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

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.

This is a preview of subscription content, log in to check access.

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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    Article  Google 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.

    PubMed  Article  Google 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.

    Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google Scholar 

  42. McDaniel, S. H., Hepworth, J., & Doherty, W. J. (1999). The shared emotional themes of illness. Journal of Family Psychotherapy, 10, 1–8.

    Article  Google 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.

    Article  Google 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.

    PubMed  Google 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.

    Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

    PubMed  Article  Google 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.

  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.

    Article  Google 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.

    Article  Google 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.

  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.

    Article  Google 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.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Everett L. Worthington Jr.

Additional information

The first author gratefully acknowledges support for the present project by the Fetzer Institute, grant # 2254.01 and the General Clinical Research Center at Virginia Commonwealth University, NIH 5M01 RR000065–410535. For the second author, this manuscript contributes to an interdisciplinary project on The Pursuit of Happiness established by the Center for the Study of Law and Religion at Emory University and the John Templeton Foundation.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Worthington, E.L., Witvliet, C.V.O., Pietrini, P. et al. Forgiveness, Health, and Well-Being: A Review of Evidence for Emotional Versus Decisional Forgiveness, Dispositional Forgivingness, and Reduced Unforgiveness. J Behav Med 30, 291–302 (2007). https://doi.org/10.1007/s10865-007-9105-8

Download citation

Keywords

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