Mantra recitation and prayer wheels

1. Introduction

Version followed: Tibetan Buddhist recitation of the six-syllable mantra of Avalokiteśvara (Tib. Chenrezig), OM MANI PADME HUM, as the Fourteenth Dalai Lama, Tenzin Gyatso, explained it in a public lecture at the Kalmuck Mongolian Buddhist Center, New Jersey; prayer-wheel practice as Lama Zopa Rinpoche advised it for the FPMT (Foundation for the Preservation of the Mahayana Tradition) and its centre Land of Medicine Buddha; and, for Bon, the three heart mantras as publicly taught at Olmo Ling Bon Center (Tempa Dukte Lama). [source: Dalai Lama, On the meaning of OM MANI PADME HUM; Lama Zopa Rinpoche, Benefits of Prayer Wheels; Land of Medicine Buddha; Olmo Ling]

What it is. Mantra recitation is the repeated voicing (aloud, softly or mentally) of a sacred syllable-formula, usually counted on a mala (rosary). A prayer wheel (Tib. mani chö-khor, also mani khorlo) is a cylinder holding rolled printed mantras or texts around an axle; turning it is held to be equivalent to reciting what it contains. Wheels range from hand-held to temple wheels turned by passers-by, and wheels driven by water, wind or the heat of a lamp. Tibetan Buddhist wheels are turned clockwise (the direction in which the script reads, the sun's course, and the direction of circumambulating a stupa); Bon wheels are turned counter-clockwise. [source: Huntington Archive, Prayer Wheel – Mani chö-khor]

How change happens, as the tradition states it. In the Dalai Lama's account, the six syllables stand for the path itself: OM for the practitioner's ordinary body, speech and mind and for a Buddha's pure ones; MANI (jewel) for method, the altruistic intention to become enlightened for others, with compassion and love; PADME (lotus) for wisdom, chiefly the wisdom realising emptiness; HUM for the inseparable union of method and wisdom. Practice gradually transforms impure body, speech and mind into a Buddha's, because each person has "the seed of purity" within; he advises reciting while reflecting on the meaning. Prayer-wheel practice is presented by Lama Zopa Rinpoche as purifying negative karma and obscurations, creating merit, blessing all beings in the area and developing compassion. These are religious claims of the tradition, reported here as the tradition holds them. [source: Dalai Lama lecture; Lama Zopa Rinpoche, Benefits of Prayer Wheels]

For the psychotherapist, this is a devotional practice of a living tradition, not a therapy technique. The therapist's work is client-led: understanding what the practice means to the client, supporting it where the client wants it to be part of their coping and values, adapting for trauma and adverse experiences, watching for scrupulosity, and referring questions of practice to the client's own lama, teacher or centre. [synthesis]

Health claims (one line): FPMT materials state that prayer wheels can stop disease and help healing, and report recoveries from serious illness; no clinical evidence shows that mantra recitation or prayer wheels treat physical disease, and illness belongs with the client's doctor. [source: FPMT prayer-wheel card; Land of Medicine Buddha] [synthesis for evidence status]

2. Framework

This is not a phased therapy, and the tradition does not set session counts for clinical use; none are given here. The framework has two layers.

The tradition's own frame (as published):

Gradual path: buddhahood is reached step by step; every Buddha was once an ordinary being. Recitation is one support on that path, joined to reflection on its meaning. [source: Dalai Lama lecture]
Openly taught level: the mani mantra is recited publicly by monastics and laypeople and is inscribed on prayer wheels open to any visitor; FPMT's Land of Medicine Buddha invites visitors to turn its wheels while reciting it, and suggests it even for seriously ill people with no knowledge of Dharma. [source: Huntington Archive; Land of Medicine Buddha; FPMT card]
Restricted level: in Bon, the three heart mantras (Du Tri Su, Ma Tri, Sa Le Od) belong to the Bon ngöndro (preliminary practices) leading to Tantra and Dzogchen and are taught by an ordained lama. [source: Olmo Ling] Deity-yoga forms of Chenrezig practice and other tantric sadhanas are generally taught after empowerment or transmission from a qualified lama [uncertain: not verified]. This guide gives only the public outline and sends all such questions to the client's teacher.

The therapist's working frame [synthesis]:

Assessment: spiritual and religious history, the place of recitation in the client's life, current mental state, trauma history, and any adverse experiences in practice. Move on when you know what the practice means to the client and whether there are risk signs (psychosis, mania, severe dissociation, scrupulosity).
Consent and client-led planning: the client decides whether and how their practice is discussed or used in therapy; agree roles (therapist is not a teacher). Move on when consent is explicit and documented.
Integration: work with meaning, compassion, grief, coping and values, in the client's own words and tradition; adapt for trauma; liaise with the teacher only if the client wishes.
Review: check regularly for benefit, for adverse effects and for compulsive patterns; reduce, change or pause any therapy use of the practice if harms appear, while respecting the client's religious life.

Format: individual therapy; recitation itself is done by the client at home, at a centre or in community, not led by the therapist.

3. Guiding principles

The tradition defines the practice. Practical meaning: take the meaning of the syllables, the merit of turning, the direction of the wheel, from the client and their teachers, never from the therapist. [source: Dalai Lama lecture; Huntington Archive]
Attribute, do not adjudicate. Practical meaning: speak of karma, merit, blessing and purification as "in your tradition…", neither affirming nor dismissing them. [synthesis]
Client-led and consented. Practical meaning: raise the practice only if the client brings it or agrees; record consent; the client can withdraw it from the work at any time. [synthesis]
Meaning over mechanics. Practical meaning: the Dalai Lama stresses reciting with reflection on meaning; explore what compassion (method) and wisdom mean to the client rather than counting repetitions. [source: Dalai Lama lecture]
Compassion as the stated motive. Practical meaning: the motivation Lama Zopa names is benefiting all sentient beings; use this value to support self-compassion and care for others, cross-referring Domain II (MSC, CFT). [source: Lama Zopa Rinpoche, Benefits of Prayer Wheels]
Stay in role. Practical meaning: the therapist is not a lama, guru, confessor or spiritual director; give no ritual instructions, transmissions or advice on practice; refer. [synthesis]
Respect restriction. Practical meaning: never ask for, write down or teach restricted mantras, visualisations or sadhana content; do not encourage clients to bypass their teachers. [synthesis]
Trauma-sensitive by default. Practical meaning: apply Treleaven's five areas (attention, arousal, relationship, dissociation, social context) to any practice the client uses for coping. [source: Treleaven 2018, publisher description]
Expect possible adverse effects. Practical meaning: ask routinely about difficult experiences; they can occur in people with no prior mental health history. [source: Farias et al. 2020; Lindahl et al. 2017 (Brown University summary)]
Health to the doctor. Practical meaning: physical illness is managed medically; a client may also recite or turn a wheel for peace of mind as their tradition suggests. [synthesis]
Competence and humility. Practical meaning: build spiritual and religious competence (attitudes, knowledge, skills) and consult when outside it. [source: Vieten et al. 2013, abstract]

4. Intervention inventory

The first three entries describe the practice as the tradition openly teaches it, so the therapist can understand what the client does; the therapist does not lead these rites. The remaining entries are the therapist's own work alongside the practice.

4.1 Mantra recitation as the tradition openly teaches it (public outline)

Purpose and when to use: to understand what a Tibetan Buddhist client does when reciting the mani mantra, so you can explore it respectfully. Use when the client mentions daily recitation, a mala, or reciting at a centre. [source: Dalai Lama lecture]
Steps (as published, in outline; the client's teacher is the authority on details):
1. The practitioner recites the six syllables, aloud or quietly, often counting on a mala. [source: Land of Medicine Buddha; Huntington Archive]
2. While reciting, the practitioner reflects on the meaning: compassion and the altruistic intention (MANI), wisdom (PADME), their union (HUM), and the transformation of ordinary body, speech and mind (OM). [source: Dalai Lama lecture]
3. The practice is framed by a motivation to benefit all beings and closes by wishing that all beings be freed from suffering. [source: Lama Zopa Rinpoche advice; FPMT card] Formal dedication prayers vary by lineage [uncertain: not verified].
4. Visualisation of the deity Chenrezig and other tantric elements are taught by lamas within their lineages and are not described here.
Example language (illustrative): "You mentioned you recite the mani mantra each morning. Would you like to tell me what it means to you, in your own words?"
Watch for: whether recitation is experienced as nourishing and connected to compassion, or as pressured, counted anxiously or done to undo thoughts (see 4.10). It is working, in the client's own terms, when they describe it as steadying, meaningful or connecting.

4.2 Prayer-wheel turning as the tradition openly teaches it (public outline)

Purpose and when to use: to understand a client's use of a hand-held or temple wheel, at home, while walking around a stupa or at a centre. [source: Huntington Archive]
Steps (as published, in outline):
1. A Tibetan Buddhist practitioner turns the wheel clockwise; a Bon practitioner turns it counter-clockwise. Hand-held wheels are spun with a weighted chain; large wheels are pushed or cranked while walking around them. [source: Huntington Archive]
2. The practitioner recites the mani mantra while turning. [source: Land of Medicine Buddha]
3. FPMT advice offers an optional visualisation: light from the mantras in the wheel purifies oneself and then all beings; or beams draw sickness, harm and negative karma into the wheel; at the end, light from the wheel frees beings in the six realms, who become the Compassion Buddha. [source: FPMT card; Land of Medicine Buddha]
4. The stated motivation is the wish to benefit beings and help them reach enlightenment. [source: Lama Zopa Rinpoche, Benefits of Prayer Wheels]
Example language (illustrative): "When you walk round the wheels at the centre, what happens for you? What does your tradition say it does?"
Watch for: rhythmic, movement-based practice can be grounding for some clients; note whether turning becomes compulsive (fear something bad will happen if not done) or whether the client believes it replaces medical care. [synthesis]

4.3 Bon heart-mantra practice (public outline, referral only)

Purpose and when to use: to orient to a Bon client who recites the three heart mantras. Use as background only.
Steps: as Olmo Ling publishes it, Du Tri Su is described as a mantra for healing and transforming suffering, strengthening vital energy and clearing obstacles; Ma Tri for clearing the suffering of the six realms and transforming afflictions such as ignorance and anger into wisdom; Sa Le Od as a meditation on the nature of mind. They are part of the Bon ngöndro and are taught and guided by an ordained lama. No method is given here. [source: Olmo Ling]
Example language (illustrative): "These practices sound important to you. Questions about how to do them belong with your lama; here we can look at how they fit with what you're going through."
Watch for: clients asking the therapist to teach or check a practice; redirect to the teacher.

4.4 Spiritual and religious history, including the Cultural Formulation Interview

Purpose and when to use: at intake or when the client raises their practice; to learn its meaning, community, teacher and role in coping.
Steps:
1. Ask whether religion or spirituality is important to the client and whether they want it included in therapy. [synthesis]
2. Use the DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions to explore identity, practices, community and how the problem is understood [uncertain: not verified; the module's items are not reproduced here].
3. Map: lineage or centre, teacher, how the client learned the practice, frequency as the client describes it, any empowerments or vows (without asking for their content), and changes since the problem began.
4. Ask about any difficult experiences in practice (see 4.8).
Example language (illustrative): "Some people find their practice helps; some find parts of it hard at times. How has it been for you lately?"
Watch for: guardedness about restricted content (respect it, do not probe); signs that the practice has recently intensified, for example around a retreat or crisis.

4.5 Exploring meaning: method, wisdom and compassion

Purpose and when to use: when the client wants to link their practice to therapy goals, such as self-criticism, anger, grief or relationships.
Steps:
1. Invite the client to explain, in their tradition's terms, what the syllables or the wheel mean to them (the Dalai Lama's reading links MANI to compassion and PADME to wisdom). [source: Dalai Lama lecture]
2. Ask how those values show up, or fail to, in the current difficulty.
3. Where the client wishes, connect the wish to benefit all beings to compassion towards themselves; cross-refer Domain II (MSC, CFT) and Domain VII (contemplative and Buddhist psychotherapy, spiritually integrated psychotherapy). [synthesis]
4. Use the lotus image only if the client offers it (growing from mud unstained) as a metaphor for acting well amid difficulty. [source: Dalai Lama lecture for the image; synthesis for its use]
Example language (illustrative): "You said MANI is about compassion. When you're harsh with yourself after a mistake, where is that compassion?"
Watch for: the therapist steering doctrine; spiritual bypassing (using practice to avoid feeling or acting) [synthesis]. Working: the client links values to concrete choices.

4.6 Recitation or turning as a client-chosen coping resource

Purpose and when to use: when the client already uses recitation to steady themselves and wants to use it deliberately between sessions, for example in anxiety, insomnia or hospital stays.
Steps [synthesis]:
1. Confirm the client's wish and that their teacher's guidance allows this use.
2. Identify situations where they already recite and what helps (pace, quiet or aloud, holding a mala or small wheel).
3. Agree a plan in the client's words; keep it flexible, with no targets.
4. Review its effect next session; drop or change it if it brings distress.
5. For a structured, secular-compatible format based on repeating a sacred word, cross-refer the Mantram Repetition Program (guide 310).
Example language (illustrative): "When you notice panic building on the ward, you said quietly reciting helps. Would it be useful to plan when you might do that?"
Watch for: recitation used to suppress or neutralise intrusive thoughts (a compulsion, see 4.10); avoidance of needed exposure work. Working: lower distress, and the client feels connected to their tradition rather than pressured.

4.7 Illness, dying and grief

Purpose and when to use: FPMT advice suggests the practice to seriously ill people for peace of mind now, a peaceful death, and a healthy body and mind. [source: FPMT card] Use when a client or relative is ill, dying or bereaved and draws on this practice.
Steps [synthesis]:
1. Ask what the client hopes the practice will do; acknowledge the tradition's account of blessing and merit.
2. Support it as a source of meaning and community; involve their centre or lama for prayers or rites if wanted.
3. Make sure medical decisions remain with the treating team; if the client believes the practice can replace treatment, explore this gently and involve the doctor.
4. In grief, explore practices done for the dead in the client's community, as they describe them.
Example language (illustrative): "Turning the wheel for your mother seems to give you a way to keep caring for her. And her doctors are still guiding the treatment, is that right?"
Watch for: guilt if the illness worsens despite practice ("I did not practise enough"); address as a possible scrupulosity or moral-injury theme.

4.8 Screening and monitoring for adverse experiences

Purpose and when to use: at intake, before a client starts an intensive recitation retreat or accumulation commitment, and at review. Contemplative practice can bring challenging experiences; the Varieties of Contemplative Experience study, which included Tibetan Buddhist practitioners and teachers, catalogued 59 kinds across seven domains (cognitive, perceptual, affective, somatic, conative, sense of self, social), lasting from days to over a decade, with influencing factors in practitioner, practice, relationships and health behaviours (sleep, diet, exercise). A systematic review of 83 studies found a pooled prevalence of adverse events of 8.3%, most often anxiety, depression and cognitive anomalies, including in people without prior mental health problems. [source: Lindahl et al. 2017 via Brown University news; Farias et al. 2020, PubMed abstract]
Steps:
1. Ask open questions about difficult experiences in practice: fear, panic, insomnia, involuntary movements, sensitivity to light or sound, loss of emotion, changes in sense of self. [source: Brown University summary]
2. Before a retreat, review psychiatric and trauma history, sleep and current stress, and whether a teacher will be available; these are among the factors the study names, offered as hypotheses rather than established causes. [source: Brown University summary; synthesis for the checklist]
3. If difficulties appear, discuss with the client reducing intensity or pausing intensive practice, prioritising sleep, eating and ordinary activity, and grounding through the senses and movement [synthesis]; encourage them to talk with their teacher.
4. Point the client to specialist support if wanted: Cheetah House offers peer and facilitated support groups and consultations for meditators in distress, and consultation and training for clinicians. [source: Cheetah House]
Example language (illustrative): "Sometimes practice brings up things that are hard — that is known, and it isn't a failure on your part. Has anything like that happened?"
Watch for: the client's sense that difficulties are their fault (the study authors stress normalising this); worsening sleep; agitation; dissociation. Working: symptoms ease with reduced intensity and support.

4.9 Telling spiritual crisis apart from mental disorder

Purpose and when to use: when a client reports visions, intense bliss or terror, felt blessings or spirit harms, or a sense of mission linked to practice.
Steps:
1. Hold both possibilities: an experience meaningful within the tradition, and a psychiatric condition (psychosis, mania, depression, dissociation). DSM-5 provides a V-code, V62.89 "religious or spiritual problem", which Prusak (2016) describes as allowing a non-reductive differential between religion or spirituality and psychopathology, while noting its limits. The DSM-5-TR code is Z65.8. [source: Prusak 2016, abstract]
2. Check function and context [synthesis]: sleep, self-care, functioning, risk, whether the experience fits the client's tradition as their teacher and community understand it, and whether it is spreading beyond practice into daily life.
3. With consent, ask the client's teacher how such experiences are understood in their lineage.
4. Refer urgently to psychiatric care for signs of psychosis, mania or risk, while respecting the client's spiritual frame.
Example language (illustrative): "I don't want to label what's happening too quickly. Can we look together at how you're sleeping and managing day to day, and what your teacher makes of it?"
Watch for: both over-pathologising and missing illness. [synthesis]

4.10 Scrupulosity around recitation

Purpose and when to use: when recitation is repeated until "just right", counted anxiously, restarted after a perceived error, or used to cancel "bad" thoughts. The IOCDF describes scrupulosity as OCD with religious or moral obsessions; compulsions include repeating prayers until perfect, repeating sacred phrases, mentally neutralising thoughts and seeking reassurance from religious leaders; it is driven by distress, narrowly focused and impairing. [source: IOCDF, What is OCD and Scrupulosity]
Steps:
1. Assess with the client: is the repetition chosen and meaningful, or compelled by fear?
2. Explain OCD and how ERP (exposure and response prevention) aims to separate the OCD from the client's religious values. [source: IOCDF]
3. With consent, consult the client's lama or teacher about what the tradition actually requires (for example whether imperfect recitation is acceptable); involving a religious leader is optional and depends on the client. [source: IOCDF]
4. Build exposures that do not ask the client to act against their faith, for example reciting once without re-checking, tolerating doubt about having done it "right". Exposure needs informed consent, a graded plan and attention to distress tolerance. [synthesis]
5. Questions about medication go to the client's prescriber.
Example language (illustrative): "Your lama said a heartfelt recitation is enough. The OCD says it must be perfect. Which voice do you want to follow?"
Watch for: reassurance-seeking from the therapist or teacher; the therapist being pulled into checking recitations. Working: less time on repeats, more freedom in practice.

4.11 Trauma-sensitive adaptation

Purpose and when to use: when a trauma survivor uses recitation or visualisation and experiences flashbacks, dissociation or overwhelm, or before introducing any practice-linked coping plan.
Steps: apply the five principles Treleaven sets out for trauma-sensitive mindfulness — attention, arousal, relationship, dissociation and social context. [source: Treleaven 2018, publisher description] Practical forms [synthesis]: keep eyes open and attention partly on the room or the mala's touch; recite aloud rather than silently if inner focus triggers; stop or shorten practice when arousal rises; respect choice; be alert to power dynamics with teachers and communities, and to cultural and social context.
Example language (illustrative): "If closing your eyes brings the memories back, it's fine to keep them open and feel the beads in your fingers."
Watch for: numbness, spacing out, sudden distress. Working: the client can stay within a tolerable range of arousal while practising.

4.12 Referral and collaboration with teachers

Purpose and when to use: whenever questions concern how to practise, restricted content, vows or empowerments, or the meaning of experiences in the lineage.
Steps [synthesis]:
1. Ask whether the client has a teacher, centre or community and wants contact.
2. With written consent, agree what will be shared; share only what is needed.
3. Keep roles clear: the teacher guides practice, the therapist the mental-health work.
4. If the client has no teacher, suggest they approach an established centre of their lineage (for example an FPMT centre for Gelug practice, or a Bon centre such as Olmo Ling) rather than learning restricted practices informally.
Example language (illustrative): "That sounds like a question for your lama. Would it help if I spoke with them, with your permission?"
Watch for: a teacher's advice that conflicts with safety (for example to continue intensive practice despite psychosis); discuss openly with the client.

4.13 The teacher relationship, power and leaving a group

Purpose and when to use: when a client describes pressure, secrecy, exploitation or fear related to a teacher or group, or is leaving one.
Steps [synthesis]:
1. Explore the relationship's power: who decides, what happens if the client questions or leaves.
2. Note signs of coercive control: isolation from family and friends, control of money, time or sexuality, punishment for doubt, secrecy demands beyond legitimate restriction.
3. Support decisions without labelling the group; address religious trauma and loss of community if the client leaves (Cheetah House lists resources on religious and systemic trauma). [source: Cheetah House]
4. Follow safeguarding and reporting duties where abuse is disclosed.
Example language (illustrative): "You can value the practice and still question how you've been treated. Both can be true."
Watch for: shame about doubting; fear of spiritual consequences of leaving.

4.14 The therapist's role, self-disclosure and competence

Purpose and when to use: throughout.
Steps:
1. Develop spiritual and religious competence: Vieten et al. (2013) propose 16 basic competencies across attitudes, knowledge and skills. [source: Vieten et al. 2013, abstract]
2. Avoid dual roles: do not recite with clients, teach, give transmissions or become their spiritual guide. [synthesis]
3. Disclose your own religious commitments only when it serves the client; never use therapy to promote or discourage a tradition. [synthesis]
4. Follow your professional ethics code on competence, multiple relationships and respect for religion [synthesis].
Example language (illustrative): "I'm not a Buddhist teacher, so I won't advise you on how to practise. What I can do is help with how this is affecting you."
Watch for: clients seeking spiritual authority from the therapist; your own enthusiasm or scepticism shaping the work.

5. Handling problems

The tradition's sources do not address psychotherapy; the guidance below is [synthesis] unless a source is given.

Stuck client (practice feels empty or mechanical): explore meaning rather than amount; the Dalai Lama's emphasis on reflecting on the meaning while reciting can be the client's own resource. [source: Dalai Lama lecture] Suggest the client discuss dryness in practice with their teacher.
Resistance to discussing religion in therapy: respect it; the practice is the client's, not a therapy tool. Return to it only if the client opens the door.
Client wants the therapist to endorse or dispute religious claims (merit, blessing, spirit harm): reflect what the tradition holds and what it means to the client; stay neutral.
Overwhelm or adverse experiences during practice or retreat: normalise, reduce intensity, ground, protect sleep, involve the teacher with consent, consider Cheetah House resources, and assess for psychiatric conditions needing urgent care. [source: Brown University summary; Cheetah House; Farias et al. 2020]
Non-adherence to a practice-based coping plan: treat as information; the plan may not fit the client's tradition, mood or schedule. Revise or drop it; never frame missed recitation as failure.
Ruptures over religion (the therapist seemed dismissive, or too eager): name and repair; ask what felt off; reaffirm the client's authority over their own faith.
Guilt that practice did not prevent illness or death: explore the belief, consult the teacher on the tradition's view if the client wishes, and consider moral injury and complicated grief.
Belief that the practice will cure physical disease and refusal of treatment: hold respect and safety together; FPMT materials themselves frame the practice for peace of mind alongside healing claims [source: FPMT card]; involve the doctor and, if wished, the teacher.
Requests for restricted content (a client asks the therapist to teach a mantra or visualisation, or wants to learn practices from books or online without a teacher): decline, explain that these are taught within lineages, and help the client find a recognised teacher or centre.
Compulsive counting or repeating: assess for scrupulosity and offer ERP with consultation of the religious authority as the client wishes. [source: IOCDF]
Teacher misconduct disclosed: listen, attend to safety and safeguarding duties, do not name or investigate on the client's behalf, and support access to independent reporting routes.
Minors: where a child or young person is involved in intensive practice or monastic life, consider assent, parental consent and safeguarding procedures. [uncertain: not verified]

Sources

Web sources:

Books and articles cited:

Treleaven, D. A. (2018). Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing. W. W. Norton.
Vieten, C., Scammell, S., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2013). Spiritual and religious competencies for psychologists. Psychology of Religion and Spirituality, 5(3), 129–144.
Prusak, J. (2016). Differential diagnosis of "Religious or Spiritual Problem" – possibilities and limitations implied by the V-code 62.89 in DSM-5. Psychiatria Polska, 50(1), 175–186.
Farias, M., et al. (2020). Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatrica Scandinavica, 142(5), 374–393. [uncertain: full author list not verified]
Lindahl et al. (2017). The varieties of contemplative experience. PLOS ONE.
American Psychiatric Association. DSM-5-TR, Cultural Formulation Interview and supplementary modules. [uncertain: not verified]
ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem')

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