Journal of Behavioral Medicine

, Volume 30, Issue 4, pp 291–302 | Cite as

Forgiveness, Health, and Well-Being: A Review of Evidence for Emotional Versus Decisional Forgiveness, Dispositional Forgivingness, and Reduced Unforgiveness

  • Everett L. WorthingtonJr
  • Charlotte Van Oyen Witvliet
  • Pietro Pietrini
  • Andrea J. Miller
Article

Abstract

The extant data linking forgiveness to health and well-being point to the role of emotional forgiveness, particularly when it becomes a pattern in dispositional forgivingness. Both are important antagonists to the negative affect of unforgiveness and agonists for positive affect. One key distinction emerging in the literature is between decisional and emotional forgiveness. Decisional forgiveness is a behavioral intention to resist an unforgiving stance and to respond differently toward a transgressor. Emotional forgiveness is the replacement of negative unforgiving emotions with positive other-oriented emotions. Emotional forgiveness involves psychophysiological changes, and it has more direct health and well-being consequences. While some benefits of forgiveness and forgivingness emerge merely because they reduce unforgiveness, some benefits appear to be more forgiveness specific. We review research on peripheral and central nervous system correlates of forgiveness, as well as existing interventions to promote forgiveness within divergent health settings. Finally, we propose a research agenda.

Keywords

Forgiveness Health Cancer Cardiovascular Intervention Peripheral nervous system Central nervous system Stress Coping 

References

  1. Baumeister, R. F., Exline, J. J., & Sommer, K. L. (1998). The victim role, grudge theory, and two dimensions of forgiveness. In E. L. Worthington Jr. (Ed.), Dimensions of forgiveness: Psychological research & theological perspectives (pp. 79–104). Philadelphia: Templeton Foundation Press.Google Scholar
  2. Bennett, M. L. (1998). A study of the relationship of prayer between family caregiver and cancer patient in easing caregiver burden. Dissertation Abstracts International: Section B: The Sciences and Engineering, 59(1-B), 169.Google Scholar
  3. Berlinger, N., & Wu, A. W. (2005). Subtracting insult from injury: Addressing cultural expectations in the disclosure of medical error. Journal of Medical Ethics, 31, 106–108.PubMedCrossRefGoogle Scholar
  4. Blair, R. J. R., Morris, J. S., Frith, C. D., Perett, D. I., & Dolan, R. J. (1999). Dissociable neural responses to facial expressions of sadness and anger. Brain, 122, 883–893.PubMedCrossRefGoogle Scholar
  5. Brosschot, J. F., & Thayer, J. F. (2003). Heart rate response is longer after negative emotions than after positive emotions. International Journal of Psychophysiology, 50, 181–187.PubMedCrossRefGoogle Scholar
  6. Carson, J. W., Keefe, F. J., Goli, V., Fras, A. M., Lynch, T. R., Thorp, S. R., & Buechler, J. L. (2005). Forgiveness and chronic low back pain: A preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress. Journal of Pain, 6, 84–91.PubMedCrossRefGoogle Scholar
  7. Casey, K. L., Svensson, P., Morrow, T. J., Raz, J., Jone, C., & Minoshima, S. (2000). Selective opiate modulation of nociceptive processing in the human brain. Journal of Neurophysiology, 84, 525–533.PubMedGoogle Scholar
  8. Coan, J. A., Allen, J. J. B., & Harmon-Jones, E. (2001). Voluntary facial expression and hemispheric asymmetry over the frontal cortex. Psychophysiology, 38, 912–925.PubMedCrossRefGoogle Scholar
  9. Eisenberger, N. I., Lieberman, M. D., & Williams, K. D. (2003). Does rejection hurt? An fMRI study of social exclusion. Science, 302, 290–292.PubMedCrossRefGoogle Scholar
  10. Enright, R. D., & Fitzgibbons, R. P. (2000). Helping clients forgive: An empirical guide for resolving anger and restoring hope. Washington, DC: American Psychological Association.Google Scholar
  11. Exline, J. J., Worthington, E. L. Jr., Hill, P., & McCullough, M. E. (2003). Forgiveness and justice: A research agenda for social and personality psychology. Personality and Social Psychology Review, 7, 337–348.PubMedCrossRefGoogle Scholar
  12. Farrow, T. F. D., & Woodruff, P. W. R. (2005). Neuroimaging of forgivability. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 259–272). New York: Brunner-Routledge.Google Scholar
  13. Farrow, T. F. D., Zheng, Y., Wilkinson, I. D., Spence, S. A., Deakin, J. F. W., Tarrier, N., Griffiths, P. D., & Woodruff, P. W. R. (2001). Investigating the functional anatomy of empathy and forgiveness. Neuroreport: An International Journal for the Rapid Communication of Research in Neuroscience, 12, 2433–2438.Google Scholar
  14. Fincham, F. D., Hall, J. H., & Beach, S. R. H. (2005). Til lack of forgiveness doth us part: Forgiveness and marriage. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 207–225). New York: Brunner-Routledge.Google Scholar
  15. Fredrickson, B. L. (1998). What good are positive emotions?. Review of General Psychology, 2, 300–319.CrossRefGoogle Scholar
  16. Friedman, M., Thoresen, C. E., Gill, J. J., Ulmer, D., Powell, L. H., Price, V. A., Brown, B., Thompson, L., Rabin, D. D., Breall, W. S., Bourg, E., Levy, R., & Dixon, T. (1986). Alterations of Type A behavior and its effects on cardiac recurrent in post-myocardial infraction patients: Summary results of the coronary prevention recurrence project. American Heart Journal, 112, 653–665.PubMedCrossRefGoogle Scholar
  17. Gerber, L. E. (1990). Transformations of self-understanding in surgeons whose medical treatment efforts were not successful. American Journal of Psychotherapy, 44, 75–84.PubMedGoogle Scholar
  18. Gisi, T. M., & D’Amato, C. (2000). What factors should be considered in rehabilitation: Are anger, social desirability, and forgiveness related in adults with traumatic brain injuries? International Journal of Neuroscience, 105, 121–133.PubMedCrossRefGoogle Scholar
  19. Glinder, J. G., & Compas, B. E. (1999). Self-blame attributions in women with newly diagnosed breast cancer: A prospective study of psychological adjustment. Health Psychology, 18, 475–481.PubMedCrossRefGoogle Scholar
  20. Gray, J. A. (1994). Personality dimensions and emotion systems. In P. Ekman & R. J. Davidson (Eds.), The nature of emotion: Fundamental questions (pp. 329–331). New York: Oxford University Press.Google Scholar
  21. Greene, J. D., Sommerville, R. B., Nystrom, L. E., Darley, J. M., & Cohen, J. D. (2001). An fMRI investigation of emotional engagement in moral judgment. Science, 293, 2105–2108.PubMedCrossRefGoogle Scholar
  22. Greenwood, K. A., Thurston, R., Rumble, M., Waters, S. J., & Keefe, F. J. (2003). Anger and persistent pain: Current status and future directions. Pain, 103, 1–5.PubMedCrossRefGoogle Scholar
  23. Hall, J. H., & Fincham, F. D. (2005). Self-forgiveness: The stepchild of forgiveness research. Journal of Social and Clinical Psychology, 24, 621–637.Google Scholar
  24. Hansen, M. J. (2002). Forgiveness as an educational intervention goal for persons at the end of life. Dissertation Abstracts International, 63(1224), 4A.Google Scholar
  25. Harmon-Jones, E., Sigelman, J. D., Bohlig, A., & Harmon-Jones, C. (2003). Anger, coping, and frontal cortical activity: The effect of coping potential on anger-induced left frontal activity. Cognition and Emotion, 17, 1–24.CrossRefGoogle Scholar
  26. Harmon-Jones, E., Vaughn-Scott, K., Mohr, S., Sigelman, J., & Harmon-Jones, C. (2004). The effect of manipulated sympathy and anger on left and right frontal cortical activity. Emotion, 4, 95–101.PubMedCrossRefGoogle Scholar
  27. Harris, A. H. S., & Thoresen, C. E. (2005). Forgiveness, unforgiveness, health, and disease. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 321–333). New York: Brunner-Routledge.Google Scholar
  28. Harris, A. H. S., & Thoresen, C. E. (2006). Extending the influence of positive psychology interventions into health care settings: Lessons from self-efficacy and forgiveness. Journal of Positive Psychology, 1, 27–36.CrossRefGoogle Scholar
  29. Huang, S-T. T., & Enright, R. D. (2000). Forgiveness and anger-related emotions in Taiwan: Implications for therapy. Psychotherapy, 37, 71–79.Google Scholar
  30. Kaplan, B. H. (1992). Social health and the forgiving heart: The Type B story. Journal of Behavioral Medicine, 15, 3–14.PubMedCrossRefGoogle Scholar
  31. Koenig, H. (2007). Altruistic love and physical health. In S. G. Post (Ed.), Altruism and health: Perspectives from empirical research (pp. 422–441). Oxford: Oxford University Press.Google Scholar
  32. Lawler, K. A., Younger, J. W., Piferi, R. L., Billington, E., Jobe, R., Edmondson, K., & Jones, W. H. (2003). A change of heart: Cardiovascular correlates of forgiveness in response to interpersonal conflict. Journal of Behavioral Medicine, 26, 373–393.PubMedCrossRefGoogle Scholar
  33. Lawler, K. A., Younger, J. W., Piferi, R. L., Jobe, R. L., Edmondson, K. A., & Jones, W. H. (2005). The unique effects of forgiveness on health: An exploration of pathways. Journal of Behavioral Medicine, 28, 157–167.PubMedCrossRefGoogle Scholar
  34. Lawler-Row, K. A., & Piferi, R. L. (2006). The forgiving personality: Describing a life well lived? Personality and Individual Differences, 41, 1009–1020.CrossRefGoogle Scholar
  35. Lieberman, M. D., Jarcho, J. M., Berman, S., Naliboff, B. D., Suyenobu, B. Y., Mandelkern, M., & Mayer, E. A. (2004). The neural correlates of placebo effects: A disruption account. Neuroimage, 22, 447–445.PubMedCrossRefGoogle Scholar
  36. Lin, W., Mack, D., Enright, R. D., Krahn, D., & Baskin, T. W. (2004). Effects of forgiveness therapy on anger, mood, and vulnerability to substance use among inpatient substance-dependent clients. Journal of Consulting and Clinical Psychology, 72, 1114–1121.PubMedCrossRefGoogle Scholar
  37. Marques, A. H., & Sternberg, E. M. (2007). The biology of positive emotions and health. In S. G. Post (Ed.), Altruism and health: Perspectives from empirical research (pp. 149–188). Oxford: Oxford University Press.Google Scholar
  38. Mauldin, G. R., & Anderson, W. T. (1998). Forgiveness as an intervention in contextual family therapy: Two case examples. TCA Journal, 26, 123–132.Google Scholar
  39. McCraty, R., Atkinson, M., Riller, W.A., Rein, G., & Watkins, A. D. (1995). The effects of emotion on short-term power spectrum analysis of heart rate variability. American Journal of Cardiology, 76, 1089–1093.PubMedCrossRefGoogle Scholar
  40. McCullough, M. E., Pargament K. I., & Thoresen C. E. (Eds.). (2000). Forgiveness: Theory, research and practice. New York: Guilford Press.Google Scholar
  41. McCullough, M. E., Root, L. M., & Cohen, A. D. (2006). Writing about the benefits of an interpersonal transgression facilitates forgiveness. Journal of Consulting and Clinical Psychology, 74, 887–897.PubMedCrossRefGoogle Scholar
  42. McDaniel, S. H., Hepworth, J., & Doherty, W. J. (1999). The shared emotional themes of illness. Journal of Family Psychotherapy, 10, 1–8.CrossRefGoogle Scholar
  43. McEwen, B. S. (2002). The end of stress as we know it. Washington D.C.: Joseph Henry Press.Google Scholar
  44. Mullet, E., Neto, F., & Riviere, S. (2005). Personality and its effects on resentment, revenge, and forgiveness and on self-forgiveness. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 159–182). New York: Brunner-Routledge.Google Scholar
  45. Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1, 115–144.CrossRefGoogle Scholar
  46. Phillips, C. F. (1999). The lived experience of spirituality and healing among persons with life-threatening cancer: “Making it real. Dissertation Abstracts International, 59(4370), 12A.Google Scholar
  47. Phillips, L. J., & Osborne, J. W. (1989). Cancer patients’ experiences of forgiveness therapy. Canadian Journal of Counseling, 23, 236–251.Google Scholar
  48. Pietrini P., & Guazzelli M. (1997). Life events in the course of chronic diseases: A psychological myth or a psycho-neuro-biochemical loop? Clinical and Experimental Rheumatology, 15, 125–128.PubMedGoogle Scholar
  49. Pietrini, P., Guazzelli, M., & Grafman J. (1998). Gender differences in brain activation during aggressive imageries. International Journal of Psychophysiology, 30(1–2), 33.CrossRefGoogle Scholar
  50. Pietrini, P., Guazzelli, M., Basso, G., Jaffe, K., & Grafman, J. (2000). Neural correlates of imaginal aggressive behavior assessed by positron emission tomography in healthy subjects. American Journal of Psychiatry, 157, 1772–1781.PubMedCrossRefGoogle Scholar
  51. Pietrini, P., Ricciardi, E., Gentili, C., Vanello, N., Sani, L., & Guazzelli, M. (2004). How the brain responds to hurtful events: neural activity elicited by aggressive versus forgiving behavior in humans. International Journal of Psychophysiology, 54(1–2), 26.Google Scholar
  52. Rainville P., Duncan G. H., Price D. D., Carrier B., & Bushnell M. C. (1997). Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science, 277, 968–971.PubMedCrossRefGoogle Scholar
  53. Rippentrop, A. E., Altmaier, E. M., Chen, J. J., Found, E. M., & Keffala, V. J. (2005). The relationship between religion/spirituality and physical health, mental health, and pain in a chronic pain population. Pain, 116, 311–321.PubMedCrossRefGoogle Scholar
  54. Romero, C., Friedman, L. C., Kalidas, M., Elledge, R., Chang, J., & Liscum, K. R. (2006). Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer. Journal of Behavioral Medicine, 29, 29–36.PubMedCrossRefGoogle Scholar
  55. Schwartz, A. R., Gerin, W., Davidson, K. W., Pickering, T. G., Brosschot, J. F., Thayer, J. F., Christenfeld, N., & Linden, W. (2003). Toward a causal model of cardiovascular responses to stress and the development of cardiovascular disease. Psychosomatic Medicine, 65, 22–35.PubMedCrossRefGoogle Scholar
  56. Seybold, K. S., Hill, P. C., Neumann, J. K., & Chi, D. S. (2001). Physiological and psychological correlates of forgiveness. Journal of Psychology and Christianity, 20, 250–259.Google Scholar
  57. Smith, R. S. (1989). Psychological trauma following automobile accidents: A review of literature. American Journal of Forensic Psychology, 7, 5–20.Google Scholar
  58. Stone, B. E. (2001). Cancer as initiation: Surviving the fire. Dissertation Abstracts International: Section B: The Sciences and Engineering, 62(1-B), 593.Google Scholar
  59. Toussaint, L. L., & Williams, D. R. (October, 2003). Physiological correlates of forgiveness: Findings from a racially and socio-economically diverse sample of community residents. Presented at A Campaign for Forgiveness Research Conference, Atlanta, GA.Google Scholar
  60. Toussaint, L. L., Williams, D. R., Musick, M. A., & Everson, S. A. (2001). Forgiveness and health: Age differences in a U.S. probability sample. Journal of Adult Development, 8, 249–257.CrossRefGoogle Scholar
  61. Waltman, M. A. (2003). The psychological and physiological effects of forgiveness education in male patients with coronary artery disease. Dissertation Abstracts International, 63(3971), 8–B.Google Scholar
  62. Witvliet, C. V. O. (2001). Forgiveness and health: Review and reflections on a matter of faith, feelings, and physiology. Journal of Psychology and Theology, 29, 212–224.Google Scholar
  63. Witvliet, C. V. O., Ludwig, T. E., & Vander Laan, K. (2001). Granting forgiveness or harboring grudges: Implications for emotion, physiology, and health. Psychological Science, 12, 117–123.CrossRefGoogle Scholar
  64. Witvliet, C. V. O., Ludwig, T. E., & Bauer, D. (2002). Please forgive me: Transgressors’ emotions and physiology during imagery of seeking forgiveness and victim responses. Journal of Psychology and Christianity, 21, 219–233.Google Scholar
  65. Witvliet, C. V. O., & McCullough, M. E. (2007). Forgiveness and health: A review and theoretical exploration of emotion pathways. In S.G. Post (Ed.), Altruism and health: Perspectives from empirical research (pp. 259–276). Oxford: Oxford University Press.Google Scholar
  66. Witvliet, C. V. O., Worthington, E. L., Jr., Root, L. M., Sato, A. F., Ludwig, T. E., & Exline, J. J. (in press). Retributive justice, restorative justice, and forgiveness: An experimental psychophysiology analysis. Journal of Experimental Social Psychology, in press.Google Scholar
  67. Worthington, E. L. Jr. (2001). Unforgiveness, forgiveness, and reconciliation in societies. In R. G. Helmick & R. L. Petersen (Eds.), Forgiveness and reconciliation: Religion, public policy, and conflict transformation (pp. 161–182). Philadelphia: Templeton Foundation Press.Google Scholar
  68. Worthington, E. L. Jr. (Ed.). (2005a). Handbook of forgiveness. New York: Brunner-Routledge.Google Scholar
  69. Worthington, E. L. Jr. (2005b). More questions about forgiveness: Research agenda for 2005–2015. In E. L. Worthington Jr. (Ed.), Handbook of forgiveness (pp. 557–574). New York: Brunner-Routledge.Google Scholar
  70. Worthington, E. L. Jr. (2006). Forgiveness and reconciliation: Theory and application. New York: Brunner-Routledge.Google Scholar
  71. Worthington, E. L. Jr., & Scherer, M. (2004). Forgiveness is an emotion-focused coping strategy that can reduce health risks and promote health resilience: Theory, review, and hypotheses. Psychology and Health, 19, 385–405.CrossRefGoogle Scholar
  72. Worthington, E. L. Jr., Witvliet, C. V. O., Lerner, A. J., & Scherer, M. (2005). Forgiveness in medical practice and research. EXPLORE: The Journal of Science and Healing, 1, 169–176.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Everett L. WorthingtonJr
    • 1
  • Charlotte Van Oyen Witvliet
    • 2
  • Pietro Pietrini
    • 3
  • Andrea J. Miller
    • 1
  1. 1.Virginia Commonwealth UniversityRichmondUSA
  2. 2.Hope CollegeHollandUSA
  3. 3.University of Pisa Medical SchoolPisaItaly

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