Muraqabah: How I adapted mindfulness to work for Muslim patients

I discovered mindfulness when I was on my university placement as an honorary assistant psychologist and became increasingly interested in what it could offer. I tried lots of different meditation and visualisation techniques but, despite this, as a Muslim, I felt something was missing for me. It felt like practising something 'alien' when looking at it through a religious lens. 

But then I discovered muraqabah; a type of meditation in the Islamic faith. I began to wonder if it would work for some of the patients in the ward I worked in. Sharing my experiences here, I hope to show that it's ok to bring your own identity to the forefront when trying to facilitate such interventions.

What is Muraqabah?

The term muraqabah is derived from the root letters of ر ق ب, meaning "to watch, observe, regarding attentively (something)". The Islamic definition for muraqabah is "the constant knowledge of the servant and conviction in the supervision of the Truth, glory be to Him, over one's outward and inward states." It would be roughly translated into English as Islamic meditation. The purpose of muraqabah is to cultivate the remembrance of Allah, therefore 'polishing' our hearts and unveiling the virtuous nature of our souls. 

When an individual performs muraqabah, they go through different stages which have been identified and described in detail by Islamic scholars of the past. 

Mushahadah (Observation) is where an individual is aware and concentrates on anything. This is usually the stage where they become aware and mindful of their whims and thoughts, and they attempt to quieten them through simple breathing. 

Tasawwur (Imagination) is where the individual focuses on a religious object or person, e.g. the Ka'bah, the Prophet Muhammed (PBUH), a spiritual teacher, etc and imagines it/them in their minds. During this stage, the individual's attention is cultivated, and their general focus increases.

Tafakkur (Contemplation/Reflection of Creation) is where the individual focuses their attention and deeply reflects on the world, how and why Allah has created everything, etc. As a result of this stage, the individual will notice their creativity increasing.

Tadabbur (Contemplation/Reflection of God) is where the individual focuses on Allah, pondering over His various names and attributes, whilst in a state of remembering him abundantly. This is the stage where the individual connects directly with Allah.

Muhasaba (Self-Evaluation) is the final stage of muraqabah. This is where the individual begins to reflect on their own traits and attempts to question such aspects of themselves. This would usually occur once the individual has completed the previous stages of muraqabah successfully and are in a calm state of mind.

Inpatient Mindfulness

On the acute inpatient wards which I work in, I work with another assistant psychologist to conduct a weekly emotional coping skills group, where we teach patients stress, anger, and anxiety management skills. As part of this, we teach different techniques such as mindfulness breathing, where patients would be focusing on their breath and mindfulness of objects, where patients would focus on various objects in the room.

When I initially introduce mindfulness or meditation to Muslim patients on the ward, there is often a sense of hesitancy towards it. They sometimes feel unmotivated to engage, often stating, "I have Islam, why would I need that?" or "I pray, which is enough for me". However, meditation, from a purely linguistic perspective, was practiced by the righteous Islamic figures of the past through muraqabah. My goal with introducing muraqabah on to the ward is to increase psychological engagement with Muslim patients.

Whenever I ask Muslim patients whether they have heard of muraqabah, they usually reply in the negative; after explaining it and practising it with them, I observe that they usually are more open to other psychological interventions which occur on the ward. 

Applications of Muraqabah on the ward

I have given two examples below where I have taught and practiced muraqabah with patients, on the acute inpatient ward I work at. (Pseudonyms have been used in place of the patients' names to preserve their identity.)

The first patient I practiced muraqabah with was Dwight. He was a revert (someone who converted to Islam) and had a diagnosis of personality disorder, anxiety and depression. Dwight would experience auditory hallucinations when in the presence of excess noise.

As part of the psychological interventions held on the wards, I conduct a psychology drop-in where I introduce myself and ask patients about anything that is on their minds. Dwight mentioned that individuals from the Asian-Muslim community that he lived in would constantly tell him that he would never be forgiven for what he had done. I drew upon my religious knowledge and told him that God can forgive anyone He wishes, if they repent (see Qur'an 39:53). Later that day, he had asked me if he could re-take his Shahadah (testification of faith) with me, as he felt that, due to the beliefs he expressed in his ward round, he was not a Muslim anymore. After this, he began to actively engage in the psychology groups that were taking place on the ward. Following this, staff noted a positive change in Dwight's behaviour.

On one of the days the ward was particularly unsettled; with patients getting into quite loud verbal altercations with one another, whilst the ward's emergency alarm was set off. I saw Dwight pacing up and down the ward corridor, covering his ears with his hands. When I approached him to see what was wrong, he said he was hearing voices, however, he could not go back to his room as he was waiting to take his medication. We both sat in a squatting position near the clinic and I told him to close his eyes and establish a breathing rhythm; breathing in for four seconds, pausing for one, and breathing out for six. After he did this a couple of times, I then told him to start directing his attention to Allah and focusing purely on Him; reassuring him that Allah was with him in this moment of distress. I instructed him to imagine that his heart was calling out the name of Allah repeatedly, whilst I recited once in Arabic to him the Quranic verse, "And remember the name of your Lord and devote yourself to Him wholeheartedly." (Qur'an 73:8); translating it for him also. I noticed that Dwight was becoming much calmer and more relaxed as time went on, even though the noise levels were still quite high. When the alarm stopped, he became completely calm.

Shortly after, Dwight approached me and thanked me for guiding him through what had happened. He felt that he was much more connected to his faith and God due to the muraqabah that we did and that that he would practice it more.

Milo was a Pakistani gentleman with a diagnosis of schizoaffective disorder. Although quite settled on the ward, he would get distressed every so often due to other patients being physically and verbally aggressive towards him and would often physically retaliate against them when this would happen.

Whilst running the mindfulness session for the coping skills group, Milo found it difficult to focus on his breathing and said he wanted to focus on God instead. At that moment, I felt that he could benefit from muraqabah and I explained to him what it was. Since he was the only patient who wanted to take part in the group that day, I decided to guide him through a session of muraqabah. Like with Dwight, I instructed Milo to find a breathing rhythm and to start focusing on Allah. On top of this, I told him to imagine a beam of light entering his heart, whilst imagining it repeatedly calling out the name of Allah. We did this for about five minutes. After this, Milo then mentioned about how he felt muraqabah was much more effective for him than regular mindfulness and expressed interest in wanting to do it again. 

Further adaptations

Upon reflection, I feel as though providing muraqabah as an alternative mindfulness intervention has increased the overall engagement of Muslim service users on the ward when it comes to psychological interventions in general. In my opinion, the introduction of muraqabah on the ward will make Muslim service users feel more comfortable in expressing their religion and religious views as part of their recovery.

I'd love to engage these service users in other practices of muraqabah and incorporate them into other coping skills sessions on the ward. For example, I also teach visualisation, a coping skill where service users tap into their imagination in order to calm and soothe themselves. An Islamic adaptation of this would be to instruct patients to imagine that they are in the vicinity of the Ka'bah, Islam's holiest site, which is practiced by some Muslims around the world today.

I am currently working with my supervisor to create resources, such as a leaflet and an information sheet for Muslim service users regarding muraqabah and how to perform it; as well as other ways we can culturally and religiously adapt psychological interventions on the inpatient wards to suit a culturally and religiously diverse population of service users.

I would love to hear from others if they have had any similar experiences whilst delivering interventions and treatments.

• Junaid Shabir is an Assistant Psychologist working on two male acute inpatient units for Birmingham and Solihull NHS Mental Health Foundation Trust.