Barriers to Belief: Mental Distress and Disaffection from the Church

We probably all know people who have left the Church. For many of us, I’m sure that is why we are here today. Often, people become involved in apologetics because they want to help convince their friends or family members who have left the Church to come back. Or they want to understand why they left. Or they want to help prevent others from leaving.

About 25 years ago, one of my best friends left the Church. As I have struggled to understand why this young man who was raised in the Church, had served a mission and was married in the temple later left the Church, other close friends, extended family members, and immediate family members have also left the Church. As a result, I have thought a lot about why. I have had conversations with people who have left, I have studied perhaps hundreds of stories that have been shared online and I have examined survey results and scientific literature to gain some understanding of their perspectives. Along the way, I’ve also met with many therapists and researchers. Dr. Giles is one of those and I’m grateful for his willingness to join me in making this presentation.

We would like now to share some observations with you, and I hope that having this kind of discussion will help all of us to be better shepherds. We have come to understand that there are many factors that contribute to disaffection from the Church. I’ll begin with a general discussion of this topic but we will then focus on mental distress as one of the many factors that can contribute to disaffection from the Church. And when we say “mental or emotional distress,” we intend to include not only mental illness, but also distress that perhaps falls short of meeting all of the criteria for a clinical diagnosis. Mental and emotional distress can impact all of us even if we are not actually diagnosed with mental illness. And while mental distress is not the only, and perhaps not even the predominant factor, it is worth examining and understanding the role it may play in the development of a faith crisis as we seek to lift one another’s burdens.

Disaffection from the Church is not new. Before we even came to this world, a third part of the host of Heaven turned away from God. (Rev. 12:4; D&C 29:36) We can read all throughout the scriptures stories of the children of “goodly parents” who deny their faith. But the reasons are not always clear.

In more recent times, we have all been aware of those among us who have drifted away. Growing up, I had relatives and neighbors who simply appeared to have lost interest in religion, and just became more interested in doing other things on Sunday. We may have attributed their disaffection to the fact that they were offended, or that they couldn’t stop smoking or that they really, really liked the taste of coffee. Or, they may have quietly continued attending church, even though they had lost their faith, for fear of becoming social outcasts in a large community of believers.

One thing that is different today is that there are more ways for people to share their stories of disaffection from the Church than ever before. And the fact that there are new outlets for sharing these stories has perhaps emboldened people to be more open about their loss of faith.

It is not hard, now, to find a new community on the internet; a community of non-believers. A community with whom one can share one’s story of disaffection from the Church and instead of shock, fear and dismay, they will encounter compassion, understanding and encouragement. Therefore, in seeking to prevent disaffection from the Church, it is more important now than ever that we extend compassion, understanding and encouragement to those who express feelings of pain, doubt and discouragement while they are still in the Church. We must prepare to address the sincere crisis with compassion and truth. After all, if people who are experiencing a faith crisis find more comfort and compassion outside of Christ’s community, we probably are not doing what Jesus would do.

Of course, some of the comfort offered outside the community of believers is false comfort, and we should be clear about that.  One thing often said by online critics is that Church membership is in decline and that even Elder Marlin K. Jensen admitted that people are “leaving in droves.” However, it is not true that membership is in decline or that Elder Jensen said that people are “leaving in droves.”[1] In fact, once people started claiming that Elder Jensen had said this, it was reported in the Washington Post that, Elder Jensen insisted that critics of the Church were overstating the LDS exodus over the Church’s history. He was quoted as saying, “To say we are experiencing some Titanic-like wave of apostasy is inaccurate.”[2] He is, however, concerned about people encountering troubling information on the internet and leaving the Church.

In the face of growing membership rolls for the Church internationally, critics of the Church claim that there is actually a wave of apostasy that is simply obscured in the Church’s official numbers since many people leave the Church and do not remove their names from the rolls. However, this speculation is refuted by the data. Attendance at other predominantly white, Christian churches in America is in decline. But researchers have noted that “there is little evidence to suggest that [the Church of Jesus Christ of Latter-day Saints is] experiencing similar declines.” [3] While it is true that Church growth in the United States has slowed, when Americans are asked what Church they belong to, the same proportion of people, 1.9%, claimed they were Mormons in 2017 as they did in 2011.

It has been reported that Christian millennials in general, not just Mormon millennials, are “leaving in droves.”[4] It therefore significant to note that “Mormons are also much younger than other white Christian religious traditions. Nearly one-quarter (23%) of Mormons are under the age of 30. Fewer than half (41%) are age 50 or older.”[5] In light of the fact that our Church is younger than other churches, and yet is it not shrinking like other churches, it seems, as Mark Twain might say, the reports of the death of the Church are greatly exaggerated.

Of course, reports that people are leaving in droves may help those who leave the Church to feel more confident in their decisions, especially as they join on-line communities. When someone close to you leaves the Church, something shifts. The taboo against leaving is diminished and the social prohibition that says that leaving the Church is something you should not do fades too. Social media amplifies that because more people hear about it. As people feel supported in their decision to leave the Church, and emboldened in finding they are not alone, we hear more about why they have left. The bright side of this is that it gives us the opportunity to understand and to prepare a wiser, more compassionate and more effective ministry to those who are struggling.

It can come as a surprise to those who have assumed that people only leave because they were sinning to hear all variety of reasons that people have left. It may also have come as a surprise to hear President Uchtdorf say that, “[s]ometimes we assume it is because they have been offended or lazy or sinful. Actually, it is not that simple. In fact, there is not just one reason that applies to the variety of situations.”[6] In fact, when the Pew Forum on Religion and Public Life asked over 2,800 Americans why they had decided to join a new church, or leave religion behind entirely, “[t]he answers were so varied that analysts nearly ran out of codes to categorize them.”[7]

Discussions regarding loss of faith among Mormons commonly identify intellectual or social factors, such as troubling historical or doctrinal issues,[8] or social or cultural factors, such as not feeling like they belonged among Mormons, or simply wanting to do other things with their time.[9] So there is not just one reason all people leave. But it is also true that for any one person, there are probably a complicated variety of factors that led to an exit from the Church.

In my personal experience of examining the stories of people who have left the Church, I’ve found that people often point to some incident that ignited a flame under them, creating severe emotional pain. When the flame was not extinguished, it became too difficult to stay in the Church. They may have identified some point of doctrine or episode of history or a policy of the Church. Some have acknowledged being offended by a Church leader or other member. Some have reported that due to shame or guilt, they stayed away and found it difficult to return. And, of course, there are other reasons.

Unfortunately, believers can sometimes be dismissive of the doubter’s pain. For every person who identifies one particular issue that led to their exit, there are many others who have encountered the same issue and have decided to stay. Church apologists who are familiar with the arguments against the Church and the responses to those arguments are sometimes guilty of exclaiming “They left because of that! That’s just silly!” Every member of the Church has encountered difficult doctrinal or historical issues. Every member has been offended or felt like they did not fit in. And every member has sinned. (Rom. 3:23) So when those of us who stay hear that someone left because of one particular issue, we may find it hard to understand unless it is an issue with which we have personally struggled. And even then, we may conclude that we stayed, so they should too.

Of course, some who have left the Church find it difficult to understand how we can stay. They often assume that if we just knew what they knew, if we just watched this movie, or read that letter, we wouldn’t stay either. They are surprised to learn that many of us know everything that they know, but choose to stay anyway. And just as there are a variety of reasons people leave, there are a variety of reasons that we stay. We hope that the reasons we stay may help others to see how they too can stay. However, as we are always ready to give a reason for the hope that is within us, we should do so with gentleness and respect (1 Pet. 3:15). We should not trivialize, demonize, or dismiss those who leave. We don’t embrace the apostasy, of course, but we should seek to understand and love the lost sheep, and where we can, offer comfort, care and compassion.

Whether one leaves or stays, a complex set of factors is involved. Once some incident lights a flame of discontent, various other experiences may feed the flame. For example, a person who is disturbed by some item of history or doctrine may begin to find it harder to avoid taking offense at the actions of Church leaders and Church policies. A person who feels overwhelmed by the demands of a religion that calls upon us to become perfect, (Matt. 5:48), may stumble upon upsetting issues related to Church doctrine or history and feel relieved at the thought that perhaps it isn’t true anyway. A variety of social, historical, doctrinal, spiritual and intellectual factors combine, so that, if a person does not find a way to douse the flame of distress, they will feel compelled to escape.

Along with social, historical, doctrinal, spiritual and intellectual factors, psychology may also play a prominent role in many cases. This concept first dawned on me as I searched for answers to the question of why people leave the Church. As I looked for common factors among those closest to me, and among the stories of others who have shared their experiences on the internet, it occurred to me that many of those who leave the Church comment on the mental illnesses they are also experiencing. I began to explore the possible connection between mental distress and disaffection from the Church and I found an emerging body of scientific literature that helps explain how depression and anxiety disorders can possibly contribute to disaffection from the Church.

A 2015 survey conducted by Michelle Medeiros, a non-Mormon Ph.D. candidate at Palo Alto University, found that “more religious Mormons were more likely to report lower levels of obsessions and compulsions, and, correspondingly, less religious Mormons were more likely to report higher levels of these traits.” [10] One could say that either OCD is causing a decrease in religiosity, or a decrease in religiosity is causing an increase in OCD. However, as OCD has a strong biological component, it seems more likely that OCD may be causing a decrease in religiosity.

Scientists have also observed that “there are major similarities in information processing between anxious and depressed patients. In both groups, maladaptive schemata systematically distort the processes involved in the perception, storage, and retrieval of information.”[11] In other words, people with depression and anxiety see things differently and remember things differently.[12] It has also been postulated that “‘an anxious patient will be hypersensitive to any aspects of a situation that are potentially harmful but will not respond to its benign or positive aspects.’ There is plentiful evidence that anxious individuals selectively allocate processing resources to threatening rather than to non-threatening stimuli.”[13] “Non-anxious individuals, if anything, show the opposite kind of bias”[14]

To illustrate this point, two friends of mine who are married were burglarized once while they were at church. She is anxious and he is not.  It haunts her to remember how he left a side door unlocked which allowed the burglar to enter their home while they were away. She ruminates on what might have happened if they had surprised the intruder by returning while he was there.  Despite his wife’s distress, he still forgets to lock doors. When he is home he doesn’t lock the door to the house or garage, even at night. By contrast, she locks doors whenever possible, including times when she has locked him out of the house while he mowed the lawn.  Their psychology results in completely different evaluation of likely threats, even after experiencing the same burglary through an unlocked door.

A substantial body of research exists that demonstrates that anxious people, whether they have been diagnosed with an anxiety disorder or whether they simply have an anxious disposition, are drawn to threatening information, tend to dwell on threatening information longer than others, and tend to interpret information in a threatening way when the information is ambiguous.[15] Whether they experience a social phobia, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, or generalized anxiety disorder, they have a harder time ignoring information that they perceive as threatening.[16]

When the future is unclear, people who experience anxiety and depression tend to expect the negative and tend to expect the results to be more costly when compared to those who are not anxious or depressed.[17]

This research makes it easier to understand how two different people can encounter the same information and respond to it in very different ways. Consider how this may play out when encountering information regarding Church history, policies, doctrine, or ambiguous social situations. An anxious person will tend to focus on the threatening information, will tend to think about it longer, and when it is open to multiple interpretations, an anxious person will tend to interpret it in a more threatening way. If you are generally more likely to identify a situation as threatening, and more likely to expect the results of the issue to be devastating, your experience with challenging issues at Church is more likely to be painful and hard to ignore or dismiss.

For many of us, when we encounter Church history or doctrine that is upsetting or hard to understand, we find some relief in “putting it on the shelf.” We stop thinking about it and perhaps come back to it later when we have more information. However, those who are anxious or depressed seem to experience difficulties in ignoring or forgetting negative information.[18] It is more difficult for them to divert their attention from threatening information.[19] For many people, they cannot just “put things on the shelf” and forget about them. Instead, issues that they find threatening just keep piling up, but do not easily leave their forefront of their minds. In light of this, it is interesting to note that many ex-Mormons talk about how, after putting so many things “on the shelf,” their shelf finally broke. It is therefore important to ask how we might help unburden a loaded shelf before it breaks, or strengthen the shelf, or repair a broken shelf and clean up the shattered mess beneath it.

In many instances you don’t need a scientific study to tell that depression and anxiety can reduce Church activity. If someone is lying in bed for most of the day due to depression, that probably explains why they are not coming to Church on Sunday morning. We may wrongly assume that they have been offended, or have lost their faith for some reason, without considering that the person may need to be treated for depression.  In the past, some bishops have maybe even felt reluctant to refer someone to a psychologist. However, the Church now provides bishops with resources to address mental illness and LDS.org[20] even lists phone numbers people can call along with information on how to respond to mental illness. So as we minister to others, and seek to build faith, is it important to recognize how mental distress can affect our experience at Church. Inactivity due to mental health issues may spiral into a faith crisis. Faith comes by hearing the word (Rom. 10:17) and faith grows as we nourish the seeds of faith, (Alma 32:37). Faith may begin to wither and weaken when a person reduces activity in the Church and isolates oneself from hearing the word.

Anxiety psychology probably impacts church participation in significant numbers in ways we may not have considered. Another interesting study is being conducted by Jana Reiss who commissioned a survey of 541 former Mormons to determine why they left the Church. She reports that, among millennials, tied for first place among the reasons they gave for leaving the Church was that they “felt judged or misunderstood.”[21] This is especially interesting in light of the fact that “[t]he defining feature of social anxiety disorder, also [sometimes] called social phobia, is intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation.” [22] Of course, all of us experience some concern over being judged by others. But when the concern starts to interfere with normal activities, this ordinary concern may have developed into a psychological disorder.  This is a condition that “affects approximately 15 million American adults and is the second most commonly diagnosed anxiety disorder following specific phobia. The average age of onset for social anxiety disorder is during the teenage years,” just the time when we see many begin to drift away from the Church. There are effective treatments available for social anxiety disorders, through therapies and other means. Sadly, “[d]espite the availability of effective treatments, fewer than 5% of people of with social anxiety disorder seek treatment in the year following initial onset and more than a third of people report symptoms for 10 or more years before seeking help.”[23]

Our Church expects us to be social. We are expected to speak and pray in Church, to teach lessons, read things aloud, answer questions in class, call people on the phone, and we are sometimes asked to knock on the doors of strangers and ask them if they are willing to drastically change their lives. These are difficult things for anyone to do, but they can be among the hardest things to do, or simply impossible, when someone experiences an anxiety disorder. Someone may be sitting in the lobby during sacrament meeting because they find it difficult to be in a room with a large group. Or someone may go home after sacrament meeting because they feel worn out after spending an hour in a crowd of people and they need to take a break. We may wrongfully assume they have a weak testimony. As a consequence, we may begin to treat such a person as one who lacks faith or who has repudiated us and our faith. If that person begins to experience a sense of rejection, they may further distance themselves from members of the Church, they may seek out more supportive communities, or tragically, may simply suffer in isolation. It is not hard to imagine how this kind of separation from members of the Church and Church activity can ultimately result in a loss of testimony.

Similarly, a person who turns down a request to pray in church or give a talk may not have a lack of faith, but may simply have a fear of speaking in public. “As a syndrome, social phobia is the third most common psychiatric disorder, with estimated life-time prevalence rates of 7-13 per cent.”[24] “The fear of public speaking is called Glossophobia (or, informally, stage fright). It is believed to be the single most common phobia affecting as much as 75% of the population.”[25] It is said that people are more scared of public speaking than they are of dying. So when you attend a funeral, most people would rather be in the casket than giving the eulogy.

Someone who experiences maladaptive perfectionism or scrupulosity may feel overwhelmed with guilt and a painful sense of inadequacy as they listen to a speaker talk about how her family reads the scriptures together every day, or how her life was changed by a ministering brother or sister who came every month, or how much she enjoys going to the temple every week. As others talk about how energized and uplifted they felt during the talk, a person with anxiety or depression may feel alone, scared and hopeless as they wonder whether they really belong in this Church and whether they really want to go to heaven if such perfect performance is expected.

Let me share with you now one example of how mental distress can affect a faithful person and how wise leaders and family members can adapt the Church’s standardized ideals to meet the needs of individual circumstances.

We all know that Steve Young did not serve a mission. I always assumed that the reason was that he felt a need to develop his football career, and considering the great influence he has been, I’ve never faulted him for that. But I was surprised recently to learn that he wanted badly to serve a mission and the reason he did not had nothing to do with football. At the time he decided he would not serve a mission, he had been the eighth-string quarterback and had recently been moved to playing defense. More importantly, his decision had nothing to do with a lack of faith. Rather, as he thought about being away from home for two years, he began to feel overwhelmed with anxiety. It had been so difficult for him to just travel to Provo to go to school that he had not actually unpacked his clothes during the entire fall semester. Once he came home for the Christmas break, he decided to talk to his bishop and tell him he could not go on a mission. He felt terribly guilty.

But as he told his bishop that he decided it was best for him to continue going to BYU, his bishop told him about an impression he had received a couple of weeks earlier that Steve was going to visit him to tell him that he planned to return to school. The bishop also received the clear impression that he should tell Steve that it was right for him to return to BYU. Instead of trying to talk him into going on a mission, the bishop told him to serve Jesus Christ, live your religion and be a great example.[26] It was not until he was 32 years old that he was finally diagnosed with separation anxiety. [27]

Steve Young had understanding parents and a bishop who was open to receiving a surprising revelation. It is not hard to imagine how, under a different set of circumstances, Steve Young may have decided that it was easier to leave the Church than it was to remain a member of a Church that had expectations for him that he felt he could not satisfy.

As a Church, we have gotten better at identifying the kinds of problems Steve Young faced and accommodating them. The process of applying for a mission call now includes considerations of mental health, and mission programs are adapted to the capabilities of the faithful youth who struggle with mental health issues.  Calls can be issued for shorter assignments, can be closer to home, and assignments can be adapted to the strengths of faithful individuals without imposing crushing challenges.  Our Church is learning to deploy unique, faithful individuals into appropriate ministries without assuming that every person is the same and must adapt to a standardized pattern.  Likewise, I believe apologists and ministering brothers and sisters can learn to adapt to the unique needs of people who are experiencing a faith crisis, including a faith crisis with mental health components.

Now, in introducing psychology as a factor that can contribute to disaffection from the Church, we hope that we have made very clear that we do not think that there is any one factor that causes a person to leave, including any particular psychological factor. In other words, mental illness is only one factor that could create a vulnerability that can lead to disaffection from the Church. Of course, like other factors mentioned, some people who struggle with mental health issues leave, and some stay.

Our point, of course, is that it may help those who experience mental health issues to stay if they received proper treatment, if they were to consider new perspectives on history, practice and doctrine, or if they received appropriate kinds of support from church leaders, friends and family. So it is our hope in introducing this topic that we can encourage people to be more aware of mental illness issues and seek help for themselves and others.

A significant amount of research exists demonstrating that religion has a positive effect on mental health. Daniel K. Judd found that “the overall body of research from the early part of the twentieth century to the present supports the conclusion that Latter-day Saints who live their lives consistent with the teachings of their faith experience greater well-being, increased marital and family stability, less delinquency, less depression, less anxiety, less suicide, and less substance abuse than those who do not.”[28] As Daniel Peterson explained at last year’s FairMormon conference, regular church attendance is associated with “a roughly 30 percent reduction in mortality over 16 years of follow-up; a five-fold reduction in the likelihood of suicide; and a 30 percent reduction in the incidence of depression.”[29] This suggests that if a person struggles with mental illness, leaving the Church would be counter-productive with respect to mental health. Yet, it seems that some people who experience mental illness choose to disengage from church activity in response to struggles they experience, perhaps assuming that leaving church will resolve their mental anxieties or depression.

This response would not be unlike that of a woman I heard about recently who had panic attacks when she entered parking garages. She initially responded to this by avoiding parking garages. Of course, this made her life more difficult since she often had to park a long way from where she wanted to go. Once she sought treatment for her anxieties, she learned how to begin using a parking garage again, making her life easier and happier.

Similarly, if a person is distressed because of church activity, the answer would not be to stop going to church. Some may feel that it is church that is causing their depression and anxiety, but upon leaving, the mental illness does not go away. They have simply abandoned something that could have helped them. So the proper thing to do would be to seek treatment so that person is able to gain all of the social, intellectual, spiritual, and mental health benefits that come from church activity.

In presenting these ideas, we do not mean to suggest that there are no issues of Church history or doctrine that are confusing or upsetting, or that Church members and Church leaders never do anything that might be considered offensive. What we hope that you will take away from this is that when someone with mental illness is faced with a challenging situation, there are things we can do as friends, family members and Church leaders to help. Of course, there are those who will say that we are stigmatizing those who leave and are suggesting that we can dismiss those who leave the Church as merely being crazy. We are most certainly not saying that. However, the only way to avoid the accusation would be to simply ignore the problem. If we were to ignore the fact that mental illness can make it difficult for some people to remain active in the Church, we would be ignoring an opportunity, and perhaps shirking a duty, to help bear one another’s burdens; to mourn with those who mourn and to comfort those who stand in need of comfort (Mos. 18:8-9).

Just as there are a variety of reasons that people leave, there are a variety of things we can do to help them to stay. So we would like to turn now to a discussion of some of the key features of mental distress that can affect Church activity, and what friends, family, Church leaders and individuals themselves can do to respond to the challenges posed by mental distress.

Features of Mental Distress Which May Present Barriers to Belief and Participation

 In this section, we’ll look at elements which contribute to mental distress and which also may block religious belief and participation.  We will then consider ways that people can get help when suffering from mental distress.

One way to understand mental distress is to consider it through the lens of Cognitive Psychology which is the basis of one of the most common evidence-based treatments for depression³⁰ and one of the most effective.³¹ Cognitive therapy says there is a link between what we think, how we feel, and what we do.³² Our thoughts influence our emotions and our emotions influence our actions.  Using this model, mental distress, which is manifest by our emotions, is viewed as being impacted by our way of thinking.  A number of distorted ways of thinking have been identified as contributing to mental disorders such as Major Depressive Disorder.

As we will more fully explain, the cognitive distortions that contribute to mental distress can also be seen as barriers to belief and participation in religious activities.  This illustration shows that mental distress is built upon cognitive distortions.  Religious belief and participation may be negative affected or blocked by those distorted ways of thinking.

For example, one common cognitive distortion is “All-or-Nothing Thinking.”  All-or-Nothing Thinking causes us to view the world in strict, mutually-exclusive categories.  This way of thinking contributes to depressed mood because when one categorizes one’s experience strictly between perfect and ruined, most experiences will end up in the ruined category–even if they are nearly perfect.  It’s either all or nothing.  There is no in-between. This distortion may affect religious thinking by causing a person to expect that unless every aspect of doctrine makes sense, none of it can be true.  It’s either all or nothing.

Another common distortion is Overgeneralization.  Overgeneralization causes people to view a single event as a never-ending pattern.  This pattern often includes the words “always” and “never.”  This way of thinking contributes to depressed mood by incorrectly concluding that experience has only been of one type while overlooking other aspects of the experience.  A single event is not the same as a never-ending pattern, but Overgeneralization would have you believe otherwise.  This way of thinking may affect religious belief and participation by inaccurately assigning frequency to religious experience (e.g., When an answer to prayer is slow in coming, a person may tell himself or herself that they never get answers to prayers and so they stop praying entirely).

Mental Filter is another common cognitive distortion, causing people to pick one aspect of a situation and make that the focus of their attention while ignoring and filtering out other equally important aspects.  This way of thinking contributes to depressed mood by only orienting to one aspect of a given situation—usually the negative or unfavorable aspect.  An example of this would be when a person focuses on one unkind thing which was said or done to them at church while ignoring or filtering out the many other kind things which have been said or done to them there.

There are other types of cognitive distortions, but the point to be made here is that mental distress is sometimes significantly fueled by cognitive distortions. Such distorted thinking may also serve as a barrier to religious belief and participation.

Fundamental to mental distress related to anxiety is the Intolerance of Uncertainty, or fear of the unknown.  Those who struggle with anxiety tend to have higher intolerance of uncertainty as manifest by persistent thoughts about the unknowns in a particular situation.³³ Dwelling on the unknowns is a surefire way to increase anxious feelings.  In other words, focusing on the unknowns, rather than the knowns, will create mental distress.  In the words of the French Philosopher Michel de Montaigne, “He who fears he shall suffer, already suffers what he fears.”

Anxiety may also arise when new information conflicts with old.  This conflict may make it unclear how to proceed and result in inconsistent thoughts, beliefs or attitudes.  Such internal conflict is often referred to as cognitive dissonance.

Cognitive dissonance may cause us to choose from the following responses: Reject the new information as false; consider the new information as unimportant, suspend judgment (“putting it on the shelf” as discussed above); accept or reject the new information, but with a greater understanding of context and definitions; reject the old information (for example, rather than take the time to process how one’s former assumptions about Church history and doctrine might need to be readjusted, one might hastily decide the Church is not true in order to more quickly resolve the anxiety created by cognitive dissonance and uncertainty).

Besides creating depressed or anxious mood, these distortions can also make it difficult to focus on the more subtle influence of what we call “the still, small voice,” thereby creating a sense of distance or isolation from God and communication with Him, which may be erroneously interpreted as, “God doesn’t care or isn’t there,” instead of being more accurately seen as distorted thinking getting in the way.  Some report that the medications they take also have the effect of muting their sensitivity to those spiritual feelings.

In summary, then, cognitive distortions contribute to mental distress.  Those distorted ways of thinking affect our mood.  Cognitive distortions may also serve to undermine the process of religious belief and participation by creating distorted ways of thinking which make it difficult to process new information when compared to information we already have.

Ways in Which People Can Get Help

So, when a person is experiencing mental distress what can be done?  How can that person be helped?  In this section we’ll consider what can be done by the individual, friends and family, and the Church and Church leaders.  Finally we’ll talk about the prospect of professional help.

It is useful to think about helping people with mental distress as three concentric circles.  The first, in the center, is Self.  Ultimately, the responsibility for overcoming mental distress lies with the individual.  Unless the individual is motivated and engaged, very little progress will be made.   Next is Family and Friends.  These are the people closest to the person in need.  They are the ones who are the most intimately connected to the individual and have the most access.  Next, there is the Church.  The Church consists of neighbors and leaders who also know and love the individual, but are not as intimately acquainted with the individual, perhaps, as family and friends.

The Individual

Healthy practices that a person may adopt to help themselves include exercise,³⁴ adequate rest, proper diet, and developing social connections.³⁵ Developing attitudes of generosity³⁶ and gratitude³⁷ have also been shown to be helpful for maintaining good mental health.  These practices are clinically proven to contribute to good mental health.

Family and Friends

Family and friends can help by knowing what to say (and what not to say), having the right attitude toward mental illness and, helping those afflicted make a plan of action.  For the most part, the things to say should be messages of support and presence.  Words and help or hurt.  Efforts to explain or to fix usually have the unintended result of making the person feel bad or wrong for their condition.  Friends and family don’t have to fix their loved one—or the situation they face, but they should try to reassure and comfort them.

There is no way to list all the things to say or do for a loved one with emotional distress, but there are a few attitudes to cultivate which, when followed, will give some ideas about what to say or do. Emotional distress is a real thing.  Depression and anxiety are legitimate medical conditions.  If we were in a major auto accident, we might have bandages and bruises which were visible to others and would verify or validate their injuries.  Major emotional trauma often has few physical signs but can be no less debilitating than physical injuries.

It is important to be patient with the person struggling with emotional distress and with the process of recovery and healing.  There may be setbacks.  That is common.

Communication is very important to develop and maintain understanding among family and friends.  Ask questions and make observations.  Share your thoughts and feelings and ask the loved one about theirs.  You may be surprised at what they say.

Accommodation and adjustment are powerful ways to show support.  Creative problem-solving with humor and good will has the potential to say, “I love you,” and “I am here for you,” in powerful ways.  We wouldn’t be helping very much if we allowed our loved one to avoid every distressing situation, but we can be resourceful in how we help them to meet the challenges they face every day.

Part of meeting the challenges of every day is helping to develop a plan of action which might include education, self-care, and the use of available resources.  Knowledge is power and becoming knowledgeable about the condition they find themselves in will help everyone know what to do. Self-care, as has been covered previously, is essential to feeling better emotionally.  While we can’t provide self-care for our loved one, we can encourage and support their efforts for self-care. We can also help identify available resources which may be found through family support, church leaders and the priesthood, the blessings associated with temple worship, and the help to be found through healthcare.

The Church

The Church can also help through existing doctrines, opportunities for activity, and shepherding from Church leaders.  These three areas can contribute positively to alleviation of mental distress.

President Boyd K. Packer stated, “True doctrine, understood, changes attitudes and behavior.”³⁸ President Packer lists two of the three elements of Cognitive Psychology in this statement: Thoughts and Actions, only he calls them Attitudes and Behavior.  If attitudes and behavior are changed by true doctrine, it is reasonable to conclude that feelings could also be changed by true doctrine.

Some interesting research has found this to be the case: that true doctrine does change feelings.  One study of LDS people found that believing God is a loving God (a true doctrine) contributed to limiting or reducing anxious traits in those who held that belief.  It also found that those who hold a view of God that is less loving or more controlling than what is commonly taught in LDS doctrine were more likely to endorse more serious or frequent anxious traits.³⁹

Other research has also found that increased views of the lovingness of God were most strongly related to a reduction of emotional symptoms for LDS people.  In other words, subscribing to the LDS doctrine that God is our father and He is perfectly loving appears to have the effect of reducing mental distress.   Similarly, other researchers found that those who reported having an experience confirming the doctrine of God’s grace as taught by the LDS Church had a positive relationship with mental health while those who had a more legalistic view of God’s dealings with his children correlated with decreased mental health.⁴⁰

This slide shows the stark difference in scores of Shame, Anxiety and Depression between LDS Church members who view God through a construct of works being the most important (called “Legalism”) and those who view grace as the most important.  As you can see, those with a Legalism outlook had noticeably higher scores on Shame, Anxiety, and Depression than did the members with a grace outlook.  These findings should come as no surprise to those who were here an hour ago listening to Brad Wilcox speak on grace.

Association with the church also brings opportunities for church activity.  Activity in the church produces social connection through serving others, teaching and learning from others, and working toward the common good. As mentioned earlier, social connection can also help reduce mental distress.

Church Leaders

 Church leaders are in a position to make a powerful impact on those struggling with mental distress. Demonstrating compassion and a willingness to be attentive to the afflicted member can be a great comfort to the struggling member.  As noted above, helping them to develop a plan of action can also be very helpful and provide focus and motivation to those who are distressed.  In addition, mobilizing ward resources may be appropriate.

Ward resources include involving the ward council, ministering brothers and sisters, and specifically-called ward specialists.  There may be ward temporal resources that could be brought to bear on the situation.  Also, inspired ecclesiastical counseling could be included.

As demonstrated earlier, true doctrine changes attitudes and behavior—and there is evidence to say it also can alleviate mental distress.  If that is true, then teaching the pure word of God could be seen as important medicine for those who are distressed—and for all of us, really.  When it comes to counseling from ecclesiastical leaders, consider how many true doctrines there are to understand and how they might change a person’s functioning if they were better understood.

Professional Help

Sometimes, the efforts of the individual and the support of family, friends, and the Church do not have sufficient impact on the emotional distress.  When this is the case, it may be time to seek professional help.  When the loved one is not responding sufficiently to the help offered or they are not maintaining the progress they have made, it may be that the problem is of a psychological nature and they require professional help. One way to think about the severity of a loved one’s symptoms is to consider the amount of distress combined with the inability to control the symptoms combined with the frequency of the difficulties.

For most mental disorders related to depression and anxiety, the research is clear that professional counseling is an effective treatment.⁴¹

For depression and anxiety, counseling and medication appear to be equally effective.  For some people, the combination of counseling and medication will be more beneficial than either treatment separately.

Cognitive Behavioral Therapy which focuses on the link between our thoughts, feelings, and actions, is one of the most common evidence-based therapies for depression.⁴² Cognitive Behavioral Therapy also appears to be one of the most effective.⁴³

In recent addresses, Elder Holland has discussed his struggle with depression. Clearly,

the fact that one experiences anxiety/depression does not mean that one cannot

fully participate and accept significant responsibilities in the Church.  He said, “If things continue to be debilitating, seek the advice of reputable people with certified training, professional skills, and good values. Be honest with them about your history and your struggles. Prayerfully and responsibly consider the counsel they give and the solutions they prescribe. If you had appendicitis, God would expect you to seek a priesthood blessing and get the best medical care available. So too with emotional disorders. Our Father in Heaven expects us to use all of the marvelous gifts He has provided in this glorious dispensation.”⁴⁴

Summary

 We’ve been talking about mental distress and the potential it has to affect religious belief and participation.  Some interesting research has been done which suggests that the factors which produce depressive and anxious symptoms are also those which make it difficult to navigate conflicting information such as may exist about the Church’s history, policies, and doctrine.  There are a number of things individuals can do for themselves when experiencing depressive or anxious symptoms, and there are things that friends, family, and Church leaders may do for that individual as well.  Sometimes professional help is needed to address the mental distress.

We hope this presentation can be seen as a step toward more clearly understanding the factors which contribute to disaffection from the Church and what can be done to help ourselves and others remain close to the Church and the salvation found therein.  Thank you for your attention.

Q&A

Q1: Can you comment on how your findings relate to Church members dealing with LGBTQ issues, someone experiencing same sex attraction?

A1: [Giles] I think whether we’re talking about issues with mental health or issues with same sex attraction, a number of things, I think that the elements and the process is the same particularly for family and friends. We want to be supportive, we want to be loving, and we want to better understand that person. Today we talked about some of the things that mentally might be going on for the person to create the anxiety and depressive symptoms that they have. Once we understand that better, we can be more effective in our help. The same with any issues, whether they’re mourning the loss of a child, or whether they’re struggling with substance abuse, or they’re struggling with LGBTQ issues. Understanding where they’re coming from, getting a view of where they’re hung up, is an important first step, and so in a lot of ways it’s exactly the same.

Q2:  Please flesh out the response to the inevitable question: “Steve Densely said ex-Mormons are all mentally ill.”

A2: [Densley] Okay, so my answer to that is “No, I didn’t.” We’ll be publishing our remarks on FairMormon website. We can refer people to that. I tried to say in five or six different ways that that’s not what I’m saying. So the point here is that mental illness is one component among many other different kinds of things that can contribute to disaffection from the Church. And I would adamantly state there is no one thing that causes people to leave, and mental illness is not one thing that causes people to leave.  It’s one thing that may, in some situations, contribute to disaffection from the Church, and it’s important that we recognize that, so that we can help people. We can reach out to people who are suffering and are burdened, and we can help lift those burdens.

[Giles] Thank you for asking that question, giving Steve a chance to respond. That’s one of our biggest concerns is that what we’ve said today might be misinterpreted as saying what was suggested. So thank you for asking that question.

Q3:  Is the decrease in missionary age increasing incidents of anxiety and depression in the missionary force? I heard a mission medical advisor speculate that that might be the case.

[Giles] When you consider what missionaries are asked to do and the amazing, incredible challenges that missionaries face in the service that they’re asked to render, and then you take them into that challenge a year earlier, developmentally, if we just talk about this in terms of human development, they’re less ready, just developmentally, for that at an earlier age. That’s just a fact.  Now one of the things that President Monson said is that 18 would be the earliest people, young men, could leave on a mission. They don’t have to leave on their 18th birthday. That was never part of the message, but I think that’s been interpreted as the case. And so to be able to understand where our particular child is in terms of his development and preparation and readiness for doing what is admittedly a very challenging task, we should do that more prayerfully and rely on the Spirit, not just on the calendar. So probably our kids are more at risk because they’re younger, but I don’t know of any numbers that suggest that there’s more anxiety, depression, but I wouldn’t be surprised.

Densley: Okay, we’ll hit two questions really quickly, and then there are so many really great questions. This is a really important topic. Dr. Giles and I will stick around afterwards and I’m sure some of you have some more questions that we can try to answer personally, but one question here that we almost went into, but it’s such a huge topic that we didn’t want it to distract from everything else, and that’s suicide. So the question was:

Q4: Why do you think Utah has the fifth highest suicide rate in the nation? Does this have anything to do with religion?

A4: [Densley]  There are some really important things and interesting things that came out recently, and I’m trying to remember his name. He’s a BYU professor that just published an op ed piece, I think in the Deseret News on this, because Ellen DeGeneres said that people are killing themselves because of Mormon doctrine, and it’s not true. There’s no support for that. It makes sense that you could draw this connection between people feeling like that there are a lot of things that they’ve got to do in this Church they can’t live up to, and so they’re going to kill themselves. The data doesn’t bear it out. In fact, there was a survey done by I think it’s the Utah Department of Health where they tried to figure out why is it that Utah has such high suicide rates, and when you look at the data and break it down by religion, those who are non-Mormons have higher suicide rates than the Mormons.

Q5: Much suffering is caused when we equate happiness to obedience. Will you address this? Will you address how we can handle this statement, when said in a church setting?

A5: [Densley] In response to this, I hope that you all listened to what Brad Wilcox said. I asked Scott to let us speak directly after Brad Wilcox for this reason. It is a big problem that we sometimes get mixed up with our emphasis on obedience because it is important to be obedient. Obedience does bring us happiness, but we should not feel like if we’re not strictly obedient, that we somehow are lost souls and that there’s no hope for us. The hope is provided through the grace of Christ, and the purpose of the obedience is not to try to figure out who is it that gets in and who doesn’t. The purpose of commandments is to help us to understand how we can become Christlike and how we can become more happy.  Brad Wilcox has got a whole bunch of books out there on the table and I’d refer them all to you. I think that they’re great.

Notes

[1] For a transcript and analysis of Elder Jensen’s remarks, see Stephen Smoot, “Reports of the Death of the Church are Greatly Exaggerated,” FairMormon Blog, Jan. 15, 2013 (accessed March 31, 2018).

[2] Peggy Fletcher Stack, “Mormons confront ‘epidemic’ on online misinformation,” Washington Post, Feb. 1, 2012.

[3] Daniel Cox & Robert P. Jones, “America’s Changing Religious Identity,” PRRI, Sept. 6, 2017.

[4] Daniel Burke, “Millennials leaving church in droves, study finds,” CNN.com, May 14, 2015.

[5] Daniel Cox & Robert P. Jones, “America’s Changing Religious Identity,” PRRI, Sept. 6, 2017.

[6] Dieter F. Uchtdorf, Come, Join with Us, General Conference, October 2013.

[7] Amy Sullivan, “Church-Shopping: Why Americans Change Faiths,” TIME, April 28, 2009.

[8] See, e.g., “What Mormons had to say about their faith crises,” Salt Lake Tribune, Feb. 13, 2016 in which a poll of Salt Lake Tribune readers identified the following items as triggering a “faith crisis”: 1) 327 of over 1,700 respondents mentioned Joseph Smith’s sealings to the wives of other husbands, his differing “First Vision” accounts, his character, and/or translation questions about Mormon scripture (presumably the Book of Mormon and Book of Abraham); 2) 322 respondents mentioned polygamy in LDS history; 3) 373 respondents mentioned LGBT policies and practices; 4) A few (about 20 of over 1,700 respondents) brought up their activities in Ordain Women, which advocates female ordination to the all-male LDS priesthood.

[9] See, e.g., Stan L. Albrecht, Marie Cornwall and Perry H. Cunningham, “Religious Leave-Taking: Disengagement and Disaffiliation among Mormons,” in David G. Bromley, Falling from the Faith: Causes and Consequences of Religious Apostasy (Newberry Park, California: SAGE Publications, 1988), chapter 4, in which it was reported that 54%, with people wanted to spend their limited time and resources on other interests and activities. 40% indicated that they didn’t feel they belonged 25% reported feeling it didn’t matter to anyone whether they attended or not. About a third of the respondents third gave contextual reasons (movement to a new community where they didn’t get involved, work schedule conflicts, etc.). 23% reported problems with specific doctrines or teachings. 20% reported problems with other members of the congregation. Some said the church demanded too much of their time and money (cf. 1 Tim. 6:10 & Matt. 13:22). Others said it no longer was a help in finding the meaning in life. Female respondents in particular were affected by marriage to a nonmember spouse.

[10] Medeiros, Michelle, Ph.D., “Intrusive Worries, Related Behaviors, and Religious Beliefs Among Mormons” (PhD diss., Palo Alto University, 2015) 42.

[11] Michael Eysenck , Anxiety: The Cognitive Perspective (Hove, East Sussex: Lawrence Erlbaum Associates Ltd., 1992), 20.

[12] “An impressive body of empirical evidence … has firmly established that emotional disorders such as anxiety and depression are accompanied by characteristic cognitive biases in the processing of emotional information.” Jenny Yiend, & Bundy Mackintosh, “Experimental Modification of Processing Biases,” in Jenny Yiend, (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 190.

[13] Michael Eysenck , Anxiety: The Cognitive Perspective (Hove, East Sussex: Lawrence Erlbaum Associates Ltd., 1992), 21. (quoting Aaron T. Beck, & Gary Emery, Anxiety Disorders and Phobias: A Cognitive Perspective, [New York: Basic Books, 1985] 33). There is “considerable evidence that individuals with generalized anxiety selectively allocate their attentional resources to threat-related information. … Attentional biases have also been studied in other anxiety conditions, such as social anxiety and specific fears. There is considerable evidence indicating that socially anxious individuals have an attentional bias favouring social-threat stimuli, such as angry faces and social-threat words ….” Karin Mogg & Brenden P. Bradley, “A Cognitive-Motivational Perspective,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 74 (citations omitted).

[14] Susan Mineka, “The Positive and Negative Consequences of Worry in the Aetiology of Generalized Anxiety Disorder: A Learning Theory Perspective,” In Jenny Yiend, (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 31.

[15] Paula Hertel, “Habits of Thought,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 109-10 (citations omitted). “There is abundant evidence that anxiety is associated with an attentional bias for threat …. There is also evidence that anxiety is associated with a failure to disengage from threat ….” Anne Richards, “Anxiety and the Resolution of Ambiguity,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 109-10 (citations omitted). “Evidence that anxiety vulnerability is associated with the negative interpretation of ambiguity is equally compelling.” Colin MacLeod, et al., “Causal Status of Biases,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 174.

[16] Colin MacLeod, et al., “Causal Status of Biases,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 173 (citations omitted). “[S]elective allocation of attention toward threatening information” has been confirmed in generalized anxiety disorder, obsessive compulsive disorder, panic disorder and specific phobia.” Colin MacLeod, et al., “Causal Status of Biases,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 174 (citations omitted).

[17] Anne Richards, “Anxiety and the Resolution of Ambiguity,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 130 (citations omitted).

[18] Paula Hertel, “Habits of Thought,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 121-22 (citations omitted).

[19] Elaine Fox, “Maintenance or Capture of Attention,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 100.

[20] “Mental Health,” The Church of Jesus Christ of Latter-day Saints, accessed July 29, 2018, https://www.lds.org/mentalhealth?lang=eng.

[21] Jana Reiss, “Do Mormons leave the Church because they ‘got offended’?,” Flunking Sainthood, Religion News Service, January 27, 2017. Tied for first place was “I did not trust the Church leadership to tell the truth surrounding controversial or historical issues.” This was followed by: “The Church’s positions on LGBT issues;” “I could no longer reconcile my personal values and priorities with those of the Church;” and “I drifted away from Mormonism.” She further reports: “In the sample as a whole, the top answer was ‘I could no longer reconcile my personal values and priorities with those of the Church,” closely followed by “I stopped believing there was one true church.’”

[22] “Social Anxiety Disorder,” Anxiety and Depression Association of America, accessed July 25, 2018.

[23] “Social Anxiety Disorder,” Anxiety and Depression Association of America, accessed July 25, 2018.

[24] Colette Hirsch, David M. Clark, “Mental imagery and social phobia,” in Jenny Yiend (Ed.), Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (New York: Cambridge University Press, 2004), 233.

[25] Nazia Ali, Ruchi Nagar, “To Study the Effectiveness of Occupational Therapy Intervention in the Management of Fear of Public Speaking in School Going Children Aged Between 12-17 Years,” The Indian Journal of Occupational Therapy  45, No. 3 (September 2013 – December 2013).

[26] “The Surprising Reason Steve Young Didn’t Serve a Mission (and It Has Nothing to Do with Football),” LDS Living, Feb. 24, 2018.

[27] Eric Branch, “In New Book, Ex-49er Steve Young Details His Battle With Anxiety,” San Francisco Chronicle, Oct. 28, 2016.

[28] Daniel K. Judd, “The Relationship Between Religion, Mental Health, and The Latter-day Saints,” BYU Religious Education Review, Winter 2018, 13.

[29] Daniel Peterson, “What Difference Does it Make?,” FairMormon Conference, August 2017 (quoting Tyler J. VanderWeele, “Does Religious Participation Contribute to Human Flourishing?” at bigquestionsonline.com).

³⁰ John Hunsley, Katherine Elliott, Zoe Therrien, “The Efficacy and Effectiveness of Psychological Treatments,” Canadian Psychology, 55, no. 3 (September 2013): 161-76.

³¹ Sarah R. Braun, Bettina Gregor, Ulrich S. Tran, “Comparing Bona Fide Psychotherapies of Depression in Adults With Two Meta-Analytical Approaches,” PLoS ONE 8, no. 6 (June 2013).

³² David Burns, “Feeling Good: The New Mood Therapy,” (New York: Quill, 1980), 2.

³³“Originally thought to be specific to generalized anxiety disorder, recent research has clearly demonstrated that IU [intolerance of uncertainty] is a broad transdiagnostic dispositional risk factor for the development and maintenance of clinically significant anxiety.” In other words, IU is more fundamental than anxiety.  Anxiety is built upon IU. R. Nicholas Carleton, “The Intolerance of Uncertainty Construct in the Context of Anxiety Disorders: Theoretical and Practical Perspectives,” Expert Rev. Neurother, 12, no. 8 (Aug. 2012): 937–947.

³⁴ R. Nicholas Carleton, “The Intolerance of Uncertainty Construct in the Context of Anxiety Disorders: Theoretical and Practical Perspectives,” Expert Rev. Neurother, 12, no. 8 (Aug. 2012), 937-47.

³⁵ Rick Nauert, “Social Connections Can Help to Reduce Depression,” PsychCentral , accessed September 5, 2018, https://psychcentral.com/news/2014/03/20/social-connections-can-help-to-reduce-depression/67371.html.

³⁶ Steve Densley, Jr., “Science Confirms the Blessings of Generosity,” Meridian, December 19, 2017, https://ldsmag.com/science-confirms-the-blessings-of-generosity/.

³⁷ Steve Densley, Jr., “Why ‘Count Your Many Blessings’ Isn’t Just a Nice Thing to Say,” Meridian, November 20, 2017, https://ldsmag.com/why-count-your-many-blessings-isnt-just-a-nice-thing-to-say/.

³⁸ Boyd K. Packer, “Little Children,” Ensign, November 1986.

³⁹ Medeiros, Michelle, Ph.D., “Intrusive Worries, Related Behaviors, and Religious Beliefs Among Mormons” (PhD diss., Palo Alto University, 2015) 42, 59-60.

⁴⁰ Daniel K. Judd, W. Justin Dyer, Justin B. Top, “Grace, Legalism, and Mental Health: Examining Direct and Mediating Relationships,” Psychology of Religion and Spirituality, (June 2018), 8..

⁴¹ John Hunsley, Katherine Elliott, Zoe Therrien, “The Efficacy and Effectiveness of Psychological Treatments,” Canadian Psychology, 55, no. 3 (September 2013): 3.

⁴² John Hunsley, Katherine Elliott, Zoe Therrien, “The Efficacy and Effectiveness of Psychological Treatments,” Canadian Psychology, 55, no. 3 (September 2013): 3.

⁴³ Sarah R. Braun, Bettina Gregor, Ulrich S. Tran, “Comparing Bona Fide Psychotherapies of Depression in Adults With Two Meta-Analytical Approaches,” PLoS ONE 8, no. 6 (June 2013).

⁴⁴Jeffrey R. Holland, “Like a Broken Vessel,” General Conference, October 2013.