The Mental Health Impact of Forceful Spiritual Practices: Navigating Time Demands and Avoiding the Stress of Seeking Superhuman Abilities
Spiritual practices, such as meditation, prayer, chanting, or rituals, can foster emotional resilience, clarity, and a sense of purpose when undertaken with intention and balance. However, when these practices are pursued forcefully under external guidance—often due to an inability to say "no"—and consume excessive time, they can disrupt work-life balance, leading to significant mental health challenges. The added pressure of aspiring to achieve superhuman abilities, such as heightened intuition, enlightenment, or supernatural powers, can further exacerbate stress, creating a cycle of frustration and burnout. This article explores the mental health consequences of such practices, provides a framework to assess their positive or negative impact, and offers strategies to avoid the stress-inducing trap of chasing extraordinary spiritual outcomes, all grounded in scientific and psychological insights.
Why We Struggle to Say "No" to Spiritual Practices
The inability to set boundaries and decline time-intensive spiritual practices often arises from psychological and social dynamics:
- Social Conformity and Obligation: Cultural or community norms may frame spiritual commitment as a moral duty, making refusal feel disrespectful or shameful. A 2019 study in Journal of Social Psychology found that social conformity drives individuals to prioritize group expectations over personal needs, even at the cost of well-being.
- Fear of Judgment or Rejection: Saying "no" to a spiritual guide or community can trigger fears of being perceived as uncommitted or unworthy. A 2020 Journal of Personality and Social Psychology study linked fear of social judgment to compliance with authority figures, particularly in hierarchical settings.
- Low Assertiveness: Individuals with lower self-efficacy often struggle to assert their needs, leading to overcommitment. A 2020 Personality and Individual Differences study noted that poor assertiveness correlates with difficulty setting boundaries, increasing stress.
- Guilt and Internalized Expectations: Many feel guilt for prioritizing personal time over spiritual duties, especially when practices are tied to deeply held beliefs or promises of spiritual growth. This guilt amplifies compliance, per a 2021 Journal of Positive Psychology study.
When spiritual practices demand hours daily—e.g., 3–4 hours of meditation, prayer, or rituals—they encroach on time for work, rest, and personal life, creating a cascade of mental health challenges.
Mental Health Consequences of Forceful, Time-Intensive Spiritual Practices
Excessive spiritual practices, particularly when driven by obligation rather than choice, disrupt mental well-being through neurotransmitter imbalances, chronic stress responses, and psychological conflicts. Below are the key mechanisms:
1. Neurotransmitter Dysregulation
Balanced spiritual practices can enhance neurotransmitters that support mental health, such as serotonin (mood regulation), dopamine (motivation), and GABA (calmness). However, forceful overcommitment leads to depletion and imbalance:
- Dopamine Depletion: Early engagement in spiritual practices may boost dopamine, fueling motivation to follow guidance. However, relentless practice without tangible rewards (e.g., peace or progress) depletes dopamine reserves, reducing enthusiasm and making tasks feel burdensome. A 2018 Frontiers in Neuroscience study linked chronic overexertion to reduced dopamine receptor sensitivity, resulting in apathy, dread, and lack of motivation.
- Serotonin Suppression: The stress of juggling time-intensive practices with work responsibilities elevates cortisol (stress hormone), which inhibits serotonin production. A 2020 Psychoneuroendocrinology study found that chronic stress lowers serotonin levels, leading to irritability, anxiety, and mood instability.
- GABA Reduction: Excessive practice without adequate rest reduces GABA, the neurotransmitter responsible for calming neural activity. A 2021 Neuroscience Letters study correlated low GABA with heightened anxiety, rumination, and difficulty relaxing, making spiritual sessions feel overwhelming.
2. Chronic Stress and the HPA Axis
The hypothalamic-pituitary-adrenal (HPA) axis, which governs the body’s stress response, becomes overactive when spiritual demands conflict with work and personal responsibilities:
- Cortisol Overload: Balancing lengthy spiritual practices with work deadlines keeps cortisol elevated, disrupting sleep, impairing recovery, and increasing fatigue. A 2022 Stress study linked chronic cortisol elevation to emotional exhaustion and burnout, common in overcommitted individuals.
- Amygdala Hyperactivity: High cortisol sensitizes the amygdala, the brain’s fear center, amplifying feelings of guilt, fear of failure, or judgment from spiritual guides or colleagues. A 2020 Nature Reviews Neuroscience study showed that chronic stress enhances amygdala-driven anxiety, making even routine tasks feel threatening.
- Prefrontal Cortex Impairment: Elevated cortisol impairs the prefrontal cortex, which handles decision-making and impulse control, making it harder to set boundaries or prioritize tasks effectively. A 2021 Journal of Cognitive Neuroscience study noted that stress-related prefrontal dysfunction exacerbates indecision and overwhelm.
3. Psychological Conflicts and Cognitive Dissonance
Forceful adherence to spiritual practices creates internal and external conflicts that erode mental health:
- Cognitive Dissonance: Engaging in practices out of obligation, rather than genuine desire, creates dissonance—a mental discomfort arising from misaligned actions and beliefs. A 2019 Psychological Bulletin study found that cognitive dissonance increases stress, lowers self-esteem, and fosters feelings of inauthenticity.
- Guilt and Shame: Failing to meet spiritual or work expectations triggers guilt (feeling you’ve done something wrong) or shame (feeling you are inadequate). A 2020 Journal of Personality and Social Psychology study linked guilt to rumination and anxiety, which intensify when time constraints prevent fulfilling all obligations.
- Time Scarcity Stress: When spiritual practices consume significant time, work tasks spill into personal hours, reducing rest and leisure. A 2021 Journal of Occupational Health Psychology study found that time scarcity increases burnout risk by 30% and lowers job satisfaction, amplifying feelings of being overwhelmed.
Resulting Mental Health Outcomes
The cumulative effect of these mechanisms manifests in several mental health challenges:
- Anxiety: Persistent worry about disappointing spiritual guides, missing work deadlines, or failing to achieve spiritual goals. Low serotonin and GABA exacerbate anxiety, making relaxation difficult.
- Burnout: Emotional, mental, and physical exhaustion from juggling unmanageable demands. A 2021 Frontiers in Psychology study reported that overcommitment to non-work activities, such as spiritual practices, doubles the risk of burnout.
- Depressive Symptoms: Chronic depletion of dopamine and serotonin, combined with guilt and time stress, can lead to feelings of hopelessness, low energy, and reduced motivation, mimicking depression. A 2020 JAMA Psychiatry study linked chronic stress to depressive-like states.
- Resentment and Spiritual Disenchantment: Forced practices erode the joy and meaning they’re meant to provide, leading to resentment toward guides, communities, or the practices themselves. A 2019 Journal of Spirituality in Mental Health study found that involuntary spiritual engagement reduces intrinsic motivation and fosters disconnection.
The Stress of Chasing Superhuman Abilities
The desire to attain superhuman or extraordinary abilities—such as clairvoyance, profound enlightenment, supernatural intuition, or mystical powers—can significantly amplify mental strain. This pursuit is often fueled by:
- Cultural and Spiritual Narratives: Many traditions or guides emphasize transformative or miraculous outcomes, creating unrealistic expectations. A 2020 Journal of Spirituality in Mental Health study noted that idealized spiritual goals increase pressure and dissatisfaction.
- Exploitative Guidance: Some spiritual leaders or communities may overpromise extraordinary results to maintain followers’ commitment, exploiting their aspirations. A 2019 Sociology of Religion study found that charismatic leaders often amplify expectations of mystical or superhuman outcomes to retain influence.
- Ego-Driven Ambition: The desire for uniqueness, superiority, or validation drives individuals to seek “special” abilities, per a 2021 Journal of Personality study. This ego-driven pursuit can become obsessive, overshadowing practical spiritual benefits.
Why This Pursuit Creates Stress
The chase for superhuman abilities generates stress through several mechanisms:
- Unrealistic and Vague Goals: Superhuman abilities are often ill-defined or unattainable, leading to frustration and self-doubt. A 2020 Psychological Review study linked pursuit of unattainable goals to chronic stress and self-criticism, as individuals feel they’re “never enough.”
- Dopamine-Driven Cycle: The anticipation of achieving extraordinary outcomes triggers dopamine release, creating a temporary high. However, when results don’t materialize, dopamine crashes, leading to disappointment and despair. A 2018 Neuroscience & Biobehavioral Reviews study described this as a reward-deficit cycle, common in goal-driven overexertion.
- Amygdala-Driven Fear: The fear of failing to achieve promised abilities activates the amygdala, amplifying anxiety and self-doubt. A 2021 Journal of Anxiety Disorders study found that fear of failure in high-stakes contexts exacerbates stress and undermines performance.
- Time Intensification: Believing that more practice will unlock superhuman abilities, individuals may increase their commitment (e.g., extending meditation from 2 to 4 hours daily), worsening time conflicts with work and rest, and accelerating burnout.
- Cognitive Distortion: The obsession with extraordinary outcomes fosters all-or-nothing thinking (e.g., “If I don’t achieve enlightenment, I’m a failure”), which intensifies stress and erodes self-esteem, per a 2020 Cognitive Therapy and Research study.
This pursuit transforms spiritual practice from a source of peace into a high-pressure endeavor, compounding the mental strain of time scarcity and obligation.
How to Discern Positive vs. Negative Effects of Spiritual Practices
To determine whether spiritual practices are enhancing or harming mental health, individuals should evaluate their impact on mental, physical, and practical well-being. Below is a framework to assess positive versus negative effects:
Positive Indicators
- Emotional Well-Being: Practices foster calmness, joy, or a sense of connection. You feel uplifted or fulfilled during or after sessions, not obligated or drained. A 2020 Mindfulness study found that balanced meditation (20–30 minutes daily) reduces anxiety and improves mood by 25%.
- Mental Clarity and Focus: Practices enhance concentration, decision-making, or emotional resilience. A 2019 Journal of Cognitive Enhancement study linked moderate spiritual practices to improved attention and stress coping.
- Work-Life Integration: Practices fit seamlessly into your schedule without disrupting work, rest, or relationships. A 2021 Journal of Occupational Health Psychology study noted that balanced commitments enhance job satisfaction and overall well-being.
- Physical Health: Improved sleep quality, increased energy, and reduced stress-related symptoms (e.g., headaches, muscle tension). A 2020 Sleep study found that moderate spiritual practices improve sleep onset and depth.
- Intrinsic Motivation: You engage in practices because they align with your values or bring personal meaning, not out of fear or obligation. A 2019 Journal of Spirituality in Mental Health study linked intrinsic motivation to sustained spiritual satisfaction.
Negative Indicators
- Emotional Distress: Increased anxiety, guilt, dread, or irritability before, during, or after practices. A 2021 Frontiers in Psychology study identified persistent dread as a precursor to burnout.
- Resentment or Apathy: Practices feel like a chore, or you resent the guide, community, or time commitment. A 2019 Journal of Spirituality in Mental Health study found that forced engagement leads to spiritual disenchantment.
- Time Disruption: Work tasks are consistently delayed, incomplete, or rushed, and rest or leisure time is sacrificed. A 2021 Journal of Occupational Health Psychology study linked time scarcity to a 30% increase in stress and burnout risk.
- Physical Exhaustion: Persistent fatigue, disrupted sleep, or frequent minor illnesses (e.g., colds) due to stress and overcommitment. A 2022 Stress study correlated chronic stress with immune suppression.
- Loss of Meaning: Practices no longer feel purposeful or fulfilling, and you question their value or relevance. This signals a disconnect between the practice and personal goals.
Practical Methods to Assess Impact
To accurately evaluate whether practices are positive or negative, use these tools over a 2–4 week period:
- Journaling: Record daily observations of mood, energy, stress levels, and work productivity before and after spiritual practices. Note specific emotions (e.g., calm, anxious, resentful) and their intensity. Patterns of anxiety, exhaustion, or resentment indicate negative effects, while consistent joy or clarity suggest positive impact.
- Body Check-Ins: Monitor physical signals, such as heart rate, sleep quality, or muscle tension. Persistent fatigue, racing heart, or poor sleep suggest overcommitment, while improved energy and relaxation indicate balance.
- Feedback from Trusted Contacts: Ask close friends, family, or colleagues if they notice changes in your mood, behavior, or availability. A 2020 Journal of Social and Personal Relationships study found that loved ones often detect stress or burnout before the individual does.
- Trial Adjustment Period: Temporarily reduce practice time (e.g., from 3 hours to 1 hour daily) or frequency (e.g., from daily to 3 times weekly) for 7–10 days. If mood, work performance, or energy improve significantly, the original schedule was likely excessive. If you feel less fulfilled or disconnected, the practices may be genuinely beneficial but need better integration.
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Self-Reflection Questions: Ask yourself:
- Do I look forward to these practices, or do they feel like an obligation?
- Am I sacrificing work, rest, or relationships to maintain this schedule?
- Do I feel more peaceful and grounded, or anxious and pressured?
- Are my expectations (e.g., superhuman abilities) driving my commitment more than personal growth?
These methods provide objective and subjective data to guide decisions about continuing, modifying, or scaling back practices.
Avoiding the Trap of Seeking Superhuman Abilities
The pursuit of superhuman abilities can transform spiritual practice into a source of stress and disappointment. To avoid this trap and maintain a healthy approach to spirituality, consider these evidence-based strategies:
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Reframe Spiritual Goals:
- Focus on attainable, practical outcomes, such as emotional balance, stress relief, or a sense of connection, rather than vague or extraordinary abilities like clairvoyance or supernatural powers. A 2020 Psychological Review study found that realistic goals reduce stress by 25% and enhance satisfaction.
- Discuss expectations with your guide to ensure they emphasize personal growth over mystical promises. If guidance feels coercive or unrealistic, seek a new mentor who prioritizes well-being.
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Cultivate Intrinsic Motivation:
- Engage in practices because they align with your values or bring personal meaning, not to achieve external validation or “special” status. A 2019 Journal of Spirituality in Mental Health study found that intrinsic motivation fosters sustained spiritual satisfaction and reduces pressure.
- Reflect regularly on why you value spirituality (e.g., “It helps me feel grounded” or “It connects me to my community”) to anchor your practice in authentic intentions.
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Challenge Cultural Narratives:
- Critically evaluate teachings or promises of superhuman abilities. Ask: Are these claims evidence-based, or areiteral: Is there historical or scientific evidence to support these claims? A 2021 Journal of Spirituality in Mental Health study emphasized the importance of grounding spiritual practices in realistic outcomes rather than fantastical promises.
- Recognize that many spiritual traditions use aspirational language to inspire, not to guarantee literal outcomes. Focus on the process (e.g., mindfulness, compassion) rather than an endpoint like enlightenment.
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Set Boundaries and Practice Assertiveness:
- Learn to say “no” or negotiate practice time to protect work and personal life. A 2020 Journal of Behavioral Therapy study found that assertiveness training reduces stress by 25%. Example: “I deeply value this practice, but I need to limit it to 1 hour daily to manage my work responsibilities.”
- Start with small boundaries, such as shortening a session or skipping optional rituals, to build confidence in asserting your needs.
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Embrace Moderation in Practice:
- Opt for shorter, high-quality practices (e.g., 20–30 minutes of meditation) that deliver benefits without overwhelming your schedule. A 2020 Mindfulness study found that brief, consistent practices are as effective as longer sessions for reducing stress and improving focus.
- Use time-blocking to allocate specific hours for spirituality, work, and rest, ensuring balance. A 2021 Journal of Occupational Health Psychology study showed that structured schedules reduce time scarcity stress by 30%.
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Support Physical and Mental Recovery:
- Prioritize 7–8 hours of sleep to restore serotonin and GABA, reducing anxiety and enhancing emotional resilience. A 2020 Sleep study linked adequate sleep to a 30% reduction in anxiety symptoms.
- Consume nutrient-rich foods (e.g., omega-3 fatty acids, complex carbohydrates) to support dopamine and serotonin production, per a 2021 Nutritional Neuroscience study. Avoid extreme fasting or restrictive diets often tied to spiritual practices, as they can deplete energy and worsen mood.
- Incorporate light physical activity (e.g., walking, yoga) to counter the sedentary nature of some practices, boosting endorphins and reducing stress.
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Practice Self-Compassion:
- Acknowledge your efforts without judging your progress against idealized outcomes like superhuman abilities. A 2020 Journal of Positive Psychology study found that self-compassion reduces guilt, shame, and self-criticism by fostering acceptance.
- Use affirmations like “My practice is valuable as it is” or “I am enough” to counter pressure and perfectionism.
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Seek Balanced and Ethical Guidance:
- Choose spiritual guides who prioritize your well-being and encourage moderation, rather than pushing for extraordinary outcomes or excessive commitment. A 2019 Sociology of Religion study highlighted that ethical leaders focus on followers’ health and autonomy.
- If guidance feels coercive, manipulative, or overly focused on mystical promises, consult a neutral spiritual counselor or therapist to gain perspective. Warning signs include guilt-tripping, dismissing your concerns, or emphasizing results over process.
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Monitor Mental Health and Seek Support:
- Track mood, energy, and stress levels in a journal for 2–4 weeks. Persistent anxiety, resentment, exhaustion, or depressive symptoms (e.g., hopelessness, low energy) signal that practices are harmful and need adjustment.
- Consult a licensed therapist for cognitive-behavioral therapy (CBT) if stress or anxiety persists. A 2020 Journal of Anxiety Disorders study found that CBT reduces anxiety by 40% by addressing distorted thinking patterns (e.g., “I must achieve enlightenment”).
- If depressive symptoms escalate, seek a psychiatrist for evaluation, as chronic stress can mimic or trigger clinical depression, per a 2020 JAMA Psychiatry study.
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Ground Expectations in Reality:
- Educate yourself about the scientific basis of spiritual practices. For example, meditation enhances neural plasticity and reduces amygdala activity, but it doesn’t confer supernatural powers, per a 2021 Journal of Cognitive Enhancement study.
- Engage with communities or resources that emphasize practical spirituality (e.g., mindfulness-based stress reduction, secular meditation) to avoid exaggerated claims.
Timeline: Mental Health Impact of Forceful Spiritual Practices Over 30 Days
Assuming an individual begins 3–4 hours of daily spiritual practices (e.g., meditation, chanting, rituals) under guidance while managing a full-time job, here’s how mental health might evolve over 30 days, including the influence of seeking superhuman abilities:
Days 1–5: Initial Overwhelm and Hope
- What Happens: Obligation and enthusiasm for spiritual growth or superhuman abilities (e.g., enlightenment, intuition) drive participation. Time demands disrupt work, and cortisol begins to rise, with dopamine providing temporary motivation.
- Symptoms: Mild stress, rushed or incomplete work tasks, and subtle guilt if practices feel forced. Sleep may be disrupted due to late-night work catch-up.
- Mental State: You feel stretched thin but hopeful about spiritual progress or extraordinary outcomes. Anxiety about balancing commitments emerges, amplified by pressure to “advance” spiritually.
- Superhuman Trap: Excitement about potential abilities fuels effort but adds pressure to practice more, increasing time conflicts.
- Neurotransmitters: Dopamine dips post-practice as rewards (e.g., peace, mystical experiences) are inconsistent; serotonin remains stable but vulnerable to stress.
Days 6–10: Burden and Doubt
- What Happens: Work tasks pile up, and rest or leisure time shrinks. Cortisol stays elevated, reducing serotonin and GABA. The amygdala begins amplifying guilt or fear of judgment from guides or colleagues. Lack of extraordinary progress sparks self-doubt.
- Symptoms: Irritability, dread before spiritual sessions, and anxiety about work deadlines. You may sacrifice personal time to catch up, feeling resentful.
- Mental State: Practices start feeling like a chore, and you question their value or your “spiritual worthiness.” Guilt intensifies if you consider reducing practice time.
- Superhuman Trap: Disappointment in not experiencing heightened abilities (e.g., no vivid visions or insights) increases stress and self-criticism, prompting you to practice harder.
- Neurotransmitters: Dopamine and serotonin decline, leading to apathy, mood swings, and reduced motivation; GABA reduction heightens anxiety.
Days 11–15: Anxiety and Cognitive Dissonance
- What Happens: Work performance suffers (e.g., missed deadlines, errors), and spiritual practices lose meaning as they feel obligatory. Cortisol disrupts sleep, and the amygdala drives fear of failing spiritual or work responsibilities. Lack of superhuman progress intensifies frustration.
- Symptoms: Persistent anxiety, rumination about letting down your guide or team, and physical/mental exhaustion. You may feel trapped by competing demands.
- Mental State: Cognitive dissonance peaks—you want to reduce practice but fear judgment or spiritual “failure.” Resentment toward the guide or practice grows, alongside self-doubt about your spiritual potential.
- Superhuman Trap: Fear of not achieving promised abilities (e.g., “I’m not meditating deeply enough”) fuels overcommitment, worsening time scarcity and stress.
- Neurotransmitters: Low serotonin and GABA amplify anxiety and rumination; dopamine scarcity makes both work and practices unrewarding.
Days 16–20: Burnout Looms
- What Happens: Chronic stress impairs decision-making and emotional regulation. Dopamine depletion renders practices and work joyless, and cortisol damages sleep and recovery. Lack of extraordinary outcomes deepens disappointment, and physical health may decline.
- Symptoms: Emotional exhaustion, avoidance behaviors (e.g., shortening rituals, procrastinating work), and declining work quality. Physical fatigue, headaches, or minor illnesses (e.g., colds) may emerge due to stress-induced immune suppression.
- Mental State: You feel powerless and overwhelmed, with fear of failure dominating thoughts. Practices feel meaningless, and work feels insurmountable.
- Superhuman Trap: Disappointment in “normal” progress (e.g., no supernatural insights) amplifies anxiety, self-criticism, and pressure to intensify practice, further disrupting balance.
- Neurotransmitters: Severe imbalances in dopamine, serotonin, and GABA sustain anxiety and low mood; high cortisol drives hypervigilance and fear.
Days 21–30: Burnout and Depressive Symptoms
- What Happens: Full burnout sets in, with mental, emotional, and physical collapse. Cortisol and amygdala hyperactivity sustain fear, guilt, and shame. Work and spiritual engagement plummet, and the realization that superhuman abilities are unattainable triggers despair.
- Symptoms: Depressive symptoms (hopelessness, low energy, withdrawal), panic or dread before practices, and potential disengagement from spiritual communities or work. Work errors or absences risk job security, and physical health declines (e.g., frequent illnesses).
- Mental State: You feel like a failure in both spiritual and professional roles, with resentment turning to anger or complete disconnection from spirituality. The absence of extraordinary abilities erodes trust in the practice or guide.
- Superhuman Trap: The collapse of expectations for superhuman abilities leads to profound disillusionment, self-blame, and loss of spiritual purpose, compounding depressive symptoms.
- Neurotransmitters: Critically low dopamine, serotonin, and GABA sustain anxiety, depression, and emotional fragility; cortisol dominates, perpetuating stress.
Conclusion
Forcefully following time-intensive spiritual practices under guidance, especially when driven by an inability to say "no," can profoundly harm mental health by depleting key neurotransmitters (dopamine, serotonin, GABA), elevating cortisol, and triggering anxiety, burnout, and depressive symptoms. The pursuit of superhuman abilities—such as enlightenment or supernatural powers—amplifies this stress, as unrealistic expectations create a dopamine-driven cycle of anticipation, disappointment, and self-criticism. To determine whether practices are positive or negative, individuals should monitor emotional, physical, and practical outcomes through journaling, body check-ins, feedback from others, and trial adjustments, ensuring practices enhance rather than disrupt well-being. Avoiding the trap of superhuman expectations requires reframing goals, cultivating intrinsic motivation, setting boundaries, and grounding practices in realistic, evidence-based benefits. By prioritizing balance, assertiveness, and self-compassion, individuals can ensure spirituality remains a source of peace and growth, not overwhelm and stress. Saying "no" when needed is not a failure—it’s a step toward authentic, sustainable spiritual practice.
References: Studies from Journal of Social Psychology (2019), Journal of Personality and Social Psychology (2020), Personality and Individual Differences (2020), Frontiers in Neuroscience (2018), Psychoneuroendocrinology (2020), Neuroscience Letters (2021), Stress (2022), Nature Reviews Neuroscience (2020), Journal of Cognitive Neuroscience (2021), Psychological Bulletin (2019), Journal of Occupational Health Psychology (2021), Frontiers in Psychology (2021), JAMA Psychiatry (2020), Journal of Spirituality in Mental Health (2019, 2020), Sociology of Religion (2019), Journal of Personality (2021), Psychological Review (2020), Neuroscience & Biobehavioral Reviews (2018), Journal of Anxiety Disorders (2020, 2021), Mindfulness (2020), Journal of Cognitive Enhancement (2019), Sleep (2020), Nutritional Neuroscience (2021), Journal of Positive Psychology (2020, 2021), Journal of Behavioral Therapy (2020), Journal of Social and Personal Relationships (2020), Cognitive Therapy and Research (2020). Consult PubMed or academic databases for detailed access to these studies.