Forgiveness as an intervention goal with incest survivors

Assessing Psychometric Properties of the Italian Version of the Heartland Forgiveness Scale

Despite increasing popularity and intensive worldwide use, few studies have assessed the validity and factorial structure of the Heartland Forgiveness Scale (HFS). However, scientific literature showed that the original factorial structure of the HFS was not fully replicated and—in addition—the Italian translation is still lacking. To fill this gap, this study aims to extend evidence about the original HFS factorial validity by analyzing the Italian version. The final sample was composed of 523 randomly enrolled participants [139 males (26.6%), 384 females (73.4%)] aged from 18 to 82 years (mean = 42.53, SD = 16.41) who completed the Italian version of the HFS. The confirmatory factor analysis showed good fit indices for the original hierarchical factor solution and a significant decrease in model fit was found for all of the competing models. Also, the Italian version of the HFS revealed good reliability and very good psychometrical properties. Findings suggest that the Italian version of the HFS can be considered a reliable and good psychometrically based instrument for the assessment of dispositional forgiveness of the Self, Other, and Situation.

The Effectiveness of Psychological Interventions for Women Traumatized by Sexual Abuse: A Systematic Review and Meta-Analysis

Women traumatized by sexual abuse as children or adults experience psychological disorders, such as post-traumatic stress, depression, anxiety, and social adjustment. The published research includes a broad array of studies on psychological interventions intended to ease their symptoms. This study systematically examined the specific effects of psychological interventions for women traumatized by sexual abuse and statistically evaluated interventions by calculating effect sizes in a meta-analysis. A literature search was conducted of electronic databases of journals, gray literature and Clinical Research Information Service. Medical Subject Heading terminology, text words, and logical operators were applied, and 2,029 articles published in English or Korean were retrieved. Inclusion criteria were full-text articles on randomized controlled trials in which: (1) the subjects were women 18 years or older who had been sexually assaulted or raped; (2) all types of exclusively psychological treatment were used; (3) comparisons were mediated or routinely managed without psychosomatic treatment; (4) interventions did not target patients with chronic mental illnesses or neurocognitive dysfunctions; and (5) the studies were not on animals, empirical research, cohorts, research protocols, or integrated literature reviews. Ten articles fully met the inclusion criteria. The main findings were: (1) interventions had long-term effects on post-traumatic stress reduction, (2) effects on depression were effective only 3 months post-intervention, and (3) there were no follow-up effects on anxiety reduction or social adjustment improvement. The types of therapeutic intervention, delivery mode, number and duration of sessions, and number of weeks varied.

Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth

Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.

The Influence of Decisional and Emotional Forgiveness on Attributions

Research on forgiveness suggests that forgiveness is an emotion-focused coping process important for clinical settings as it can promote both physical and mental health (Worthington et al., 2005; Witvliet and McCullough, 2007). Investigating antecedents of forgiveness, empirical studies and theoretical models propose that attributions influence forgiveness. However, hardly any studies or theoretical models have ever looked at the possibility that this relationship may be reciprocal in nature and whether forgiveness also impacts a victim's attributions has not been investigated. The present, highly powered (n = 969) study seeks to fill this gap and provides the first empirical support that emotional forgiveness has a strong influence on subsequent attributions. Specifically, individuals, who have emotionally forgiven a transgression, hold the transgressor less responsible for the offense compared to those in the decisional forgiveness and control condition. Moreover, the findings conceptually replicate previous research (Lichtenfeld et al., 2015) by demonstrating that emotional, but not decisional forgiveness affects cognition and, thus, emotional and decisional forgiveness should be treated as distinct facets in the forgiveness process. Implications of these results for clinical and health psychology are discussed.

Religious Communities, Health, and Well-Being - Address to the US Air Force Chaplain

The text is adapted from a written transcript of the address to the US Air Force Chaplain Corps Summit, delivered by Tyler J. VanderWeele, on March 28, 2017 in San Antonio, Texas. The address discussed rigorous empirical research on how religious participation and religious community are related to a number of health and well-being outcomes, along with the mechanisms behind these associations, and the implications of such religion health research to military chaplains, and to society more broadly.

A Forgiveness Intervention for Women With Fibromyalgia Who Were Abused in Childhood: A Pilot Study

This pilot study compared the efficacy of a forgiveness intervention with a fibromyalgia (FM) health intervention on women with FM who have experienced emotional, physical, or sexual abuse, and emotional or physical neglect, in childhood by one of their parents. Eleven women with FM between the ages of 21 and 68 were randomized to the forgiveness intervention (n = 5) or the FM health intervention (n = 6), and completed the once-weekly individualized program for 24 weeks. The participants completed measures assessing forgiveness, overall FM health, depression, anger, anxiety, self-esteem, and coping strategies at the pretest, the posttest, and the 12-week follow-up test. They also completed the forgiveness intervention and FM health intervention final tests at the posttest, which assessed their knowledge on forgiveness and FM health. The forgiveness intervention participants had greater improvements in forgiveness (p < .001) and overall FM health (p = .046) from the pretest to the posttest, and in forgiveness (p = .018) and state anger (p = .027) from the pretest to the follow-up test than the FM health intervention participants. Moreover, the forgiveness intervention participants scored higher on the forgiveness final test than the FM health intervention participants (p < .001), and the FM health intervention participants scored higher on the FM health final test than the forgiveness intervention participants (p < .001). The results indicate that the forgiveness intervention was potentially helpful in improving forgiveness and overall FM health, and in decreasing state anger of this particular sample of women with FM.

The relationship between forgiveness, spirituality, traumatic guilt and posttraumatic stress disorder (PTSD) among people with addiction

Spirituality and forgiveness have been shown to be associated with psychological well-being, while guilt has been associated with poor health. Little is known, however, about the relationship between forgiveness, spirituality, guilt, posttraumatic stress (PTSD) and psychological co-morbidity among people in recovery from addiction. Eighty-one people (F = 36, M = 45) in recovery from drug and alcohol addiction were recruited from two residential units and two drop-in centres in a city in the United Kingdom. They completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28), the Spiritual Involvement and Beliefs Scale (SIBS), the Heartland Forgiveness Scale (HFS), the Traumatic Guilt Inventory (TGI), the Michigan Alcoholism Screening Test (MAST-22) and the Drug Abuse Screening Test (DAST-20). The control group comprised of 83 (F = 34, M = 49) individuals who confirmed that they did not have addiction and completed the PDS & GHQ-28. 54 % of the addiction group met the criteria for full PTSD and reported anxiety, somatic problems and depression. They described themselves as spiritual, had strong feelings of guilt associated with their addiction, and had difficulty in forgiving themselves. Controlling for demographics, number of events and medication management, regression analyses showed that spirituality predicted psychological co-morbidity, whilst feelings of guilt predicted PTSD symptoms and psychological co-morbidity. Unexpectedly, forgiveness did not predict outcomes. This study supports existing literature, which shows that people with drug and alcohol addiction tend to have experienced significant past trauma and PTSD symptoms. Their posttraumatic stress reactions and associated psychological difficulties can be better understood in the light of guilt and spirituality. Meanwhile, their ability to forgive themselves or others did not seem to influence health outcomes.

Construction of a questionnaire for readiness to reconcile in victims of human rights violations

BACKGROUND

Post-conflict reconciliation is supposed to have a positive impact on survivors of war and conflict. However, knowledge is limited as validated questionnaires to assess individual readiness to reconcile in the context of human rights violations are still missing.

OBJECTIVES

This study aimed to develop and pilot-test a questionnaire to assess individual readiness to reconcile in victims of human rights violations.

METHODS

The questionnaire was developed and pilot-tested in a sample of 60 adult Kurdish refugees from Turkey. In addition to the questionnaire, trauma exposure, Posttraumatic Stress Disorder (PTSD), depression, anxiety, perceived emotional closeness to the Kurdish people as well as the participants' ability to differentiate between perpetrators and the people in general were assessed in structured interviews, and their associations with readiness to reconcile were analyzed.

RESULTS

Factor and item analysis resulted in an 18-item questionnaire with three subscales (openness to interactions; absence of feelings of revenge; openness to conflict resolution). Cronbach's α for the subscales ranged from 0.74 to 0.90, explaining 61% of the total variance. The ability to differentiate between perpetrators and people in general and perceived emotional closeness were the best predictors for readiness to reconcile. The level of trauma exposure was not linked to readiness to reconcile. Although readiness to reconcile was negatively related to PTSD, depression and anxiety, none of these associations reached statistical significance.

CONCLUSIONS

The questionnaire appears to be a reliable measure with good psychometric properties. Further validations in different samples are needed.

Forgive to live: forgiveness, health, and longevity

This study examined multiple types of forgiveness as predictors of mortality and potential psychosocial, spiritual, and health mechanisms of the effects of forgiveness on longevity. Data from a nationally representative sample of United States adults ages 66 and older assessed forgiveness, health, religiousness/spirituality, and socio-demographics (N = 1,232). God's unconditional forgiveness and conditional forgiveness of others initially emerged as statistically significant predictors of mortality risk. However, only conditional forgiveness of others remained a significant predictor of mortality after controlling for religious, socio-demographic, and health behavior variables. Mediators of the association between conditional forgiveness of others and mortality were examined, and a statistically significant indirect effect was identified involving physical health. These findings suggest that conditional forgiveness of others is associated with risk for all-cause mortality, and that the mortality risk of conditional forgiveness may be conferred by its influences on physical health.

Forgiveness: A note for psychiatrists

Although forgiveness has received a lot of attention in the past two decades and its role in physical and mental health is being increasingly recognized, psychiatrists are unaware of its therapeutic benefits. A literature review was conducted with a view to create awareness of the recent advances in forgiveness research. Although forgiveness has been shown to be beneficial, more research is required, especially in the psychiatric setting. The role of resentment and bitterness in the causation of psychiatric disorders remain largely unevaluated and requires further study.

Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial

BACKGROUND

Significant palliative care intervention has focused on physical pain and symptom control; yet less empirical evidence supports efforts to address the psychosocial and spiritual dimensions of experience.

OBJECTIVE

To evaluate the impact of an intervention (Outlook) that promotes discussions of end-of-life preparation and completion on health outcomes in dying persons, including pain and symptoms, physical function, emotional function (anxiety and depression), spiritual well-being, and quality of life at the end of life.

DESIGN

A three-arm pilot randomized control trial. Subjects were recruited from inpatient and outpatient hospital, palliative care, and hospice settings. Intervention subjects met with a facilitator three times and discussed issues related to life review, forgiveness, and heritage and legacy. Attention control subjects met with a facilitator three times and listened to a nonguided relaxation CD. True control subjects received no intervention.

MEASUREMENTS

Preoutcomes and postoutcomes included the Memorial Symptom Assessment Scale, QUAL-E, Rosow-Breslau ADL Scale, Profile of Mood States anxiety sub-scale, the CESD short version, and the Daily Spiritual Experience Scale.

RESULTS

Eighty-two hospice eligible patients enrolled in the study; 38 were women, 35 were African American. Participants' primary diagnoses included cancer (48), heart disease (5) lung disease (10), and other (19) Ages ranged from 28-96. Participants in the active discussion intervention showed improvements in functional status, anxiety, depression, and preparation for end of life.

CONCLUSIONS

The Outlook intervention was acceptable to patients from a variety of educational and ethnic backgrounds and offers a brief, manualized, intervention for emotional and spiritual concerns.

Negative affect and anger rumination as mediators between forgiveness and sleep quality

Research indicates that forgiveness of interpersonal transgressions relates to better sleep quality, whereas maintaining feelings of anger and hostility relates to poorer sleep quality. However, the mechanisms explaining these relationships have yet to be determined. We examined whether negative affect and anger rumination mediate the relationship between forgiveness of others and sleep quality using a sample of 277 undergraduates from a medium-sized Midwestern Catholic university. Participants completed self-report questionnaires assessing forgiveness of others (situational and dispositional), sleep quality (nocturnal sleep and daytime fatigue), negative affect (depression and anxiety), and anger rumination. Using structural equation modeling, we found that negative affect and anger rumination mediated the relationship between forgiveness and sleep quality through two indirect pathways. In one pathway, negative affect mediated between forgiveness and sleep quality. In the second pathway, both negative affect and anger rumination functioned as mediators. Implications for clinicians and researchers are discussed.

Concept analysis of forgiveness with a multi-cultural emphasis

AIM

This paper is a report of a concept analysis of forgiveness.

BACKGROUND

Worldwide interest in and funding for forgiveness research has brought about a body of knowledge from many disciplines that could be clinically useful to nursing. At this time, nurse scholars are beginning to challenge one another to focus on this important area of inquiry. To date, however, most scholarship on forgiveness has been conducted in related disciplines, rather than in nursing. Conceptual and theoretical work is needed in nursing to promote knowledge development in this area.

METHOD

The CINAHL, Medline and PsycInfo databases were searched for papers published between 1990 and 2007 using the keywords, forgiveness, forgive, or reconciliation in the title or abstract. The non-linear evolutionary process of concept analysis was used to identify the concept of interest, its origins, realm, attributes and context, characteristics, and implications. Forgiveness was also explored from an international multi-cultural perspective. An exemplar is included to illuminate the concept. A total of 34 scholarly works from a variety of disciplines were included in the analysis.

FINDINGS

A definition of forgiveness emerged from the analysis, as well as a multi-cultural understanding of the concept. Three important attributes of forgiveness are that it is the relinquishing of a negative response, replacing the negative response with a benevolent response, and a process that occurs over time. Multi-cultural attributes centre on group harmony, re-establishing harmonious connections between people, and the morality of considering others as worthy of love and understanding.

CONCLUSION

A multi-cultural understanding of forgiveness may provide the impetus for further theory development and research in nursing, and could be used to educate nurses on beginning interventions in this area.

Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer

We evaluated whether a self-forgiving attitude and spirituality were related to psychological adjustment among 81 women being treated for breast cancer at a medical oncology clinic in a county general hospital. Both a self-forgiving attitude and spirituality were unique predictors of less mood disturbance and better quality of life (p's < 0.001). These results are consistent with previous research that has demonstrated a positive relationship between spirituality and well-being. The findings also suggest that self-forgiveness should be explored experimentally to determine whether it can protect against the psychological effects of breast cancer-related stress. Interventions targeting these characteristics could improve the quality of life and alleviate stress, especially in women with breast cancer in public sector settings.

Self-forgiveness, spirituality, and psychological adjustment in women with breast cancer

We evaluated whether a self-forgiving attitude and spirituality were related to psychological adjustment among 81 women being treated for breast cancer at a medical oncology clinic in a county general hospital. Both a self-forgiving attitude and spirituality were unique predictors of less mood disturbance and better quality of life (p's < 0.001). These results are consistent with previous research that has demonstrated a positive relationship between spirituality and well-being. The findings also suggest that self-forgiveness should be explored experimentally to determine whether it can protect against the psychological effects of breast cancer-related stress. Interventions targeting these characteristics could improve the quality of life and alleviate stress, especially in women with breast cancer in public sector settings.

The unique effects of forgiveness on health: an exploration of pathways

The relationship of forgiveness, both state and trait, to health was assessed. Eighty-one community adults completed a packet of questionnaires and participated in a laboratory interview about a time of hurt or betrayal. Heart rate and blood pressure were recorded during a 10 min baseline, the interview and during a recovery period; interviews were structured around a framework of questions and videotaped. Four measures of forgiveness were all statistically associated with five measures of health (physical symptoms, medications used, sleep quality, fatigue, and somatic complaints). Trait forgiveness was associated with decreased reactivity (rate-pressure product) to the interview, but sympathetic reactivity did not account for the trait forgiveness-health association. Four mechanisms or pathways by which forgiveness could lead to fewer physical symptoms were examined: spirituality, social skills, reduction in negative affect, and reduction in stress. All factors either partially or fully mediated the effect of forgiveness on health; however, the strongest mediator for both state and trait forgiveness was reduction in negative affect. For state forgiveness, the second strongest mediator was reduction in stress; for trait forgiveness, both conflict management and reduction in stress were strong contributors.

Responding to Requests Regarding Prayer and Religious Ceremonies by Patients Near the End of Life and Their Families

Prayer and religious ceremonies may help patients near the end of life and their relatives find comfort and discover meaning in their lives. In this paper, we analyze how physicians might respond in two situations regarding prayer and religious ceremonies. First, how should physicians respond when such patients or their families ask physicians to pray for them or with them? Physicians' responses to such requests will depend on their own religious and spiritual beliefs, the congruence of their beliefs with those of the patient and family, and their relationship with the patient. Many physicians may be willing to be present and stand silently while the patient prays. Second, how should physicians respond when such patients and families seek to carry out their religious and spiritual practices in the hospital? Religious ceremonies can provide meaning, hope, and solace to patients and families. Institutional guidelines regarding religious ceremonies should allow as much leeway as is compatible with good care both for the patient for whom the ritual is offered and also for other patients within the facility. Physicians should inquire whether there are religious and spiritual practices that patients and families would like to engage in. However, physicians should be cautious about recommending specific ceremonies or pratices. Physicians can respond to requests and respect patients' spiritual needs in ways that may deepen the therapeutic doctor-patient relationship, without compromising their own religious and spiritual beliefs or professional roles.