psychology

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Suicide and forgiveness

Abstract

This proposal examines the effectiveness and the role of forgiveness therapy with undergraduate students who have engaged in previous suicidal attempts and experience complications with forgiveness. Worthington's five step forgiveness model, REACH, will be used in the design of this study with therapy sessions to promote publicly verifiable knowledge results. The participants range from 18 to 42 years of age with an average mean age of 26.0 years. The growing interest with the dynamics of forgiveness gives rise for the emerging field of forgiveness therapy and the need for increased research and advancements with implementation. Participants will have difficulty understanding what forgiveness entails. The participants will acknowledge precipitating factors for their behaviors,' accept their imperfections, and begin implementing forgiveness skills they have acquired to reduce suicidal attempts. Careful consideration has been applied with cultural sensitivities to promote statistical significance. The research encompasses the cultural aspects representing the participants' grass roots with placing a restriction on geographical locations of only living within the United States to decrease error. Anticipation of results is to support a positive correlation between the optimization of forgiveness with a decline in desire to attempt suicide. The goal is to support the hypothesis projecting as the participants' level of knowledge and willingness to forgive increases it will be evidenced by a decrease in suicidal ideations and suicidal attempts.

The Effects of Forgiveness on Adults with Previous Suicidal Attempts

The idea of forgiveness is increasingly becoming a focus in therapy due to its effectiveness of reducing physical, emotional, and spiritual difficulties. Therapists who adopt the goal of reduction in presenting symptoms inadvertently decrease suicidal ideations and attempts.

The scientific study of Worthington (1998) notes there were only five studies conducted before 1985 and 55 scientific studies conducted by 1998. The results from the initial research stimulated the performance of investigating the process on how to help individuals to truly forgive focusing on specific occurrences. The idea is that individuals who learn how to undergo a process of forgiveness with empathy for a specific event will have a long-term impact in their overall ability to forgive in everyday situations (McCullough, Worthington & Rachal, 1997). This will result in a reduction of negative physical, emotional and spiritual symptoms caused by various stressors that by which lead to the acts of suicide.

The Webster's dictionary (1828) defines forgiveness as "The act of forgiving; the pardon of an offender, by which he is considered and treated as not guilty" and an obligation for Christians to forgive their enemies. Forgiveness is defined as the "emotional juxtaposition of positive other-oriented emotions against negative un-forgiveness, which eventually results in neutralization or replacement of all or part of those negative emotions with positive emotions" (Worthington &Wade, 1999 as cited in Worthington & Scherer, 2004, p.387).

Everett Worthington defines two types of forgiveness, decisional and emotional forgiveness. Decisional forgiveness involves a "behavioral intention statement that one will seek to behave toward the transgressor like one did prior to a transgression" (Worthington, 2003 as cited in Worthington & Scherer, 2004, p. 386). It is important to note that even though individuals have taken the initial step to forgive their offender, the process of forgiveness does not simply end there. Individuals may experience increased feelings of anxiety, anger, hostility and withdrawal symptoms which could cause participants to experience desires to give up and attempt suicide. Individuals may not understand why they are experiencing these symptoms because they believe they have already undergone the act of deciding to forgive.

Emotional forgiveness pertains to forgiveness as being "rooted in emotion" which is linked to motivation (Worthington et al., 2001 as cited in Worthington & Scherer, 2004, p. 386).

Everett Worthington's five step Pyramid Model forgiveness model is referred to by using an acronym REACH. REACH consist using each letter to correspond with the five stages as recall, empathize, altruistic, commit and holding. Individuals need to experience within their process of forgiving their offender for a harm or transgression. The stages do not have to be followed in a specific sequence.

Worthington (1998) discusses the REACH model stages as recall, empathize, altruistic, commit and holding. The "recall the hurt" stage consists of individuals undergoing the process in a positive, encouraging, and safe location free from judgmental or critical viewpoints. The therapists or leaders facilitate sessions with goals of evoking feelings that encompass the individual's pain connected to the incident. The stage of "empathize with the one that hurt you" emphasizes the key phrase of empathy with developing a strong case for the offender. Individuals undergo work through exercises and discuss their viewpoint and reactions. An example of an exercise would be to consider the possible precipitating factors leading to the offense. The idea of offering an "Altruistic gift" implies the gift is really not given to the offender. This stage not only asks for the victim to identify an occasion when they had specifically been forgiven in the past but to re-experience the feelings associated with forgiveness. Worthington (1998) "Commitment to forgive" stage involves the act of communicating their willingness to publicly express their experiences through sharing communication, either written or verbal, with a trusted individual.

Worthington's (1998) discusses the "Holding on to forgiveness" stage as focusing on preserving the changes participants encountered through the forgiveness process. This stage also challenges individuals to learn and examine the potential for doubting their forgiveness.

Recent experiments have been conducted using the Worthington's forgiveness model. Lampton, Oliver, Worthington, & Berry (2005) composed a study with Christian college students to measure the effectiveness of the interventions and promote forgiveness. They underwent assessment pertaining to the targeted and untargeted transgressions.

        Worthington et al. (2010) evaluated the effectiveness of two strategies, work-shop preparation and the composition of essays, to increase the effectiveness of the REACH model. A limitation consisted of the students initially volunteering to participate as an incentive and also limited the ability to randomly assign participants.

Stratton, Dean, Nonneman, Bode, and Worthington (2008) evaluated college students located in the Philippines using a psycho educational group intervention. They found the REACH model to be as effective in diverse locations.

The participants selected for this forgiveness project will include undergraduate students who will volunteer to aid in promoting forgiveness. They will have had difficulty in the past with the act of forgiving and seek to comply with the guidelines of this study.

This researcher anticipates results supporting the act of forgiveness as decreasing negative signs and symptoms as evidenced by a decrease in physical, emotional, and spiritual health. The independent or manipulated variables in this research proposal project are the Forgiveness Therapy, age and education. The dependent variables that will be measured are the levels of anxiety, stress, and hostility found in the young adults. This researcher will use the 12- item measure, Transgression Related Interpersonal Motivation Inventory (TRIM) to determine un-forgiveness motivations. An integrity check will be conducted at the end of the study and power of statistics will be strong.

Method

Participants

The participants will include two groups of fifty co-ed participants in each group, enrolled in an undergraduate university. The individuals will have lived in the United States for their entire lives. The two groups will be divided into individuals who have made a single attempt of suicide and individuals who have made attempts a series of times. The average mean age within the research is 26.0 years with the ages varying from eighteen to forty-two years of age.

The individuals will have had stated incidences with difficulty in the past with their ability to forgive. The participants will be willing to identify and confront their specific life stressors. They will report experiencing difficulty with utilizing effective coping mechanisms and suffer from depression, anxiety, anger, impulsivity, mood swings, the feeling of being out of control and helplessness.

Measures

The surveys will be conducted within two universities in two different states. The initial screening will consist of one faculty from each university distributing the Prime MD Patient Health Questionnaire self-report version through the university's email. The self-report screens for major depressive symptoms including suicide ideations and suicide attempt history. If interested, the participants will respond voluntarily within one week.

A prerequisite for the research includes presenting an initial informed consent located on the secured website. The informed consent will include the rights of the participants, explaining the purpose of the study without affecting the end results, the proposed length of the study, the possible benefits and risks of the study utilizing the Forgiveness Therapy model and the ability to withdrawal at any time throughout the study.

After the results have been computed, participants will be randomly assigned within the two categories. Emails will be distributed immediately to those participants who provided contact information with their email address. The email will ask the participants to call the hotline and schedule a face to face interview appointment. The participants who present a current high risk for suicide will be contacted immediately to encourage them to seek crisis intervention services and an evaluation for a possible acute placement.

In the beginning of the face to face interview process, participants will be presented with the print out of the legal document they agreed to consent located on the confidential website. Participants will provide their signatures on the consent document in the presence of the providers to ensure necessary ethical procedures. Necessary releases of information will be obtained in accordance with The Health Insurance Portability and Accountability Act of 1996 to request necessary documentation and evaluations from doctors, hospitals and placements.

The Asukai's Criteria will be applied to those individuals who attempted suicide to determine the physical severity of their attempts.

The Suicide Intent Scale will be given by the counselors within the interview process to assess the level of wishing to end their life and the expectations of their loss of life as an end result of self-harmful behavior (Beck, Schuyler, &Herman, 1974 as cited in Freedanthal, 2008). The Suicide Intent Scales identifies the participants' subjective emotions and circumstantial indications for their intentions.

This researcher will use the 12- item measure, Transgression Related Interpersonal Motivation Inventory (TRIM) to determine un-forgiveness motivations.

Areas for exclusion include individuals who previously lived outside the United States.

Treatment Providers

The treatment providers will include two clinical psychologists and two licensed professional counselors. They will have specialized in crisis intervention or the trauma model. The providers will have had the necessary intense training of Worthington's Forgiveness Therapy Model to ensure they have received accurate information and data. They will have studied various techniques and approaches to use with individual clients to improve their forgiveness ability (Freedman & Chang, 2010). The providers will have had a minimum of two years of practice within a therapeutic environment with clients.

Procedure and Design

The method chosen to measure the positive relationship between forgiveness therapy and the reduction of suicide attempts is Worthington's five step forgiveness model referred to by REACH. The five stages include recall, empathize, altruistic, commit and holding. The providers are knowledgeable in the possible risks for participants to become actively suicidal within any of the stages of forgiveness due to the recent visiting of painful experiences. The providers are trained in crisis intervention and suicidal intention in association with the verbal and non-verbal behavioral detection.

Within the recall the hurt stage, the providers need to be sensitive to the participants' struggling with excessive reoccurring thoughts of their previous suicide attempts. This would be due to the participants undergoing a significant amount of assessments pertaining to their attempts of suicide. The providers will be prepared for re-direction strategies with focusing on evoking the participants' emotions of pain and suffering pertaining to the events with their offender.

The participants engaging in the empathizing stage will develop a case for an individual who has hurt them, and as a result they continue to experience ongoing turmoil. Participants will complete a series of worksheets to be completed at home and within their therapy sessions. The participants may have difficulty placing themselves in their offenders' world due to years of identified or unidentified built-up rage and anger. The participants will be vulnerable with the overwhelming emotions they associate with their suicidal attempts. The providers will be prepared for the participants to place blame on the individuals for their current suicidal behaviors. The providers will repeatedly reframe situations to allow the participants to consider numerous perspectives and precipitating factors that may have occurred for their offender. The providers are aware the empathizing stage may be at a high risk for participants to become actively suicidal due to the flooding of information the participants are experiencing.

Participants in the altruistic stage think back to a specific time they remember being truly forgiven for something they had done. The participants will then identify their feelings associated with being forgiven through an in-depth exploration process. This stage involves exploration of combining positive feelings with their past traumas possessing negative feelings. Almost certainly clients will experience frustration and will begin to feel as though they are undergoing increased emotional stress and perhaps want to opt out of the therapy (Freedman & Chang, 2010).

The participants working within the commit stage will share their documentation in their journals or verbalize their feelings with the trusted provider. They will report several feeling responses such as having a sense of contentment and peacefulness.

The participants in the holding stage examine the potential for doubting to occur within the future pertaining to their forgiveness of the offender. The providers are educated and aware of the importance for the participants to be knowledgeable of the potential for self-doubt. The providers will approach this stage with the goal of seeking pro-activeness with decreasing the chances of participants to doubt their forgiveness. The providers will work with participants to identify ways in which they can preserve the changes they experience while in therapy. The provider will emphasize the importance of frequently utilizing their worksheets in the future as reminders of their forgiveness process. This will aid in the reduction of reoccurring episodes of depression and suicide attempts.

Results

This researcher will test the one-tailed t-test to test the hypothesis of this study. Within this study there was an awareness of the location and sequence of questions in the pre-screening tool. They were distributed with the sensitive questions located at the end of the questions. The demographic information was located at the very end of the assessment tool on the electronic website due to the potential for individuals to skip this section if presented in the beginning.

The validity measured within the Suicide Intent Scale included the factorial, predictive and convergent assessments of validity. The Statistical Package for Social Sciences was used to increase the organization, data comparisons and presentation of various data.

Preliminary analyses

Discussion

The implications of the forgiveness therapy research are examined in regards to the effectiveness between the two treatment groups and expanding the duration of forgiveness therapy sessions increases the ability to forgive.

This study's ability to detect the intent of the suicidal attempts is an important strength allowing for this study to exclude the accidental suicidal attempts. It is necessary to distinguish between the individual's intent to die due to the distinct thought patterns the survivors undergo. This study has allowed for the providers to focus on the cognitive processes of the survivors.

The diverse selection for how to administer the assessments permitted individuals to be more comfortable with reporting their attempts with an electronic device. This supported the evidence of when researchers use a minimalist approach it is presented as ineffective. Despite the various levels of clinical history within the two treatment groups, they both focused on the goal of promoting forgiveness. The ability for the research study to have both psychologists and counselors possessing high levels of education, experience and training increased the statistical power of reporting accuracy.

The use of video recording allows the observers to analyze the providers and the participants' level of comfort within the group sessions while decreasing the chances for unethical or unpermitted techniques to take place.

Another limitation would be an increased probability of receiving three different answers from one participant for the same question. The mismatched inconsistency in participants self-report can be unreliable if there is an inability to detect the participants' true intentions. The inability to use the research globally is a limitation.

Neglecting to provide an in-depth evaluation of substance use such as the Substance Abuse Subtle Screening Inventory (SASSI) has potential for Type II error. The SASSI could be used in the future to interpret the individuals' intentions with identifying the internal consistency. The increased uses of entheogens which have been proven to induce spiritual occurrences are becoming a debate within the court rooms. It is important to evaluate for this due to the religion posing as a preventative factor for suicidal individuals. Education with entheogens is vital due to potential risk of doctors prescribing enthogens to increase spiritual episodes with the implication it will reduce suicide ideations and attempts.

Further research testing is needed to identify the effectiveness of various forgiveness models with is needed to identify which forgiveness models are more effective with the suicidal attempted

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