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Journal of Behavioural SciencesVol. 17 Number 1-2 2007

The Effect of Rhythmic Quranic Recitation on Depression

Shabbir Ahmad Rana*

Department of Psychology, GC University, Lahore, Pakistan

Adrian Charles North

Department of Psychology, Leicester University, UK

This study investigated the effect of rhythmic recitation of

Quranic verses on depression. 175 hospitalized Pakistanis

suffering from psychotic depression were divided into

seven groups. All received the same drugs and attended the

same psychotherapy sessions, but the participants of six

experimental groups were also subjected to six otherdifferent treatments, including religious music, for 60

minutes daily over 30 days. The Beck Depression

Inventory, Hospital Depression Scale, and Hospital Anxiety

Scale were administered to measure participants level of

depression and anxiety at the start and end of the study. In

addition, doctors reports were also obtained concerning

each participants symptoms. The results indicated that the

level of depression decreased in all the seven groups, but

the level decreased most significantly among participants

who also listened to the Quranic verses. The implication ofthe study rests in highlighting the positive effect of

rhythmic Quranic recitation on psychotic depression among

Muslims, which may contribute to the further development

of cost-effective health promotion procedures in both

Islamic nations themselves and multi-cultural Western

nations.

Throughout the history of human development, music in

some form has been used as an important aid to healing. Schullian

and Schoen (1948) describe references to the divine alliance ofmusic and medicine in classical antiquity and the healing function

of music among primitive peoples. Beneficial effects of music

have been recognized by the ancient Greeks and Romans,

including Pythagoras, Democritus, Aristotle, Galen, and Celsus,

and Plato, Cicero, and Seneca all believed that music profoundly

affected the behavior of entire societies and that the state should

*Correspondence concerning this article should be addressed to Dr. ShabbirAhmad Rana, Department of Psychology, GC University Lahore. Tel: 0321-

4824602. E-mail: [email protected]


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Rana and North

regulate the performance of certain types of music. Similarly,

traditional Chinese medicine refers to the qualities of specific

instruments and sounds and their beneficial effects on various

organs of the body. From these early beginnings to the presentday, interest in music as an adjunct to the healing or therapeutic

experience has been sustained (Bartlett, 1996). Several studies

indicate that carefully selected music can reduce stress, enhance

comfort and relaxation, offer distraction from pain, and improve

cognitive performance, well being and health: for example,

McCrathy (1999) described how music could reduce stress and

negative emotion and increase positive emotion in both healthy

populations and in individuals with clinical conditions such as

anxiety, depression, panic, arrhythmias, diabetes, and chronicfatigue.

Indeed, several studies have investigated the effects of

music on mental health in general (e.g. Bonny, Pahnke & Walter,

1972; Recker, 1991; & Tang, Yao, & Zheng, 1994), and some

have focused specifically on depression. For example, Hsu and

Lai (2004) conducted a study on the effectiveness of soft music

for treatment of major depressive disorder inpatients in Taiwan. A

pretest-posttest design showed that listening to music resulted in

significantly improved depression scores. Field (1998) studied 14-19 year old females in which chronic depression had resulted in

an increased state of activation of the right frontal lobe. He found

that relaxing and listening to about 20 minutes of music changed

their brainwave state and their stress hormones. Right frontal lobe

activation was decreased and the secretion of cortisol, a stress

hormone, was reduced. Similarly, Hanser and Thompson (2003)

randomly assigned 30 older adults diagnosed with major

depressive disorder to one of three 8-week conditions.

Participants in the music condition performed significantly betterthan the controls on standardized tests of depression, distress,

self-esteem, and mood. Results consistent with these are also

reported by several other studies using a variety of methods and

participant nationalities (e.g. Cevasco, Kennedy & Generally,

2005; Hilliard, 2001; Hirokawa & Ohira, 2003; Jochims, 1992;

Lai & Good, 2005; & Wu, 2002). There is also direct evidence

that the medical profession believes that music therapy can be an

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EFFECT OF QURANIC RECITATION ON DEPRESSION

effective treatment (e.g. Hole, Wolfersdorf, & Kopittke, 1992;

Rollin, 2003). For example, Davis (1997) reported that a panel of

music therapists, psychiatrists, and corrections specialists had

strongly recommended the use of music therapy in New YorkCity hospitals and correctional institutions for the treatment of

depression. In short the above findings provide strong evidence

for the use of music as an intervention for depressed patients.

Other research over the past decade or so has investigated

the effect of religious belief on health. Lee and Newberg (2005)

reviewed the current evidence (as well as discussing

methodological issues), and concluded that there is a strong

relationship between religion and both physical and mental health.

With regard to physical health, Seeman, Dubin, and Seeman(2003) linked certain religious practices to physiological

processes, blood pressure, and the functioning of the

cardiovascular, neuroendocrine, and immune systems, and this

mirrors similar recent findings by Jones (2004), Koenig, George,

and Titus (2004), Pargament, Koenig, Tarakeshwar and Hahn

(2004), and Powell, Shahabi, and Thoresen (2003).

Of more direct relevance for the present study, there is

also increasing research evidence that religious involvement is

associated with better mental health. Hackney and Sanders(2003) meta-analysis found a positive correlation between

religiosity and mental health. James and Wells (2003) established

associations between religious belief and mental health that could

be mediated by cognitive-behavioural mechanisms. Pysiainen

(2004) found that some forms of religion can alleviate existential

anxieties, and help maintain psychological well being. Yangarber

(2004) found that reliance on religious faith can be associated

with active involvement in recovery and positive psychological

adjustment among mentally ill individuals. Corrigan, McCorkle,Schell, and Kidder (2003) studied 1,824 people with serious

mental illness and showed that both their religiosity and

spirituality were associated significantly with well-being and

mental health. Mohr and Huguelet (2004) concluded that

religiousness and spirituality could play a central role in

reconstructing a sense of self and recovery among chronic

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Rana and North

schizophrenics, and that these also help to reduce pathology,

enhance coping, and foster recovery.

With regard to specifically depression, Baetz, Griffin,

Bowen, Koenig and Marcoux (2004) analysed the data from alarge Canadian epidemiological survey of 70,884 respondents,

and found that more frequent worship service attendees had

significantly fewer depressive symptoms than those who did not

attend. Nooneys (2005) analysis of data from the National

Longitudinal Study of Adolescent Health revealed that religious

involvement prevented the occurrence of health stressors, which

reduced depression. Garrison, Marks, Lawrence, and Braun

(2004) found that mothers with stronger religious beliefs and

more involvement in religious activities may experience fewerdepressive symptoms. Similarly, Schmid, Kaeder, Schmidt and

Ostermann (2005) studied 20 patients aged 29-47 and found that

music therapy over time led to improvements in scores

concerning self-esteem, anxiety, and depression.

Although it is beyond the scope of the present research to

investigate why effects such as these should occur, it is worth

noting that several explanations for such fascinating findings have

been proposed. For example, studies have linked religiosity to

psychological well-being and physical health by several processessuch as affecting beliefs and attitudes related to mental health

(e.g. Koeing, 1997; Seeman, Dubin & Seeman, 2003); a better

understanding of the self (Ashy, 1999; George, Ellison & Larson,

2002); promoting a sense of control and order (Yangarber, 2000);

developing feelings of forgiveness for others (Krause & Ellison,

2003); promoting certain worship practices involving physical

activities linked to health (Miller & Thoresen, 2003; Powell,

Shahabi & Thoresen, 2003); raising awareness of the spiritual /

psychological aspect of health (Puchalski, 2004); or simplyincreasing the happiness of a believer (Seligman & Diener, 2005).

The present study investigated one particular religion,

namely Islam, the fundamental theoretical and practical principles

of which are based upon the Quran. It is claimed that these

principles are beneficial, protective, and have a therapeutic role

through their influence on the mental, psychosocial, and

psychosomatic well being of an individual. Indeed, Tariq and

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Jadiry (1979) conclude that the Quran, in addition to being a

religious book, also covers legal, social, pedagogical, health-

related, and humanitarian codes; & Hasanovic (1999) emphasises

that the Quran is in fact a comprehensive encyclopaedia aboutlife. Kemp (1996) reviewed the literature concerning Islam and

health and suggested that recitation of the Quran may promote

health. Indeed, the Quran offers prayers specifically to militate

against illness, such as for example And your Lord says pray

unto me and I will hear your prayer and heal (Quran, 40:60).

Khan (2002) points to the specific part of the Quran pertaining to

human health. The Quranic prayerdu'a or ruqya is given utmost

importance as the most fundamental form of asking for health: O

Lord of the people, grant me health, heal me, for Thou art a greathealer (Baniii- israaa- iil, verse 82).

Adib (2004) reviewed the literature on Islamic medicine

which is used as an alternative to the western biomedical model

within many Muslim nations. He concluded that Islamic

medicine is based upon the use of herbal remedies and faith-

healing through prayer as well as the recitation of selected holy

verses from the Quran. Furthermore, Brewer (2004) reviewed the

relevant literature and concluded that many physicians in western

hospitals employ treatment procedures based upon Islamicreligiosity. Haques (2004) survey of Muslims living in America

argued that their Islamic religiosity had positive effects on their

mental health. Guerin, Guerin, Diiriye and Yates (2004) studied

the psychological problems of the Somalian population in New

Zealand and found that, in addition to the traditional treatment

procedures, recitation of holy verses from the Quran was also

used for dealing effectively with both their physical and mental

health problems. Ohm (2003) conducted a study among African

Muslims living in America and concluded that their Islamicreligiosity promoted good psychological health. Similarly, Azhar

(1997) reported that a new form of psychotherapy based upon

Islam has been developed in Malaysia, and that this was more

popular than Freudian, supportive, and behavioural therapies; and

led to faster improvements than observed among patients on

supportive therapy.

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Rana and North

The above empirical literature suggests that music and

religion affect health. Therefore, it could be argued that if both

these variables are combined together into a new variable,

rhythmic recitation of Holy Quran, then this may have aparticularly positive effect on health relative to religion and music

in isolation. In Islam, theories of mental health are based on the

concept that obedience to God is the best way of keeping

oneself healthy. Thus, a specific part of the Quran was selected

for the present study, Surrah Rehamn (Quran, 55: 78). It is

conventional in Islam to read loudly the verses of the Quran in a

pleasant singing voice, which is called qirrat. The present

research tested the effects of reciting these verses on the severity

of symptoms suffered by hospitalised psychotic depressives in theIslamic country of Pakistan.

The empirical literature suggests that music and religion

affect health. Therefore, it could be argued that if both these

variables are combined together into a new variable, religious

music, then this may have a particularly positive effect on health

relative to religion and music in isolation. In Islam, theories of

mental health are based on the concept that obedience to God is

the best way of keeping oneself healthy. Thus, a specific part of

the Quran was selected for the present study, Surrah Rehamn(Quran, 55: 78). It is conventional in Islam to read loudly the

verses of the Quran in a pleasant singing voice, which is called

qirrat. It is pertinent to mention here that in Music Psychology,

any sound that can be heard cannot be called music unless that

sound also consists of three of the seven properties (Pitch,

Contour, Interval, Harmony, Melody, Timbre and Rhythm) and

only then that sound is called music. In this reference the sound;

qirrat (recitation of holy verses) consists of pitch, harmony,

melody and rhythm and thus can rightfully be called Islamicreligious music. Accordingly, the present research tested the

effects singing of the holy verses (Qirrat/Islamic religious music)

on the severity of symptoms suffered by hospitalised psychotic

depressives in the Islamic country of Pakistan.

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Method

Participants

Data were collected from 175 Pakistani Muslim patients

(105 males and 70 females) diagnosed as suffering from severepsychotic depression. Participants were between 22 and 50 years

of age (mean age = 32.37 years, SD = 5.94) and were in-patients

at the Punjab Institute of Mental Health in Lahore. Participants

were matched for age and then assigned randomly to one of seven

groups as detailed below. Each group consisted of 25 patients

comprising 15 males and 10 females (consistent with the sex

distribution of patients).

MeasuresFour measures were employed in the research. The Beck

Depression Inventory (BDI)consists of 21 groups of statements,

with each group consisting of four statements scored as 0, 1, 2, or

3 depending on their severity. The respondent selects the one

statement out of each group that best describes how they feel at

the present time. A total BDI score of 0-9 is considered normal,

scores of 10-16 are considered mild, scores of 17-29 are

considered moderate, and scores of 30-63 are considered

indicative of severe depression (Beck, Ward and Mendelson,1961). The Hospital Anxiety Scale (HAS) and Hospital

Depression Scale (HDS) were developed to screen for clinically

significant anxiety and depression respectively in patients

attending medical clinics. Each scale comprises 7-item measures.

Each item has a 4-choice response format, scored as 0, 1, 2, or 3

depending on severity.

Patients are asked to tick the response that they feel seems

to be closest to what they have felt in the last few days. Their

score on the Hospital Anxiety Scale (HAS) and HospitalDepression Scale (HDS) is then calculated. Scores higher than 10

are considered abnormal and the patient is diagnosed as suffering

from anxiety or depression (or both) respectively (Zigmond and

Snaith, 1983). Finally, doctors / psychologists / psychiatrists

reports (DPPRs) were employed to gather information from the

medical duty officer under whose supervision the patient was

being treated: at the start of the study, information was collected

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Rana and North

concerning diagnosis and prognosis; whereas at the end of the

study information was collected concerning whether or not they

had seen any improvement in the patients behavior during the

course of the research. If the doctor / psychologist / psychiatristnoted that the patient had improved then he / she was asked to

provide a rating from 1-10 where 1 = slight improvement and

10 = considerable improvement (whereas a score of 0 was

recorded if no improvement had been noted). It was impossible to

employ a full double-blind technique since the patients and

medical staff was all Muslims who would have been aware of the

intended effects of the musical religious content to which some of

the former were exposed. However, participants and medical staff

were completely nave as to the hypotheses of the research and tothe range of experimental groups employed (see below).

Procedure

A randomized pre-test post-test group design was used.

The BDI HAS, and HDS were administered to all the participants

at the start of the study and DPPRs were also obtained. All the

participants were given similar doses of antidepressant drugs

(Fluoxetine and Amitryptiline) and antipsychotic drugs

(Haloperidol and Chloropromazine) daily, and they all attendedthe same morning psychotherapy sessions thrice a week. Every

evening one hour of the participants time was employed for the

purposes of the study. During this time period, the patients of the

control group were free to pursue their own leisure interests (e.g.

watch TV, walk in the grounds etc.), whereas the patients of the

six experimental groups were taken to six different rooms, where

they were subjected to further treatment conditions. In each room,

a tape recorder was provided by the researcher and they were

asked to sit quietly and listen to the specific cassettes being played in each room. Participants in each group listened to the

specific audio cassette assigned for their group for 60 minutes

daily over 30 days for six days a week. Sunday was a designated

family day that patients could spend entirely with their relatives.

Participants assigned to a spoken religious group heard a

spoken lecture on the importance of the pillars of Islam.

Participants belonging to a sung religious group heard the qirrat

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version of Surah Rehman. Participants belonging to a spoken

uplifting group heard a spoken self-help lecture on how to

improve ones confidence, personality and social life. Participants

belonging to a sung uplifting group heard morale-boostingsongs. Participants belonging to a spoken secular group a lecture

on the pleasures of life. Participants belonging to a sung secular

group heard Punjabi romantic songs. After 30 days, the BDI,

HAS, and HDS were re-administered and DPPR reports were also

obtained to determine the effect of treatment conditions.

Results

Multivariate analysis of variance was carried out to

determine differences between the groups. These analyses were

based on differences between scores obtained on the BDI, HAS,

HDS, and DPPRs at the beginning and end of the experiment, and

investigated any differences between the seven groups. The

results of univariate (and Tukey HSD) tests are shown in Table 1

and indicate that scores on all the variables improved in all the

conditions. However, the scores improved significantly most in

the sung religious group, in which the participants listened to the

religious music.Of all the conditions, religious music led to the

greatest positive effect.

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Rana and North

Table1

Mean Differences between the conditions

Variable F

CG EC1

M

EC2

M

EC3

M

EC4

M

EC5

M

EC6

MChange

in BDI 111.1 -2.72 -1.92 - 16.00 -2.00 -6.44 -1.48 -2.08

Change

in HAS 124.9 +.92 -4.00 - 9.52 +.44 -4.76 +.28 +.24

Change

in HDS 59.28 +.56 -.56 - 8.68 -.12 -4.96 -.12 4.0

Amount

ofimprovem

ent

(DPPR)

11.03 - .76 - .96 - 3.40 -.92 -1.56 -.56 -.84

*p


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Table 2

Number of participants who improved

Discussion and Conclusions

Comparisons were made between the scores on the BDI,

HAS, and HDS, and also the DPPRs obtained before and after thevarious treatment interventions. Results indicated that levels of

depression, whether assessed by psychometric tests or

assessments by health workers, decreased significantly among the

participants belonging to all the groups (as well as scores on the

HAS). However, the greatest improvements were seen among

those participants who listened to the religious music, and this

effect was significant compared to that observed in the remaining

groups. As such Tables 1 and 2 support the hypothesis that a

combination of music and religion (plus drugs and psychotherapy) ought to be more effective than drugs and

psychotherapy alone and also drugs and psychotherapy plus either

music orreligion alone. The positive effect of rhythmic recitation

of Quran on psychotic depression among Muslims may contribute

to the further development of cost-effective health promotion

procedures in both Islamic nations themselves and multi-cultural

Group

Any improvement

No Yes

Control group 18 7

Spoken religious words group 15 10

Sung religious words group 7 18

Spoken uplifting words group 17 8

Sung uplifting words group 12 13

Spoken secular words group 19 6

Sung secular words group 17 8

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Rana and North

Western nations. There was also some indication that uplifting

music (plus drugs and psychotherapy) was more effective than

many of the other interventions. Music of this nature may also

constitute a relatively cost-effective means of helping thosesuffering from depression. However there was little evidence that

spoken religious words (or spoken uplifting or spoken secular

words) plus drugs and psychotherapy were more effective than

drugs and psychotherapy alone: spoken religious words, as well

as other spoken words, were of no benefit in reducing depression

levels (although they may have had other benefits that were not

measured in the present study such as providing a source of

comfort).

Note also however that at the end of the study, meanscores indicated that even the religious music group still fell into

the category of severe depression. Future research might

investigate whether prolonging the duration of exposure to

religious music from 30 days to 60 days or more would further

decrease the severity of depression experienced by the

participants. Research along these lines may also involve explicit

measures of the length of hospital stay required and the cost-

savings that might accrue from this. Note also that there is no

suggestion that the religious aspect of the present results isactually attributable to divine influence, and a placebo effect of

some nature is a more likely explanation of the greater levels of

improvement among those exposed to the religious music as

compared to other forms of music. Furthermore, the literature

reviewed in the introduction suggests that the relationship

identified here between religious music and depression might well

depend on cognitive-behavioral mechanisms which are at present

understood poorly. Other potential limitations of the present

research include whether the results can be generalized to peoplewith other psychological disorders, and people of other religions

(in which the relationship between music, religion, and healing is

less explicit). In short, there is much more to be learned about the

potential mediators and pathways when assessing the net effects

of Islamic religious music on health outcomes. The present

findings suggest that the issue nevertheless deserves further

attention.

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