Journal of Behavioural Sciences Vol.

17 Number 1-2 2007

The Effect of Rhythmic Quranic Recitation on Depression

Shabbir Ahmad Rana*
Department of Psychology, GC University, Lahore, Pakistan
Adrian Charles North
Department of Psychology, Leicester University, UK

This study investigated the effect of rhythmic recitation of

Quranic verses on depression. 175 hospitalized Pakistanis
suffering from psychotic depression were divided into
seven groups. All received the same drugs and attended the
same psychotherapy sessions, but the participants of six
experimental groups were also subjected to six other
different treatments, including religious music, for 60
minutes daily over 30 days. The Beck Depression
Inventory, Hospital Depression Scale, and Hospital Anxiety
Scale were administered to measure participants’ level of
depression and anxiety at the start and end of the study. In
addition, doctor’s reports were also obtained concerning
each participant’s symptoms. The results indicated that the
level of depression decreased in all the seven groups, but
the level decreased most significantly among participants
who also listened to the Quranic verses. The implication of
the study rests in highlighting the positive effect of
rhythmic Quranic recitation on psychotic depression among
Muslims, which may contribute to the further development
of cost-effective health promotion procedures in both
Islamic nations themselves and multi-cultural Western
nations.

Throughout the history of human development, music in

some form has been used as an important aid to healing. Schullian
and Schoen (1948) describe references to the divine alliance of
music and medicine in classical antiquity and the healing function
of music among primitive peoples. Beneficial effects of music
have been recognized by the ancient Greeks and Romans,
including Pythagoras, Democritus, Aristotle, Galen, and Celsus,
and Plato, Cicero, and Seneca all believed that music profoundly
affected the behavior of entire societies and that the state should

*Correspondence concerning this article should be addressed to Dr. Shabbir

Ahmad Rana, Department of Psychology, GC University Lahore. Tel: 0321-
4824602. E-mail: shabbirrana786@hotmail.com
 Rana and North
38

regulate the performance of certain types of music. Similarly,

traditional Chinese medicine refers to the qualities of specific
instruments and sounds and their beneficial effects on various
organs of the body. From these early beginnings to the present
day, interest in music as an adjunct to the healing or therapeutic
experience has been sustained (Bartlett, 1996). Several studies
indicate that carefully selected music can reduce stress, enhance
comfort and relaxation, offer distraction from pain, and improve
cognitive performance, well being and health: for example,
McCrathy (1999) described how music could reduce stress and
negative emotion and increase positive emotion in both healthy
populations and in individuals with clinical conditions such as
anxiety, depression, panic, arrhythmias, diabetes, and chronic
fatigue.
Indeed, several studies have investigated the effects of
music on mental health in general (e.g. Bonny, Pahnke & Walter,
1972; Recker, 1991; & Tang, Yao, & Zheng, 1994), and some
have focused specifically on depression. For example, Hsu and
Lai (2004) conducted a study on the effectiveness of soft music
for treatment of major depressive disorder inpatients in Taiwan. A
pretest-posttest design showed that listening to music resulted in
significantly improved depression scores. Field (1998) studied 14-
19 year old females in which chronic depression had resulted in
an increased state of activation of the right frontal lobe. He found
that relaxing and listening to about 20 minutes of music changed
their brainwave state and their stress hormones. Right frontal lobe
activation was decreased and the secretion of cortisol, a stress
hormone, was reduced. Similarly, Hanser and Thompson (2003)
randomly assigned 30 older adults diagnosed with major
depressive disorder to one of three 8-week conditions.
Participants in the music condition performed significantly better
than the controls on standardized tests of depression, distress,
self-esteem, and mood. Results consistent with these are also
reported by several other studies using a variety of methods and
participant nationalities (e.g. Cevasco, Kennedy & Generally,
2005; Hilliard, 2001; Hirokawa & Ohira, 2003; Jochims, 1992;
Lai & Good, 2005; & Wu, 2002). There is also direct evidence
that the medical profession believes that music therapy can be an
EFFECT OF QURANIC RECITATION ON DEPRESSION 39

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

Rollin, 2003). For example, Davis (1997) reported that a panel of
music therapists, psychiatrists, and corrections specialists had
strongly recommended the use of music therapy in New York
City hospitals and correctional institutions for the treatment of
depression. In short the above findings provide strong evidence
for the use of music as an intervention for depressed patients.
Other research over the past decade or so has investigated
the effect of religious belief on health. Lee and Newberg (2005)
reviewed the current evidence (as well as discussing
methodological issues), and concluded that there is a strong
relationship between religion and both physical and mental health.
With regard to physical health, Seeman, Dubin, and Seeman
(2003) linked certain religious practices to physiological
processes, blood pressure, and the functioning of the
cardiovascular, neuroendocrine, and immune systems, and this
mirrors similar recent findings by Jones (2004), Koenig, George,
and Titus (2004), Pargament, Koenig, Tarakeshwar and Hahn
(2004), and Powell, Shahabi, and Thoresen (2003).
Of more direct relevance for the present study, there is
also increasing research evidence that religious involvement is
associated with better mental health. Hackney and Sanders’
(2003) meta-analysis found a positive correlation between
religiosity and mental health. James and Wells (2003) established
associations between religious belief and mental health that could
be mediated by cognitive-behavioural mechanisms. Pysiainen
(2004) found that some forms of religion can alleviate existential
anxieties, and help maintain psychological well being. Yangarber
(2004) found that reliance on religious faith can be associated
with active involvement in recovery and positive psychological
adjustment among mentally ill individuals. Corrigan, McCorkle,
Schell, and Kidder (2003) studied 1,824 people with serious
mental illness and showed that both their religiosity and
spirituality were associated significantly with well-being and
mental health. Mohr and Huguelet (2004) concluded that
religiousness and spirituality could play a central role in
reconstructing a sense of self and recovery among chronic
 Rana and North
40

schizophrenics, and that these also help to reduce pathology,

enhance coping, and foster recovery.
With regard to specifically depression, Baetz, Griffin,
Bowen, Koenig and Marcoux (2004) analysed the data from a
large Canadian epidemiological survey of 70,884 respondents,
and found that more frequent worship service attendees had
significantly fewer depressive symptoms than those who did not
attend. Nooney’s (2005) analysis of data from the National
Longitudinal Study of Adolescent Health revealed that religious
involvement prevented the occurrence of health stressors, which
reduced depression. Garrison, Marks, Lawrence, and Braun
(2004) found that mothers with stronger religious beliefs and
more involvement in religious activities may experience fewer
depressive symptoms. Similarly, Schmid, Kaeder, Schmidt and
Ostermann (2005) studied 20 patients aged 29-47 and found that
music therapy over time led to improvements in scores
concerning self-esteem, anxiety, and depression.
Although it is beyond the scope of the present research to
investigate why effects such as these should occur, it is worth
noting that several explanations for such fascinating findings have
been proposed. For example, studies have linked religiosity to
psychological well-being and physical health by several processes
such as affecting beliefs and attitudes related to mental health
(e.g. Koeing, 1997; Seeman, Dubin & Seeman, 2003); a better
understanding of the self (Ashy, 1999; George, Ellison & Larson,
2002); promoting a sense of control and order (Yangarber, 2000);
developing feelings of forgiveness for others (Krause & Ellison,
2003); promoting certain worship practices involving physical
activities linked to health (Miller & Thoresen, 2003; Powell,
Shahabi & Thoresen, 2003); raising awareness of the spiritual /
psychological aspect of health (Puchalski, 2004); or simply
increasing the happiness of a believer (Seligman & Diener, 2005).
The present study investigated one particular religion,
namely Islam, the fundamental theoretical and practical principles
of which are based upon the Quran. It is claimed that these
principles are beneficial, protective, and have a therapeutic role
through their influence on the mental, psychosocial, and
psychosomatic well being of an individual. Indeed, Tariq and
EFFECT OF QURANIC RECITATION ON DEPRESSION
41

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

religious book, also covers legal, social, pedagogical, health-
related, and humanitarian codes; & Hasanovic (1999) emphasises
that the Quran is in fact a comprehensive encyclopaedia about
life. Kemp (1996) reviewed the literature concerning Islam and
health and suggested that recitation of the Quran may promote
health. Indeed, the Quran offers prayers specifically to militate
against illness, such as for example “And your Lord says pray
unto me and I will hear your prayer and heal” (Quran, 40:60).
Khan (2002) points to the specific part of the Quran pertaining to
human health. The Quranic prayer du'a or ruqya is given utmost
importance as the most fundamental form of asking for health: “O
Lord of the people, grant me health, heal me, for Thou art a great
healer (Baniii- israaa- iil, verse 82).
Adib (2004) reviewed the literature on Islamic medicine
which is used as an alternative to the western biomedical model
within many Muslim nations. He concluded that Islamic
medicine is based upon the use of herbal remedies and faith-
healing through prayer as well as the recitation of selected holy
verses from the Quran. Furthermore, Brewer (2004) reviewed the
relevant literature and concluded that many physicians in western
hospitals employ treatment procedures based upon Islamic
religiosity. Haque’s (2004) survey of Muslims living in America
argued that their ‘Islamic religiosity’ had positive effects on their
mental health. Guerin, Guerin, Diiriye and Yates (2004) studied
the psychological problems of the Somalian population in New
Zealand and found that, in addition to the traditional treatment
procedures, recitation of holy verses from the Quran was also
used for dealing effectively with both their physical and mental
health problems. Ohm (2003) conducted a study among African
Muslims living in America and concluded that their ‘Islamic
religiosity’ promoted good psychological health. Similarly, Azhar
(1997) reported that a new form of psychotherapy based upon
Islam has been developed in Malaysia, and that this was more
popular than Freudian, supportive, and behavioural therapies; and
led to faster improvements than observed among patients on
supportive therapy.
 42 Rana and North

The above empirical literature suggests that music and

religion affect health. Therefore, it could be argued that if both
these variables are combined together into a new variable,
‘rhythmic recitation of Holy Quran’, then this may have a
particularly positive effect on health relative to religion and music
in isolation. In Islam, theories of mental health are based on the
concept that ‘obedience to God’ is the best way of keeping
oneself healthy. Thus, a specific part of the Quran was selected
for the present study, Surrah Rehamn (Quran, 55: 78). It is
conventional in Islam to read loudly the verses of the Quran in a
pleasant singing voice, which is called qirrat. The present
research tested the effects of reciting these verses on the severity
of symptoms suffered by hospitalised psychotic depressives in the
Islamic country of Pakistan.
The empirical literature suggests that music and religion
affect health. Therefore, it could be argued that if both these
variables are combined together into a new variable, ‘religious
music’, then this may have a particularly positive effect on health
relative to religion and music in isolation. In Islam, theories of
mental health are based on the concept that ‘obedience to God’ is
the best way of keeping oneself healthy. Thus, a specific part of
the Quran was selected for the present study, Surrah Rehamn
(Quran, 55: 78). It is conventional in Islam to read loudly the
verses of the Quran in a pleasant singing voice, which is called
qirrat. It is pertinent to mention here that in Music Psychology,
any sound that can be heard cannot be called music unless that
sound also consists of three of the seven properties (Pitch,
Contour, Interval, Harmony, Melody, Timbre and Rhythm) and
only then that sound is called music. In this reference the sound;
qirrat (recitation of holy verses) consists of pitch, harmony,
melody and rhythm and thus can rightfully be called Islamic
religious music. Accordingly, the present research tested the
effects singing of the holy verses (Qirrat/Islamic religious music)
on the severity of symptoms suffered by hospitalised psychotic
depressives in the Islamic country of Pakistan.
EFFECT OF QURANIC RECITATION ON DEPRESSION
43

Method
Participants
Data were collected from 175 Pakistani Muslim patients
(105 males and 70 females) diagnosed as suffering from severe
psychotic depression. Participants were between 22 and 50 years
of age (mean age = 32.37 years, SD = 5.94) and were in-patients
at the Punjab Institute of Mental Health in Lahore. Participants
were matched for age and then assigned randomly to one of seven
groups as detailed below. Each group consisted of 25 patients
comprising 15 males and 10 females (consistent with the sex
distribution of patients).

Measures
Four measures were employed in the research. The Beck
Depression Inventory (BDI) consists of 21 groups of statements,
with each group consisting of four statements scored as 0, 1, 2, or
3 depending on their severity. The respondent selects the one
statement out of each group that best describes how they feel at
the present time. A total BDI score of 0-9 is considered normal,
scores of 10-16 are considered mild, scores of 17-29 are
considered moderate, and scores of 30-63 are considered
indicative of severe depression (Beck, Ward and Mendelson,
1961). The Hospital Anxiety Scale (HAS) and Hospital
Depression Scale (HDS) were developed to screen for clinically
significant anxiety and depression respectively in patients
attending medical clinics. Each scale comprises 7-item measures.
Each item has a 4-choice response format, scored as 0, 1, 2, or 3
depending on severity.
Patients are asked to tick the response that they feel seems
to be closest to what they have felt in the last few days. Their
score on the Hospital Anxiety Scale (HAS) and Hospital
Depression Scale (HDS) is then calculated. Scores higher than 10
are considered abnormal and the patient is diagnosed as suffering
from anxiety or depression (or both) respectively (Zigmond and
Snaith, 1983). Finally, doctors’ / psychologists’ / psychiatrists’
reports (DPPRs) were employed to gather information from the
medical duty officer under whose supervision the patient was
being treated: at the start of the study, information was collected
 Rana and North
44

concerning diagnosis and prognosis; whereas at the end of the

study information was collected concerning whether or not they
had seen any improvement in the patient’s behavior during the
course of the research. If the doctor / psychologist / psychiatrist
noted that the patient had improved then he / she was asked to
provide a rating from 1-10 where 1 = “slight improvement” and
10 = “considerable improvement” (whereas a score of 0 was
recorded if no improvement had been noted). It was impossible to
employ a full double-blind technique since the patients and
medical staff was all Muslims who would have been aware of the
intended effects of the musical religious content to which some of
the former were exposed. However, participants and medical staff
were completely naïve as to the hypotheses of the research and to
the range of experimental groups employed (see below).

Procedure
A randomized pre-test post-test group design was used.
The BDI HAS, and HDS were administered to all the participants
at the start of the study and DPPRs were also obtained. All the
participants were given similar doses of antidepressant drugs
(Fluoxetine and Amitryptiline) and antipsychotic drugs
(Haloperidol and Chloropromazine) daily, and they all attended
the same morning psychotherapy sessions thrice a week. Every
evening one hour of the participants’ time was employed for the
purposes of the study. During this time period, the patients of the
control group were free to pursue their own leisure interests (e.g.
watch TV, walk in the grounds etc.), whereas the patients of the
six experimental groups were taken to six different rooms, where
they were subjected to further treatment conditions. In each room,
a tape recorder was provided by the researcher and they were
asked to sit quietly and listen to the specific cassettes being
played in each room. Participants in each group listened to the
specific audio cassette assigned for their group for 60 minutes
daily over 30 days for six days a week. Sunday was a designated
family day that patients could spend entirely with their relatives.
Participants assigned to a ‘spoken religious’ group heard a
spoken lecture on the importance of the pillars of Islam.
Participants belonging to a ‘sung religious’ group heard the qirrat
EFFECT OF QURANIC RECITATION ON DEPRESSION 45

version of Surah Rehman. Participants belonging to a ‘spoken

uplifting’ group heard a spoken self-help lecture on how to
improve one’s confidence, personality and social life. Participants
belonging to a ‘sung uplifting’ group heard morale-boosting
songs. Participants belonging to a ‘spoken secular’ group a lecture
on the pleasures of life. Participants belonging to a ‘sung secular’
group heard Punjabi romantic songs. After 30 days, the BDI,
HAS, and HDS were re-administered and DPPR reports were also
obtained to determine the effect of treatment conditions.
Results
Multivariate analysis of variance was carried out to
determine differences between the groups. These analyses were
based on differences between scores obtained on the BDI, HAS,
HDS, and DPPRs at the beginning and end of the experiment, and
investigated any differences between the seven groups. The
results of univariate (and Tukey HSD) tests are shown in Table 1
and indicate that scores on all the variables improved in all the
conditions. However, the scores improved significantly most in
the ‘sung religious’ group, in which the participants listened to the
religious music. Of all the conditions, religious music led to the
greatest positive effect.
 46 Rana and North

Table1
Mean Differences between the conditions

CG EC1 EC2 EC3 EC4 EC5 EC6

Variable F M M M M M M
Change
in BDI 111.1 -2.72 -1.92 - 16.00 -2.00 -6.44 -1.48 -2.08

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

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

Amount
of 11.03 - .76 - .96 - 3.40 -.92 -1.56 -.56 -.84
improvem
ent
(DPPR)
*p<0.001, df = 6 for each variable.

Key: CG, control group; EC1=Spoken religious words; EC2 = Sung religious
words; EC3 = Spoken uplifting words; EC4 = Sung uplifting words; EC5 = Spoken
Secular words; EC6 = Sung secular words

Chi-square analysis was carried out on DPPRs to

determine if there was any association between the condition in
which participants appeared and assessments of whether or not
they showed any improvement over the course of the study. The
result of this was significant (χ2 (6) = 17.66, p = <.007) and Table
2 indicates that the greatest number of positive DPPRs were
provided for participants belonging to the ‘Sung Religious Group’
who heard the religious music.
EFFECT OF QURANIC RECITATION ON DEPRESSION
47

Table 2
Number of participants who improved
Any improvement
Group No Yes

Control group 18 7

Spoken religious words group 15 10

Sung religious words group 7 18

Spoken uplifting words group 17 8

Sung uplifting words group 12 13

Spoken secular words group 19 6

Sung secular words group 17 8

Discussion and Conclusions

Comparisons were made between the scores on the BDI,
HAS, and HDS, and also the DPPRs obtained before and after the
various treatment interventions. Results indicated that levels of
depression, whether assessed by psychometric tests or
assessments by health workers, decreased significantly among the
participants belonging to all the groups (as well as scores on the
HAS). However, the greatest improvements were seen among
those participants who listened to the religious music, and this
effect was significant compared to that observed in the remaining
groups. As such Tables 1 and 2 support the hypothesis that a
combination of music and religion (plus drugs and
psychotherapy) ought to be more effective than drugs and
psychotherapy alone and also drugs and psychotherapy plus either
music or religion alone. The positive effect of rhythmic recitation
of Quran on psychotic depression among Muslims may contribute
to the further development of cost-effective health promotion
procedures in both Islamic nations themselves and multi-cultural
 48 Rana and North

Western nations. There was also some indication that uplifting

music (plus drugs and psychotherapy) was more effective than
many of the other interventions. Music of this nature may also
constitute a relatively cost-effective means of helping those
suffering from depression. However there was little evidence that
spoken religious words (or spoken uplifting or spoken secular
words) plus drugs and psychotherapy were more effective than
drugs and psychotherapy alone: spoken religious words, as well
as other spoken words, were of no benefit in reducing depression
levels (although they may have had other benefits that were not
measured in the present study such as providing a source of
comfort).
Note also however that at the end of the study, mean
scores indicated that even the religious music group still fell into
the category of ‘severe depression’. Future research might
investigate whether prolonging the duration of exposure to
religious music from 30 days to 60 days or more would further
decrease the severity of depression experienced by the
participants. Research along these lines may also involve explicit
measures of the length of hospital stay required and the cost-
savings that might accrue from this. Note also that there is no
suggestion that the religious aspect of the present results is
actually attributable to divine influence, and a placebo effect of
some nature is a more likely explanation of the greater levels of
improvement among those exposed to the religious music as
compared to other forms of music. Furthermore, the literature
reviewed in the introduction suggests that the relationship
identified here between religious music and depression might well
depend on cognitive-behavioral mechanisms which are at present
understood poorly. Other potential limitations of the present
research include whether the results can be generalized to people
with other psychological disorders, and people of other religions
(in which the relationship between music, religion, and healing is
less explicit). In short, there is much more to be learned about the
potential mediators and pathways when assessing the ‘net’ effects
of Islamic religious music on health outcomes. The present
findings suggest that the issue nevertheless deserves further
attention.
EFFECT OF QURANIC RECITATION ON DEPRESSION
49

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