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Forgiveness Therapy for the Promotion of Mental Well-Being: A Systematic Review and Meta-Analysis
Abstract
Interpersonal hurts and violence against the individual have a high prevalence and are associated with a range of long-term problems in terms of psychological functioning. There is a growing body of research highlighting the role of forgiveness therapy in improving different aspects of psychological health in populations who have experienced diverse types of hurt, violence, or trauma. This article reports the findings of a systematic review and meta-analysis of the efficacy of process-based forgiveness interventions among samples of adolescents and adults who had experienced a range of sources of hurt or violence against them. Randomized controlled trials were retrieved using electronic databases and an examination of reference sections of previous reviews; each study was assessed for risk of bias. Standardized mean differences (SMDs) and confidence intervals (CIs) were used to assess treatment effects. The results suggest that forgiveness interventions are effective in reducing depression (SMD = −0.37, 95% CI [−0.68, −0.07]), anger and hostility (SMD = −0.49, 95% CI [−0.77, −0.22]), and stress and distress (SMD = −0.66, 95% CI [−0.91, −0.41]) and in promoting positive affect (SMD = −0.29, 95% CI [−0.52, −0.06]). There was also evidence of improvements in state (SMD = −0.55, 95% CI [−0.88, −0.21) and trait (SMD = −0.43, 95% CI [−0.67, −0.20]) forgiveness. The findings provide moderately strong evidence to suggest that forgiving a variety of real-life interpersonal offenses can be effective in promoting different dimensions of mental well-being. Further research is, however, needed.
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Managing service recovery experience: Effects of the forgiveness for older consumers
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“…conducted on segments of the overall PPI evidence base to evaluate the impact of specific types of PPIs, for example, signature strengths (Schutte & Malouff, 2019), kindness (Curry et al., 2018), forgiveness (Akhtar & Barlow, 2018), gratitude (Dickens, 2017), and optimism (Malouff & Schutte, 2017).”
BackgroundA Fourth Wave of Psychotherapies: Moving Beyond Recovery Toward Well-Being
Peteet, J. R. (2018) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000155 · Cited by 76
The Relationship between Basic Hope and Depression: Forgiveness as a Mediator
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Quintana‐Orts, C., & Rey, L. (2017) · Computers in Human Behavior · doi:10.1016/j.chb.2017.12.021 · Cited by 56
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Chiou, S.-S., Hsu, Y., Chiu, Y., Chou, C., Gill, D. L., & Lu, F. J.-H. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.03007 · Cited by 48
“…2013), intrinsic motivation (Cresswell and Eklund, 2006; Li et al., 2013), harmonious passion (Gustafsson et al., 2011), forgiveness (e.g., Watson et al., 2017; Akhtar and Barlow, 2018), and altruism (e.g., Feigin et al., 2018) have been examined by researchers in sports as well as in many domains.”
BackgroundKraiss, J. T., Redelinghuys, K., & Weiss, L. (2022) · Journal of Happiness Studies · doi:10.1007/s10902-022-00545-y · Cited by 46
“…concepts or interventions related to well-being such as kindness, optimism, posttraumatic growth, strengths, resilience, gratitude, and forgiveness (Akhtar & Barlow, 2018; Baskin & Enright, 2004; Curry et al., 2018; Davis et al., 2016; Dickens, 2017; Malouff & Schutte, 2017; Roepke, 2015;…”
Barcaccia, B., Salvati, M., Pallini, S., Baiocco, R., Curcio, G., Mancini, F., & Vecchio, G. M. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01550-1 · Cited by 43
Quintana‐Orts, C., & Rey, L. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15112389 · Cited by 41
“Previous studies have suggested the beneficial effects of forgiveness in psychological and physical health in a variety of interpersonal offenses, most of which are focused on adult forgiveness [29,31].”
BackgroundForgiveness Interventions for Older Adults: A Review
López, J., Fernández, I. S., Giménez, I. P., & Noriega, C. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10091866 · Cited by 50
“pointed out a need for further forgiveness intervention research assessing their effectiveness with older adults [22].”
BackgroundInfluentialStripp, T. A., Wehberg, S., Büssing, A., Koenig, H. G., Balboni, T. A., VanderWeele, T. J., Søndergaard, J., & Hvidt, N. C. (2023) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2023.100602 · Cited by 40
Slavich, G. M., Shields, G. S., Deal, B., Gregory, A., & Toussaint, L. L. (2019) · Annals of Behavioral Medicine · doi:10.1093/abm/kaz015 · Cited by 30
“First, both forgiveness and acetaminophen have independently been shown to reduce social pain [37, 40].”
BackgroundResultInfluentialForgiving Adolescents: Far From Depression, Close to Well-Being
Barcaccia, B., Pallini, S., Pozza, A., Milioni, M., Baiocco, R., Mancini, F., & Vecchio, G. M. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01725 · Cited by 37
Quintana‐Orts, C., Rey, L., Chamizo‐Nieto, M. T., & Worthington, E. L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17217966 · Cited by 31
“Previous meta-analysis and systematic reviews highlight forgiveness as a coping mechanism found to have many positive and a few negative effects for adolescents who had been victims of interpersonal transgressions such as bullying [12,62,63].”
BackgroundBeyond the bucket list: Unfinished and business among advanced cancer patients
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The bitter taste of revenge: Negative affect, depression and anxiety
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“Indeed, forgiveness interventions can bring about positive affective, cognitive and behavioural changes capable of improving individuals’ well-being and psycho-physical health (Akhtar and Barlow 2018; Freedman and Zarifkar 2016;Macaskill 2005; Menahem and Love 2013; Reed and Enright 2006).”
BackgroundAnger Rumination and Mindfulness: Mediating Effects on Forgiveness
Anuncibay, R. D. L. F., Barbadillo, Á. G., Sánchez, D. O., Ordóñez-Camblor, N., & Pizarro-Ruiz, J. P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052668 · Cited by 31
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“For instance, Lundahl et al. [63] and Aktar and Barlow [66] state in their study that Enright’s process model outperformed the REACH model.”
ResultInterpersonal Offenses and Psychological Well-Being: The Mediating Role of Forgiveness
González, E. G., Anchía, R. J., Díaz, M. P. M., Galán, M. J. C., Cagigal, V., & Ursúa, M. P. (2019) · Journal of Happiness Studies · doi:10.1007/s10902-018-00070-x · Cited by 37
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A Review of the Empirical Research Using Enright’s Process Model of Interpersonal Forgiveness
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Assessing Psychometric Properties of the Italian Version of the Heartland Forgiveness Scale
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“…the past 30 years, the construct of forgiveness gained increasing attention and popularity allowing to produce a large amount of research in several fields (Freedman and Enright, 1996; Girard and Mullet, 1997; McCullough et al., 2000; Fehr et al., 2010; Wade et al., 2014; Akhtar and Barlow, 2016).”
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Wade, N. G., & Tittler, M. V. (2019) · Routledge eBooks · doi:10.4324/9781351123341-24 · Cited by 25
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“”(20) Forgiveness therapy is an often successful psychosocial intervention.(15,21,22,23) Step-by-step models by Enright and Worthington focus on life crises and define “decision” as pivotal.”
BackgroundValidating the Enright Forgiveness Inventory – 30 (EFI-30)
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“2010), and practicing forgiveness (Akhtar and Barlow 2016).”
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“Although this is in line with previous forgiveness interventions (Akhtar & Barlow, 2018), the usage of a larger sample size could lead to different and more representative results.”
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“Two recent meta-analyses provide evidence of the effectiveness of forgiveness education (Akhtar & Barlow, 2018; Wade, Hoyt, Kidwell, & Worthington, 2014).”
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“Forgiveness treatment could be developed to help IPV survivors to free themselves from past adverse experiences by reducing their negative emotions and transforming their thoughts (Akhtar & Barlow, 2018; Lundahl et al., 2008).”
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“Forgiveness has its root in both philosophy and theology (Enright & North, 1998; Worthington, 1998), but an increasing abundance of research has been done studying the effect of forgiveness on health and well-being (Akhtar & Barlow, 2018; Toussaint et al., 2015; Wade et al., 2014).”
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“A meta-analysis study assessing the effectiveness of forgiveness interventions have found that forgiveness intervention can reduce depression, anxiety and stress and promoting positive affect (Akhtar & Barlow, 2018).”
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“Forgiveness therapies aim to promote mental well-being by enabling others to examine such notions as a way to foster forgiveness and a method of healing [21,32].”
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“Additionally, significant negative relationships exist between forgiveness and depression (Akhtar & Barlow, 2018; Gençoğlu et al., 2018).”
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“, 2016; Akhtar and Barlow, 2018; Barcaccia et al., 2019), physical health (Lee and Enright, 2019), decreased blood pressure for both victim and perpetrator (Hannon et al., 2010), greater health resilience (Worthington and Scherer, 2004), increased longevity [e.g., Barcaccia et al. (2020); see Witvliet et al. (2001)],…”
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“In addition, they do better on multiple indicators of physical health and are more willing to forgive others [6].”
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Predictors of forgiveness among divorced parents.
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The Handbook of Wellness Medicine
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Schuttenberg, E. M., Sneider, J., Rosmarin, D., Cohen-Gilbert, J., Oot, E., Seraikas, A., Stein, E. R., Maksimovskiy, A., Harris, S., & Silveri, M. (2022) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2022.782893 · Cited by 9
“, 2020) and forgiveness interventions (Akhtar and Barlow, 2018) might be used in a synergistic way to maximize the effectiveness in treating adolescent depression and anxiety.”
BackgroundKim, J. J., & Enright, R. D. (2024) · Education Sciences · doi:10.3390/educsci14020155 · Cited by 10
“In fact, many forgiveness intervention studies show that individuals who learn to forgive show improvement in the area of mental health [14,15].”
BackgroundDer Vergebungsprozess als ein psychotherapeutischer Behandlungsansatz
Mavrogiorgou, P., Meister, K., & Juckel, G. (2018) · Verhaltenstherapie · doi:10.1159/000486579 · Cited by 10
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Affetme Esnekliğinin Ergenlerin İyi Oluşunu Yordayıcı Rolü
Asıcı, E. (2019) · Erzincan Üniversitesi Eğitim Fakültesi Dergisi · doi:10.17556/erziefd.440497 · Cited by 10
FORGIVENESS OF OTHERS AND HEALTH: A REVIEW OF KEY MODELS AND IMPLICATIONS
Skalski‐Bednarz, S. B., Toussaint, L. L., Webb, J. R., & Krok, D. (2024) · Zeszyty Naukowe Wyższej Szkoły Humanitas w Sosnowcu Pedagogika · doi:10.5604/01.3001.0054.9768 · Cited by 9
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Witvliet, C. V., Luna, L. M. R., Vlisides‐Henry, R. D., & Griffin, G. D. (2019) · The Journal of Positive Psychology · doi:10.1080/17439760.2019.1615104 · Cited by 8
“Increasingly, people have sought forgivenesspromoting interventions that also overcome the adverse impact of interpersonal offenses and rumination about them (Akhtar & Barlow, 2018; Enright & Fitzgibbons, 2015; Wade, Hoyt, Kidwell, & Worthington, 2014).”
BackgroundForgiveness, its factors, and unforgivable acts in romantic relationships: A mixed‐methods study
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“We did so taking into account that the topics of forgiveness and meaning in life can be discussed during therapeutic sessions (Akhtar & Barlow, 2018; Hill et al., 2017), and therefore the current use of psychological or therapeutic services may reduce unexplained variation in forgiveness by…”
Mizahla Başa Çıkma ile Mental İyi Oluş Arasındaki İlişkide Affediciliğin Aracılık Rolü
Kayiş, A. R., & Satıcı, S. A. (2019) · Kastamonu Eğitim Dergisi · doi:10.24106/kefdergi.3099 · Cited by 8
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“Previous research found negative childhood events (Boland et al., 2020; Jones et al., 2020), forgiveness (Akhtar & Barlow, 2018; Praptomojati & Subandi, 2020), social support (Wolff & Sánchez, 2019), and religiosity (Jang et al., 2018; Stansfield et al., 2018) have the potential to improve the…”
BackgroundAnger Rumination Vs. Revenge Planning: Divergent Associations with Aggression and Life Satisfaction
Contreras, I. M., & Novaco, R. W. (2023) · Journal of School Violence · doi:10.1080/15388220.2023.2186420 · Cited by 8
“Meta-analyses on the efficacy of forgiveness therapy are very promising, with significant reductions observed for a number of negative psychological outcomes and the significant promotion of positive outcomes (Akhtar & Barlow, 2018; Baskin & Enright, 2004; Wade et al., 2014).”
BackgroundA Pilot Study of Motive Control to Reduce Vengeance Cravings.
Rowe, M., Kimmel, J., Pavlo, A. J., Antunes, K., Bellamy, C. D., O’Connell, M. J., Ocasio, L., Desai, M. U., Bal, J. A., & Flanagan, E. H. (2018) · PubMed · doi:10.29158/jaapl.003792-18 · Cited by 7
“Meta-analysis has produced moderately strong evidence suggesting that these interventions are effective in reducing depression, anger and hostility, and stress and distress.(14) However, a hallmark of forgiveness interventions is that they require the victim to develop empathy and compassion for the offender.”
BackgroundMeasuring predictors of psychopathology in Italian adolescents: Forgiveness, avoidance and revenge
Barcaccia, B., Ioverno, S., Salvati, M., Medvedev, O. N., Pallini, S., & Vecchio, G. M. (2021) · Current Psychology · doi:10.1007/s12144-021-01414-2 · Cited by 11
The HEXACO Model of Personality, Religiosity, and Trait Forgiveness
Matuszewski, K., & Moroń, M. (2022) · Pastoral Psychology · doi:10.1007/s11089-022-01006-2 · Cited by 16
Survivors’ Paths Toward Forgiveness in Restorative Justice Following Sexual Violence
Hadar, N., & Gal, Ṭ. (2023) · Criminal Justice and Behavior · doi:10.1177/00938548231162108 · Cited by 15
Systematic Review and Meta-Analysis of Positive Psychology Interventions in Workplace Settings
Martínez-Martínez, K., Cruz-Ortiz, V., Llorens, S., Salanova, M., & Bianchi, M. L. (2025) · Social Sciences · doi:10.3390/socsci14080481 · Cited by 10
“…specifically—for example, interventions to establish character strengths (Schutte and Malouff 2019; Vásquez-Pailaqueo et al. 2025), forgiveness (Akhtar and Barlow 2018; Baskin and Enright 2004), compassion (San Román-Niaves et al. 2024), optimism (Bastounis et al. 2016; Carrillo et al. 2019),…”
Hikmat, R., Yosep, I., Widianti, E., Suryani, S., Sriati, A., & Susanti, I. (2024) · OBM Neurobiology · doi:10.21926/obm.neurobiol.2404249 · Cited by 6
Côté, M., Dufour, M., & Tremblay, J. (2022) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12596 · Cited by 6
Dejanipont, B., Wang, C., Jenkins, S. R., Ta, A., Prybutok, V. R., & Vosvick, M. A. (2023) · Sexuality Research and Social Policy · doi:10.1007/s13178-023-00831-1 · Cited by 7
“…to protect victims of negative social interactions from further unhealthy relationships, the findings suggest counselors to emphasize to clients “that forgiveness does not necessarily involve reconciliation, con-doning, tolerating, or excusing hurtful behavior” (Akhtar & Barlow, 2018, p. 120).”
Tao, L., Ji, M., Zhu, T., Fu, H. C., & Sun, R. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.569134 · Cited by 6
“Meta-analysis has found that FIs can produce significant positive effects, including satisfaction, happiness, confidence, hopefulness, energy, softheartedness, warmth, and compassionate (Akhtar and Barlow, 2018).”
BackgroundGratitude, Forgiveness, and Anger: Resources and Risk Factors for Italian Prison Inmates
Danioni, F., Paleari, F. G., Pelucchi, S., Lombrano, M. R., Lumera, D., & Regalia, C. (2021) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x211049191 · Cited by 8
“…interventions for prison inmates specifically focused on forgiveness capable of promoting wellbeing, positive social relationships and quality of life, and reduce recidivism (Forgiveness Therapy; see e.g., Akhtar & Barlow, 2018; Day et al., 2008; Enright et al., 2016; Praptomojati & Subandi, 2020).”
BackgroundRomantic Attachment and Adjustment to Separation: The Role of Forgiveness of the Former Partner
Guzmán‐González, M., Włodarczyk, A., Contreras, P., Rivera-Ottenberger, D., & Garrido-Rojas, L. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01476-8 · Cited by 8
Bonab, B. G., Khodayarifard, M., Geshnigani, R. H., Khoei, B., Nosrati, F., Song, J. Y., & Enright, R. D. (2024) · Journal of Moral Education · doi:10.1080/03057240.2024.2360210 · Cited by 5
Skrodzka, M., & Vollhardt, J. R. (2024) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2832 · Cited by 8
Kuang, S., Xiaohong, W., Li, C., Yan, S., & Li, H. (2025) · Journal of Health Psychology · doi:10.1177/13591053251317322 · Cited by 5
“The willingness to forgive serves as a shield against being consumed by negative emotions like anger, anxiety, and sadness (Akhtar and Barlow, 2018).”
Wu, Q., Wang, L., & Choi, A. W. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13425 · Cited by 5
Forgiveness Therapy to Improve Subjective Well-Being Among Families of Patients with Chronic Illness
Diana, R. R., Nashori, F., & Pihasniwati, P. (2023) · International Journal of Islamic Educational Psychology · doi:10.18196/ijiep.v4i1.17965 · Cited by 5
Buonanno, C., Iuliano, E., Grossi, G., Mancini, F., Stendardo, E., Tudisco, F., & Pizzini, B. (2021) · Brain Science · doi:10.3390/brainsci11101333 · Cited by 5
“It has also been reported that promoting forgiveness increases anger control and reduces trait anger and anger expressions [67,68].”
BackgroundKim, J. J., Tracy, E. L., & Enright, R. D. (2022) · Journal of Religion and Health · doi:10.1007/s10943-022-01505-9 · Cited by 6
Büssing, A., Recchia, D. R., & Toussaint, L. L. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00582 · Cited by 5
Kupferberg, A., & Hasler, G. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1372650 · Cited by 5
“The ability to forgive and repair relationships has been linked to a reduction in depression, indicating its effectiveness in regulating negative affect (66, 67).”
BackgroundSocial pain: A systematic review on interventions
Brooks, B. M., Cordero, F. J., Alchermes, S. L., & Brooks, B. M. (2025) · F1000Research · doi:10.12688/f1000research.159561.1 · Cited by 3
Rivera-Ottenberger, D., Guzmán‐González, M., Calderón, C., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168236 · Cited by 4
Post-Traumatic Bio-Behavioral Rehabilitation of Adult Female Victims
Brewer‐Smyth, K., Koenig, H. G., Kafonek, K., Adams, T., Raine, A., Phil, D. L. E., & Granger, D. A. (2021) · Delaware Journal of Public Health · doi:10.32481/djph.2021.021 · Cited by 4
Worthington, E. L. (2024) · Education Sciences · doi:10.3390/educsci14090927 · Cited by 11
“The intervention studies from several reviews (e.g., [16,20–23]) and meta-analyses [24–27] on forgiveness interventions identified studies meeting the inclusion and exclusion criteria ( k = 25).”
BackgroundPositive Psychotherapy with a Pulse: Achieving Depth through Dialogue
Pugh, M., & Salter, C. (2020) · International Journal of Applied Positive Psychology · doi:10.1007/s41042-020-00046-4 · Cited by 5
Metadata
- Authors
- Akhtar, S., & Barlow, J.
- Affiliations
- University of Warwick (GB)
- Corresponding author
- Akhtar, Sadaf
- ORCID
- Barlow, Jane
- Venue
- Trauma, Violence, & Abuse
- Publisher
- SAGE Publications
- Published
- 2016-03-23
- Volume
- 19
- Issue
- 1
- Pages
- 107-122
- ISSN
- 1524-8380 (ISSN-L)
- 1552-8324
- OpenAlex
- W2311701971
- Semantic Scholar
- 0bab0ad0ff97e0d9546f12752a4c4b5708d38301
- Cited by
- 257
- References
- 38
- Citations by year
- 2026: 17 · 2025: 15 · 2024: 28 · 2023: 30 · 2022: 31 · 2021: 22 · 2020: 80 · 2019: 19 · 2018: 11 · 2017: 4
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Trauma Violence & Abuse (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Forgiveness and Related Behaviors
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- forgiveness therapy, psychological well-being, depression, anger-hostility, positive affect, forgiveness, trauma, adolescents, adults
- MeSH terms
- Exposure to Violence, Adaptation, Psychological, Adolescent, Adult, Counseling, Female, Humans, Interpersonal Relations, Male, Stress Disorders, Post-Traumatic, Case-Control Studies, Randomized Controlled Trials as Topic, Young Adult, Forgiveness
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