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The Immediate and Delayed Cardiovascular Benefits of Forgiving
BRITTA A. LARSEN,PHD, RYAN S. DARBY,PHD, CHRISTINE R. HARRIS,PHD, DANA KAY NELKIN,PHD, PER-ERIK MILAM, MA,
AND NICHOLAS J.S. CHRISTENFELD,PHD
Background: The putative health benefits of forgiveness may include long-term buffering against cardiovascular reactivity associated
with rumination. Although studies show short-term benefits of adopting a forgiving perspective, it is uncertain whether this perspective
protects against repeated future rumination on offenses, which may be necessary for long-term health benefits. Also unclear is whether
forgiveness offers unique benefits beyond simple distraction. Methods: Cardiovascular parameters (systolic blood pressure [SBP],
diastolic blood pressure [DBP], and heart rate) were measured while 202 participants thought about a previous offense from an angry
or forgiving perspective or were distracted. All participants were then distracted for 5 minutes, after which they freely ruminated on the
offense. Results: Angry rumination initially yielded the greatest increase in blood pressure from baseline (mean [M] [standard deviation
{SD}]: SBP = 9.24 [11.16]; M [SD]: DBP = 4.69 [7.48]) compared with forgiveness (M [SD]: SBP = 3.30 [6.48]; M [SD]: DBP = 1.51
[4.94]) and distraction (M [SD]: SBP = 4.81 [6.28]; M [SD]: DBP = 1.75 [3.80]), which did not differ from each other (p9.30). During
free rumination, however, those who had previously focused on forgiveness showed less reactivity (M [SD]: SBP = 7.33 [9.61]; M
[SD]: DBP = 4.73 [7.33]) than those who had been distracted (M [SD]: SBP = 10.50 [7.77]; M [SD]: DBP = 7.71 [6.83]) and those
who previously focused on angry rumination (M [SD]: SBP = 12.04 [11.74]; M [SD]: DBP = 8.64 [12.63]). There were no differences
for heart rate. Conclusions: Forgiveness seems to lower reactivity both during the initial cognitive process and, more importantly,
during mental recreations of an offense soon thereafter, potentially offering sustained protection, whereas effects of distraction appear
transient. Key words: forgiveness, cardiovascular reactivity, rumination, distraction, cardiovascular disease, emotion.
SBP = systolic blood pressure; DBP = diastolic blood pressure;
CVR = cardiovascular reactivity.
INTRODUCTION
While forgiving has long been considered an important
moral virtue, it also seems to be beneficial for physical
health (1). Forgiveness has been associated with fewer reported
physical symptoms (2), fewer medications taken (3), a stronger
immune system (4), and reduced cardiovascular mortality (5).
Despite these robust findings, it remains uncertain whether for-
giveness is causally associated with these health benefits (6) and,
if so, through which mechanisms they are associated.
One possible mechanism connecting forgiveness to long-term
health is that forgiveness is associated with less strain on the
cardiovascular system. Studies examining trait forgiveness have
generally found this to be true. More forgiving people have lower
blood pressure at baseline (7) and also show faster cardiovas-
cular recovery after offense (8,7), yielding lower overall blood
pressure (2,9). Because these findings are based on trait differ-
ences, however, they cannot speak to whether forgiveness actu-
ally plays a causal role in these physiological responses (6).
To try to get closer to a possible causal relationship between
forgiveness and blood pressure, several studies have examined
state forgiveness by comparing physiological responses to for-
given and unforgiven offenses. Lawler et al. (2) interviewed
participants about a time of betrayal and assessed both trait for-
giveness and the extent to which participants had forgiven the
offender for that particular offense (state forgiveness). Those
with higher state forgiveness showed reduced cardiovascular
reactivity (CVR) during the interview, suggesting that forgive-
ness was beneficial. However, state forgiveness in this case
was again determined by the participants rather than by random
assignment; thus, it remains possible that some factor other
than forgiveness was responsible for buffered CVR.
Witvliet and colleagues (10) addressed this issue by con-
ducting a within-individual study. Participants were assigned
to imagine a hurtful incident from an angry perspective and
then from a forgiving perspective, for alternating 16-second
intervals over the course of several minutes. They found that
the intervals of angry, unforgiving thoughts were associated
with greater CVR than those in which participants adopted a
forgiving perspective, suggesting that forgiveness is associated
with cardiovascular benefits independent of the characteristics
of the forgiver.
Although this finding suggests that forgiveness strains
the cardiovascular system less than anger, it does not answer
whether forgiveness offers benefits beyond simply not engag-
ing in unforgiveness, a hyperaroused negative state marked by
angry rumination on offenses (c.f. Harris and Thoresen (11)).
Angry rumination has been associated with greater short-term
CVR (12) and greater long-term cardiovascular morbidity and
mortality (13,14); thus, anything preventing angry rumination
could be health protective. Distraction, for example, has been
found to facilitate cardiovascular recovery after stress compared
with rumination (12,15). It could be that any alternative to angry
rumination is beneficial and that forgiveness would be no better
than distraction. To our knowledge, no study has demonstrated
that forgiveness has cardiovascular benefits beyond those of
simple distraction.
For forgiveness to have meaningful effects on health, it is
likely that it must affect longer-term changes in emotions and
cognitions associated with an offense. According to the reactiv-
ity hypothesis, although isolated episodes of reactivity during a
stressor may not lead to disease, continued elevations in blood
pressure brought on by recurring rumination can build up over
time, straining the cardiovascular system and increasing risk
Psychosomatic Medicine 74:745Y750 (2012) 745
0033-3174/12/7407Y0745
Copyright *2012 by the American Psychosomatic Society
From the Departments of Psychology (B.A.L., R.S.D., C.R.H., N.J.S.C.)
and Philosophy (D.N., P.-E.M.), University of California, San Diego, La Jolla,
California.
Address correspondence and reprint requests to Britta A. Larsen, PhD, De-
partment of Psychology, University of California, San Diego, 9500 Gilman Dr,
La Jolla, CA 92093-0109. E-mail: blarsen@ucsd.edu
This research was supported by a University of California, San Diego Inter-
disciplinary Collaboratories Fellowship awarded to B.A.L., R.S.D., and P.-E.M.
Received for publication September 15, 2011; revision received March 19,
2012.
DOI: 10.1097/PSY.0b013e31825fe96c
Copyright © 2012 by the American Psychosomatic Society. Unauthorized reproduction of this article is prohibited.
of disease (16,13). The benefits of forgiveness may lie in its
enduring nature; forgiving may extend protection by changing
the way people think about the incident in the future. When
examining the possible health benefits of forgiveness, then, it
is important to examine physiological reactivity not only during
forgiveness or angry rumination interventions but also during
future mental recreations of the event. Although previous re-
search has examined the immediate cardiovascular effects of
adopting a forgiving perspective, no study has examined whether
engaging in forgiving cognitions changes responses to later con-
templation of offenses.
The purpose of the current study was to explore the car-
diovascular effects of engaging in forgiving or angry cogni-
tions surrounding an offense, examining reactivity both when
these cognitions are first initiated and, more critically, during
later unrestrained rumination. This study also sought to com-
pare the possible benefits of forgiveness and distraction during
these two periods to determine whether forgiveness offers ben-
efits beyond simple distraction.
METHODS
Participants
Participants were 202 healthy undergraduates (168 women) recruited during
the summer and fall of 2010, ranging in age from 18 to 29 years (mean [standard
deviation] = 20.4 [1.6] years). Of the participants, 63% were Asian, 15.5% were
non-Hispanic white, 15.5% were Hispanic/Latino, and 6% were classified as
‘‘other.’’
1
Participants received course credit in exchange for participation. The
University of California, San Diego institutional review board approved the study,
and participants provided written informed consent before participating.
Measures
Blood pressure and heart rate (HR) were monitored continuously using
an Ohmeda Finapres 2300 (TNO Biomedical Instrumentation, Amsterdam, the
Netherlands). This takes beat-to-beat measurements using an inflatable cuff
placed on the middle finger of the nondominant hand.
Before the baseline, participants filled out a survey assessing a variety of traits
associated with forgiveness, such as angry rumination and desire for revenge.
2
Nine of these items comprised a measure of trait forgiveness. Six items were
coded positively (e.g., ‘‘generally, I forgive those who hurt me,’’ ‘‘withholding
forgiveness is wrong,’’ and ‘‘I generally make peace with the people who hurt
me’’), and the other three items were reverse coded (e.g., ‘‘Iusually hold it against
people when they hurt me,’’ and ‘‘when someone hurts me I feelresentment toward
the offender’’). All were rated on a Likert scale from 1 (not at all)to 5 (verymuch
so). These items showed good internal validity (>= 0.85) and were normally
distributed (mean [standard deviation] = 30.73 [6.1], range = 13Y45).
Procedure
After filling out the trait forgiveness survey, participants sat quietly for
5 minutes to obtain baseline readings. Previous studies using a Finapres have
found that 5 minutes is sufficient to produce a reliable estimate of resting levels
because the Finapres produces readings with each heartbeat (12,17). Next,
all participants were asked to think of a time they had been hurt, betrayed, or
offended, preferably somewhat recently and involving a friend or acquaintance
rather than a stranger. They were told that they should select an incident but not to
think about it in any detail. Participants were randomly assigned to a conditionafter
choosing an incident to ensure that the condition did not influence their choice.
Participants then engaged in a 2-minute directed rumination task, in which
they thought about the hurtful incident from one of three assigned perspectives.
Forgiveness Condition
Participants were instructed to picture themselves forgiving the offender and
were offered the following strategies for doing so:
"Spend the next few minutes thinking about this incident, and picture
yourself forgiving the person involved. This could mean picturing yourself
simply letting go of hurt and anger and moving on, trying to see the incident
from their perspective or imagining what outside circumstances could have
influenced their actions, trying to see the good in the other person despite what
they did to hurt you, and imagining reconciling with them or anything else you
may think is important in forgiving. Be sure to keep your mind on the incident and
the process of forgiving the person."
Angry Rumination Condition
Participants were instructed to picture themselves being angry or offended
by the incident and were given the following ideas of things to focus on:
"Spend the next few minutes thinking about this incident, and picture
yourself being angry and offended. You could focus on several different parts of
being angry: think about their disregardfor your feelings,why their actionswere so
wrong or hurtful, and think of the ways you would liketo get revenge or things you
would have liked to say or do to them in return. Imagine holding onto the re-
sentmentand anger you felt when you werefirst hurt. Be sure to keepyour mind on
the incident and the hurt and anger it caused."
Distraction Condition
Participants were told not to think about the incident they had chosen but
instead to think about their activities the previous weekend in a nonemotional
way. This was designed to include a recall element like the other conditions but
without the emotional component:
"Spend the next few minutes thinking of everything you did last weekend. Try
to rememberit in as much detail as possible, walking yourself through eachhour of
each day from Friday evening to Sunday night. Do your best to actually picture
yourself in eachactivity, and remember all the people involved. Imagine the actual
activities themselves but do not focus on the emotions that may have been
involved."
Directed rumination was followed by a 5-minute recovery task during which
all participants looked through pictures of famous faces and highlighted the
ones they recognized. This was designed to distract participants from further
rumination.
All participants, including those in the distraction condition, then engaged in a
2-minute free rumination task. They were instructed to once again think of the
hurtful incident they imagined before (or, for those in the distraction condition, to
imagine it for the first time) but were told to imagine it any way they wished:
"Think about the incident you recalled earlier. This time, I would like you to
think of the incident and exactly what happened. Walk through it like you are
going through it again. Focus on how you feel about the person or people
involved. (For those in the rumination or forgiveness condition, to be clear,you
no longer have to think about it in theway that we assigned to you earlier. That is,
think of or picture the incident however you want toVwhatever comes naturally to
you when you imagine it now). Walk yourself through the incident in your mind
describing what happened as though you were describing it to an outside party.
Again, it is important that, asyou sit thinking about it, you keep your focus on the
incident and the emotions it brings up."
Afterward, participants had another 5-minute recovery period during which
they filled out a brief survey and manipulation check. In prior studies looking at
poststress recovery, 5 minutes has been sufficient to assess the impact of vari-
ous interventions, such as rumination, distraction, suppression, music, and for-
giveness (2,7,12,15,18,19). Participants were then debriefed and excused.
Manipulation Check
To ensure that those in the rumination and forgiveness conditions had
thought about the incident in the intended way, they filled out a final survey
1
Because this was an ethnically diverse sample, we also ran our analyses with
ethnicity as a covariate. This did not change the results, and ethnicity did not
emerge as a significant covariate. There was also no main effect of ethnicity on
trait forgiveness.
2
These items were part of a separate, ongoing study related to trait differences in
forgiveness and will not be reported on.
B. A. LARSEN et al.
746 Psychosomatic Medicine 74:745Y750 (2012)
Copyright © 2012 by the American Psychosomatic Society. Unauthorized reproduction of this article is prohibited.
indicating the degree to which they engaged in cognitions indicative of angry
rumination or forgiveness during the directed rumination period. This included
items such as ‘‘I focused on the hurt and anger I felt’’ or ‘‘I tried to see the goodin
the other person.’’ These were entered into two separate scales to capture partici-
pants’ focus on forgiveness (seven items; >= 0.76) and on anger (six items; >=
0.75). Participants also indicated how much they thought about things unrelated to
the incident, such as social plans or school. All items were rated on Likert scales
from 1 (not at all) to 5 (very much). Because the questions centered on how
participants thought about the hurtful incident during the directed rumination pe-
riod, those in the distraction condition, who were instructed to think about
something entirely different, were not given the manipulation check because the
questions did not apply to them.
Data Reduction and Analysis
Cardiovascular parameters of interest were systolic blood pressure (SBP)
and diastolic blood pressure (DBP). HR was also included. For each measure, the
mean at baseline was subtracted from the mean for each period.
RESULTS
Manipulation Check
An analysis of variance (ANOVA) confirmed that those in
the forgiveness condition focused on forgiving thoughts sig-
nificantly more than those in the angry rumination condition
during directed rumination (F(1,132) = 13.25, pG.001). In
addition, those in the angry rumination condition focused on
angry thoughts significantly more than those in the forgive-
ness condition (F(1,132) = 33.0, pG.001), suggesting that the
manipulation was effective. The conditions did not differ in the
degree to which participants thought about things unrelated to
the incident (F(1,133) = 0.54, p=.46).
Participant Characteristics
Baseline readings for the three conditions are shown in
Table 1. There were no differences between conditions in base-
line SBP (F(2,145) = 0.95, p= .39), baseline DBP (F(2,145) =
0.05, p= .95), baseline HR (F(2,145) = 0.39, p= .68), trait
forgiveness (F(2,197) = 0.25, p= .78), or sex makeup (W
2
(N=
202) = 0.85, df =1,p= .65). Consistent with previous litera-
ture (9), women scored higher in trait forgiveness than men
(F(1,194) = 11.95, p= .001).
Cardiovascular Reactivity
Systolic Blood Pressure
To determine whether SBP changes throughout the study
varied by condition, a repeated-measures ANOVA was performed
on change in SBP from baseline during directed rumination, first
recovery, free rumination, and second recovery, with condition as
the between-individual factor. Data showed a significant inter-
action of time and condition on SBP (F(6,411) = 2.34, p= .031).
3
As shown in Figure 1, SBP was smallest during the directed
rumination period for those in the forgiveness condition, fol-
lowed by the distraction and then angry rumination conditions.
This replicates previous findings showing that, during directed
perspective taking, forgiveness is associated with lower blood
pressure than anger. During the free rumination period, those
in the forgiveness condition again showed the lowest blood
pressure, whereas those in the distraction and angry rumination
conditions showed larger blood pressure increases. This per-
sisted into the last recovery period.
Follow-up ANOVAs were then performed to test for sig-
nificant differences at each individual period. This showed a
significant effect of condition on SBP during directed rumi-
nation (F(2,137) = 6.49, p= .002). Planned comparisons be-
tween conditions revealed that those in angry rumination had
significantly higher SBP than both those in the forgiveness
(t= 3.47, df = 139, p= .001) and distraction (t= 2.58, df = 139,
p= .011) conditions, although these two did not differ from
each other (t= 0.89, df = 139, p= .38).
There was no difference between conditions in the first
recovery phase (F(2,137) = 0.91, p= .40). This is consistent
with findings showing that strong irrelevant distractors can
homogenize blood pressure levels across conditions (12).
Condition had a marginal effect on SBP during free rumi-
nation (F(2,137) = 2.77, p= .066), and planned comparisons
showed a significant difference between the angry rumination
and forgiveness conditions (t=2.30,df =139,p=.023).There
was also a marginal effect of condition on SBP during the last
recovery (F(2,137) = 2.50, p= .086), which in this case was
driven by a significant difference between the forgiveness and
distraction conditions (t=2.15,df =139,p=.033),withthosein
the forgiveness condition again showing the lowest reactivity.
To determine the influence of trait forgiveness on SBP,
we performed a median split on the trait forgiveness scores to
divide participants into high and low forgivers. A repeated-
measures ANOVA was performed using trait forgiveness (high
or low) as the between-individual variable and change in SBP
TABLE 1. Baseline Characteristics of the Forgiveness, Rumination, and Distraction Conditions
Forgiveness (n= 69) Rumination (n= 66) Distraction (n= 67)
Female, % 82.6 83.3 77.6
Trait forgiveness 30.3 (6.1) 30.8 (6.1) 31.1 (6.1)
Cardiovascular measures
Systolic blood pressure, mm Hg 110.6 (12.72) 107.5 (12.60) 107.6 (12.60)
Diastolic blood pressure, mm Hg 72.6 (11.3) 73.3 (11.3) 72.7 (11.3)
Heart rate, beats per min 78.8 (11.4) 77.0 (11.5) 77.2 (11.5)
Data are presented as mean (standard deviation) unless otherwise indicated. No between-group differences were significant.
3
We also ran analyses using trait forgiveness as a covariate. Trait forgiveness did
not emerge as a significant covariate, and including it did not change our results.
FORGIVENESS AND CVR
Psychosomatic Medicine 74:745Y750 (2012) 747
Copyright © 2012 by the American Psychosomatic Society. Unauthorized reproduction of this article is prohibited.
during the four periods as the within-individual variable. Al-
though those high in trait forgiveness generally had smaller
change scores throughout the study, there was no significant
difference between high and low forgivers overall (F(1,137) =
0.09, p= .77) and no interaction of trait forgiveness and time
(F(3,411) = 1.1, p=.35).
Diastolic Blood Pressure
A repeated-measures ANOVA, like that performed with SBP,
was used to determine if DBP changed throughout the study as
a function of condition. This again showed a significant interac-
tion of time and condition (F(6,411) = 4.37, pG.001).
As Figure 2 shows, the pattern for DBP was similar to that
of SBP, particularly for those in the angry rumination and
forgiveness conditions. Those in the distraction condition were
nearly identical to those in the forgiveness condition during di-
rected rumination and recovery but then rose to the level of
those in the angry condition during the free rumination period.
Analysis of DBP during specific periods showed a signifi-
cant effect of condition during directed rumination (F(2,139) =
4.67, p= .011). As with SBP, planned comparisons of condi-
tions showed that DBP was significantly higher in the angry
rumination condition than in the forgiveness (t=2.75,df =141,
p= .007) and distraction (t=2.53,df =141,p= .012) condi-
tions, which did not differ from each other. There was no effect
of condition during the first recovery (F(2,139) = 0.3, p=.74)
or free rumination period (F(2,139) = 2.3, p= .10), although
the forgiveness condition in this period was marginally lower
than the angry condition (t=2.05,df =141,p= .06). Again,
as with SBP, there was an effect of condition on DBP during
the last recovery period (F(2,139) = 3.11, p= .048). DBP in the
forgiveness condition was significantly lower than that in the
distraction condition (t=2.36,df =141,p= .02) and marginally
lower than that in the angry rumination condition (t=1.88,
df =141,p=.06).
As with SBP, trait forgiveness was not found to influence
DBP overall (F(1,139) = 0.69, p= .41) and showed no inter-
action with time across the study (F(3,417) = 0.04, p= .99).
Heart Rate
The same repeated-measures ANOVA was performed for
HR. The analysis showed no interaction of condition and time
on HR (F(6,420) = 0.98, p= .44). There were also no effects of
condition on any of the individual time points (for all, p9.2).
DISCUSSION
Consistent with previous findings, these data show that
imagining a hurtful event in a forgiving way leads to smaller
increases in blood pressure than imagining the same event from
an angry perspective. Importantly, however, these data also
show that engaging in forgiving cognitions can lead to changes
that outlast the rumination instructions and that thinking about
an upsetting incident from a forgiving perspective can protect
against later elevations in blood pressure. When freely thinking
about the incident, those who had engaged in forgiving cogni-
tions earlier showed the smallest elevations in blood pressure,
although they were given the same instructions at this time as
those who had been in the angry rumination condition. These
differences persisted into the second recovery period, despite
having no instructions to think about the incident at all. This
is the first study to show that focusing on forgiveness is protec-
tive not only in that moment but can offer recurring protection
by changing how individuals respond to subsequent rumina-
tion in the near future. Based on theorizing on the reactivity
hypothesis (20), it could be this recurring protection that leads
to long-term health benefits.
The free rumination period also showed that distraction
may not be an entirely effective way to deal with offense. Like
those who forgave, those who were distracted initially showed
lower blood pressure than those focusing on angry rumina-
tion. However, when they were allowed to freely ruminate on
Figure 1. Change in systolic blood pressure from baseline during each period of
the study, by condition (error bars represent between-individual standard error).
Figure 2. Change in diastolic blood pressure from baseline during each period of
the study, by condition (error bars represent between-individual standard error).
B. A. LARSEN et al.
748 Psychosomatic Medicine 74:745Y750 (2012)
Copyright © 2012 by the American Psychosomatic Society. Unauthorized reproduction of this article is prohibited.
the incident, their blood pressure rose more than did the blood
pressure of those in the forgiveness condition and continued
to increase into the recovery period. This pattern was especially
pronounced in DBP, which showed the distraction and forgive-
ness conditions to be essentially identical until free rumina-
tion, when the blood pressure of those who had been distracted
climbed to higher levels. Distraction, then, may be somewhat
protective while one engages in it but seems to be ineffective
as soon as it ends. The benefits of forgiveness beyond distrac-
tion may thus be most pronounced in subsequent mental rec-
reations of the event.
The observed blood pressure pattern suggests that those
who simply ‘‘let it go’’ or avoid thinking about an incident
may not get all the benefits associated with forgiving. Recent
work shows that that compassionate reappraisal is associated
with more benefits than emotional suppression while thinking
about an incident (21); the current data show that these bene-
fits may extend to subsequent rumination as well. When par-
ticipants are given time to process the event from a new
perspective, even briefly, it seems to alter the way in which
they think about the event in the near future. These data suggest
that simple cognitive exercises may be enough to initiate this
process. The strength of this effect is underscored by the fact
that the manipulation lasted only 2 minutes, taking a forgiving
perspective was a matter of assignment rather than choice, and
participants were specifically told they were not required to
take this perspective during free rumination. This demonstrates
that the benefits of forgiveness are not restricted to those high
in trait forgiveness (7,8) or those who self-report feeling state
forgiveness (2) but can extend generally to those assigned to
engage in temporary state forgiveness.
There are, of course, various questions not addressed by
these data. It is unclear, for example, which forgiving cogni-
tions were most effective. In designing interventions, it would
be useful to know which of the suggested strategies is most
effective in producing lasting forgiveness. Recent work has ex-
plored various strategies of reappraising a hurtful event, such
as focusing on compassion for the offender or focusing on the
benefits gained through the experience, both of which show
unique physiological and emotional benefits compared with
angryrumination(22).Itremainstobeseen,however,whichap-
proaches to forgiveness result in greatest long-term health bene-
fits. A mediation analysis of elements of forgiveness and health
outcomes showed that reductions in anger did not fully explain
health benefits associated with forgiveness (23). Increasing pos-
itive emotions and cognitions, then, in addition to reducing
anger and hostility, may be necessary to achieving all the ben-
efits of forgiveness. In fact, Worthington and colleagues (24,25)
have suggested that replacing negative cognitions with positive
ones such as empathy and compassion is the very essence of
forgiveness. In this light, it would be useful to study the imme-
diate cardiovascular effects of different forgiveness strategies,
including those that simply reduce negative appraisals and those
that replace them with positive ones.
In addition, in our study, the ‘‘free rumination’’ period was
not entirely unconstrained because participants were still told
to ruminate on the hurtful incident. It is possible that forgive-
ness would be health promoting not only by reducing the car-
diovascular reactions to such thoughts but also by reducing
the probability of having such thoughts. Our study, then, might
underestimate the benefits. Future research could also explore
other effects of forgiveness, such as whether those taking on a
forgivingperspectivewouldbelessaffectedbydirectednega-
tive rumination or less willing to engage in it.
It is unlikely that results during free rumination were due to
physiological carryover from earlier rumination because condi-
tions did not differ after the first recovery period and those in
the distraction condition showed marked changes from the first
rumination period to the second. It is possible, however, that
differences in cognitions during free rumination were due to the
laboratory environment rather than real cognitive changes. For
example, participants in the forgiveness and angry rumination
conditions may have felt that they were obligated to continue
seeing the incident from the previously designed perspective
and that the results reflect a continuation of the earlier directed
rumination period. Although this is a concern, participants were
explicitly told that they did not have to think about the trans-
gression in the same manner as previously assigned and that
they should think about it in whatever way felt most natural.
Given these instructions, it seems likely that the effects seen here
were due to changes in their mental recreations of the event and
not due to direct influence of the earlier manipulation instruc-
tions. It is possible, however, that, because participants were in
the same context as during the initial rumination period, what-
ever was ‘‘most natural’’ was simply to think of the incident in
the same way they had before. It would be useful for future
studies to explore rumination across contexts, particularly out-
side the laboratory, to determine the strength of the forgiveness
intervention.
Another drawback of the current study is that the time
limitations of the study period prevented assessment of long-
term changes in perspective or CVR. Given the rather short
time frame of our blood pressure monitoring, we cannot assess
whether the intervention had any permanent impact, and people
may revert after some time to habitual modes of thought. Some
work proposing a cycle of rumination and arousal would sug-
gest that changing the arousal associated with thoughts of an
event is likely to have ongoing benefits (14,26). Neverthe-
less, it seems that a clear next step is to investigate forgiveness-
associated effects on CVR further into the future to determine
how long lasting these effects really are. Such lasting effects
may only come after a more thorough intervention.
Finally, it is not clear whether imagining oneself forgiving
is the same thing as actually forgiving or whether they would
produce different results. This limitation is common across
the field (10,22,23) and calls into question whether the results
are truly generalizable. Still, in our study, even imagining for-
giving resulted in reduced CVR during subsequent rumina-
tion on the event, suggesting that imagining oneself forgiving
can yield cardiovascular benefits. In addition, it would also be
useful to replicate the current findings with a sample from
the general population because the current sample comprised
FORGIVENESS AND CVR
Psychosomatic Medicine 74:745Y750 (2012) 749
Copyright © 2012 by the American Psychosomatic Society. Unauthorized reproduction of this article is prohibited.
undergraduates, who may not be representative in the interper-
sonal offenses they experience, and was mostly women, who
tend to be more forgiving than men.
The reactivity hypothesis suggests that small changes in
CVR like those seen here can build up over time and result
in differences in health outcomes (16). However, additional
research is needed to determine whether modest differences
in the laboratory over a short period could translate to actual
differences in health outcomes. Our results do suggest a possi-
ble mechanism for health differences associated with forgive-
ness and indicate that, although forgiveness is often assumed
to benefit offenders, it seems that those who forgive can also
experience concrete benefits for themselves.
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