As promised, more information about our forgiveness study.

[rivka]

Background:
Our research on forgiveness in people with HIV stems from our clinical experience. Again and again, people told us stories about their emotional struggles with HIV that centered around themes of anger, guilt, shame, and forgiveness. Forgiveness seems to be particularly important in HIV because there's still such intense shame and stigma associated with HIV infection, and because HIV infection usually occurs within the context of social relationships.

A quick definitional moment: Forgiveness is deliberately letting go of negative emotions (such as anger or the desire for vengeance) towards an offender and replacing them with positive emotions (such as wishing the offender well or recognizing that the offender has worth as a human being). Forgiveness doesn't have anything to do with what the offender "deserves" - it's a process that's internal to the forgiver. Forgiveness is not excusing or rationalizing the offense, forgoing justice, or reconciling with the offender. (Reconciliation may or may not accompany forgiveness. Often it's a bad idea.)

So, anyway: we started to wonder whether forgiveness (and lack thereof) affects emotional and physical health in people with HIV. The positive emotional health benefits of forgiveness have been well-documented in other studies with other populations, but we thought it might have specific physical effects as well, either because

(a) lack of forgiveness causes stress, and stress has a negative effect on the immune system (these are both well-established research findings, although a direct link between forgiveness and immune function hasn't yet been demonstrated),

or (b) forgiveness and lack of forgiveness may influence health behaviors. (For example, a person who feels guilty and unforgivable because of things they've done wrong may not take their medicines because they don't feel they deserve to live, or may abuse drugs and alcohol in an attempt to mask negative feelings.)

Method:
We studied 131 adults with HIV - 91% of them African-American, 45% of them female, with an average age of 42. They'd had HIV, on average, for 8.6 years. About one-third of them had less than a high school education, one-third had a high school diploma or GED, and one-third had more than a high school education - usually a year or two of community college, although a few had a four-year college degree. They were overwhelmingly Christian or Black Muslim, with only a very few expressing no belief in God. (No, I didn't define "belief in God." Do you think I'm crazy?)

The participants completed a comprehensive interview about their mental health, living situation, life stress, understanding of HIV, health behaviors (e.g., medication adherence, smoking, drug use), and transmission risk behaviors (e.g., unprotected sex, needle sharing). They also completed some paper-and-pencil questionnaires about their spiritual beliefs, involvement in organized religion, mood, quality of life, and coping style.

We looked at forgiveness and lack of forgiveness across four life contexts: spiritual (do they feel that HIV is God's punishment for their sins? do they blame God because they have HIV?), self (have they forgiven themselves for becoming infected?), interpersonal (have they forgiven the person who infected them? do they feel that important people in their lives blame them or reject them?), and medical (can they forgive their doctor for not having a cure?). We wrote stories about people either forgiving or not forgiving in each of these contexts, with the material in the stories taken from patient accounts. Then we asked participants to rate how similar they were to the main character in each story, on a scale of 1 to 10. So we wound up with twelve scores with names like "forgiving self" and "unforgiven by others."

(We're collecting the data at three time points, but I'm only going to talk about Time One here because that's the only point that's fully analyzed. We also went at Time Three on to collect physiological data about how participants' bodies respond to a mildly emotionally stressful task, as well as blood samples to study their immune response, but we haven't finished collecting that data yet so I'm not going to talk about it here.)

Results:
Forgiveness-in-general, across contexts, is strongly associated with fewer symptoms of depression, fewer life stressors, life stressors which are less severe, higher quality of life, and higher feelings of satisfaction with one's health. It's also associated with greater involvement in organized religion and a greater likelihood of private religious acts such as prayer. These results are interesting, but not particularly exciting to me.

Here's what I really find exciting: people who felt forgiving towards the person who infected them with HIV were less likely to report having unprotected sex with others. So forgiveness was associated, not just with benefits for the forgiving individual and the forgiven person, but benefits for other people not related to the initial transgression.

Also, people who forgave their doctors for being unable to cure them missed fewer doses of their medicine, whereas people who felt unforgiven and rejected by their parterns and families missed more doses of their medicine. Our hypothesis is that people who feel unforgiven may not feel they "deserve" to live, or may not want to burden their rejecting families with their continued survival.

Still to come: we're continuing to collect and analyze data on whether forgiveness is related to HIV patients' physical health. We're also hoping to identify mechanisms by which forgiveness might have positive effects on the mind and body - for example, by looking at whether forgiving and unforgiving people have different responses to stress.

So that's what I talked about at the conference, and on teevee. Any questions?

Comments

[kalmn.livejournal.com]

no questions. amazement at your total coolness, yes, but no questions.

[aloha-moira.livejournal.com]

Very neat study! The stress responses are particularly interesting. Just a question about the time points - how far apart are they from the initial time point?

[rivka.livejournal.com]

Supposedly, 6 months and 12 months post Time One. Realistically, 6-11 months and 12-18 months post Time One.

[elisem.livejournal.com]

Very, very interesting. And I'll definitely want to know what you find out about this bit:

We're also hoping to identify mechanisms by which forgiveness might have positive effects on the mind and body - for example, by looking at whether forgiving and unforgiving people have different responses to stress.

[ranunculus.livejournal.com]

What you are doing is very, very interesting. The way I understand the study, in "Time One" the participants have already forgiven and become more accepting of their status. It seems to me that a study begun at the time of diagnosis, would be very valuable. That way you can evaluate whether there is a change in behavour pre and post forgiveness.

Keep us posted!

- R - Who is off to see Dr Dean speak today. I'm excited!

[rivka.livejournal.com]

The way I understand the study, in "Time One" the participants have already forgiven and become more accepting of their status.

Some of them have, and some of them really haven't. We had people ranging all up and down the forgiveness scale.

- Who is off to see Dr Dean speak today. I'm excited!

Yay!

[ailbhe]

Interesting. I'm not surprised that people who are aware of their own spiritual life (I use this phrase because it includes people like me, who don't exactly pray or worship in commonly-understood ways) forgive more easily than people who don't - that was how I understood what you said? - because IME people like that tend to feel less, er, alone in the universe than people who have no sense of spirituality, even if the latter have not exactly decided on atheism. S'il n'existait pas le Dieu il faut necessaire de l'inventer, or however it's spelled.

I also think that negative emotions make stress harder to handle generally, and that stress makes physical incapacity harder to handle generally, so I'll be interested in that bit later.

I'll read this again when I'm not also trying to work out what to cook for dinner. But I wanted to ack that I'd seen it, since I was one of the first to ask you to put it up here :)

[ororo.livejournal.com]

Fascinating, thanks for sharing. :)

[tendyl.livejournal.com]

Forgiveness-in-general, across contexts, is strongly associated with fewer symptoms of depression, fewer life stressors, life stressors which are less severe, higher quality of life, and higher feelings of satisfaction with one's health.

I find this very interesting...hell, the whole thing is intreging.

[sashajwolf.livejournal.com]

Very cool.

[mittelbar.livejournal.com]

Although it goes without saying, it's better to say it: nift!

[elusis.livejournal.com]

people who felt unforgiven and rejected by their parterns and families missed more doses of their medicine.

That's the bit I'm really exicted about. At one point I was thinking of changing my dissertation to a study of whether the quality of relationships with partners/family affected medication compliance in HIV+ patients.