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Granting Forgiveness or Harboring Grudges: Implications for Emotion, Physiology, and Health


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Interpersonal offenses frequently mar relationships. Theorists have argued that the responses victims adopt toward their offenders have ramifications not only for their cognition, but also for their emotion, physiology, and health. This study examined the immediate emotional and physiological effects that occurred when participants (35 females, 36 males) rehearsed hurtful memories and nursed grudges (i.e., were unforgiving) compared with when they cultivated empathic perspective taking and imagined granting forgiveness (i.e., were forgiving) toward real-life offenders. Unforgiving thoughts prompted more aversive emotion, and significantly higher corrugator (brow) electromyogram (EMG), skin conductance, heart rate, and blood pressure changes from baseline. The EMG, skin conductance, and heart rate effects persisted after imagery into the recovery periods. Forgiving thoughts prompted greater perceived control and comparatively lower physiological stress responses. The results dovetail with the psychophysiology literature and suggest possible mechanisms through which chronic unforgiving responses may erode health whereas forgiving responses may enhance it.
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Research Article
VOL. 12, NO. 2, MARCH 2001 Copyright © 2001 American Psychological Society
Implications for Emotion, Physiology, and Health
Charlotte vanOyen Witvliet, Thomas E. Ludwig, and Kelly L. Vander Laan
Hope College
Interpersonal offenses frequently mar relationships. Theo-
rists have argued that the responses victims adopt toward their offend-
ers have ramifications not only for their cognition, but also for their
emotion, physiology, and health. This study examined the immediate
emotional and physiological effects that occurred when participants
(35 females, 36 males) rehearsed hurtful memories and nursed
grudges (i.e., were unforgiving) compared with when they cultivated
empathic perspective taking and imagined granting forgiveness (i.e.,
were forgiving) toward real-life offenders. Unforgiving thoughts
prompted more aversive emotion, and significantly higher
(brow) electromyogram (EMG), skin conductance, heart rate, and
blood pressure changes from baseline. The EMG, skin conductance,
and heart rate effects persisted after imagery into the recovery peri-
ods. Forgiving thoughts prompted greater perceived control and com-
paratively lower physiological stress responses. The results dovetail
with the psychophysiology literature and suggest possible mechanisms
through which chronic unforgiving responses may erode health
whereas forgiving responses may enhance it.
Social relationships are often marred by interpersonal offenses. An
expanding group of theorists, therapists, and health professionals has
proposed that the ways people respond to interpersonal offenses can
significantly affect their health (McCullough, Sandage, & Worthing-
ton, 1997; McCullough & Worthington, 1994; Thoresen, Harris, &
Luskin, 1999). Unforgiving responses (rehearsing the hurt, harboring
a grudge) are considered health eroding, whereas forgiving responses
(empathizing with the human condition of the offender, granting for-
giveness) are thought to be health enhancing (e.g., Thoresen et al.,
1999; Williams & Williams, 1993). Although several published stud-
ies have found a positive relationship between forgiveness and mental
health variables (Al-Mabuk, Enright, & Cardis, 1995; Coyle & En-
right, 1997; Freedman & Enright, 1996; Hebl & Enright, 1993), the
current literature lacks controlled studies of forgiveness and variables
related to physical health.
Indirect evidence suggests that the health implications of forgive-
ness and unforgiveness may be substantial. Research associates the
unforgiving responses of blame, anger, and hostility with impaired
health (Affleck, Tennen, Croog, & Levine, 1987; Tennen & Affleck,
1990), particularly coronary heart disease and premature death
(Miller, Smith, Turner, Guijarro, & Hallet, 1996). Further, research
suggests that reductions in hostility—brought about by behavioral in-
terventions that emphasize becoming forgiving—are associated with
reductions in coronary problems (Friedman et al., 1986; Kaplan,
Another line of research suggests that granting or withholding for-
giveness may influence cardiovascular health through changes in
allostatic load
. Allostasis involves changes in the multiple
physiological systems that allow people to survive the demands of
both internal and external stressors (McEwen, 1998). Although al-
lostasis is necessary for survival, extended physiological stress re-
sponses triggered by psychosocial factors such as anxiety and hostility
can result in allostatic load, eventually leading to physical breakdown.
Interpersonal transgressions and people’s adverse reactions to them
may contribute to allostatic load and health risk through sympathetic
nervous system (SNS), endocrine, and immune system changes (e.g.,
Kiecolt-Glaser, 1999). In contrast, forgiveness may buffer health by
reducing physiological reactivity and allostatic load (Thoresen et al.,
An understanding of the relationships among unforgiving re-
sponses, forgiving responses, physiology, emotion, and health may
benefit from the established framework of bioinformational theory
(Lang, 1979, 1995). Lang posited that physiological responses are es-
sential aspects of emotional experiences, memories, and imagined re-
sponses. An extensive literature has supported this view, documenting
that physiological responses reliably vary depending on the emotional
experiences people think about, or imagine (e.g., Cook, Hawk, Davis,
& Stevenson, 1991; Lang, 1979; Witvliet & Vrana, 1995, 2000). Two
emotional dimensions strongly influence the physiological reactions
that occur:
(negative–positive) and
(e.g., Lang, 1995;
Witvliet & Vrana, 1995). For example, the valence of emotion is im-
portant for facial expressions, with negative imagery stimulating
greater muscle tension in the brow than positive imagery (Witvliet &
Vrana, 1995). With heightened emotional arousal, cardiovascular
measures such as blood pressure (e.g., Yogo, Hama, Yogo, & Mat-
suyama, 1995) and heart rate show greater reactivity, and skin conduc-
tance—an index of SNS activity—is also more reactive (e.g., Witvliet
& Vrana, 1995).
Interpersonal transgressions are emotionally laden experiences that
often stimulate negative and arousing memories or imagined emo-
tional responses (e.g., grudges). According to Lang’s theory, unforgiv-
ing memories and mental imagery might produce negative facial
expressions and increased cardiovascular and sympathetic reactivity,
much as other negative and arousing emotions (e.g., fear, anger) do. In
contrast, forgiving responses should reduce the negativity and inten-
sity of a victim’s emotional response, quelling these physiological re-
actions, as more pleasant and relaxing imagery does (Witvliet &
Vrana, 1995). In terms of allostasis (McEwen, 1998), emotional states
(e.g., unforgiving responses) that intensify and extend cardiovascular
and sympathetic reactivity would increase allostatic load, whereas
those that limit these physiological reactions (e.g., forgiving re-
sponses) would improve health.
Address correspondence to Charlotte vanOyen Witvliet, Psychology Depart-
ment, Hope College, Holland, MI 49422-9000; e-mail:
Granting Forgiveness or Harboring Grudges
VOL. 12, NO. 2, MARCH 2001
The literature on forgiveness has focused on the effects of two un-
forgiving responses (rehearsing the hurt, harboring a grudge) and two
forgiving responses (developing empathy for the offender’s humanity,
granting forgiveness) to interpersonal violations.
Unforgiving Responses
Rehearsing the hurt
Once hurt, people often rehearse memories of the painful experi-
ence, even unintentionally, perhaps because the physiological reactiv-
ity that occurs during emotionally significant events facilitates
memory encoding and retrieval (cf. Witvliet, 1997). When people re-
hearse hurtful memories, they may perpetuate negative emotion and
adverse physiological effects (Witvliet, 1997; Worthington, 1998). In-
terestingly, Huang and Enright (2000) found that in the first minute of
describing a past experience with conflict (vs. describing a typical
day), individuals who had forgiven because of religious pressure
showed greater blood pressure increases compared with those who
had forgiven because of unconditional love.
Harboring a grudge
When people hold a grudge, they stay in the victim role and perpet-
uate negative emotions associated with rehearsing the hurtful offense
(Baumeister, Exline, & Sommer, 1998). Despite this, victims may be
drawn to hold grudges because they may secure tangible or emotional
benefits, such as a regained sense of control or a sense of “saving
face” (Baumeister et al., 1998). Yet nursing a grudge is considered “a
commitment to remain angry (or to resume anger periodically),” and
to perpetuate the adverse health effects associated with anger and
blame (Baumeister et al., 1998, p. 98).
Forgiving Responses
Developing feelings of empathy
Developing feelings of empathy for the perpetrator is considered to
play a pivotal role in turning the victim away from unforgiveness and
beginning the forgiveness process (Worthington, 1998). Empathy in-
volves thinking of the offender’s humanity (rather than defining the
person solely in terms of the offense) and trying to understand what
factors may have influenced the offending behavior (Enright & Coyle,
1998). When victims engage in this sort of perspective taking, the re-
sulting empathic compassion reduces the intense arousal and negative
valence of hurts and grudges and introduces more positively valent
emotion for the victim (McCullough et al., 1997). Empathy is also
thought to shift victims’ facial expressions and reduce their stress re-
sponses in the cardiovascular and sympathetic nervous systems (Wor-
thington, 1998).
Granting forgiveness
Granting forgiveness builds on the core of empathy and involves
cognitive, emotional, and possibly behavioral responses (McCullough
et al., 1997). It is important to note that forgiveness still allows for
holding the offender responsible for the transgression, and does not in-
volve denying, ignoring, minimizing, tolerating, condoning, excusing,
or forgetting the offense (see Enright & Coyle, 1998). Although no
universal definition of forgiveness exists, theorists emphasize that it
involves letting go of the negative feelings and adopting a merciful at-
titude of goodwill toward the offender (Thoresen, Luskin, & Harris,
1998). This may free the wounded person from a prison of hurt and
vengeful emotion, yielding both emotional and physical benefits, in-
cluding reduced stress, less negative emotion, fewer cardiovascular
problems, and improved immune system performance (McCullough et
al., 1997; Worthington, 1998).
Unforgiving responses may erode health by activating negative, in-
tense emotion and cardiovascular and SNS reactivity. Forgiving
responses may buffer health or promote healing by quelling cardio-
vascular reactivity and SNS hyperarousal (Thoresen et al., 1999). In
this study, we investigated these hypotheses by measuring physiology
continuously as each participant thought about a real-life offender in
unforgiving and forgiving ways, providing a window into the moment-
by-moment effects of choosing each response. We used a within-sub-
jects repeated measures design (Vrana & Lang, 1990; Witvliet &
Vrana, 1995, 2000), allowing us to compare the physical effects of
adopting unforgiving versus forgiving responses to a particular of-
fender. Building on the psychophysiology literature relevant to health,
we measured imagery effects on self-reports of emotion valence and
emotional arousal; self-reports of perceived control, anger, and sad-
ness; facial electromyogram (EMG) measured at the
(brow) region; skin conductance (as an indicator of SNS activity);
heart rate; and blood pressure. We hypothesized that unforgiving im-
agery would prompt more negative and arousing emotion and hence
lower perceived control than forgiving imagery (cf. Witvliet & Vrana,
1995). We also predicted that unforgiving imagery would be associ-
ated with greater increases in
muscle tension and greater
skin conductance, heart rate, and blood pressure changes (associated
with heightened emotional arousal during unforgiving imagery).
Given the importance that extended physiological reactivity may
have for allostatic load and health consequences (e.g., McEwen,
1998), we examined whether differences between the effects of unfor-
giving and forgiving imagery would persist after the imagery periods,
when participants tried to stop their imagery and engaged in a relax-
ation task. Although such persistence had not been tested previously,
evidence from the trauma literature suggests that negative and arous-
ing personal imagery that evokes heightened physiological reactivity
is difficult to quell (cf. Witvliet, 1997). Physiological differences may
also persist because the valence and arousal of unforgiving imagery
differs considerably from the target mood of relaxation. If the physio-
logical reactivity persists after imagery, unforgiving responses to in-
terpersonal offenses may contribute to adverse health effects because
the heightened cardiovascular and SNS reactivity both during and af-
ter imagery may increase allostatic load.
This study used a standard within-subjects emotional imagery par-
adigm (Vrana & Lang, 1990; Witvliet & Vrana, 1995, 2000), adapting
it to study the emotional and physiological effects of imagining unfor-
giving and forgiving responses to an interpersonal offender.
Charlotte vanOyen Witvliet, Thomas E. Ludwig, and Kelly L. Vander Laan
VOL. 12, NO. 2, MARCH 2001
Seventy-two introductory psychology students voluntarily partici-
pated in this experiment. Because 1 female discontinued the study be-
fore its conclusion, the data for 71 (36 male, 35 female) participants
are reported. Data for 2 participants were excluded from blood pres-
sure analyses because of equipment problems.
Stimulus Materials
The script materials used to prompt autobiographical forgiveness-
related imagery were based on the forgiveness literature (McCullough
et al., 1997). To maximize internal validity, we had all participants use
the same unforgiving scripts (rehearsing the hurt, harboring a grudge)
and forgiving scripts (empathizing with the offender, granting forgive-
ness). To maximize external validity, we instructed each participant to
apply all the unforgiving or forgiving responses to the same interper-
sonal offense from his or her life. This approach allowed us to assess
the emotional and physiological effects of choosing to adopt unforgiv-
ing versus forgiving responses to a particular real-life offender. The
imagery scripts encouraged participants to consider the thoughts, feel-
ings, and physical responses that would accompany each type of un-
forgiving and forgiving response.
We used a Dell 486 computer to time the experimental events and
collect on-line physiological data (VPM software; Cook, Atkinson, &
Lang, 1987). Auditory tones at three frequencies—high (1350 Hz),
medium (985 Hz), and low (620 Hz)—signaled imagery and relax-
ation trials. The tones were 500 ms long and 73 dB[A]. They were
generated by a Coulbourn V85-05 Audio Source Module with a
shaped-rise time set at 50 ms. The tones were presented through Altec
Lansing ACS41 speakers located 2.5 feet to the left of the participant’s
head during the instructions, and through Optimus Nova 67 head-
phones during data collection.
Facial EMG was recorded at the
(i.e., brow) muscle re-
gion using sensor placements suggested by Fridlund and Cacioppo
(1986). Facial skin was prepared using an alcohol pad and Medical
Associates electrode gel. Then miniature Ag-AgCl electrodes filled
with Medical Associates electrode gel were applied. EMG signals
were amplified (
50,000) by a Hi Gain V75-01 bioamplifier, using
90-Hz high-pass and 1-kHz low-pass filters. A Coulbourn multifunc-
tion V76-23 integrator (nominal time constant
10 ms) then rectified
and integrated the signals.
Skin conductance levels (SCLs) were measured by a Coulbourn
isolated skin conductance V71-23 coupler using an applied constant
voltage of 0.5 V across two standard electrodes. Electrodes were filled
with a mixture of physiological saline and Unibase (Fowles et al.,
1981) and applied to the hypothenar eminence on the left hand after it
was rinsed with tap water. A 12-bit analog-digital converter sampled
the skin conductance and facial EMG channels at 10 Hz.
Electrocardiogram data were collected using two standard elec-
trodes, one on each forearm. A Hi Gain V75-01 bioamplifier amplified
and filtered the signals. The signals were then sent to a digital input on
the computer that detected R waves and measured interbeat intervals
in milliseconds.
We continuously measured blood pressure at each heartbeat with
an Ohmeda 2300 Non-Invasive Blood Pressure Monitor, placing the
cuff between the first and second knuckles on the middle finger of the
left hand.
Each participant completed a two-part, 2-hr testing session. First,
the participant identified a particular person he or she blamed for mis-
treating, offending, or hurting him or her. Then the participant com-
pleted a questionnaire about the nature of the offense and his or her
responses to it. Second, in the imagery phase of the study, the partici-
pant actively imagined each type of unforgiving and forgiving
response to the previously identified offender eight times in systemati-
cally manipulated orders that were counterbalanced across partici-
pants. The study session was divided into blocks of trials, with two
types of imagery trials in each block. Acoustic tones (high, low) were
used to signal exactly when the participant was to imagine each type
of forgiving or unforgiving response. Medium tones signaled partici-
pants to engage in a relaxation task, thinking the word
every time
they exhaled (e.g., Vrana & Lang, 1990; Witvliet & Vrana, 1995,
Physiology was monitored continuously during trials consisting of
an 8-s baseline (relaxation) period, 16-s imagery period, and 8-s re-
covery (relaxation) period. On-line monitoring allowed us to measure
the immediate psychophysiological effects of people’s unforgiving
and forgiving responses as they occurred.
After each block of imagery trials, participants rated their feelings
during the preceding two types of imagery. Using a video display and
computer joystick (see Hodes, Cook, & Lang, 1985), participants
rated their level of emotional valence (negative-positive) and arousal
(low-high), as well as anger, sadness, and perceived control. As a ma-
nipulation check, participants also rated how much empathy they felt
for the offender and how much they felt they had forgiven the offender
during the different imagery conditions (from
not at all
All ratings were converted to a scale ranging from 0 to 20. Participants
privately registered all ratings directly into a computer and were en-
couraged to be completely honest.
Data Collection and Reduction
During the experiment, participants’ heart rate and blood pressure
were measured on a heartbeat-to-heartbeat basis, and facial EMG and
SCL data were measured on a second-to-second basis. Cardiac inter-
beat intervals were converted off-line to heart rate in beats per minute
for each imagery period. Within each type of imagery condition (hurt,
grudge, empathy, forgiveness), the physiology measures were aver-
aged over 4-s epochs, resulting in two 4-s epochs during the baseline
period, four 4-s epochs during the imagery period, and two 4-s epochs
during the recovery period. During the imagery and recovery periods,
change scores for each 4-s epoch were created by subtracting values
from the 4-s baseline epoch immediately before the imagery period.
The hurt and grudge imagery trials were considered to constitute
condition because rehearsing the hurt and holding a
grudge are emotionally negative and arousing and are often experi-
enced together (see Baumeister et al., 1998). Thus, for the analyses,
data for the hurt and grudge imagery trials were averaged. Similarly,
the empathy and forgiveness imagery trials were considered to consti-
tute the
condition because feeling empathy for the perpetra-
tor and granting forgiveness are more positive and less arousing, and
empathy is considered central to the forgiveness process (Worthing-
Granting Forgiveness or Harboring Grudges
VOL. 12, NO. 2, MARCH 2001
ton, 1998). Thus, data for the empathy and forgiveness trials were av-
eraged. The averaged data in the unforgiving condition were compared
with the averaged data in the forgiving condition using analyses of
variance (ANOVAs) with repeated measures.
The overall effect of
emotion condition (forgiving vs. unforgiving imagery) during the im-
agery and recovery periods was assessed.
Interpersonal offenses
Participants reported that their primary offenders included friends,
romantic partners, parents, and siblings. Common offenses included
betrayals of trust, rejection, lies, and insults.
Comparison of the ratings in the forgiving and unforgiving condi-
tions reveals patterns consistent with predictions (Table 1). During un-
forgiving imagery, participants reported feeling more negatively
(1, 70)
.001; aroused,
(1, 70)
.001; angry,
(1, 70)
.001; and sad,
(1, 70)
.001; they also felt less in control,
(1, 70)
.001. During
forgiving imagery, participants reported significantly greater empathy
for and forgiveness toward the offender,
(1, 70)
(1, 70)
.001, respectively.
Figure 1 shows that
EMG change scores were signifi-
cantly higher for the unforgiving condition than the forgiving condi-
tion during both the imagery period,
(1, 70)
.001, and
the recovery period,
(1, 70)
These predicted
findings parallel the strong relationship between
EMG and
negative valence in the literature (see Fridlund & Izard, 1983; Witvliet
& Vrana, 1995). The data for the recovery period suggest that negative
emotion persisted despite efforts to “turn off” the imagery and relax.
As depicted in Figure 2, tonic SCLs showed a general decrease
both during and after imagery, a pattern reflecting habituation to the
experimental context. It is important to note that SCL change scores
were significantly lower for the forgiving condition than the unforgiv-
ing condition during the imagery period,
(1, 70)
and during the recovery period,
(1, 70)
.001, indicating
comparatively less SNS arousal. This pattern dovetails with partici-
pants’ reports of higher arousal during the unforgiving condition. This
1. Further analyses supported this theoretical rationale. Physiology did not
differ between the hurt and grudge conditions, nor between the empathy and
forgiveness conditions, but physiology did differ significantly for each of the
two unforgiving conditions compared with each of the two forgiving condi-
tions (for all comparisons of heart rate, skin conductance, blood pressure, and
.05, except that blood pressure differences be-
tween grudge and both empathy and forgiveness conditions were marginal,
2. In the interest of space, we do not report epoch effects, although the fig-
ures depict data across epochs to assist readers in understanding the physiolog-
ical results across the imagery and recovery periods.
3. Individual difference variables included sex, offense severity, whether
the offender had apologized, whether the offender and victim had repaired
their relationship, and the degree to which the victim had held a grudge and
had desired revenge against, had empathized with, or had forgiven the of-
fender. These variables did not have significant effects on heart rate, mean arte-
rial pressure, skin conductance, or
4. EMG was measured at two additional sites. Increases at the
(under the eye) also were significantly greater during unforgiving imag-
ery, but
(cheek) EMG showed no effects.
Table 1. Mean self-ratings for the unforgiving and forgiving
imagery conditions
Imagery condition
Measure Unforgiving Forgiving
Valence 5.63 13.21
(2.72) (3.27)
Arousal 15.34 7.21
(2.95) (3.68)
Control 8.37 13.03
(3.85) (3.43)
Sadness 11.71 7.14
(4.41) (4.28)
Anger 15.75 5.11
(2.63) (3.84)
Empathy 3.87 13.91
(3.35) (3.55)
Forgiveness 4.08 14.64
(3.27) (3.92)
Note. Participants’ ratings about how they felt during each type of
imagery were converted to a scale from 0 to 20. For valence, 0 is
strongly negative, and 20 is strongly positive. For arousal and control, 0
is very low, and 20 is very high. For sadness, anger, empathy, and
forgiveness, 0 means “not at all,” and 20 means “completely.” Standard
deviations are in parentheses.
Fig. 1. Change from baseline for corrugator electromyograms (EMGs)
during the 16-s imagery and 8-s recovery periods.
Charlotte vanOyen Witvliet, Thomas E. Ludwig, and Kelly L. Vander Laan
VOL. 12, NO. 2, MARCH 2001
result is striking because emotional differences must be highly potent
to yield significant effects on SCLs in imagery paradigms (Witvliet &
Vrana, 1995), and the differences persisted even as participants tried
to quell their responses and relax.
Heart Rate
As depicted in Figure 3, heart rate increased from baseline regard-
less of how participants imagined responding to their offenders, a pat-
tern found in other studies of personalized emotional imagery
(Witvliet & Vrana, 1995, 2000). As hypothesized, the heart rate in-
creases were greater in the unforgiving condition than in the forgiving
condition during both the imagery period,
(1, 70)
and the recovery period,
(1, 70)
.001. The persistence
of the heart rate increase parallels the persisting SCL and
EMG effects and is consistent with the arousal ratings and findings in
the literature, in which significantly greater heart rate increases oc-
curred during highly arousing imagery (e.g., Cook et al., 1991; Wit-
vliet & Vrana, 1995, 2000). Together with the
and SCL
results, these data suggest that it is difficult to quell the aversive emo-
tion and physiological reactivity associated with unforgiving imagery.
Mean Arterial Pressure
Figure 4 shows that mean arterial pressure increased significantly
more during the unforgiving than the forgiving condition,
(1, 68)
.01, as predicted.
This finding parallels the heart rate data,
the self-ratings, and findings in the literature, which links blood pres-
sure reactivity to higher levels of arousal (e.g., Yogo et al., 1995) and
anger (e.g., Kunzendorf, Cohen, Francis, & Cutler, 1996). During the
recovery periods, mean arterial pressure did not differ significantly be-
tween conditions,
(1, 68)
The physiology of forgiveness and unforgiveness is uncharted ter-
ritory for empirical study, despite theoretical explorations of the possi-
ble health costs of unforgiveness and health benefits of forgiveness
(e.g., McCullough et al., 1997; Williams & Williams, 1993). In this
study, we investigated the emotional and physiological effects when
people imagined responding to their real-life offenders in unforgiving
ways (rehearsing the hurt, harboring a grudge) and forgiving ways
(empathic perspective taking, granting forgiveness).
Emotion and Physiology
The results were consistent with bioinformational theory (Lang,
1979, 1995) in that imagery of unforgiving and forgiving responses to
a particular offender yielded differences in both self-reported emotion
Fig. 2. Change from baseline for skin conductance level during th
16-s imagery and 8-s recovery periods.
Fig. 3. Change from baseline for heart rate during the 16-s imager
and 8-s recovery periods.
Fig. 4. Change from baseline for mean arterial pressure during th
16-s imagery and 8-s recovery periods.
5. Diastolic blood pressure was significantly higher throughout unforgiving
imagery than forgiving imagery; systolic blood pressure was significantly
greater during unforgiving imagery in Epochs 2 and 3.
Granting Forgiveness or Harboring Grudges
122 VOL. 12, NO. 2, MARCH 2001
and physiological responding. Participants felt significantly more neg-
ative, aroused, angry, and sad and less in control during the unforgiv-
ing condition than during the forgiving condition (Table 1). They also
showed greater facial tension at the corrugator (brow) muscle region
during unforgiving imagery (Fig. 1), paralleling effects of negative
emotion reported in the literature (see Fridlund & Izard, 1983; Wit-
vliet & Vrana, 1995). During the arousing unforgiving imagery, par-
ticipants experienced significantly greater SNS arousal—as indicated
by higher SCL change scores (Fig. 2)—and greater cardiovascular re-
activity in terms of heart rate and blood pressure (Figs. 3 and 4). These
results parallel arousal effects reported in the literature (e.g., Witvliet
& Vrana, 1995; Yogo et al., 1995). Further, the elevated corrugator
EMG, skin conductance, and heart rate change scores during unforgiv-
ing imagery persisted into the postimagery recovery period. Overall,
the physiological patterns in this study are quite consistent with the
patterns that occur during emotional imagery in general (Witvliet &
Vrana, 1995), suggesting that the physiological effects of unforgiving
and forgiving responses to interpersonal offenses may be influenced
substantially by the emotional quality of these responses.
Health Implications
These four physiological measures provide a window into what
happens to the body during emotional thoughts about an offender,
even when the thoughts are very brief. Although it is unlikely that the
brief unforgiving trials in this study would have a clinically significant
effect on health, we believe that the effects obtained in this study pro-
vide a conservative measure of effects that naturally occur during un-
forgiving responses to real-life offenders. Lang (1979) has argued that
physiological effects during emotional imagery mirror naturally oc-
curring effects, but are less potent. In daily life, people may intensify
their hurtful memories and vengeful thoughts (e.g., embellishing ac-
counts of the offense with language that heightens contempt) and
punctuate their imagery with overt behaviors (e.g., slamming doors,
shouting), thereby intensifying and extending blood pressure surges,
heart rate elevations, and SNS activation.
The emotional and physiological effects identified in this study may
be mediators of a relationship between forgiveness and health (Thore-
sen et al., 1999). Earlier work identified anger, hostility, anxiety, and de-
pression as psychosocial risk factors for heart disease, and chronic SNS
arousal as a mechanism for the relationship between psychosocial fac-
tors and heart disease (Allan & Scheidt, 1996). This pattern is reflected
in the current study, as participants reported significantly higher anger
and sadness, and lower perceived control, during unforgiving imagery
than during forgiving imagery, and also showed greater SNS arousal
and cardiovascular reactivity during unforgiving imagery.
Chronic unforgiving, begrudging responses may contribute to ad-
verse health outcomes by perpetuating anger and heightening SNS
arousal and cardiovascular reactivity. Expression of anger has been
strongly associated with chronically elevated blood pressure (Schwenk-
mezger & Hank, 1996) and with the aggregation of platelets, which
may increase vulnerability for heart disease (Wenneberg et al., 1997),
especially if the expressions of anger are frequent and enduring (see
Thoresen et al., 1999). Although fleeting feelings of unforgiveness
may not erode health, more frequent, intense, and sustained unforgiv-
ing emotional imagery and behaviors may create physiological vulner-
abilities or exacerbate existing problems in a way that erodes health.
SNS arousal may also influence immune system functioning
(Kiecolt-Glaser, Malarkey, Cacioppo, & Glaser, 1994; Thoresen et al.,
1999). For example, research suggests that marital discord can induce
changes in SNS, endocrine, and immune system functioning, even in
individuals reporting high marital satisfaction and healthy lifestyles
(Kiecolt-Glaser, 1999). When psychosocial stress is chronic, it may
have the most impact on these physiological functions, thereby influ-
encing susceptibility to and progression of diseases (e.g., cancer,
infectious illnesses). Conversely, interventions that buffer against psy-
chosocial stressors, including interpersonal conflict, may ultimately
influence health (see Kiecolt-Glaser & Glaser, 1995).
The concept of allostasis (McEwen & Stellar, 1993) may have con-
siderable utility for understanding possible links between forgiveness
and health (Thoresen et al., 1999). Allostatic load can occur when
physiological systems remain activated, despite termination of an ex-
ternal stressor (McEwen, 1998). In the present study, varied physio-
logical responses (e.g., SCL, heart rate, blood pressure, and facial
EMG) were activated when people thought about responding to their
offenders. This reactivity was significantly greater during unforgiving
than forgiving imagery. Further, physiological reactivity remained sig-
nificantly higher for SCL, heart rate, and corrugator EMG even in the
recovery period after imagery. This suggests that if unforgiving emo-
tion is sufficiently potent and enduring, and if some physiological sys-
tems (e.g., SNS, cardiovascular) resist recovery, unforgiving responses
could contribute to allostatic load.
In contrast, less heart rate, blood pressure, and EMG reactivity oc-
curred during the forgiving imagery than during the unforgiving imag-
ery, and SCLs showed greater habituation. It may be that when people
enact forgiving responses, the physiological demands of unforgiving
emotional hurt and anger are reduced, thereby decreasing allostatic
load and associated health risks. Interestingly, McEwen (1998) has ad-
vocated the use of behavioral interventions that reduce stress, facilitate
social support, and increase perceived control to improve allostasis
and decrease allostatic load. Interventions to promote forgiveness have
already begun to suggest an association between forgiveness and men-
tal health (e.g., Al-Mabuk et al., 1995; Coyle & Enright, 1997; Freed-
man & Enright, 1996; Hebl & Enright, 1993). Furthermore, “increased
frequency of forgiving others . . . could function to reduce the chronic-
ity of distress (e.g., anger, blame, and vengeful thoughts and feelings)
that has prospectively been shown to alter brain, coronary, and im-
mune functioning. Such reductions could encourage diminished SNS
arousal in frequency, magnitude and duration, resulting over time in
less physical disease risk” (Thoresen et al., 1999, p. 259). The present
study begins to build the empirical case for this assertion.
Research on forgiveness is still in its early development. We be-
lieve that this study—the first to explore the physiological effects of
adopting various unforgiving and forgiving responses to real-life of-
fenders—provides a good foundation for future research. Although
people cannot undo past offenses, this study suggests that if they de-
velop patterns of thinking about their offenders in forgiving ways
rather than unforgiving ways, they may be able to change their emo-
tions, their physiological responses, and the health implications of a
past they cannot change.
Acknowledgments—This research was supported by a grant to Charlotte
vanOyen Witvliet from the John Templeton Foundation for Scientific Stud-
ies on the Subject of Forgiveness. We wish to thank Erin Thompson, Den-
nis Ahmad, Jenette Bongiorno, January Estes, Emily Hollebeek, Daniel
Kubacki, Michelle Lynch, Renata Meixner, Sharon Schultz, Sarah Snyder,
and Dara Spearman for assistance with data collection.
Charlotte vanOyen Witvliet, Thomas E. Ludwig, and Kelly L. Vander Laan
VOL. 12, NO. 2, MARCH 2001 123
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... Moreover, previous findings indicate that the opposite mental state of forgiveness seems to be unforgiveness rather than revenge (Wade & Worthington, 2003). Unforgiveness has been defined as a mental state of not forgiving an interpersonal transgression, characterized by negative emotions such as resentment, grudge, hostility, and anger, and little motivation to reduce these negative emotions (Berry et al., 2005; The relation between forgiveness and PTSD Although forgiveness has been frequently shown to promote mental and physical health (Berry et al., 2001;Freedman & Enright, 1996;Thompson et al., 2005;Thoresen et al., 2000;Lawler et al., 2003;Witvliet et al., 2001), most studies have investigated the impact of forgiveness on mental health only in the context of slight harms and close relationships. Few have focused on forgiveness in the aftermath of traumatic events and its relationship with PTSD. ...
... However, nothing is known from these studies about the mechanisms that underlie the reported positive effect of forgiveness on PTSD or the specific impact of forgiveness beyond the reduction of revenge. Findings from other studies suggest that the health-improving effect of forgiveness is mainly attributable to the reduction of the arousal level (Witvliet et al., 2001), of anger (Orth et al., 2008), and of stress (Lawler et al., 2005). Yet these factors are the same as those that have been said to mediate the relation between revenge and PTSD Worthington, 1998). ...
... Some authors suggested that posttraumatic intrusions directly lead to posttraumatic hyperarousal and to the enhancement of anger (Chemtob et al., 1997;Schützwohl & Maercker, 2000). It has been shown that arousal level is associated with both anger and retaliatory response (Witvliet et al., 2001;Zechmeister et al., 2004). Following these findings, revenge also might result from a related constellation of symptoms: Intrusions and hyperarousal may cause anger, which under certain conditions (e.g., specific cognitive appraisal, intrapersonal preconditions) may lead to feelings of revenge that on their part might be PTSD maintaining. ...
... Forgiving others can also help improve relationships, and especially, it can protect children from injustices that are passed on through generations (Enright, 2016). On the other hand, higher unforgiveness is associated with higher aversive emotions, heart rate, or blood pressure (Witvliet et al., 2001). ...
... Moreover, individuals perceived negative effects of unforgiveness, such as experiencing pain, stress, depression, disrupted relationships, or even heart disease and cancer. Previous research has similarly shown that greater unforgiveness is associated with mental and physical distress, such as higher blood pressure, cortisol reactivity, or higher depression (e.g., Harris & Thoresen, 2005;Witvliet et al., 2001). Participants supported Enrightʼs (2016) belief that anger is an emotion affecting both mind and body, citing its direct concrete consequences such as reduced concentration, greater ruminations, or reduced performance. ...
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Objectives. The main aim of this study was to qualitatively explore the general population’s understanding of forgiveness with regard to its definition, factors, and effects. The special focus of the study was on comparing the views on forgiveness by two generations, young adults, and seniors. Participants and setting. Semi-structured interviews were done with 20 participants from two age groups: ten young adults aged 21 to 29 years (M = 23.4, SD = 2.79) and ten seniors aged 61 to 68 years (M = 64, SD = 2.47). Research questions. Research questions were focused on examining how laypersons conceptualize forgiveness; notably, how they view the factors and effects of forgiveness. It was also explored whether there are any specifics and differences in the views on forgiveness between young adults and seniors. Data analysis. The data obtained from semi-structured interviews were analyzed by Consensual Qualitative Research (Hill et al., 2005). Results. For most individuals in both generations, the basis of forgiveness was letting go of anger and pain. The most significant factor positively related to forgiveness was an apology and admitting the mistake. The most noteworthy negative factor was the depth of the hurt. Individuals perceive positive consequences of forgiveness, especially on their mental health and strengthening their relationships. It seems that young adults perceive forgiveness more as an interpersonal process, while seniors perceive it more as an internal process of an individual. Study limitations. The use of qualitative methodology and the sample size limits the generalization of the findings or comparing two samples at the level of statistical significance. Participants may have had various experiences dealing with hurt and forgiveness throughout their lives which could have influenced their views on forgiveness. Implications. Gaining a deeper understanding of how young adults and seniors understand forgiveness and its effects, what they perceive as helpful or blocking in their forgiving, can help counselors and therapists to improve their interventions aimed at promoting forgiveness.
... In the field of well-being promotion studies, the trait forgiveness (in face of its momentary state) is of a considerable interest due to its influence over time and situations and general greater positive psychological impact [95]. In healthy participants, forgiveness has been associated with a variety of psychological well-being indicators such as reduced anger, along with lower depression and anxiety [24,[96][97][98]. Forgiveness has been also related to reduced sympathetic arousal, enhanced parasympathetic tone, and physical health and longevity [96][97][98]. ...
... In healthy participants, forgiveness has been associated with a variety of psychological well-being indicators such as reduced anger, along with lower depression and anxiety [24,[96][97][98]. Forgiveness has been also related to reduced sympathetic arousal, enhanced parasympathetic tone, and physical health and longevity [96][97][98]. In addition, in several studies using a heterogeneous sample of pain patients with various etiologies, locations, and pain duration and extension, forgiveness has been related to less time spending in avoiding or fighting again pain, reduced pain intensity and pain interference, as well as greater levels of mental health [99]. ...
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Anger has been associated with increased pain perception, but its specific connection with Fibromyalgia Syndrome (FMS) has not yet been established in an integrated approach. Therefore, the present systematic review focuses on exploring this connection, and based on this connection, delimiting possible gaps in the research, altogether aimed at improving FMS clinical intervention and guiding future research lines. Anger is considered a basic negative emotion that can be divided into two dimensions: anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical means). The current systematic review was performed based on the guidelines of the PRISMA and Cochrane Collaborations. The Prospective Register of Systematic Reviews (PROSPERO) international database was forehand used to register the review protocol. The quality of chosen articles was assessed and the main limitations and research gaps resulting from each scientific article were discussed. The search included PubMed, Scopus, and Web of Science databases. The literature search identified 13 studies eligible for the systematic review. Levels of anger-in have been shown to be higher in FMS patients compared to healthy participants, as well as patients suffering from other pain conditions (e.g., rheumatoid arthritis). FMS patients had also showed higher levels of state and trait anxiety, worry and angry rumination than other chronic pain patients. Anger seems to amplify pain especially in women regardless FMS condition but with a particularly greater health-related quality of life´s impact in FMS patients. In spite of the relevance of emotions in the treatment of chronic pain, including FMS, only two studies have proposed intervention programs focus on anger treatment. These two studies have observed a positive reduction in anger levels through mindfulness and a strength training program. In conclusion, anger might be a meaningful therapeutic target in the attenuation of pain sensitivity, and the improvement of the general treatment effects and health-related quality of life in FMS patients. More intervention programs directed to reduce anger and contribute to improve well-being in FMS patients are needed.
... There are two important characteristics related to using sensory cues for tailored immersion in VRET: authenticity and timing. First, to increase emotional engagement, it is important to choose cues that are authentic to the traumarelated memory and the expectations of patients, while leaving out irrelevant ones (Witvliet et al., 2001;Gilbert, 2016;Picard et al., 2017). Identification of such personal sensory cues may take place offline, in advance of therapy sessions (e.g., from a subject's descriptions of the traumatic experience, by letting a subject select music that is relevant to the trauma or that is calming). ...
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With the application of virtual reality (VR), tailored interventions can be created that mirror the traumatic experiences of veterans with post-traumatic stress disorder (PTSD). Visual elements can be mimicked, and auditory and other senses stimulated. In doing so, the degree of immersion can be adjusted to optimize the therapeutic process. Objectively measuring the sensory immersion is key to keep subjects within their personal window of tolerance. Based on this information the therapist can decide manipulate the sensory stimulation embedded in the treatment. The objectives of this article are to explore the different immersive design aspects of VRET that can be modified to influence the experienced presence in veterans with PTSD, and to discuss possible methods of measuring the emotional response facilitated by immersive design aspects and experienced presence. Four design aspects are discussed: system, sensory cues, narrative and challenge. We also report on a user experiment in three veterans that informed on quality and depth of immersion. Believability of the neutral virtual environment was important for maintaining the veterans' presence within the VR experience. The immersive design aspects that were personalized and supportive in the narrative of the veteran such as music and self-selected images appeared to have a strong influence on recall and reliving of the traumatic events. Finally, in order to increase the therapeutic effect in veterans with PTSD, the highlighted design aspects should be recognized and tailored to maximize immersion in virtual reality exposure therapy.
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A successful partnership implies one's ability to attract and retain a partner. Readiness to forgive contributes to the renewal and improvement of broken relationships, while an attachment style plays an important role in the formation of internal 'working models' that serve as 'guidelines' for the formation of new relationships. The goal of this study was to investigate whether there is a connection between attachment and success in maintaining a partnership, and if so, whether that relationship is direct or mediated by the capacity to forgive. Based on the results obtained with the Mediation Analysis with Multiple Mediators, we found that insuffcient effort in the process of finding a partner is not directly associated with Avoidance, i.e., the negative working model of others; this connection is created indirectly through the strategy to avoid forgiveness. The sample used in this study is representative and included 387 participants, 82,7% of which were female participants between 18 and 40 years of age (AS = 23,90; SD = 4,22). The instruments used were the Mating Effort Scale (Apostolou et al., 2018), Partner Selectivity Scale (Apostolou et al., 2018), the Scale for Success in Finding a Partner (Apostolou et al., 2018), the Tendency to Forgive Scale (McCullough, Root, & Cohen, 2006), Affective Partner Attachment Scale (Brennan, Clark & Shaver, 1995). The results obtained indicate that insufficient effort in the process of finding a partner is not directly associated with Avoidance; this connection is created indirectly through the strategy to avoid forgiveness (ab=-,043, [-,077, -,017]). As for the connection between Effort and Anxiety, it is mediated by the Revenge dimension (ab = -,051, [-,080, -,026]). Forgiveness avoidance has been shown to be a statistically significant mediator in the relationship between Failure to Find a Partner and Avoidance (ab = -,029, [-,052, -,010]). All obtained mediations are partial. This research shows that success in maintaining a relationship, selectivity when looking for a partner and the effort invested to start and maintain a relationship are closely associated with a person's emotional development: his/her vision of him/ herself, vision of others and emotional capacity developed through life, such as the tendency to forgive. The findings of this research would be much more valuable if the research was conducted on both partners in a certain relationship and if the situation related to forgiveness was kept under control, which is a recommendation for other studies.
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Bu çalışmanın amacı örgütsel affetme eğilimi ve örgütsel sağlık ilişkisi ve örgütsel affetme eğiliminin örgütsel sağlık üzerindeki etkisinin belirlenmesidir. Tanımlayıcı nitelikte olan bu çalışma, Yozgat Bozok Üniversitesi Eğitim ve Araştırma Hastanesi’nde görev yapan sağlık çalışanları üzerinde 2021 yılında gerçekleştirilmiştir. Çalışmada veri toplama aracı olarak anket tekniğinden yararlanılmıştır. Çalışmada basit tesadüfi örneklem yöntemi seçilmiş olup, çalışmaya katılmayı kabul eden 307 sağlık çalışanı ile online platformlar üzerinden veriler toplanmıştır. Toplanan verilerin analizi SPSS 22.00 ve SPSS AMOS 24.00 programları aracılığı ile analiz edilmiştir. Araştırmadan elde edilen bulgulara göre örgütsel affetme ile örgütsel sağlık ve alt boyutları arasında anlamlı ilişkilerin olduğu tespit edilmiştir. Ayrıca örgütsel affetmenin örgütsel sağlık üzerinde etkisinin olduğu görülmüştür. Araştırmada model testi olarak yapısal eşitlik modellemesi testi uygulanmıştır. Örgütsel affetme alt boyutları olan affediciliği gerekçelendirme ve affediciliği kabul örgütsel sağlık üzerinde pozitif etkiye sahiptir. Affediciliği ret boyutu ise örgütsel sağlık üzerinde negatif etkiye sahiptir. Araştırmadan elde edilen sonuçlar ışığında kurum ve kuruluşlar açısından metafor bir kavram olan örgütsel sağlığı geliştirmeleri için örgütsel affetmenin varlığını benimsemeleri gerekliliği vurgulanmış ve gelecekte yapılacak çalışmalar için önerilerde bulunulmuştur. The aim of this study is to determine the relationship between organizational forgiveness tendency and organizational health and the effect of organizational forgiveness tendency on organizational health. This descriptive study was carried out on healthcare professionals working at Yozgat Bozok University Training and Research Hospital in 2021. Questionnaire technique was used as a data collection tool in the study. Simple random sampling method was chosen in the study, and data were collected through online platforms with 307 healthcare professionals who agreed to participate in the study. The analysis of the collected data was analyzed through SPSS 22.00 and SPSS AMOS 24.00 programs. According to the findings obtained from the research, it has been determined that there are significant relationships between organizational forgiveness and organizational health and its sub-dimensions. On the other hand, it has been observed that organizational forgiveness has an effect on organizational health. Structural equation modeling test was used as a model test in the research. Organizational forgiveness sub-dimensions, justifying forgiveness and accepting forgiveness, have a positive effect on organizational health. Forgiveness rejection dimension, on the other hand, has a negative effect on organizational health. In the light of the results obtained from the research, the necessity of adopting the existence of organizational forgiveness in order to improve organizational health, which is a metaphoric concept for institutions and organizations, was emphasized and suggestions were made for future studies.
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In this book, a particular emphasis, was given to the technological development of new health care/services approaches describing processes regarding the introduction and implementation of technologies into health systems; the knowledge translation; evidence-based policy and its utility as a guide for implementation of health-promoting technologies; big data analytics for health policy in decisions making; and realworld cases.
This study examines skin conductance level (SCL) trajectories and childhood exposure to intimate partner aggression (IPA) committed between parents in a sample of college students. Although IPA among parents does not directly involve children, children frequently see or are exposed to IPA first-hand when it occurs. This exposure to IPA increases risks for psychopathology and emotional or behavioral difficulties for children or adolescents later in life. However, research has not yet examined the stress response patterns of individuals exposed to IPA, nor how reactivity to stress may be altered based on this exposure. Participants included 161 college students who completed questionnaires assessing demographics, mental health, and exposure to IPA, and also reported on family functioning and parental drinking habits. Additionally, participants completed a three-minute mirror tracing task followed by a three-minute recovery period while SCL was monitored. Multilevel modeling was used to assess whether frequency or level of exposure to IPA was related to trajectories of SCL. Neither variable was related to SCL trajectories during the mirror-tracing task. However, both frequency and level of exposure were related to SCL trajectories during the recovery period, such that for participants reporting higher levels of either IPA exposure variable, SCL trajectories during recovery declined less rapidly and did not decline to as low of a level compared to participants reporting lower levels of IPA exposure. This blunted SCL recovery may be due to wear and tear from repeated innervation, or a calibrating of the SCL response to adapt to a volatile home environment.
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South Africans live in a broken country where hatred leads to violence and destroys the relationships between people. The pertinent question here is: Is forgiveness between South Africans possible? This article is an attempt to understand ‘forgiveness’ in Ephesians, and to discuss the power of such forgiveness in a violent and broken South Africa. Ephesians 4:23 demands a change in the people’s mindset in order to be able to, inter alia, be kind and compassionate when they forgive each other (Eph 4:32). This forgiveness means to take control as a believer and to use one’s power as a Christian to forgive because God forgave us. We need to be the initiators of the transaction. Forgiveness is a ‘means for imitating God’, for ‘carrying out God’s plan’, and ‘enhancing one’s relationship’ with God. Forgiveness will restore relations; it is a gift to oneself and to others, to society, to one’s country. Ephesians advises to no longer rehearse and re-think the memories of pain, to stop harbouring and nursing grudges, to stop playing the victim and perpetuating negative emotions associated with this rehearsing, and to break people’s commitment to remain angry. Contribution: Ephesians aims to persuade believers that forgiveness is a choice to imitate God. Forgiveness is an act out of grace, kindness, and compassion.
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The relationship between forgiveness and anger-related emotions was examined with an adult sample in Taiwan. Levels of forgiveness were based on the analyses in Enright, Santos, and Al-Mabuk (1989). Thirty matched pairs of level 4 (forgiveness as an obligation) and level 6 (forgiveness as moral love) participants out of 1,427 adults screened were assessed on variables of anger-related emotions via self-report, facial expressions, the frequency of casting down the eyes, and blood pressure. These measurements were administered during or immediately after the participants recorded an incident of deep, interpersonal hurt against him or her. The frequencies of masking smiles and casting down of eyes showed that level 4 participants (who based forgiveness on obligation) had more residual anger-related affect to the hurtful event than did the level 6 participants (who based forgiveness on the moral principle of love). Blood pressure data also suggested higher elevation in the beginning when level 4 participants retold their hurtful events. Psychotherapeutic implications are discussed.
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An intervention, with forgiveness toward their abuser as the goal, was implemented with 12 female incest survivors. The women, from a midwestern city, were 24 to 54 years old, and all were Caucasian. A yoked, randomized experimental and control group design was used. The participants were randomly assigned to an experimental group (receiving the forgiveness intervention immediately) or a waiting-list control group (receiving the intervention when their matched experimental counterpart finished the intervention). Each participant met individually with the intervener once per week. The average length of the intervention for the 12 participants was 14.3 months. A process model of forgiveness was used as the focus of intervention. Dependent variables included forgiveness, self-esteem, hope, psychological depression, and state-trait anxiety scales. After the intervention, the experimental group gained more than the control group in forgiveness and hope and decreased significantly more than the control group in anxiety and depression. When the control group then began the program they showed similar change patterns to the above, as well as in self-esteem improvement.
In a sample of 287 heart attack victims who were interviewed 7 weeks and 8 years after their attack or who were known to have died during follow-up, interrelations among causal attributions for the attack, perceived benefits of the attack, survivor morbidity, and heart attack recurrence were explored. Analyses focused on early cognitive predictors of heart attack recurrence and 8-year morbidity and on the effects of surviving another heart attack on cognitive appraisals. Independently of sociodemographic characteristics and physicians' ratings of initial prognosis, patients who cited benefits from their misfortune 7 weeks after the first attack were less likely to have another attack and had lower levels of morbidity 8 years later. Attributing the initial attack to stress responses (e.g., worrying, nervousness) was also predictive of greater morbidity in 8-year survivors and blaming the initial attack on other people was predictive of reinfarctions. Men who survived a subsequent heart attack were more likely than men who did not have additional attacks to cite benefits and made more attributions 8 years after the initial attack. (37 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective: This article presents a new formulation of the relationship between stress and the processes leading to disease. It emphasizes the hidden cost of chronic stress to the body over long time periods, which act as a predisposing factor for the effects of acute, stressful life events. It also presents a model showing how individual differences in the susceptibility to stress are tied to individual behavioral responses to environmental challenges that are coupled to physiologic and pathophysiologic responses.Data Sources: Published original articles from human and animal studies and selected reviews. Literature was surveyed using MEDLINE.Data Extraction: Independent extraction and cross-referencing by us.Data Synthesis: Stress is frequently seen as a significant contributor to disease, and clinical evidence is mounting for specific effects of stress on immune and cardiovascular systems. Yet, until recently, aspects of stress that precipitate disease have been obscure. The concept of homeostasis has failed to help us understand the hidden toll of chronic stress on the body. Rather than maintaining constancy, the physiologic systems within the body fluctuate to meet demands from external forces, a state termed allostasis. In this article, we extend the concept of allostasis over the dimension of time and we define allostatic load as the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response resulting from repeated or chronic environmental challenge that an individual reacts to as being particularly stressful.Conclusions: This new formulation emphasizes the cascading relationships, beginning early in life, between environmental factors and genetic predispositions that lead to large individual differences in susceptibility to stress and, in some cases, to disease. There are now empirical studies based on this formulation, as well as new insights into mechanisms involving specific changes in neural, neuroendocrine, and immune systems. The practical implications of this formulation for clinical practice and further research are discussed.(Arch Intern Med. 1993;153:2093-2101)
In Experiment 1, sixty-eight subjects completed, first, a thirty-two-trial task measuring image vividness and image “realness,” then, a task measuring heart rate during one minute of negative imaging, one minute of positive imaging, one minute of negative self-talk, and one minute of positive self-talk. In this first study, negative imaging induced elevations in the heart's pulse, whereas negative self-talk did not. In Experiment 2, sixty subjects completed the vividness/“realness” task, a new task involving paper-and-pencil measures of imaging ability, and a task measuring both heart rate and blood pressure during negative imaging, then positive imaging. In this second study, negative imaging induced higher pulse, as well as higher blood pressure and more intense emotion, in subjects whose imagery was more vivid and more “real” and whose image-induced emotion was mostly anger. Also in the latter study, negative imaging induced higher diastolic blood pressure in subjects who were doubly deficient as reality-testers—subjects who not only discriminated their percepts less quickly from their more vivid images but also made fewer correct discriminations.
A theory of emotional imagery is described which conceives the image in the brain to be a conceptual network, controlling specific somatovisceral patterns, and constituting a prototype for overt behavioral expression. Evidence for the hypothesis that differentiated efferent activity is associated with type and content of imaginal activity is considered. Recent work in cognitive psychology is described, which treats both the generation of sensory imagery and text comprehension and storage as examples of the processing of propositional information. A similar propositional analysis is applied to emotional imagery as it is employed in the therapeutic context. Experiments prompted by this view show that the conceptual structure of the image and its associated efferent outflow can be modified directly through instructions and through shaping of reports of image experience. The implications of the theory for psychopathology are considered, as well as its relevance to therapeutic behavior change.