Forgiveness as a catalyst for psychological, physical, and spiritual resilience in disasters and crises.

Worthington, Everett L., Jr. ; Griffin, Brandon J. ; Toussaint, Loren L. 等

In this conceptual article, we argue that some people are resilient in the face of disasters while others are not. Resilience may necessitate forgiveness--of perpetrators of interpersonal harms (e.g., Rwandan Genocide in 1994); of inadequate responder assistance (e.g., Hurricane Katrina); or in situations where community members perceive themselves as victims of offense by virtue of their group affiliation, although they themselves were not actually harmed (e.g., survivors of school shootings). Victims may experience unforgiveness toward others in human-caused disasters and may deal with unforgiveness toward God in natural disasters. Forgiveness may be an effective response to disaster-related injustices that promotes resilience. We used a meta-analysis of forgiveness interventions and an empirical study of awareness-raising campaigns on college campuses to estimate the effects of forgiveness on public health, public mental health, relationships, and spirituality across society after disasters. We advocate for forgiveness as one of many potential resilient responses. Specifically, forgiveness could potentially transform unforgiveness into a stronger sense of purpose and improved social relations.

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In 2005, Hurricane Katrina killed over 1,800 people and resulted in millions of dollars of damage (Cook, Aten, Moore, Hook, & Davis, 2013). The social and economic fabric of communities along the Gulf coast was disrupted by the pandemonium and confusion that followed. Although many people pulled together to promote recovery, those who were caught up in this tragedy experienced substantial hatred, unforgiveness, and blame. Victims blamed the local governments that should have protected people, the federal government for their tardy and meager responses, and others for the chaos that ensued regardless of whether those people were blameworthy.

These reactions are similar to responses to disasters in non-U.S. locations. For instance, during the Rwandan Genocide in 1994, people were hunted down with machetes, approximately 800,000 people died, and property was damaged or destroyed. The social fabric of Rwanda was also damaged. Longstanding resentments about colonial policies, hierarchies, wrongs, and privilege boiled over, and social mob mentality often was fueled by and yielded a product of hatred and unforgiveness. The Rwandan government was blamed for failing to prevent (and even inciting) the mass murders and genocide. Other governments were blamed for not interceding or not providing enough aid during the recovery period. The same arguments could be made for wars within other nations (e.g., Syria, Afghanistan, Iraq, the former Yugoslavia, and Southeast Asian wars of liberation), for systemic oppression within nations (e.g., the South African apartheid era), or for wars between nations (e.g., World Wars I and II).

Whether disasters are natural and unpredictable or human-made conflicts, the people's experiences and responses are similar: Lives are destroyed, and blame is often assigned to others or oneself for the losses encountered. Forgiveness also might be one of many responses to these massive injustices along with seeking revenge or seeking divine or societal justice. It is not just repair that is needed when disaster occurs. Rather, Aten (2012) suggests:

Disaster is much more than just an "event," such as a tornado striking. A disaster reflects the sum of a community's vulnerabilities, the realities of catastrophe, and possibilities or challenges to resilience. Disasters give us insights into the gestalt of the social systems and needs within a community. Disasters inevitably bring both strengths and weaknesses of a community to the forefront. Acute weakness at a systems level are forced to the surface after a disaster, which can help us begin to better recognize the larger social injustices and systems embedded in our communities that affect spiritual and emotional health. To help strengthen and build capacity for disaster spiritual and emotional recovery is to help strengthen and build capacity for spiritual and emotional wellness. (p. 132)

Redemption must supplement repair. In response to Aten's (2012) call for spiritual and emotional wellness, we argue, as our thesis to the present article, that forgiveness is an important public health consideration in the aftermath of disaster and crisis. We use psychological literature to support our argument. Forgiveness can potentially stimulate spiritual resilience by engaging spiritual resources that increase the ability to cope with stresses produced both during and after disaster or crises, especially in the absence of adequate resources to fully cope. In such cases, resilience--or the proclivity of individuals, communities, and nations to bounce back--is vital. We suggest that interventions designed to promote forgiveness possess versatile applications from personal to international contexts that aid recovery and resilience by resolving emotional and spiritual distress.

The Impact of Disasters and Forgiveness on Physical and Mental Health

The Public Health Burden of Unforgiveness in Disasters

Disasters and crises are often followed by unforgiveness. Disasters and crises are clearly stressful, often characterized by psychological loss, material resource loss (Cook et al., 2013), relational loss, and social loss. All these losses place demands on individuals, families, communities, and nations to recover them (Lazarus, 1999). A typical response to extreme losses is to seek to determine and attribute blame, which can lead many people to resentments, bitterness, hate, depression, and anxiety--the core emotions of unforgiveness (Worthington, 2006). Although determining the root cause of some disasters may help generate solutions, aggressive blame impairs many recovery efforts as people become mired in unforgiveness. Over time the emotions associated with blaming and unforgiveness can lead to physical and mental health problems (Toussaint, Worthington, & Williams, 2015). When disasters occur at the community level, this can lead to a decline in overall community mental and physical health as well as decline in social and spiritual functioning (Aten, O'Grady, Milstein, Boan, & Schruba, 2014).

Disasters, by nature, are appraised as threatening by most, though not by all, who go through them (Bonanno, 2005). Bonanno (2005) has shown that far fewer people actually experience lasting damage from disasters than might be expected, and many return to usual levels of functioning within weeks. Others, though, might experience a slow decline in functioning or an immediate decline that does not remit within protracted periods. Some people seem to be doing well but experience delayed decreases in functioning. Even within those four general categories of responses there are many individual differences in responses. However, almost everyone experiences a sense of threat from disasters. Threat appraisals initiate stress reactions, which involve emotional, cognitive, motivational, behavioral, and social manifestations of disruption and change. While some people succeed in their attempts to reduce these stresses, others do not.

Disasters demand numerous adjustments from most people, and each of these demands for adjustment create stress transients and accompanying negative emotions. Resentments, hostility, anxiety, depression, and unforgiveness are common. Intermittent or chronic unforgiving emotions repeatedly stress a person's body, brain, and entire social network. Such stresses negatively affect the physical, mental, emotional, spiritual, and social health of individuals. The aftermath of a catastrophe creates a public health danger along with the need for a public health cure because many (though not all) individuals are negatively affected by the catastrophe and unforgiveness and stress are often widespread.

Physical health consequences of unforgiveness. Unforgiveness consists of six intertwined emotions: resentment, bitterness, hostility, hatred, anger, and fear (Worthington, 2006). Among these, the most destructive is likely hostility, although it functions in conjunction with the other emotions. Hostility is a trait involving a negative cynical attitude toward others, with a propensity for anger or aggression (Cook & Medley, 1954). The impact of hostility on health is recognized as an independent risk factor for all-cause mortality (e.g., Klabbers, Bosma, van den Akker, Kempen, & van Eijk, 2012). This is especially so when causal mechanisms involve repeated stressors.

Frequent hostility increases the number of times that cortisol secretion floods the bloodstream. Sapolsky (2004) has shown that frequent cortisol transients are related to dysfunction of most physical systems (i.e., gastrointestinal, immune, cardiovascular, respiratory, and reproductive systems, and brain functioning). Besides other effects, cortisol plus stress transients wear on the arterial and other vascular walls, straining the cardiovascular system. Hostility has been found to predict increased risk of cardiovascular disease in initially healthy populations and poorer prognosis in patients who already have the disease (Chida & Steptoe, 2009). Hostility-related acute episodes of anger can trigger myocardial infarction and sudden cardiac death (Mostofsky, Maclure, Tofler, Muller, & Mittleman, 2013). Besides cardiac events, hostility has been implicated in the long-term development of atherosclerosis (Pollitt et al., 2005).

Despite the evidence linking hostility to physical illness, the underlying mechanisms involved are not fully clear. The relationship between hostility and illness is mediated through behavioral pathways, with hostility leading to adverse health behaviors such as poor diet, sedentary lifestyle, smoking, and excessive alcohol consumption (Siegler et al., 2003)--all of which are established risk factors for cardiovascular disease. However, even after adjusting for health behaviors, hostility is still related to cardiovascular disease (Chida & Steptoe, 2009; Klabbers et al., 2012). Thus, direct biological mechanisms might also be involved.

Hostility has been linked to disturbances across many biological systems: autonomic dysfunction (Thomas, Nelesen, & Dimsdale, 2004), peripheral nervous system arousal in response to acute stress involving heightened systolic blood pressure (SBP) and diastolic blood pressure (DBP), inflammation involving interleukin-6 and cortisol (Ranjit et al., 2007), and heightened cardiovascular stress responsivity (for a review, see Chida & Hamer, 2008). In sum, the hostility that is part of unforgiveness can be deadly if it persists.

Severe disasters provide ongoing stressors. Severe disasters, whether single incidents (e.g., a hurricane or terrorist attack) or ongoing circumstances (e.g., wartime or famine), are sources of chronic stress or repeated severe stressors (Cline et al., 2010). The many demands to adjust (i.e., stressors) create an allostatic load on the body and frequent coping demands on the mind (McEwen, 2002).

Disasters can compromise mental health in individuals and widely across communities. Common mental health consequences of disasters are anxiety and depression. Most people experience some level of anxiety during disasters, and for many, the fear and uncertainties can be disabling. When people are anxious, they are unable to activate the executive functioning part of their brains required for improvising a new way forward in the wake of disaster. People who experience a sense of powerlessness and depression struggle to construct action-based narratives that could lift them from their current circumstances. These acute mental health problems can potentiate other more insidious mental health disorders such as post-traumatic stress disorder (PTSD). For instance, former child soldiers in Nepal, who were coerced to harm friends and relatives and to witness other atrocities, reported higher levels of PTSD relative to those who were not recruited by armed groups after the 10-year war between the Communist Party of Nepal and the government (Kohart et al., 2008).

Similarly, Ochu, O'Grady, Aten, and Davis (2015) surveyed 407 survivors (179 male, 227 female) of the Liberian civil war, which took place between 1989 and 2003. More than 1 million people lost their homes and thousands of people lost their lives. Some people killed, maimed, and raped their relatives and friends, while others were forced to witness their family members being beheaded, raped, and defiled. The traumas in Liberia were experienced by individuals, majorities in groups, and communities. Many people reacted by experiencing trauma, though not everyone responded this way. Ochu et al. reported partial correlations of .19 between PTSD symptoms and negative religious coping and of. 13 between PTSD and positive religious coping. These correlations seemed to indicate that post-traumatic stress symptoms were instigating both positive and negative religious coping more strongly than the coping was mitigating or exacerbating PTSD symptoms.

However, forgiveness can help restore individuals and communities. Many meta-analyses and reviews demonstrate that forgiveness is related to mental health improvements (Wade, Hoyt, Kidwell, & Worthington, 2014). This is especially true of intentional interventions. There are no naturalistic observational studies of the effects of a catastrophe on unforgiveness. However, in a cross-sectional study on survivors of the Liberian civil war (Ochu, O'Grady, Aten, & Davis, 2015), positive and negative religious coping were strongly related to post-traumatic growth (PTG) in expected directions. Positive religious coping was positively correlated with PTG at .49 and negative religious coping was negatively related to PTG at -.21. In addition, trait forgivingness mediated the relationship between positive religious coping and PTG and the relationship between direct or indirect war experience and PTG. Thus, positive religious coping only produces PTG if the person is high in forgiveness as a personality trait.

The Impact of Disasters and Forgiveness on Worldviews

Disasters can compromise cosmologies. Cosmologies are overarching worldviews that people construct to make identity, purpose, value, and meaning from life (Ashforth & Vaidyanath, 2002). Disasters are typically huge events that shatter assumptions and disrupt people's cosmologies (Janoff-Bulman, 1992). When disasters occur, people feel out of control (Baum, Fleming, & Davidson, 1983) and may engage in "seeking" or in a search for causal attributions--the latter of which can also lead to a crumbled cosmology, threats to self-esteem, blame, and unforgiveness.

When foundational aspects of a person's or community's cosmology are shattered, the person is usually propelled from a stable dwelling place to seeking (Worthington & Sandage, 2015; Wuthnow, 1998). Seeking involves trying to construct an account that makes sense of the events within one's now disrupted understanding of the world. Many people can take apart their old cosmology and rebuild it by accounting for their trauma experience(s) in a way that promotes psychological health and growth (O'Grady & Orton, in press; O'Grady, Orton, Schreiber-Pan, & Wismick, 2013). However, others get stuck in unproductive narratives. It is natural to blame someone. Thus, some people adopt causal attributions that blame individuals, communities, governments, nature, or even God.

In the wake of disasters, God will inevitably be blamed by some and clung to by others--often the same people of faith (Exline, Park, Smyth, & Carey, 2011). When Christians or other communities of faith are caught up in disasters, these communities of faith can be healing agents. For instance, Wuthnow (2000) showed that Bible study, prayer, and other religious group activities can facilitate the forgiveness process. Of course, the possibility exists that faith communities can also worsen the experience. Greer et al. (2014) found that when people were harmed by other Christians, which was the experience of most Rwandans, then the transgression is doubly hard to forgive.

Disasters can result in narratives that include unforgiveness. Often, shattered worldviews are replaced by ones that, at least for some period of time, include resentment, bitterness, hostility, hatred, anger, and fear--in short, unforgiveness. These threatened worldview-associated emotions may be a byproduct of the search for someone to blame. For example, both sociometer theory (Leary, Tambor, Terdal, & Downs, 1995) and terror management theory (TMT; Pyszczynski, Greenberg, Solomon, Arndt, & Schimel, 2004) support the idea that disasters create threats to self-esteem, which often lead individuals to place blame on others as a way of restoring a positive view of themselves--a widespread desire especially in Western, individualistic countries such as the United States (Heine, Lehman, Markus, & Kitayama, 1999; Sedikides, Gaertner, & Toguchi, 2003). If individuals continue to blame others, such blame may turn into resentment, bitterness, hostility, hatred, anger, and anxiety (i.e., the elements of unforgiveness). Unforgiveness might have one focused target, such as the Federal Emergency Management Agency (FEMA) after Hurricane Katrina in the Gulf in 2005. Unforgiveness can also be directed at inadequate helpers, unsupportive friends or family members, non-responsive government, a capricious God, or cruel fate.

Disasters often provoke grief and rumination over losses. Grieving lost aspects of one's cosmology or of a stable dwelling place is common. Grief typically involves rumination about the lost relationship. Thus, ruminative cognition and negative emotion characterize grief (Toblin et al, 2012). Social rumination occurs as people rehearse the story of what happened and its impact and seek to reframe the meaning of the event through repetitive narratives. Individuals who repeat stories characterized by unforgiveness against people, systems, or God, particularly in the big events of disaster, may program themselves to become bitter, resentful, and unforgiving.

The Impact of Disasters and Forgiveness on Communities

Community Response

Disasters affect some people vicariously. Researchers such as Roberts and Ashley (2008); Norris, Perilla, and Murphy (2001); and Schuster et al. (2001) have shown that people can experience the effects of disasters vicariously. For example, Schuster et al. (2001) found that, after the September 11, 2001 attacks on the United States, over 40% of adults and about one-third of children who were not physically present in New York experienced at least one trauma-related symptom. In these situations, people sometimes appeared to experience unforgiveness indirectly because they belonged to a group that was directly affiliated with the victims of an offense.

For example, on June 17, 2015, the Charleston church shooting occurred when a young white male, motivated by racial prejudice, perpetrated a mass shooting during a meeting at a local, predominantly African American church. Nine members of the church were tragically killed. Within hours, members of the affected church had publicly forgiven the murderer, but throughout society (despite the generous response of the actual victims), this incident of serious injustice became a lightning rod for much unforgiveness. People identified with the family members, fellow church members, and others involved. Although the direct survivors, family members, and close friends felt the wrong and its consequences most intensely, many of those who identified with the victims and families felt rage and unforgiveness. This might aptly be called "third-party (un)forgiveness" (Green, Burnette, & Davis, 2008, p. 407).

Studies conducted by Green, Burnette, and Davis (2008) indicated that unforgiveness extends well beyond the victim-perpetrator dyad. Evidence suggested the occurrence of a third-party forgiveness effect: individuals who are not directly involved in an offense but who affiliate with the victims are less forgiving of perpetrators than the victims are themselves. The greater the extent to which people outside the victim-perpetrator dyad assigned blame to the perpetrator and appraised the perpetrator's intentions as negative, the greater the unforgiveness these third-parties experienced--despite not being directly harmed by the perpetrator.

Similarly, disasters may evoke unforgiveness, even among those who are not directly harmed. Although promoting forgiveness among third-parties in these situations will likely be difficult (because apologies from the perpetrator and benevolent attributions toward the perpetrator are both unlikely), reparation of individual and group well-being via forgiveness is an important component of resiliency in response to disaster. Indeed, when the survivors of the Charleston church shooting offered forgiveness to the accused gunman, a message of hope sounded in media outlets across the U.S., and the event and its public discussion resulted in changed race relations. State legislators were prompted to discuss removal of the confederate flag from state capitol grounds. This heightened attention to symbols associated with racism has continued to result in public rejection of many historic symbols of civil war racism. The discussions of forgiveness that ensued were uplifting, but the discussions about racism and social justice have, in many ways, permanently changed U.S. society (see Kong & Forsyth, 2016; Worthington, Griffin, & Lavelock, 2016).

Disasters have transgenerational repercussions. Wars and conflicts affect not only the adults but also the youth and generations to come. The Sierra Leonean war on March 23,1991, lasted for about 12 years. It resulted in numerous orphaned children, many of whom were recruited as child soldiers. Separated from their families, children were trained to become assassins by guerrillas or government troops and, in some cases, were given drugs. Other children joined rebel armies or fought with the government troops voluntarily to avenge the deaths of their relatives (Skinner, 1999). Female child soldiers were sometimes raped and became young mothers or tried to have unsafe abortions (Williamson, 2006). Consequently, the family structure was often disrupted, and the negative consequences of such disruption reverberated through generations (Skinner, 1999). The lives of adults and children were lost. Children were often ill-equipped to raise their own offspring. Resources were often inadequate to support the survivors of the war (e.g., rehabilitation for children with chopped limbs, access to education, society reintegration; Williamson, 2006). Arguably, these repercussions served as catalysts for unforgiveness towards the government (Opotow, 2016), towards oneself for engaging in heinous crimes (Worthington, 2013), towards others such as the rebel soldiers for abducting children (Bayer, Klasen, & Adam, 2007), and towards God/the Sacred (Exline et al., 2011) for allowing these atrocities to occur in the first place.

People turn to their faith communities for help. Koenig (2006) described the important role that communities of faith can play in helping people prepare for and respond to disasters. People frequently look to their religious communities for a stable theology of suffering. They look to their pastor for guidance and other spiritual leaders for leadership. They look to their communities for comfort and emotional help, for resources, for social support, and for meals, clothing, and finances. Generally, communities of faith are responsive to pleas for help. Kromm and Sturgis (2008) described how religious communities were among the first to help in the aftermath of Hurricane Katrina. In fact, Cain and Barthelemy (2008) found that in Louisiana, residents rated faith communities' efforts to help as more effective than the efforts of non-profits, local government, or state government.

Resilience

Resilience Can Promote Recovery

Resilience is bouncing back from stress and disaster. Bonanno (2005) suggested an empirical typology of four responses to potentially traumatic events. One is sudden decline in personal functioning measured by mental and physical health. Another is gradual decline in mental and often physical health. A third is a delayed reaction in which the person does not respond negatively at first, but slides into mental and physical problems months later. A fourth (i.e., resilience) is a decline in mental and physical functioning at first, but within a week or two, the person recovers to and maintains the pre-event level of functioning.

Some studies suggest that resilience might be a trait. Hu, Zhang, and Wang (2015) conducted a meta-analysis of 60 studies with 111 effect sizes to determine the relationship between trait resilience and mental health and to examine moderating variables between the two. They found that (a) trait resilience was negatively correlated with poorer mental health and positively correlated with positive mental health. They also found that (b) age moderated the relationship between trait resilience and negative indicators. Adults showed a higher correlation compared to children and adolescents. Trait resilience and positive mental health were not moderated by age. Results also showed that (c) gender moderated the relationship between trait resilience and mental health. For males, the correlation was less than for females. Finally, (d) adversity moderated the relationship between trait resilience and mental health. For people actively coping with adversity, trait resilience was more strongly related to mental health than it was for those not actively coping with adversity.

Other studies, however, suggest that resilience manifests as a state or process (O'Grady & Orton, in press). Some people even show post-traumatic growth following a disaster (Park & Ai, 2006). This post-traumatic growth is a return to a higher level of functioning than before the potentially traumatic event. It occurs when two conditions are present. First, the event must be very stressful (e.g., losing a relative to a mass shooting, earthquake). Second, the person must deliberately engage in strategies that promote effective coping. In the case of post-traumatic growth, people have reported a broader view of life, including an increased sense of meaning and purpose (Tedeschi & Calhoun, 2004; Triplett, Tedeschi, Cann, Calhoun, & Reeve, 2012). Other signs of post-traumatic growth include improved social relations, strengthened religious and spiritual beliefs, renewed faith, more positive self-images, new sense of strength, and a transformed way of viewing life (Linley & Joseph, 2004; Tedeschi & Calhoun, 2004).

Forgiveness and Resilience

Although traits of resilience generally help people deal well with traumas (Bonanno, 2005), people who are not resilient by trait might still respond resiliently (Ochu et al., 2015; O'Grady & Orton, in press). Forgiveness is often useful for people under interpersonal and moral stress (Enright & Fitzgibbons, 2014; Strelan & Covic, 2006; Worthington, 2006). In addition to the scholarship that demonstrates the usefulness of forgiving in times of interpersonal stress, we suggest that forgiveness also has the potential to instigate resilience and bolster tendencies toward resilience. After a disaster, resilience occurs through a number of mechanisms, and forgiveness can stimulate the conditions needed to bring about a resilient response.

How Forgiveness Helps Stimulate Resilience

Forgiveness model of resilience. People cope with very few crises and disasters over the course of their lives, whereas they are more likely to come into contact with transgressions and offenses on a daily basis. Strelan and Covic (2006) and Worthington (2006) have independently put forth (similar) stress-and-coping models of forgiveness. In these models, a transgression is a type of stressor that people appraise as more or less threatening and as more or less able to be managed (Lazarus, 1999). Fearful, angry, or depressed emotions are signals of threat and of potential difficulty in coping. Those emotional signals become part of a stress response, which involves physiological, cognitive, emotional, motivational, and behavioral components. The degree of stress response is moderated by personal variables such as hardiness, resilience, and response style. For example, Toussaint, Shields, Dorn, and Slavich (2014) showed that dispositional forgiveness buffered the negative effects of lifetime stress exposure on mental health.

People attempt to modify one or more of the elements of the stress-and-coping process by engaging in coping responses that target (a) the stressor-as seen in problem-focused coping, which seeks to reduce stress by finding solutions to problems (Lazarus, 1999; Worthington, 2006); (b) the appraisals-as seen in meaning-focused coping, which seeks to reduce stress by finding deeper meaning in the experience of the stressor (Park, 2010; Park & Ai, 2006); or (c) the stress responses--as seen in emotion-focused coping, which seeks to reduce stress by managing negative emotions (Lazarus, 1999; Worthington, 2006). The relative frequency of these stress-and-coping processes facilitates the practice of useful coping skills that one might employ in the event of a disaster.

Forgiveness can improve mental health, which can help people bounce back more quickly. Forgiveness often reduces depression, anxiety, anger, rumination, obsession, and stress (Toussaint et al., 2015). It also is associated with increases in hope, which is vital for communities to mobilize in cohesive and growth-promoting ways. By positively affecting mental health and activating hope, people can engage in recombinant innovations that lead to renewed peoples and communities (O'Grady & Orton, in press).

Forgiveness can dislodge people from rumination or change its nature, thus helping them bounce back. Resilience can be encouraged by reducing the depth and duration of automatic rumination. Rumination is instigated as people try to deal with the emotional impact of a large tragedy (Calhoun, Cann, Tedeschi, & McMillan, 2000; Nolen-Hoeksema & Davis, 1999; Tedeschi & Calhoun, 2004; Zoellner & Maercker, 2006). Forgiveness can kick people out of the negativity of unforgiving ruminations (see Berry, Worthington, O'Connor, Parrott, & Wade, 2005). However, forgiveness is unlikely to completely stop rumination, as is frequently illustrated by people grieving losses. Nonetheless, forgiveness shifts the emotional content of ruminative cognitions away from resentful, bitter, hostile, hateful, anxious, and depressed content, which has both mental and physical health benefits (Wade et al., 2014).

Adapting cognitions in order to adapt to disasters may involve a broader range of processes than merely changing (or sometimes not changing) cognitive patterns. Consistent with cognitive adaption theory of disasters, (Karanci & Ekram, 2007), survivors construct a meaning-making narrative for a disaster. That narrative can involve recasting offensive events, or rethinking God's role in events, or forgiving an active shooter who killed or injured the victim or a loved one. The narrative can be the kernel of forgiveness from which a plant of forgiveness eventually grows and thrives. Reconstructing forgiving relationships provides a sense of enhanced meaning that might be explicit and consciously constructed in relationship with others, or it might be implicit, not verbalized, and not consciously understood. Successful meaning-making may increase the likelihood of experiencing resilience or stress-related growth.

Forgiveness and religion are generally focused on others, which reduces self-focus and permits resilience. A distinction between religion and spirituality is often made and is important in many nonreligious communities. Religion is a set of beliefs, values, and practices related to an organized body of people. Spirituality, on the other hand, is one's personal sense of closeness to the Sacred (Worthington & Sandage, 2015) and can be centered on one's relationship with the Divine, unlike religion, which is practiced in a community of like-believers. Thus, by nature, religion is other-oriented. It prizes other believers, and it turns one's attention outward to ministry beyond the in-group of like-minded religious people. It also is more community-embedded (see next section) than is spirituality. Forgiveness is often related to people's religion. It is experienced internally as a decision or changed emotion (Exline, Worthington, Hill, & McCullough, 2003), just as religion is also experienced internally as beliefs, values, and practices. Like religion, forgiveness is also a social practice: It happens in a social context when an offender hurts the potential forgiver. Actions are taken around the transgression, such as reproaches by the victim (Schonbach, 1990), accounts, apologies, requests for forgiveness (by the offender), and expressions that one has forgiven (by the forgiver).

Forgiveness can also play a part in religious communities. Social engagement has been shown to reduce rumination. Forgiveness can reduce rumination by activating social networks either through involvement in a religious community or through the social interactions involved in forgiving and reconciling (Worthington, 2003). Religious communities can provide a context and moral guidelines for forgiveness. When a religious community values forgiveness, they are likely to encourage it in their religious groups and congregational meetings, which can also promote further discussion about it within the families and dyads that compose the community. Because religion is centered in a community of believers who share generally similar beliefs, values, and practices, these communities can corporately employ similar religious coping methods and religious practices to reduce stress and rumination. For example, communities might engage in unified communal prayer or organize and host programming for physical and stress relief efforts. Communities might also be a source of social support because of their ability to provide a sense of common suffering, common meaning, and shared presence in suffering.

Resilience may also prompt forgiveness. There might be a reciprocal influence between resilience and forgiveness. People who are more resilient might bounce back from their unforgiving moods and ruminative recriminations more easily because their resilient personality is more agreeable and less high in neuroticism, which facilitates forgiveness (Griffin, Worthington, Wade, Hoyt, & Davis, 2015; Ochu et al., 2015).

Societal Promotion of Forgiveness to Build Resilience

Resilience fosters forgiveness of whatever target the victim blames--others, nature, systems, bystanders, or God. Resilient people are not dealing repeatedly with what happened in the past because they have, in many ways, moved beyond the tragedy and are focused on coping with it. Thus, they are less likely to ruminate than people who are still mired in lower psychological functioning. The decreased rumination contributes to greater and quicker forgiveness. Alternatively, less resilient people who are able to forgive quickly can build their resilience and reduce their propensity for negative physical, mental, relational, and spiritual health problems resulting from disaster. People who are forgiving are engaged in less rumination, and can thus move more toward resilience than unforgiving people can.

Promoting Forgiveness Through Publicly Available Forgiveness Interventions is Cost-Effective and Useful

In the current section, we have drawn upon (a) accumulated research on unforgiveness and its sequelae, (b) interventions to promote forgiveness (for a meta-analysis, see Wade et al., 2014), and (c) some educated guesses to describe the potential impact of societal interventions to promote forgiveness and prevent trauma in the wake of disasters. We have attempted to make reasoned estimates of how much physical, mental, relational, and spiritual impact is made when people forgive.

A meta-analysis of intervention research showed that forgiveness interventions result in less depression, less anxiety, and more hope--precisely the features needed to make a resilient recovery from a disaster or crisis (see Wade et al., 2014). Therefore, our public health analysis suggests forgiveness can be promoted both by large community-based campaigns to raise awareness about forgiveness and by small-group and individual remote (workbook-based) interventions to promote more in-depth forgiveness than might be available through merely raising the awareness of forgiveness in a culture. Although we are admittedly speculative, we have estimated the effects of each forgiveness intervention within a society.

Even in conflict and warfare, forgiveness interventions can be promoted by what peacemakers call Track I Diplomacy and Track II Diplomacy (Botcharova, 2001; Montville, 1990). Track I Diplomacy reduces conflict through public edicts by leaders who declare truces or promote processes that reduce or end armed or active conflict. Track II Diplomacy brings thought leaders together from conflicting communities so they can tell and hear each other's stories. Generally, after hearing stories from leaders of the opposing side, empathy is generated and some spontaneous forgiveness and motivation to reconcile might occur. Thus, the thought leaders return to their in-groups, motivated to spread a more reconciliative attitude.

Worthington and Aten (2010) added a third type of peacemaking to promote more resilient responses to conflict and war--Track III Diplomacy. In Track III Diplomacy, thought leaders either lead or persuade other leaders in their in-group to lead forgiveness groups. These groups help people within each ingroup to experience forgiveness toward the members of the out-group. The group structure of like-minded individuals helps people share their doubts openly, wrestle with common experiences, and consider forgiveness without experiencing either resistance from the presence of out-group members or public pressure to conform by saying, "I forgive them," especially when inconsistent with their feelings. To this suggestion, posed by Worthington and Aten in 2010, we now add that other ways of promoting forgiveness within the in-group are available and have been, or are being, studied to adduce evidence of the degree to which they might engender forgiveness.

We argue that promoting forgiveness through publicly available forgiveness interventions is cost-effective and useful. It promotes resilience by "unsticking" people from unforgiveness and by easing spiritual struggle. It might also promote, draw upon, or engage existing humility, which is in line with Christian virtue. In addition, forgiveness fosters other-orientedness, which may also promote patience, self-control, positive mood, and gratitude.

Forgiveness Interventions Cultivate Forgiveness--Results from a Meta-Analysis

In a recent meta-analysis of investigations of forgiveness interventions in which participants were randomly assigned to a forgiveness intervention or to some control condition (i.e., waiting list, no-treatment control, or alternative treatment), Wade, Hoyt, Kidwell, and Worthington (2014) located 62 intervention studies. Of these studies, 53 were randomized controlled trials (RCTs). These studies were analyzed in Wade et al., and the remaining non-randomized studies were excluded. Within the RCTs, there were 21 studies of Enright's process intervention (Enright & Fitzgibbons, 2014), 18 studies of Worthington's (2006) REACH Forgiveness model, and 14 studies of all other interventions combined.

The most important findings from the meta-analysis are threefold. First, forgiveness interventions were better at producing forgiveness than either no treatment or alternative interventions (e.g., mindfulness or relaxation). Second, no forgiveness intervention was superior to any other intervention when time was considered. The most difficult problems required more time. The process model (Enright & Fitzgibbons, 2014) equaled the REACH Forgiveness model (Worthington, 2006) in effect size, which in turn corresponded with other forgiveness interventions in the amount of change in forgiveness that people experienced per hour of treatment. Thus, there was a strong dose-response relationship of about 0.1 standard deviation of change per hour of treatment. Third, even though most forgiveness interventions did not explicitly address mental health issues such as depression or anxiety, depression and anxiety were decreased in people completing forgiveness interventions. The effect size was about half as large as the effect size for forgiveness.

To understand the implications of this, we have noted that a 6-hour forgiveness group (regardless of whose program was used) would promote about 0.6 standard deviations of change in forgiveness, about 0.3 standard deviations of change in both depression and anxiety, and about 0.6 standard deviations of increase in hope. To provide perspective, meta-analyses of cognitive-behavioral therapy (CBT) for depression demonstrate that targeted CBT tends to produce approximately 1.0 standard deviation of reduction in either depression or anxiety after an average of 20 to 26 hours of treatment. To reiterate, a brief psychoeducational forgiveness intervention that does not mention depression or anxiety, produced (on average) one-third of all gains that took CBT 20 to 26 sessions to produce. We might suspect, then, that forgiveness psychoeducation--in addition to being useful in Christian congregations; in psychotherapy group practices as an adjunct to individual psychotherapy, couples therapy, or family therapy; or in organizations as wellness interventions of Employee Assistance Programs' (EAP) interventions--can possibly be useful after traumas. Forgiveness interventions can be implemented in conjunction with other treatments for trauma (including complex trauma), with restoration of resources or informational programs to deal with losses of resources, or with extended psychotherapy. These interventions, though, might also be a treatment of focus, as we might imagine would have been useful in Rwanda after the hatred and rawness of the mass killing had died down and have been shown to be useful in the aftermath of the Liberian civil war (see Ochu et al., 2015).

Campus-Wide, Awareness-Raising Forgiveness Interventions Cultivate Forgiveness

In one research effort, Griffin et al., 2016) tried to change a Christian college community so that its people were more forgiving. They engaged the student, faculty, and student affairs leaders to devote 2 weeks of intensive effort to increase students, faculty, and university staff awareness of forgiveness. In some cases, this involved initial assessments of people's current status regarding their own forgiveness; programs encouraging forgiveness-related book-reading; forgiveness-related essay contests and awards; chapel presentations and other public speeches on forgiveness; newspaper articles recounting episodes of heroic forgiveness; displays encouraging forgiveness placed in dining halls and public areas; and presentations to fraternities, sororities, and other campus organizations about how to forgive. Psychoeducational assistance was also made available through assigned reading of material on forgiveness and through training residence hall Resident Assistants (RAs), graduate students, and other people within the university to run REACH Forgiveness groups. Finally, assessments were again conducted, inquiring about forgiveness at the end of the 2 weeks of saturating the campus in awareness-raising opportunities. Over 600 people completed surveys regarding forgiveness. Merely completing surveys, of course, was at least one exposure and invitation to students to reflect both on their forgiveness of individuals whom they held a grudge against and on their assessment of themselves as a forgiving person. In a generalization of Griffin et al. (2015) to seven other Christian colleges, Worthington, Kulick, and Griffin (2014) have reported that the amount of involvement, buy-in, and creativity in awareness-raising interventions that was available differed across universities. Some universities reported little change in forgiveness attitudes and forgiveness skills across participants while others reported substantial changes.

Griffin et al. (2016) reported several findings. First, the mean dose of exposure to forgiveness stimuli was 2.5 hours per community member. Although we had students check boxes to name the events and stimuli they saw, we were unable to assess the depth of engagement of each student with each event or stimulus. Thus, a dose of 2.5 hours, is not synonymous with a 2.5-hour forgiveness psychoeducational group in which attention of the person is focused. Griffin et al.'s assessment of the amount of forgiveness experienced by each person revealed a dose-response relationship of 0.02 standard deviations of change per hour of experience which equates to 0.05 standard deviations of change, on the average, across the university for the 2-week forgiveness blitz. Averages mask individual responses; that is, in this particular case, many students experienced little exposure and changed little, but a few students sought out a lot of exposure and changed their forgiveness greatly. Some of the participants who participated in the REACH Forgiveness groups during the forgiveness blitz achieved similar levels of change to other students who experienced REACH Forgiveness groups with campus awareness-raising campaigns at other universities (e.g., Lampton, Oliver, Worthington, & Berry, 2006; Stratton, Dean, Nooneman, Bode, & Worthington, 2008). For example, at John Brown University, Lampton et al. (2006) reported that the people in the REACH Forgiveness treatment groups had mean changes of -0.25 on revenge, -0.80 on avoidance, and +0.98 on positive response to the offender relative to people in the awareness-raising only condition, which reported mean changes of -0.32 on revenge, -0.13 on avoidance, and +0.77 on positive response to the offender. Notably, while the treatment groups definitely (and statistically) helped, the changes associated with awareness-raising were substantial.

Forgiveness Interventions Cultivate Forgiveness in the Wake of Disasters

Two other efforts to use forgiveness education to promote resilience in the wake of human-made disaster are worth briefly mentioning. First, Toussaint, Peddle, Cheadle, Sellu, and Luskin (2009) used a psychoeducational approach to teach forgiveness to Sierra Leonean survivors of civil war. Schoolteachers in Freetown, the capital city, met for almost 8 hours over 4 days to learn about forgiveness. Meetings were didactic, experiential and centered on common themes in forgiveness education including: (a) remembering the offense, (b) empathy, (c) relaxation, (d) altruism, and (e) commitment to becoming a forgiving person. Results of this work showed that individuals experienced decreased stress, negative affect, depression, and avoidance of offenders and increased benevolence, gratitude, and satisfaction with life. Second, Staub, Pearlman, Gubin, and Hagengimana (2005) developed and deployed a 9-day psychoeducation and experiential training program for Rwandan genocide survivors. The program was broadly focused on healing, reconciliation, and forgiveness. The psychoeducation dealt with (a) effects of trauma, (b) paths to healing, and (c) basic psychological needs. This program was successful in reducing trauma symptoms and creating more positive attitudes toward others. Given the severity and recency of the war-crimes, brutality, and savage killings in both Rwanda and Sierra Leone, these findings hold hope for the contribution of forgiveness to resilience-building following disasters even though disasters typically do not have perpetrators who are readily identifiable (cf. acts of terrorism).

Conclusion

In this conceptual paper, we have argued that unforgiveness is a byproduct of disaster--due to nature or human nature. People who experience natural and human-made disasters can harbor chronic unforgiving emotions toward God and toward other people, which have the potential to become a public health concern. Although many methods exist by which victims of disaster may alleviate their distress (e.g., seeking divine or societal justice, revenge, etc.), forgiveness is recommended as a resilient response and as a response that we hypothesized could promote more resilience. That is, individuals and communities who forgive in the aftermath of experiencing disaster transform unforgiveness into a stronger sense of purpose and improved social relations. We estimated the effect size of community-wide forgiveness-promoting efforts and noted that a mean effect size might be on the order of 0.05 standard deviations but also changes in depression, anxiety, and hope. Given these averages and the knowledge that typically community change is distributed normally, we suggest that awareness-raising and provision of psychoeducational forgiveness interventions could substantially affect physical and mental health across a community. Thus, we suggest that forgiveness interventions can be public health interventions with the potential to change many, but not all, people in a disaster-affected community.

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Everett L. Worthington, Jr., Brandon J. Griffin

Virginia Commonwealth University

Loren L. Toussaint

Luther College

Camilla W. Nonterah, Shawn O. Utsey, and Rachel C. Garthe

Virginia Commonwealth University

Author Note: We want to express our gratitude to the Templeton World Charity Foundation (TWCF0101/AB66, Can Forgiveness Be Strengthened in West and South Africa?) for funding that made the current project possible. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Templeton World Charity Foundation. Additionally, this research also depended on a grant from the Fetzer Institute (#2512.04, Forgiveness in Christian Colleges), for which we are grateful.

Correspondence concerning this article should be addressed to Everett L. Worthington, Jr., Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA 23284. Email: eworth@vcu.edu

WORTHINGTON JR., EVERETT L. PhD. Address: Virginia Commonwealth University, 806 West Franklin Street, P.O. Box 842018, Richmond, VA 23284. Title-. Professor of Psychology. Degrees: PhD (Counseling Psychology) University of Missouri-Columbia. Specializations-, forgiveness, humility, religious/spiritual interventions, Hope-Focused Couple Approach.

GRIFFIN, BRANDON J. MS. Address: Virginia Commonwealth University, Department of Psychology, 806 West Franklin Street, Richmond, VA 23284. Title: Doctoral candidate (Counseling Psychology) Virginia Commonwealth University. Degrees: MS (Counseling Psychology) Virginia Commonwealth University.

TOUSSAINT, LOREN L. PhD. Address: 700 College Drive, Department of Psychology, Luther College, Decorah, IA 52101. Title: Associate Professor. Degrees: PhD (Health Psychology) University of Wisconsin-Milwaukee. Specializations: forgiveness, religion/ spirituality.

NONTERAH, CAMILLA W. MA. Address: 806 West Franklin Street, Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284. Title: Doctoral candidate (Counseling Psychology) Virginia Commonwealth University. Degrees: MA (Psychology) Central Connecticut State University.

UTSEY, SHAWN O. PhD. Address: 806 West Franklin Street, Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284. Title: Professor of Psychology. Degrees: PhD (Fordham University). Specializations: Psychology of the African-American experience.

GARTHE, RACHEL. C. MS. Address: Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA 23284. Title: Doctoral candidate (Counseling Psychology) Virginia Commonwealth University. Degrees: MS (Developmental Psychology) Virginia Commonwealth University.