Abstract
The present study was conducted with the aim of examining the feasibility of implementing a religious coping protocol based on the Holy Quran in reducing perceived stress. The research method was a single-subject, multiple-baseline experiment. The research instruments were the Milon Clinical Multiaxial Questionnaire, the Perceived Stress Scale, and the religious coping protocol. Purposive sampling was conducted and 3 people were selected from among the stressed clients of the Samah Qom Counseling Center. Each client was randomly assigned between 3 and 7 baseline sessions. The research findings showed that the clinical satisfaction of the clients with implementing the religious coping protocol was 93% and desirable. The research findings also showed that the improvement rate of all three clients based on the baseline mean reduction index was 36% and significant. In the intra-situational visual analysis, the level changes, stability changes, and trend changes in the intervention phase for all three clients were decreasing and stable. In the inter-situational visual analysis, the level changes and trend changes indicated a decreasing trend in stress for all three clients. Also, the effect size was measured using non-parametric methods of percentage of overlapping data and percentage of non-overlapping data, and the results indicate a very high effect (100 percent) in implementing the religious coping protocol on reducing the perceived stress of clients. Therefore, it is possible to use the religious coping protocol based on the Holy Quran for people with perceived stress, and this protocol can be used to examine its effectiveness in research groups.

Introduction
Perceived stress is one of the most prevalent psychological phenomena in modern life, with significant effects on individuals' physical and mental health (VandenBos, 2015; American Psychiatric Association, 2023). Numerous studies have demonstrated that continuous exposure to stress and life adversities can impair human performance, immune function, and life expectancy (Shields & Slavich, 2017). Research has shown that high-stress occupations are associated with hypertension (Rosen & O'Rourke, 2012) and increased risk of coronary heart disease (Yoshikawa et al., 2002), with employees in such positions reporting lower scores on mental health, physical health, and job satisfaction compared to other occupations (Janssen et al., 2005). Furthermore, longitudinal studies have demonstrated that the number of stressful life events predicts mortality over 17 years (Phillips & Der, 2008). Studies have also shown that stress predisposes individuals to viral infections and the severity of symptoms (Ogden, 2012). Recent research continues to highlight the lasting negative consequences of stress (Vázquez-Lara et al., 2025; Martins, Palmeira, & Matos, 2025; Amiri, Mahmood, Javed, & Khan, 2024), drawing researchers' attention to the role of religion as an effective coping mechanism in stress management.
Research indicates that religious coping is among the most effective strategies for psychological health outcomes, with evidence also supporting its effects on physical health (Nooney & Woodrum, 2002). Recent studies in health psychology demonstrate that religion is not merely a meaning-giving system but can directly influence stress management by creating a sense of control, strengthening social support, and reducing physiological arousal (Koenig, 2018; Park, Holt, Le, Christie, & Williams, 2021). Religion can operate through mechanisms such as meaning-making, strengthening social support networks, and increasing internal control, but these effects occur specifically through "religious coping" (Pargament & Park, 2019). Evidence shows that using positive religious coping strategies (such as prayer, trust, feeling of divine support, and searching for meaning) can reduce stress, increase hope, and improve quality of life (Pargament & Park, 2019). Systematic reviews and meta-analyses have demonstrated that positive religious coping significantly reduces perceived stress and improves depression and stress-related indicators (Sherman, Simonton, & Latif, 2023; Garssen, Visser, & Pool, 2021).
Despite the growing evidence supporting the role of religious coping in managing psychological consequences, some studies have pointed to the moderating role of cultural differences in the effectiveness of coping protocols (Abu-Raiya & Pargament, 2015). In Muslim societies, religion is not merely a personal belief but a comprehensive framework for understanding the world. Islamic religious teachings about trust, remembrance, hope, forgiveness, acceptance, and reinterpretation of hardships as opportunities for growth can provide both theoretical and practical foundations for coping interventions (Khatib, 2021). However, transferring these teachings into coping and therapeutic interventions requires their reconstruction in cultural and clinical language. The literature on cultural adaptation of psychological interventions shows that merely adding religious content to an intervention without deep revision of the meaning structure may reduce effectiveness or even produce contrary results (Ano & Vasconcelles, 2005; Abu-Raiya & Pargament, 2015; García et al., 2017). Therefore, identifying and utilizing effective stress coping methods, especially with cultural backgrounds, has gained increasing importance among researchers. Although studies demonstrate the importance of religious coping with stress among psychologists, examining the feasibility of religious intervention in different cultural contexts, especially Islamic culture, remains an under-researched topic. This study aims to examine the feasibility of implementing a religious coping protocol based on the Holy Quran in reducing perceived stress.

Research Methodology
This study employed a single-subject experimental design with a multiple baseline approach. Single-subject designs are particularly suitable for feasibility studies (Gallo, Comer, & Barlow, 2013). Feasibility studies are preliminary investigations aimed at developing an initial protocol, determining the preliminary success rate, and providing initial information about potential treatment effects (VandenBos, 2015; Rounsaville, Carroll, & Onken, 2001). To examine the feasibility of implementing the religious coping protocol, participants' behavior was first measured during the baseline period (Phase A), followed by the intervention period (Phase B) with continuous observation. Any change observed between baseline and intervention phases is attributed to treatment efficacy (Cozby & Bates, 2015).
The statistical population comprised all clients with stress who had referred to the Samah Counseling Center in Qom and were seeking counseling for stress treatment. Purposive sampling was employed, and from the list of 25 clients awaiting treatment, 10 were referred to the researcher. From these, 3 clients meeting inclusion criteria (age over 20, diagnosed stress without acute disorders or personality disorders, and willingness to participate) were selected. Exclusion criteria included acute psychiatric disorders, simultaneous participation in other treatments, and use of psychiatric medications in the past nine months. Each client was randomly assigned between 3 to 7 baseline sessions. Data collection instruments included the Millon Clinical Multiaxial Questionnaire (MCMI) for exclusion criteria, the Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983), and the researcher-developed religious coping protocol based on the Quranic conceptual model (Khatib et al., 2021). The protocol consisted of five sessions addressing the nature of stress, self-perception, God-perception, other-perception, and world-perception. The intervention was implemented individually and weekly, with a one-month follow-up. Data were analyzed using visual analysis (within- and between-phase) and non-parametric effect size methods including Percentage of Non-overlapping Data (PND) and Percentage of Overlapping Data (POD).

Discussion
Feasibility Assessment through Clinical Satisfaction
The findings demonstrated high clinical satisfaction across all feasibility indicators. Participants showed 100% attendance in both intervention and follow-up sessions. Individual activity completion was 95%, treatment satisfaction 90%, ease of technique implementation 85%, perceived usefulness of techniques 90%, and technique application 90%, with an overall mean satisfaction of 93%. These results indicate that the religious coping protocol is feasible and acceptable for individuals with perceived stress. The high attendance and adherence rates suggest that participants found the protocol engaging and relevant to their needs. This is particularly significant given the cultural and religious context of the participants, suggesting that Quranically-based interventions can be successfully implemented in clinical settings with Muslim populations.
Efficacy Assessment through Outcome Measures
The findings revealed statistically and clinically significant improvement in perceived stress across all three participants. The Baseline Mean Reduction Index (BMLR) showed substantial improvement rates: 52% for participant one, 26% for participant two, and 29% for participant three, with an overall improvement rate of 36%. These improvements were maintained during the one-month follow-up period, indicating sustainability of treatment effects. The visual analysis showed that during the baseline phase, participant one had stable stress levels, while participants two and three showed increasing trends, indicating worsening conditions without intervention. Following the intervention, all three participants demonstrated decreasing and stable stress patterns. The within-phase visual analysis revealed that for all participants, the range of changes was within the stability envelope (over 80% of data points), and trend directions changed from increasing (baseline) to decreasing (intervention), indicating meaningful therapeutic change.
The between-phase visual analysis showed significant reductions in level changes and trend changes from baseline to intervention. The median level change (difference between the second half median of baseline and the first half median of intervention) showed reductions of 9, 2, and 2 points for participants one, two, and three respectively. The mean level change showed reductions of 11, 3.5, and 3 points respectively. The magnitude of effect was further confirmed by non-parametric effect size measures: the Percentage of Non-overlapping Data (PND) and Percentage of Overlapping Data (POD) both reached 100% for all participants, indicating a very high treatment effect. These findings are consistent with previous studies demonstrating the effectiveness of Quranic-based coping skills training in improving mental health and reducing stress (Iranmehr & Kadkani, 2017), and cognitive restructuring based on beliefs in divine mercy and strengthening connection with God (Pishnamazi, Teyk, & Barati, 2017; Abdi et al., 2015).
Mechanisms of Change: Quranic Teachings as Cognitive-Emotional Regulators
The effectiveness of the Quranic coping protocol can be understood through several psychological mechanisms. First, the protocol facilitates meaning-making through religious reinterpretation of stressful events. According to Lazarus and Folkman's (1984) cognitive appraisal theory, when events are evaluated from a monotheistic perspective, psychological threats transform into opportunities for personal growth. Quranic teachings such as "God will bring ease after hardship" (Quran, 65:7) and "Perhaps you dislike something which is good for you" (Quran, 2:216) provide alternative cognitive frameworks that facilitate meaning-making of stressful events. Second, the protocol employs specific cognitive restructuring techniques derived from Quranic teachings, including expectation regulation (Quran, 24:54), correction of attribution errors (Quran, 4:79), situation reinterpretation (Quran, 24:11), problem minimization (Quran, 2:183-184), hope instillation (Quran, 65:7), self-control (Quran, 12:90), and acceptance (Quran, 2:112).
Third, the protocol enhances spiritual connection as a source of existential support. Quranic teachings emphasize that "truly in the remembrance of God do hearts find rest" (Quran, 13:28). This remembrance is not merely verbal but involves the cognitive and emotional awareness of God's presence. This process, as Park (2005) has noted, operates through religious cognitive restructuring, helping individuals reinterpret stressful events within their religious frameworks, particularly when religious teachings are taught as coherent coping strategies. Fourth, the protocol transfers the locus of control from "intrapersonal" to "transpersonal" dimensions, thereby increasing existential support and meaning, and reducing existential anxiety stemming from feelings of powerlessness against events.
Theoretical and Clinical Implications
The findings support the growing body of evidence for culturally adapted interventions. The Quranic coping protocol represents a culturally grounded approach that integrates religious teachings with psychological principles. This is consistent with the cultural adaptation literature that emphasizes the importance of adapting interventions to the cultural and religious context of the target population (Ano & Vasconcelles, 2005; Abu-Raiya & Pargament, 2015; García et al., 2017). The high feasibility and promising outcomes suggest that culturally adapted religious interventions can be both acceptable and effective. The protocol's focus on multiple dimensions—self, God, others, and world—reflects the holistic approach of Islamic psychology, which addresses the spiritual, psychological, social, and existential dimensions of human experience. This multidimensional approach may contribute to the sustained effects observed during the follow-up period, as it addresses the underlying meaning-making structures rather than merely symptom reduction.
From a clinical perspective, the protocol offers a structured, manualized intervention that can be implemented by trained therapists. The five-session format provides a concise yet comprehensive intervention that can be integrated into various clinical settings. The specific techniques derived from Quranic teachings provide concrete strategies that clients can apply in their daily lives, potentially enhancing self-efficacy and coping skills. The high rates of client satisfaction and technique application suggest that the protocol is acceptable and usable for clients, which is essential for real-world implementation. The feasibility of this protocol also has implications for other Muslim populations, suggesting that Quranically-based interventions could be adapted and implemented across diverse cultural and clinical contexts.

Conclusion
This study examined the feasibility of implementing a religious coping protocol based on the Holy Quran in reducing perceived stress among three individuals. The findings demonstrated high clinical satisfaction (93%) and significant improvement in perceived stress (36% overall improvement). Visual analysis confirmed decreasing and stable stress patterns during the intervention phase for all participants, with maintenance of effects during follow-up. Non-parametric effect size measures (PND and POD = 100%) indicated very high treatment effects. These results support the feasibility of implementing Quran-based religious coping protocols for individuals with perceived stress and suggest that such protocols can be effectively used in research and clinical settings.
The study has several limitations. Single-subject designs have limited generalizability due to the small number of participants, reducing external validity. The study was not fully controlled, and the effects of confounding variables such as spontaneous improvement, time passage, therapist effects, or treatment conditions cannot be completely ruled out. Repeated measurement in single-subject studies may also create learning effects, potentially influencing self-report scores. Future research should implement larger-scale randomized controlled trials to provide more robust evidence for the protocol's effectiveness and generalizability. Additionally, comparative studies examining the protocol against other evidence-based interventions would help establish its relative efficacy. Despite these limitations, the findings contribute to the growing literature on culturally adapted psychological interventions and provide initial evidence for the feasibility of Quran-based coping protocols in reducing perceived stress. This study highlights the importance of integrating religious teachings into clinical interventions and the potential of such culturally grounded approaches to enhance mental health outcomes.