of fasting on the symptoms of depression is important for several reasons. Depression is a worldwide epidemic. In the United States alone, depression is among the ten most frequently reported medical conditions and 19 million people are thought to suffer from it (Eisenberg et al., 1993; Eisenberg et al., 1998; Kessler, Chiu, Demler, & Walters, 2005). Scientists estimate that one third of the population will experience depression during their lifetime and by 2020, depressive disorders will be the second largest illness in the world (Kessler et al., 2005; Moshiri et al., 2006; Rorsman et al., 1990). These are sobering facts, in light of the fact that depression poses a substantial risk of death and is associated with a high rate of disability (Gotlib & Hammen, 2009). The often-quoted mortality rate is that about 15% of patients with major depression will eventually die by suicide, a rate confirmed in a large-scale review of 30 studies (Goodwin & Jamison, 1990; Guze & Robins, 1970).

Although suicide rates have declined since the introduction of selective serotonin reuptake inhibitors (SSRIs) in 1988, approximately 30% of patients with major depression do not respond to SSRIs (Gibbons, Hur, Bhaumik, & Mann, 2005; Rosack, 2005). Many end up taking a combination of two or more antidepressant medications with minimal results. Despite the availability of a wide range of antidepressant drugs, nearly 30% of all depressed patients fail to respond to antidepressant medication of any kind (Kirsch, 2008; Shergill & Katona, 1997).

Among antidepressant medications, SSRIs have been found to be particularly effective, making them the medication of choice in most cases (Cipriani et al., 2010). However, researchers have questioned the true drug effects of this class of antidepressants, as well as others. In the past decade, three reviews examined a total of 105 studies on antidepressants and concluded that the drugs were no more effective than sugar pills except in the severest form of depression (Fournier et al., 2010; Khan, Leventhal, Khan, & Brown, 2002; Kirsch, 2008). This research suggests that while antidepressants can be effective, other alternatives may offer similar benefits without the side effects.

Concerns have been raised over the side effects associated with antidepressants, which include suicide, worsening of depression, and unusual changes in behavior in children, adolescents, and adults. In the fall of 2004, the U.S. Food and Drug Administration (FDA) instructed drug manufacturers to add black box warnings to antidepressant medications because of serious side effects, including feelings of suicidality in adolescents (Cheung, Sacks, Dewa, Pong, & Levitt, 2008). A black-box warning, the most severe warning that can be placed on a drug label, is used to alert doctors and patients of potential problems.

Based on this evidence, complementary and alternative medicine (CAM) therapies, like fasting, represent a viable option for patients that are not helped by antidepressants or want to avoid the side effects. The use of CAM therapies has gained increased acceptance, making it a feasible alternative to pharmacology. In 1991, 34% of the U.S. adult population reported using CAM therapy during the previous year (Eisenberg et al., 1993). By 2007, that figure rose to almost 40% (Barnes, Bloom, & Nahin, 2009). Between 2002 and 2007 increased use was seen among adults for deep breathing exercises, guided visualization, meditation, naturopathy, and yoga (Barnes et al., 2009; Barnes, Powell-Griner, McFann, & Nahin, 2004). Transpersonal scholars have suggested these methods as a means of personal transformation (Assagioli, 2007; Braud & Anderson, 1998; Daniels, 2005; Frager & Fadiman, 2005; Grof & Grof, 1989; Kornfield, 2001; Vaughan, 2005; Walsh & Vaughan, 1993). When examined under the lenses of exceptional human experiences (EHEs), peak experiences, and self-actualization, the scope of transpersonal interest becomes even wider (Braud, 2009; Maslow, 1971; White, 1994). Furthermore, fasting is a highly transformative spiritual experience, making it particularly relevant to the field of transpersonal psychology. Another concern of transpersonal psychology is the integration of body, mind, and spirit (Daniels, 2005; Tart, 1997). Fasting addresses this relationship in a distinctive manner because it simultaneously alters the participant physiologically, psychologically, and spiritually. Gandhi (2001/1961), an avid faster, explained the connection as follows:

Just as there is an identity of the spirit, so there is an identity of matter and in essence the two are inseparable. Spirit is matter rarefied to the utmost limit. Hence, whatever happens to one’s body must affect the whole matter and the whole spirit. (p. 50)

The physiological changes that occur during a fast have been associated with psychological transformation. Beginning in the 1970s, psychiatrists reported success treating psychiatric conditions with therapeutic fasting, most notably schizophrenia (Boehme, 1977; Cott, 1971; Cott, 1974). Additionally, scientists discovered some of the biological mechanisms that may explain how fasting relieves the symptoms of psychopathology, such as depression. For example, fasting has been shown to attenuate hypertension and diabetes (Goldhamer et al., 2002) and improve arterial and heart health (Horne et al., 2008,), all strongly associated with the incidence of depression (Chellappa & Ramaraj, 2009; Jonas, Franks, & Ingram, 1997; Toker, Shirom, & Melamed, 2008). These studies are further examined in the literature review chapter.

Although transpersonal theorists have recommended research into the effects of fasting (Sperry, Hoffman, Cox, & Cox, 2007), research efforts so far have been limited to the measurement of biological markers (Goldhamer, 2002; Horne et al., 2008). Research exploring the association of fasting and mental health would be relevant at this time.

Definitions for Terms Used in the Study

Just as there are different reasons for fasting, there are several definitions. Psychiatrist Len Sperry (2001) asserted that fasting is used “as a means of weight loss, detoxification of the body for medical purposes, or as a spiritual practice” (p. 154). In this study, the intervention will be therapeutic fasting, which is defined as the complete abstinence from all substances except water in an environment of complete rest and medical supervision.

Because this study uses the Beck Depression Inventory (BDI-II) as its psychometric measure, depression is defined within this context. The BDI-II is a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression as listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (2000b). The BDI-II’s 21 items are intended to index symptoms of depression, the primary indicators being increase or decrease in sleep and appetite, changes in body image, work difficulty, weight loss or gain, somatic preoccupation, agitation, concentration difficulty, and loss of energy.

References
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Randi Fredricks is a Naturopathic Psychotherapist with a Doctorate in Naturopathy and a Masters in Psychology. She sees clients at her office in San Jose, California. She can be reached at 800-957-5655 or you can contact her online. This article is an excerpt from Randi Fredricks' book Fasting: An Exceptional Human Experience. Copyright © 2009. All rights reserved. No part of this article may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems.






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