Empowering mental health following a cancer diagnosis: The role of self-forgiveness
When someone experiences an injustice at the hands of another, such as a robbery or violence, they will generally have difficulty with forgiving the offender. However, when someone is diagnosed with cancer – particularly preventable cancers caused by smoking, obesity, and alcohol, for example – then the blame is often self-targeted(1). If someone is responsible for harming themselves, they may experience negative emotions such as regret, shame, and guilt for the damage caused to their body(1).
In these instances, it is important to consider the role of self-forgiveness. This can be either decisional or emotional. Decisional forgiveness involves responding differently to the actions underlying the self-blame (i.e. quitting smoking). Emotional forgiveness concerns the replacement of negative, with positive emotions(2). Self-forgiveness has been associated with improved health and wellness, as well as reduced psychological distress(3).
What happens when I worry?
Dr. Michael Barry, author of the book ‘The Forgiveness Project’, estimates that 61 percent of cancer patients have forgiveness issues(4). He explains that holding on to negative emotions creates a state of chronic anxiety. This additional stress has a negative impact on the production of natural killer cells in the fight against cancer(4). This may be intensified if you blame yourself, as research suggests that self-blame is associated with poor mental health(5).
Still, worrying is a natural response to a challenge, particularly one on the scale of a cancer diagnosis. It is the feeling that you are unable to cope with these worries that can worsen the anxiety(6). The very nature of worrying has been associated with negative beliefs about the consequences of worrying(7). However, the intention is not to make you worry about worrying. In moderation, worrying can help you coordinate an effective response to threats and challenges(7). Therefore, it is important to understand instead, how you might emotionally adjust to deflect these thoughts and focus on experiencing positive changes.
Encouraging self-forgiveness
Self-forgiveness is a powerful coping mechanism for dealing with the negative effects of self-blame(8). Research has examined the use of meditation, reflection, and expressive writing. There are consistent findings that these interventions can help to reduce feelings of guilt and self-blame, as well as encourage self-forgiveness and self-improvement(9,10). Such interventions are suggested to be effective on both a group and individual level, as well as both therapy- and self-directed meaning that you are able to work towards self-forgiveness in a way that you feel comfortable(11,12). Achieving self-forgiveness is a strong first step towards reaching emotional adjustment for dealing with the challenges you may face along your cancer journey.
Empowering positive mental health
It is well-documented that patients can find benefits from their cancer experience, with these positive changes lasting long after diagnosis for many survivors(13). Research suggests that worry and post-traumatic growth are independent(14,15). Therefore, you may experience positive changes on your journey, while you emotionally adjust. However, it is not expected that you achieve this adjustment alone.
An intervention including training in relaxation, meditation and emotional expression found significant decreases in cancer worry and anxiety(16). These improvements in emotional wellbeing were also found for interventions using metacognitive therapy(17) and mindfulness-based stress reduction(18). Overall, there are numerous ways to empower positive mental health, by learning techniques that can be applied in to everyday life.
References
1. Fisher ML, Exline JJ. Moving toward self‐forgiveness: Removing barriers related to shame, guilt, and regret. Social and Personality Psychology Compass. 2010 Aug;4(8):548-58.
2. Worthington EL, Witvliet CV, Pietrini P, Miller AJ. Forgiveness, health, and well-being: A review of evidence for emotional versus decisional forgiveness, dispositional forgivingness, and reduced unforgiveness. Journal of behavioral medicine. 2007 Aug 1;30(4):291-302.
3. Toussaint L, Barry M, Angus D, Bornfriend L, Markman M. Self-forgiveness is associated with reduced psychological distress in cancer patients and unmatched caregivers: Hope and self-blame as mediating mechanisms. Journal of psychosocial oncology. 2017 Sep 3;35(5):544- 60.
4. Barry M. The forgiveness project: The startling discovery of how to overcome cancer, find health, and achieve peace. Kregel Publications; 2011 Sep 20.
5. Else-Quest NM, LoConte NK, Schiller JH, Hyde JS. Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychology and Health. 2009 Oct 1;24(8):949-64.
6. Curran L, Sharpe L, Butow P. Anxiety in the context of cancer: a systematic review and development of an integrated model. Clinical psychology review. 2017 Aug 1;56:40-54.
7. Britton GI, Neale SE, Davey GC. The effect of worrying on intolerance of uncertainty and positive and negative beliefs about worry. Journal of behavior therapy and experimental psychiatry. 2019 Mar 1;62:65-71.
8. Toussaint LL, Webb JR, Hirsch JK. Self-forgiveness and health: A stress-and-coping model. InHandbook of the psychology of self-forgiveness 2017 (pp. 87-99). Springer, Cham.
9. Peterson SJ, Van Tongeren DR, Womack SD, Hook JN, Davis DE, Griffin BJ. The benefits of self-forgiveness on mental health: Evidence from correlational and experimental research. The Journal of Positive Psychology. 2017 Mar 4;12(2):159-68.
10. Toussaint L, Barry M, Bornfriend L, Markman M. Restore: The journey toward self-forgiveness: A randomized trial of patient education on self-forgiveness in cancer patients and caregivers. Journal of Health Care Chaplaincy. 2014 Apr 1;20(2):54-74.
11. Worthington EL, Griffin BJ, Wade NG. Group intervention to promote self-forgiveness. InHandbook of the psychology of self-forgiveness 2017 (pp. 179-192). Springer, Cham.
12. Griffin BJ, Worthington EL, Bell CM, Davis DE. Self-directed intervention to promote self-forgiveness. InHandbook of the psychology of self-forgiveness 2017 (pp. 207-218). Springer, Cham.
13. Adorno G, Lopez E, Burg MA, Loerzel V, Killian M, Dailey AB, Iennaco JD, Wallace C, Sharma DK, Stein K. Positive aspects of having had cancer: A mixed‐methods analysis of responses from the American Cancer Society Study of Cancer Survivors‐II (SCS‐II). Psycho‐oncology. 2018 May;27(5):1412-25.