THE THERAPEUTIC CONTRIBUTION OF SPIRITUALITY TO THE WELL-BEING OF PATIENTS WITH ANXIETY AND DEPRESSION: A SYSTEMATIC REVIEW

REGISTRO DOI: 10.69849/revistaft/ar10202510312155

Renayra Santos Furtado; Rodrigo de Menezes Belmonte Loureiro; Leonardo Rodrigues Viana; Anthony Matheus dos Santos Gomes; André Souza de Carvalho; Laysa Martins Silva; Rita de Cássia de Oliveira.

ABSTRACT

OBJECTIVE: This study aimed to perform a systematic literature review to investigate and analyze the therapeutic contribution of spirituality to the wellbeing of patients with anxiety and depression disorders. METHODOLOGY: This review followed the PICO strategy, using the descriptors “spirituality,” “anxiety,” and “depression”. The searches were conducted in the PubMed and BVS databases. After applying the inclusion and exclusion criteria, eight articles were selected. The Joanna Briggs Institute (JBI) tool was used to assess the risk of bias, and the GRADE tool was used to evaluate the strength of the evidence. RESULTS: Spirituality was found to act as a protective factor and an effective coping strategy in reducing symptoms of anxiety and depression in various populations, including pregnant women, dialysis patients, and students. Practices such as prayer, meditation, and community engagement were associated with greater resilience, optimism, and quality of life. CONCLUSION: It is recommended that more research with robust methodologies be conducted to deepen the understanding of this relationship. This would encourage the consideration of spirituality in clinical practice as part of a holistic and integrated approach to mental health.

Keywords: Spirituality, Anxiety, Depression, Mental Health, Well-being

INTRODUCTION

For a long time, the concept of well-being was exclusively associated with the absence of physical illness, neglecting the complexity of the human being as a biopsychosocial entity. However, from the 1960s and 1970s onward, psychology began to investigate more deeply the subjective factors that influence quality of life, including personal satisfaction, positive and negative emotions, and the perception of existential meaning (Seidl & Faria, 2005). In the 1980s, with the advent of positive psychology, elements such as life purpose, resilience, and optimism were incorporated into the study of well-being, thereby expanding its scope beyond mere physical health (Panzini et al., 2017).

Among the multiple aspects that constitute well-being, spirituality emerges as a fundamental component, albeit one historically marginalized in the scientific field. This perspective began to shift in 1988 when the World Health Organization (WHO) recognized spirituality as an integral dimension of the multidimensional concept of health, highlighting its influence on quality of life (Souza & Soares, 2005). It is important to emphasize that spirituality should not be confused with institutionalized religion, as it transcends specific creeds and rituals, encompassing universal values such as empathy, compassion, love, and inner balance.

Over the past decade, research has demonstrated a significant relationship between spirituality and improvements in quality of life, particularly among individuals facing mental disorders (American Psychiatric Association, 2013). In Brazil, where mental disorders are a leading cause of disability, depression and anxiety stand out as prevalent conditions that often coexist and exacerbate one another (Moreira et al., 2020; Aggarwal et al., 2023). Depression is characterized by persistently low mood and anhedonia, while anxiety is marked by fear disproportionate to reality; both profoundly compromise wellbeing and may lead to severe outcomes, such as self-harm and suicide (Koenig, 2012; Lucchetti et al., 2011).

In this context, complementary strategies to pharmacological treatment have been investigated, including spiritual practices, meditation, and the search for existential meaning. Studies indicate that spirituality can function as an adjuvant therapeutic resource, helping reduce psychological distress and promoting greater social integration (Almeida et al., 2016). Furthermore, a sense of belonging and connection to something greater than oneself has been associated with increased emotional resilience and a reduction in depressive and anxiety symptoms (Pargament et al., 2000).

Despite the growing academic interest in the topic, gaps remain in the recognition of spirituality as a scientifically validated tool for promoting mental health (13). Therefore, the aim of this systematic review is to compile and analyze scientific evidence on the therapeutic effects of spirituality on psychological health, assessing its impact on quality of life and well-being in patients with depression and anxiety.

METHODOLOGY

This study was guided by the methodological framework for systematic reviews proposed by Mendes et al. (2008), which was operationalized through six sequential stages: (1) identification of the theme and formulation of the guiding question; (2) establishment of study inclusion and exclusion criteria; (3) definition of the information to be extracted from the selected studies and their categorization; (4) critical analysis of the selected studies; (5) interpretation of the results; and (6) presentation of the synthesized knowledge.

The qualitative PICO strategy was employed to formulate the research question, structured as follows:

P (Population): Patients with depressive and anxiety disorders.
I (Intervention): Integrative spirituality practices in healthcare.
C (Comparison): Patients who do not receive spiritual approaches as part of their treatment.
O (Outcome): Improvement in emotional well-being.

Thus, the guiding question was: “How does the integrative practice of spirituality contribute to the improvement of emotional well-being in patients with anxiety and depressive disorders, compared to those who do not receive spiritual approaches as part of their treatment?”

Eligibility Criteria

The inclusion and exclusion criteria were defined to select the most pertinent studies for the review.

The general criteria for this review were as follows:

Inclusion Criteria:

Studies whose thematic focus was related to individuals suffering from anxiety and/or depressive disorders.
Full-text articles and abstracts available free of charge.
Articles published in Portuguese or English.
Publication date between 2020 and 2025.

Exclusion Criteria:

Studies not pertinent to the central theme.
Incomplete texts or those requiring payment for access.
Dissertations, theses, conference proceedings, books, letters, errata, experience reports, case reports, editorials, and integrative or systematic reviews.

Furthermore, to illustrate the specificity of criteria encountered in the literature and to ensure transparency in the selection process, the following examples of inclusion and exclusion criteria from identified studies were considered as a reference for the overall evaluative framework:

Study 1 (Pregnant Women): Included pregnant women aged 18 or older, living in a city in the Eastern Anatolia region of Turkey during March 2021, without visual impairment, open to communication, and without serious mental health problems. Excluded were men, non-pregnant women, individuals under 18, those visually impaired, not open to communication, or with mental health problems (Author, Year).
Study 2 (Indigenous Students): Included participants who were ≥18 years old; self- identified as First Nations, Inuit, or Métis; were registered as full- or part-time students; and had no prior participation in a Mindfulness-Based Intervention (MBI). Excluded were participants who did not meet these inclusion criteria (Author, Year).
Study 3 (Refugees): Included current or former refugees who self-identified as Arab or MENA-born and were native Arabic speakers. Excluded were anyone under the age of 21 and those unable to provide informed consent (Author, Year).
Study 4 (Hemodialysis Patients): Included patients aged at least 18 years, on hemodialysis for at least 6 months, and with no mental illness detected by a doctor. Excluded were patients who used medication without a diagnosis defined by a doctor (Author, Year).
Study 5 (Family Relatives): Included individuals aged 18 or older, who were first-degree relatives (mother, father, spouse, child) of a patient who received intensive care treatment for at least 24 hours, had visited their patient at least once, and were willing to participate. Excluded were those not speaking Turkish and unable to adequately answer the cognitive questions (Author, Year).
Study 6 (Macro-level Data): Included countries with complete data on dementia, religiosity, depression, and social capital. Excluded were countries with missing data or where religiosity metrics were not applicable (Author, Year).
Study 7 (Students): Included dentistry and nursing students (undergraduate and postgraduate), between 18 and 30 years old, who consented to participate. Excluded were those with a history of psychiatric conditions, using medications that could influence cognitive or emotional performance, or not meeting the age/program criteria (Author, Year).
Study 8 (Surgical Patients): Included patients >20 years old with a diagnosis of degenerative cervical disease scheduled for Anterior Cervical Discectomy and Fusion (ACDF) surgery, who were conscious, verbally communicative, and provided free consent. Excluded were patients unable to attend follow-up visits, complete questionnaires, provide reliable responses, or those with severe cognitive impairments (Author, Year).

Search Strategy and Study Selection

The study selection was conducted through online searches in the PubMed and Virtual Health Library (VHL) databases. Controlled vocabularies from the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used. The article search was performed in March 2025, utilizing the following descriptors: “Depression”, “Depressive Disorder”, “Anxiety”, “Anxiety Disorders”, “Spirituality”, “Religion and Science”, “Religion”, “Spiritual Therapies”, “Holistic Health”, “Integral Healthcare Practice”, “Mental Health Recovery”, and “Preventive Psychiatry”. The Boolean operators “AND” and “OR” were used to combine the terms, resulting in the following search strategies:

(depression OR Depressive Disorder OR anxiety OR Anxiety Disorders) AND (spirituality OR Religion and Science OR Religion OR Spiritual Therapies) AND (Holistic Health OR Integral Healthcare Practice OR Mental Health Recovery OR Preventive Psychiatry)
(depression OR anxiety OR Anxiety Disorders) AND (spirituality OR Religion OR Spiritual Therapies) AND (Holistic Health OR Integral Healthcare Practice)

The studies were examined by two pairs of researchers, following eligibility protocols based on the guiding question. After checking for potential duplicates, exclusions were performed using the Rayyan software tool to aid in the screening of articles based on title and abstract reading. Subsequently, the selected articles were read in full for data interpretation and risk of bias analysis according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach (Brasil, Ministério da Saúde, 2024).

Studies that met the established criteria were included in the review, and the obtained information was systematized to facilitate the presentation and understanding of the results. Furthermore, a flow diagram following the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines (Page et al., 2021) was elaborated to ensure organization throughout the study selection process, from the identification of database records to the final inclusion of eligible articles read in full.

Finally, to ensure transparency and avoid duplication of the present systematic review content, the study protocol was registered on the PROSPERO (International Prospective Register of Systematic Reviews) platform (Centre for Reviews and Dissemination, University of York, n.d.), under registration number CRD 1016226.

This study was conducted in six stages, following the guidelines of Mendes et al. (Mendes et al., 2008): 1) Identification of the topic and formulation of the guiding question for the design of the systematic review; 2) Definition of inclusion and exclusion criteria for the studies or literature search; 3) Determination of the information to be extracted from the selected studies and categorization of the works; 4) Analysis of the selected studies; 5) Evaluation of the results; and 6) Presentation of the synthesis of the analyzed knowledge.

The qualitative PICO strategy was used to formulate the research question, with P (population): patients with depressive and anxiety disorders; I (intervention): integrative practice of spirituality in health care; C (comparison): patients who do not receive spiritual approaches as part of their treatment; O (outcome): improvement in well-being (15). Accordingly, the guiding question using the PICO strategy was: “How does the integrative practice of spirituality contribute to the improvement of emotional wellbeing in patients with anxiety and depressive disorders, compared to those who do not receive spiritual approaches as part of their treatment?”

The selection of studies was based on online searches in the PubMed and Virtual Health Library (BVS) databases. Controlled vocabularies were selected from the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH). The article search was conducted in March 2025 using the following descriptors: “Depression,” “Depressive Disorder,” “Anxiety,” “Anxiety Disorders,” “Spirituality,” “Religion and Science,” “Religion,” “Spiritual Therapies,” “Holistic Health,” “Integral Healthcare Practice,” “Mental Health Recovery,” and “Preventive Psychiatry,” in accordance with the above-mentioned databases and aligned with the guiding research question. Boolean operators “AND” and “OR” were used to combine the terms. The search strategy was as follows: “(depression OR Depressive Disorder OR anxiety OR Anxiety Disorders) AND (spirituality OR Religion and Science OR Religion OR Spiritual Therapies) AND (Holistic Health OR Integral Healthcare Practice OR Mental Health Recovery OR Preventive Psychiatry)” and “(depression OR anxiety OR Anxiety Disorders) AND (spirituality OR Religion OR Spiritual Therapies) AND (Holistic Health OR Integral Healthcare Practice).”

The present study included articles addressing individuals with anxiety and/or depressive disorders, with full text and abstract freely available, in Portuguese or English, and published between 2020 and 2025. Exclusion criteria comprised studies not relevant to the topic, incomplete or paid texts, dissertations, theses, conference reports, books, letters, errata, experience reports, case reports, editorials, and integrative or systematic reviews.

The studies were examined by two pairs of researchers, following eligibility protocols based on the guiding research question. After checking for potential duplicates, exclusion was carried out using the Rayyan software tool, which assists in screening articles based on title and abstract review. Subsequently, the articles were selected through full-text reading for result interpretation and methodological quality assessment using the Joanna Briggs Institute (JBI) tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the strength of the studies’ recommendations (Brazil, Ministry of Health, 2024).

Furthermore, studies that met the established criteria were included in the review, and the information obtained was systematized to facilitate the presentation and comprehension of the results. Additionally, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Page et al., 2021) was developed to ensure organization during the study selection process, from the identification of records in the databases, through the screening process, to the final inclusion of articles selected based on eligibility and full-text reviewed in a systematic manner.

Finally, to ensure transparency and avoid duplication of content in the present systematic review, the study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform (Centre for Reviews and Dissemination, University of York, n.d.), under registration number 1016226.

RESULTS

The database search resulted in a total of 590 studies, of which 519 were indexed in PubMed and 71 were retrieved from BVS. These articles proceeded to the first screening phase, in which the filters “full text,” “free,” “last 5 years,” and languages (English and Portuguese) were applied, resulting in the exclusion of 470 articles. The remaining 120 studies were then submitted to the second screening phase, which involved reading titles and abstracts, leading to the exclusion of 106 articles. Finally, 8 observational studies were included according to the pre-established eligibility criteria. This sequence of processes is detailed in Figure 1. Table 1 presents the main characteristics of the selected studies.

Regarding the methodological quality of the studies, the JBI tool revealed that the studies presented low to moderated risk of bias (Figure 2). Furthermore, when assessed using the GRADE tool, the studies showed very low certainty of evidence and very serious imprecision (Figure 3).

Figure 1. PRISMA flowchart, according to Page et al. (2021)

Figure 2

Fonte: McGuinness, 2019

Figure 3. GRADE table, authors (2025).

Spirituality compared to No Spirituality for Patients with Anxiety and Depression

DISCUSSION

This systematic review investigated the therapeutic contribution of spirituality to the well-being of patients with anxiety and depression, analyzing eight studies published between 2020 and 2025. The synthesized evidence indicates that spiritual practices are consistently associated with a significant reduction in symptoms of depression and anxiety across diverse populations and contexts. Furthermore, spirituality appears to facilitate the development of resilience and improve coping mechanisms in the face of adverse experiences, such as those exacerbated by the COVID-19 pandemic or intense medical treatments like surgery (Huang et al., 2024; Mangoulia et al., 2025). This area of research is particularly compelling for the scientific community, as it explores an integrative, low-cost, and highly accessible dimension of human experience that remains underexplored in mainstream clinical practice. The relative scarcity of robust, longitudinal studies in this field further underscores the novelty and importance of these findings.

Spirituality as a Coping Resource in Contexts of Psychosocial Vulnerability

The incorporation of spirituality into the therapeutic process has been associated with improved well-being across different dimensions, particularly in the reduction of anxiety and depression symptoms (Görücü & Arslan, 2024). Comprehensive care for the individual extends beyond the physical, requiring a broader approach that considers the psychosocial context. For instance, three of the analyzed studies highlighted that social determinants—such as the prejudice faced by refugees and the high academic demands on students—act as significant stressors that worsen mental health (Bridi et al., 2023; Beshai et al., 2023; Rajkumar, 2023). These groups often employ spirituality to reframe traumatic experiences, which fosters resilience and mitigates symptoms of depression and anxiety. The study by Beshai et al. (2023) is illustrative, demonstrating that for Indigenous communities, spiritual interventions are frequently woven into cultural identity itself, serving as a primary strategy for coping with mental health challenges by providing a coherent moral and existential framework.

The Inclusion of Spirituality in Holistic Hospital Care

The hospital setting represents a critical environment where the inclusion of spirituality can significantly enhance quality of life and influence recovery trajectories. Spirituality was identified as a key factor in improving the mental health of individuals undergoing invasive surgical procedures (Huang et al., 2024). According to these authors, surgeries can profoundly impact psychological well-being, creating a need for spiritual support during the vulnerable postoperative period. However, a significant care gap exists; many patients do not receive adequate holistic care after surgery, which can prolong recovery and hinder the alleviation of depressive and anxiety symptoms (Huang et al., 2024). This gap is also evident in chronic care settings. A descriptive observational study involving patients undergoing dialysis treatment found that a significant proportion of participants exhibited clinically significant anxiety and depression (Senmar et al., 2020). Notably, the same study reported that the incorporation of spirituality was associated with better psychological adaptation to the illness, reinforcing the need for integrative approaches by hospital healthcare teams.

Spirituality as a Protective Resource Against Anxiety and Depression

The protective role of spirituality against symptoms of depression and anxiety was a consistent finding across the reviewed literature. Practices such as prayer, mindfulness, attendance at religious services, and personal reflection on spirituality were correlated with decreases in symptoms of depression, anxiety, and stress (Bridi et al., 2023; Beshai et al., 2023; Görücü & Arslan, 2024; Senmar et al., 2020). A compelling example comes from a cross-sectional study with pregnant women, which identified a negative correlation between levels of spiritual well-being and both fear of COVID-19 and depressive symptoms (Durmuş et al., 2021). The authors posited that high-stress contexts, such as a pandemic during pregnancy, exacerbate psychological distress, and that spirituality can serve as an effective resource for reducing anxiety and promoting resilience.

This protective effect extends to situations of imminent life risk and profound uncertainty. The research by Görücü and Arslan (2024) observed that as death-related anxiety and trauma-derived fears increase, so does the focus on spiritual well-being. Spiritual practices provided crucial emotional support to relatives of patients in intensive care units, who face extreme despair, thereby promoting improvements in their mental health. Intriguingly, the potential benefits may extend beyond mood disorders. An ecological, cross-sectional study identified a possible protective effect of religiosity on the development and burden of dementia, with frequent religious practices being inversely associated with depression levels and dementia incidence (Görücü & Arslan, 2024). However, the causal mechanisms remain unclear— whether this is a direct effect of spirituality or mediated by the reduction of anxiety—highlighting a critical avenue for future research in a field with still-limited foundational studies.

Study Limitations

This review acknowledges several limitations, both in the underlying studies and in the synthesis process. A significant challenge was the heterogeneity in the measurement of spirituality across studies, which employed various scales (e.g., SWBS, FACIT-Sp-12) assessing different dimensions of faith, belief, and purpose. This variability precludes a meta-analytic synthesis of cause and effect. Compounding this issue, the predominance of observational designs (notably cross-sectional studies) inherently limits the ability to draw causal inferences. Furthermore, most studies did not adequately control for key confounding variables, such as pre-existing social support networks or concomitant use of psychotropic medications, which could independently influence mental health outcomes.

Despite these limitations, this review possesses notable strengths, including its focus on recent evidence (up to 2025) and its adherence to methodological rigor through the use of JBI tools for quality assessment and the GRADE framework for evaluating the strength of evidence. The application of the PICO strategy ensured a focused investigation, minimizing selection bias.

Spirituality as a Coping Resource in Contexts of Psychosocial Vulnerability

Based on the analyzed studies, the incorporation of spirituality into the therapeutic process and into coping with adverse situations has been associated with improved well-being across different dimensions, particularly in the reduction of anxiety and depression symptoms (5). Comprehensive care for the individual goes beyond the physical aspect, requiring a broader approach that considers the psychosocial context. Three studies (1, 6, 8) emphasized that social factors—such as the prejudice faced by refugees, immigrants, and Indigenous peoples, as well as the high academic demands placed on students—can act as stressors and contribute to the worsening of psychosocial conditions.

Social groups that incorporate spirituality as a way to reframe their experiences tend to develop greater resilience in the face of emotional adversity, which contributes to reducing symptoms of depression and anxiety. This aspect was evidenced in the study by Shadi Beshai et al. (2), which demonstrated that among Indigenous peoples, spiritual interventions are often integrated into culture as a strategy for coping with mental health problems. These practices provide a moral and existential framework, strengthening individuals’ sense of direction and identity.

The Inclusion of Spirituality in Holistic Hospital Care

Spirituality was also identified as a key factor in enhancing the quality of life of individuals undergoing invasive surgical procedures, in addition to positively influencing the recovery process (7). According to Ching-Ya Huang et al. (8), surgical interventions can significantly impact patients’ mental health, necessitating a spiritual approach during the postoperative period. However, a considerable proportion of patients do not receive adequate holistic care after surgery, which may prolong recovery time and hinder the reduction of depressive and anxiety symptoms during this period of heightened vulnerability.

The importance of holistic care, including the spiritual dimension, was also evidenced in a descriptive observational study involving patients undergoing dialysis treatment (3). The study indicated that over 50% of these patients exhibited some degree of anxiety and depression due to the impact of their chronic illness. However, the incorporation of spirituality was associated with better adaptation to their clinical condition, reinforcing the need for integrative approaches in the hospital setting by the healthcare team (3).

Spirituality as a Protective Resource Against Anxiety and Depression

Spirituality was associated with a significant reduction in depression and anxiety symptoms in six studies directly and in two studies indirectly, acting as a protective factor. Practices such as prayer, weekly attendance at religious sites, mindfulness, and reflections on the importance of spirituality were linked to decreases in symptoms of depression, anxiety, and stress, as well as improvements in mental health in seven articles (1, 2, 3, 4, 5, 6, 8).

In a cross-sectional study involving 336 pregnant women, a negative correlation was identified between levels of spiritual well-being and fear of COVID-19 infection, as well as depressive symptoms.

The same study also found a positive correlation between fear of COVID-19 infection and depression.

According to the authors, contexts of high psychosocial stress, such as the COVID-19 pandemic and the gestational period, may exacerbate psychological distress (20). In this scenario, spirituality during the prenatal period was shown to be an effective factor in reducing anxiety, improving mental health, and promoting resilience in the face of adversity.

The protective role of spiritual aspects on mental health, particularly in situations of imminent life risk and social instability, was observed in two studies (1, 4). According to Selçuk Görücü et al. (5), as death-related anxiety and trauma-derived fears increase, so does the focus on spiritual well-being. These practices were shown to provide emotional support to relatives of patients hospitalized in intensive care units, who face moments of despair and uncertainty, thereby promoting improvements in mental health and cognition.

In addition to reducing anxiety and depression, a lower risk for the development of other neuropsychiatric conditions, including dementia, was also observed (5). In an ecological, observational, cross-sectional study, a possible protective effect of religiosity on the development and burden of dementia was identified. Frequent religious practices—such as daily prayers, reflections on faith, and participation in rituals—were inversely associated with depression levels and the incidence of dementia (5). Nevertheless, it remains unclear whether this association results from a direct influence of spirituality or from indirect effects mediated by anxiety reduction, highlighting the need for further research in this area.

Study Limitations

Among the studies, heterogeneity was observed in the measures of spirituality, including the SWBS and FACIT-Sp-12 scales, which assess faith in different ways (belief, life purpose, connection with the divine). This prevents a combined evaluation of cause and effect, which, when compounded by the predominance of observational designs (75% cross-sectional), limits causal inferences. Furthermore, most studies did not control for confounding variables, including prior social support or concomitant medication use.

This review stands out for its temporal scope (recent studies up to 2025) and methodological rigor, employing tools such as JBI for assessing study quality and GRADE for evaluating the strength of evidence. The application of the PICO strategy ensured a focus on the target population and interventions of interest, minimizing selection bias.

Standardization of instruments is recommended, as the use of validated scales for spirituality in future studies would allow for direct comparisons. Longitudinal research is needed to assess the long-term effects of spirituality, particularly in vulnerable populations, including patients with suicidal ideation. Although spirituality demonstrates therapeutic potential for anxiety and depression, its effectiveness depends on standardized and culturally contextualized interventions. Future studies should prioritize experimental designs and interdisciplinary dialogue, combining scientific and spiritual knowledge to achieve a holistic approach to mental health.

CONCLUSIONS

This review observed that spirituality plays a significant role as a complementary resource in the treatment of mental disorders, such as anxiety and depression, particularly in contexts characterized by psychosocial vulnerability, including crises, chronic illnesses, or life transitions. The studies suggest that spiritual practices, such as prayer, meditation, and participation in religious communities, contribute to strengthening emotional resilience, reducing stress, and promoting a sense of purpose and belonging. All these elements positively impact mental health and coping with adverse experiences. However, the heterogeneity of methods used in the studies, the lack of standardization in assessing spirituality, and the predominance of observational studies over randomized clinical trials limited the generalizability of the results and the identification of causal relationships. Therefore, it is essential that future research invest in more rigorous designs, such as randomized clinical trials and longitudinal studies, using validated instruments that allow for more precise comparisons. Deepening the dialogue between science and spirituality through interdisciplinary approaches may significantly contribute to legitimizing and integrating spirituality into evidence-based clinical practice, expanding the therapeutic possibilities available to healthcare professionals and promoting more comprehensive and humanized care for psychological suffering.

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