1Department of Human Science, LUMSA University of Rome
Abstract: Religious and spiritual practices stand among the oldest forms of interventions aimed at alleviating suffering and promoting well-being. The historical and ongoing debate between science and faith is undertaken in favor of an integrated perspective that acknowledges the beneficial contributions of both viewpoints, with an emphasis on the relationship between conscious and unconscious dimensions. Numerous scientific pieces of evidence recognize the positive effects of spiritual practices on psychosomatic health. In particular, the Polyvagal Theory empirically explores the interconnection between emotional states, behaviors, and neural functions, aiding in understanding the contributions of religious rituals and spiritual practices to emotional and autonomic regulation. An integrated view of the mind-body relationship and the significance of the spiritual dimension emerge as fundamental, illuminated by the Polyvagal Theory, to promote psychosomatic well-being in everyday life and psychotherapy.
Keywords: Spirituality, Psychosomatics, Autonomic Nervous system, Polyvagal Theory, Well-being.
- The Transcendent Dimension
Prayer stands as one of the oldest and most widespread forms of intervention aimed at alleviating human suffering. Through systems of symbolic elements and rituals, humans can connect with the divine, seeking meaning in existence and activating the attachment system in the hope of receiving help in daily life and situations of extreme difficulty (Simão et al., 2016).
A fundamental aspect of the relationship between the individual and the transcendent dimension involves recognizing its object-relational nature, which takes on multiple meanings, ranging from protective to ritualistic functions, and even assuming punitive and judgmental aspects (Kernberg, 2012). Each of us, indeed, has an inner world inhabited by something that is other than the Self; thus, on various levels, the representation of the other, and consequently the divine, simultaneously reflects intrapsychic aspects and traces of interpersonal experience, given that existence itself cannot be separated from a relational framework and the social engagement we have with others.
At the core of psychic dynamism, the vital expression of human experience, the influential agency of spirituality, an expression of transcendence, becomes evident. Consequently, the emergence of spirituality, when experienced in its best form as a promoter of well-being, facilitates listening, the processing of object representations, agency, as well as the construction of a bond of trust and security with the other-than-Self. These benefits, however, require the effort to make room for the transcendent dimension by abandoning an ego-centric and mono-dimensional stance and opening up to a relationship of reciprocity and recognition with that which cannot be controlled or known (Kernberg, 2012).
In this context, the history of psychoanalysis highlights the tumultuous relationship, especially in its early days, between spirituality and depth psychology. As known, Freud, concerned with the need to integrate the new discipline characterized by the conception of the unconscious as a container of psychic forces present but not visible into a scientific Weltanschauung, delimits the field of psychology from that of religion, relegating spirituality to a necessary illusion for humans. A different role, however, is attributed to spirituality in Jung’s work, who throughout his career emphasized the importance of the transcendent dimension as a fundamental factor in individual and collective psychic life.
The object-relational experience of spirituality, of being recognized and protected, and the sensation of being part of a whole that transcends phenomenal reality, allows for an exploratory and trusting relationship with the internal and external environment, promoting the formation of a deep Self and personality development. Like all object-relations, the one with spirituality can potentially have a regulatory function for our emotions, similar to early childhood relationships in which the child internalizes the relationship with the caregiver and experiences more or less effective regulatory processes that protect against unnamed terror (Bion, 1962) and accompany them in subsequent life stages.
Fonagy (2017) defines this primary relationship with the object as epistemic trust, capable of contributing to well-being and resilience based on expectations, intentionality, and trust with which one extends toward the other (understood as an intra and inter-psychic, spiritual, and potentially conscious object), making it possible to recognize the object as an organizer of meaning. Trust, understood as an act of engagement, connection, and communication with the object and thus an act of fides, allows going beyond fear, the boundaries of Self-Other, and allows experiencing the uniqueness of what is not visible. Assuming a more liberated and therefore more vulnerable attitude towards what is Other than us enables access to a transcendent position (Grotstein, 2007) that underlies the individual’s ability to tolerate their own limits, leaving open the possibility of orienting oneself and being inspired by spiritual components.
In this sense, the transcendent as an object embodied in religious symbols, liturgy, and prayer stimulates a transformative process and social engagement, catalyzed through connection with the other-than-Self. Even in Kleinian conception (Klein, 1978), the depressive position characterized by awareness of one’s aggression towards a predominantly good object represents a mental position with profound religious and spiritual implications (van der Velde & Hegger, 2018). In this mental state, the individual may experience the need for redemption, purification, and repair of the relationship, assuming a responsible and deeply moral stance towards what is other than Self.
With the introduction of the concept of the transcendent position (Grotstein, 2007), understood as a more evolved mental position than the depressive position, there is an attempt to go beyond guilt-inducing experiences or containment of destructive impulses. This emphasizes the importance for psychological well-being of emotionally rediscovering the freedom to let the inner object come and go, overcoming anxieties of separation and fragmentation. The transcendent position introduced by Grotstein (2007) is presented as a overcoming of the Kleinian dichotomy between the schizoparanoid and depressive positions. Access to the spiritual and transcendent dimension is linked to accepting the reducibility of the Self, the importance of being in harmony with what is other than ourselves, and the necessity of not exercising control, either relational or imaginative, over the Other and one’s own inner world. This line of thought converges with third-wave cognitive approaches, mindfulness, and the increasing importance attributed in scientific literature to interoception, the ability to feel one’s psychosomatic states with contemplation and acceptance without passing judgment, criticism, or premature attempts to enclose them in a predefined sense. Internal images, visceral sensations, dream world, and partial representations of the Other are thus dissociated aspects until they can be given meaning through interoceptive awareness (Levine, 2010; Levine, 2015). The connection between the living body and fides facilitates access to the transcendent dimension at the unconscious level in the vitality of the hic et nunc. Another example of the importance of a transcendent, contemplative, and accepting attitude towards the vitality of the Self is provided by the recent contribution of Bodydreaming (Dunlea, 2019), which explores the interconnection between body and psyche, emphasizing the therapeutic journey of early traumatic experiences as they manifest in the dream experience, generating a harmonious dance between symbolic, visceral, and transcendent dimensions.
Therefore, an interdisciplinary debate on the importance of spirituality as a cornerstone of psychosomatic well-being is necessary. In this regard, Bradford (2023) addresses the theme of integrating the spiritual dimension in healthcare, a topic discussed in recent decades. Since the 1980s, the term “spirituality” has appeared in medical scientific databases, and the World Health Organization (1998) defines health as a dynamic state of physical, mental, spiritual, and social well-being. From a psychotherapeutic perspective, considering the patient’s spiritual experience cannot be separated from having an integrated view of their functioning, reflective attitudes, and historical and cultural roots. It is the therapist’s task to respectfully grasp the meanings and functions that religious beliefs and practices assume in the individual’s psychic experience. For example, does the patient find comfort and support in their spiritual experience? Or do they experience it anxiously, punitively, and judgmentally? Operations of splitting, denial, antisocial, narcissistic, paranoid, or even psychotic tendencies can influence a negative view of religiosity. Conversely, in other situations, religious practices can act as a filter capable of downplaying psychopathological tendencies, serving as a source of relief and protective factor (van der Velde & Hegger, 2018). The experience of fides, for instance, as an affectively significant experience, can contribute to deepening the experience of love (Kernberg, 2012). This gradual shift from an internal object investment to a new spiritual dimension could promote more favorable relational modes. For example, in patients with insecure attachment, it could foster a secure attachment style through their experience in relation to the divine (Granqvist & Kirkpatrick, 2016).
Kernberg (2012), diverging from the formal assumptions formulated by Freud (1927), who posited that the clinician should maintain a stance free from the chains of faith and cultural restrictions that obscure therapeutic sensitivity and compromise the scientificity of the “opaque screen,” provides a new interpretation of the relationship between psychoanalysis and religion, transcending the traditional either-or dichotomy. According to the author, religion can be considered a separate domain, significant for social cohesion but autonomous from psychological inquiry. The individual’s perception of the divine inherently encapsulates personal projections that, over the years, become deposited in collective meanings as they are absorbed by the culture of belonging and respective rituals. Clearly, the crucial consideration lies in the use that both the patient and the community make of spirituality and religious beliefs.
For instance, Milgram (1974) highlights how pre-constructed rational goals can lead to regressive behaviors and become threatening. Another example could be Bion’s (1961) thinking that refers to regressions of dependence or fight-flight responses resulting from loyalty and the nature of leadership. Similarly, Turquet’s (1975) studies on the tendency of large groups to regress towards confusion and diffusion of the self in the absence of direction and solid leadership. In parallel, religion offers similar insights into the potentially destructive nature of affiliation with its practices and beliefs when serving regressive impulses within the community or the human psyche. An example is religiously motivated terrorism, sadly witnessed in our contemporary world. Aggression and regressive tendencies based on the activation of an individual or collective fight/flight response to a threat transform spirituality and faith into a fundamentalist religious ideology that, instead of facilitating encounter and exchange, promotes the nullification of contact and conflict without repair. When this scenario takes precedence, we face a situation where destructive forces and unregulated threat perception have taken control of reason (Kernberg, 2012).
2. The Contribution of Prayer Practices to Psychosomatic Well-being
In recent decades, the scientific community has shown a growing interest in rigorously investigating the efficacy of prayer as an element (affective, cognitive, and behavioral) bridging health and illness, analyzing its integration into routine healthcare. Professionals in palliative care, particularly those following the biopsychosocial model, have been pioneers in recognizing the importance of spiritual care in patient management. The spiritual dimension, by promoting intimacy and values, serves as a promoter of a sense of belonging, security, and well-being, activating secure aspects of attachment bonds. In this perspective, the conception of spiritual belief extends beyond organized religious practices and includes even those who remain external to them while experiencing a strong belief. The intercultural and multidimensional approach to spirituality is emphasized to understand and respect different systems of moral orientation (habits, values, symbols, feelings, thoughts), integral parts of practices aimed at relieving pain through processes of unconscious bodily and psychic awareness (Doehring 2019).
The theme of cathartic liberation appears to mark both spiritual processes and sciences, particularly psychology and neurophysiology, which in recent decades have proposed therapeutic techniques engaging multiple sensory organs in the induction and maintenance of psychosomatic balance, thereby reopening the mind-body-spirituality debate from an evidence-based perspective (Doehring 2019).
Positive Psychology, for example, often explores the use of spiritual techniques and practices such as traditional meditation and mandala drawing—an original practice of Tibetan Buddhists later developed as an analytical technique by Jung (to preserve personality integrity). In a recent study by Liu and colleagues (2020), it is highlighted that both individual and group mandala coloring techniques have effects on enhancing spirituality and promoting subjective well-being and individual positivity, especially in group settings (Liu et al. 2020).
Mounting evidence suggests that the processing of bodily signals or bodily awareness contributes to intersubjectivity, affective experiences, and has a profound effect on social responses. An emerging and increasingly accredited practice in the field of health is yoga, defined as a process that allows practitioners to progress towards improvement and a sense of well-being and mind-body integration through contact with the transcendent dimension. Ancient texts such as the Upanishads, the Bhagavad Gita, and the Samkhya Karika offer fundamental teachings on yoga and its major components: postures (asana), breathing (pranayama), ethics (yama and niyama), and meditation (pratyahara, dharana, dhyana, samadhi). Through these elements, the practice supports individual transformation in the experience of illness, pain, or disability, finding fertile ground for the reharmonization of the body, mind, and environment towards the experience of eudaimonic well-being (sattva) (Sullivan et al. 2018a). In line with this, there is also, for example, cyclic meditation, originating from Prashanti Kuteeram, which involves very slow movements aimed at becoming aware of every small change in balance and muscle tension, promoting physiological balance and reducing arousal and heart rate fluctuations (An et al. 2010; Takahashi et al. 2005).
From a phenomenological perspective, experience can be explored in the measure it reflects the continuous interaction and co-creation between body, mind, and environment. Husserl (1982) defined the “natural attitude” (natürliche Grundeinstellung) as the way through which one confronts and knows the world outside of habitual patterns, through a more profound experience of subjective experience. Central to this is the concept of the “lived body” (Merleau-Ponty 1964), which signifies the manner in which the world and the body gain meaning and become conscious starting from their essence, as if there were a co-penetration between subject and world, where the body is the temple of subjectivity (Sullivan et al. 2018b). From an analytical standpoint, Jung (1942) explored the underlying symbolism of religious rituals, emphasizing the act, intrinsic to liturgy, of incorporating the divine within oneself—a mystery capable of fostering vital momentum for practitioners and providing psychic conditions deeply rooted in the human soul. Symbols, metaphors, myths, and active imagination serve as gateways to explore a profound meaning of experience and give consciousness a sense of meaning in existence (Saremi 2020). Practices and a sense of belonging are involved and fuel the dialectic of conscious/unconscious dimensions.
Recent literature evidence recognizes common elements, for example, between yogic practices and depth psychology, emphasizing that their integration can promote flexibility and adaptation to mental healing processes (An et al. 2010; Saremi 2020; Tyagi & Cohen 2016). Both perspectives identify the constant importance of continuous change, while recognizing immutable aspects of the body and psyche. They facilitate dialogue between the conscious and unconscious dimensions and support elements such as loss, pain, the continuous cyclicity of nature and human life. They focus on processes of self-inquiry, self-transformation, and self-realization, including a holistic view of the human being, recognizing the inseparable whole of its parts (body, mind, and spirit). Specific prayer styles, mindfulness practices (e.g., Mindfulness-Based Movement, MBM), and yoga postures (e.g., Nidra) are widely used in the literature to mitigate disregulative signs typical of conditions like post-traumatic stress disorder (PTSD), depressive symptoms (Chu et al. 2017; Cramer et al. 2017; Hughes & Stoney 2000; Saremi 2020), anxiety (Amjadian et al. 2020; Boelens et al. 2009; Brown & Gerbarg 2005; Pascoe & Crewther 2016), traumatic grief (Doehring 2019), and are integrated into the care of patients with carcinoma (Jim et al. 2015; Lucas et al. 2018; Olver & Dutney 2012).
Numerous randomized trials, focusing on the relationship between standard medical care and practices of intercessory prayer (i.e., prayers on behalf of loved ones), highlight positive effects of prayer, especially in users who were aware of receiving protection, as opposed to those who received it without their knowledge, showing greater clinical complications (Roberts et al. 2009). Similarly, supplication prayer, akin to intercessory prayer, promoted beneficial effects in clinical practice, including reduced deaths, shorter hospital stays, and improved prognoses (Simão et al. 2016). Furthermore, beneficial effects of Christian prayer are known, for example, in accompanying towards the end of life (Ball & Vernon 2015) and in stress reduction (Chirico et al. 2020).
3. The Contribution of Polyvagal Theory to Understanding the Efficacy of Spiritual Practices
Aligned with the reported studies, a significant contribution in the neuro-psycho-physiological field that centralizes the role of the Autonomic Nervous System (ANS), the primary system involved in the mind-body relationship, is the Polyvagal Theory (PVT) elaborated by Stephen Porges (2009). Originating from the study of the evolution of the ANS, the PVT emphasizes the neurophysiological substrates and processes dedicated to emotional regulation, survival defensive responses, and social engagement, providing plausible explanations for response patterns underlying affective and behavioral disorders.
Porges (2001, 2007, 2009), tracing the phylogenetic origins of brain structures, highlights the neurophysiological and neuroanatomical aspects of the tenth pair of cranial nerves, the vagus nerve, the main component of the parasympathetic nervous system (PNS). The theory proposes that different branches of the vagus nerve are associated with specific adaptive behavioral strategies and articulates three different functional subsystems that are hierarchically organized based on the evolutionary biological action they exert (Porges & Furman 2011). The dorsal vagal branch (unmyelinated fibers) is the phylogenetically most primitive component of the PNS, shared with reptiles and almost all vertebrates, providing primary vagal regulation and being responsible for sub-diaphragmatic organs (e.g., intestine). The dorsal neural circuit supports hypo-arousal reactions (e.g., decreased heart rate) and employs immobilization or freezing as a defense strategy. Functionally, the vertebrate, by shutting down observable behavior, seems to feign death (vagal paradox), with most psychophysiological functions seemingly turned off to ensure survival (Porges 2009). This defense system activates in cases of overwhelming and intolerable danger. The second branch, evolving from vertebrates, is the sympathetic nervous system (SNS), acting as an antagonist to the dorsal branch. Sympathetic fibers, by producing catecholamines, provide metabolic resources necessary for a “fight/flight” response. In the face of danger, the body acts immediately, either to fight or to withdraw if the threat is unbearable or imminent. The most evolutionarily complex branch, shared by all mammals, is the ventral vagal (myelinated fibers), a primary autonomic circuit involved in an integrated system of social engagement and regulation of above-diaphragmatic organs (e.g., heart, bronchi). Functionally, the ventral vagal circuit serves as a mediator between the SNS and the dorsal counterpart and could be conceptualized as a co-regulation process.
Porges introduces the concept of “neuroception,” defining it as an automatic process through which the ANS assesses the environment, tracking cues of risk or safety without resorting to conscious awareness (Porges 2009). Detecting the environment as safe or threatening allows for changing the physiological state to optimize survival. Neuroception thus triggers and anticipates processes that involve both conscious environmental sensations (exteroception) and conscious monitoring of bodily changes (interoceptive), conveying internal responses (fear, calm) and observable responses (fight/flight, freezing, stability/relaxation) based on the ANS’s unconscious awareness processes. Each neural circuit (or functional subsystem) can dominate depending on the neuroception of safety/danger detected in the environment. The perception of a safe state stimulates the ventral vagal defense system. Mylelinated fibers support trust, relational stability, and prosocial functions (mobilization -sympathetic system- turns into play, and immobilization -dorsal circuit- becomes intimacy, rest). Conversely, the perception of threat or insecurity prompts fight/flight responses in the ANS. However, if the organism is unable to fight and/or flee, the system enters a paradox: the dorsal vagal branch promotes an immediate, involuntary, and temporary shutdown to ensure survival.
The evolution of the species, through the stages of phylogenesis, has allowed for the development of a functional neural organization that regulates the visceral state to support social behavior. The ventral vagal branch is responsible for relational processes and is considered in the literature as a neural system of social engagement (Kok & Fredrickson 2010; Porges 2001). The functioning of the system is supported by the regulation and activity of numerous neural substrates that, collectively, from the higher structures of the cortex to the internal structures in the brainstem (e.g., the ambiguous nucleus), cooperate and control muscles to modulate sensory response processes and ensure social engagement. Cortical motoneurons regulate lower motor neurons to allow eyelid opening; facial striated muscles enable facial expressions; middle ear muscles allow distinguishing human voice from background noise; laryngeal and pharyngeal muscles enable vocalization and language (Porges 1998). The autonomic regulation responds functionally to internal and external metabolic demands, both in maintaining homeostasis and in restoring and protecting against extreme stimulus conditions (social engagement system in constant interaction with the hypothalamus-pituitary-adrenal axis). The inhibitory components of the ANS (e.g., visceromotor portion of the ambiguous nucleus) act through myelinated efferent fibers on target organs located in the peripheries (Porges 2001).
This “social” nervous system takes its first steps already in the early stages of life and allows the newborn to co-participate and learn from the environment through non-verbal communication and sensory stimuli (e.g., sounds, smells, tactile sensations). In interacting with the caregiver, the infant will use visual stimuli, such as facial expressions, which will automatically guide them to interact with a specific response as contextually coherent as possible. If they find a serene face with relaxed features, they will try to engage in a relationship; conversely, if they encounter a frowning face, with grimaces or worse, expressionless (e.g., still-face experiment – Tronick 1978), non-reactive, the newborn will experience a sense of agitation and react by avoiding interaction or experiencing fear. Furthermore, the tone of voice is also an indicator of safety/threat in the environment. Prosodic voices help maintain a physiological state of well-being, as does singing, which not only controls breathing but also promotes rhythm, intonation, and releases a sense of security. It’s no coincidence that infants surrender to the dreamlike dimension thanks to singing.
The study of the anatomy and neurophysiology of the heart inspired Porges to extract the neural characteristics of vagal regulation from heart rate variability (HRV), the primary measure of the ANS activity. Cardiac vagal inhibitory fibers show a discharge pattern that follows the rhythm of breathing (Hayano & Yasuma 2003; Yasuma & Hayano 2004). This allowed the author to develop a method to quantify respiratory sinus arrhythmia (RSA), representing a functional index of a neural feedback circuit regulating the inhibitory influence of myelinated vagus (vagal tone) on the sinoatrial node, which, in turn, inhibits heart rate (vagal brake) (Porges 2007, 2023).
Efferent (CNS-ANS) and afferent (ANS-CNS) pathways converge, involving both sympathetic and parasympathetic fibers. In fact, the influence on heart rate (HR) is determined by both the vagal and sympathetic components: the former decreases/regulates it, while the latter increases it. Therefore, there will be a series of physiological modifications in the organism based on the predominant influence of the sympathetic or parasympathetic branch. The finding of a homeostatic balance, given by this reciprocal and continuous charging/discharging of the ANS, allows the vagal tone to be considered a physiological marker of emotional regulation, delimiting alterations in arousal (Porges 1998).
Numerous pieces of evidence (Appelhans & Luecken 2006; Morton et al. 2022; Poli et al. 2021; Kolacz et al. 2021, 2023; Heilman et al. 2023; Bailey et al. 2023; Dale et al. 2018; Dana 2018) suggest that in psychopathology and conditions of high stress, both efferent and afferent processes can be compromised. This compromise could manifest as a lasting dysregulation of the ANS and a persistent inactivity or hyperactivity of one of its branches. The greater the heart rate variability (HRV), the more significant the regulation of HR and, consequently, of the autonomic activity. An increase in HRV corresponds to increased physiological flexibility, meaning greater heart rate variation in a given condition capable of responding elastically and flexibly to environmental demands (Porges et al. 2023).
In line with the neurovisceral integration model (Thayer & Lane 2000), we could consider vagal tone, indexed by HRV, as an expression of the functional integration of neural circuits involved in emotional and cognitive processes. Park & Thayer (2014) emphasize that higher HRV parameters are associated with more adaptive cognitive and emotional modulation, compared to lower HRV levels, which are instead linked to hypervigilant cognitive responses that hinder emotional regulation (hypofunctional prefrontal regulation and hyperactive subcortical structures) (Gross 1998; Gross & Thompson 2007). Literature evidence allows us to consider reduced HRV levels as predictors and risk factors for increased cardiac mortality or sudden death (Khattab et al. 2007; Tsuji et al. 1994).
At this point, it is important to ask: can the PVT theory help explain the beneficial effects of religious practices? Firstly, it is essential to highlight how this model has given rise to the use or understanding of a series of bottom-up practices (from the body to cognition) that draw from ancient spiritual practices (consider mindfulness and singing, typical elements of religious liturgy). Additionally, as illuminated by a compelling study on the applications of PVT to group functioning (Flores & Porges 2017), the group can represent a fundamental moment of “neural exercise” to promote social engagement and a sense of belonging among individuals. What better occasion than participation in a liturgical moment to foster these aspects? During liturgical celebration, involvement in singing, sharing physical proximity, and shared glances are some of the bodily and non-verbal aspects that facilitate social engagement with others, promoting a sense of welcome, reciprocity, sharing, and rediscovery of security. Moreover, many studies delve into the use of techniques in psychotherapy based on self-empowerment and self-regulation mechanisms as tools for mental well-being development or recovery. Mindfulness and yoga, following adequate and consistent training, have been shown to influence cognitive responses, regulation of emotional and behavioral states mediated by stress (Gard et al. 2014). The central element lies in the fact that religious practice promotes the process of interoception, whereby individuals become aware of their own bodies and how they react to intrapsychic and environmental stimuli. Maintaining consistent practice not only allows for the automation and efficiency of postures, attitudes, reflexivity, and concentration over time.
Interoceptive sensitivity and heart rate monitoring represent a dimension of fundamental importance. Advanced practitioners of yogic techniques, for example, report greater internal concentration and greater subjective awareness of bodily/visceral processes compared to non-practitioners (Fiori et al. 2016). It has been demonstrated that encouraging conscious awareness of mind-body phenomena plays a central role in patient care: it promotes processes of reinterpretation of proprioceptive and exteroceptive environments, improves emotional regulation, and resilience (Sullivan et al. 2018a).
From a therapeutic perspective, PVT (Porges 2011) provides reflections on ways to recognize and manage the neural substrates underlying mental states and direct them towards adaptive strategies for somatopsychic integration. Following the assumption that mind-body therapies develop a bidirectional connection with the vagal pathways of the parasympathetic system, we could consider them as the “means” through which to implement processes of regulation, containment, and stimulus processing, leveraging their characteristics of accessibility and immediacy. In this sense, therapy, as argued by Porges and Dana (2018), becomes a neural exercise (Lucas et al. 2018).
It has been found that practices such as breathing, meditation, and singing influence both afferent and efferent processes, serving as a conduit for active involvement of the ventral complex of the vagus (Hayano & Yasuma 2003; Porges & Carter 2017). Spiritual and liturgical moments thus stand out as strategies for the application of neuro and psychophysiological processes (Arias et al. 2006; Tyagi & Cohen 2016; Fabbro 2014). While spiritual techniques offer effective and concrete modalities to promote mind-body well-being and integration, scientific theories such as PVT elucidate the physiological processes, including the associated risks and benefits that coordinate and enable these practices. In a holistic perspective, it is crucial to move beyond the duality of spirituality vs. scientificity, as the common attributes of these two realms allow access to a phenomenology of complexity, where the mind-body-transcendence relationship finds fertile ground to reveal manifest and internal, conscious and unconscious aspects. Through the regulation of autonomic states and, more broadly, the activity of the autonomic nervous system (ANS), one can grasp the bidirectional nature of the studied dialogue.
Empirical evidence in the literature (Cysarz et al. 2004; Lucas et al. 2018; Sarang & Telles 2006; Telles et al. 2016; Drury et al. 2019) allows for the verification of the applicability of the holistic model described in this work, with a central focus on the role of HRV, a non-invasive cornerstone for studying autonomic cardiac activity.
Several studies investigate the beneficial contribution, for example, of spiritual practices to cardiac regulation parameters, emphasizing their complexity due to different relaxation techniques and, not least, considering the specific cardiac characteristics of subjects at baseline. Guided relaxation practices have proven more effective in reducing physiological arousal and, consequently, increasing cardiac vagal activity (e.g., higher values of HF, pNN50) compared to autonomous relaxation sessions or standard medical treatments (Telles et al. 2016; Vempati & Telles 2002), after which heart rate (HR) and blood pressure (BP) returned more rapidly to baseline levels. Comparisons between yogic relaxation sessions and placebo relaxation sessions, for instance, have highlighted their validity in terms of fluctuations in HRV indices. Khattab et al. (2007) compared HRV in yoga practitioners and non-practitioners during traditional yogic exercises and placebo exercises, finding, at the end of the blind observation, that the average interval of ECG R-waves was higher (indicated by vagal tone indices SDNN and RMSSD) during yogic sessions compared to placebo sessions and the cardiac parameters of non-practitioners. Regarding sympathetic activity index parameters, the latter seems to prevail during physical activities such as postures (asanas), especially in cases of cyclical yogic practice, while parasympathetic activity increases and regulates the autonomic system once the practice is finished (Sarang & Telles 2006).
Cysarz et al. (2004) investigated RSA activity in a therapeutic context during guided recitation of hexameter poems (verses that allow for a low breathing frequency), highlighting significant cardiorespiratory synchronization compared to moments of controlled or less spontaneous breathing. Similarly, Bernardi et al. (2001) conducted an experiment using prayer recitation as a trigger. Cyclical recitation slowed down, or rather facilitated, respiratory rhythm and, consistently, promoted greater heart rate variability (ventral-vagal tone). Spirituality, even independent of experimental settings and evaluated based on self-reported subjective experiences, seems to be associated with better autonomic control or regulation, where belief and spiritual practice per se promote a balance between the sympathetic and parasympathetic circuits (Berntson et al. 2008).
In conclusion, this contribution provides food for thought on the importance of spiritual practices for psychosomatic well-being. In line with the reported evidence, it would be appropriate, in clinical patient care, to focus on the bidirectional mind-body relationship, paying attention to the bodily dimension (which provides information about unfavorable internal conditions and can communicate with the ventral branch of the vagus) and the psychic dimension (which makes deep attributes visible and is promoted by relaxation body practices).
Holistic healthcare in patient-centered care should consider patients’ needs in totality and respond in the most appropriate way to their requests. For instance, in addressing the need for assisted prayer, including religious figures in the healthcare team could be considered. Considering prayer practices as effective and non-pharmacological palliative interventions, one could reflect on the implementation of such interventions not only to improve outcomes but also on health economic outcomes and clinical sustainability (Simão et al. 2016).
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