Forgiveness

Is Forgiveness Related to Physical Health?

A recent meta-analysis reveals that forgiving is connected to physical health.

Posted Apr 11, 2019

It is well known that when people follow a scientifically valid pathway to forgiving those who have been unjust to them, then positive psychological outcomes are observed.  For example, Freedman and Enright (1996) showed that after about a 14-month intervention in which incest survivors forgave their father or father-figure, then they reduced in anxiety and depression and increased in self-esteem.  Such results have been observed for people in drug rehabilitation (Lin et al., 2004), in hospice (Hansen, Enright, Baskin, & Klatt, 2009) and with other populations (see Enright & Fitzgibbons, 2015).  

Until recently, there was no meta-analysis of the relationship between forgiving those who have been unfair and physical health outcomes.  We recently published the first such meta-analysis (Lee & Enright, 2019).  In answering the question of this relationship between the degree of forgiveness and the degree of physical health, several issues must be kept in mind.  First, the vast majority of these studies do not show a cause-and-effect relationship between forgiveness and physical health because they tend to be correlational, not experimental (in which forgiveness first is changed and then physical changes are seen only after forgiveness is improved).  In other words, it is not necessarily the case that those who forgive become healthier.  Instead, it could be the case that healthier people have more energy and enthusiasm to forgive.  Even so, this kind of "first look" is important for even seeing if there is a relationship between forgiving and being more healthy.  

A second issue is this:  Examining a very wide set of physical variables actually makes it more difficult to find a relationship between forgiveness and health.  Why?  Let us suppose, for example, that there is such a relationship between forgiveness and only cardiac symptoms and not other health issues.  When we examine all existing relations between forgiveness and cardiac issues, physical pain, sleep quality, and host of other physical variables, then we actually are watering down any possible statistical significance between forgiveness and its true partner in the physical realm (if, as the example here goes) of cardiac issues.  Thus, if we can find a relationship between forgiveness and a broad base of physical variables, this would show that forgiveness in relation to physical health is worth taking seriously.  It, further, would suggest that it is time to look even more carefully at the forgiveness and physical health relationship to see what, exactly, is impacted in the physical realm when people forgive.

A third issue is similar to the second one above.  Forgiveness also had its own wide variety of assessments in that some researchers looked at the degree to which a research participant's forgiveness included thinking, feeling, and behaving toward one person, whereas other researchers looked at only the degree of resentment that remained in the participants.  Still, other researchers focused more on what is called trait forgiveness, or the general tendency to forgive across most situations and most people.  

KuanShu Designs
Source: KuanShu Designs

The Meta-Analysis 

In the Lee and Enright (2019) meta-analysis, a very wide range of physical variables across 136 comparisons were examined together as we correlated the degree to which participants forgave those who treated them unjustly and the following kinds of physical variables (among others because not all are mentioned here):

  • cholesterol (Brenneis, 2002; Friedberg et al., 2009); 
  • fibromyalgia impact questionnaire  (Offenbaecher Kohls et al., 2013);
  • heart health (Friedberg et al., 2007); cardiovascular risk (Standish, 2016); heart rate (Patel, 2013);
  • HIV-related symptom questionnaire (Martin et al., 2010);
  • hypertension (Connery, 2002);
  • lupus (Pilch, 2016);
  • physical pain by self-report (McDermott et al., 2017; Parenteau & Hamilton, 2014; Saffarinia et al.,2016); and
  • sleep quality (Lawler-Row, 2010; Shirazi et al., 2016).

Given this wide variety of variables, it was surprising that the correlation between forgiveness (no matter how it was assessed) and physical health (no matter what the physical issue is) was statistically significant, r = .14, well beyond a probability level of .01.  The statistical power of the results was found to be 1.00, a strong result. These findings emerged regardless of age (ages ranged from 12 to 106 with an average of 36.68 years), gender, race, education level, or employment status. A correlation of .14 is small, but it does point to a statistical reality that the more people forgive the healthier they are in a broad, general sense.  Again, this does not mean that the forgiving is causing an increase in physical health.  Is there such evidence?

The Cause-and-Effect Relationship Between First Forgiving and then Experiencing Improved Physical Health 

KuanShu Designs
Source: KuanShu Designs

There are two randomized experimental and control group studies showing that as people learn to forgive, then their physical health improves.  The first (Waltman et al., 2009) examined men on a cardiac unit of a hospital.  We used as the physical variable what is known as the ejection fraction test, or the amount of blood flow through the heart.  When there is cardiac compromise and the person is highly stressed, there is a tendency for there to be less blood flow through the heart.  That was the case for all 24 men in both the experimental group, that had a forgiveness intervention and the control group, that had heart-health education as usual.  Upon the follow-up test, after the forgiveness intervention ended, those in the experimental group (who learned to forgive), when they recalled the person and situation in which they were unjustly treated, had statistically-significantly more blood flow through their hearts than was the case for the men in the control group.  Those in the experimental group did not have their hearts return to normal, but the intervention likely helped them to avoid chest pains and sudden death.  This was the first published study to show that as people forgive, then this positively affects a major organ of the body.

The second experimental study (Lee & Enright, 2014) showed that as women who have fibromyalgia and who were abused in some way in childhood learn to forgive, then their fibromyalgia symptoms statistically significantly reduce relative to the participants in the control group.

Conclusion for the Forgiveness and Physical Health Relationship

The science shows that forgiving others is related to general physical health.  Two experimental studies to date show the cause-and-effect relationship between forgiving others and becoming physically healthier.  Perhaps it is time to consider forgiveness therapy as part of the treatment regimen at least for some challenging physical conditions.  This would require first screening patients for past injustices against them and the extent to which they continue to harbor excessive anger which can be ameliorated through forgiving.  The research to date indicates that it is time to explore more deeply the hypothesis that learning to forgive might enhance physical health.

References

Brenneis, M. J. (2001). The relationship between forgiveness and physical health indicators in recovering members of the clergy. Journal of Ministry in Addiction and Recovery, 7(2), 43-59. doi:10.1300/J048v07n02_04

Connery, T. J. (2002). Forgiveness: A correlational study between the spirit of forgiveness and physical health in senior citizens (Doctoral dissertation). Retrieved from Proquest Dissertations and Theses database. (UMI No. 3056731).

Enright, R. D., & Fitzgibbons, R. P. (2015). Forgiveness therapy: An empirical guide for resolving anger and restoring hope. Washington, DC: American Psychological Association.

Freedman, S. R., & Enright, R. D. (1996).  Forgiveness as an intervention goal with incest survivors.  Journal of Consulting and Clinical Psychology, 64(5), 983-992.

Friedberg, J. P., Suchday, S., & Shelov, D. V. (2007). The impact of forgiveness on cardiovascular reactivity and recovery. International Journal of Psychophysiology, 65, 87-94. doi:10.1016/j.ijpsycho.2007.03.006

Friedberg, J. P., Suchday, S., & Srinivas, V. S. (2009). Relationship between forgiveness and psychological and physiological indices in cardiac patients. International Journal of Behavioral Medicine, 16, 205–211. doi:10.1007/s12529-008-9016-2

Hansen, M.J., Enright. R.D., Baskin, T.W., & Klatt, J. (2009).  A palliative care intervention in forgiveness therapy for elderly terminally-ill cancer patients. Journal of Palliative Care, 25, 51-60.

Lawler-Row, K. A. (2010). Forgiveness as a mediator of the religiosity-health relationship. Psychology of Religion and Spirituality, 2, 1–16. doi:10.1037/a0017584. doi:10.1037/a0017584

Lee, Y.-R., & Enright, R. D. (2014). A forgiveness intervention for women with fibromyalgia who were abused in childhood: A pilot study. Spirituality in Clinical Practice, 1, 203–217. doi: 10.1037/scp0000025

Lee, Y.R. & Enright, R.D. (2019): A meta-analysis of the association between forgiveness of others and physical health, Psychology & Health, DOI: 10.1080/08870446.2018.1554185

Lin, W.F., Mack, D., Enright, R.D., Krahn, D., & Baskin, T. (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(6), 1114-1121.

Martin, L. A., Vosvick, M., & Riggs, S. A. (2012). Attachment, forgiveness, and physical health Quality of life in HIV + adults. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 24, 1333-1340. doi:10.1080/09540121.2011.648598

McDermott, K. A., Smith, H. L., Matheny, N. L., & Cougle, J. R. (2017). Pain and multiple facets  of anger and hostility in a sample seeking treatment for problematic anger. Psychiatry Research, 253, 311–317. doi:10.1016/j.psychres.2017.04.006

Offenbaecher, M., Kohls, N., Toussaint, L. L., Sigl, C., Winkelmann, A., Hieblinger, R.,.… Büssing, A. (2013). Spiritual needs in patients suffering from fibromyalgia. Evidence-Based Complementary and Alternative Medicine, 2013, 1-13.doi:10.1155/2013/178547

Parenteau, S. C., & Hamilton, N. A. (2014). To Forgive Is Divine, but Does It Help Patients Adjust to Chronic Pain? Unpublished manuscript, Department of Psychology, Auburn University at Montgomery, Alabama, United States.

Patel, A. I. (2013). Cardiovascular Benefits of Forgiveness in Women: A Psychophysiological Study (Unpublished undergraduate thesis). Ohio State University, Columbus, OH.

Pilch, M., Scharf, S. N., Lukanz, M., Wutte, N. J., Fink-Puches, R., Glawischnig- Goschnik, M., … Aberer, E. (2016). Spiritual well-being and coping in scleroderma, lupus erythematosus, and melanoma. Journal of the German Society of Dermatology, 717-728. doi:10.1111/ddg.12715

Saffarinia, M., Mohammadi, N., & Afshar, H. (2016). The role of interpersonal forgiveness in resilience and severity of pain in chronic paint patients. Journal of Fundamentals and Mental Health, 18, 212-219.

Shirazi, M., Fardin, M. A., Arab, A., Sanagoue, G., & Alisofi, A., N. (2016). The impact of positive psychological states in predicting sleep quality amongst pregnant women. Iranian Journal of Psychiatry and Behavioral Sciences, 10, e5767. doi:10.17795/ijpbs-5767.

Standish, E. (2016). Forgiveness, health, and psychological adjustment in older adults (Doctoral dissertation). Retrieved from Proquest Dissertations and Theses database (Proquest No.10105009)

Waltman, M.A., Russell, D.C., Coyle, C.T., Enright, R.D., Holter, A.C., & Swoboda, C. (2009).  The effects of a forgiveness intervention on patients with coronary artery disease.  Psychology and Health, 24, 11-27.