Research · April 21, 2014
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- Healthy female volunteers (n = 308) were allocated to three studies that assessed the incremental contribution of trait forgiveness after accounting for anger on autonomic modulation, sympathovagal balance and baroreflex functioning, aortic hemodynamics, 24-hour ambulatory blood pressure, and ambulatory arterial stiffness.
- A more cardiotoxic profile was associated with anger, while more favorable hemodynamic effects were associated with trait forgiveness, suggesting that clinical benefit could possibly be achieved through anger reduction and forgiveness.
Expert Comment
ABSTRACT
High trait anger is linked to adverse cardiovascular outcomes. A potential antidote to the cardiotoxic influence of anger is trait forgiveness (TF), as it has shown associations with improved blood pressure (BP) and cardiovagal tone regulation in cardiac patients. However, it has yet to be determined if anger and forgiveness independently predict cardiovascular parameters. Trait anger (State-Trait Anger Expression Inventory-2) and TF (Tendency to Forgive Scale) were evaluated in 308 (M = 21.11years ± SD = 2.52) healthy female volunteers allocated to 3 related, yet distinct, studies. Hierarchical multiple regressions tested the incremental contribution of TF after accounting for anger. Study 1 assessed autonomic modulation through beat-to-beat BP and spectral analysis to examine sympathovagal balance and baroreflex functioning. Study 2 used tonometry and pulse wave analysis for aortic hemodynamics. Study 3 assessed 24-hour ambulatory BP and ambulatory arterial stiffness index. Hierarchical models demonstrated that anger was significantly associated with increased sympathovagal tone, increased hemodynamic indices, high ambulatory BPs, and attenuated BP variability and baroreflex. In contrast, TF was associated with more favorable hemodynamic effects (i.e., decreased ventricular work and myocardial oxygen consumption). In conclusion, these results demonstrate divergent cardiovascular effects of anger and forgiveness, such that anger is associated with a more cardiotoxic autonomic and hemodynamic profile, whereas TF is associated with a more cardioprotective profile. These findings suggest that interventions aimed at decreasing anger while increasing forgiveness may be clinically relevant.
The American Journal of Cardiology
Effect of Anger and Trait Forgiveness on Cardiovascular Risk in Young Adult Females
Am J Cardiol 2014 Apr 21;[EPub Ahead of Print], RW May, MA Sanchez-Gonzalez, KA Hawkins, WB Batchelor, FD Fincham
Primary Care
Mind Matters
Two studies that PracticeUpdate is featuring this week show that the mind matters. Virtanen and colleagues found that for those at high risk for diabetes psychological stress doubled the risk of developing the disease, although this was not the case for those at low risk.1
The second paper was an interesting experiment of the effect of emotions on objective heart measures in women. May and colleagues showed a dichotomy between a negative emotion (anger) and a process to let it go (forgiveness).2 Anger was associated with cardiac risk markers including blood pressure elevation and increased ventricular work, while forgiveness was associated with cardioprotective factors such as lower blood pressure, reduced ventricular work, and lower oxygen demand. The authors pointed out that the cardioprotective effects of forgiveness in this study are similar to those seen with beta blockers.
Another dichotomy in medicine is the constant struggle to influence these parameters externally with medications or internally through a process such as forgiveness. The beta blocker is helpful and can be prescribed quickly but can lead to side effects, polypharmacy, higher cost, and, in general, more reliance on “things” to maintain health. In contrast, forgiveness can stimulate self-healing mechanisms from within with little harm, reducing the need to add more “things,” with the potential to significantly improve overall quality of life.
Although forgiveness is a simple choice, it is a very difficult process to go through and is hard to facilitate in a 15 to 20 minute office visit. Working with our behavioral health colleagues is a good first step. Here is a patient handout on forgiveness that may be helpful for patients who may be carrying a lot of anger.
Forgiveness does not mean that what was done is now okay, but rather it means that through forgiving one chooses not to carry the burden around with for the rest of his or her life, which can potentially reduce the risk of heart disease and diabetes.
I think Martin Luther King said it best, “I have decided to stick with love. Hate is too great a burden to bear.”
References