Self-Forgiveness and Self-Condemnation in the Context of Addictive Behavior and Suicidal Behavior.

Addictive behavior and suicidal behavior are serious individual- and public-level health concerns. For those struggling with either or both, self-condemnation is a common experience, especially with respect to shame, guilt, and self-stigma. Self-forgiveness, a construct common to both religiousness/spirituality and positive psychology, may be an effective tool in addressing the self-condemnation inherent to those struggling with addictive behavior and suicidal behavior. In this review paper, we discuss (1) the nature and definition of forgiveness, (2) theoretical modeling developed regarding the general association of forgiveness with health, (3) theoretical modeling developed regarding the specific association of forgiveness with better outcomes related to addictive and/or suicidal behavior, (4) the relevance of shame, guilt, and self-stigma to the development and maintenance of addictive and suicidal behavior, and (5) the role of self-forgiveness in addressing self-condemnation, especially shame, guilt, and self-stigma. Little work explicitly focused on the association of self-forgiveness with shame, guilt, and/or self-stigma has been done. However, empirical evidence is accumulating in support of other associations proposed in the Forgiveness-Addiction-Recovery Association (FARA) Model described herein. As such, it is likely that similar support will be found when the focus is deliberately turned to shame, guilt, and self-stigma.

Thwarted Belongingness and Suicide Risk in Primary Care: Perceived Burdensomeness and Psychache as Mediators.

Suicide is a significant public health concern, particularly among primary care patients, given that many individuals who die by suicide visit their primary care provider in the months prior to their death. We examined constructs from two prominent theories of suicide, the interpersonal and psychache theories, including thwarted belongingness, perceived burdensomeness, and psychache. Among our sample (n = 224) of patients, perceived burdensomeness and psychache, individually and in serial, mediated the relation between thwarted belongingness and suicidal behavior. Thwarted belongingness was associated with greater perceived burdensomeness and, in turn, with more psychache and increased suicide risk. Our results elucidate the associations between the interpersonal and psychache theories of suicide. Clinical strategies that may reduce thwarted interpersonal needs and psychache, and which are appropriate for medical settings, are discussed.

Translation and validation of the Chinese version of the Friedman life balance scale among nursing students: A psychometric analysis.

AIM: To conduct a Chinese translation and validation of the Friedman Life Balance Scale (FLBS). BACKGROUND: Prevalence of mental disorders is high among nursing students. Life balance is important for nursing students, which may help them increase efficiency in their studies and develop physical and psychological health. Yet, little is known about life balance in nursing students. Therefore, it is crucial to evaluate the status of life balance of the students to lay the foundation for exploring its associated factors. DESIGN: A multi-centre cross-sectional design. METHOD: The study was comprised of 420 nursing students from 15 hospitals and two educational institutes in East, North and Northeast China from July 2021 to January 2022. The Chinese version of the FLBS was translated and adapted based on published, standardized, international guidelines. Psychometric evaluation included floor and ceiling effects, factorial validity, convergent validity, discriminant validity, internal consistency, test-retest reliability, diagnosis accuracy and calibration. The tests used for validity included floor and ceiling effects, confirmatory factor analysis, average extracted variance (AVE) value, composite reliability, correlations with life satisfaction and subjective well-being. The tests used for reliability incudes Cronbach's alpha and intraclass correlation coefficients. Diagnosis accuracy was tested by the area under the curve and calibration was tested by Hosmer-Lemeshow goodness-of-fit test. RESULTS: The Chinese version of the Friedman life balance scale did not demonstrate floor or ceiling effect, showing content validity is not limited. Confirmatory factor analysis showed acceptable model fit after it was modified. Convergent validity and discriminant validity of the Friedman life balance scale were supported, except subscales two and three were not discriminated well by AVE technique. The internal consistency was acceptable and the test-retest reliability was good with 0.858. The area under the curve was 0.762 and the optimal cut-off point for depressive symptoms was 44. Hosmer-Lemeshow goodness-of-fit test showed the calibration to be acceptable. Life balance is moderate among Chinese nursing students. The subscale "self-forgive, compassion, love" had the highest correlations with well-being and life satisfaction. CONCLUSIONS: The Chinese version of the Friedman life balance scale is a suitable instrument for assessing life balance in Chinese-speaking contexts. It also may have potential utility in identifying nursing students with or without depressive symptoms that may need further examination. Future work should examine additional samples of Chinese nursing students, as well as, perhaps other student populations to determine the extent to which the psychometric properties of the FLBS generalize to other students and contexts.

Longitudinal Relationship between Forgiveness of Self and Forgiveness of Others among Individuals with Alcohol Use Disorders.

Previous research has suggested that forgiveness of self and forgiveness of others might function differently over the course of addiction recovery. However, we know little about the longitudinal process of these dimensions of forgiveness for individuals addressing alcohol-use disorders. Increased knowledge would inform the content and sequencing of intervention strategies. Three hundred and sixty-four individuals managing alcohol dependence participated in a 30-month longitudinal study, reporting their capacity to forgive self and to forgive others every 6 months. Findings indicated that a) participants were more forgiving of others than themselves, b) both types of forgiveness increased over time, c) forgiveness of self increased more rapidly than forgiveness of others, and d) while increases in both types of forgiveness predicted increases in the other type, the effect of forgiveness of others on forgiveness of self was twice as strong as the reverse effect. Implications for facilitating forgiveness in treatment are discussed.

Forgiveness and Suicidal Behavior: Cynicism and Psychache as Serial Mediators.

Research is burgeoning regarding the beneficial association of forgiveness with numerous health-related outcomes; however, its particular relationship to suicidal behavior has received relatively little attention. Both cynicism and psychache, or agonizing psychological pain, have displayed deleterious associations with suicidal behavior, but have rarely been incorporated into more comprehensive models of suicidal behavior. Consistent with the recent development of a theoretical model regarding the forgiveness-suicidal behavior association, the present study utilized an undergraduate sample of college students (N = 312) to test a mediation-based model of the cross-sectional association of forgiveness with suicidal behavior, as serially mediated by cynicism and psychache. Dispositional forgiveness of self and forgiveness of uncontrollable situations were each indirectly associated with less suicidal behavior via less psychache. Also, dispositional forgiveness of others was indirectly associated with less suicidal behavior via less cynicism and less psychache, in a serial fashion. The present results are consistent with the extent literature on the forgiveness-suicidal behavior association, cynicism, and psychache, and pending future studies, may be utilized to inform further treatment efforts for individuals at a high risk of attempting suicide.

Addressing Social Anxiety Concurrently With Prison-Based Sex Offender Treatment: A Case of Individual Needs in an Era of Manualized Treatment.

Emotional regulation may be an underaddressed therapeutic target in sex offender treatment. This article presents a case report of "Adam," a Caucasian male referred to a prison-based sex offender treatment program. Adam's social anxiety was recognized as an antecendent to his sexual offending, and treatment of such, as a critical adjunct to sex offender treatment, is discussed herein. Adam's individualized treatment included aspects of rational emotive behavior therapy and time-limited dynamic psychotherapy. Adam showed an increased understanding of his anxiety and improvement in his social interactions, both in the context of treatment groups and with female staff, and was willing to continue follow-up care in the community. This case provides support for the individualized treatment of incarcerated offenders as opposed to exclusively utilizing manualized psychoeducational interventions.

Struggling With Adversities of Life: The Role of Forgiveness in Patients Suffering from Fibromyalgia.

OBJECTIVES: We compared the magnitude and direction of associations between forgiveness and pain, mental and physical health, quality of life, and anger in a sample of fibromyalgia syndrome (FM) participants and healthy controls. In addition, we compared FM and controls on mean levels of these variables. MATERIALS AND METHODS: A total of 173 individuals with FM and 81 controls completed this study. FM participants and controls were residents of Germany recruited with the support of the German Fibromyalgia Patient Association and several self-help groups. FM participants and controls were about 53 years of age, mostly married (70%), Christians (81%), with levels of education ranging from 9 to 13+ years. All participants completed assessments of forgiveness, pain, health, quality of life, and anger. RESULTS: Analyses revealed that FM participants reported higher pain and anger and poorer health and quality of life. FM participants also reported lower levels of both forgiveness of self and others. Size and direction of associations of forgiveness with pain, health, quality of life, and anger in were not significantly different between healthy individuals and individuals with FM. DISCUSSION: Forgiveness of self and others is beneficially associated with pain, health, quality of life, and anger in FM participants at levels that are of similar size and direction as in healthy controls. However, FM participants manifest lower levels of forgiveness of self and others. Therapeutic promotion of forgiveness as a psychosocial coping strategy may help patients with FM to better manage psychological and physical symptoms, thereby enhancing well-being.

Ritualistic, theistic, and existential spirituality: initial psychometric qualities of the RiTE measure of spirituality.

An expanded model to conceptualize sacred human experiences is discussed wherein the term Spirituality is broadened to include: (1) Ritualistic Spirituality, (2) Theistic Spirituality, and (3) Existential Spirituality. However, a measure incorporating this expanded model does not yet exist. A 67-item self-report questionnaire was developed and data were collected from 1,301 undergraduate students. A series of factor analytic procedures yielded a three-factor structure consistent with the guiding theoretical model and refinement produced three 10-item subscales. Evidence for construct validity and sound psychometric properties was indicative of a reliable, valid, and unique tool to assess the multidimensional nature of spirituality.

Forgiveness and health: assessing the mediating effect of health behavior, social support, and interpersonal functioning.

Religiousness and spirituality are important to most Americans and while beneficial associations between forgiveness and health are consistently observed, little is known regarding the mechanism of association. Cross-sectional multiple mediation-based analyses of associations between dimensions of forgiveness and physical and mental health were conducted using a sample of 363 undergraduate students from rural Southern Appalachia. Controlling for demographic variables (i.e., gender, age, education, ethnicity, and marital status) and lifetime religiousness, multivariable analyses reflected associations of forgiveness of self and forgiveness of others, but not feeling forgiven by God, with physical health status, somatic symptoms, mental health status, and psychological distress. All such associations operated through health behavior and/or social support; however, only in the context of forgiveness of self did such associations also operate through interpersonal functioning (problems). While forgiveness of self and forgiveness of others each appear to have a robust indirect relationship with health, mediation-based associations involving forgiveness of self were nearly twice as frequent. It may be that forgiveness of self is relatively more important to health-related outcomes.

Depressive symptoms and interpersonal needs as mediators of forgiveness and suicidal behavior among rural primary care patients.

BACKGROUND: Suicide is the 10th leading cause of death in the US, and rates of suicide are higher in rural than urban areas. As proposed by the Interpersonal-Psychological Theory of Suicide, thwarted belongingness and perceived burdensomeness are risk factors for suicidal behavior, although protective individual-level characteristics such as forgiveness, may indirectly affect suicidal behavior by decreasing the deleterious effect of thwarted interpersonal needs. METHOD: A sample of uninsured adults recruited from a rural primary clinic (N=101) completed the Brief Multidimensional Measure of Religiousness and Spirituality; Suicidal Behaviors Questionnaire-Revised; Interpersonal Needs Questionnaire; and Center for Epidemiologic Studies Depression Scale. Parallel and serial multivariable mediation analyses were conducted to test for direct and indirect effects of forgiveness on suicidal behavior. RESULTS: In parallel mediation, covarying depressive symptoms, forgiveness of self had an indirect effect on suicidal behavior, through perceived burdensomeness. Inclusion of depressive symptoms as a mediator revealed an indirect effect of forgiveness of self and others on suicidal behavior via depression, thwarted belongingness, and perceived burdensomeness in a serial mediation model. LIMITATION: A longitudinal study, with an equal representation of males and diverse populations is needed to replicate our findings. DISCUSSION: Our findings have implications for the role health providers can play in addressing suicide with rural patients. Promoting forgiveness, may, in turn affect interpersonal functioning and decrease risk for suicidal behavior.

Forgiveness and health: psycho-spiritual integration and the promotion of better healthcare.

Psychology and religiousness/spirituality continue to be perceived as incongruent and incompatible, often resulting in a disconnection and suboptimal level of collaboration between the two fields to the detriment of healthcare. Nevertheless, forgiveness, or an absence of ill will, is a construct central to both mainstream world religion/spirituality and the field of psychology. Understanding and recognizing the construct of forgiveness and its mutually central application can foster increased collaboration between the fields. As a result, individually and collectively, the two fields will be better able to expand and further develop their many shared principles in the service of better healthcare.

Forgiveness and health among people in outpatient physical therapy.

PURPOSE: Forgiveness is associated with a variety of health-related outcomes; however much of this work has been in the context of forgiveness of others, direct associations and otherwise healthy samples. This study examined associations involving multiple dimensions of forgiveness, including indirect effects through health behavior, among outpatients receiving physical therapy. METHODS: Participants from southern Appalachia (n = 141) completed cross-sectional self-report measures of forgiveness, lifetime religiousness, health behavior, health status and pain. Mediation analysis was employed to examine the direct and indirect relationships between forgiveness and health. RESULTS: Forgiveness of self was associated with: (i) overall health status, physical health status and current pain in an indirect-only fashion and (ii) mental health status and chronic pain in a direct-only fashion. Feeling forgiven by God was associated with health-related social functioning in a direct-only fashion. Forgiveness of others was not associated with the health-related outcomes. CONCLUSIONS: Forgiveness of self appears to be the most important to health, yet the most difficult to achieve. Religious culture may influence whether feeling forgiven by God is also important. Forgiveness-based intervention may be useful in the context of rehabilitation, in general, and physical therapy, in particular.

Six-month changes in spirituality and religiousness in alcoholics predict drinking outcomes at nine months.

OBJECTIVE: Although spiritual change is hypothesized to contribute to recovery from alcohol dependence, few studies have used prospective data to investigate this hypothesis. Prior studies have also been limited to treatment-seeking and Alcoholics Anonymous (AA) samples. This study included alcohol-dependent individuals, both in treatment and not, to investigate the effect of spiritual and religious (SR) change on subsequent drinking outcomes, independent of AA involvement. METHOD: Alcoholics (N = 364) were recruited for a panel study from two abstinence-based treatment centers, a moderation drinking program, and untreated individuals from the local community. Quantitative measures of SR change between baseline and 6 months were used to predict 9-month drinking outcomes, controlling for baseline drinking and AA involvement. RESULTS: Significant 6-month changes in 8 of 12 SR measures were found, which included private SR practices, beliefs, daily spiritual experiences, three measures of forgiveness, negative religious coping, and purpose in life. Increases in private SR practices and forgiveness of self were the strongest predictors of improvements in drinking outcomes. Changes in daily spiritual experiences, purpose in life, a general measure of forgiveness, and negative religious coping also predicted favorable drinking outcomes. CONCLUSIONS: SR change predicted good drinking outcomes in alcoholics, even when controlling for AA involvement. SR variables, broadly defined, deserve attention in fostering change even among those who do not affiliate with AA or religious institutions. Last, future research should include SR variables, particularly various types of forgiveness, given the strong effects found for forgiveness of self.

Forgiveness, depression, and suicidal behavior among a diverse sample of college students.

Depression and suicide are significant public health concerns for college-age young adults. Meaning-based characteristics, such as forgiveness, a voluntary coping process involving offering, feeling, or seeking a change from negative to positive cognitions, behaviors, and affect toward a transgressor, may buffer such poor mental health outcomes. Utilizing mediation analyses, we examined cross-sectional associations between forgiveness, depression, and suicidal behavior in a diverse student sample reporting mild to severe depressive symptoms. The effect of self-forgiveness on suicidal behavior was fully mediated by depression; self-forgiveness was associated with depression and, in turn, with suicidal behavior. Forgiveness of others was directly associated with suicidal behavior. Prospective research is needed, yet self and other-forgiveness may be appropriate targets for promotion in suicide prevention efforts.

Mental health, not social support, mediates the forgiveness-alcohol outcome relationship.

Religiousness and spirituality are important to most Americans, and evidence suggests that they may contribute to both addiction and recovery. Forgiveness is a specific dimension of religiousness and spirituality that may enhance recovery, but the mechanism(s) through which it operates is unknown. We hypothesized that higher levels of forgiveness would be associated with higher levels of mental health and social support, which, in turn, would be associated with improved alcohol-related outcomes. Baseline and 6-month longitudinal data from a sample of 149 individuals with alcohol use disorders seeking outpatient substance abuse treatment were analyzed through multiple-mediation statistical techniques. While previous research has shown direct associations among forgiveness, alcohol-related outcomes, mental health, and social support, this study found that the direct associations between forgiveness and alcohol-related outcomes were no longer significant when mental health and social support were analyzed as mediator variables. At baseline, for each alcohol-related outcome measured (alcohol-related problems, percent heavy drinking days, percent days abstinent, and drinks per drinking day), mental health individually played a role in the relationship with both forgiveness of self and forgiveness of others, fully mediating or operating through an indirect-only pathway. For alcohol-related problems only, mental health fully mediated the relationship with forgiveness of self at follow-up and operated through an indirect-only pathway with forgiveness of others longitudinally. Social support and feeling forgiven by God were nonsignificant variables at baseline, follow-up, and longitudinally.

Forgiveness, health, and problematic drinking among college students in southern Appalachia.

Evidence is growing regarding the salutary relationships between spirituality and health, including alcohol problems, yet little is known about spirituality and health in the context thereof. Cross-sectional associations between forgiveness and health were examined among college student problematic drinkers (n = 126; ♀ = 60%; M (age) = 22) in Southern Appalachia. Controlling for demographic variables (including religiosity), dimensions of forgiveness accounted for 7-33 percent of the variance in the health-related variables in a salutary fashion. Forgiveness of Self appears to be the most important dimension of forgiveness measured, yet the most difficult to develop.

Forgiveness and health-related outcomes among people with spinal cord injury.

PURPOSE: As motor vehicle accidents and violence cause the majority of spinal cord injuries (SCI) sustained in the USA and people with SCI will likely struggle with emotional issues related to the offender, the purpose of this exploratory study was to examine potential salutary effects of forgiveness among people with SCI incurred traumatically. Specifically, we hypothesized that forgiveness would have positive associations with health-related outcomes. METHOD: A community-based sample of 140 adults (19-82 years of age) with SCI completed a self-report survey regarding dispositional forgiveness of self and others, health behavior, health status, and life satisfaction. Hierarchical multiple regression analyses were employed to examine the relationships in question. RESULTS: After controlling for demographic variables, forgiveness of self was significantly associated with health behavior and life satisfaction (uniquely accounting for 7% and 13% of the variance, respectively) and forgiveness of others was significantly associated with health status (uniquely accounting for 9% of the variance). CONCLUSION: Results suggest that forgiveness may play a role in the health and life satisfaction of people with traumatic SCI, with the benefit depending on the type of forgiveness offered.

Six-month changes in spirituality, religiousness, and heavy drinking in a treatment-seeking sample.

OBJECTIVE: This descriptive and exploratory study investigated change in alcoholics' spirituality and/or religiousness (S/R) from treatment entry to 6 months later and whether those changes were associated with drinking outcomes. METHOD: Longitudinal survey data were collected from 123 outpatients with alcohol use disorders (66% male; mean age = 39; 83% white) on 10 measures of S/R, covering behaviors, beliefs, and experiences, including the Daily Spiritual Experiences and Purpose in Life scales. Drinking behaviors were assessed with the Timeline Followback interview. Alcoholics Anonymous (AA) participation and attendance were also measured. RESULTS: Over 6 months, there were statistically significant increases in half of the S/R measures, specifically the Daily Spiritual Experiences scale, the Purpose in Life scale, S/R practices scale, Forgiveness scale, and the Positive Religious Coping scale. There were also clinically and statistically significant decreases in alcohol use. Multiple logistic regression analyses showed that increases in Daily Spiritual Experiences and in Purpose in Life scores were associated with increased odds of no heavy drinking at 6 months, even after controlling for AA involvement and gender. CONCLUSIONS: In the first 6 months of recovery, many dimensions of S/R increased, particularly those associated with behaviors and experiences. Values, beliefs, self-assessed religiousness, perceptions of God, and the use of negative religious coping did not change. Increases in day-to-day experiences of spirituality and sense of purpose/meaning in life were associated with absence of heavy drinking at 6 months, regardless of gender and AA involvement. The results of this descriptive study support the perspective of many clinicians and recovering individuals that changes in alcoholics' S/R occur in recovery and that such changes are important to sobriety.

Forgiveness and alcohol problems among people entering substance abuse treatment.

Forgiveness is argued to be highly relevant to problematic substance use, yet supportive empirical evidence is lacking. Findings are presented from a longitudinal study exploring the relationship between religiousness and spirituality (RS) variables and alcohol use disorders. We examined forgiveness of self (ForSelf), of others (ForOthers), and by God (ByGod), hypothesizing positive relationships with RS and negative relationships with alcohol use and consequences, at both baseline (N = 157) and six-month follow-up (N = 126). ForSelf scores were significantly lower than ForOthers and ByGod scores, and ForOthers scores increased modestly over time. ByGod was most consistently associated with other RS variables. ForSelf and ForOthers were associated with alcohol-related variables at both time points, and baseline ForSelf and ForOthers were associated with fewer drinking consequences at follow-up, but not after controlling for other pertinent variables. ForSelf may be most difficult to achieve and thus most important to recovery, thereby preventing full recovery and fostering relapses.

Gender differences in the relationship between empathy and forgiveness.

Much research has shown that women are more empathic than men. Yet, women and men are equally forgiving. However, it is not clear whether empathy is more important to forgiveness for men or for women. The purpose of the present study was to examine gender differences in levels of empathy and forgiveness and the extent to which the association of empathy and forgiveness differed by gender. Participants were 127 community residents who completed self-report measures of empathy and forgiveness. The present results showed that women were more empathic than men, but no gender difference for forgiveness was apparent. However, the association between empathy and forgiveness did differ by gender. Empathy was associated with forgiveness in men--but not in women.