In addition to confession, another important way of letting go of negative emotions is

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Overview

CE credits: 1

Learning objectives: After reading this article, CE candidates will be able to:

1. Discuss what true forgiveness is—and is not.
2. Describe the mental health benefits of forgiveness.
3. Describe two models that help people forgive others.

Everett Worthington, PhD, had been studying forgiveness for nearly a decade when he was faced with the worst possible opportunity to put his research to the test: His mother was murdered in a home invasion. Though police were confident they'd identified the perpetrator, the man was never prosecuted. There was no justice. But despite the tragic nature of that loss, it didn't mean forgiveness was off the table.

"I had applied the forgiveness model many times, but never to such a big event," says Worthington, a professor of psychology at Virginia Commonwealth University. "As it turned out, I was able to forgive the young man quite quickly."

Worthington hardly describes himself as a superstar forgiver, however. Developing the skill took years of practice, he says. "I had a professor in grad school that gave me a B, and it took me 10 years to forgive that guy."

Most of us will never be faced with forgiving such a devastating offense as the murder of a loved one—an example of what Loren Toussaint, PhD, a professor of psychology at Luther College, in Decorah, Iowa, calls "heroic forgiveness." Yet nearly everyone can benefit from being more forgiving, Toussaint says.

Whether you've suffered a minor slight or a major grievance, learning to forgive those who hurt you can significantly improve both psychological well-being and physical health.

"Forgiveness is a topic that's psychological, social and biological," he adds. "It's the true mind-body connection."

What is forgiveness?

Many people think of forgiveness as letting go or moving on. But there's more to it than that, says Bob Enright, PhD, a psychologist at the University of Wisconsin, Madison, who pioneered the study of forgiveness three decades ago. True forgiveness goes a step further, he says, offering something positive—empathy, compassion, understanding—toward the person who hurt you. That element makes forgiveness both a virtue and a powerful construct in positive psychology.

Outside scientific circles, though, many people are a bit confused about the concept.

One common but mistaken belief is that forgiveness means letting the person who hurt you off the hook. Yet forgiveness is not the same as justice, nor does it require reconciliation, Worthington explains. A former victim of abuse shouldn't reconcile with an abuser who remains potentially dangerous, for example. But the victim can still come to a place of empathy and understanding. "Whether I forgive or don't forgive isn't going to affect whether justice is done," Worthington says. "Forgiveness happens inside my skin."

Another misconception is that forgiving someone is a sign of weakness. "To that I say, well, the person must not have tried it," says Worthington.

And there may be very good reasons to make the effort. Research has shown that forgiveness is linked to mental health outcomes such as reduced anxiety, depression and major psychiatric disorders, as well as with fewer physical health symptoms and lower mortality rates. In fact, researchers have amassed enough evidence of the benefits of forgiveness to fill a book; Toussaint, Worthington and David R. Williams, PhD, edited a 2015 book, "Forgiveness and Health," that detailed the physical and psychological benefits.

Toussaint and Worthington suggest that stress relief is probably the chief factor connecting forgiveness and well-being. "We know chronic stress is bad for our health," Toussaint says. "Forgiveness allows you to let go of the chronic interpersonal stressors that cause us undue burden."

While stress relief is important, Enright believes there are other important mechanisms by which forgiveness works its magic. One of those, he suggests, is "toxic" anger. "There's nothing wrong with healthy anger, but when anger is very deep and long lasting, it can do a number on us systemically," he says. "When you get rid of anger, your muscles relax, you're less anxious, you have more energy, your immune system can strengthen."

In one meta-analysis, for example, Yoichi Chida, MD, PhD, found that anger and hostility are linked to a higher risk of heart disease, and poorer outcomes for people with existing heart disease ( Journal of the American College of Cardiology, 2009).

Forgiveness can also help rebuild self-esteem, Enright adds. "When people are beaten down by injustice, you know who they end up not liking? Themselves," he says. "When you stand up to the pain of what happened to you and offer goodness to the person who hurt you, you change your view of yourself."

Putting in the effort

As with any human trait, some people are naturally more forgiving than others. Worthington has found in his research that more forgiving types tend to have higher levels of agreeableness and lower levels of neuroticism. People who have a tendency to ruminate are generally less quick to forgive, since they are more likely to hold onto grudges or hurt feelings. People who have a religious faith also seem to have an upper hand in forgiving. "All of the major religions value forgiveness," Worthington notes.

Being forgiving can pay off, as Toussaint and colleagues found in a study exploring the relationship among stress, psychological well-being and forgiveness. They found, as expected, that people who had greater levels of accumulated lifetime stress exhibited worse mental health outcomes. But among the subset of volunteers who scored high on measures of forgiveness, high lifetime stress didn't predict poor mental health ( Journal of Health Psychology, 2016). The power of forgiveness to erase that link was surprising, Toussaint says. "We thought forgiveness would knock something off the relationship [between stress and psychological distress], but we didn't expect it to zero it out," he says.

In another study, Toussaint followed participants for five weeks and measured how their levels of forgiveness ebbed and flowed. He found that when forgiveness rose, levels of stress went down. Reduced stress, in turn, led to a decrease in mental health symptoms ( Annals of Behavioral Medicine, 2016).

There's also good news for the grudge holders and revenge seekers of the world. With practice, most anyone can learn to be more forgiving. "You don't have to be the world's most forgiving person," Toussaint says. "If you work at it, it takes the edge off the stress and ultimately that helps you feel better."

Developing empathy is a good place to start. He says that journaling or expressive writing with the goal of being empathetic can help. Angry about your boss's rude remark? Try to put yourself in her shoes. Maybe she's under a lot of pressure. The project isn't going as planned. I'm not always perfect. "Writing with an empathetic tone ... can nudge you into a more positive place," he says.

Toussaint's research has also found that for religious people, prayer can boost forgiveness. He and his colleagues studied Americans and Indians, representing Christian, Hindu and Muslim backgrounds. He found that those who said a brief prayer for their romantic partner were less likely to exhibit retaliatory motives when presented with statements such as "When my partner wrongs me, I do something to even the score" ( International Journal of Psychology, 2015).

Unfortunately, Toussaint says, many people give up too soon and conclude they're just not forgiving. He urges people to keep trying, even when it's hard. "A natural resurgence of unforgiving feelings is normal," he says. "It's like having a piece of cake during a diet. Just because you have a setback doesn't mean you're an unforgiving person."

Putting in the time

Many people can benefit from self-directed efforts to boost forgiveness, Toussaint says. But psychologists can also offer more formal strategies to help people forgive.

Enright's forgiveness therapy process model uses a 20-step system to move people through four phases: uncovering one's negative feelings about the offense, deciding to forgive, working toward understanding the offending person, and discovering empathy and compassion for him or her. Enright has shown this model is effective in various one-one-one interventions, including a study that showed it alleviated depression, anxiety and PTSD in women who have experienced spousal emotional abuse ( Journal of Consulting and Clinical Psychology, 2006). "Through these cognitive exercises, they begin to see the other person as a wounded human being, as opposed to stereotyping them and defining them by their hurtful actions," Enright says.

Worthington's REACH Forgiveness model also aims to find compassion for the offender, through a five-step process that helps people address their hurt, find empathy for the person who hurt them, reach forgiveness and hold onto that forgiveness over time. His model has been applied more often in group settings.

Despite the differences in the interventions, both help to promote forgiveness and the mental health benefits that go along with it. In a meta-analysis of 54 forgiveness studies, Worthington found that both his and Enright's models helped people forgive and also improved their mental health ( Journal of Consulting and Clinical Psychology, 2014). "There's a strong dose-response relationship between the amount of time people try to forgive and the amount of forgiveness they're successful at experiencing. It's all about the time spent," he says. "You run people through a six-hour group, not only do they forgive but they also reduce their levels of depression and anxiety."

Forgiveness is often an important feature in couples therapy, too, where betrayal and resentment frequently play starring roles, says Kristina Coop Gordon, PhD, a clinical psychologist who studies relationship dysfunction and couples therapy at the University of Tennessee–Knoxville.

Gordon's main practice is in addressing infidelities. In that context, exploring forgiveness often means couples have to face the hurt and betrayal, and address it head on so they feel safe enough to move on. That look backward can be a departure from many popular psychotherapy models, such as cognitive-behavioral therapy, which tend to focus on the present, Gordon adds. But she believes it can be important to revisit the past in order to forgive and move forward. "Sometimes it's worthwhile to go back to historical events and process them on a deeper level, with couples and with individuals," she says. "If you're too focused on the present, you can forget about the past's influence in the present."

Despite the proven benefits of moving on, forgiveness can be a hard concept for some people to embrace. It can feel unfair to have to put in the effort to forgive when the other person was the one in the wrong. But that's life, Enright says.

"Without our deserving it, we can experience thunderous injustices. The injury was unfair, the person who created it was unfair. But now we have a place for healing," he says.

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