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Journal of Behavioral Medicine, Vol. 26, No. 5, October 2003 (°

C 2003)

A Change of Heart: Cardiovascular Correlates of

Forgiveness in Response to Interpersonal Conflict
Kathleen A. Lawler,1,2 Jarred W. Younger,1 Rachel L. Piferi,1
Eric Billington,1 Rebecca Jobe,1 Kim Edmondson,1 and Warren H. Jones1
Accepted for publication: February 10, 2003

This study sought to examine the psychophysiological correlates of forgive-

ness in response to interpersonal conflict. One hundred eight college students
(44 males and 64 females) participated in two interviews about times of inter-
personal betrayal, one about a parent and one about a friend/partner. Measures
of forgiving personality and state forgiveness were collected, as well as stress,
hostility, empathy, and self-reported illness symptoms. During baseline, inter-
views and recovery periods, repeated measures were taken of blood pressure,
heart rate, frontalis EMG, and skin conductance. Trait forgiveness was asso-
ciated with lower levels of blood pressure. State forgiveness was associated
with lower blood pressure levels, heart rate, and rate pressure product. Acute,
stress-induced reactivity was also linked to forgiveness: state forgiveness was
associated with diastolic and mean arterial pressure and rate pressure product
reactivity during the parent interview. Increased blood pressure recovery after
stress was also linked to trait forgiveness. Forgiveness may produce benefi-
cial effects directly by reducing allostatic load associated with betrayal and
conflict, and indirectly through reductions in perceived stress.
KEY WORDS: forgiveness; blood pressure; health; stress.

INTRODUCTION

A variety of emotional experiences, such as hostility and anger, have

been linked to ill health and cardiovascular disease through increased sym-
pathetic nervous system reactivity to stress. Interventions to improve health
1Department of Psychology, University of Tennessee, Knoxville, Tennessee 37996-0900.
2To whom correspondence should be addressed; e-mail: klawler@utk.edu.

373

0160-7715/03/1000-0373/0 °
C 2003 Plenum Publishing Corporation
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374 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

have focused on reducing these emotions, either directly through cognitive-

behavioral therapy or indirectly through exercise and meditation. However,
there is not a clear, linear relationship between reductions in anger and either
cardiovascular reactivity to stress or cardiovascular health. Hypertension has
been linked to suppressed hostility and low levels of anger expression may
lead to rumination and resentment.
When faced with interpersonal conflict, or social stress, individuals cope
in a variety of ways. One may retaliate directly, such as taking revenge, or
one may avoid the situation or offender. However, both the expression and
the suppression of aggression may be associated with negative health conse-
quences (Johnson and Spielberger, 1992; Julius et al., 1985). A third alterna-
tive is forgiveness (Enright, 2001); one may choose to forgive the offender for
his or her transgression. Forgiveness either avoids the experience of anger
altogether, or may provide a means for ending enduring thoughts of revenge
and ruminative thoughts of the stressful experience.
There is an extensive philosophical literature on forgiveness; however,
only in the past decade or so has this topic received significant empirical
investigation as a therapeutic approach to adjustment problems (Koenig,
1994). Enright (Enright et al., 1989; Enright and the Human Development
Study Group, 1991) began the programmatic investigation into the psycho-
logical consequences of forgiveness, followed by extensive development of
the concept by Worthington and McCullough (McCullough et al., 1998; e.g.,
McCullough and Worthington, 1995). Clinical studies have examined the
role forgiveness plays in reducing feelings of anxiety, depression and hos-
tility (e.g., Al-Mabuk et al., 1995; Enright and Fitzgibbons, 2000). Williams
and Williams (1994) have incorporated forgiveness as one feature in their
prescription for improving cardiovascular health, and forgiveness has been
embedded in multimodal intervention programs for both heart disease and
cancer (Friedman et al., 1986; Kaplan, 1992).
The direct examination of the association of forgiveness with physical
health, and the study of potential mechanisms whereby it may convey any
benefits, is in its infancy. No controlled studies have demonstrated that for-
giveness affects physical health outcomes (Thoresen et al., 2000), and even
correlational studies examining levels of forgiveness and health are scarce
(Berry and Worthington, 2001; Seybold et al., 2001). Furthermore, few stud-
ies have examined the physiological correlates of forgiveness, from which we
may be able to develop models underlying any discernible effects of forgive-
ness. Huang and Enright (2000) reported the first investigation of forgiveness
including a physiological measure, blood pressure. Based on their develop-
mental model of stages of forgiveness, Chinese participants citing forgiveness
as a duty (level 4) were compared to those citing forgiveness as love (level 6).
The individuals with less mature reasoning underlying forgiveness exhibited
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 375

more masking smiles, more gaze aversion, and greater increases in blood
pressure while they described the betrayal incident. This study compared
levels of forgiveness, rather than a dimension from no forgiveness to com-
plete forgiveness, but still suggests that variations in forgiveness may have
physiological concomitants.
Witvliet et al. (2001) reported the first experimental investigation of
the physiological correlates of forgiveness. Participants recalled an experi-
enced betrayal event, and then imagined reacting to the event in forgiving
and grudge-holding ways, compared to baseline. Forgiveness imagery was
related to smaller corrugator EMG, skin conductance, heart rate, and mean
arterial pressure increases from baseline than images of grudge holding or
rumination. The connection between imagery of forgiveness and magnitude
of physiological reaction was not related to actual forgiveness, severity of
the recalled offense, or achievement of reconciliation; however, it clearly
demonstrates an association between forgiving imagery and lowered physi-
ological reactivity compared to nonforgiving imagery.
This investigation sought to examine current levels of forgiveness, as
an individual recalled an interpersonal conflict, and concomitant physio-
logical reactivity. Philosophical writing about forgiveness has defined it as
an opposite construct to resentment (Murphy, 1988). However, indicating
what forgiveness is not has been easier than developing a consensual defi-
nition of what it is (Moberly, 1901). Murphy (1988) has defined forgiveness
as being more about feelings, than about action, which is labeled mercy. He
states that forgiveness is the forswearing of resentment on moral grounds
and argues that these moral grounds must be compatible with self-respect,
respect for others as moral agents, and respect for the rules of morality or
the moral order. Hampton (1988), in a dialogue with Murphy (1988), en-
larges this definition to include “a change of heart,” such that forgiveness
is a process involving both overcoming resentment and a change of heart,
viewed as a decision to see the offender in a more favorable light, without
condoning the offender’s wrong action. These components can also be seen
in Thoresen’s proposed definition of forgiveness (Thoresen et al., 2000) as
a multidimensional, latent construct, with two primary components: (1) let-
ting go of negative thoughts, feelings, and behaviors and (2) seeking a more
compassionate understanding of the offender. These definitions all focus on
what could be called state forgiveness, or a response to a particular event.
Clearly, that is an important dimension of forgiveness to assess; however,
other writers suggest that forgiveness may be more of a trait (Gorsuch and
Hao, 1993). Jones (1995), in his recent book, Embodying Forgiveness, defines
forgiveness as not so much a word, action or feeling, but as “an embodied
way of life. . . ” (p. xii). Thus, we have evaluated forgiveness both as a state,
a response to two betrayal events, and as a personality trait.
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376 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

Kaplan et al.(1994) has suggested that forgiveness can be integrated

within the literature on stress, coping and health. The literature on the as-
sociation between stress and health is extensive (Aldwin, 1994; e.g., Cassel,
1976; Lawler et al., 1999); he proposes that religion in general, and forgive-
ness in particular, may be thought of as a way of coping with stress that
could have beneficial effects on health. There are a number of mechanisms
that could underlie such an association between forgiveness and health:
lifestyle behaviors, social support, cognitive factors, and physiological re-
activity (Levin, 2001). This study investigates the mechanism of decreased
physiological responsiveness to the recollection of interpersonal conflict.
In examining such a model of stress, forgiveness, and physiological re-
activity, it is important to include some other factors known to play a role in
health. Thus, we measured chronic levels of stress, hostility, and self-reported
health, as well as degrees of state and trait forgiveness and acute physiologi-
cal reactivity, during two betrayal interviews, one in relation to a parent and
one to a friend or partner. Based on the literature, both stress and hostility
are linked to increased sympathetic nervous system activity and to decreased
health (e.g., Miller et al., 1996). We hypothesize that forgiveness may operate
in a similar, but inverse way, by being associated with decreased sympathetic
nervous system activity and increased health. Forgiveness may have this ef-
fect directly on physiological responding, or indirectly by decreasing stress
and hostility. Correlational and regression analyses will be used to examine
the relative contributions of stress, hostility and forgiveness on physiological
response levels and self-reported health. In addition, analyses of variance
will be used to examine the main and interactive effects of state and trait for-
giveness on cardiovascular reactivity during the betrayal interview stressors.
As the majority of intervention studies have focused on increasing forgive-
ness toward a particular offender, greater state forgiveness is expected to
be associated with reduced reactivity. The role of trait forgiveness is rela-
tively unexplored with regard to its physiological correlates, but higher levels
may be associated with perception of less stress on a day-to-day basis and,
therefore, associated with better health.

METHOD

Participants

One hundred eight college students participated in this study, 44 males

and 64 females. The mean age was 20.4 years (2.95 sd), with a range of
18–35 years. The majority of participants were Caucasian (86%), with 9%
African American and 5% other.
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 377

Measures

The Acts of Forgiveness scale (AF; Drinnon and Jones, 1999) was used
to assess state forgiveness. The AF consists of 45 items regarding a specific
offender and a specific offense. Research supports both the internal (coeffi-
cient alpha of .96, mean interitem r of .37, test–retest r of .90) and temporal
(test–retest r of .90, over 3 months) reliability of the AF. Participants respond
to items, such as “I can never trust the person in question again” and “I still
hold a grudge against the person in question,” on a 5-point Likert-type re-
sponse format, verbally anchored from Strongly disagree to Strongly agree.
Preliminary evidence also supports the validity of scale interpretations, both
convergently and discriminantly, and construct validity and criterion validity
have been assessed.
State forgiveness was also assessed with the Transgression-related In-
terpersonal Motivations Inventory (TRIM; McCullough et al., 1998). This
12-item scale contains two subscales, Revenge and Avoidance. Participants
rate the offender on a 5-point Likert scale on items such as “I’ll make him/her
pay” and “I avoid him/her.” The subscales have satisfactory internal relia-
bility, with alphas ranging from .86 to .93 in two administrations. Test–retest
reliabilities over 3 weeks (r ’s = .86 and .79) and 9 weeks (r ’s = .64 and
.65) were also adequate. For the purpose of validating the definition of for-
giveness, a measure of state empathy (Coke et al., 1978) and a 1-item for-
giveness question (On a scale from 1–9, how much have you forgiven your
parent/friend/partner?) were also included.
The Forgiving Personality Inventory (FPI; Drinnon et al., 2000) was
used to assess trait forgiveness. It contains 33 items, such as “I tend to be
a forgiving person” and “I tend to hold grudges,” to which the participant
responds on a 5-point Likert scale from Strongly disagree to Strongly agree.
The scale has demonstrated more than adequate reliability, with a coefficient
alpha of .93, mean interitem correlation of .30, and a test–retest correlation
of .86, over a 2-month interval.
Stress was assessed with the Inventory of College Students’ Recent Life
Experiences (Kohn et al., 1990). It contains 49 items, such as “Finding courses
too demanding” and “Conflicts with boyfriend/girlfriend/spouse.” These are
answered with a 4-point Likert scale from Not at all to Very much a part of
my life, over the past month. The coefficient alpha was reported as .88, and
its correlation with the perceived stress scale (Cohen et al., 1983) was .59
( p < .0005).
Hostility was measured with the Cook and Medley scale (Cook and
Medley, 1954), a measure that has been used in several studies of the health
consequences of hostility (Miller et al., 1996). It contains 50 items derived
from the MMPI and has high test–retest reliability (r = .85, p < .0001). The
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378 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

response categories were scored on a 4-point scale from Not true of me to

Very much true of me.
The Cohen–Hoberman Physical Symptoms Checklist (Cohen and
Hoberman, 1983) contains a list of 33 items of physical symptoms which
the individual may have experienced in the past month, such as headaches
and stiff joints. It was scored with a 4 point Likert scale, ranging from Not at
all to Very much a part of my life. The coefficient alpha for this instrument is
reported at .88. These items were originally selected to exclude symptoms of
an obviously psychological nature, such as “felt nervous or depressed.” The
scale was significantly correlated with use of the Student Health Service in
two separate samples, over a 5-week interval.

Procedure

Students volunteered to participate, as one option for nominal course

credit in introductory psychology. The study was described as concerned with
relationship conflict, and students signed up for a time and day to come to the
Health Psychology laboratory. Upon arrival, participants read and signed an
Informed Consent statement. Participants were given an Interview Recall
sheet, which indicated that

During the interview, you will be asked to recall a time when you were deeply hurt
by someone close to you (close friend/partner, relative, romantic partner.) Think of
a time now when you were deeply hurt or betrayed by someone close to you. On
the following couple of lines, jot down a few words about the incident to remind you
during the interview which event you picked to share.

This was followed by the same paragraph, except that the offender
was changed to “parents or primary caregiver.” After completion of these
items, they were escorted into the subject room, where transducers for the
physiological recording were applied.
After transducer application and assessment for signal clarity, the partic-
ipant was asked to rest for 10 min. During this time, they watched a relaxing
video of tropical fish; the video is accompanied by quiet, instrumental music
(Piferi et al., 2000). At the end of the rest period, the experimenter entered
to begin the first interview. The interview was videotaped, with the recorder
being turned off during the state assessment recovery periods. Subjects were
aware that they could ask to turn off the videocamera at any time, or could
ask that an audiotape be substituted for videotaping. This occurred in only
one instance, and the data from that individual were not included in the
sample. The order of the interviews (parent, friend/partner) was counter-
balanced across subjects.
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 379

The parent interview began with the statement, “In this interview, I
would like you to describe a time when a parent or caregiver deeply hurt
or upset you (with a brief reference to their interview recall sheet). Take
a moment to remember the specific event and then describe exactly what
happened in as much detail as you can.” After the individual finished their
initial response, follow-up questions were asked. These were: How long ago
did this happen? What feelings do you remember during the event? Did
you express your feelings to the other person in any way? Why do you
suppose they did this to you? In addition, questions were asked about quality
of relationship and the impact of this event. Finally, a perspective-taking
question was included: “Now, suppose your (father, mother etc.) were here
and I asked them to describe this event. What would they say?”
After the interview, the participant completed the Acts of Forgive-
ness, TRIM scales with reference to this specific event, and the measure
of state empathy toward the offender. This recovery/questionnaire period
lasted from 4 to 7 min. The second interview followed, which was identical
in form, changing only the focus from parent to friend/partner, or vice versa.
After the second interview, the participants completed the state forgiveness
and empathy forms during a recovery/questionnaire period. At the very end
of the second recovery period, the 1-item forgiveness measures were given,
one for each described event. After removing the blood pressure cuff and
transducers, the participant was brought to a separate room, where he or she
filled out the remaining questionnaires.

Physiological Data

The laboratory consisted of a 5-room suite, a main room for greeting

subjects and filling out questionnaires, and smaller rooms opening onto the
suite, two of which were used for the experiment. The subject room contained
a recliner chair, a desk with TV/VCR, a chair for the interviewer and a second
desk for electrodes, supplies, and an intercom. A wooden lap table was placed
across the recliner for writing ease. The equipment was in an adjacent room,
along with tables, chairs, and a computer.
Blood pressure was measured noninvasively with a Critikon Dinamap
Vital Signs Monitor, Model 1846SX (Johnson and Johnson, Tampa, FL). A
blood pressure cuff was placed on the participant’s nondominant upper arm,
and measurements were activated from the equipment room. At the end of
cuff deflation, systolic, diastolic, mean arterial pressure and heart rate were
printed out on a hard-copy output.
A Coulbourn Instruments LabLinc V physiograph was used to record
forehead EMG, skin conductance, and heart rate. Pairs of 4-mm silver–silver
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380 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

chloride electrodes were used to transduce forehead EMG and skin conduc-
tance, and three 8-mm electrodes were used for heart rate. These signals
were fed into a Model V71-23 skin conductance coupler for skin conduc-
tance, models V75-04 isolated bioamplifier with bandpass filter, and V77-26
tachometer for heart rate, and models V75-04 amplifier and V76-23A mul-
tifunction integrator for forehead EMG signals.

Data Quantification

All questionnaires were hand-scored and scale or subscale scores en-

tered into an SPSS data file. Blood pressure readings were taken at minutes
5, 7, and 9 of the rest period and averaged to form a resting mean blood
pressure reading. Readings were taken every 2 min during the interviews,
beginning 15 s into the interview. In the statistical analyses, we used the
first, second, and last readings for each individual. During the question-
naire/recovery periods, readings were taken at 15 s after the period began
and 1 min later.
Two derived measures were also included for their relevance to cardio-
vascular function and coronary heart disease (Papillo and Shapiro, 1990):
mean arterial pressure and rate pressure product. Mean arterial pressure
reflects the average level of blood pressure during the cardiac cycle, and is
computed by the formula: MAP = 1/3 (SBP − DBP) + DBP. Rate pressure
product is the product of systolic blood pressure and heart rate, and reflects
the sympathetic input to the heart (Kitamura et al., 1972; Robinson, 1967).
Both of these measures have the additional advantage of being uncorrelated
with gender. Means were calculated for the same intervals as blood pressure
above.
Heart rate, forehead EMG, and skin conductance were recorded con-
tinuously throughout the session. Mean levels of heart rate were calculated
during minutes 6, 8, and 10 of the resting period (when the blood pressure
cuff was not being activated), and for each minute of the interview, and
for the first 3 min of the recovery period. As with blood pressure, the rest-
ing minutes were averaged to form a resting mean, and the first, third, and
last minutes of the interview were used for analyses. For the recovery pe-
riod, means for minutes 1, 2, and 3 were entered. These same intervals were
used to evaluate number of EMG spikes, and number of skin conductance
responses.
Correlational and regression analyses were computed on an average
of all repeated measures/variables, across both interviews. Reactivity anal-
yses during the parent and partner/friend interviews and recovery peri-
ods were computed as analyses of covariance with repeated measures. The
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 381

Table I. Correlations Among Forgiveness-Related Constructs

EMP REV AVD INT

AF-P .80 −.52 −.78 .53

AF-F .73 −.49 −.75 .66
ONE-P .58 −.39 −.64 .56
ONE-F .44 −.32 −.44 .36

Note. AF-P is Acts of Forgiveness for parent, AF-F is for

friend/partner, ONE-P is the one item forgiveness measure for par-
ent, ONE-F for friend/partner. EMP is the measure of state empa-
thy toward offender, REV and AVD are the subscales of the TRIM
and reflect tendencies for revenge and avoidance. INT is the coded
measure of affective description of offender, taken from the recorded
interviews.

between-subjects variables were gender, state, and trait forgiveness groups,

based on median split scores. Significance levels of all tests were conducted
at p < .05, with Greenhouse–Geisser corrections for all repeated mea-
sures/effects. Variations in degrees of freedom reflect varying sample sizes
across physiological recordings due to occasional problems in signal clarity
or electrode malfunction.

RESULTS

Definition of Forgiveness

Forgiveness is proposed to include both a reduction in negative feel-

ings and actions and an increase in compassion toward an offender. In a
preliminary attempt to determine whether our measure of forgiveness, AF,
indicated both types of changes, we examined the correlations between state
forgiveness and two indications of negative feelings, desire for revenge and
for avoidance, and two indications of positive feelings, empathy toward the
offender and affective description of the offender expressed during the in-
terview.3 As shown in Table I, both a 1-item forgiveness question and the
AF were positively correlated with both indications of positive feelings to-
ward the offender, the self-report of empathy, and the observer-coded affec-
tive description of offender from the interview. In addition, both measures

3The videotaped interviews have been coded, as part of a separate research project. One item
from the interview, affective description of offender, was included as a measure of positive
feelings toward the offender here. The coding was performed by the senior author; a subset
of interviews was also coded by an undergraduate student, trained by the second author. The
correlation between the two raters was .92, p < .01.
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382 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

of forgiveness were negatively correlated with desire for revenge and for
avoidance. The magnitude of the relationships is quite comparable across
both parent and friend offenders, and all correlations were significant at
p < .0001.

Correlational Analyses of Forgiveness

The initial analysis of these data involved the assessment of relation-

ships among stress, gender, and hostility with the average values for each
physiological variable: diastolic and systolic blood pressure, mean arterial
pressure, heart rate, rate pressure product, EMG, and skin conductance.
Regression analyses entering gender, stress, and hostility found no relation-
ships (all p’s > .25) between either stress or hostility with any physiological
variable. As expected, gender was related to systolic blood pressure and
to heart rate; males had higher systolic pressures while females had higher
heart rates.
Next, we examined the relationships between state and trait forgive-
ness and the average levels of physiological response across all measure-
ment intervals (baseline, interviews and recovery periods), controlling for
any effects of gender. These partial correlations are found in Table II. As
is quickly evident, only the cardiovascular variables were associated with
forgiveness. Trait forgiveness was inversely correlated with mean diastolic,
systolic, and mean arterial pressure, the strongest association being with
diastolic pressure. Thus, examining average levels of blood pressure, indi-
viduals with higher trait forgiveness had lower systolic and diastolic blood
pressure.

Table II. Partial Correlations of State and Trait Forgiveness With Total Physiological Response
Levels
AF p TRIM p FP p

DBP −.39 .002 .34 .008 −.45 .0001

SBP −.39 .002 .38 .003 −.31 .02
MAP −.37 .004 .35 .007 −.42 .001
HR −.39 .003 .37 .004 −.03
RPP −.48 .0001 .46 .0001 −.13
EMG −.23 .02 −.18
SCR .23 −.25 .21

Note. AF and TRIM are the state forgiveness measures, averaged across both interviews. FP is
trait forgiveness. The physiological measures are diastolic blood pressure (DBP), systolic blood
pressure (SBP), mean arterial pressure (MAP), heart rate (HR), rate pressure product (RPP),
frontalis electromyographic activity (EMG), and skin conductance responses (SCR). Partial
correlations are controlled for effects of gender.
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 383

State forgiveness, averaged across both interviews (whether measured

by the Acts of Forgiveness Scale or by the TRIM), was associated with
both blood pressure and heart rate, the strongest association being with
rate pressure product. Individuals who had forgiven a specific offender to a
greater degree had lower levels of blood pressure, heart rate, and rate pres-
sure product. Diastolic blood pressure is more representative of background
blood pressure levels, while rate pressure product is more associated with
sympathetic nervous system drive to the heart. Thus, in keeping with the
senses of trait and state forgiveness, forgivingness as a personality construct
was more strongly linked to background levels of blood pressure, while for-
giveness as an emotion or action was more strongly linked to sympathetic
input to the heart. Interestingly, both measures of state forgiveness yielded
identical results; the difference in sign reflects that fact that the Acts of For-
giveness scores reflect increasing forgiveness, while the TRIM scores reflect
decreasing forgiveness.

Physiological Reactivity During Betrayal Interviews

Analyses of covariance were conducted on three interview minutes

(first, third, and last), with baseline as the covariate. The between-subjects
variables were gender, trait forgiveness groups (FP), and state forgiveness
groups (AF), based on groups divided at the median (FP median = 126;
AF parent = 174; AF friend = 157).
Men and women were compared on all three forgiveness-related mea-
sures. There were no significant gender differences on the trait measure
of forgiveness (men = 124.3, women = 127.2) or on the AF for par-
ents (men = 169; women = 165.5). However, males had higher AF for
friend/partners than women (162.5 > 145.5, p < .01). This gender differ-
ence also reflects the fact that women were less forgiving of friend/partners
than parents ( p < .0001), while men had comparable scores for forgiveness
of parent and friend/partner.

Parent Interview

For systolic blood pressure, there was an interaction of Sex × FP

(F(1,93) = 4.36, p < .04). For men, low-and high-FP groups had similar
increases (low FP = 129.5; high FP = 130.3), whereas for women, the low-
FP group was more reactive, showing greater increases (low FP = 122.3;
high FP = 114.9). For diastolic blood pressure, there was a significant inter-
action of AF × Repeated measures (F(2,196) = 3.04, p < .05), as shown
in Fig. 1. Individuals in the low-AF group had sustained diastolic increases,
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384 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

Fig. 1. Diastolic blood pressure reactivity during the

parent interview.

while those in the high state forgiveness group demonstrated a progressive

decline as they described the incident.
For mean arterial pressure, shown in Fig. 2, there was an interaction of
Repeated measures × AF × FP groups (F(2,194) = 3.0, p < .05) as well as
an interaction of FP and Repeated measures (F(2,204) = 3.375, p < .04)
and a main effect of FP (F(1,102) = 4.66, p < .03). In addition to the greater
increases associated with low-FP individuals, there was a main effect of AF
for the low-FP group during the last minute of the interview ( p < .05). Low-
FP state nonforgivers had the greatest increases in mean arterial pressure,
and this difference was especially marked at the end of the interview while

Fig. 2. Mean arterial pressure reactivity during the parent interview.

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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 385

Fig. 3. Rate pressure product reactivity during the parent interview.

the low FP, high-state forgivers had decreased to levels seen by the high-FP
students.
There was also a triple interaction of Repeated measures × FP × AF
for rate pressure product (F(2,194) = 6.79, p < .001), as shown in Fig. 3.
Overall, low-FP individuals had higher RPP, especially in the low-AF group,
and this difference increased across the interview. Follow-up analyses found
a main effect of AF for the low-FP group (F(1,50) = 4.2, p < .045) and an
interaction of Repeated measures × AF for the high-FP group (F(2,100) =
4.0, p < .03). For the low-FP group, less state forgiveness was associated with
higher rate pressure product; for the high FP group, those describing a time
of forgiveness showed progressively more rate pressure product decline.
Finally, at the last minute, there was an FP × AF interaction (F(1,102) =
6.04, p < .016); the AF group difference was much stronger in the low-FP
students.
There was also an interaction of Repeated measures and state forgive-
ness for EMG (F(2,144) = 4.17, p < .02), due to a decrease in the number
of EMG spikes across the interview for the high-AF group (15.2 > 12.35),
compared to a stable rate for the low-AF group (14.3 = 14.9). There were
no forgiveness group effects for heart rate reactivity or number of skin con-
ductance responses.

Parent Recovery

Recovery after the parent interview was also examined with analyses of
covariance; the between-subjects factors were gender, FP, and AF groups,
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386 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

Table III. Physiological Recovery Means for Men and Women

Men Women
Min 1 Min 2 Min 1 Min 2

Parent Interview: SBP

Low FP, Low AF 122.1 117.9 114.9 112.3
Low FP, High AF 124.4 119.8 106.7 109.8
High FP, Low AF 127.5 122.5 111.9 111.8
High FP, High AF 120.9 120.5 109.0 106.7
Parent Interview: DBP
Low FP 64.0 63.5 69.0 69.0
High FP 61.0 62.5 65.7 64.9
Parent Interview: MAP
Low FP, Low AF 87.8 86.2 87.6 85.1
Low FP, High AF 87.8 87.5 83.2 84.9
High FP, Low AF 79.8 78.5 84.5 83.8
High FP, High AF 79.9 78.6 83.2 79.0
Friend/Partner Interview: DBP
Low FP 65.2 64.7 67.7 68.2
High FP 64.2 64.2 66.1 64.1
Friend/Partner Interview: MAP
Low FP 86.0 84.3 84.3 85.1
High FP 86.8 85.1 82.2 82.7

with two repeated measures as the within-subjects factors. The average re-
sponse to the interview was the covariate. The means for variables with
forgiveness group differences are shown in Table III.
For systolic recovery, there was a significant interaction of Sex×FP×AF
groups (F(1,98) = 8.35, p < .005). For women, the only sustained decrease
in SBP from minute 1 to 2 occurred for the highly forgiving individuals (high
FP) who described an event that was forgiven (high AF). There was also a
main effect of AF for women (F(1,59) = 8.2, p < .006); at every comparison,
high-AF women had lower levels of SBP in recovery than low AF. There were
no forgiveness group differences in systolic recovery for men.
For diastolic recovery, there was a significant main effect of FP and an
interaction of Sex and FP (F(1,74) = 4.92, p < .03). For men, there was a
main effect of FP (F(1,38) = 8.6, p < .006); highly forgiving men recovered
to lower levels of diastolic blood pressure than less forgiving men. There were
no forgiveness group differences in diastolic recovery for women, although
the differences are in the same direction.
For mean arterial pressure, there was an interaction of Sex × FP group
(F(1,97) = 9.9, p < .002), as in diastolic blood pressure. For males, there
was a main effect of FP group (F(1,37) = 11.1, p < .002); highly forgiving
men had lower levels of mean arterial pressure during recovery. For women,
there was an interaction of FP × AF × Repeated measures (F(1,59) = 5.2,
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 387

p < .026). At minute 1, no groups differed; however, at minute 2, again

there was an interaction of FP × AF (F(1,39) = 6.98, p < .01). Women who
were both highly forgiving and who described a time of forgiveness had the
greatest recovery compared to all other groups.
For EMG, there was a Repeated measures × FP interaction (F(2,120) =
4.02; p < .05); FP groups differed during the second minute of recovery,
with high-FP groups exhibiting greater recovery than low (5.4 < 8.3). In
addition, the Repeated measures effect was significant only for the high-FP
group ( p < .03), further documenting the greater recovery across minutes
for the high-FP group. There were no differences in forgiveness groups for
recovery in heart rate, rate pressure product, or skin conductance responses.

Friend/Partner Interview

There were no significant forgiveness group differences in reactivity

to the friend/partner interview for any physiological variable, except for
rate pressure product. In that case, there was an interaction of Repeated
measures × AF × Sex (F(2,194) = 3.62, p < .047). For males, there were no
significant group differences. For females, the women who described a time
of forgiveness showed smaller increases at the beginning of the interview
than the low-AF women (103.7 < 110.1).

Friend/Partner Recovery

During recovery, for diastolic blood pressure there was a significant

interaction of FP × gender × Repeated measures (F(1,99) = 4.0, p < .05).
At minute 1, high-FP men recovered more than low-FP men, while the
women did not differ by FP group. For minute 2, both men and women
in the high-FP group recovered more than the low-FP group. The same
interaction was significant for mean arterial pressure (Sex × FP × Repeated
measures: (F(1,98) = 5.24, p < .02)); high-FP females exhibited greater
recovery than low-FP females, with no significant differences among the
male groups. There were no recovery group differences for systolic blood
pressure, heart rate, rate pressure product, or EMG.

Self-Reported Illness Symptoms and Forgiveness Groups

A correlational analysis of the psychological questionnaire measures

and the health measure was also computed. Self-reports of illness were
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388 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

Fig. 4. Path analysis model linking forgiveness, hostility, stress and illness.

negatively related to state forgiveness (r = −.26, p < .006), and positively

related to hostility (r = .22, p < .02), and stress (r = .40, p < .0001).
Path analysis supported the model shown in Fig. 4; beta weights are shown
on the connecting lines. Stress is the most proximal variable associated with
health, but both hostility and state forgiveness are associated with stress: for-
giveness decreases stress while hostility increases stress. Having a forgiving
personality increased the likelihood of state forgiveness. Thus, forgiveness
may have an effect on health indirectly, by decreasing levels of perceived
stress.

DISCUSSION

Philosophical writings about the meaning of forgiveness generally ar-

gue for two components: a decrease in negative affect or behavior and an
increase in compassion toward the offender. Correlational analyses here
found evidence for both components: state forgiveness, whether measured
by the AF or a 1-item criterion measure, was positively correlated with empa-
thy and positive descriptions of the offender and negatively correlated with
a desire either for revenge or avoidance. However, these data are simply a
“snapshot” in time; it would be of interest to test the development of these
components. Most intervention studies use the development of empathy as
a means to increase forgiveness, implying that the development of compas-
sion plays an influential role in the subsequent development of forgiveness
(Enright, 2001; Worthington, 2001).
In addition, we do not have a direct measure of emotional feelings
of resentment toward the offender. There is a significant literature linking
resentment, usually measured with one of the Buss and Durkee (1957) Hos-
tility scales, to the experience of hostility and to increased cardiovascular
reactivity (Lawler et al., 1993; Manuck et al., 1985). It would be of inter-
est to explore the concept of resentment directly with both state and trait
forgiveness, and concomitant physiological reactivity.
The primary goal of this research was to explore the relationship be-
tween forgiveness and physiological responses. We first determined that nei-
ther stress nor hostility was related to physiological responses in this sample.
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 389

Controlling for the well-known effects of gender on physiological responses,

we found that forgiveness is aptly described as “a change of heart” (Calhoun,
1992; Hampton, 1988). Trait forgiveness was associated with lower levels of
blood pressure, especially diastolic blood pressure. In addition, state for-
giveness, averaged across two interviews, was also associated with lower
blood pressure levels, lower heart rate, and lower rate pressure product. Con-
versely, being unable to forgive specific offenders was related to increased
levels of cardiovascular and sympathetic tone.
Acute, stress-induced, cardiovascular reactivity has been linked to both
hypertension and coronary heart disease (Julius, 1992; Krantz and Manuck,
1984; Light et al., 1999). During the parent interview, we found extensive
relationships between diastolic, mean arterial, and rate pressure product re-
activity and degree of state forgiveness. Low-state forgiveness was associated
with more sustained diastolic reactivity across the interview; a similar failure
to decrease reactivity with time was found with mean arterial pressure and
with rate pressure product, especially in those with a less forgiving person-
ality. Forgiving personality was also directly related to systolic reactivity in
women and to mean arterial reactivity in both men and women. Thus, fail-
ing to forgive, especially in those who are less forgiving on a general basis, is
associated with a more sustained period of cardiovascular reactivity during
the retelling of the conflict experience. Furthermore, this heightened level
of reactivity was carried forward into the recovery period by these low-trait,
low-state forgivers.
The recovery period involved sitting quietly, without speaking, and fill-
ing out three state questionnaires. Thus, the subject matter of the interview
was still salient; however, they were no longer speaking about the event and
had finished their description of it. Furthermore, the last section of the inter-
view focused on the offender’s perspective, which might have led to lowered
feelings of anger toward the offender. The effects that were found in re-
covery were all associated with trait forgiveness. Thus, having a forgiving
personality was linked to a greater “letting go” of the experience in a physi-
ological sense: they showed greater diastolic and mean arterial reduction in
pressures. At times, there were also interactive effects with state forgiveness,
such that for women, state forgiveness was linked to greater systolic recov-
ery while for men, state forgiveness was linked to greater diastolic recovery.
Thus, forgiveness has cardiovascular effects both in the re-experiencing of
an interpersonal conflict and in the rate of recovery from such recollection.
In this study, the acute reactivity effects associated with forgiveness
were largely found with the parent interview, with few effects during the
friend/partner interview. This may point out an important feature of health
and forgiveness: the negative effects of nonforgiveness may be more im-
portant in relationships that are long-standing and from which extrication
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390 Lawler, Younger, Piferi, Billington, Jobe, Edmondson, and Jones

is difficult, if not impossible. Such features may be important in future

studies with an older sample; forgiveness may have physiological benefits
primarily in those situations where relationships are long-term and rela-
tively permanent. The qualities of the relational context in which forgive-
ness/nonforgiveness occurs may be a fruitful point for future research.
Murphy (1988) has raised the possibility that forgiveness may even have
harmful effects, especially if offered too quickly. Trait forgiveness is proba-
bly a reflection of the readiness to forgive in daily encounters; however, in
grave circumstances, the process of forgiveness may be as important as the
outcome. As shown in Huang and Enright (2000), the rationale underlying
forgiveness (level 4, forgiveness as duty vs. level 6, forgiveness as love) may
also be associated with cardiovascular levels. Thus, future investigations may
explore the process underlying forgiveness decisions and its relationship to
physiological reactivity.
A second purpose of this research was to explore the relationship be-
tween forgiveness and self-reported symptoms of physical illness. Illness
was positively correlated with stress and hostility, while showing a negative
correlation with state forgiveness. Subsequent path analysis of these rela-
tionships supported a model whereby both state forgiveness and hostility
predict levels of stress, which predicts illness. Future longitudinal research
may profitably test the predictive validity of this model, evaluating state for-
giveness at time 1, and testing its relationship to stress and the stress-illness
relationship at time 2.
Finally, a recent symposium at the Society of Behavioral Medicine
(Christenfeld, 2002) focused on the health costs of rumination, part of the
process of nonforgiveness (McCullough et al., 2001). Dozens of papers have
focused on the harmful roles of stress, anger and hostility in cardiovascular
diseases and general health (e.g., Chesney and Rosenman, 1985; Johnson
and Spielberger, 1992). Forgiveness represents a positive response to inter-
personal conflict that is associated with decreased levels of cardiovascular
responses, decreased cardiovascular and EMG reactivity, and fewer illness
symptoms, potentially due to decreased perception of stress. Thus, forgive-
ness may produce beneficial effects by reducing the allostatic load (McEwen,
1986) associated with betrayal and conflict experiences and, therefore, may
be of benefit as an additional strategy in the development of coping responses
with stress.

ACKNOWLEDGMENTS

This research was supported by a grant to Warren H. Jones and Kathleen

A. Lawler from the John Templeton Foundation for Scientific Studies on the
subject of forgiveness, and this support is gratefully acknowledged.
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Cardiovascular Correlates of Forgiveness in Response to Interpersonal Conflict 391

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